Lisinopril: Effective Blood Pressure Control and Heart Protection
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Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor widely prescribed for the management of hypertension and certain cardiovascular conditions. As a first-line antihypertensive agent, it works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby promoting vasodilation and reducing peripheral resistance. Its well-established efficacy, favorable safety profile, and additional cardioprotective benefits make it a cornerstone in modern cardiovascular therapy. This medication is commonly used in both monotherapy and combination regimens to achieve optimal blood pressure targets.
Features
- Active ingredient: Lisinopril
- Drug class: Angiotensin-converting enzyme (ACE) inhibitor
- Available formulations: Oral tablets (2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg)
- Bioavailability: Approximately 25%
- Half-life: 12 hours
- Excretion: Primarily renal
- Prescription status: Requires medical prescription
Benefits
- Effectively lowers systolic and diastolic blood pressure, reducing the risk of stroke, myocardial infarction, and kidney damage
- Provides cardioprotective effects in patients with heart failure by decreasing cardiac afterload and improving ejection fraction
- Slows progression of diabetic nephropathy and reduces proteinuria in patients with type 2 diabetes
- Demonstrates once-daily dosing convenience due to its prolonged half-life
- Shows proven mortality benefit in post-myocardial infarction patients
- Offers cost-effective therapy compared to many newer antihypertensive agents
Common use
Lisinopril is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also FDA-approved for the management of heart failure, often as adjunctive therapy with diuretics and digitalis. Additionally, lisinopril is used to improve survival following acute myocardial infarction in hemodynamically stable patients. Off-label uses include the prevention of migraine headaches and management of proteinuric kidney diseases. The medication is particularly valuable in diabetic patients due to its renal protective properties.
Dosage and direction
The initial dosage for hypertension typically ranges from 10-40 mg once daily, with maintenance doses adjusted based on therapeutic response. For heart failure, starting doses are usually lower (2.5-5 mg daily) with gradual titration. Post-myocardial infarction patients may begin with 5 mg within 24 hours of onset, followed by 5 mg after 24 hours, then 10 mg daily. Administration should occur at approximately the same time each day, with or without food. Dosage adjustments are necessary in renal impairment, with recommended reductions based on creatinine clearance. Elderly patients may require lower initial doses due to potential age-related renal function decline.
Precautions
Patients should be monitored for hypotension, especially during initial titration and in volume-depleted individuals. Regular assessment of renal function and serum potassium levels is essential, particularly in patients with pre-existing renal impairment or those taking potassium supplements. Angioedema may occur at any time during treatment, requiring immediate discontinuation if involvement of the tongue, glottis, or larynx occurs. Caution is advised in patients with collagen vascular diseases or those receiving immunosuppressive therapy due to increased risk of neutropenia/agranulocytosis. Periodic monitoring of white blood cell counts is recommended in these populations.
Contraindications
Lisinopril is contraindicated in patients with a history of angioedema related to previous ACE inhibitor therapy. It should not be used in patients with hereditary or idiopathic angioedema. Additional contraindications include concomitant use with aliskiren in patients with diabetes and concurrent administration with neprilysin inhibitors. The medication is contraindicated during the second and third trimesters of pregnancy due to potential fetal harm. Hypersensitivity to any component of the formulation or other ACE inhibitors also represents an absolute contraindication.
Possible side effect
Common adverse effects include dizziness (6-12%), headache (5-8%), cough (up to 35%), fatigue (3-5%), and nausea (2-5%). Less frequent side effects may include orthostatic hypotension, hyperkalemia, rash, and taste disturbance. Serious but rare adverse reactions include angioedema (0.1-0.7%), neutropenia/agranulocytosis, hepatic failure, and pancreatitis. Renal impairment may occur, particularly in patients with renal artery stenosis, heart failure, or volume depletion. The characteristic dry, persistent cough is class-effect of ACE inhibitors and may necessitate discontinuation in some patients.
Drug interaction
Lisinopril exhibits significant interactions with potassium-sparing diuretics, potassium supplements, and salt substitutes containing potassium, potentially leading to dangerous hyperkalemia. Concurrent use with nonsteroidal anti-inflammatory drugs may diminish the antihypertensive effect and increase renal impairment risk. Diuretics may potentiate first-dose hypotension, requiring careful monitoring. Lithium levels may increase with concomitant ACE inhibitor use. Dual blockade of the renin-angiotensin system with ARBs or aliskiren increases risks of hypotension, hyperkalemia, and renal impairment. Antidiabetic agents may require dosage adjustment due to potential hypoglycemic effects.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Consistent daily dosing is important for maintaining stable blood pressure control. Healthcare providers should educate patients about the importance of adherence while providing clear instructions for handling missed doses to prevent both under-treatment and potential hypotension from double dosing.
Overdose
Lisinopril overdose may manifest as severe hypotension, which can progress to shock. Bradycardia, electrolyte disturbances (particularly hyperkalemia), and renal failure may also occur. Management involves supportive care with volume expansion using normal saline for hypotension. Vasopressors may be required in refractory cases. Bradycardia may respond to atropine administration. Hemodialysis may be effective in removing lisinopril, particularly in patients with renal impairment. Serum electrolyte levels and renal function should be monitored closely. Patients presenting with suspected overdose require immediate medical attention and possibly intensive care monitoring.
Storage
Lisinopril tablets should be stored at controlled room temperature (20-25°C or 68-77°F) in their original container with the lid tightly closed. Protection from light, moisture, and excessive heat is essential. The medication should be kept out of reach of children and pets. Tablets should not be stored in bathroom cabinets due to humidity fluctuations. Unused medication should be properly disposed of according to local regulations once expired or no longer needed. Patients should be advised not to transfer tablets to other containers that might not provide adequate protection from environmental factors.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Individual patient responses to lisinopril may vary based on numerous factors including age, renal function, concomitant medications, and underlying medical conditions. Healthcare providers should exercise clinical judgment when prescribing this medication, considering individual patient characteristics and current treatment guidelines. Patients should not initiate, discontinue, or modify lisinopril therapy without consulting their healthcare provider. The complete prescribing information should be reviewed before administration.
Reviews
Clinical studies consistently demonstrate lisinopril’s efficacy in blood pressure reduction, with meta-analyses showing average systolic reductions of 8-15 mmHg and diastolic reductions of 5-10 mmHg. The SOLVD prevention trial demonstrated significant reductions in mortality and hospitalization for heart failure patients. In diabetic populations, multiple studies confirm its renal protective effects independent of blood pressure control. Patient satisfaction surveys indicate generally good tolerability, though the characteristic cough leads to discontinuation in approximately 5-10% of users. Long-term follow-up data support its sustained effectiveness and safety profile over years of continuous use.