LISINOPRIL

Indications & Dose:

• BY MOUTH

Adult

Hypertension

initially 2.5 mg daily; usual maintenance dose 10-20 mg daily; max. 40 mg daily. Note: In hypertension discontinue diuretic for 2-3 days before hand and resume later if required. Heart Failure: (adjunct) initially 2.5 mg daily under close medical supervision; usual main- tenance dose 5-20 mg daily.

CHF:

PO 2.5 mg qd; usual dosage range 5-20 mg/day

Acute MI:

PO in hemodynamically stable patients within 24 hr of acute MI, 5 mg followed by 5 mg after 24 hr, 10 mg after 48 hr, then 10 nag qd; continue for 6 wk (or longer if concurrent hypertension or CHF)

Prophylaxis after myocardial infraction

Systelic blood pressure over 120mgHg, 5mg within 24 hour followed by further 5mg 24 hour later, then 10mg after a further 24 hour and continuing with 10mg once daily for 6 weekes, systelic blood pressure 100-120mgHg, initially 2.5mg once daily increased to maintainance dose of 5mg once daily..

Diabetic Nephropathy 

Initially 2.5mg once daily, adjusted according to response., usual dose range 10-20mg once daily.

Nephropathy (proteinuria):

PO 5 to 20 mg qd; (dose titration maximal response is required)

Renal impairment:

PO initial dose 5 mg qd (serum creatinine >3 mg/ dl); initial dose 2.5 mg qd (dialysis patients)

Children

Not recommended

Contraindications:

Children, aortic steno-sis, outflow obstruction, hypersensitivity. Pregnancy. 

Side Effects:

CNS: Anxiety, dizziness, fatigue, headache, insomnia, paresthesia

CV: Angina, hypotension, palpitations, postural hypotension, syncope (especially with 1st dose)

GI: Abdominal pain, constipation, melena, nausea, vomiting

GU: Acute renal failure, decreased libido, impotence, increased BUN, creatinine

HEME: Agranulocytosis, neutropenia

METAB: Hyperkalemia, hyponatremia

MS: Arthralgia, arthritis, myalgia

RESP: Asthma, bronchitis, rough, dyspnea, sinusitis

SKIN: Angioedema; flushing, rash, sweating

Cautions:

Precautions:

Renal insufficiency (<30 ml/min), hypotension (CHF, elderly, volume depletion diuretics, dialysis, cirrhosis), aortic stenosis, hyperkalemia (potassium supplements, potassium sparing diuretics, renal disease, diabetes), neutropenia (autoimmune diseases, collagen vascular, febrile illness, immunosuppressant drug therapy), proteinuria, renal artery stenosis, surgery/ anesthesia (excessive hypotension, correctable with fluids).

Breast-feeding: Use with caution.

Old age: May be used in reduced dose.

Interaction:

Drugs

 Allopurinol: Predisposition to hypersensitivity reactions to ACE inhibitors

Aspirin, NSAIDs: Inhibition of the antihypertensive response to ACE inhibitors

Azathioprine: Increased myelosuppression

Insulin: Enhanced insulin sensitivity

Lithium: Increased risk of serious lithium toxicity

Loop diuretics: Initiation of ACE inhibitor therapy in the presence of intensive diuretic therapy results in a precipitous fall in blood pressure in some patients; ACE inhibitors may induce renal insufficiency in the presence of diuretic-induced sodium depletion

Potassium-sparing diuretics: Increased risk for hyperkalemia

Prazosin, terazosin, doxazosin: Exaggerated first-dose hypotensive response to α-blockers

Trimethoprim: Additive risk of hypercalcemia, especially in patient predisposed to renal insufficiency

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: