Lisinopril

Generic Name: Lisinopril
Common Brand Names: Prinivil, Zestril

Introduction

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used primarily in the treatment of high blood pressure (hypertension), heart failure, and chronic kidney disease. It works by inhibiting the enzyme ACE, which leads to vasodilation, decreased blood pressure, and reduced workload on the heart.

Conditions of Use (Indications)

1. Hypertension: Used to treat high blood pressure, either alone or in combination with other antihypertensive medications.
2. Heart Failure: Improves symptoms and reduces mortality in patients with chronic heart failure, particularly those with reduced ejection fraction (HFrEF).
3. Chronic Kidney Disease: Helps slow the progression of renal dysfunction, particularly in patients with diabetic nephropathy.

Mechanism of Action

Lisinopril inhibits ACE, which converts angiotensin I to angiotensin II, a potent vasoconstrictor. By reducing the levels of angiotensin II, lisinopril causes vasodilation, decreases aldosterone secretion (leading to reduced sodium and water retention), and lowers blood pressure. It also decreases the strain on the heart in patients with heart failure.

Side Effects

1.Common:

• Dizziness, lightheadedness, especially when standing up quickly.
• Fatigue and headache.
• Cough (dry) due to the accumulation of bradykinin.

2.Serious:

• Hyperkalemia (elevated potassium levels).
• Angioedema (swelling of the face, lips, or throat).
• Acute renal failure, especially in patients with pre-existing kidney issues.

Harmful Interactions

1. Potassium-Sparing Diuretics: Increased risk of hyperkalemia when used with potassium-sparing diuretics (e.g., spironolactone).
2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs can reduce the blood pressure-lowering effects of lisinopril and may increase the risk of kidney damage.
3. Lithium: Concomitant use of lisinopril and lithium can increase lithium levels, leading to toxicity.

Contraindications

1. Known hypersensitivity to lisinopril or other ACE inhibitors.
2. History of angioedema with previous ACE inhibitor use.
3. Pregnancy, especially in the second and third trimesters.
4. Severe renal impairment (eGFR < 30 mL/min/1.73 m²).

Latest References

1. Mack, M., et al. (2023). “Lisinopril in Hypertension: A Comprehensive Review.” American Journal of Hypertension, DOI: 10.1093/ajh/hpz216.
2. American College of Cardiology (ACC). (2022). “Management of Heart Failure with Reduced Ejection Fraction.” ACC Guidelines.