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What is lisinopril?

Lisinopril is in a group of drugs called ACE inhibitors. ACE stands for angiotensin converting enzyme.

Lisinopril is used to treat high blood pressure (hypertension), congestive heart failure, and to improve survival after a heart attack.

Lisinopril may also be used for purposes not listed in this medication guide.

Important information about lisinopril

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

You should not use this medicine if you have hereditary angioedema.

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

Before taking lisinopril

Do not use this medicine if you are allergic to lisinopril or to any other ACE inhibitor, such as benazepril, captopril, enalapril, fosinopril, moexipril, perindopril, quinapril, ramipril, or trandolapril.

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

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

You should not use this medicine if you have hereditary angioedema.

To make sure lisinopril is safe for you, tell your doctor if you have:

  • kidney disease (or if you are on dialysis);

  • liver disease;

  • heart disease or congestive heart failure;

  • diabetes; or

  • a connective tissue disease such as Marfan syndrome, Sjogren's syndrome, lupus, scleroderma, or rheumatoid arthritis.

If you have diabetes or kidney disease, you may not be able to take lisinopril if you are also taking aliskiren (Tekturna, Tekamlo, Valturna, Amturnide).

FDA pregnancy category D. Do not use lisinopril if you are pregnant. Stop using this medication and tell your doctor right away if you become pregnant. Lisinopril 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. Do not use this medication without telling your doctor if you are breast-feeding a baby.

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.

Take each dose with a full glass of water.

Lisinopril can be taken with or without food.

Conditions that may cause very low blood pressure include: vomiting, diarrhea, heavy sweating, heart disease, dialysis, a low salt diet, or taking diuretics (water pills). Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

Your blood pressure will need to be checked often. Your kidney or liver function may also need to be tested.

If you need surgery, tell the surgeon ahead of time that you are using lisinopril. You may need to stop using the medicine for a short time.

If you are being treated for 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 lisinopril at room temperature away from moisture and heat.

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 should I avoid while taking lisinopril?

Drinking alcohol can further lower your blood pressure and may increase certain side effects of lisinopril.

Do not use salt substitutes or potassium supplements while taking lisinopril, 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 any of these signs of an allergic reaction to lisinopril: hives; severe stomach pain, difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • little or no urinating;

  • swelling, rapid weight gain;

  • fever, chills, body aches, flu symptoms;

  • tired feeling, muscle weakness, and pounding or uneven heartbeats;

  • psoriasis (raised, silvery flaking of the skin);

  • chest pain; or

  • high potassium (slow heart rate, weak pulse, muscle weakness, tingly feeling);

Common lisinopril side effects may include:

  • cough;

  • dizziness, drowsiness, headache;

  • depressed mood;

  • nausea, vomiting, diarrhea, upset stomach; or

  • mild skin itching or rash.

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.

Lisinopril Dosing Information

Usual Adult Dose for Hypertension:

Initial dose: 10 mg orally once a day, in patients not receiving a diuretic.
Maintenance dose: 20 to 40 mg orally once a day.
Some patients appear to have a further response to 80 mg, but experience with this dose is limited.

Usual Adult Dose for Congestive Heart Failure:

Initial dose: 5 mg orally once a day (If on diuretic, the diuretic dose should be reduced).
Maintenance dose: 5 to 20 mg orally once a day.

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.
10 mg orally after 48 hours.
Maintenance dose: 10 mg orally once a day. Dosing should continue for six weeks.
Patients with a low systolic blood pressure (<=120 mm Hg) when treatment is started or during the first 3 days after the infarct should be given a lower 2.5 mg oral dose of lisinopril. If hypotension occurs (systolic blood pressure <=100 mm Hg) a daily maintenance dose of 5 mg may be given with temporary reductions to 2.5 mg if needed. If prolonged hypotension occurs (systolic blood pressure <90 mm Hg for more than 1 hour), lisinopril 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.

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 to 5 mg/day increments at 1 to 2 week intervals.
Maximum dose: 40 mg/day.

Usual Pediatric Dose for Hypertension:

Pediatric patients greater than or equal to 6 years of age:
Initial dose: 0.07 mg/kg once daily (Maximum initial dose is 5 mg once daily)
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.

What other drugs will affect lisinopril?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with lisinopril, especially:

  • any other blood pressure medications;

  • gold injections to treat arthritis;

  • lithium;

  • a potassium supplement;

  • salt substitutes that contain potassium;

  • insulin or diabetes medication you take by mouth;

  • NSAIDs (non-steroidal anti-inflammatory drugs)--ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others; or

  • a diuretic or "water pill."

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.

For the Consumer

Applies to lisinopril: oral tablet

Along with its needed effects, lisinopril may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking lisinopril:

More common
  • Blurred vision
  • cloudy urine
  • confusion
  • decrease in urine output or decrease in urine-concentrating ability
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • sweating
  • unusual tiredness or weakness
Less common
  • Abdominal or stomach pain
  • body aches or pain
  • chest pain
  • chills
  • common cold
  • cough
  • diarrhea
  • difficulty breathing
  • ear congestion
  • fever
  • headache
  • loss of voice
  • nasal congestion
  • nausea
  • runny nose
  • sneezing
  • sore throat
  • vomiting
Rare
  • Arm, back, or jaw pain
  • chest discomfort, tightness, or heaviness
  • fast or irregular heartbeat
  • general feeling of discomfort or illness
  • joint pain
  • loss of appetite
  • muscle aches and pains
  • shivering
  • trouble sleeping

Some side effects of lisinopril may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common
  • Decreased interest in sexual intercourse
  • inability to have or keep an erection
  • lack or loss of strength
  • loss in sexual ability, desire, drive, or performance
  • rash
Rare
  • Acid or sour stomach
  • belching
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • feeling of constant movement of self or surroundings
  • heartburn
  • indigestion
  • muscle cramps
  • sensation of spinning
  • stomach discomfort or upset
  • swelling

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Applies to lisinopril: oral tablet

Cardiovascular

Hypotension is most likely in patients who are sodium and intravascular volume depleted. In large studies, patients have reported "heart pounding" and chest pain, although the relationship to lisinopril is questionable.

A possible relationship between lisinopril use and a case of penile angioedema has been published. After six days of lisinopril therapy, a 74-year-old patient complained of penile "swelling". Lisinopril was suspected as the cause of the angioedema and was discontinued. The localized angioedema resolved within a few days following discontinuation.

Cardiovascular side effects have included hypotension (0.6% to 1.0% of patients) and angioneurotic edema (0.2% of patients). Angina pectoris, orthostatic hypotension, and palpitations are each reported in approximately 1% of patients. Patients with heart failure are more likely to experience hypotension. In one study the incidence of hypotension-related undesirable side effects was only 0.6% compared to 4% in patients with CHF.

Renal

Renal side effects have included new (usually mild) or worsened renal insufficiency which has rarely developed during ACE inhibitor therapy. Patients with renal artery stenosis should not receive lisinopril or any other ACE inhibitor. Proteinuria has also been reported.

Patients with renal artery stenosis maintain glomerular filtration by efferent arteriolar vasoconstriction, which is blocked by lisinopril.

Although lisinopril may be associated with a rise in serum creatinine and BUN, GFR has been shown to remain unchanged or improve in most patients.

Nervous system

Nervous system side effects have included dizziness in up to 13% and headache in up to 6% of patients. Paresthesias are reported in 1% of patients.

Respiratory

A retrospective study has revealed a significantly higher incidence of discontinuation of angiotensin converting enzyme inhibitor therapy due to cough among black patients compared with non-black patients (9.6% vs. 2.4%).

Several agents have been studied for treating cough with ACE inhibitors. No long term trials exist to allow a definitive treatment option. Cromolyn has the most data showing some benefit. Other agents studied include baclofen, theophylline, sulindac, and benzonatate.

Respiratory side effects have included a reversible dry cough in up to 3% of patients. Cough has appeared as common in women as men, but in some reviews women have reported cough more often than men. Other respiratory system side effects are limited to stridor secondary to hypersensitivity to lisinopril.

Metabolic

A rise in serum potassium is due to a mild reduction in serum aldosterone concentrations.

Metabolic side effects are unusual and have included a moderate, often clinically insignificant rise in serum potassium. Lisinopril and other ACE inhibitors appear to have a beneficial effect on plasma insulin levels. Cases of hypoglycemia have been reported in diabetic patients receiving ACE inhibitors when concurrently treated with oral antidiabetic agents or insulin.

Gastrointestinal

Gastrointestinal side effects have included diarrhea (4%), nausea (3%), and vomiting (1%). Taste disturbances and constipation are reported in less than 1% of patients. Acute pancreatitis has been associated with lisinopril.

Hypersensitivity

In at least two cases of lisinopril-associated angioedema of the face and neck, the affected patients did not have a history of reactive airways disease. Patients with intestinal angioedema generally present with abdominal pain (with or without nausea or vomiting) and in some cases there was no prior history of facial angioedema, and C-1 esterase levels were normal. These symptoms resolve after stopping the ACE inhibitor.

Hypersensitivity reactions to lisinopril, as with some other angiotensin converting enzyme (ACE) inhibitors, may be life-threatening. Angioedema occurs in approximately 0.2% of patients. Angioedema of the face, extremities, lips, tongue, glottis and/or pharynx have been reported rarely in patients receiving ACE inhibitors. Obstructive laryngeal and glossal angioedema due to lisinopril is a rare, but potentially fatal reaction. In addition, intestinal angioedema has been reported in patients treated with ACE inhibitors. It is recommended that any patient with dyspnea, dysphagia, or significant facial angioedema stop therapy immediately and avoid ACE inhibitor therapy in general.

Dermatologic

Dermatologic side effects have included rare instances of urticaria, alopecia, herpes zoster, photosensitivity, skin lesions, skin infections, pemphigus, erythema, psoriasis, and rare cases of other severe skin reactions, including toxic epidermal necrolysis and Stevens-Johnson Syndrome, (causal relationship has not been established).

Hematologic

Hematologic side effects, including neutropenia and fatal aplastic anemia, have rarely been associated with lisinopril or other ACE inhibitors. A case of Henoch-Schonlein purpura complicated by polyarthritis has been associated with lisinopril.

A 64-year-old woman with aortic insufficiency, coronary artery disease, and atrial fibrillation developed fever and anorexia associated with pancytopenia within seven days after starting furosemide, digoxin, warfarin, and lisinopril. She died despite intensive supportive measures. Autopsy revealed bone marrow aplasia and changes consistent with hepatorenal failure. There was no evidence of infection or autoantibody disease. At least one other (reversible) case has been reported.

Psychiatric

Although angiotensin converting enzymes are found in many areas of the central nervous system, the mechanism for ACE inhibitor-induced mania is unclear. They are lipophilic and are not known to cross the blood-brain barrier. ACE inhibitors have been shown to alter the metabolism of enkephalins and modulate cholinergic activity. Interestingly, one case of captopril-induced hallucinations was successfully treated with naloxone.

Psychiatric complications have rarely been attributed to use of ACE inhibitors, including memory impairment, confusion, somnolence, irritability, and nervousness. A single case of mania has been associated with the use of lisinopril in an elderly woman who had previously tolerated enalapril.

Hepatic

Hepatic side effects associated with the use of ACE inhibitors have included a rare syndrome that begins with cholestatic jaundice and progresses to fulminant hepatic necrosis and (sometimes) death. Experts recommend discontinuation of therapy with this drug if jaundice or markedly elevated hepatic serum enzymes develop.

Endocrine

Endocrine side effects including case reports indicating development of the syndrome of inappropriate secretion of antidiuretic hormone have been reported.

Other

Other side effects have included olfactory disturbance.