Lisinopriil

Lisinopriil, usually written lisinopril, is an oral angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension and heart failure. It is also prescribed after acute myocardial infarction to improve survival and to slow the progression of kidney disease in diabetes.

Mechanism of action: Lisinopril inhibits ACE, decreasing conversion of angiotensin I to angiotensin II and reducing aldosterone secretion. The result is vasodilation, lower blood pressure, and reduced cardiorenal stress. Inhibition of ACE also increases bradykinin, which can contribute to cough and, rarely, angioedema.

Pharmacokinetics: Lisinopril is not a prodrug; it is active on administration. It is modestly absorbed from the gut, with bioavailability about 25%. It is not extensively metabolized in the liver and is excreted unchanged in the urine. The half-life is around 12 hours, allowing once-daily dosing in many patients, with adjustments for renal impairment.

Clinical use: Hypertension, symptomatic heart failure, and post–myocardial infarction management. It may be used to protect renal function in diabetic nephropathy. Dosage is individualized and adjusted for renal function.

Adverse effects and safety: Common adverse effects include dizziness, cough, and hyperkalemia. Angioedema is a rare but serious risk, more in certain ethnic groups. It is contraindicated in pregnancy and should be used with caution in renal impairment or with potassium-sparing diuretics or supplements. NSAIDs can reduce its antihypertensive effect.

History and availability: Lisinopril was first approved in 1991. Brand names include Zestril and Prinivil; generic versions are widely available.