Lisinopril

Overview of Lisinopril

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor primarily used for the treatment of hypertension, heart failure, and symptom control after myocardial infarction. This medication works by inhibiting the production of vasoconstrictive substances, leading to vasodilation and reduced blood pressure, thereby improving heart and kidney function.

Lisinopril is also used to delay the progression of kidney disease in diabetic patients, reducing urinary protein and protecting glomerular filtration rate. Its effects are long-lasting and its mechanism of action is unique, requiring continuous use to achieve optimal results; it is not suitable for acute blood pressure control or emergencies.

Brand Names and Generic Name

The generic name for Lisinopril is Lisinopril, with common commercial brands including Prinivil® and Zestril®. Different countries or regions may use different brand names, but the active ingredient remains Lisinopril. Patients should pay attention to the ingredient labeling on the medication box and follow the prescriptions provided by their physicians.

This medication is available in tablet or capsule form, with dosage specifications typically of 5mg, 10mg, 20mg, and 40mg. Patients should confirm the brand and ingredients on the medication packaging during medical visits and regularly return for follow-up to adjust their medication plan.

Drug Classification

Lisinopril is classified as an ACE inhibitor, a class of drugs that blocks the action of angiotensin-converting enzyme, reducing the production of vasoconstrictive substances, promoting vasodilation, and decreasing fluid volume. ACE inhibitors are first-line medications for treating cardiovascular diseases, offering multiple benefits such as reducing cardiac workload and protecting the kidneys.

Compared to other antihypertensive medications, Lisinopril's unique mechanism provides better specificity in treating heart failure and diabetic nephropathy. However, this class of drugs may cause specific side effects such as a dry cough, necessitating differentiation from other categories like calcium channel blockers or beta-blockers.

Indications

The primary indications include:

• Primary hypertension: Used alone or in combination with other medications to control systolic and diastolic blood pressure.
• Heart failure: Improves cardiac pumping function and extends survival.
• Treatment after acute myocardial infarction: Reduces ventricular hypertrophy and improves ventricular function.

Additionally, this medication is also used for:

• Diabetic nephropathy: Slows the decline in glomerular filtration rate.
• Patients with metabolic syndrome and hypertension: Can be used in conjunction with antihyperglycemic medications.

Common Side Effects

Mild side effects include:

• Persistent dry cough (occurring in about 15-20% of patients).
• Dizziness or headache (usually alleviated after adaptation).
• Fatigue or muscle aches.

Severe side effects requiring immediate medical attention:

• Acute renal dysfunction (e.g., significant decrease in urine output).
• Hyperkalemia (which may lead to arrhythmias).
• Angioedema (swelling of the face or throat, which may obstruct the airway).

Warnings and Precautions

Contraindications:

• Use is strictly prohibited in pregnant women during the second and third trimesters, as it may cause fetal malformations or death.
• Contraindicated in patients with bilateral renal artery stenosis, as it may trigger acute renal failure.
• Prohibited for those allergic to ACE inhibitors or any components of the medication.

Special Warnings:

• Concurrent use with diuretics may lead to excessive blood pressure reduction; blood pressure changes should be monitored.
• Diabetic patients should regularly check serum potassium levels.
• Patients undergoing dialysis or on a high-potassium diet may require dosage adjustments.

Drug Interactions

Contraindicated interactions include:

• Direct intra-arterial injection of potassium-rich medications (such as certain contrast agents) may induce hyperkalemia.
• Concurrent use with non-steroidal anti-inflammatory drugs (NSAIDs) may reduce antihypertensive effects.

Interactions to be cautious of:

• When used with potassium supplements or potassium-sparing diuretics (such as spironolactone), serum potassium levels should be closely monitored.
• Combined use with diuretics may induce hypotension; starting with a low dose is recommended.
• When used with antiplatelet medications, bleeding risks should be considered.

Dosing and Administration

General starting doses:

• Hypertension treatment: Once daily 5-10mg, can be adjusted up to a maximum of 40mg.
• Heart failure: Initial dose of 2.5-5mg, gradually increased weekly.

Administration precautions:

• Can be taken on an empty stomach or with food, but should be taken at the same time each day.
• Do not crush or chew the tablets; they should be swallowed whole.
• Older adults or patients with renal impairment may require dosage reduction, following physician instructions.

Missed Dose Management

If a daily dose is missed:

• If close to the next dose time (within 3 hours), skip the missed dose.
• Do not take double doses to make up for the missed dose.

Special situation handling:

• If a dose is missed for more than 12 hours, it can be taken immediately upon realization.
• If close to the next dose time, resume the normal dosing schedule and avoid frequent missed doses.

Overdose Management

Overdose may lead to:

• Severe hypotension (which may cause fainting or shock).
• Hyperkalemia causing arrhythmias.
• Acute deterioration of renal function.

Emergency measures:

• Seek immediate medical attention and bring the medication bottle for reference by healthcare personnel.
• Gastric lavage or activated charcoal may be required.
• Hospitalization may be necessary to monitor blood pressure, electrolytes, and renal function until stabilized.

 

Frequently Asked Questions

Is it necessary to take Lisinopril at the same time every day?

Yes, it is recommended to take it at the same time each day to maintain stable drug efficacy. If you occasionally forget a dose, take it immediately, but if it is close to the next dose time, skip the missed dose to avoid doubling up. Setting reminders or using a pill organizer is advised to aid memory.

What should I do if I experience a cough while taking Lisinopril?

A cough is a common side effect of this medication, possibly due to increased bronchial prostaglandin secretion after the drug inhibits angiotensin-converting enzyme. If the cough persists or affects daily life, consult a physician to assess whether a dosage adjustment or medication change is needed; do not stop the medication on your own to avoid rebound hypertension.

Is it safe to use Lisinopril concurrently with non-steroidal anti-inflammatory drugs (such as ibuprofen)?

It may reduce the antihypertensive effect of Lisinopril and increase the risk of renal dysfunction. If short-term NSAID use is necessary, inform your physician that you are taking Lisinopril and closely monitor blood pressure and renal function. Long-term concurrent use should be evaluated for alternative treatment options.

Do I need to restrict specific foods while taking Lisinopril?

A low-sodium diet is recommended to enhance the antihypertensive effect, but there is no need to specifically restrict protein or fat intake. Be cautious if taking potassium-sparing diuretics to avoid excessive consumption of high-potassium foods (such as bananas, avocados) to prevent hyperkalemia. Excessive alcohol consumption may weaken the drug's efficacy; moderate drinking is advised.

If surgery is needed, should I stop taking Lisinopril?

Before surgery, inform the anesthesiologist that you are taking this medication. Temporary discontinuation of the drug should be evaluated by a physician, as sudden cessation may trigger a hypertensive crisis. If fasting is required for surgery, it can be postponed until after resuming eating. Blood pressure and renal function changes should be monitored after major surgeries, and dosage adjustments may be necessary.