Generic Name and Formulations:
Lisinopril 5mg, 10mg, 20mg; scored tabs.
Company:
Merck & Co., Inc.
Indications for PRINIVIL:
Heart failure inadequately controlled by diuretics +/or digitalis. Adjunct to other therapies within 24 hrs post-MI in hemodynamically stable patients, to reduce mortality.
Adult:
CHF: initially 5mg once daily; if hyponatremia: initially 2.5mg once daily; may increase as tolerated up to max 40mg once daily; supervise closely. Reduce diuretic dosage before 1st dose (if possible) and observe until BP is stabilized. Post-MI: 5mg within 24 hrs of onset of symptoms, then 5mg after 24 hrs, then 10mg after 48 hrs, then 10mg once daily for up to 6 weeks; if systolic BP ≤120mmHg at onset, start with 2.5mg daily for 3 days; or if systolic BP ≤100mmHg occurs, start with 5mg daily, then reduce to 2.5mg daily as needed; discontinue if prolonged hypotension (systolic BP ≤90mmHg for >1 hr) occurs. Renal impairment (CrCl 10–30mL/min): reduce initial dose to 50%; on hemodialysis or (CrCl <10mL/min): initially 2.5mg once daily.
Children:
Not recommended.
Contraindications:
History of ACEI-associated or other angioedema. Concomitant aliskiren in patients with diabetes.
Warnings/Precautions:
Fetal toxicity may develop; discontinue if pregnancy is detected. Renal impairment. Dialysis (esp. high-flux membrane). Salt/volume depletion. Hypertrophic cardiomyopathy. CHF. Ischemic heart disease. Cerebrovascular disease. Post MI. Renal or aortic stenosis. Surgery. Monitor renal function, serum potassium in diabetics. Discontinue and monitor if angioedema, laryngeal edema, marked elevations of liver enzymes, or jaundice occurs. Black patients may have higher risk of angioedema than non-black patients. Elderly. Neonates. Pregnancy (Cat.D); monitor. Nursing mothers: not recommended.
Interactions:
See Contraindications. Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Concomitant aliskiren in renal impairment (CrCl <60mL/min): not recommended. May cause hypotension or increased BUN with diuretics. May cause hyperkalemia with K+ sparing diuretics, K+ supplements, or K+ -containing salt substitutes. May increase lithium levels; monitor frequently. Antagonized by, and increased risk of renal failure with, NSAIDs including selective COX-2 inhibitors. Increased risk of angioedema with concomitant mTOR inhibitors (eg, temsirolimus, sirolimus, everolimus). Hypoglycemia with oral antidiabetics, insulin. Nitritoid reactions with concomitant injectable gold (sodium aurothiomalate); rare.
Pharmacological Class:
ACE inhibitor.
Adverse Reactions:
Dizziness, hypotension, headache, cough, chest pain, renal dysfunction, hyperkalemia, angioedema; rare: liver dysfunction, blood dyscrasias.
Elimination:
Renal.
Generic Availability:
YES
How Supplied:
Tabs—90
