Lisinopril

Pronunciation

Lisinopril 10mg

Lisinopril 20mg

Lisinopril 5mg

Generic Name:	Lisinopril
Class:	Cardiovascular Drug
Subclass:	ACE inhibitors
Legal Classification:	P1S1S3

Drug Names

Generic Name 藥物化學名稱	HA Code 藥物代碼	Legal Classification法律藥物分類	Brand Name 藥名
Lisinorpil Tablet 5mg	LISI01	P1S1S3	ZESTRIL
Lisinorpil Tablet 10mg	LISI02	P1S1S3
Lisinorpil Tablet 20mg	LISI03	P1S1S

Mechanism of Action

Lisinopril is an inhibitor of angiotensin-I converting enzyme (ACE inhibitor). The beneficial effects of ACE inhibitors appear to result primarily from the suppression of the plasma renin-angiotensin-aldosterone system. Renin is synthesized by the kidneys and released into the circulation where it converts angiotensinogen to angiotensin-I. Angiotensin-I is then converted by angiotensin converting enzyme to angiotensin-II. Angiotensin-II is a potent vasoconstrictor responsible for arterial vasoconstriction and increased blood pressure, as well as for stimulation of the adrenal gland to secrete aldosterone. Inhibition of ACE results in decreased plasma angiotensin-II, which leads to decreased vasopressor activity and to reduced aldosterone secretion. The latter decrease may result in an increase in serum potassium concentration. Lisinopril is used in the treatment of hypertension and heart failure. It also improves your survival if you are taking it after a recent heart attack of for heart failure. It works by widening your blood vessels and making it easier for your heart to pump blood around your body. It can also be used for diabetic kidney disease, to slow down the disease.

Lisinopril comes as tablet.

Route of Administration

Lisinopril is administered orally in a single daily dose. The absorption of Lisinopril tablet is not affected by food.

Dosage

Hypertension

Adult: initially 10 mg once daily; maintenance 20 mg once daily; maximum 80 mg/day.

Heart failure

Adult: initially 2.5 mg once daily, increased in steps of up to 10 mg at least every 2 weeks; maximum 35 mg per day if tolerated.

Diabetic kidney disease 10 mg to 20 mg once daily

The antihypertensive effects of lisinopril are seen within 1 to 2 hours of a single oral dose and the maximum effect occurs after about 6 hours, although the full effect may not develop for several weeks during chronic dosing.

The haemodynamic action lasts for about 24 hours after once-daily dosing.

Side Effects

System Organ Class	Frequency	Adverse reactions
Nervous system disorders	Common	Dizziness, headache,
	Uncommon	Confusion, sleep disturbances
Respiratory disorders	Common	Dry, itickly (non-productive) cough, dyspnoea
Skin disorders	Uncommon	Itching or a mild skin rash
	rare	Alopecia, oedema of the face, extremities, lips, tongue, glottis, and/or larynx
Gastro-intestinal disorders	Common	vomiting, diarrhoea
	Uncommon	Nausea, abdominal pain and indigestion
	Rare	Dry mouth
	Very rare	Glossitis, pancreatitis
Cardiac disorders	UnCommon	Palpitations, tachycardia
Vascular disorder	common	Hypotension
	Uncommon	Raynaud’s syndrome

Pharmacokinetics

Following oral administration of lisinopril, peak serum concentrations occur within about 7 hours, although there was a trend to a small delay in time taken to reach peak serum concentrations in acute myocardial infarction patients. Lisinopril absorption is not affected by the presence of food. Lisinopril does not undergo metabolism and is excreted entirely unchanged into the urine. On multiple dosing lisinopril has an effective half-life of 12.6 hours. The clearance of lisinopril in healthy subjects is approximately 50 ml/min.

Renal impairment

Impaired renal function decreases elimination of lisinopril, which is excreted via the kidneys, but this decrease becomes clinically important only when the glomerular filtration rate is below 30 ml/min.

Efficiency:

Safety: Your very first dose may make you feel dizzy, so it is best to take it at bedtime. After the first dose, if you do not feel dizzy, you can take lisinopril at any time of day. Try to take it at the same time every day.

PREGNANCY should be avoided in pregnancy unless essential.

BREAST FEEDING avoid in the few weeks after delivery, particularly in preterm infants – risk of profound neonatal hypotension; can be used in mothers breast-feeding older infants if essential.

RENAL IMPAIRMENT

Max. initial doses 5-10 mg daily if eGFR 31-80 ml/minute/1.73 m2 (max. 40mg daily)

2.5 – 5 mg daily if eGFR 10-30 ml/minute/1.73 m2 (max. 40 mg daily)

2.5 mg daily if eGFR < 10 ml/minute/1.73 m2

MONITORING REQUIREMENTS

Renal function and electrolytes should be checked before starting ACE inhibitors (or increasing the dose) and monitored during treatment (more frequently if side effects mentioned are present).

Drug Interaction:

Diuretics: prior treatment with high dose diuretics may result in volume depletion and a risk of hypotension when initiating therapy with Lisinopril.

Potassium sparing diuretics (triamterene, amiloride and spironolactone) or potassium supplement: may cause significant increase in serum potassium.

Caution:

• Concomitant diuretics – first dose hypotension (especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated , or with heart failure)
• Use with care in those with a history of angioedema
• Use with care in patients with severe or symptomatic aortic stenosis (risk of hypotension)

FAQ

How should I take the tablet?

Your doctor may advise you to take your first dose before bedtime, because it can make you dizzy. After the first dose, if you do not feel dizzy, you can take the tablet at any time of day. Try to take it at the same time every day. You can take lisinopril with or without food. Swallow the tablet whole with a drink of water.

What should I avoid while taking?

Should avoid potassium rich foods: lisinopril has the capacity to increase potassium level in the blood. High levels of potassium can lead to irregular heartbeat. It is better to avoid potassium-rich foods like bananas.

What happen if I miss a dose?

If you forget to take a dose and you usually take lisinopril

• Once a day – take it as soon as you remember unless it is less than 12 hours until your next dose. In this case leave out the missed dose and take your next dose at the usual time

Never take 2 doses to make up for a forgotten one.