Lisinopril

General

• Type: ACE inhibitor
• Dosage Forms: 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg
• Common Trade Names: Prinivil, Zestril

General information:

• Doses > 40mg/day rarely more effective
• Decreased efficacy as mono therapy in Black patients
• Obtain Chem 10 if starting in ED to assess renal function

Adult Dosing

• Hypertension: 10 - 40mg PO Qday, max 80mg/day
• Occasionally outpatient will prescribe BID dosing of lisinopril for potential continuous BP control (or losartan)
  • 2020 large scale Kaiser study concluded no increased efficacy
  • There is potential for risk for AKI and hyperkalemia with lisinopril, but not losartan -- hypotension was not investigated

Pediatric Dosing

• 6-16 year old: 0.07mg/kg PO qday, max 40mg/day

Special Populations

• Pregnancy Rating: D
• Lactation: Safety unknown
• Renal Dosing
  • Adult: CrCl < 30, start 2.5mg qday, max 40mg q/day
  • Pediatric creatinine Cl 30-50: decrease dose 50%, CrCl < 30, avoid use
• Hepatic Dosing
  • Adult: Not defined
  • Pediatric: Not defined

Contraindications

• Allergy to class/drug
• history of angioedema
• pregnancy
• caution if renal artery stenosis
• caution if severe CHF
• caution if renal impairment

Adverse Reactions

Serious

• angioedema
• hypotension
• hyperkalemia
• renal impairment
• hepatotoxicity
• neutropenia
• pancreatitis
• steven johnson syndrome
• fetal/neonatal harm
• congenital malformations

Common

• dizziness
• elevated Cr
• headache
• diarrhea
• hypotension
• abdominal pain
• hyperkalemia

Pharmacology

• Half-life: 12 hours
• Metabolism: none
• Excretion: urine
• Mechanism of Action: inhibits angiotensin converting enzyme, interferes with conversion of angiotensin 1 to angiotensin 2

See Also

• Hypertension
• ACE inhibitor