Names and pronunciation
(lyse-in′oh-pril) Prinivil, Qbrelis
Source page 798
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Individual generic drug information
Extracted information for lisinopril only.
(lyse-in′oh-pril) Prinivil, Qbrelis
Source page 798
Func. class.: Antihypertensive, angiotensin-converting enzyme 1 (ACE) inhibitor
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Chem. class.: Enalaprilat lysine analog
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Do not confuse: lisinopril/RisperDAL/Lipitor Prinivil/Plendil/Proventil/PriLOSEC
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ACTION: Selectively suppresses renin- angiotensin-aldosterone system; inhibits ACE, thereby preventing conversion of angiotensin I to angiotensin II
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USES: Mild to moderate hypertension, adjunctive therapy of systolic HF, acute MI
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Unlabeled uses: Diabetic retinopathy, proteinuria, post MI
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Extracted information for lisinopril only.
CONTRAINDICATIONS: Hyper- sensitivity, angioedema
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Black Box Warning: Pregnancy Precautions: Breastfeeding, renal dis- ease, hyperkalemia, renal artery stenosis, HF, aortic stenosis Black Box Warning: Pregnancy/breast- feeding: to report if pregnancy is planned or suspected; not to breastfeed
Source pages 798, 800
SIDE EFFECTS CNS: Vertigo, depression, stroke, insom- nia, paresthesias, headache, fatigue, asthenia, dizziness CV: Chest pain, hypotension, sinus tachycardia EENT: Blurred vision, nasal congestion GI: Nausea, vomiting, anorexia, constipa- tion, flatulence, GI irritation, diarrhea, hepatic failure, hepatic necrosis, pancreatitis GU: Proteinuria, renal insufficiency, sex- ual dysfunction, impotence HEMA: Neutropenia, agranulocytosis INTEG: Rash, pruritus MISC: Muscle cramps, hyperkalemia RESP: Dry cough, dyspnea SYST: Angioedema, anaphylaxis, toxic epidermal necrolysis
Source page 799
INTERACTIONS Increase: hyperkalemia—potassium salt substitutes, potassium-sparing diuretics, potassium supplements, cycloSPORINE Increase: possible toxicity—lithium Increase: hypotensive effect—diuretics, other antihypertensives, probenecid, phenothiazines, nitrates, acute alcohol ingestion Increase: hypersensitivity—allopurinol Decrease: lisinopril effects—aspirin, indomethacin, NSAIDs; dose may need adjustment Drug/Food • High-potassium diet (bananas, orange juice, avocados, nuts, spinach) should be avoided; hyperkalemia may occur; moni- tor potassium levels Drug/Lab Test Interference: glucose/insulin tolerance tests, LFTs, BUN, creatinine Drug/Herb Increase: hypotensive effect—garlic Increase: hypotensive effect—black licorice L
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TREATMENT OF OVERDOSE: Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure
Source page 800
Extracted information for lisinopril only.
DOSAGE AND ROUTES Hypertension • Adult: PO initially 10 mg, 10-40 mg/ day; max 80 mg/day • Child ≥6 yr: PO 0.07 mg/kg/day up to 5 mg/day; titrate q1-2wk up to 0.6 mg/ kg/day or 40 mg/day • Geriatric: PO 2.5-5 mg/day, increase q7days Heart failure • Adult: PO 5 mg/day, increase if needed max 40 mg/day in hypernatremia of <130 mEqL or creatinine >3 mg/dL or CCr <30 mL/min, 2.5 mg/day initially Acute myocardial infarction • Adult: PO give 5 mg within 24 hr of onset of symptoms, then 5 mg after 24 hr, 10 mg after 48 hr, then 10 mg daily Renal dose • Adult: PO CCr <30 mL/min, reduce dose by 50%, initially 5 mg/day, max 40 mg/ day; CCr <10 mL/min, 2.5 mg/day, max 40 mg/day
Source pages 798, 799
Available forms: Tabs 2.5, 5, 10, 20, 30, 40 mg
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Administer: • Severe hypotension may occur after 1st dose of product; may be prevented by reducing or discontinuing diuretic ther- apy 3 days before beginning lisinopril therapy • Without regard to food
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Extracted information for lisinopril only.
Assess: • Heart failure: edema in feet, legs daily; weight daily; dyspnea, wet crackles • Skin turgor, dryness of mucous mem- branes for hydration status • Acute MI: can be used in combination with salicylates, β blockers, throm bolytics • Hypertension: B/P, pulse q4hr during beginning treatment and periodically; black patients should take in combina- tion with diuretics thereafter; note rate, rhythm, quality; apical/pedal pulse be- fore administration; notify prescriber of any significant changes • Blood studies, platelets; WBC with dif ferential at baseline, periodically q3mo; if neutrophils <1000/mm3, discontinue treatment (recommended with collagen- vascular disease) • Baselines of renal, hepatic studies be- fore therapy begins, periodically; LFTs, uric acid, glucose may be increased • Angioedema, anaphylaxis, toxic epi- dermal necrolysis: facial swelling, dys pnea, tongue swelling (rare); have emer gency equipment nearby; may be more common in black patients • Electrolytes: potassium, sodium, chlorine Black Box Warning: Pregnancy/ breastfeeding: assess pregnancy, breastfeeding status before giving this product; if pregnant, do not use; do not breastfeed
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Evaluate: • Therapeutic response: decreased B/P, HF symptoms
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to discontinue product abruptly; to taper • To rise slowly to sitting or standing position to minimize orthostatic hypo- tension • To avoid increasing potassium in the diet • To report dry cough
Source page 800
Extracted information for lisinopril only.
PHARMACOKINETICS Onset 1 hr, peak 6-8 hr, duration 24 hr, excreted unchanged in urine, half-life 12 hr
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Filter the extracted dose blocks for this individual drug.
Hypertension
• Adult: PO initially 10 mg, 10-40 mg/ day; max 80 mg/day
Candidate age grouping · source pages 798, 799
Hypertension
• Child ≥6 yr: PO 0.07 mg/kg/day up to 5 mg/day; titrate q1-2wk up to 0.6 mg/ kg/day or 40 mg/day
Candidate age grouping · source pages 798, 799
Hypertension
• Geriatric: PO 2.5-5 mg/day, increase q7days Heart failure
Candidate age grouping · source pages 798, 799
Hypertension
• Adult: PO 5 mg/day, increase if needed max 40 mg/day in hypernatremia of <130 mEqL or creatinine >3 mg/dL or CCr <30 mL/min, 2.5 mg/day initially Acute myocardial infarction
Candidate age grouping · source pages 798, 799
Hypertension
• Adult: PO give 5 mg within 24 hr of onset of symptoms, then 5 mg after 24 hr, 10 mg after 48 hr, then 10 mg daily Renal dose
Candidate age grouping · source pages 798, 799
Hypertension
• Adult: PO CCr <30 mL/min, reduce dose by 50%, initially 5 mg/day, max 40 mg/ day; CCr <10 mL/min, 2.5 mg/day, max 40 mg/day
Candidate age grouping · source pages 798, 799