Lisinopril

General

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

General information:

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

Adult Dosing

• HTN: 10 - 40 mg PO Qday, max 80 mg/day

Pediatric Dosing

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

Special Populations

• Pregnancy Rating: D
• Lactation: Safety unknown
• Renal Dosing
  • Adult: CrCl < 30, start 2.5 mg qday, max 40 mg q/day
  • Pediatric Cr 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