What To Know About Lisinopril (Prinivil and Zestril)

Lisinopril (brand names Prinivil and Zestril) is considered a drug in the class of angiotensin-converting enzyme (ACE) inhibitors. It used to treat hypertension and heart failure. Lisinopril is also given after a recent heart attack or stroke because it’s been found to improve the survival rate when a person suffers from either of these maladies.

ACE inhibitors work by creating a chemical called angiotensin II, which causes the blood vessels to constrict and then rise. By blocking the activity of ACE, less angiotensin II is produced by the body; this results in relaxing the blood vessels which lowers the blood pressure.

Lisinopril is available as an oral (by mouth) tablet as well as a liquid solution. The oral tablets are available in 2.5, 5, 10, 20, and 40 mg tablets. The liquid form of lisinopril must be special ordered by your health care provider. Sometimes lisinopril is combined with other blood pressure medications (such as hydrochlorothiazide) to help potentiate its effectiveness. Anxiety is a possible side effect of lisinopril.

Uses

The Food and Drug Administration (FDA) has approved lisinopril for the treatment of:

• Heart failure
• Hypertension
• Acute (sudden and severe) myocardial Infarction (heart attack)
• High blood pressure in children aged 6 and older

Off-Label Uses

There are several off-label uses for lisinopril. This means the drug is sometimes prescribed but has not been approved by the FDA for use for a specific condition (due to lack of sufficient evidence from clinical research studies).

Lisinopril is sometimes given for kidney disease. Although there has been some clinical research studies to back the effectiveness of lisinopril for some types of kidney disease, such as proteinuric (high amounts of protein in the urine) kidney disease. More studies are needed before the drug will be considered a mainstream medication for the treatment of this condition.

Other off-label uses for lisinopril include:

• Migraine headache
• Prevention of diabetes
• Mitral valve regurgitation
• Myocardial fibrosis
• Cardiomyopathy
• Infertility
• Diabetic retinopathy

Before Taking Lisinopril

Before giving you a prescription for lisinopril, your health care provider will evaluate your blood pressure readings and may do some blood tests to check your kidney function. A potassium level may be taken as well because lisinopril can raise serum (blood) potassium levels.

Before taking lisinopril be sure to tell your health care provider if:

• You are taking any other prescription medications, over-the-counter (OTC) medications, vitamins, supplements, or any other type of drugs
• You are pregnant or plan to become pregnant or are breastfeeding
• You have kidney disease
• You have heart problems
• You have been diagnosed with low blood pressure
• You have diabetes
• You are scheduled for any type of major surgery
• You have had a recent bout of diarrhea or vomiting
• You are on a special diet, such as a low sodium diet
• You have had an allergic reaction to lisinopril
• You plan to have a desensitization treatment for allergies

Other ACE Inhibitors

There are several other drugs that are considered ACE inhibitors, including

• Benazepril (Lotensin)        
• Captopril (Capoten)
• Enalapril (Vasotec) 
• Fosinopril (Monopril)         
• Perindopril (Aceon) 
• Quinapril (Accupril) 
• Ramipril (Altace)     
• Trandolapril (Mavik)

Dosage

Your health care provider will prescribe the dosage of lisinopril that is right for you depending on many factors, including the type of medical condition you have—such as high blood pressure or heart failure—and other factors. Always take lisinopril exactly as instructed by the prescribing health care provider.

Average Dosage

The average starting dosage of lisinopril is between 2.5 mg and 10 mg. It is usually to be taken only once per day.

According to the FDA, lisinopril should be started at a lower dosage and increased gradually over a time span of several weeks. The starting dosage is different, depending on the type of medical treatment you are taking lisinopril for, such as:

• High blood pressure: 10 mg one time per day
• Recent heart attack: 5 mg one time per day
• Heart failure: 5 mg one time per day

The maximum dosage of lisinopril is 80 mg one time per day.

Dosages are lower for children and depend on many factors such as condition, the child’s age, weight, and more.

Every prescription medication should be taken according to the drug manufacturer; there is usually a range of dosages that are considered therapeutic. Your health care provider will instruct you on what the correct dosage is for you.

How To Take and Store

How To Take Lisinopril

The best time of day to start taking your initial dosage of lisinopril is just before bedtime because it may cause dizziness. Once the dizziness subsides, it’s okay to take it any time of the day.

Lisinopril can be taken with food or on its own. Do not crush the tablet; swallow it whole with a drink of water or other types of fluid. 

If you were prescribed the liquid form, you’ll receive an oral (by mouth) syringe to help you measure the precise dosage. If you are unsure about how to measure your dosage, be sure to talk to your nurse, the pharmacist, or other health care provider.

How To Store Lisinopril

Storage recommendations for lisinopril include:

• Keeping it at room temperature
• Keeping it out of the reach of small children
• Protecting the bottle from getting wet
• Keeping the lid tightly closed
• Throwing away any unused tablets or liquid once it has reached its expiration date

Side Effects

Common

Common side effects of lisinopril that do not usually require immediate medical attention (unless they do not go away or are causing discomfort) include:

• A change in the perception of taste
• A cough (sometimes referred to as lisinopril cough)
• Dizziness
• Light sensitivity
• A headache
• A fever
• Anxiety

If anxiety is severe, or it does not subside after taking lisinopril for a short time, it should be reported to your health care provider. Be aware that if you stop taking lisinopril suddenly, this can cause or worsen lisinopril anxiety.

Other signs of abruptly discontinuing lisinopril can include tachycardia (a fast heart rate) and sweating.

Severe

Severe side effects, those that should be reported to your health care provider right away, include:

• Dysuria: Problems passing urine, which could be a sign of kidney problems.
• Signs of increased potassium levels: Such as weakness in the muscles, chest pain, or irregular heart rate.
• Signs of liver problems: Such as flu-like symptoms, light-colored stools, dark urine, general malaise, upper right abdominal pain, nausea, yellowing of the skin or in the whites of the eyes.
• Dizziness, feeling faint, lightheadedness, or falling: These are signs of low blood pressure.
• Nausea and vomiting
• An allergic reaction: Including symptoms such as a rash, swelling in the face, lips, throat, hand, feet, or tongue
• Difficulty breathing

This list may not describe every possible side effect from lisinopril If you experience any other side effects, be sure to contact your health care provider. You can also report side effects to the FDA by calling 1-800-FDA-1088.

Lisinopril Warnings and Interactions

Do not use heavy machinery or perform any type of activity that requires mental alertness. Do not stand up, or sit up suddenly after taking lisinopril, particularly if you are a senior as this could increase your risk of falls. 

Lisinopril should be used with caution in some conditions, including:

• Hyperkalemia (high potassium levels) ACE inhibitors can raise blood potassium levels; lisinopril should be used with caution in those with hyperkalemia.
• Those with African ancestry-some studies have found that people of African ancestry do not respond well to ACE inhibitors, also, this population may be more at risk for a potentially fatal complication from lisinopril, called angioedema. 

Note, these do not represent all of the warnings for taking lisinopril; be sure to talk with your healthcare provider about any other precautions or warnings linked with ACE inhibitors.

What Is a Black Box Warning?

A black box warning (also referred to as a “boxed warning”), is a drug that has been deemed by the FDA as having a serious safety risk.

The black box warning for Lisinopril includes information about the use during pregnancy. ACE inhibitors (such as lisinopril) can cause injury or even death to the developing fetus during the second or third trimester of pregnancy. If pregnancy occurs, lisinopril should be discontinued as soon as possible.    

Precautions and Contraindications

A contraindication is a medication, surgery, or procedure, which shouldn’t be used in a specific situation because it could cause harm. This could describe when two medications should not be given together, or in the instance of a certain condition (such as kidney disease).

Another scenario that constitutes a contraindication is when a person (such as a child or a pregnant woman) should not be given a specific medication. Contraindications for lisinopril include medications such as:

• Hymenoptera venom (venom from insects used to treat immune-related or inflammatory disease)
• Aliskiren
• Angiotensin receptor blockers, like losartan, sucabitril or valsartan
• Some diabetic medications
• Diuretics
• Lithium
• NSAIDs
• Potassium supplements
• Salt substitute

This list of medications is not all-inclusive, so be sure to provide your health care provider with a list of every type of medication you are taking, including the dosage and when you take the drug/s.

Don’t forget to including OTC medications, herbal and natural supplements (including vitamins), and any other type of mediation you take.

Other Contraindications

Other contraindications for lisinopril include:

• Pregnant or breastfeeding mothers
• History of angioedema
• Bilateral renal artery stenosis
• Kidney failure
• Diabetes mellitus