Lisinopril

Lisinopril

Lisinopril side effects are thankfully uncommon, with cough being the most common Lisinopril side effect. This article will guide you through what you need to know about Lisinopril and review both the common and the serious Lisionopril side effects. The trade names for Lisinopril are Prinivil and Zestril. Lisinopril is a medication used for the treatment of hypertension. It is also used for reduction of complications post myocardial infarction as well as for treatment of congestive heart failure. Lisinopril can also be used as a preventative medication to avoid the development or progression of nephropathy in patients with diabetes mellitus.   Lisinopril is available in 5, 10, 20, and 40 mg and the maximum daily dose is 80 mg, although doses over 40 mg are usually not more effective than the 40 mg dose. Lisinopril is also available in fixed combination pills with hydrochlorothiazide at lisinopril –HCTZ 10-12. 5, 20-12.5 and 20-25 mg pills.

Black Box Warnings: Lisinopril is absolutely contraindicated in pregnancy, and may cause increased morbidity and mortality in infants. Lisinopril users should stop lisinopril use immediately on diagnosis of pregnancy, and lisinopril should be used with caution in women of child bearing age.  (see manufacturer labeling for details)

Common Lisinopril Side Effects: The most common side effect of all of the ACE inhibitor medications including Lisinopril is an annoying persistent cough.  This resolves if the medication is stopped, but can take weeks or months to completely go away.  This cough is felt to happen because the area where angiotensin 1 is converted into angiotensin 2, and the area where lisinopril and the other ACE inhibitors have their primary effect is in the lung. Other common Lisinopril side effects include those related to low blood pressure like lightheadedness and dizziness and severe hypotension.  Patients may also experience diarrhea, headache, fatigue, abdominal pain, photosensitivity, and elevated serum potassium levels.

Serious Lisinopril Side Effects: Relatively common and potentially serious Lisinopril side effects are swelling of the lips, mouth or airway called angioedema.  Angioedema may also occur in the bowel, and severe allergic reactions can occur.  Elevated potassium, hyperkalemia, can occur and lead to cardiac arrhythmia and death.  Renal impairment can occur, most often in patients with preexisting obstruction of one or both renal arteries. Bone marrow dysfunction with agranulocytosis, neutropenia, as well as liver toxicity, pancreatitis, and  SIADH (syndrome of inappropriate anti-duretic hormone) can occur as Lisinopril side effects.  Use in pregnancy can lead to oligohydramnios, fetal harm and death, and major fetal abnormalities if used in the first trimester of pregnancy.

When  cough occurs medications in the Angiotensin Receptor Blocker (ARB) class of medications can often be substituted for the Lisinopril and resolution of the cough is expected.  Reevaluation of renal function after initiation of Lisinopril is usually recommended to assure there is not a significant reduction of renal function.

Contraindications, Cautions and Drug Interactions: Lisinopril use is contraindicated in patients with a prior history of an ACE inhibitor angioedema, as well as in patients with hereditary angioedema. As mentioned above lisinopril is absolutely contraindicated in pregnancy.  Caution needs to be used in institution of lisinopril in patients with volume depletion (dehydration). Careful monitoring of renal function is needed in patients with renal dysfunction, although lisinopril is often used by nephrologists to avoid further renal insufficiency. Drug interactions primarily relate to cumulative Lisinopril side effects.  Use with an ARB medication can lead to hyperkalemia, and although the drugs can be used together, this needs monitoring.  Azothiaprine and lithium have specific drug interaction issues.  Non-steroidal anti-inflammatory medications can reduce the effectiveness of the ACE inhibitors, and are best avoided or monitored.  See the manufacturer prescribing information for the long list of medications to consider, but most other medications can be used with appropriate monitoring.  Some herbal medications and supplements have potential interaction with lisinopril and include  black kohash and kava.

Pregnancy and Lactation Class: Pregnancy Category C in the first trimester, but class D in the second and third trimesters. The safety of lactation for pregnant women is unknown.

Pharmacology: One nice advantage of lisionopril is that it has essentially no hepatic metabolism, so has no CYP450 precautions.  Lisinopril is nearly 100% excreted in the urine.

Special Considerations: Avoidance of use in pregnancy is very important. Careful initiation in patients already on a diuretic or who may be dehydrated is needed to avoid severe drops in blood pressure.

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