Generic name: lisinopril (lyse IN oh pril)
Brand name: Prinivil, Qbrelis, Zestril
Drug class: Angiotensin Converting Enzyme Inhibitors
Zestril (lisinopril) is an ACE inhibitor. ACE stands for angiotensin converting enzyme.
Zestril is used to treat high blood pressure (hypertension) in adults and children who are at least 6 years old.
Zestril is also used to treat congestive heart failure in adults, or to improve survival after a heart attack.
Warnings
Do not use Zestril if you are pregnant. It could harm the unborn baby. Stop using this medicine and tell your doctor right away if you become pregnant.
You should not use Zestril if you have ever had angioedema. Do not take this medicine within 36 hours before or after taking medicine that contains sacubitril (such as Entresto).
If you have diabetes, do not use Zestril together with any medication that contains aliskiren (such as Tekturna or Tekamlo).
You may also need to avoid taking Zestril with aliskiren if you have kidney disease.
Before taking this medicine
You should not use Zestril if you are allergic to lisinopril, or if you:
- have a history of angioedema;
- recently took a heart medicine called sacubitril; or
- are allergic to any other ACE inhibitor, such as benazepril, captopril, enalapril, fosinopril, moexipril, perindopril, quinapril, ramipril, or trandolapril.
Do not take Zestril within 36 hours before or after taking medicine that contains sacubitril (such as Entresto).
If you have diabetes, do not use Zestril together with any medication that contains aliskiren (such as Tekturna or Tekamlo).
To make sure Zestril is safe for you, tell your doctor if you have:
- kidney disease (or if you are on dialysis);
- liver disease; or
- high levels of potassium in your blood.
Do not use Zestril if you are pregnant, and tell your doctor right away if you become pregnant. Lisinopril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester.
You should not breastfeed while using Zestril.
How should I take Zestril?
Take Zestril exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Drink plenty of water each day while you are taking this medicine.
Zestril can be taken with or without food.
Your blood pressure will need to be checked often. Your kidney function and electrolytes may also need to be checked.
Call your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking lisinopril. This can lead to very low blood pressure, a serious electrolyte imbalance, or kidney failure.
If you need surgery, tell the surgeon ahead of time that you are using Zestril.
If you have high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.
Store Zestril at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What to avoid
Drinking alcohol can further lower your blood pressure and may increase certain side effects of Zestril.
Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Zestril can decrease sweating and you may be more prone to heat stroke.
Do not use potassium supplements or salt substitutes while taking Zestril, unless your doctor has told you to.
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.
Zestril side effects
Get emergency medical help if you have signs of an allergic reaction to Zestril: hives; severe stomach pain, difficult breathing; swelling of your face, lips, tongue, or throat. You may be more likely to have an allergic reaction if you are African-American.
Call your doctor at once if you have:
- a light-headed feeling, like you might pass out;
- fever, sore throat;
- high potassium - nausea, weakness, tingly feeling, chest pain, irregular heartbeats, loss of movement;
- kidney problems - little or no urination, swelling in your feet or ankles, feeling tired or short of breath; or
- liver problems - nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Common Zestril side effects may include:
- headache, dizziness;
- cough; or
- chest pain.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Dosing information
Usual Adult Dose for Hypertension:
Initial dose: 10 mg orally once a day; 5 mg orally once a day
Maintenance dose: 20 to 40 mg orally once a day
Maximum dose: 80 mg orally once a day
Comments:
-The initial dose is 5 mg orally once a day in patients receiving a diuretic.
-The 80 mg dose is used but does not appear to give greater effect.
-If blood pressure is not controlled with lisinopril alone, a low dose of a diuretic may be added (e.g., hydrochlorothiazide, 12.5 mg). After the addition of a diuretic, it may be possible to reduce the dose of lisinopril.
Usual Adult Dose for Congestive Heart Failure:
Initial dose: 2.5 to 5 mg orally once a day
Maintenance dose: Dosage should be increased as tolerated
Maximum dose: 40 mg orally once a day
Comments:
-The diuretic dose may need to be adjusted to help minimize hypovolemia, which may contribute to hypotension. The appearance of hypotension after the initial dose of lisinopril does not preclude subsequent careful dose titration with the drug.
Usual Adult Dose for Myocardial Infarction:
Initial dose: 5 mg orally (within 24 hours of the onset of acute myocardial infarction)
Subsequent doses: 5 mg orally after 24 hours, then 10 mg orally after 48 hours.
Maintenance dose: 10 mg orally once a day. Dosing should continue for at least 6 weeks.
Comments:
-Therapy should be initiated at 2.5 mg in patients with a low systolic blood pressure (less than or equal to 120 mm Hg and greater than 100 mmHg) during the first 3 days after the infarct. If prolonged hypotension occurs (systolic blood pressure less than 90 mmHg for more than 1 hour) therapy should be withdrawn.
Uses: Reduction of mortality in acute myocardial infarction
Usual Adult Dose for Diabetic Nephropathy:
Initial dose: 10 to 20 mg orally once a day
Maintenance dose: 20 to 40 mg orally once a day
Dosage may be titrated upward every 3 days
Comments:
-Not an approved indication.
Usual Geriatric Dose for Hypertension:
Initial dose: 2.5 to 5 mg orally once a day
Maintenance dose: Dosages should be increased at 2.5 mg to 5 mg per day at 1 to 2 week intervals.
Maximum dose: 40 mg orally once a day
Usual Pediatric Dose for Hypertension:
Pediatric patients greater than or equal to 6 years of age:
Initial dose: 0.07 mg/kg orally once a day (Maximum initial dose is 5 mg once a day)
Maintenance dose: Dosage should be adjusted according to blood pressure response at 1 to 2 week intervals.
Maximum dose: Doses above 0.61 mg/kg or greater than 40 mg have not been studied in pediatric patients
Comments:
-This drug is not recommended in pediatric patients less than 6 years old or in pediatric patients with glomerular filtration rate less than 30 mL/min.
What other drugs will affect Zestril?
Tell your doctor about all your current medicines and any you start or stop using, especially:
- a diuretic or "water pill";
- lithium;
- gold injections to treat arthritis;
- insulin or oral diabetes medicine;
- a potassium supplement;
- medicine to prevent organ transplant rejection - everolimus, sirolimus, tacrolimus, temsirolimus; or
- NSAIDs (nonsteroidal anti-inflammatory drugs) - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.
This list is not complete. Other drugs may interact with lisinopril, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.