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Lisinopril

 

Lisinopril is an oral medication used to manage high blood pressure, also known as hypertension.  Tablets are marketed as a generic or under a brand names of Prinivil, or Zestril; a new oral liquid is marketed as Qbrelis,.  Lisinopril is commonly used alone or in combination with other oral blood pressure medications.

Lisinopril is classified as an “Angiotensin Converting Enzyme (ACE) Inhibitor”, a common classification for anti-hypertension medications. This class of medications with generic names ending in –pril was developed by mimicking the actions of a snake venom on blood pressure. In 1968, it was discovered that proteins in viper’s venom inhibited ACE activity in the lungs of a dog, leading to the examination of ACE inhibitors in the management of high blood pressure. At first, there was hesitation to test this drug class in the United States because ACE inhibitors were thought appropriate only for management of extreme and malignant cases of high blood pressure. The FDA approved the first ACE inhibitor in 1981 for the management of high blood pressure, although lisinopril was not approved for use until 2003.

            Chronic high blood pressure can strain the heart and arteries, and can lower the efficiency of the cardiovascular system.

  • Over time, this leads to damage in critical organs, such as the brain, kidneys, and heart, increasing the risk for stroke and heart failure.
  • At higher blood pressure, blood is thicker and more likely to clot, which results in an increased risk of heart attack and stroke.

An enzyme known as the Angiotensin-Converting Enzyme (ACE) activates angiotensin II, a hormone responsible for tightening the muscle surrounding blood vessels. This tightening creates less space for the blood to flow, increasing blood pressure. Lisinopril helps manage this condition by inhibiting the angiotensin-converting enzyme (ACE), which prevents the activation of angiotensin II. Therefore, lisinopril relaxes blood vessels and lowers blood pressure.

Lisinopril is used to treat hypertension.  It is a drug of choice in patients with heart failure, diabetes or kidney disease.  Injury to the heart most commonly occurs due to acute myocardial infarction or chronic hypertension.  ACE inhibitors slow detrimental changes that occur in the heart and have been shown to improve survival. ACE inhibitors have also been shown to protect the kidneys in patients with diabetes or kidney disease.

Drugs in the ACE inhibitor class all have similar effects, but Lisinopril the most popular one because it can be taken once each day.  In many cases, an adult prescribed lisinopril will initially take between 2.5 mg and 10 mg, depending on the condition for which lisinopril is prescribed.  For most patients, this medication will be prescribed for daily use. The first effects of lisinopril can be noticed within one hour, but the medication can take up to six hours to reach maximum efficacy.

Lisinopril


Lisinopril can be taken with or without food, and this medication works best if the patient can take this drug at the same time each day. The patient should exercise caution to not miss doses, or alter the time of day the medication is taken.

Since hypertension is a silent condition, patients may not feel any better when taking this medication, but the regular use of lisinopril helps manage chronic high blood pressure. The regular use of this medication will control symptoms associated with high blood pressure, as well as prolong the life of patients with this condition.

As with the chronic use of any medication, there are common side effects that some patients will experience. The most common adverse reaction to the ACE inhibitors is a persistent dry cough; patients experiencing this are likely to be switch to an Angiotensin Receptor Blocker, drugs with a similar action that do not cause this adverse effect. Approximately 10% of patients will experience hypotension, or significantly low blood pressure as a result of potentially too high of a dose to combat hypertension. Up to 20% of patients will experience dizziness. There is also a slight chance a patient will experience a reversible decrease in kidney function. Adjusting the amount of lisinopril may help lessen these side effects if they become noticeable or uncomfortable to the patient.

Angioedema is a severe reaction that can occur with the use ACE inhibitors, and is characterized by swelling underneath the skin. This is particularly dangerous if the swelling occurs in the face and throat; this is a medical emergency.  Although an angioedema reaction is rare, patients should stop taking the medication and talk to their prescriber or pharmacist immediately if they believe they are experiencing angioedema.

Lisinopril should not be used in patients who are overly sensitive or allergic to it, have experienced adverse reactions to it or other ACE inhibitors.

Lastly, patients taking lisinopril should continue to check their blood pressure regularly as instructed by their prescriber to ensure optimum use of this medication.

Resources:

PubMedHealth – Lisinopril

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0010968/

 

The Pharmaceutical Journal – From Snake Venom to ACE Inhibitor

http://www.pharmaceutical-journal.com/news-and-analysis/news/from-snake-venom-to-ace-inhibitor-the-discovery-and-rise-of-captopril/10884359.article

 

CHF Patients – ACE Inhibitors

http://chfpatients.com/ace.htm

 

About Jordan E. Jenrette

Jordan Jenrette is a first-year pharmacy student at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. She received her Bachelor of Science in Biochemistry at Virginia Tech with a minor in Chemistry. Jordan works as a student researcher at her school of pharmacy. She is a member of the American College of Clinical Pharmacy, the Colorado Student Society of Health-System Pharmacists, and the CPR Program at the CU Anschutz Medical Campus. After graduation, Jordan plans to work as a clinical pharmacist specializing in either emergency medicine or cardiology.