Prinivil (lisinopril) is an angiotensin-converting enzyme (ACE) inhibitor prescribed for the management of hypertension, heart failure, and post-myocardial infarction care. As a first-line antihypertensive agent, it works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in decreased vascular resistance and improved blood flow. Its well-established efficacy profile and once-daily dosing make it a cornerstone therapy in cardiovascular risk reduction. Clinical evidence supports its role in slowing the progression of renal disease in hypertensive patients with diabetes.

Features

• Active ingredient: Lisinopril (5mg, 10mg, 20mg, 40mg tablets)
• Pharmacological class: Angiotensin-converting enzyme (ACE) inhibitor
• Administration: Oral, once-daily dosing
• Bioavailability: Approximately 25%, not significantly affected by food
• Half-life: 12 hours (prolonged in renal impairment)
• Excretion: Primarily renal (unchanged drug)
• FDA-approved indications: Hypertension, heart failure, acute myocardial infarction

Benefits

• Effectively lowers systolic and diastolic blood pressure through renin-angiotensin-aldosterone system (RAAS) inhibition
• Reduces afterload in heart failure patients, improving ejection fraction and functional capacity
• Demonstrates nephroprotective effects in diabetic patients with microalbuminuria
• Decreases mortality risk when administered within 24 hours of acute myocardial infarction
• Provides 24-hour blood pressure control with single daily dosing
• Shows proven cardiovascular risk reduction in long-term clinical studies

Common use

Prinivil is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is routinely prescribed for management of congestive heart failure to improve survival and reduce hospitalization. Following myocardial infarction, it is used in hemodynamically stable patients to improve survival. Off-label uses include diabetic nephropathy management and prevention of migraine headaches. The medication is typically incorporated into long-term treatment regimens for chronic cardiovascular conditions.

Dosage and direction

Hypertension: Initial dose 10mg once daily; maintenance dose 20-40mg daily. Maximum dose: 80mg daily.
Heart Failure: Start with 5mg daily; maintenance dose 5-40mg daily.
Post-Myocardial Infarction: 5mg within 24 hours, then 5mg after 24 hours, 10mg thereafter.
Take at the same time each day, with or without food. Crush tablets if swallowing difficulty occurs. Dosage adjustments required for renal impairment (CrCl <30 mL/min: start with 5mg daily). Titrate based on blood pressure response and tolerability.

Precautions

Monitor blood pressure within 2 weeks of initiation and after dosage changes. Assess renal function and serum potassium before initiation and periodically during therapy. Use caution in patients with renal artery stenosis, collagen vascular diseases, or those undergoing major surgery. Avoid use in pregnancy (Category D) due to risk of fetal injury. Elderly patients may require lower initial doses. Patients should maintain adequate hydration and report symptoms of infection (sore throat, fever) promptly.

Contraindications

History of angioedema related to previous ACE inhibitor therapy. Concomitant use with aliskiren in patients with diabetes. Patients with hereditary or idiopathic angioedema. Hypersensitivity to lisinopril or any ACE inhibitor. Bilateral renal artery stenosis. During second and third trimesters of pregnancy.

Possible side effect

Common (≥1%): dizziness (6.5%), headache (5.4%), cough (3.9%), fatigue (3.5%), nausea (2.2%).
Less common: orthostatic hypotension, hyperkalemia, rash, impotence, diarrhea.
Serious: angioedema (0.1-0.7%), neutropenia/agranulocytosis, hepatic failure, renal impairment, symptomatic hypotension. Most side effects are dose-dependent and often diminish with continued therapy.

Drug interaction

Potassium supplements/potassium-sparing diuretics: Increased risk of hyperkalemia.
NSAIDs: May reduce antihypertensive effect and worsen renal function.
Lithium: Increased lithium levels and toxicity risk.
Diuretics: Enhanced hypotensive effect, especially with initial combination.
Gold injections: Nitritoid reactions reported with sodium aurothiomalate.
Antidiabetic agents: Enhanced hypoglycemic effect may require dosage adjustment.

Missed dose

Take the missed dose as soon as remembered, unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed dose. If multiple doses are missed, contact healthcare provider for guidance. Maintain regular dosing schedule to ensure consistent blood pressure control.

Overdose

Symptoms include profound hypotension, bradycardia, circulatory shock, hyperkalemia, and renal failure. Management involves supportive care including IV fluids and vasopressors for hypotension. Hemodialysis may be effective due to significant renal excretion. Monitor electrolytes and renal function closely. Angiotensin II infusion may be considered in severe cases.

Storage

Store at controlled room temperature (20-25°C/68-77°F). Keep container tightly closed. Protect from moisture and light. Keep out of reach of children. Do not use after expiration date printed on packaging. Do not transfer to other containers as moisture protection may be compromised.

Disclaimer

This information is for educational purposes only and does not replace professional medical advice. Dosage and treatment decisions should be made by qualified healthcare providers based on individual patient characteristics. Not all side effects or interactions are listed. Patients should consult their prescribing physician before making any changes to their medication regimen.

Reviews

Clinical trials demonstrate 65-75% of hypertensive patients achieve blood pressure control with Prinivil monotherapy. Meta-analyses show 20-25% reduction in stroke risk and 15-20% reduction in myocardial infarction risk compared to placebo. Heart failure studies indicate 16% mortality reduction and 26% risk reduction in combined endpoint of mortality/hospitalization. Patient satisfaction surveys report high adherence rates due to once-daily dosing and generally favorable side effect profile compared to other antihypertensive classes.