Renal Dose Adjustment (Based on CrCl)
Hypertension
- Adults
- 10-30 mL/min: 5 mg PO qd; adjust upward until blood pressure controlled or to MAX: 40 mg/day
- <10 mL/min: 2.5 mg PO qd; adjust upward until blood pressure controlled or to MAX: 40 mg/day
- Child <6yrs
- <30 mL/min: Contraindicated
Heart failure or hyponatremia (<130 mEq/L) (Based on CrCl)
- < 30 mL/min: Start 2.5 mg PO qd
- MAX: 40 mg/day
- Child <6yrs: CrCl < 30 mL/min: Contraindicated
MI
- Cr>2 : Advise caution, dose adjustments not defined
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- Angioedema involving the extremities, face, lips, mucous membranes, tongue, glottis or larynx has been reported in patients treated with ACE inhibitors. If airway obstruction occurs, institute emergency therapy with epinephrine. Use with extreme caution in patients with hereditary angioedema
- Captopril, another angiotensin converting enzyme inhibitor, has been shown to cause agranulocytosis and bone marrow depression. Risk increases with renal function impairment, CHF, SLE or other collagen vascular disease. Monitor WBCs in patients with collagen-vascular disease, especially if the disease is associated with impaired renal function
- Significant hypotension may occur after first dose, especially in patients with severe salt or volume depletion or those with CHF. Start therapy under close medical supervision in these patient groups
- Fetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death have occurred when this drug was administered to pregnant women
- Apprise mothers of the potential hazards to their fetuses, and perform serial ultrasound examinations to assess the intraamniotic environment. On observation of oligohydramnios discontinue therapy unless it is considered lifesaving for the mother. As appropriate fetal testing should be considered depending upon the week of pregnancy. Oligohydramnios may not be observed until after the fetus has sustained irreversible injury
- ACE inhibitor component of this combination drug is associated with hypotension, oliguria, and hyperkalemia; closely observe infants with histories of in utero exposure to ACE inhibitors. Provide support for blood pressure and renal perfusion on occurrence of oliguria. If required provide exchange transfusion or dialysis as means of reversing hypotension and/or substituting for impaired renal function
- Assess heart failure patients for evidence of worsening failure (evaluation of peripheral edema, shortness of breath). Increase in weight (eg, 2 pounds in 1 day or 5 pounds in 1 wk), worsening edema, shortness of breath are signs of worsening of heart failure
- Rarely, ACE inhibitors can cause cholestatic jaundice progressing to fulminant hepatic necrosis and (sometimes) death. Discontinue therapy if marked elevations of hepatic enzymes occur
- Monitor BUN/Cr at baseline, then periodically, or more frequently if CHF, renal artery stenosis
- Monitor electrolytes and BP periodically
- Monitor WBC with differential count at baseline if collagen vascular disease and renal impairment
Cautions: Use cautiously in
- Renal impairment
- Renal artery stenosis
- Severe hepatic impairment
- CAD
- Severe CHF
- Aortic stenosis
- Cerebrovascular disease
- Collagen vascular disease
- Hypotension
- Hyponatremia
- Volume depletion
- Hypertrophic cardiomyopathy
- Elderly patients
- Hyperkalemia risk
- Dialysis with high-flux membranes
Pregnancy Category:C (D in second and third trimesters)
Breastfeeding: Safety unknown, alternate drugs might be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 2 June 2010).
US Trade Name(s)
US Availability
lisinopril (generic)
- TABS: 2.5, 5, 10, 20, 30, 40 mg
Prinivil
Zestril
- TABS: 2.5, 5, 10, 20, 30, 40 mg
Canadian Trade Name(s)
Canadian Availability
lisinopril (generic)
Prinivil, Zestril
UK Trade Name(s)
UK Availability
lisinopril (generic)
Zestril
Australian Trade Name(s)
- Fibsol
- Liprace
- Lisinobell
- Lisodur
- Prinivil
- Zestril
Australian Availability
lisinopril (generic)
Fibsol, Liprace, Lisinobell, Lisodur, Prinivil, Zestril
Pricing data from www.DrugStore.com in U.S.A.
- Lisinopril 30 MG TABS [Bottle] (SANDOZ)
30 mg = $20.99
90 mg = $56.97 - Zestril 10 MG TABS [Bottle] (ASTRAZENECA)
30 mg = $55.11
90 mg = $143.27 - Prinivil 5 MG TABS [Bottle] (MERCK SHARP & DOHME)
90 mg = $102.98
180 mg = $195.96 - Zestril 5 MG TABS [Bottle] (ASTRAZENECA)
30 mg = $50.99
90 mg = $129.97 - Zestril 40 MG TABS [Bottle] (ASTRAZENECA)
30 mg = $73.99
90 mg = $205.97 - Zestril 20 MG TABS [Bottle] (ASTRAZENECA)
30 mg = $52.99
90 mg = $149.97 - Zestril 30 MG TABS [Bottle] (ASTRAZENECA)
30 mg = $71.99
90 mg = $199.98 - Lisinopril 40 MG TABS [Bottle] (LUPIN PHARMACEUTICALS)
30 mg = $17.99
90 mg = $39.97 - Zestril 2.5 MG TABS [Bottle] (ASTRAZENECA)
30 mg = $37.99
90 mg = $91.97 - Prinivil 20 MG TABS [Bottle] (MERCK SHARP & DOHME)
30 mg = $45.99
90 mg = $119.97 - Lisinopril 20 MG TABS [Bottle] (LUPIN PHARMACEUTICALS)
30 mg = $14.99
90 mg = $33.97 - Lisinopril 10 MG TABS [Bottle] (LUPIN PHARMACEUTICALS)
30 mg = $13.99
90 mg = $32.97 - Lisinopril 5 MG TABS [Bottle] (LUPIN PHARMACEUTICALS)
30 mg = $14.89
60 mg = $17.98 - Lisinopril 2.5 MG TABS [Bottle] (LUPIN PHARMACEUTICALS)
30 mg = $12.99
60 mg = $23.98 - Prinivil 10 MG TABS [Bottle] (MERCK SHARP & DOHME)
60 mg = $75.99
180 mg = $205.96
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
