Dosing & Uses
Dosage Forms & Strengths
tablet
- 2.5mg
- 5mg
- 10mg
- 20mg
- 30mg
- 40mg
oral solution
- 1mg/mL (Qbrelis)
Acute Myocardial Infarction
5 mg PO within 24 hours of onset of symptoms of acute MI, THEN 5 mg after 24 hours, 10 mg after 48 hours, and 10 mg qDay for 6 weeks
If patient has low systolic blood pressure (ie, ≤120 mm Hg) when treatment initiated or during the first 3 days, administer a lower dose of 2.5 mg
If hypotension occurs (systolic BP ≤100 mm Hg), a daily maintenance dose of 5 mg may be given, with temporary reductions to 2.5 mg if needed
Dosing considerations
- Discontinue with prolonged hypotension (ie, systolic BP <90 mm Hg for >1 hr)
Hypertension
Uncomplicated essential hypertension
Not taking diuretic: 10 mg PO qDay initially; usual range is 20-40 mg/day as single daily dose
Dosing considerations
- Taking diuretic: Discontinue diuretic for 2-3 days before initiating lisinopril to reduce chance of hypotension; may resume diuretic if blood pressure is not controlled; if diuretic cannot be discontinued, initial dose of lisinopril 5 mg should be used under supervision for at least 2 hours and until blood pressure has stabilized for at least 1 hour
Heart Failure
Adjunctive therapy with diuretics and (usually) digitalis
5 mg PO qDay initially; increase by ≤10 mg no more frequent than 2 week intervals to 20-40 mg PO qDay
Patients with hypnatremia (<130 mEq/L serum sodium): 2.5 mg PO qDay initially; increase by ≤10 mg no more frequent than 2 week intervals to 20-40 mg PO qDay
Usual effective dosage range: 5-40 mg PO qDay (Zestril); 5-20 mg PO qDay (Prinivil)
Dosage Modifications
Renal impairment
- Acute myocardial infarction: Use caution in renal dysfunction (serum creatinine >2 mg/dL)
- Hypertension and CrCl >30 mL/min: 10 mg PO qDay initially; not to exceed 40 mg/day
- Hypertension and CrCl 10-30 mL/min: 5 mg PO qDay initially; not to exceed 40 mg/day
- Hypertension and CrCl <10 mL/min or hemodialysis: 2.5 mg PO qDay initially; not to exceed 40 mg/day
- Heart failure and CrCl <30 mL/min: 2.5 mg PO qDay initially; not to exceed 40 mg/day
Diabetic Nephropathy (Off-label)
Initial: 5 mg PO qDay (with diuretic)
May gradually increase dose according to blood pressure response; dosage range is 20-40 mg/day
Dosing considerations
- Long-term treatment with ACE inhibitors, usually combined with diuretics, reduces blood pressure and albuminuria and protects kidney function in patients with hypertension, diabetes mellitus, and nephropathy
Dosage Forms & Strengths
tablet
- 2.5mg
- 5mg
- 10mg
- 20mg
- 30mg
- 40mg
oral solution
- 1mg/mL (Qbrelis)
Hypertension
Indicated for hypertension in pediatric patients aged ≥6 yr to lower blood pressure
Age <6 years or GFR <30 mL/min/1.73m²: Safety and efficacy not established
≥6 years and GFR ≥30 mL/min/1.73m²: 0.07 mg/kg PO qDay initially, not to exceed 5 mg/day; may slowly titrate upward and adjusted according to blood pressure; not to exceed 0.61 mg/kg/day or >40 mg/day
Primary Hypertension (Orphan)
Oral solution: Orphan designation for treatment of primary hypertension with complications and secondary hypertension in pediatric patients (ages 0 through 16 years of age)
Sponsors
- codaDose, Inc; 5659 Southfield Drive; Flowery Branch, GA 30542
- Silvergate Pharmaceuticals, Inc; 6251 Greenwood Plaza Blvd, Suite 101; Greenwood Village, CO 80111
Hypertension
Uncomplicated essential hypertension
Consider lower initial dose of 2.5-5 mg and titrate to response in the elderly
Usual range is 20-40 mg/day as single daily dose
Adjust dose to blood pressure response; doses up to 80 mg have been used but do not appear to have a greater effect
Dosing considerations
Taking diuretic: Discontinue diuretic for 2-3 days before initiating lisinopril to reduce chance of hypotension; may resume diuretic if blood pressure is not controlled; if diuretic cannot be discontinued, initial dose of lisinopril 2.5 mg should be used under supervision for at least 2 hours and until blood pressure has stabilized for at least 1 hour
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (3)
- aliskiren
lisinopril decreases effects of aliskiren by Other (see comment). Contraindicated. Comment: Aliskiren use contraindicated with ACE-inhibitors in patients with diabetes; avoid coadministration with ACE-inhibitors if GFR. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of ACE-inhibitors with drugs that affect RAAS may increase the risk of renal impairment (including acute renal failure) and cause loss of antihypertensive effect. Monitor renal function periodically.
- protein a column
lisinopril, protein a column. Other (see comment). Contraindicated. Comment: Risk of anaphylactic reaction. Mechanism: buildup of bradykinin d/t deactivation of kininase by ACE inhibitors. D/C ACE inhibitor 72h prior to use of protein A column.
- sacubitril/valsartan
sacubitril/valsartan, lisinopril. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan.
Serious - Use Alternative (37)
- aspirin
aspirin, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- aspirin rectal
aspirin rectal, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- azilsartan
azilsartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- candesartan
candesartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- celecoxib
celecoxib, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- choline magnesium trisalicylate
choline magnesium trisalicylate, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- diclofenac
diclofenac, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- diflunisal
diflunisal, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- eprosartan
eprosartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- etodolac
etodolac, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- fenoprofen
fenoprofen, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- flurbiprofen
flurbiprofen, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ibuprofen
ibuprofen, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ibuprofen IV
ibuprofen IV, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- indomethacin
indomethacin, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- irbesartan
irbesartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- ketoprofen
ketoprofen, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ketorolac
ketorolac, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ketorolac intranasal
ketorolac intranasal, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- lofexidine
lofexidine, lisinopril. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.
- losartan
losartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- meclofenamate
meclofenamate, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- mefenamic acid
mefenamic acid, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- meloxicam
meloxicam, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- nabumetone
nabumetone, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- naproxen
naproxen, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- olmesartan
olmesartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- oxaprozin
oxaprozin, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- piroxicam
piroxicam, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- potassium phosphates, IV
lisinopril and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- pregabalin
lisinopril, pregabalin. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration results in additive risk of developing angioedema of face, mouth, and neck. Angioedema may result in respiratory compromise.
- sacubitril/valsartan
sacubitril/valsartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- salsalate
salsalate, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- sulindac
sulindac, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- telmisartan
telmisartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
- tolmetin
tolmetin, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- valsartan
valsartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.
Monitor Closely (108)
- albiglutide
lisinopril increases effects of albiglutide by unknown mechanism. Use Caution/Monitor. ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .
- aldesleukin
aldesleukin increases effects of lisinopril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- alfuzosin
lisinopril, alfuzosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- aluminum hydroxide
aluminum hydroxide decreases effects of lisinopril by unspecified interaction mechanism. Use Caution/Monitor.
- amifostine
amifostine, lisinopril. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.
- amiloride
lisinopril, amiloride. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
- asenapine
lisinopril, asenapine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- aspirin
lisinopril, aspirin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly with high dose aspirin, in elderly or volume depleted individuals.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate decreases effects of lisinopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
lisinopril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - avanafil
avanafil increases effects of lisinopril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- azathioprine
lisinopril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.
- bretylium
lisinopril, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.
- bumetanide
lisinopril, bumetanide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.
- calcium carbonate
calcium carbonate decreases effects of lisinopril by unspecified interaction mechanism. Use Caution/Monitor.
- canagliflozin
lisinopril and canagliflozin both increase serum potassium. Use Caution/Monitor.
- carbidopa
carbidopa increases effects of lisinopril by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.
- celecoxib
lisinopril, celecoxib. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- chlorpropamide
lisinopril increases effects of chlorpropamide by pharmacodynamic synergism. Use Caution/Monitor.
- choline magnesium trisalicylate
lisinopril, choline magnesium trisalicylate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- dalteparin
dalteparin increases toxicity of lisinopril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.
- diclofenac
lisinopril, diclofenac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- diflunisal
lisinopril, diflunisal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- digoxin
lisinopril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.
- doxazosin
lisinopril, doxazosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- drospirenone
lisinopril, drospirenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
- enoxaparin
enoxaparin increases toxicity of lisinopril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.
- eplerenone
lisinopril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
- ethacrynic acid
lisinopril, ethacrynic acid. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.
- etodolac
lisinopril, etodolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- everolimus
lisinopril, everolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.
- exenatide injectable solution
lisinopril increases effects of exenatide injectable solution by Other (see comment). Use Caution/Monitor. Comment: ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .
- exenatide injectable suspension
lisinopril increases effects of exenatide injectable suspension by Other (see comment). Use Caution/Monitor. Comment: ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor.
- fenoprofen
lisinopril, fenoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- finerenone
lisinopril and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.
- flurbiprofen
lisinopril, flurbiprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- furosemide
lisinopril, furosemide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.
- glimepiride
lisinopril increases effects of glimepiride by pharmacodynamic synergism. Use Caution/Monitor.
- glipizide
lisinopril increases effects of glipizide by pharmacodynamic synergism. Use Caution/Monitor.
- glyburide
lisinopril increases effects of glyburide by pharmacodynamic synergism. Use Caution/Monitor.
- gold sodium thiomalate
lisinopril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).
- heparin
heparin increases toxicity of lisinopril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.
- ibuprofen
lisinopril, ibuprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- ibuprofen IV
lisinopril, ibuprofen IV. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- indomethacin
lisinopril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- insulin aspart
lisinopril increases effects of insulin aspart by pharmacodynamic synergism. Use Caution/Monitor.
- insulin degludec
lisinopril, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
- insulin degludec/insulin aspart
lisinopril, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
- insulin detemir
lisinopril increases effects of insulin detemir by pharmacodynamic synergism. Use Caution/Monitor.
- insulin glargine
lisinopril increases effects of insulin glargine by pharmacodynamic synergism. Use Caution/Monitor.
- insulin glulisine
lisinopril increases effects of insulin glulisine by pharmacodynamic synergism. Use Caution/Monitor.
- insulin inhaled
lisinopril, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
- insulin lispro
lisinopril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.
- insulin NPH
lisinopril increases effects of insulin NPH by pharmacodynamic synergism. Use Caution/Monitor.
- insulin regular human
lisinopril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.
- ketoprofen
lisinopril, ketoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- ketorolac
lisinopril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- ketorolac intranasal
lisinopril, ketorolac intranasal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- lanthanum carbonate
lanthanum carbonate decreases levels of lisinopril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.
- levodopa
levodopa increases effects of lisinopril by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.
- liraglutide
lisinopril increases effects of liraglutide by unknown mechanism. Use Caution/Monitor. ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .
- lithium
lisinopril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.
- lurasidone
lurasidone increases effects of lisinopril by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.
- maraviroc
maraviroc, lisinopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.
- meclofenamate
lisinopril, meclofenamate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- mefenamic acid
lisinopril, mefenamic acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- meloxicam
lisinopril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- metformin
lisinopril increases toxicity of metformin by unspecified interaction mechanism. Use Caution/Monitor. Increases risk for hypoglycemia and lactic acidosis.
- methylphenidate
methylphenidate will decrease the level or effect of lisinopril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.
- methylphenidate transdermal
methylphenidate transdermal decreases effects of lisinopril by anti-hypertensive channel blocking. Use Caution/Monitor.
- mipomersen
mipomersen, lisinopril. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.
- moxisylyte
lisinopril, moxisylyte. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- nabumetone
lisinopril, nabumetone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- naproxen
lisinopril, naproxen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- nesiritide
nesiritide, lisinopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.
- nitroglycerin rectal
nitroglycerin rectal, lisinopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .
- oxaprozin
lisinopril, oxaprozin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- phenoxybenzamine
lisinopril, phenoxybenzamine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- phentolamine
lisinopril, phentolamine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- piroxicam
lisinopril, piroxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- potassium acid phosphate
lisinopril increases levels of potassium acid phosphate by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.
- potassium chloride
lisinopril increases levels of potassium chloride by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.
- potassium citrate
lisinopril increases levels of potassium citrate by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.
- potassium citrate/citric acid
lisinopril and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.
- potassium iodide
potassium iodide and lisinopril both increase serum potassium. Use Caution/Monitor. Potassium salts may increase the hyperkalemic effects of ACE inhibitors; the effect may be the result of aldosterone suppression in patients receiving ACE inhibitors.
- prazosin
lisinopril, prazosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- salsalate
lisinopril, salsalate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- silodosin
lisinopril, silodosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- sirolimus
lisinopril, sirolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.
- sodium bicarbonate
sodium bicarbonate decreases effects of lisinopril by unspecified interaction mechanism. Use Caution/Monitor.
- sodium citrate/citric acid
sodium citrate/citric acid decreases effects of lisinopril by unspecified interaction mechanism. Use Caution/Monitor.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of lisinopril by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of lisinopril by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- spironolactone
lisinopril, spironolactone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
- sulfasalazine
sulfasalazine decreases effects of lisinopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
lisinopril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - sulindac
lisinopril, sulindac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- synthetic human angiotensin II
lisinopril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.
- tadalafil
tadalafil increases effects of lisinopril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- temsirolimus
lisinopril, temsirolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.
- terazosin
lisinopril, terazosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
- tolazamide
lisinopril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.
- tolbutamide
lisinopril increases effects of tolbutamide by pharmacodynamic synergism. Use Caution/Monitor.
- tolmetin
lisinopril, tolmetin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- torsemide
lisinopril, torsemide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.
- triamterene
lisinopril, triamterene. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.
- trimethoprim
trimethoprim and lisinopril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- voclosporin
voclosporin and lisinopril both increase serum potassium. Use Caution/Monitor.
voclosporin, lisinopril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity. - xipamide
xipamide increases effects of lisinopril by pharmacodynamic synergism. Use Caution/Monitor.
- zotepine
lisinopril, zotepine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.
Minor (29)
- aceclofenac
aceclofenac decreases effects of lisinopril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- acemetacin
acemetacin decreases effects of lisinopril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- agrimony
agrimony increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.
- brimonidine
brimonidine increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.
- capsicum
capsicum, lisinopril. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increase ACE inhibitor induced cough.
- chlorpromazine
chlorpromazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.
- cornsilk
cornsilk increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.
- creatine
creatine, lisinopril. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction) Combination may have additive nephrotoxic effects.
- entecavir
lisinopril, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.
- fluphenazine
fluphenazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.
- lornoxicam
lornoxicam decreases effects of lisinopril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- maitake
maitake increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.
- octacosanol
octacosanol increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.
- parecoxib
parecoxib decreases effects of lisinopril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- patiromer
patiromer, lisinopril. cation binding in GI tract. Minor/Significance Unknown. No observed clinically important interaction. No separation of dosing required.
- perphenazine
perphenazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.
- probenecid
probenecid increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.
- prochlorperazine
prochlorperazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.
- promazine
promazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.
- promethazine
promethazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.
- reishi
reishi increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.
- rifampin
rifampin decreases levels of lisinopril by increasing metabolism. Minor/Significance Unknown.
- salicylates (non-asa)
salicylates (non-asa) decreases effects of lisinopril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- shepherd's purse
shepherd's purse, lisinopril. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.
- thioridazine
thioridazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.
- tizanidine
tizanidine increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.
- tolfenamic acid
tolfenamic acid decreases effects of lisinopril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- treprostinil
treprostinil increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.
- trifluoperazine
trifluoperazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.
Adverse Effects
>10%
Heart failure
- Dizziness (19%)
- Hypotension (11%)
Hypertension
- Cough (3.5-69%)
1-10%
Heart failure
- Creatinine increased (10%)
- Syncope (7%)
- Hyperkalemia (4.8-6%)
- Hypotension (4.4%)
- Diarrhea (3.7%)
- Chest pain (3.4%)
- Abdominal pain (2.2%)
- Rash (1.7%)
- Infection (1.5%)
-
≥1%
- Asthenia
- Angina pectoris
- Nausea
- Dyspnea
- Cough
- Pruritus
Hypertension
- Headache (5.7%)
- Dizziness (5.4%)
- Hyperkalemia (serum potassium >5.7 mEq/L) (2.2%)
- Increased BUN and serum creatinine (2%)
Acute myocardial infarction
- Hypotension (9%)
- Renal dysfunction (2.4%)
-
≥1%
- Body as a whole: Fatigue, asthenia, orthostatic effects
- Digestive: Pancreatitis, constipation, flatulence, dry mouth, diarrhea
- Hematologic: Rare cases of bone marrow depression, hemolytic anemia, leukopenia/neutropenia and thrombocytopenia
- Endocrine: Diabetes mellitus, inappropriate antidiuretic hormone secretion
- Metabolic: Gout
- Skin: Urticaria, alopecia, photosensitivity, erythema, flushing, diaphoresis, cutaneous pseudolymphoma, toxic epidermal necrolysis, Stevens Johnson syndrome, and pruritus
- Special senses: Visual loss, diplopia, blurred vision, tinnitus, photophobia, taste disturbances, olfactory disturbances
- Urogenital: Impotence
- Miscellaneous: A symptom complex has been reported which may include a positive ANA, an elevated erythrocyte sedimentation rate, arthralgia/arthritis, myalgia, fever, vasculitis, eosinophilia, leukocytosis, paresthesia and vertigo
- Rash, photosensitivity or other dermatological manifestations may occur alone or in combination with these symptoms
<1%
Acute myocardial infarction
- Cough (0.5%)
- Generalized edema (0.01%)
- Angioedema (0.01%)
Postmarketing Reports
- Metabolism and nutrition disorders: Hyponatremia, cases of hypoglycemia in diabetic patients on oral antidiabetic agents or insulin
- Nervous system and psychiatric disorders: Mood alterations (including depressive symptoms), mental confusion
Warnings
Black Box Warnings
Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system, causing oligohydramnios, which may result in fetal injury and/or death
Contraindications
Hypersensitivity to lisinopril/other ACE inhibitors
History of ACE inhibitor-induced angioedema, hereditary or idiopathic angioedema
Coadministration of neprilysin inhibitors (eg, sacubitril)
Coadministration with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73m²
Cautions
Anaphylactoid reactions reported in some patients dialyzed with high-flux membranes
Hematologic effects including agranulocytosis and neutropenia/agranulocytosis reported especially in patients with renal impairment and collagen vascular disease; monitor CBC periodically with differential
Less effective in African Americans
Excessive hypotension with concomitant diuretics, hypovolemia, hyponatremia may occur
Neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan
Risk of hyperkalemia, especially in patients with renal impairment or DM or in patients taking concomitant K+-elevating drugs
ACE inhibition also causes an increase in bradykinin levels, which putatively mediates angioedema; in comparison with other patients, a higher incidence of angioedema caused by ACE inhibitors has been observed in black patients
A dry hacking cough may occur within a few months of initiating drug therapy with ACE inhibitors; exclude other causes of cough before discontinuing therapy
Cholestatic jaundice associated with ACE inhibitors; discontinue if marked elevation of hepatic transaminases or jaundice occurs
Coadministration with mTOR inhibitors (eg, temsirolimus, everolimus) may increased risk for angioedema
Discontinue STAT if patient becomes pregnant
Use caution in patients with renal impairment; renal deterioration reported in patients with low renal blood flow
Use caution in patients with severe aortic stenosis, cardiovascular disease, collagen vascular disease, hypertrophic cardiomyopathy
Dual blockade of the renin-angiotensin-aldosterone system (ie, ARB plus an ACE inhibitor) in patients with established atherosclerotic disease or heart failure or with diabetes with end organ damage is associated with a higher frequency of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure), as compared with use of a single renin-angiotensin-aldosterone system agent; limit dual blockade to individually defined cases, with close monitoring of renal function
Neonates with history of in utero exposure: If oliguria or hypotension occurs, support of blood pressure and renal perfusion; exchange transfusions or dialysis may be required
Angioedema of the face, extremities, lips, tongue, glottis and/or larynx, including some fatal reactions, at any time during treatment; patients with involvement of the tongue, glottis or larynx are likely to experience airway obstruction, especially patients with history of airway surgery; promptly discontinue and provide appropriate therapy and monitoring until complete and sustained resolution of signs and symptoms of angioedema has occurred
Intestinal angioedema reported; patients presented with abdominal pain (with or without nausea or vomiting); in some cases there was no prior history of facial angioedema and C-1 esterase levels were normal; symptoms resolved after stopping the ACE inhibitor
Hypotension may occur sometimes complicated by oliguria, progressive azotemia, acute renal failure or death; patients at risk of excessive hypotension include heart failure with systolic blood pressure below 100 mmHg, ischemic heart disease, cerebrovascular disease, hyponatremia, high dose diuretic therapy, renal dialysis, or severe volume and/or salt depletion of any etiology; in such patients initiate therapy under medical supervision and follow such patients for the first two weeks of treatment and whenever dose of lisinopril and/or diuretic is increased; avoid use in patients who are hemodynamically unstable after acute MI; symptomatic hypotension also possible in patients with severe aortic stenosis or hypertrophic cardiomyopathy
Patients undergoing major surgery or during anesthesia with agents that produce hypotension, lisinopril may block angiotensin II formation secondary to compensatory renin release; if hypotension occurs and considered to be due to this mechanism, it can be corrected by volume expansion
Monitor renal function periodically; changes in renal function including acute renal failure can be caused by drugs that inhibit renin-angiotensin system; patients whose renal function may depend in part on activity of the renin-angiotensin system (eg, patients with renal artery stenosis, chronic kidney disease, severe congestive heart failure, post-myocardial infarction or volume depletion) may be at particular risk of developing acute renal failure; consider withholding or discontinuing therapy in patients who develop a clinically significant decrease in renal function
Pregnancy & Lactation
Pregnancy
Therapy can cause fetal harm when administered to a pregnant woman; use of drugs that act on renin- angiotensin system during second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death
Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in first trimester have not distinguished drugs affecting renin- angiotensin system from other antihypertensive agents; when pregnancy is detected, discontinue therapy as soon as possible
Disease-associated maternal and/or embryo/fetal risk
- Hypertension in pregnancy increases maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (eg, need for cesarean section, and post-partum hemorrhage)
- Hypertension increases fetal risk for intrauterine growth restriction and intrauterine death; pregnant women with hypertension should be carefully monitored and managed accordingly
Fetal/Neonatal adverse reactions
- Oligohydramnios in pregnant women who use drugs affecting renin-angiotensin system in second and third trimesters of pregnancy can result in the following: reduced fetal renal function leading to anuria and renal failure, fetal lung hypoplasia and skeletal deformations, including skull hypoplasia, hypotension, and death; in the unusual case that there is no appropriate alternative therapy to drugs affecting the renin-angiotensin system for a particular patient, apprise the mother of potential risk to fetus
- In patients taking drug during pregnancy, perform serial ultrasound examinations to assess the intra- amniotic environment; fetal testing may be appropriate, based on the week of gestation; if oligohydramnios is observed, discontinue therapy, unless it is considered lifesaving for the mother
- Patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained irreversible injury
- Closely observe infants with histories of in utero exposure to the drug for hypotension, oliguria, and hyperkalemia; in neonates with a history of in utero exposure to the drug, if oliguria or hypotension occurs, support blood pressure and renal perfusion; exchange transfusions or dialysis may be required as a means of reversing hypotension and/or substituting for disordered renal function
Lactation
No data are available regarding presence of lisinopril in human milk or effects on the breastfed infant or on milk production
The drug is present in rat milk; because many drugs are secreted in human milk, and because of thepotential for serious adverse reactions in breastfed infants from ACE inhibitors, discontinue breastfeeding or discontinue therapy
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Angiotensin converting enzyme (ACE) inhibitors dilate arteries and veins by competitively inhibiting the conversion of angiotensin I to angiotensin II (a potent endogenous vasoconstrictor) and by inhibiting bradykinin metabolism; these actions result in preload and afterload reductions on the heart
ACE inhibitors also promote sodium and water excretion by inhibiting angiotensin-II induced aldosterone secretion; elevation in potassium may also be observed
ACE inhibitors also elicit renoprotective effects through vasodilation of renal arterioles
ACE inhibitors reduce cardiac and vascular remodeling associated with chronic hypertension, heart failure, and myocardial infarction
Absorption
Bioavailability: 25%
Onset: 1 hr (initial); 6 hr (peak)
Duration: 24 hr
Peak plasma time: 6-8 hr
Therapeutic plasma concentration: 1-5 ng/mL
Distribution
Protein bound: 25%
Vd: 124 L
Metabolism
Does not undergo metabolism
Elimination
Half-life: 12 hr
Renal clearance: 106 mL/min
Total body clearance: 250 mL/min
Excretion: Excreted unchanged entirely in the urine
Dialysis: Removed by hemodialysis
Administration
Extemporaneous Preparation
To make 200 mL of suspension at 1.0 mg/mL, add 10 mL of Purified Water USP to a polyethylene terephthalate (PET) bottle containing ten 20-mg tablets of lisinopril
Shake for at least one min; add 30 mL of sodium citrate and citric acid oral solution or cytra-2 diluent and 160 mL of Ora-Sweet SF to concentrate in PET bottle
Gently shake for several seconds to disperse ingredientsShake suspension before each use
Oral Administration
Take with or without food
Missed dose
- Take as soon as possible
- Do not take the missed dose if it is too close to the next scheduled dose; just take the next dose at the regular scheduled time
Storage
Prepared suspension: Refrigerate 2-8ºC(36-36ºF) for up to 4 weeks
Tablets: Store at 15-30ºC (59-86ºF), protect from moisture; dispense in a tight container
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Zestril oral - | 30 mg tablet |  | |
| Zestril oral - | 5 mg tablet |  | |
| Zestril oral - | 10 mg tablet |  | |
| Zestril oral - | 40 mg tablet |  | |
| Zestril oral - | 20 mg tablet |  | |
| Zestril oral - | 2.5 mg tablet |  | |
| Qbrelis oral - | 1 mg/mL solution |  | |
| lisinopril oral - | 20 mg tablet |  | |
| lisinopril oral - | 10 mg tablet |  | |
| lisinopril oral - | 5 mg tablet |  | |
| lisinopril oral - | 40 mg tablet |  | |
| lisinopril oral - | 20 mg tablet |  | |
| lisinopril oral - | 10 mg tablet |  | |
| lisinopril oral - | 40 mg tablet |  | |
| lisinopril oral - | 20 mg tablet |  | |
| lisinopril oral - | 5 mg tablet |  | |
| lisinopril oral - | 2.5 mg tablet |  | |
| lisinopril oral - | 20 mg tablet |  | |
| lisinopril oral - | 5 mg tablet |  | |
| lisinopril oral - | 10 mg tablet |  | |
| lisinopril oral - | 10 mg tablet |  | |
| lisinopril oral - | 40 mg tablet |  | |
| lisinopril oral - | 20 mg tablet |  | |
| lisinopril oral - | 10 mg tablet |  | |
| lisinopril oral - | 2.5 mg tablet |  | |
| lisinopril oral - | 30 mg tablet |  | |
| lisinopril oral - | 5 mg tablet |  | |
| lisinopril oral - | 2.5 mg tablet |  | |
| lisinopril oral - | 40 mg tablet |  | |
| lisinopril oral - | 30 mg tablet |  | |
| lisinopril oral - | 2.5 mg tablet |  | |
| lisinopril oral - | 5 mg tablet |  | |
| lisinopril oral - | 30 mg tablet |  | |
| lisinopril oral - | 2.5 mg tablet |  | |
| lisinopril oral - | 30 mg tablet |  | |
| lisinopril oral - | 20 mg tablet |  | |
| lisinopril oral - | 10 mg tablet |  | |
| lisinopril oral - | 5 mg tablet |  | |
| lisinopril oral - | 30 mg tablet |  | |
| lisinopril oral - | 40 mg tablet |  | |
| lisinopril oral - | 40 mg tablet |  | |
| lisinopril oral - | 20 mg tablet |  | |
| lisinopril oral - | 10 mg tablet |  | |
| lisinopril oral - | 5 mg tablet |  | |
| lisinopril oral - | 30 mg tablet |  | |
| lisinopril oral - | 30 mg tablet |  | |
| lisinopril oral - | 40 mg tablet |  | |
| lisinopril oral - | 5 mg tablet |  | |
| lisinopril oral - | 40 mg tablet |  | |
| lisinopril oral - | 2.5 mg tablet |  | |
| lisinopril oral - | 30 mg tablet |  | |
| lisinopril oral - | 20 mg tablet |  | |
| lisinopril oral - | 10 mg tablet |  | |
| lisinopril oral - | 5 mg tablet |  | |
| lisinopril oral - | 2.5 mg tablet |  | |
| lisinopril oral - | 5 mg tablet |  | |
| lisinopril oral - | 10 mg tablet |  | |
| lisinopril oral - | 20 mg tablet |  | |
| lisinopril oral - | 5 mg tablet |  | |
| lisinopril oral - | 40 mg tablet |  | |
| lisinopril oral - | 30 mg tablet |  | |
| lisinopril oral - | 5 mg tablet |  | |
| lisinopril oral - | 40 mg tablet |  | |
| lisinopril oral - | 30 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
lisinopril oral
LISINOPRIL - ORAL
(lyse-IN-oh-pril)
COMMON BRAND NAME(S): Prinivil, Zestril
WARNING: This medication can cause serious (possibly fatal) harm to an unborn baby if used during pregnancy. It is important to prevent pregnancy while taking this medication. Consult your doctor for more details and to discuss the use of reliable forms of birth control while taking this medication. If you are planning pregnancy, become pregnant, or think you may be pregnant, tell your doctor right away.
USES: Lisinopril is used to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. It is also used to treat heart failure and to improve survival after a heart attack.Lisinopril belongs to a class of drugs known as ACE inhibitors. It works by relaxing blood vessels so blood can flow more easily.
HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually once daily.If you are using the suspension form of this medication, shake the bottle well before each dose. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.The dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight.To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. Keep taking this medication even if you feel well. Most people with high blood pressure do not feel sick.For the treatment of high blood pressure, it may take 2 to 4 weeks before you get the full benefit of this medication. For the treatment of heart failure, it may take weeks to months before you get the full benefit of this medication. Tell your doctor if your condition does not get better or if it gets worse (for example, your blood pressure readings remain high or increase).
SIDE EFFECTS: Dizziness, lightheadedness, tiredness, or headache may occur as your body adjusts to the medication. Dry cough may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fainting, symptoms of a high potassium blood level (such as muscle weakness, slow/irregular heartbeat).Although lisinopril may be used to prevent kidney problems or treat people who have kidney problems, it may also rarely cause serious kidney problems or make them worse. Your doctor will check your kidney function while you are taking lisinopril. Tell your doctor right away if you have any signs of kidney problems such as a change in the amount of urine.Lisinopril may rarely cause serious (possibly fatal) liver problems. Get medical help right away if you have any symptoms of liver damage, such as: nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking lisinopril, tell your doctor or pharmacist if you are allergic to it; or to other ACE inhibitors (such as benazepril); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: history of an allergic reaction which included swelling of the face/lips/tongue/throat (angioedema), blood filtering procedures (such as LDL apheresis, dialysis), high level of potassium in the blood.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Too much sweating, diarrhea, or vomiting may cause dehydration and increase your risk of lightheadedness. Report prolonged diarrhea or vomiting to your doctor. Be sure to drink enough fluids to prevent dehydration unless your doctor directs you otherwise.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This product may increase your potassium levels. Before using potassium supplements or salt substitutes that contain potassium, consult your doctor or pharmacist.Older adults may be more sensitive to the side effects of this drug, especially dizziness and increases in potassium level.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using lisinopril. Lisinopril may harm an unborn baby. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication. Consult your doctor for more details. (See also Warning section.)It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also Precautions section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: aliskiren, certain drugs that weaken the immune system/increase the risk of infection (such as everolimus, sirolimus), lithium, drugs that may increase the level of potassium in the blood (such as ARBs including losartan/valsartan, birth control pills containing drospirenone), sacubitril.Some products have ingredients that could raise your blood pressure or worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).A very serious reaction may occur if you are getting injections for bee/wasp sting allergy (desensitization) and are also taking lisinopril. Make sure all your doctors know which medicines you are using.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, fainting.
NOTES: Do not share this medication with others.Lifestyle changes that may help this medication work better include exercising, stopping smoking, and eating a low-cholesterol/low-fat diet. Consult your doctor for more details.Lab and/or medical tests (such as kidney function, potassium levels) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.Check your blood pressure and pulse (heart rate) regularly while taking this medication. Learn how to check your own blood pressure and pulse at home, and share the results with your doctor.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store the tablets and suspension at room temperature away from light and moisture. Do not store in the bathroom. Discard any unused suspension after 4 weeks. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised February 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
