Drug Name
Generic Name : lisinopril
Brand Name: Apo-Lisinopril (CAN), Prinivil, Zestril
Classification: Antihypertensive, ACE inhibitor
Pregnancy Category C (first trimester)
Pregnancy Category D (second and third trimesters)
Dosage & Route
ADULTS NOT TAKING DIURETICS
- Initial dose, 10 mg/day PO. Adjust dosage based on response. Usual range is 20–40 mg/day as a single dose.
ADULTS TAKING DIURETICS
- Discontinue diuretic for 2–3 days. If it is not possible to discontinue, give initial dose of 5 mg, and monitor for excessive hypotension.
- CHF: 5 mg PO daily with diuretics and digitalis. Effective range: 5–20 mg/day.
- Acute MI: Start within 24 hr of MI with 5 mg PO followed in 24 hr by 5 mg PO; 10 mg PO after 48 hr, then 10 mg PO daily for 6 wk.
PEDIATRIC PATIENTS > 10 YR
- Usual starting dose is 0.07 mg/kg once daily up to 5 mg total.
PEDIATRIC PATIENTS < 6 YR
- Safety and efficacy not established; drug usually not recommended.
GERIATRIC PATIENTS AND PATIENTS WITH RENAL IMPAIRMENT
- Excretion is reduced in renal failure. Use smaller initial dose, and adjust upward to a maximum of 40 mg/day PO.
Therapeutic actions
- Lisinopril competitively inhibits angiotensin-converting enzyme (ACE) from converting angiotensin I to angiotensin II resulting in decreased levels of angiotensin II (a potent vasoconstrictor). This increases plasma renin activity and reduces aldosterone secretion. It also increases bradykinin levels.
Indications
- Treatment of hypertension alone or in combination with thiazide-type diuretics
- Adjunctive therapy in CHF for patients unresponsive to diuretics and digitalis alone
- Treatment of stable patients within 24 hr of acute MI to improve survival with beta blocker, aspirin, or thrombolytics
Adverse effects
- Dizziness, headache, fatigue; cough, upper respiratory tract infection; rash; diarrhoea, nausea, vomiting, abdominal pain; chest pain, weakness; orthostatic effects; hypotension; hyperkalaemia; impotence; decreased haemoglobin; increased serum creatinine.
- Potentially Fatal: Severe hypotension, angioedema.
Contraindications
- History of angioedema related to previous treatment with ACE inhibitors, hereditary or idiopathic angioedema. Bilateral renal artery stenosis. Pregnancy (2nd or 3rd trimester), lactation.
Nursing considerations
Assessment
- History: Allergy to lisinopril or enalapril, impaired renal function, CHF, salt or volume depletion, lactation, pregnancy
- Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, LFTs, renal function tests, CBC and differential
Interventions
- Begin drug within 24 hr of acute MI; ensure that patient is also receiving standard treatment (eg, aspirin, beta-adrenergic blockers, thrombolytics).
- WARNING: Keep epinephrine readily available in case of angioedema of the face or neck region; if breathing difficulty occurs, consult physician, and administer epinephrine.
- WARNING: Alert surgeon, and mark patient’s chart with notice that lisinopril is being taken. The angiotensin II formation subsequent to compensatory renin release during surgery will be blocked. Hypotension may be reversed with volume expansion.
- Monitor patients on diuretic therapy for excessive hypotension following the first few doses of lisinopril.
- Monitor patients closely in any situation that may lead to a decrease in BP secondary to reduction in fluid volume (excessive perspiration and dehydration, vomiting, diarrhea) because excessive hypotension may occur.
- Arrange for reduced dosage in patients with impaired renal function.
- BLACK BOX WARNING: Suggest the use of contraceptives; if pregnancy should occur, discontinue drug as soon as possible.
Teaching points
- Take this drug once a day. It may be taken with meals. Do not stop taking without consulting your health care provider.
- Be careful with any conditions that may lead to a drop in blood pressure (such as diarrhea, sweating, vomiting, dehydration). If light-headedness or dizziness occurs, consult your health care provider.
- Do not take this drug during pregnancy; use of contraceptive measures is advised.
- You may experience these side effects: GI upset, loss of appetite, change in taste perception (may be transient; take with meals); rash; fast heart rate; dizziness, light-headedness (transient; change position slowly, and limit activities to those that do not require alertness and precision); headache, fatigue, sleeplessness.
- Report mouth sores; sore throat; fever; chills; swelling of the hands or feet; irregular heartbeat; chest pains; swelling of the face, eyes, lips, or tongue; and difficulty breathing.