Lisinopril

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure (hypertension), congestive heart failure, and to improve survival after a heart attack. It is also prescribed to protect kidney function in certain patients with hypertension or diabetes. The medication is available as an oral tablet under brand names such as Prinivil and Zestril, as well as in generic forms, and is typically taken once daily or as directed by a clinician.

Mechanism of action and effects: Lisinopril inhibits ACE, reducing the production of angiotensin II, which leads to vasodilation and decreased secretion of aldosterone. This lowers blood pressure and decreases the heart’s workload. By increasing bradykinin levels, lisinopril can contribute to a cough and, rarely, to angioedema. The drug is not a prodrug and is largely cleared by the kidneys.

Administration and dosing: Dosing is tailored to the condition and patient factors. For hypertension, starting doses are commonly 5 mg once daily, with titration to 10-20-40 mg daily as needed. For heart failure, starting doses are often 2.5-5 mg daily, titrating to 20-40 mg daily. In the setting of acute myocardial infarction, lisinopril may be started within 24 hours of the event and adjusted based on tolerance and response. Because lisinopril is excreted unchanged by the kidneys, kidney function can influence dosing and monitoring is recommended.

Contraindications and safety: Lisinopril is generally avoided during pregnancy due to fetal risk and is contraindicated in individuals with a history of ACE-inhibitor–associated angioedema. Caution is advised in kidney impairment and in situations with elevated potassium or concurrent use of NSAIDs or potassium-sparing agents. Common side effects include cough, dizziness, and hyperkalemia; serious but rare risks include angioedema and significant drops in blood pressure. Monitoring of blood pressure, kidney function, and potassium levels is advised during therapy.