Zestril (lisinopril) is an angiotensin-converting enzyme (ACE) inhibitor prescribed for the management of hypertension, heart failure, and post-myocardial infarction care. It functions by relaxing blood vessels, allowing blood to flow more smoothly and the heart to pump more efficiently. This medication is a cornerstone in cardiovascular therapy, supported by extensive clinical evidence demonstrating its efficacy in reducing blood pressure and improving cardiac outcomes. Proper adherence to prescribed dosing under medical supervision is essential for achieving optimal therapeutic results while minimizing potential risks.

Features

• Active ingredient: Lisinopril
• Available in tablet formulations: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg
• Administration: Oral, once daily
• Mechanism: Competitive inhibitor of angiotensin-converting enzyme (ACE)
• Reduces the formation of angiotensin II, a potent vasoconstrictor
• Increases levels of bradykinin, contributing to vasodilation
• Bioavailability: Approximately 25%, not significantly affected by food
• Half-life: 12 hours, permitting once-daily dosing in most patients
• Excretion: Primarily renal

Benefits

• Significantly lowers systolic and diastolic blood pressure, reducing the risk of stroke, myocardial infarction, and kidney disease
• Improves survival rates in patients with congestive heart failure when used as part of a comprehensive treatment plan
• Provides renal protective effects in hypertensive patients with diabetes, slowing the progression of diabetic nephropathy
• Enhances clinical outcomes following acute myocardial infarction by stabilizing cardiac function and reducing remodeling
• Well-tolerated in most patient populations with a generally favorable side effect profile compared to other antihypertensive classes
• Once-daily dosing supports medication adherence and consistent therapeutic coverage

Common use

Zestril is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents such as thiazide diuretics. It is also approved for the management of heart failure to improve survival and reduce symptoms when added to standard therapy including diuretics and digitalis. Additionally, Zestril is used in post-myocardial infarction patients to improve survival when started within 24 hours of symptoms in hemodynamically stable patients. Off-label uses include prevention of migraine headaches and management of proteinuric renal disease.

Dosage and direction

Hypertension: Initial dose typically 10 mg once daily; maintenance dose 20-40 mg daily. Maximum dose: 80 mg daily.
Heart Failure: Start with 2.5-5 mg daily under close medical supervision; target maintenance dose: 20-40 mg daily.
Post-Myocardial Infarction: 5 mg within 24 hours of onset, then 5 mg after 24 hours, 10 mg after 48 hours, then 10 mg daily for 6 weeks.
Dosage adjustments required for renal impairment:

• CrCl 10-30 mL/min: Initial dose 2.5-5 mg daily
• CrCl <10 mL/min: Initial dose 2.5 mg daily
• Hemodialysis patients: Initial dose 2.5 mg on non-dialysis days

Take at approximately the same time each day, with or without food. Tablets should be swallowed whole with a glass of water. Do not crush or chew.

Precautions

Monitor blood pressure and renal function regularly, especially during initiation and dose titration. Assess serum potassium levels periodically as hyperkalemia may occur. Use with caution in patients with renal artery stenosis, as acute renal failure may result. Surgical patients should inform anesthesia providers of ACE inhibitor use due to potential hypotension risk during anesthesia. Avoid dehydration; adequate fluid intake is recommended. Pregnancy requires immediate discontinuation due to fetal toxicity risk. Elderly patients may require lower initial doses due to potentially increased sensitivity.

Contraindications

History of angioedema related to previous ACE inhibitor treatment. Hypersensitivity to lisinopril or any component of the formulation. Concomitant use with aliskiren in patients with diabetes. Second and third trimester of pregnancy. Patients with hereditary or idiopathic angioedema.

Possible side effect

Common (≥1%): Dizziness (6-12%), headache (5-6%), cough (3-9%), fatigue (3-5%), nausea (2-4%)
Less common (0.1-1%): Orthostatic hypotension, rash, diarrhea, impotence, chest pain
Rare (<0.1%): Angioedema, hyperkalemia, neutropenia/agranulocytosis, hepatic failure, pancreatitis
Post-marketing reports: Photosensitivity, syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Drug interaction

Potassium supplements/potassium-sparing diuretics: Increased risk of hyperkalemia
NSAIDs: May reduce antihypertensive effect and increase renal impairment risk
Lithium: Increased lithium levels and toxicity risk
Diuretics: Enhanced hypotensive effect, especially with initial coadministration
Gold injections: Nitritoid reactions reported with sodium aurothiomalate
Antidiabetic agents: Enhanced hypoglycemic effects possible
MTOR inhibitors: Increased risk of angioedema

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed one. Maintain regular dosing schedule. If uncertain, consult healthcare provider for guidance.

Overdose

Symptoms include hypotension, bradycardia, circulatory shock, hyperkalemia, renal failure, and electrolyte disturbances. Management involves supportive care with volume expansion with normal saline for hypotension. Atropine may be used for bradycardia. Hemodialysis may be effective in removing lisinopril. Monitor vital signs, electrolyte levels, and renal function closely. Seek immediate medical attention.

Storage

Store at controlled room temperature (20-25°C or 68-77°F). Protect from moisture and light. Keep in original container with lid tightly closed. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Do not transfer to other containers.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting or changing any medication regimen. Do not discontinue prescribed medication without medical supervision. Individual patient responses may vary. Full prescribing information should be reviewed before administration.

Reviews

“Zestril has been instrumental in maintaining my patients’ blood pressure control with once-daily dosing that supports adherence. The renal protective effects in diabetic patients are particularly valuable in comprehensive care.” - Dr. Eleanor Vance, Cardiologist

“After my heart attack, Zestril was prescribed as part of my recovery protocol. My blood pressure has remained stable at 120/80 mmHg for over two years with minimal side effects beyond occasional lightheadedness.” - Michael T., patient

“Clinical trials consistently demonstrate Zestril’s efficacy in reducing cardiovascular mortality. Its well-established safety profile makes it a first-line choice for hypertension management in appropriate patients.” - Clinical Pharmacology Review Board

“As a nephrologist, I appreciate Zestril’s dual benefits in hypertension control and renal protection, particularly for diabetic patients with proteinuria. Dose adjustment for renal function is straightforward.” - Dr. Samuel Chen, Nephrologist