Formulary
Lisinopril: Indications, Dosing, Side Effects and Interactions
Lisinopril clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 7 min read
Lisinopril: Indications, Dosing, Side Effects and Interactions
Lisinopril clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Hypertension**
- **Adult** (By Mouth): Initially 10 mg once daily; usual maintenance 20 mg once daily; maximum 80 mg per day.
**Hypertension, when used in addition to diuretic, in cardiac decompensation or in volume depletion**
- **Adult** (By Mouth): Initially 2.5-5 mg once daily; usual maintenance 20 mg once daily; maximum 80 mg per day.
**Short-term treatment following myocardial infarction in haemodynamically stable patients-systolic blood pressure over 120 mmHg**
- **Adult** (By Mouth): Initially 5 mg, taken within 24 hours of myocardial infarction, followed by 5 mg, to be taken 24 hours after initial dose, then 10 mg, to be taken 24 hours after second dose, then 10 mg once daily for 6 weeks (or continued if heart failure), temporarily reduce maintenance dose to 5 mg and if necessary 2.5 mg daily if systolic blood pressure 100 mmHg or less during treatment; withdraw if prolonged hypotension occurs during treatment (systolic blood pressure less than 90 mmHg for more than 1 hour).
**Short-term treatment following myocardial infarction in haemodynamically stable patients-systolic blood pressure 100-120 mmHg**
- **Adult** (By Mouth): Initially 2.5 mg once daily, maintenance 5 mg once daily, increase to maintenance dose only after at least 3 days of the initial dose, should not be started after myocardial infarction if systolic blood pressure less than 100 mmHg, temporarily reduce maintenance dose to 2.5 mg daily if systolic blood pressure 100 mmHg or less during treatment; withdraw if prolonged hypotension occurs (systolic blood pressure less than 90 mmHg for more than 1 hour).
**Renal complications of diabetes mellitus**
- **Adult** (By Mouth): Initially 2.5-5 mg once daily, adjusted according to response; usual dose 10-20 mg once daily.
**Heart failure (adjunct) (under close medical supervision)**
- **Adult** (By Mouth): Initially 2.5 mg once daily; increased in steps of up to 10 mg at least every 2 weeks; maximum 35 mg per day.
**Hypertension for lisinopril**
- **Child 6-11 years (under expert supervision)** (By mouth): Initially 70 micrograms/kg once daily (max. per dose 5 mg), increased to up to 600 micrograms/kg once daily, alternatively increased to up to 40 mg once daily, dose to be increased in intervals of 1-2 weeks.
- **Child 12-17 years (under expert supervision)** (By mouth): Initially 5 mg once daily; usual maintenance 10-20 mg once daily; maximum 80 mg per day.
**Proteinuria in nephritis (under expert supervision) for lisinopril**
- **Child 6-11 years** (By mouth): Initially 70 micrograms/kg once daily (max. per dose 5 mg), increased to up to 600 micrograms/kg once daily, alternatively increased to up to 40 mg once daily, dose to be increased in intervals of 1-2 weeks.
- **Child 12-17 years** (By mouth): Initially 5 mg once daily; usual maintenance 10-20 mg once daily; maximum 80 mg per day.
**Diabetic nephropathy (under expert supervision) for lisinopril**
- **Child 12-17 years** (By mouth): Initially 5 mg once daily; usual maintenance 10-20 mg once daily; maximum 80 mg per day.
**Heart failure (adjunct) (under close medical supervision) for lisinopril**
- **Child 12-17 years** (By mouth): Initially 2.5 mg once daily; increased in steps of up to 10 mg at least every 2 weeks; maximum 35 mg per day.
Cautions
For all angiotensin-converting enzyme inhibitors Concomitant diuretics; diabetes (may lower blood glucose; increased risk of hyperkalaemia); first dose hypotension (especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with cerebrovascular disease, ischaemic heart disease, or heart failure); patients of black African or African-Caribbean origin (may respond less well to ACE inhibitors); peripheral vascular disease or generalised atherosclerosis (risk of clinically silent renovascular disease); primary aldosteronism (patients may respond less well to ACE inhibitors); the risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended); use with care in patients with aortic or mitral valve stenosis (risk of hypotension); use with care in patients with hypertrophic cardiomyopathy Cautions, further information Anaphylactoid reactions To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux membranes (e.g. polyacrylonitrile) and during low-density lipoprotein apheresis with dextran sulfate; they should also be withheld before desensitisation with wasp or bee venom. M Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: with hyperkalaemia with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls)
Contraindications
For all angiotensin-converting enzyme inhibitors Hereditary or idiopathic angioedema; history of angioedema associated with prior ACE inhibitor therapy; the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m 2 ; the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with diabetes mellitus
Side effects
For all angiotensin-converting enzyme inhibitors Common or very common Alopecia; angina pectoris; angioedema (can be delayed; more common in black patients); arrhythmias; asthenia; chest pain; constipation; cough; depression; diarrhoea; dizziness; drowsiness; dry mouth; dyspnoea; electrolyte imbalance; gastrointestinal discomfort; headache; hypotension; myalgia; nausea; palpitations; paraesthesia; renal impairment; rhinitis; skin reactions; sleep disorder; syncope; taste altered; tinnitus; vertigo; vomiting Uncommon Arthralgia; confusion; eosinophilia; erectile dysfunction; fever; haemolytic anaemia; hyperhidrosis; myocardial infarction; pancreatitis; peripheral oedema; photosensitivity reaction; respiratory disorders; stroke Rare or very rare Agranulocytosis; hepatitis; leucopenia; neutropenia; pancytopenia; Stevens-Johnson syndrome; thrombocytopenia Side-effects, further information In light of reports of cholestatic jaundice, hepatitis, fulminant hepatic necrosis, and hepatic failure, ACE inhibitors should be discontinued if marked elevation of hepatic enzymes or jaundice occur. Side-effects For lisinopril Common or very common Postural disorders Uncommon Hallucination; mood altered; Raynaud's phenomenon Rare or very rare Alveolitis allergic; anaemia; autoimmune disorder; azotaemia; bone marrow depression; gynaecomastia; hepatic disorders; hypersensitivity; hypoglycaemia; lymphadenopathy; olfactory nerve disorder; SIADH; sinusitis; toxic epidermal necrolysis Frequency not known Leucocytosis; vasculitis
Interactions
**Severe interactions:**
- Use of potassium sparing diuretics (e.g.
**Other interactions (18):**
- Antihypertensive agents When Lisinopril 1mg/ml oral solution is combined with other antihypertensive agents (e.g.
- Clinical trial data has shown that dual blockade of the renin-angiotensin-aldosterone system (RAAS) through the combined use of ACE-inhibitors, angiotensin II receptor blockers or aliskiren is...
- Concomitant treatment of ACE inhibitors with mammalian target of rapamycin (mTOR) inhibitors (e.g.
- Diuretics When a diuretic is added to the therapy of a patient receiving Lisinopril 1mg/ml oral solution the antihypertensive effect is usually additive.
- Patients already on diuretics and especially those in whom diuretic therapy was recently instituted, may occasionally experience an excessive reduction of blood pressure when Lisinopril 1mg/ml oral...
- The possibility of symptomatic hypotension with Lisinopril 1mg/ml oral solution can be minimised by discontinuing the diuretic prior to initiation of treatment with Lisinopril 1mg/ml oral solution...
Pregnancy
Important safety information For all angiotensin-converting enzyme inhibitors MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: not for use in pregnancy (December 2014) See Conception and contraception and Pregnancy . MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: recommendations on how to use for breastfeeding (December 2014) See Breast feeding .
Breast feeding
For all angiotensin-converting enzyme inhibitors Information on the use of ACE inhibitors in breast-feeding is limited. Breast feeding For lisinopril Not recommended; alternative treatment options, with better established safety information during breast-feeding, are available.
Renal impairment
For all angiotensin-converting enzyme inhibitors Caution (hyperkalaemia and other side-effects of ACE inhibitors are more common in those with impaired renal function). M Dose adjustments Start with low dose and adjust according to response. M Renal impairment For lisinopril Dose adjustments See Prescribing in renal impairment . Max. initial doses 5-10 mg daily if creatinine clearance 30-80 mL/minute (max. 40 mg daily); 2.5-5 mg daily if creatinine clearance 10-30 mL/minute (max. 40 mg daily); 2.5 mg daily if creatinine clearance less than 10 mL/minute. M
Medicinal forms
Solution,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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