Lisinopril
Mechanism :
Lisinopril is an ACE inhibitor which is used in the treatment of hypertension, congestive heart failure and following myocardial infarction in hemodynamically stable patients.
Indication :
- Hypertension
- Congestive Heart Failure
Contraindications :
In patients who are hypersensitive to this product and in patients with a history of angioneurotic edema relating to previous treatment with an angiotensin converting enzyme inhibitor.
Dosing :
Hypertension:
Above 6 years; GFR <30 ml/minute/1.73 m².
0.07 mg/kg orally once every day initially and doses are increased gradually according to blood pressure levels. Max: 0.61 mg/kg/day or 40 mg/day.
Adverse Effect :
Neutropenia, agranulocytosis, thrombocytopenia, anemia, pancytopenia, rash, pruritus, arthralgia, fever, eosinophilia. Hypotension, angioedema, cough, dizziness, headache, kidney disease.
Interaction :
Diuretics: A precipitous reduction of blood pressure usually within the first hour of receiving the initial dose.
Potassium-Sparing Diuretics such as Spironolactone, Triamterene, or Amiloride: Since it decreases aldosterone production, elevation of serum potassium may occur.
Nonsteroidal Anti-Inflammatory Agents: Reduces the antihypertensive effect.
Lithium: Increased serum lithium levels and symptoms of lithium toxicity.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Initial dose 2.5 mg daily and titrate according to response |
| 10-20 | Initial dose 2.5 mg daily and titrate according to response |
| <10 | Initial dose 2.5 mg daily and titrate according to response |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unknown dialysability. Dose as in GFR<10 mL/min |
| HD | Dialysed. Dose as in GFR<10 mL/ min |
| HDF/High flux | Dialysed. Dose as in GFR<10 mL/ min |
| CAV/VVHD | Unknown dialysability. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
No dose adjustments are recommended.