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Lisinopril is a drug of the angiotensin-converting enzyme (ACE) inhibitor class primarily used in treatment of hypertension, congestive heart failure, and heart attacks, and also in preventing renal and retinal complications of diabetes. Its indications, contraindications and side effects are as those for all ACE inhibitors.
Historically, lisinopril was the third ACE inhibitor (after captopril and enalapril) and was introduced into therapy in the early 1990s. A number of properties distinguish it from other ACE inhibitors: It is hydrophilic, has a long half-life and tissue penetration, and is not metabolized by the liver.
Lisinopril is typically used for the treatment of hypertension, congestive heart failure, acute myocardial infarction, and diabetic nephropathy.
In special populations
The dose needs to be adjusted in those with poor kidney function.
Side effects, some or all of which are serious and require immediate medical attention, include:
- Chills, signs of infection
- Dark urine, decreased urination (oliguria)
- Difficulty swallowing or breathing (signs of angioedema), allergic reaction (anaphylaxis)
- Yellowing of skin or eyes (jaundice)
- Abdominal pain, bloating, vomiting
- Chest pain or tightness, dizziness, lightheadedness, fainting (syncope)
- Dry cough
- Joint pain
- Diarrhea, nausea
- Drowsiness, headache, tiredness
- Muscle cramps
- Serious (possibly fatal) liver problems
Lisinopril causes the kidneys to retain potassium, which may lead to hyperkalemia. From a study of more than 1,000 patients who have hyperkalemia when using it, the condition may happen more on older male users.
A rare but severe allergic reaction can occur that affects the bowel wall and secondarily causes abdominal pain. This anaphylactic reaction is very rare and must be given immediate medical attention.
Pregnancy and breastfeeding
Lisinopril has been assigned to pregnancy category D by the FDA for use during the second and third trimesters and to category C during the first trimester. Animal and human data have revealed evidence of embryolethality and teratogenicity associated with angiotensin converting enzyme (ACE) inhibitors. There are no controlled data in human pregnancy. Congenital malformations have been reported with the use of ACE inhibitors during the first trimester of pregnancy, while fetal and neonatal toxicity, death, and congenital anomalies have been reported with their use during the second and third trimesters of pregnancy. If the patient becomes pregnant, lisinopril should be discontinued as soon as possible; it is considered contraindicated during pregnancy.
There are no data on the excretion of lisinopril into human milk. The manufacturer recommends, due to the potential for serious adverse reactions in nursing infants, a decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
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