What are ACE inhibitors and how do they work. How do ACE inhibitors benefit heart health. What are the common side effects of ACE inhibitors. Can pregnant women or children take ACE inhibitors. How should ACE inhibitors be taken for maximum effectiveness.

Understanding ACE Inhibitors: The Heart Health Heroes

Angiotensin-converting enzyme (ACE) inhibitors are a class of medications that play a crucial role in managing various heart conditions. These powerful drugs work by dilating blood vessels, which leads to increased blood flow and reduced workload on the heart. This article delves into the world of ACE inhibitors, with a particular focus on lisinopril, to provide you with a comprehensive understanding of their uses, benefits, and potential side effects.

How Do ACE Inhibitors Work?

ACE inhibitors function by blocking the production of angiotensin II, a hormone that causes blood vessels to constrict. By inhibiting this process, these medications help to:

• Widen blood vessels
• Increase blood flow
• Lower blood pressure
• Reduce strain on the heart

This multifaceted approach makes ACE inhibitors highly effective in treating various cardiovascular conditions.

The Wide-Ranging Applications of ACE Inhibitors

ACE inhibitors are versatile medications prescribed for several heart-related conditions. Their primary uses include:

1. Hypertension management
2. Heart failure treatment
3. Post-heart attack care
4. Diabetes-related kidney protection
5. Heart disease prevention in high-risk individuals

Are ACE inhibitors only used for high blood pressure? While hypertension management is a common application, these medications offer benefits far beyond blood pressure control. For instance, in heart failure patients, ACE inhibitors can prevent further cardiac weakening and potentially extend life expectancy. Similarly, when administered after a heart attack, certain ACE inhibitors may mitigate the impact on heart strength and improve long-term survival rates.

Lisinopril: A Prominent Member of the ACE Inhibitor Family

Lisinopril, marketed under brand names such as Prinivil and Zestril, is one of the most widely prescribed ACE inhibitors. It shares many characteristics with its counterparts but has some unique features that make it a popular choice among healthcare providers.

Key Features of Lisinopril

• Long-acting formulation, often allowing for once-daily dosing
• Well-tolerated by most patients
• Effective in treating multiple cardiovascular conditions
• Available in generic form, making it more affordable for many patients

How does lisinopril compare to other ACE inhibitors? While all ACE inhibitors share a common mechanism of action, lisinopril’s long duration of effect and broad range of indications make it a versatile option for many patients. However, the choice of ACE inhibitor often depends on individual patient factors and physician preference.

Proper Administration of ACE Inhibitors

To maximize the benefits of ACE inhibitors while minimizing potential side effects, it’s crucial to take these medications as prescribed. Here are some general guidelines:

• Take on an empty stomach, typically one hour before meals
• Follow the dosing schedule provided by your healthcare provider
• Never stop taking an ACE inhibitor without consulting your doctor
• Attend regular check-ups to monitor blood pressure and kidney function

Why is it important to take ACE inhibitors consistently? Consistent use of these medications ensures stable blood pressure control and ongoing protection for your heart and blood vessels. Abrupt discontinuation can lead to a rapid increase in blood pressure, potentially causing adverse cardiovascular events.

Potential Interactions: Navigating Diet and Medications

While ACE inhibitors are generally safe and effective, they can interact with certain foods, supplements, and medications. Being aware of these potential interactions is crucial for maintaining your health and the effectiveness of your treatment.

Dietary Considerations

When taking ACE inhibitors, pay attention to the following dietary factors:

• Salt substitutes: Many contain potassium, which can accumulate to dangerous levels when combined with ACE inhibitors
• Low-sodium diets: Essential for managing blood pressure, but should be implemented under medical guidance
• Alcohol: May enhance the blood pressure-lowering effect of ACE inhibitors, leading to dizziness or fainting

Medication Interactions

Several medications can interact with ACE inhibitors, potentially altering their effectiveness or increasing the risk of side effects:

• NSAIDs (e.g., ibuprofen, naproxen): May reduce the blood pressure-lowering effect of ACE inhibitors
• Diuretics: Can enhance the risk of dehydration and electrolyte imbalances
• Potassium supplements: May lead to dangerously high potassium levels
• Certain diabetes medications: Can increase the risk of low blood sugar

How can patients manage potential drug interactions? Always inform your healthcare provider about all medications, supplements, and herbal products you’re taking. They can assess potential interactions and adjust your treatment plan accordingly.

Recognizing and Managing Side Effects

While ACE inhibitors are generally well-tolerated, they can cause side effects in some individuals. Being aware of these potential adverse reactions can help you identify and address them promptly.

Common Side Effects

• Dry cough
• Dizziness or lightheadedness
• Headache
• Fatigue
• Altered taste sensation

Serious Side Effects Requiring Immediate Medical Attention

• Swelling of the face, lips, tongue, or throat (angioedema)
• Severe dizziness or fainting
• Irregular heartbeat
• Signs of kidney problems (e.g., changes in urination)
• Persistent nausea or vomiting
• Yellowing of the skin or eyes (jaundice)

What should patients do if they experience side effects? For mild side effects, consult your healthcare provider for management strategies. For severe or persistent side effects, seek immediate medical attention. Never discontinue your medication without professional guidance.

Special Considerations: Pregnancy and Pediatric Use

While ACE inhibitors are invaluable in treating various cardiovascular conditions, their use requires special consideration in certain populations, particularly pregnant women and children.

ACE Inhibitors and Pregnancy

ACE inhibitors are contraindicated during pregnancy, especially in the second and third trimesters. Their use can lead to:

• Fetal kidney damage
• Reduced amniotic fluid
• Birth defects
• Neonatal hypotension

Women of childbearing age taking ACE inhibitors should use effective contraception and inform their healthcare provider immediately if they become pregnant or plan to conceive.

Pediatric Use of ACE Inhibitors

While ACE inhibitors can be used in children, their administration requires careful consideration:

• Dosing must be carefully adjusted based on the child’s weight and response
• Children may be more sensitive to the blood pressure-lowering effects
• Long-term effects on growth and development require ongoing monitoring
• Use is typically reserved for specific conditions, such as hypertension or heart failure that hasn’t responded to other treatments

Are there alternatives to ACE inhibitors for pregnant women or children? Yes, other classes of antihypertensive medications, such as certain beta-blockers or calcium channel blockers, may be suitable alternatives depending on the specific condition and individual factors. Always consult with a healthcare provider to determine the most appropriate treatment option.

Monitoring and Long-Term Management

Successful treatment with ACE inhibitors requires ongoing monitoring and management. This ensures the medication remains effective and safe over time.

Regular Check-ups

Patients taking ACE inhibitors should have regular follow-up appointments to:

• Monitor blood pressure
• Assess kidney function
• Check potassium levels
• Evaluate overall cardiovascular health
• Adjust medication dosage if necessary

Lifestyle Modifications

To maximize the benefits of ACE inhibitor therapy, patients should also adopt heart-healthy lifestyle habits:

• Maintain a balanced, low-sodium diet
• Engage in regular physical activity as advised by your healthcare provider
• Manage stress through relaxation techniques or counseling
• Quit smoking and limit alcohol consumption
• Maintain a healthy weight

How often should patients on ACE inhibitors have follow-up appointments? Initially, more frequent visits (every 2-4 weeks) may be necessary to adjust dosage and monitor for side effects. Once stable, appointments may be spaced out to every 3-6 months, or as recommended by your healthcare provider.

ACE inhibitors, including lisinopril, have revolutionized the treatment of various cardiovascular conditions. By understanding how these medications work, their benefits, potential side effects, and proper usage, patients can play an active role in managing their heart health. Always consult with your healthcare provider for personalized advice and never adjust your medication regimen without professional guidance. With proper use and monitoring, ACE inhibitors can significantly improve cardiovascular health and quality of life for many individuals.

Types of ACE Inhibitors for Heart Disease Treatment

Written by WebMD Editorial Contributors

• Why Are They Prescribed?
• How Should I Take Them?
• Will My ACE Inhibitor Interact With Any Foods or Drugs?
• What Are the Side Effects?
• Can Pregnant Women Take Them?
• Can Children Take Them?
• More

Angiotensin-converting enzyme (ACE) inhibitors are heart medications that widen, or dilate, your blood vessels. That increases the amount of blood your heart pumps and lowers blood pressure.

They also raise blood flow, which helps to lower your heart’s workload.

Examples of ACE inhibitors include:

• benazepril (Lotensin)
• captopril (Capoten)
• enalapril (Vasotec)
• fosinopril ​​​​​​​(Monopril)
• lisinopril (Prinivil, Zestril.)
• moexioril (Univasc)
• perinopril (Aceon)
• quinapril (Accupril)
• ramipril (Altace)
• trandolapril (Mavik)

Of course, they’ll help manage high blood pressure. But your doctor may prescribe an ACE inhibitor for these other heart conditions:

Heart failure: They can prevent further weakening of your heart and prolong your life.

Heart attack: When given after one, some ACE inhibitors may lessen the impact on your heart strength and help you live longer.

Diabetes: Some can slow the process that leads to kidney damage in many people with type 2 diabetes.

Heart disease prevention: If you’re at high risk, they’ve been shown to lessen your chance of having a heart attack or stroke.

Usually on an empty stomach, an hour before meals. Follow the directions on the label about how often to take it. The number of doses you take each day, the time between them, and how long you’ll need to take it will depend on the type of ACE inhibitor you’re prescribed, and your condition.

While taking them, have your doctor check your blood pressure and kidney strength regularly.

Never stop taking an ACE inhibitor without first discussing with your doctor. If you’re taking them for heart failure, your symptoms may not improve right away. However, long-term use helps manage chronic heart failure and lessen the chance that your condition will get worse.

It may. Don’t use salt substitutes unless your doctor or nurse approves. Some contain potassium, and since ACE inhibitor medications cause the body to retain potassium, it can be dangerous to your health. Read food labels to choose foods low in salt and potassium. A dietitian can help, too.

Over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs, like Aleve and Motrin) and aspirin may cause your body to retain salt and water, and decrease the effect of an ACE inhibitor. Check with your doctor before taking any anti-inflammatories.

It’s important for your doctor to know about all the drugs you are taking. Some, in addition to those above, may not work well with ACE inhibitors.

Talk to your doctor before taking any new medicines, including over-the-counter drugs, herbs, and supplements.

Possible ones include:

Cough: If this persists or is severe, contact your doctor. Ask what type of cough medicine you can use to ease it.

Red, itchy skin rash: If you have this, don’t treat the rash yourself. Call your doctor.

Dizziness, lightheadedness, or faintness when you get up: This may be strongest after your first dose, especially if you’ve been taking a water pill (diuretic). Get up more slowly. If it keeps up, reach out to your medical team.

Salty or metallic taste, or a decreased ability to taste: This usually goes away as you continue taking the medicine.

Physical symptoms: Call your doctor if you have:

• Sore throat
• Fever
• Mouth sores
• Unusual bruising
• Fast or irregular heartbeat
• Chest pain
• Swelling of feet, ankles, or lower legs

Swelling of your neck, face, and tongue: Contact your doctor right away if you have any of these. This is a potential emergency.

High potassium levels: This is a potentially life-threatening complication. Therefore, people on ACE inhibitors should have blood tests regularly to measure potassium levels.

Signs of too much in your body include:

• Confusion
• Irregular heartbeat
• Nervousness
• Numbness or tingling in hands, feet, or lips
• Shortness of breath or difficulty breathing
• Weakness or heaviness in your legs

Contact your doctor right away if you have any of these.

Severe vomiting or diarrhea: These can make you dehydrated. That can lead to low blood pressure. Call your doctor right away.

Also reach out to your medical team if you have any other symptoms that concern you.

Women should not take them during pregnancy, especially during the second and third trimesters. They can lower blood pressure and cause kidney failure or high potassium levels in the blood of the mother. They can cause death or deformity in the newborn.

Babies shouldn’t be breastfed if the mother is taking an ACE inhibitor. The medicine can pass through breast milk.

The short answer is yes. However, kids are more sensitive to the effects of them on their blood pressure. So, they’re at higher risk of severe side effects.

Before giving an ACE inhibitor to a child, discuss the potential benefits and risks with your pediatric cardiologist (heart doctor).

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Most voted positive review

72 People found this comment helpful

BP was 186/92 then Dr. prescribed 20mg Lisinopril & I quickly developed blurred vision, headaches, tiredness and a nagging dry cough. Dr. quickly lowered dosage to 10mg & had me take pill at night & symptoms decreased significantly. 14 months later after losing 32lbs, my dosage was again lowered to 5mg and “ALL” the above symptoms are gone. BP now 108/70. If you experience bad side effects lik…

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B/P still stays “too” high and had “By/Pas surgery in 2005. Heart ‘Rate ,stays too low! Benn prescribed ‘about every B/P med. there is;and “side effects worst than treatment and “end up in the ER!”. On “5 mgs”once a day! Heart stays in the low “40’s to 50’s” giving me very little ‘energy’ Plus,I take “very little medication due to extreme “side effects”.Tried me on 2.5 mgs of Lisinopril still did …

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12 years angio demea of small intestines, 2 “ ascending aneurism, colonic diverticula., Mild atherosclerotic. Suffered horribly for the past -20 years and will suffer until I take my last breath.

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It works great for lowering my blood pressure. But my quality of life is lousy. I cough constantly. I can’t stand up without feeling like I’m going pass out. I can’t even work outside in my garden anymore because if I walk more than 10 feet I feel like my chest is on fire. If I have to walk any further my chest and my muscles all feel like they are on fire. Dr. Says it’s fine because my BP is great. I never had any of these symptoms until I started this medicine.

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I was prescribed Lisinopril for sudden onset hypertension when I was 35 years old. Within 6 weeks my weight went from 130 to 154 lbs. I was told “everyone tolerates lisinopril” and there was no way the weight change could be related to Lisinopril. I developed a cough and continued to gain weight. My blood pressure became more labile and I started needing to go to the ER several times a month for hypertensive crisis episodes and severe tachycardia. My lisinopril dose got doubled during one ER visit and a few hours later I fainted.
When I stopped lisinopril my weight quickly normalized back to baseline.
While may be Lisinopril an effective and great medication for many people, that was not my experience. I will never take Lisinopril or any ACE inhibitor ever again. Of note, I have a rather extensive list of adverse reactions to meds (recently diagnosed MCAD)Read More Read Less

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If you already suffer from acid reflux or have an inflammatory condition DO NOT TAKE THIS MEDICATION. I have Scleroderma and a host of gastrointestinal issues. This medication WILL make your sternum & stomach feel like it’s on fire. It will also have you vomiting acid for hours on end every 10 minutes. That being said, with diet & exercise you’ll have an excellent BP. I don’t know about everyone else, but I’ll never take this again. The chest pain, inflamed sternum and progressive stomach issues have completely gone since I tapered off the medication (by the advice of my doctor) and came off of it completely. Use this with caution if you have autoimmune conditions. With diet & exercise my bp is back to normal.Read More Read Less

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My Dr put me on 5mg of Lisinopril for damage to my kidneys due to diabetes and hep c. My main concern is will my hep c have any bad side affects taking this med? I have looked everywhere but have found no help. Guess I am grasping at straws. I have had diabetes and hep cover 20 years.

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Very bad muscle pain, ringing in the ears, headache, stomach pain, after 1 pill

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My mom has never had issues with High Blood Pressure until recently. Doctor put her on Lisinopril and at first it did wonders BP went from like 160/90 to 125/80 but after taking for about three weeks, she developed soreness around the neck and dizziness really bad. Could not even walk in Walmart and had to hold on to her 88 year old mom if not she would have fell. She stopped taking the medication but started feeling sick due to her BP rising up so we will try it out again. This time by drinking lots of water and having it flush out her system. Read More Read Less

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The experience was horrible. The 1st week I took it, everything started changing. I had less energy and I was tired all the time. I had no appetite and was nauseous. I assumed it was my birth control because it was new also and sometimes it does have side effects. It got worse after that I started getting dizzy and tired to the point where I wanted to sleep and not get out of bed. When there was food made I couldn’t make myself eat and I love food so everyone thought it was weird. I felt like I wanted to throw up but couldn’t. I got to the point where I was breaking down and crying about how sick I felt every day. I stopped using my birth control and it was like the symptoms got worse. I told my doctor that something was wrong because now I knew it was lisinopril and she told me none of her patients have had these symptoms and I have to get used to it, even though my blood pressure was 170 over 110 at that visit. The doctor felt like I should keep taking it. That was the last time I went to her doctor’s office. I found a new doctor and found out that it was doing nothing for my blood pressure because it was still high at 150 over 100. When I explained everything to my new doctor he said it sounded like I was having a horrible allergic reaction to it. I was never going to get used to it because my body was basically rejecting it. I am glad I found the doctor I am with today. It’s so amazing when someone actually listens.Read More Read Less

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Soon after starting this drug i developed dry hacking cough that was so bad it interfered with my ability work and sleep. It never got better or went away.

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Bad sour stomach and just overall lethargic feeling. Intermittent irregular heartbeat. The 2.5 mg tabs have brought my blood pressure down approximately 10 to 15 points on the systolic and 10 points on the diastolic.

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This BP medicine almost killed me!! Im a 40 year old female started on this silent killer because my blood pressure was staying 150/100. Woke up one day feeling something huge was stuck in my throat, from there my finger started itching mins later my whole body had hives from head to toe!!! My face/lips started swelling hands arms legs feet head eyes ears everywhere!!! Went to E. R had acute kidney injury!! Became so bruised was unable to walk! After about 5 days many iv fluids Benadryl and steroids acid reflux meds finally able to walk and swelling has went down. Please do not take this medication!!! Im only one day on the mend still feeling awful just want to warn people about thisRead More Read Less

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Dry cough, side pain not sure kidneys or liver, vision blurred at times, stuffy nose, tiredness, weak, worst of all it definetly affects erection! etc, i feel its worst taking it then not!

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It lowers my bp but causes constipation, sometimes headaches, also weakness in muscles. I wish I could find a bp medication with no side effects.

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Lowered my blood pressure but I get terrible anxiety from it. Anxiety so bad I have to
take anxiety medication twice a day. The Lisinopril manufactured by LUPIN is the worst! I do not recommend it.

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This med works great for me as far as lowing blood pressure. What my issue is with it is the horrible nasal congestion within 30 min of taking it. My nose swells closed and breathing is horrible. I did research and ACE Inhibitors along with ARB’s are considered Vasodilators. So they cause your veins to expand which is great but also they expand in nose blocking off air. I have yet to find a blood pressure pill that is not causing stuffy nose. Not sure why doctors deny this side effect, I know its the pill since when I stop using it my nose works fine, as soon as I take it swollen closed all day. Read More Read Less

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I was described this medication by my doctor and since l taken l have had a persistent cough to the point lm choking off my spit.

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The studies show that this has about a 1% chance of causing erectile dysfunction. I am sorry but the studies must be wrong. I take it and nothing works down there, not even a little. I tell my doctor who says “Nope can’t be the medicine.Keep taking it”. They check my testosterone levels. Run others tests. All comes back fine. But still, I have terrible ED. I eat right, I workout. Nope. Still severe ED. “Can’t be the medicine” they continue to tell me! So I decided to have a little experiment and come off the medicine for a couple days just to test it. It is without question THIS MEDICINE that caused my ED.Read More Read Less

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Was prescribed 10mg for a 130/100 bp. First day was ok I was able to work. The next dose gave horrible chest pains, seeing stars, general numbness and weakness. I was at work but could not do my job. Heavy sweats, vomiting and confusion. I almost drove myself to the ER. I thought I was dying. I did not take my third dose and I feel much better today. Hope this will help someone that’s in distress like I was.

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I had temporary high blood pressure because of a hormone imbalance. My doc prescribed lisinopril. Worst experience. While it did lower my blood pressure, I was tired, lethargic and the cough was horrible. I reduced the dose until I got off of it. The cough is still persistent and lingering. Hate it!

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I was on Lisinopril 5mg for only 2 days and it caused awful headaches & excruciating leg cramps (so bad that even walking didn’t take the cramp away – had to drink a cup of pickle juice to ease it at all). Then I started having shooting pains thru my calf all the next day & it weakened my leg to where I almost fell down the bleachers at my grandson’s football game. When I told my doctor, he told me to immediately stop it! He is putting me on Amlodipine, and I pray it doesn’t cause these awful side effects. Read More Read Less

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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:

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:

1. Tachycardia.
2. Hypotension.
3. Gastritis.
4. Pancreatitis.
5. Urticaria.
6. Shortness of breath.
7. Dyspepsia.
8. Thrombocytopenia.
9. Leukopenia.
10. Anemia.
11. Tremor.
12. 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

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:

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:

1. Tachycardia.
2. Hypotension.
3. Gastritis.
4. Pancreatitis.
5. Urticaria.
6. Shortness of breath.
7. Dyspepsia.
8. Thrombocytopenia.
9. Leukopenia.
10. Anemia.
11. Tremor.
12. 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.

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Lisinopril FT

Precautions

Anaphylactoid and possible associated 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 effect”). 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 in 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 mm Hg 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, there may be an increase in blood urea nitrogen and serum creatinine. 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 myocardial infarction, treatment with lisinopril should be initiated with caution in patients with evidence of impaired renal function (serum creatinine 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 administration 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 impaired renal function (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 for patients 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 observation of a specialist and mandatory monitoring of renal function, water and electrolyte balance, and blood pressure are 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 failure (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 starting Lisinopril, if possible, 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, so special care is required when selecting the dosage of lisinopril in this case, despite the fact that 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 hypertensive patients without overt renal dysfunction, concomitant therapy with lisinopril and diuretics may result in an increase in blood urea and creatinine levels. 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.