Lisinopril

Lisinopril is an ACE inhibitor that is directly active and does not first need to be activated in the liver. This distinguishes it from ramipril and enalapril. It is used to treat high blood pressure, heart failure, and after a heart attack.

Lisinopril is available as a single-ingredient product and in combination with hydrochlorothiazide (Lisinopril-ratiopharm® comp.). It is taken once daily.

Lisinopril inhibits angiotensin-converting enzyme (ACE):

Mechanism of action:

• Direct ACE inhibition (not a prodrug)
• Prevents the formation of angiotensin II
• Blood vessels relax, blood pressure falls
• Reduces aldosterone release

Special feature:

• No metabolism in the liver required
• Therefore can also be used in liver disease
• Is excreted unchanged via the kidneys
• Duration of action: 24 hours (once-daily dosing)

Clinical effect: Lowers systolic blood pressure by an average of 10-15 mmHg. In addition, a protective effect on the heart and kidneys.

Lisinopril is suitable for:

• Adults with high blood pressure
• Patients with heart failure
• Early treatment after an acute heart attack
• Diabetic nephropathy

Particularly suitable in:

• Liver disease (no hepatic activation required)
• Patients who prefer a once-daily dose

Not suitable:

• Pregnancy and breastfeeding
• History of angioedema

High blood pressure:

• Starting dose: 10 mg once daily
• Usual dose: 20 mg once daily
• Maximum dose: 80 mg daily

Heart failure:

• Starting dose: 2.5 mg once daily
• Target dose: 20-35 mg once daily

Available strengths:

• 2.5 mg, 5 mg, 10 mg, 20 mg tablets

Combination:

• Lisinopril + hydrochlorothiazide (comp.)

How to take:

• Once daily, always at the same time of day
• Regardless of meals
• With a glass of water

Notes:

• First dose preferably in the evening
• Gradual dose increase
• Regular laboratory checks (kidneys, potassium)
• Drink enough fluids, especially in hot weather

Caution:

• After the first dose, blood pressure may drop more sharply
• Especially after previous diuretic therapy
• Do not stop taking it suddenly

Lisinopril must not be taken in cases of:

• Hypersensitivity to lisinopril or other ACE inhibitors
• History of angioedema
• Pregnancy in the 2nd and 3rd trimester
• Bilateral renal artery stenosis
• Concomitant use with sacubitril/valsartan

Caution in:

• Kidney impairment (dose adjustment)
• Hyperkalemia
• Aortic stenosis
• Hypertrophic cardiomyopathy
• Collagen vascular diseases

Pregnancy and breastfeeding: Lisinopril is not recommended in the 1st trimester of pregnancy and is contraindicated in the 2nd and 3rd trimesters. Can cause malformations and kidney damage in the unborn child. Treatment should not be started during pregnancy. If pregnancy is detected, treatment must be stopped immediately and, if necessary, another therapy started. Lisinopril is not recommended during breastfeeding.

Common (1-10%):

• Dry, irritating cough
• Dizziness
• Headache
• Diarrhea
• Orthostatic drop in blood pressure

Uncommon (0.1-1%):

• Fatigue
• Skin rash
• Nausea
• Worsening of kidney function
• Hyperkalemia

Rare:

• Angioedema (emergency!)
• Severe allergic reactions
• Changes in blood count

Note: If swelling of the face, lips, or tongue occurs, call emergency medical services immediately – angioedema is an emergency.

Important interactions:

• Potassium-sparing diuretics → risk of hyperkalemia
• NSAIDs → reduced effect, kidney damage
• Lithium → increased lithium levels
• Other blood pressure-lowering drugs → enhanced effect
• Aliskiren → contraindicated in diabetes

Caution:

• Insulins and oral antidiabetics (hypoglycemia possible)
• Gold injections (nitritoid reactions)
• mTOR inhibitors (increased risk of angioedema)