Lisinopril

From Anvita Health Wiki

Contents 1 Introduction 2 Indications 3 Dosage 4 Dosage-adjustment-in-renal-failure 5 Pharmacokinetics 6 Adverse-effects 7 Drug-interactions 8 Mechanism-of-action 9 More General Terms 10 Internet Database 11 References

Introduction

• Tradenames: Prinivil, Zestril.

Indications

• hypertension
• heart failure
• post myocardial infarction ( MI)
• migraine prophylaxis [5]

Dosage

• HTN: Start 10 mg PO QD, max 40 mg/day
• CHF: Start 2.5-5 mg PO QD/ BID, max 20-40 mg/day
• MI: Start 5 mg within 24 hours if hemodynamically stable 5 mg 24 hours later, then 10 mg QD

• Tabs: 2.5, 5, 10, 20, 40 mg.

Dosage-adjustment-in-renal-failure

*   creatinine clearance                dosage 
*       10-50 mL/min               50-75% of normal dose 
*        < 10 mL/min               25-50% of normal dose

Pharmacokinetics

• onset of action: 1 hour
• peak hypotensive effect within 6 hours after oral dose
• duration of action 24 hours
• minimal protein binding
• elimination 1/2life

• about 12 hours
• prolonged in patients with renal insufficiency

• 10% of drug is excreted unchanged into the urine
  

• elimination via kidney

Adverse-effects

• infrequent (1-10%)

• dizziness, headache, fatigue, diarrhea, upper respiratory tract symptoms, cough, hypotension, increased BUN & creatinine

• uncommon (< 1%)

• chest discomfort, fever, flushing, malaise, angina pectoris, myocardial infarction, orthostatic hypotension, arrhythmias, tachycardia, peripheral edema, vasculitis, palpitations, pancreatitis, hepatitis, abdominal pain, anorexia, constipation, flatulence, dry mouth, gout, shoulder pain, depression, somnolence, insomnia, bronchitis, sinusitis, pharyngeal pain, urticaria, pruritis, diaphoresis, blurred vision, angioedema, syncope, neutropenia, bone marrow suppression
  

• drug adverse effects of ACE inhibitors

Drug-interactions

• coadministration of K+ sparing diuretics causes increased hyperkalemic effect
• coadministration with NSAIDs causes reduced antihypertensive response
• phenothiazines increase pharmacologic effects of ACE inhibitors
• allopurinol in combination results in high risk of hyper- sensitivity reactions
• lisinopril increases plasma lithium & digoxin levels
  
• drug interaction(s) of renin-angiotensin inhibitors with trimethoprim-sulfamethoxazole
• drug interaction(s) of lithium carbonate with ACE inhibitors
• drug interaction(s) of ACE inhibitors with aliskiren
• drug interaction(s) of ACE inhibitors with angiotensin II receptor antagonists
• drug interaction(s) of potassium chloride with ACE inhibitors
• drug interaction(s) of spironolactone with ACE inhibitors
• drug interaction(s) of diuretics with ACE inhibitors
• drug interaction(s) of beta blockers with ACE inhibitors
• drug interaction(s) of NSAIDs with ACE inhibitors
• drug interaction(s) of ACE inhibitors, angiotensin II receptor antagonists & beta-blockers
• drug interaction(s) of NSAIDs, diuretics & ACE inhibitors

Mechanism-of-action

• dicarocyl-containing ACE inhibitor
• inhibits conversion of angiotensin I to angiotensin II
• inhibits degradation of bradykinin

More General Terms

• pyrrolidine; tetrahydropyrrole
• amide
• amine
• carboxylic acid
• angiotensin-converting enzyme [ACE] inhibitor

Internet Database

PubChem: 55186
PubChem: 55187
PubChem: 3937

References

1. Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1990. pg 760-1
2. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
4. Kaiser Permanente Northern California Regional Drug Formulary, 1998
5. Journal Watch 23(4):34, 2003 BMJ 322:19, 2001

lisinopril (Prinivil, Zestril)