Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor prescribed primarily for the management of hypertension, heart failure, and post-myocardial infarction care. It works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby promoting vasodilation, reducing blood pressure, and decreasing cardiac afterload. This medication is widely recognized for its cardioprotective benefits, including slowing the progression of renal disease in diabetic patients. Available in oral tablet form, lisinopril is typically administered once daily, with dosages individualized based on patient condition and response.

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)
• Administration: Once-daily dosing, with or without food
• Onset of action: Peak plasma concentration within 7 hours
• Half-life: Approximately 12 hours
• Bioavailability: Around 25%, with minimal first-pass metabolism
• Excretion: Primarily renal

Benefits

• Effectively lowers systolic and diastolic blood pressure, reducing the risk of stroke, myocardial infarction, and other cardiovascular events.
• Improves survival rates and symptom management in patients with congestive heart failure by decreasing cardiac workload.
• Provides renal protective effects, particularly in diabetic patients with proteinuria, slowing the progression of diabetic nephropathy.
• Enhances hemodynamic stability and reduces mortality following acute myocardial infarction when initiated within 24 hours.
• Offers convenient once-daily dosing, supporting long-term adherence to antihypertensive therapy.
• Demonstrates a favorable safety and tolerability profile in most patient populations when appropriately monitored.

Common use

Lisinopril is indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also used in the management of symptomatic heart failure, often as adjunctive therapy with diuretics and/or digoxin. Additionally, lisinopril is prescribed to improve survival in hemodynamically stable patients within the first 24 hours of acute myocardial infarction. Another key indication includes the treatment of diabetic nephropathy in patients with type 2 diabetes mellitus and hypertension, where it has been shown to reduce proteinuria and slow the decline in glomerular filtration rate.

Dosage and direction

For hypertension, the initial dose is typically 10 mg once daily, which may be adjusted based on blood pressure response, up to a maximum of 40 mg daily. In heart failure, treatment usually begins with 2.5–5 mg once daily under close medical supervision, with gradual titration to a target maintenance dose of 20–40 mg daily. For acute myocardial infarction, the recommended starting dose is 5 mg within the first 24 hours, followed by 5 mg after 24 hours, 10 mg after 48 hours, and then 10 mg once daily for 6 weeks. Dosage adjustments are necessary in patients with renal impairment; a reduced initial dose is advised for those with creatinine clearance below 30 mL/min. Lisinopril may be taken with or without food, but consistency in administration relative to meals is recommended.

Precautions

Patients should be monitored for hypotension, especially during initial dosing and following dose increases. Renal function and serum potassium levels should be assessed before and during treatment, particularly in those with renal artery stenosis, pre-existing renal impairment, or those taking potassium supplements or potassium-sparing diuretics. Angioedema, though rare, may occur at any time during therapy and requires immediate discontinuation and medical attention. A persistent dry cough is a common class effect of ACE inhibitors and may necessitate alternative therapy if intolerable. Use with caution in patients with collagen vascular disease or on immunosuppressants due to increased risk of neutropenia/agranulocytosis. Lisinopril is pregnancy category D and should be discontinued as soon as pregnancy is detected due to risk of fetal harm.

Contraindications

Lisinopril is contraindicated in patients with a history of angioedema related to previous ACE inhibitor therapy or hereditary/idiopathic angioedema. It should not be used in patients with hypersensitivity to lisinopril or any other ACE inhibitor. Concomitant use with aliskiren in patients with diabetes is contraindicated. Lisinopril is also contraindicated in patients with bilateral renal artery stenosis or stenosis in a solitary kidney. It must not be administered during pregnancy due to the risk of fetal injury and death.

Possible side effect

Common adverse reactions include dizziness (6–12%), headache (5–9%), persistent dry cough (up to 10%), fatigue (3–5%), and nausea (2–5%). Less frequently, orthostatic hypotension, hyperkalemia, rash, and impotence may occur. Serious but rare side effects include angioedema (0.1–0.7%), which can involve the face, lips, tongue, glottis, or larynx; neutropenia/agranulocytosis; hepatic failure; and renal impairment. Symptomatic hypotension is more likely in volume-depleted patients or those on diuretic therapy. Some patients may experience taste disturbance or photosensitivity.

Drug interaction

Concomitant use with diuretics may potentiate hypotension. Potassium supplements, potassium-sparing diuretics (e.g., spironolactone), or salt substitutes containing potassium increase the risk of hyperkalemia. Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the antihypertensive effect and increase renal impairment risk. Dual blockade of the renin-angiotensin system with ARBs or aliskiren increases risks of hypotension, hyperkalemia, and renal impairment. Lithium levels may increase with ACE inhibitor coadministration. Antidiabetic agents may potentiate hypoglycemic effects. Gold injections (sodium aurothiomalate) have been associated with nitritoid reactions.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. If it is near the time for the next dose, the missed dose should be skipped and the regular dosing schedule resumed. Doubling the dose to make up for a missed one is not recommended. Consistent daily administration is important for maintaining stable blood pressure control.

Overdose

Overdose may manifest as severe hypotension, which can progress to shock, bradycardia, electrolyte disturbances, and renal failure. Symptoms include dizziness, weakness, syncope, and palpitations. Management involves supportive care, including volume expansion with intravenous normal saline and positioning the patient in Trendelenburg position. Hemodialysis may be effective in removing lisinopril. Vasopressors such as angiotensin II may be considered if necessary. Serum electrolytes and creatinine should be monitored.

Storage

Store at controlled room temperature (20–25°C or 68–77°F), in a tightly closed container, and protect from moisture and light. Keep out of reach of children. Do not use after the expiration date printed on the packaging. Do not store in bathroom cabinets where humidity levels may fluctuate.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and individualized treatment recommendations. Do not initiate, adjust, or discontinue medication without medical supervision. Full prescribing information should be reviewed before use.

Reviews

Clinical trials and meta-analyses consistently demonstrate lisinopril’s efficacy in reducing blood pressure and cardiovascular events. In the SOLVD treatment trial, lisinopril reduced mortality by 16% in heart failure patients. The GISSI-3 trial showed a 11% reduction in 6-week mortality post-MI. Many patients report effective blood pressure control with once-daily convenience, though some discontinue due to cough. Overall, it remains a first-line agent in guidelines worldwide due to its proven benefits in diverse patient populations.