Lisinopril 20 mg tablet side effects: Side effects of lisinopril – NHS

21.09.202305.07.2023 by alexxlab

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Side effects of lisinopril – NHS

Like all medicines, lisinopril can cause side effects in some people, but many people have no side effects or only minor ones.

Common side effects

These common side effects of lisinopril happen in more than 1 in 100 people. Talk to your doctor or pharmacist if these side effects bother you or do not go away:

A dry, tickly cough that does not get better

Cough medicines do not usually help for coughs caused by lisinopril, and sometimes the cough gets better on its own. Talk to your doctor if it bothers you or stops you sleeping, as another medicine may be better. Even if you stop taking lisinopril, the cough may take up to a month to go away.

Feeling dizzy or lightheaded, especially when you stand up or sit up quickly

This is more likely to happen when you start taking lisinopril or move on to a higher dose. If lisinopril makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so you do not faint, then sit until you feel better.

Do not drive, rike a bike or operate tools or machinery until the dizziness passes. GOV.UK has more information on the law on drugs and driving.

Headaches

Make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headaches last longer than a week or are severe.

Being sick (vomiting)

Take small, frequent sips of fluids, such as water or squash, to prevent dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee.

Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor first.

If you take contraceptive pills and you’re being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

If you get vomiting from a stomach bug or illness, tell your doctor. You may need to stop taking lisinopril for a while until you feel better.

Diarrhoea

Drink plenty of fluids, such as water or squash, to prevent dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee.

Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor first.

If you take contraceptive pills and you have severe diarrhoea, your contraception may not protect you from pregnancy. Check the pill packet for advice.

If you get diarrhoea from a stomach bug or illness, tell your doctor. You may need to stop taking lisinopril for a while until you feel better.

Itching or a mild skin rash

It may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.

Blurred vision

Do not drive, ride a bike or use tools or machinery while this is happening. If it lasts for more than a day or two, speak to your doctor as they may need to change your treatment.

Serious side effects

It happens rarely, but some people may have serious side effects when taking lisinopril.

Call a doctor or contact 111 straight away if:

the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin – this can be a sign of liver problems
you’re paler than usual, feel tired, faint or dizzy, have any sign of bleeding (for example bleeding from the gums or bruising more easily than usual), a sore throat, a fever, or you get infections more easily – these can be signs of a blood or bone marrow disorder
you have severe stomach pain – this can be a sign of an inflamed pancreas (acute pancreatitis)
you have swollen ankles or blood in your pee or you’re not peeing at all – these can be signs of kidney problems

Go to 111. nhs.uk or call 111.

Immediate action required: Call 999 or go to A&E now if:

you have weakness on one side of your body, trouble speaking or thinking, loss of balance or blurred eyesight – these can be signs of a stroke
you have a faster heart rate, chest pain and tightness in your chest – these can be signs of heart problems
you have shortness of breath, wheezing and tightening of the chest – these can be signs of lung problems

Find your nearest A&E

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to lisinopril.

Immediate action required: Call 999 or go to A&E now if:

you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
you’re wheezing
you get tightness in the chest or throat
you have trouble breathing or talking
your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

Long term side effects

Taking lisinopril for a long time can sometimes cause your kidneys to not work as well as they should. Your doctor will check how well your kidneys are working with regular blood tests.

Other side effects

These are not all the side effects of lisinopril. For a full list, see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

Page last reviewed: 17 December 2021

Next review due: 17 December 2024

Lisinopril Uses, Dosage, Side Effects & Warnings

Generic name: lisinopril [ lyse-IN-oh-pril ]
Brand names: Prinivil, Qbrelis, Zestril
Dosage forms: oral solution (1 mg/mL), oral tablet (10 mg; 2. 5 mg; 20 mg; 30 mg; 40 mg; 5 mg)
Drug class: Angiotensin Converting Enzyme Inhibitors

Medically reviewed by Sanjai Sinha, MD. Last updated on May 2, 2023.

What is lisinopril?

Lisinopril is an ACE inhibitor. ACE stands for angiotensin converting enzyme.

Lisinopril is used to treat high blood pressure (hypertension) in adults and children who are at least 6 years old.

Lisinopril is also used to treat congestive heart failure in adults, or to improve survival after a heart attack.

Warnings

Do not use lisinopril if you are pregnant. It could harm the unborn baby. Stop using this medicine and tell your doctor right away if you become pregnant.

You should not use this medicine if you have ever had angioedema. Do not take lisinopril within 36 hours before or after taking medicine that contains sacubitril (such as Entresto).

If you have diabetes, do not use lisinopril together with any medication that contains aliskiren (such as Amturnide, Tekturna, Tekamlo).

You may also need to avoid taking lisinopril with aliskiren if you have kidney disease.

Before taking this medicine

You should not use lisinopril if you are allergic to it, or if you:

have a history of angioedema;
recently took a heart medicine called sacubitril; or
are allergic to any other ACE inhibitor, such as benazepril, captopril, enalapril, fosinopril, moexipril, perindopril, quinapril, ramipril, or trandolapril.

Do not take lisinopril within 36 hours before or after taking medicine that contains sacubitril (such as Entresto).

If you have diabetes, do not use lisinopril together with any medication that contains aliskiren (such as Tekturna or Tekamlo).

You may also need to avoid taking lisinopril with aliskiren if you have kidney disease.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

Do not use lisinopril if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away. This medicine can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control while taking this medicine.

It is not known whether lisinopril passes into breast milk or if it could harm a nursing baby. You should not breastfeed while using this medicine.

How should I take lisinopril?

Take lisinopril exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Drink plenty of water each day while you are taking this medicine.

Lisinopril can be taken with or without food.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Your blood pressure will need to be checked often. Your kidney function and electrolytes may also need to be checked.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking this medicine. This can lead to very low blood pressure, electrolyte disorders, or kidney failure while you are taking lisinopril.

If you need surgery, tell the surgeon ahead of time that you are using lisinopril.

If you have high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Store at room temperature away from moisture and heat. Do not freeze the oral liquid.

Dosing information

Usual Adult Dose for Hypertension:

Initial dose: 10 mg orally once a day; 5 mg orally once a day
Maintenance dose: 20 to 40 mg orally once a day
Maximum dose: 80 mg orally once a day

Comments:
-The initial dose is 5 mg orally once a day in patients receiving a diuretic.
-The 80 mg dose is used but does not appear to give greater effect.
-If blood pressure is not controlled with lisinopril alone, a low dose of a diuretic may be added (e.g., hydrochlorothiazide, 12.5 mg). After the addition of a diuretic, it may be possible to reduce the dose of lisinopril.

Usual Adult Dose for Congestive Heart Failure:

Initial dose: 2.5 to 5 mg orally once a day
Maintenance dose: Dosage should be increased as tolerated
Maximum dose: 40 mg orally once a day

Comments:
-The diuretic dose may need to be adjusted to help minimize hypovolemia, which may contribute to hypotension. The appearance of hypotension after the initial dose of lisinopril does not preclude subsequent careful dose titration with the drug.

Usual Adult Dose for Myocardial Infarction:

Initial dose: 5 mg orally (within 24 hours of the onset of acute myocardial infarction)
Subsequent doses: 5 mg orally after 24 hours, then 10 mg orally after 48 hours.
Maintenance dose: 10 mg orally once a day. Dosing should continue for at least 6 weeks.

Comments:
-Therapy should be initiated at 2.5 mg in patients with a low systolic blood pressure (less than or equal to 120 mm Hg and greater than 100 mmHg) during the first 3 days after the infarct. If prolonged hypotension occurs (systolic blood pressure less than 90 mmHg for more than 1 hour) therapy should be withdrawn.

Usual Adult Dose for Diabetic Nephropathy:

Initial dose: 10 to 20 mg orally once a day
Maintenance dose: 20 to 40 mg orally once a day
Dosage may be titrated upward every 3 days

Comments:
-Not an approved indication.

Usual Geriatric Dose for Hypertension:

Initial dose: 2.5 to 5 mg orally once a day
Maintenance dose: Dosages should be increased at 2.5 mg to 5 mg per day at 1 to 2 week intervals.
Maximum dose: 40 mg orally once a day

Usual Pediatric Dose for Hypertension:

Pediatric patients greater than or equal to 6 years of age:
Initial dose: 0. 07 mg/kg orally once a day (Maximum initial dose is 5 mg once a day)
Maintenance dose: Dosage should be adjusted according to blood pressure response at 1 to 2 week intervals.
Maximum dose: Doses above 0.61 mg/kg or greater than 40 mg have not been studied in pediatric patients

Comments:
-This drug is not recommended in pediatric patients less than 6 years old or in pediatric patients with glomerular filtration rate less than 30 mL/min.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What to avoid

Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Lisinopril can decrease sweating and you may be more prone to heat stroke.

Do not use potassium supplements or salt substitutes while taking this medicine, unless your doctor has told you to.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Lisinopril side effects

Get emergency medical help if you have signs of an allergic reaction to lisinopril: hives; severe stomach pain, difficult breathing; swelling of your face, lips, tongue, or throat. You may be more likely to have an allergic reaction if you are African-American.

Lisinopril may cause serious side effects. Call your doctor at once if you have:

a light-headed feeling, like you might pass out;
fever, sore throat;
high potassium – nausea, weakness, tingly feeling, chest pain, irregular heartbeats, loss of movement;
kidney problems – little or no urination, swelling in your feet or ankles, feeling tired or short of breath; or
>liver problems – nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Common side effects of lisinopril may include:

headache;
dizziness;
cough; or
chest pain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect lisinopril?

Tell your doctor about all your current medicines and any you start or stop using, especially:

a diuretic or “water pill”;
lithium;
gold injections to treat arthritis;
insulin or oral diabetes medicine;
a potassium supplement;
medicine to prevent organ transplant rejection – everolimus, sirolimus, tacrolimus, temsirolimus; or
NSAIDs (nonsteroidal anti-inflammatory drugs) – aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

This list is not complete. Other drugs may interact with lisinopril, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Popular FAQ

Lisinopril, a commonly prescribed angiotensin converting enzyme (ACE) inhibitor, does not lead to any measurable weight gain or weight loss based on clinical studies conducted by the manufacturer. Continue reading

Qbrelis (generic name: lisinopril) is an oral solution available in 1 mg/mL strength. The oral solution allows for easier weight-based dosing for children. Adult patients who have trouble swallowing lisinopril tablets may also benefit from Qbrelis. Continue reading

More FAQ

How long after taking 5 mg lisinopril will my blood pressure drop down?
Do ACE inhibitors make COVID-19 worse?
Can I just stop taking lisinopril?

View more FAQ

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Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use lisinopril only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Lisinopril FT

Precautions

Anaphylactoid and possible related reactions

Presumably because angiotensin-converting enzyme inhibitors interfere with the metabolism of eicosanoids and polypeptides, including endogenous bradykinin, patients receiving ACE inhibitors (including lisinopril) may experience a range of adverse reactions, including serious reactions.

Angioedema of the head and neck: There have been reports of swelling of the face, extremities, lips, tongue, glottis and/or larynx in patients receiving ACE inhibitors. This can happen at any time during treatment. A higher incidence of angioedema has been reported with ACE inhibitors in black patients compared to non-black patients. In such cases, the use of the drug should be immediately discontinued, appropriate therapy and monitoring should be provided until the symptoms are completely and sustainably resolved. Even in cases where the observed swelling of the tongue is not accompanied by difficulty in breathing, patients may require long-term observation, since treatment with antihistamines and corticosteroids may not be enough. There are very rare reports of deaths due to swelling of the larynx or tongue. Patients with tongue, glottis, or larynx involvement are likely to experience airway obstruction, especially in cases of previous airway surgery. To ensure the patency of the respiratory tract, measures of appropriate therapy should be taken immediately, for example, subcutaneous administration of adrenaline 1: 1000 (0.3 ml to 0.5 ml) (see “Side effects”). Patients with a history of non-ACE inhibitor angioedema may be at an increased risk of developing it when taking ACE inhibitors.

Bowel edema has been reported in patients treated with ACE inhibitors.

Presents with abdominal pain with or without nausea or vomiting; in some cases without a history of angioedema of the face and with a normal level of C-1 esterase. Angioedema was diagnosed by procedures such as abdominal computed tomography or ultrasound, or at the time of surgery, and the symptoms resolved after the ACE inhibitor was discontinued. Intestinal angioedema should be included in the differential diagnosis of abdominal pain in patients receiving ACE inhibitors.

Anaphylactoid reactions during desensitization: Life-threatening anaphylactoid reactions have been observed in patients receiving desensitizing treatment against hymenoptera venom and concomitant use of ACE inhibitors. In patients, these reactions can be avoided with temporary discontinuation of ACE inhibitors, but they may reappear after re-appointment.

Anaphylactoid reactions during hemodialysis: Sudden and potentially life-threatening anaphylactoid reactions have been reported in some patients using high-flux membranes (eg, AN69®) and the simultaneous use of ACE inhibitors. In such patients, dialysis should be stopped immediately and active therapy for anaphylactic reactions should be initiated. In these situations, the use of antihistamines does not lead to the disappearance of symptoms. In these patients, consideration should be given to using a different type of dialysis membrane or switching to a different class of antihypertensive drug. Anaphylactoid reactions have also been reported in patients undergoing LDL apheresis (low-density lipoprotein plasmapheresis) using dextran sulfate.

Hypotension

Excessive hypotension is rarely observed in patients with uncomplicated arterial hypertension receiving lisinopril as monotherapy. In patients with heart failure taking lisinopril, there is usually some decrease in blood pressure with a peak between 6 and 8 hours after a dose. However, discontinuation of therapy due to symptomatic hypotension when the instructions are followed is usually not necessary; care should be taken at the start of treatment. (see “Method of application and dose”).

Risk of excessive hypotension, sometimes associated with oliguria and / or progressive azotemia, rarely with acute renal failure and / or death, occurs under the following conditions: heart failure with systolic blood pressure below 100 mm Hg, hyponatremia, high doses diuretics, recent heavy diuresis or increase in the dose of a diuretic, dialysis, salt wasting of any etiology. It is advisable to discontinue diuretics (except in patients with heart failure), reduce the diuretic dose, or increase salt intake with caution prior to initiating Lisinopril therapy in patients at risk of excessive hypotension. (see “Side effect”, “Interaction with other drugs”).

Treatment with Lisinopril should not be initiated in acute myocardial infarction in patients at risk of further severe hemodynamic deterioration after treatment with vasodilators (eg, systolic blood pressure of 100 mmHg or less) or cardiogenic shock.

In patients at risk of excessive hypotension, therapy should be started under medical supervision and these patients should be closely monitored during the first two weeks of treatment and whenever the dose of Lisinopril and/or diuretic is increased. This also applies to patients with coronary artery disease or cerebrovascular disease, in whom an excessive decrease in blood pressure can lead to myocardial infarction or stroke.

If hypotension occurs, the patient should be placed in a horizontal position and, if necessary, administer 0.9% sodium chloride intravenously. Transient hypotension is not a contraindication for further use of the drug after normalization of blood pressure by increasing blood volume. If symptomatic hypotension develops, dose reduction or discontinuation of treatment with lisinopril or a concomitant diuretic may be required.

Leukopenia/neutropenia/agranulocytosis

In a study with another ACE inhibitor, captopril, its ability to cause agranulocytosis and bone marrow depression was shown, less often in uncomplicated patients, but more often in patients with renal insufficiency, especially in combination with collagenoses. Marketing experience has shown in rare cases the development of leukopenia / neutropenia and bone marrow depression, while a causal relationship with lisinopril cannot be excluded. Periodic monitoring of white blood cell counts in patients with collagenoses and kidney disease should be considered.

Liver failure

Rarely, ACE inhibitors have been associated with a syndrome that begins with cholestatic jaundice or hepatitis and progresses to fulminant hepatic necrosis and (sometimes) death. The mechanism of this syndrome is unknown. Patients receiving ACE inhibitors who develop jaundice or elevated liver enzymes should stop taking the drug and receive appropriate medical advice.

Aortic stenosis/hypertrophic cardiomyopathy: As with all vasodilators, lisinopril should be used with caution in patients with left ventricular outflow obstruction.

Impaired renal function: Due to RAAS inhibition, changes in renal function can be expected in susceptible patients. In patients with severe CHF, where renal function is dependent on RAAS activity, treatment with ACE inhibitors, including lisinopril, may be associated with oliguria and/or progressive azotemia and rarely with acute renal failure and/or death.

In hypertensive patients with unilateral or bilateral renal artery stenosis, an increase in blood urea nitrogen and serum creatinine is possible. These changes are usually reversible upon discontinuation of the drug and/or diuretic therapy. In such patients, renal function should be monitored during the first few weeks of therapy.

In some patients with arterial hypertension or heart failure without previously diagnosed kidney disease, increases in blood urea nitrogen and serum creatinine are usually minor and transient, especially when taken with diuretics. Changes are most likely in patients with pre-existing renal insufficiency. Dose adjustment and/or discontinuation of the diuretic and/or lisinopril may be required.

In acute acute myocardial infarction, treatment with lisinopril should be initiated with caution in patients with signs of impaired renal function (serum creatinine concentration greater than 2 mg/dL). If renal dysfunction develops during treatment (serum creatinine greater than 3 mg/dL or twice the initial value), the physician should consider discontinuing treatment.

Evaluation of patients with hypertension, heart failure, myocardial infarction should always include an assessment of renal function (see “Method of application and dosage”).

Hyperkalemia: Risk factors for developing hyperkalemia include renal insufficiency, diabetes mellitus, concomitant use of potassium-sparing diuretics, potassium supplements and/or potassium-containing salt substitutes.

Hyperkalemia can lead to serious, sometimes fatal, arrhythmias.

Lisinopril should be used with caution with these agents and frequent monitoring of serum potassium levels is recommended. (see “Interaction with other drugs”).

Cough: By inhibiting the degradation of endogenous bradykinin with all ACE inhibitors, persistent unproductive cough is possible, which stops after discontinuation of therapy.

Surgery / anesthesia: In patients undergoing general surgery or anesthesia with drugs that cause hypotension, lisinopril may block the formation of angiotensin II against the background of compensatory secretion of renin. If arterial hypotension due to this mechanism is noted, it is necessary to replenish the volume of fluid.

Hypoglycemia: In patients with diabetes mellitus taking oral antidiabetic drugs or insulin, it is necessary to maintain constant glycemic control during the first month of therapy with ACE inhibitors. (see “Interaction with other drugs”).

Double blockade of the renin-angiotensin-aldosterone system is associated with an increased risk of hypotension, hyperkalemia and renal dysfunction (including acute renal failure) compared with monotherapy. Dual blockade of the RAAS with Lisinopril, ARB II or Aliskiren cannot be recommended for any patient, especially those with diabetic nephropathy (see “Interaction with other medicinal products”, “Pharmacological properties”).

In some cases, when the combined use of Lisinopril and ARB II is absolutely indicated, careful supervision of a specialist and mandatory monitoring of renal function, water and electrolyte balance, blood pressure is necessary. This refers to the appointment of candesartan or valsartan as adjunctive therapy to lisinopril in patients with CHF. Conducting a double blockade of the RAAS under the close supervision of a specialist and mandatory monitoring of kidney function, water and electrolyte balance and blood pressure is possible in patients with CHF with intolerance to aldosterone antagonists (spironolactone), who have persistent symptoms of CHF, despite other adequate therapy.

It should be remembered that patients with CHF in combination with renal insufficiency (or without it) and connective tissue diseases need strict medical supervision in a hospital at the stage of selecting the dose of Lisinopril and diuretics, since it is in such patients and, especially with severe form of CHF, most often a pronounced decrease in blood pressure is possible, as a result of the use of diuretics in high doses, hyponatremia, or impaired renal function.

In patients with arterial hypertension lisinopril can cause a sharp decrease in blood pressure, especially after the first dose. Most often, arterial hypotension occurs in patients with a deficiency of electrolytes or fluids, receiving diuretics, following a low-salt diet, after vomiting or diarrhea, or after hemodialysis. In such patients, therapy should be initiated under strict medical supervision, preferably in a hospital, at low doses and the dosage adjusted with caution. At the same time, monitoring of kidney function and serum potassium levels is necessary. If possible, diuretic treatment should be discontinued.

Similar rules should be followed when prescribing Lisinopril to patients with coronary artery disease and cerebrovascular insufficiency in whom a sharp drop in blood pressure can lead to myocardial infarction or stroke. In this case, a transient hypotensive reaction is not a contraindication for taking the next dose of the drug.

Before you start taking Lisinopril, if possible, you should normalize the concentration of sodium in the blood and / or replenish the lost volume of fluid, carefully monitor the effect of the initial dose on the patient’s blood pressure level.

In elderly patients from the same dose of Lisinopril, a higher plasma concentration of lisinopril can be created, therefore, special care is required when selecting the dosage of lisinopril in this case, despite the fact that there are differences in the antihypertensive effect of lisinopril-containing drugs between the elderly and young patients were not detected. For patients over 65 years of age, an initial dose of lisinopril 2.5 mg/day is recommended, as well as monitoring of blood pressure and renal function.

When changes in laboratory parameters against the background of the use of lisinopril (see section “Side Effects”) act individually depending on the severity of these changes and the specific clinical situation. In serious cases, decide on the abolition of lisinopril and the appropriate corrective measures. In all cases, timely monitoring of laboratory parameters is very important.

For example, the concentration of electrolytes and creatinine in the blood serum and the indicators of blood cells should be monitored, especially at the beginning of lisinopril therapy, as well as while using it with immunosuppressants, cytostatics, allopurinol and procainamide.

In some patients with arterial hypertension without obvious renal dysfunction, with simultaneous therapy with lisinopril and diuretics, there may be an increase in the level of urea and blood creatinine. In such a situation, it may be necessary to reduce the dose of the ACE inhibitor or stop the diuretic.

Therapy with lisinopril may lead to an increase in the level of potassium ions in the blood, especially against the background of existing renal or heart failure. Under these conditions, the use of potassium-sparing diuretics or potassium preparations is undesirable. It is also necessary to regularly monitor the level of potassium in the blood.

In view of the fact that the potential risk of agranulocytosis and neutropenia cannot be excluded, periodic monitoring of the blood picture is required. After the abolition of ACE inhibitors, agranulocytosis and neutropenia disappear.

In patients with reduced renal function or after taking sufficiently high doses of lisinopril, rare cases of proteinuria have been noted. In clinically significant proteinuria (>1 g/day), lisinopril should only be used after a careful comparison of the expected benefit and potential risk, as well as with regular monitoring of clinical and laboratory parameters.

Some issues of the tactics of using lisinopril in the presence of changes in laboratory parameters are reflected in other sections of the instructions (“Method of application and dose”, “Interaction with other drugs”).

Pregnancy and lactation

Pregnancy

The use of ACE inhibitors is not recommended during the first trimester of pregnancy and is contraindicated during the second and third trimester of pregnancy (see “Contraindications”).

Use of these drugs during the second and third trimesters of pregnancy reduces kidney function and increases morbidity and risk of fetal and neonatal death. As a result of oligohydramnios, pulmonary hypoplasia and skeletal deformities of the fetus are possible. Potential neonatal side effects include skull hypoplasia, anuria, hypotension, renal failure, and death. When pregnancy is established, Lisinopril should be discontinued as early as possible and switched to alternative antihypertensive agents with an established safety profile for use during pregnancy.

In the absence of an appropriate alternative to ACE inhibitors for a particular patient, she should be informed of the potential risk to the fetus. It is necessary to conduct serial ultrasound examinations. If oligohydramnios is detected, the drug should be discontinued, unless it is vital for the mother. Patients and doctors should be aware that oligohydramnios can occur when the fetus already has irreversible damage.

If ACE inhibitors are used during the second trimester of pregnancy, it is recommended to monitor kidney function and skull development using ultrasound. Newborns whose mothers took lisinopril should be carefully monitored for the presence of arterial hypotension, oliguria and hyperkalemia. In animal experiments, no data on the teratogenic effects of lisinopril have been obtained. There are also no data on the negative effects of the drug on the fetus if used during the first trimester of pregnancy.

Breastfeeding

It is not known whether lisinopril passes into breast milk. Since many drugs are secreted in human milk and because of the risk of severe adverse reactions in infants when using ACE inhibitors, a decision should be made to stop breastfeeding or stop lisinopril, taking into account its importance to the mother.

Pediatric use

Contraindicated in children and adolescents under 18 years of age.

Influence on the ability to drive vehicles and other complex mechanisms
Evidence on this problem in the framework of the use of therapeutic dosages of lisinopril-containing drugs is currently absent, however, taking into account the possible occurrence of dizziness, their use (including Lisinopril) in such situations should be exercised with caution.

Lisinopril for cats and dogs

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Lisinopril – instructions for use for dogs and cats

Release form and active ingredients | Pharmacological properties | Indications and contraindications | Application principle | Side effects and special instructions

Lisinopril is a drug from the group of angiotensin-converting enzyme (ACE) inhibitors. Each veterinary pharmacy can offer customers this medication, which is widely used in the treatment of dogs and cats. The timely appointment of this medication helps to get rid of negative symptoms and prolong the life of pets with cardiovascular insufficiency.

Formulation and active ingredients

The drug is available in tablet form. Tablets of 5, 10 and 20 mg have a round shape and color ranging from white to pale pink or light gray.

The main active ingredient of the drug is lisinopril dihydrate. As auxiliary components, calcium hydrogen phosphate, corn starch, magnesium stearate and other compounds are introduced into the preparation.

Pharmacological properties

The drug has the following pharmacological action:

vasodilator;
hypotensive;
cardioprotective;
natriuretic.

Lisinopril promotes the expansion of blood vessels and improves blood circulation. The medicinal product helps to reduce systemic arterial pressure, peripheral vascular resistance, pressure in the pulmonary vessels. The drug avoids myocardial remodeling, prevents hypertrophy, dilatation, spherization of the left ventricle. In addition to these properties, the drug exhibits a nephroprotective effect.

Against the background of long-term medication, systolic function improves markedly and physical endurance of pets with chronic heart failure increases. Proper use of a pharmacological product helps to reduce the likelihood of sudden cardiac death.

Indications and contraindications

Lisinopril is prescribed for pets subject to the following diseases:

arterial hypertension occurring with frequent rises in blood pressure;
chronic heart failure, characterized by the inability of the heart to fully perform its functions;
diabetic nephropathy causing pathological changes in the renal vessels.

The drug is used in the treatment of chronic kidney failure (shown in microdoses). Lisinopril is also used for prophylactic purposes (the drug is able to prevent dysfunction of the left calving of the heart muscle and left ventricular heart failure).

Among the contraindications to treatment with this drug are individual intolerance to the active substance. The drug is used with caution in the treatment of pregnant and lactating animals.

Application principle

Lisinopril is prescribed orally, once a day. A single dosage of the drug is determined by the veterinarian based on the existing diagnosis and the individual characteristics of the patient. Be sure to take into account the condition of the patient’s kidneys and the parallel use of other drugs.

According to the instructions, the drug must be taken as follows:

Initial dose	0.125 mg/kg
maintenance dose	0. 25 mg/kg
The maximum amount of the drug per day	0.5 mg/kg

The duration of the treatment course can take 1-2 months. During the period of therapy with Lisinopril, regular monitoring of the concentration of creatinine in the blood serum is required.

Side effects and special instructions

The drug is well tolerated. Relatively rarely, against the background of its use, side effects may occur, taking the form:

Tachycardia.
Hypotension.
Gastritis.
Pancreatitis.
Urticaria.
Shortness of breath.
Dyspepsia.
Thrombocytopenia.
Leukopenia.
Anemia.
Tremor.
Oppression.

In severe cases, there is a possibility of developing anaphylaxis, which poses a considerable danger to the life of the patient.

It is not recommended to combine Lisinopril with diuretics that enhance its effect, as well as with Indomethacin, which reduces the effectiveness of the product. To exclude the development of acute arterial hypotension, it is important to strictly observe the dosage prescribed by the doctor.

The drug is stored at a temperature not exceeding +25 degrees. The shelf life of the drug is 3 years. Conditions for dispensing from the pharmacy chain – by prescription.

Release form and active ingredients | Pharmacological properties | Indications and contraindications | Application principle | Side effects and special instructions