Lisinopril

What Does Lisinopril Do?

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used primarily to treat health conditions such as high blood pressure, heart failure, heart attacks, chronic kidney disease, and diabetic nephropathy. Potential off-label uses include prevention of migraines and pre-eclampsia in high-risk pregnancies.

How Does Lisinopril Work? (the complicated bit)

Lisinopril works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, by the ACE. This action causes blood vessels to dilate, lowering resistance and hence blood pressure. In addition, it leads to a decrease in aldosterone release, further reducing fluid retention and blood volume.

Drug Type and Category of Lisinopril

Lisinopril is an antihypertensive medication and belongs to the drug class known as Angiotensin-Converting Enzyme (ACE) inhibitors.

What dosage of Lisinopril should you be taking?

The recommended dosages for lisinopril, according to NICE guidelines ¹, vary based on the condition being treated. 

Hypertension (High Blood Pressure)

• Initial Dose: 10 mg once daily
• Maintenance Dose: 20 mg to 40 mg once daily
• Maximum Dose: 80 mg once daily

Heart Failure

• Initial Dose: 5 mg once daily
• Maintenance Dose: 5 mg to 40 mg once daily
• Maximum Dose: 40 mg once daily

Post-Myocardial Infarction (Heart Attack)

• First Dose: 5 mg once, followed by 5 mg after 24 hours, and then 10 mg after 48 hours
• Maintenance Dose: 10 mg once daily

Diabetic Kidney Disease

• Initial Dose: 10 mg once daily
• Maintenance Dose: 20 mg once daily

Pediatric Use

For children aged 6 years and older, the starting dose is typically calculated based on body weight, usually around 0.07 mg/kg once daily, up to a maximum of 5 mg once daily.

Administration 

• Lisinopril is usually taken once a day, with or without food.
• Doses may be adjusted based on individual response and tolerance, and monitoring of blood pressure and kidney function is important during treatment.

What are the side-effects of Lisinopril? ²

Common Side Effects (affecting 1 in 10 to 1 in 100 people)

• Dry, tickly cough is by far the most common side-effect, and occurs in 10-20% of patients. 
• Dizziness or light-headedness, particularly upon standing (postural hypotension)
• Headaches
• Diarrhea
• Nausea and vomiting
• Fatigue
• Problems with kidney function

Uncommon Side Effects (affecting 1 in 100 to 1 in 1000 people)

• Weakness or tiredness
• Altered taste
• Skin rash or itching
• Insomnia
• Palpitations (irregular heartbeat)
• Muscle and joint pain
• Nasal inflammation (rhinitis)

Rare Side Effects (affecting 1 in 1000 to 1 in 10,000 people)

• Angioedema (swelling of the face, lips, tongue, or throat, which can cause breathing difficulties)
• Acute kidney failure
• Severe allergic reactions
• Dry mouth
• Confusion
• Severe skin reactions

Very Rare Side Effects (affecting fewer than 1 in 10,000 people)

• Blood cell disturbances, which may present as sore throat, mouth ulcers, or fever
• Pancreatitis
• Liver function issues, including jaundice

Serious Side Effects

Seek immediate medical attention if you experience:

• Swelling of the face, lips, or throat
• Yellowing of the skin or eyes (signs of liver problems)
• Severe abdominal pain (possible pancreatitis)
• Signs of kidney problems, such as decreased urination or blood in urine

Drug Interactions

• Diuretics: Combining lisinopril with diuretics can lead to excessive blood pressure reduction. Potassium-sparing diuretics increase the risk of hyperkalemia (high potassium levels).
• Diabetes Medications: Insulin and sulfonylureas may have enhanced blood sugar-lowering effects when taken with lisinopril, increasing the risk of hypoglycemia.
• Lithium: Co-administration may lead to lithium toxicity, necessitating close monitoring of lithium levels.
• Angiotensin II Receptor Blockers (ARBs): Concurrent use with ARBs or aliskiren is generally not recommended, particularly in patients with diabetes or renal impairment.

Natural Alternatives to Lisinopril³

Garlic

Garlic may act as an ACE inhibitor, similar to lisinopril. It also has antioxidant, anti-inflammatory, and nitric oxide-increasing effects that may help with heart health. A review of 7 clinical trials found that garlic reduces both systolic and diastolic blood pressure by about 7 points on average.

Pycnogenol

Pycnogenol is a natural plant extract that inhibits ACE and increases nitric oxide to help relax blood vessels. A review of 9 trials found it reduces both systolic and diastolic blood pressure by about 3 points on average, with a greater effect after 12 weeks. A small study showed Pycnogenol combined with the ACE inhibitor ramipril lowers blood pressure better than ramipril alone.

Pomegranate

Both pomegranate fruit peel and juice can block ACE activity. A review of 8 trials found pomegranate juice reduces systolic blood pressure by 5 points and diastolic by 2 points. Pomegranate seed oil may also prevent plaque buildup in arteries.

Hawthorn

Hawthorn is an herb that has been used for centuries to treat heart conditions. It contains antioxidants and may inhibit ACE. A review of 9 trials found hawthorn improves symptoms and exercise performance in people with heart failure.

Lifestyle Choices

Prevention is better than cure. Reducing blood pressure naturally through good lifestyle choices will make a big difference in preventing cardiac issues. Reducing weight, reducing stress levels, exercising regularly, eating healthy, and drinking plenty of water will help. Reducing weight through eating healthy is probably the most important lifestyle change. 

Interesting facts about Lisinopril

ACE inhibitors, including lisinopril, are derived from research on Brazilian pit viper venom. The venom blocks ACE (angiotensin-converting enzyme), leading to a drop in blood pressure—a discovery that led to the development of these drugs. 

Unlike some other ACE inhibitors, Lisinopril is not a prodrug, meaning it does not require metabolic activation to become effective. This contributes to its predictable pharmacokinetics and ease of use. 

Lisinopril was first approved by the FDA in 1987 and has been widely used since then. It's available both as a brand-name drug (Zestril, Prinivil) and in generic form.

Disclaimer

This article is generated for informational purposes only. It was created in December 2024. Medications and medical guidance can change over time. Therefore, it is essential to consult with your general practitioner or healthcare provider before making any decisions regarding medications or treatment plans. Your GP can provide personalised advice based on your specific health needs and conditions.

Citations:

1. https://bnfc.nice.org.uk/drugs/lisinopril/
2. https://www.zavamed.com/uk/side-effects-of-lisinopril.html
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3989080/