Lisinopri l5mg, 10mg,
20mg; scored tabs.
Heart failure inadequately controlled by diuretics +/or digitalis. Adjunct to
other therapies within 24 hrs post-MI in hemodynamically stable patients, to reduce mortality.
CHF: initially 5mg once daily; range 5–20mg once daily; hyponatremia or
moderate to severe renal impairment: initially 2.5mg 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.
History of ACEI-associated or other angioedema. Concomitant aliskiren in patients with diabetes.
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. Acute MI. Renal or aortic stenosis. Surgery.
Monitor renal function, serum potassium in diabetics. Monitor WBCs in renal and collagen vascular
disease patients. Discontinue 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.
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. Hypoglycemia with oral antidiabetics, insulin.
Nitritoid reactions with concomitant injectable gold (sodium aurothiomalate); rare.
Dizziness, headache, fatigue, diarrhea, upper respiratory symptoms,
cough, nausea, hyperkalemia, orthostatic hypotension, renal impairment, angioedema; liver
dysfunction, blood dyscrasias (rare).