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PRINIVIL
CHF and arrhythmias
Hypertension
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Drug Name:

PRINIVIL Rx

Generic Name and Formulations:
Lisinopril 5mg, 10mg, 20mg; scored tabs.

Company:
Merck & Co., Inc.

e-Prescribe this drug via Surescripts


Therapeutic Use:

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 Dose for PRINIVIL:

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.

Children's Dose for PRINIVIL:

Not recommended.

Pharmacological Class:

ACE inhibitor.

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. 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.

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. Hypoglycemia with oral antidiabetics, insulin. Nitritoid reactions with concomitant injectable gold (sodium aurothiomalate); rare.

Adverse Reactions:

Dizziness, headache, fatigue, diarrhea, upper respiratory symptoms, cough, nausea, hyperkalemia, orthostatic hypotension, renal impairment, angioedema; liver dysfunction, blood dyscrasias (rare).

Elimination:

Renal.

Generic Availability:

YES

How Supplied:

Tabs—90

Indications for PRINIVIL:

Hypertension.

Adult Dose for PRINIVIL:

Initially and if not on diuretics: 10mg once daily. Usual range: 20–40mg once daily. If on diuretic: suspend diuretic for 2–3 days before starting; resume diuretic if BP not controlled by lisinopril alone. If diuretic cannot be discontinued: initially 5mg daily (supervise 1st dose). CrCl 10–30mL/min: initially 5mg daily; CrCl <10mL/min: initially 2.5mg daily; max 40mg daily.

Children's Dose for PRINIVIL:

<6yrs or CrCl <30mL/min/1.73m2: not recommended. ≥6yrs: initially 0.07mg/kg (max 5mg) once daily; usual max 0.61mg/kg (40mg) once daily.

Pharmacological Class:

ACE inhibitor.

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. 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.

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. Hypoglycemia with oral antidiabetics, insulin. Nitritoid reactions with concomitant injectable gold (sodium aurothiomalate); rare.

Adverse Reactions:

Dizziness, headache, fatigue, diarrhea, upper respiratory symptoms, cough, nausea, hyperkalemia, orthostatic hypotension, renal impairment, angioedema; liver dysfunction, blood dyscrasias (rare).

Elimination:

Renal.

Generic Availability:

YES

How Supplied:

Tabs—90

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