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ZESTRIL
CHF and arrhythmias
Hypertension
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Drug Name:

ZESTRIL Rx

Generic Name and Formulations:
Lisinopril 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg; tabs.

Company:
AstraZeneca Pharmaceuticals

e-Prescribe this drug via Surescripts


Therapeutic Use:

Indications for ZESTRIL:

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 ZESTRIL:

CHF: initially 5mg once daily; range 5–40mg once daily; increase by 10mg at 2 week intervals; max 40mg 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, 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 ZESTRIL:

Not recommended.

Pharmacological Class:

ACE inhibitor.

Contraindications:

History of ACEI-associated or other angioedema.

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. Renal artery stenosis. Surgery. Monitor BP, electrolytes, renal and liver function. Monitor serum potassium in diabetics. Monitor WBC count in renal and collagen vascular disease. Discontinue if angioedema or laryngeal edema (have SC epinephrine available), jaundice or elevated liver enzymes occur. Elderly. Neonates. Pregnancy (Cat.D); monitor. Nursing mothers: not recommended.

Interactions:

May cause hypotension or increased BUN with diuretics, hyperkalemia with K+ sparing diuretics or K+ supplements. Risk of hypoglycemia with concomitant antidiabetic agents; adjust doses. May increase lithium levels; monitor frequently. May be antagonized by, and renal toxicity potentiated by NSAIDs (including COX-2 inhibitors): monitor renal function in elderly and/or volume-depleted. 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 diabetics or renal impairment (GFR <60mL/min): not recommended. Nitritoid reactions with concomitant injectable gold (eg, sodium aurothiomalate); rare.

Adverse Reactions:

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

Elimination:

Renal.

Generic Availability:

YES

How Supplied:

Tabs—100

Indications for ZESTRIL:

Hypertension.

Adult Dose for ZESTRIL:

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 ZESTRIL:

<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.

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. Renal artery stenosis. Surgery. Monitor BP, electrolytes, renal and liver function. Monitor serum potassium in diabetics. Monitor WBC count in renal and collagen vascular disease. Discontinue if angioedema or laryngeal edema (have SC epinephrine available), jaundice or elevated liver enzymes occur. Elderly. Neonates. Pregnancy (Cat.D); monitor. Nursing mothers: not recommended.

Interactions:

May cause hypotension or increased BUN with diuretics, hyperkalemia with K+ sparing diuretics or K+ supplements. Risk of hypoglycemia with concomitant antidiabetic agents; adjust doses. May increase lithium levels; monitor frequently. May be antagonized by, and renal toxicity potentiated by NSAIDs (including COX-2 inhibitors): monitor renal function in elderly and/or volume-depleted. 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 diabetics or renal impairment (GFR <60mL/min): not recommended. Nitritoid reactions with concomitant injectable gold (eg, sodium aurothiomalate); rare.

Adverse Reactions:

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

Elimination:

Renal.

Generic Availability:

YES

How Supplied:

Tabs—100

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