Lisinopril

Antihypertensive / Heart Failure Drug — ACE Inhibitor

Nigerian brand names:ZestrilTensoprilPrinivilCaraceLisi-Eze

Reviewed by the PMC Medical Team · Promise Medical Centre

Overview

Lisinopril is an ACE (angiotensin-converting enzyme) inhibitor widely used to treat high blood pressure, heart failure, and to protect the kidneys in people with diabetes and chronic kidney disease. It works by blocking the formation of angiotensin II — a hormone that narrows blood vessels — causing blood vessels to relax and blood pressure to fall. Lisinopril also reduces the workload on the heart, making it valuable in heart failure treatment. It has proven benefits in reducing the risk of stroke, heart attack, and kidney disease progression.

Uses

• Hypertension (high blood pressure): first-line treatment, particularly in patients with diabetes or chronic kidney disease • Heart failure: reduces symptoms, hospitalisations, and mortality • After heart attack (myocardial infarction): started within 24 hours to protect the heart muscle • Diabetic nephropathy: slows the progression of kidney damage in people with diabetes • Chronic kidney disease (non-diabetic): also protective in patients with significant protein in urine

How to Use

• Hypertension: typically 5–10 mg once daily, increasing to 20–40 mg as needed • Heart failure: start at 2.5–5 mg, increase slowly under medical supervision • After heart attack: 2.5–5 mg within 24 hours, increasing over several days • Take once daily at the same time each day, with or without food • Blood pressure and kidney function (creatinine, electrolytes) must be checked when starting and when increasing dose • Do not stop lisinopril without consulting your doctor

Side Effects

Common: • Persistent dry cough: the most characteristic side effect; occurs in 10–20% of patients and is more common in people of African descent; if troublesome, the doctor may switch to an ARB (e.g., losartan) • Dizziness, particularly when standing up (postural hypotension): especially in the first few doses or if dehydrated • Headache • Fatigue • Nausea Serious (seek emergency care): • Angioedema: sudden swelling of the face, lips, tongue, or throat causing difficulty breathing; more common in Black patients; a life-threatening emergency; STOP lisinopril permanently • Severe hyperkalaemia (high potassium levels): muscle weakness, palpitations, abnormal heart rhythm • Acute kidney injury: especially with concurrent NSAID use or dehydration

Warnings & Precautions

STOP lisinopril and seek emergency help if you develop swelling of the face, lips, tongue, or throat (angioedema) — this is a life-threatening emergency. • Pregnancy: CONTRAINDICATED in the second and third trimester: can cause severe fetal harm including kidney failure and death; use effective contraception if sexually active while on lisinopril; tell your doctor immediately if you become pregnant • History of angioedema: do not use lisinopril • Severe kidney disease: use with great caution; monitor kidney function closely • High potassium diet (groundnuts, beans, plantain, orange juice) or potassium supplements: increase risk of dangerous potassium levels • Monitor blood pressure carefully with the first dose: can cause a significant drop, especially if on diuretics or dehydrated

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Drug Interactions

• Potassium-sparing diuretics (spironolactone, amiloride) and potassium supplements: risk of dangerous high potassium levels (hyperkalaemia) • NSAIDs (ibuprofen, diclofenac, aspirin): reduce lisinopril's effectiveness AND increase risk of acute kidney injury: a very important interaction in Nigeria where NSAID self-medication is common • Diuretics: enhanced blood pressure lowering: first dose hypotension risk • Lithium: lisinopril increases lithium levels: risk of lithium toxicity • Allopurinol: increased risk of severe allergic reactions • Antidiabetic drugs (insulin, metformin): lisinopril may enhance glucose-lowering effect: monitor blood sugar • Immunosuppressants (e.g., cyclosporine): increased risk of hyperkalaemia

Storage

• Store at room temperature (below 25°C) away from moisture and sunlight • Keep in original packaging; keep out of reach of children

Buy only NAFDAC-registered medications

Nigeria has a significant problem with counterfeit and substandard drugs. Always purchase medications from a licensed pharmacy and check the NAFDAC registration number on the package — verify at nafdac.gov.ng.