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Zestril Generic Name & Formulations
Legal Class
Rx
General Description
Lisinopril 2.5mg, 5mg+, 10mg, 20mg, 30mg, 40mg; tabs; +scored.
Pharmacological Class
ACE inhibitor.
How Supplied
Tabs—90, 100
Manufacturer
Generic Availability
YES
Zestril Indications
Indications
To reduce signs/symptoms of systolic heart failure. Adjunct to other therapies within 24hrs post-MI in hemodynamically stable patients, to reduce mortality.
Zestril Dosage and Administration
Adult
HF with diuretic +/or digitalis: initially 5mg once daily; max 40mg once daily; hyponatremia, CrCl ≤30mL/min, or hemodialyis: 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 24hrs of onset of symptoms, then 5mg after 24hrs, then 10mg after 48hrs, 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 >1hr) occurs. CrCl ≤30mL/min or hemodialysis: initially 2.5mg once daily; max 40mg daily as tolerated.
Children
Not established.
Zestril Contraindications
Contraindications
History of ACEI-associated or other angioedema. Concomitant neprilysin inhibitors (eg, sacubitril); do not administer lisinopril within 36hrs of switching to or from sacubitril/valsartan. Concomitant aliskiren in patients with diabetes.
Zestril Boxed Warnings
Boxed Warning
Fetal toxicity.
Zestril Warnings/Precautions
Warnings/Precautions
Fetal toxicity may develop; discontinue if pregnancy is detected. Renal impairment. Dialysis (esp. high-flux membrane). Salt/volume depletion. Hypertrophic cardiomyopathy. Severe CHF. Ischemic heart disease. Cerebrovascular disease. Hyponatremia. Renal artery stenosis. Surgery. Monitor BP, electrolytes, renal and liver function. Monitor serum potassium in diabetics. Discontinue if angioedema or laryngeal edema, jaundice or marked elevations of liver enzymes occur. Black patients may have higher rate of angioedema than non-Black patients. Elderly. Neonates. Pregnancy: monitor. Nursing mothers: not recommended.
Zestril Pharmacokinetics
See Literature
Zestril Interactions
Interactions
See Contraindications. May cause hypotension or increased BUN with diuretics. May cause hyperkalemia with K+ sparing diuretics, K+ supplements, or K+-containing salt substitutes. Risk of hypoglycemia with concomitant antidiabetic agents; adjust doses. 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. May increase lithium levels; monitor frequently. Increased risk of angioedema with concomitant mTOR inhibitors (eg, temsirolimus, sirolimus, everolimus) or neprilysin inhibitors. Nitritoid reactions with concomitant injectable gold (eg, sodium aurothiomalate); rare.
Zestril Adverse Reactions
Adverse Reactions
Headache, dizziness, cough, hypotension, chest pain, hyperkalemia; renal impairment, angioedema, liver dysfunction, blood dyscrasias (rare).
Zestril Clinical Trials
See Literature
Zestril Note
Not Applicable
Zestril Patient Counseling
See Literature
Zestril Generic Name & Formulations
Legal Class
Rx
General Description
Lisinopril 2.5mg, 5mg+, 10mg, 20mg, 30mg, 40mg; tabs; +scored.
Pharmacological Class
ACE inhibitor.
How Supplied
Tabs—90, 100
Manufacturer
Generic Availability
YES
Zestril Indications
Indications
Hypertension.
Zestril Dosage and Administration
Adult
Initially and if not on diuretics: 10mg once daily. Usual range: 20–40mg once daily. Doses up to 80mg have been used. If BP not controlled by lisinopril alone, may add low-dose diuretic. After adding diuretic, may need to reduce lisinopril dose. If on diuretics: initially 5mg daily. CrCl ≥10–≤30mL/min: initially 5mg daily; max 40mg daily as tolerated. CrCl <10mL/min or hemodialysis: initially 2.5mg once daily.
Children
<6yrs or CrCl <30mL/min/1.73m2: not established. ≥6yrs: initially 0.07mg/kg (max 5mg) once daily; usual max 0.61mg/kg (40mg) once daily.
Zestril Contraindications
Contraindications
History of ACEI-associated or other angioedema. Concomitant neprilysin inhibitors (eg, sacubitril); do not administer lisinopril within 36hrs of switching to or from sacubitril/valsartan. Concomitant aliskiren in patients with diabetes.
Zestril Boxed Warnings
Boxed Warning
Fetal toxicity.
Zestril Warnings/Precautions
Warnings/Precautions
Fetal toxicity may develop; discontinue if pregnancy is detected. Renal impairment. Dialysis (esp. high-flux membrane). Salt/volume depletion. Hypertrophic cardiomyopathy. Severe CHF. Ischemic heart disease. Cerebrovascular disease. Hyponatremia. Renal artery stenosis. Surgery. Monitor BP, electrolytes, renal and liver function. Monitor serum potassium in diabetics. Discontinue if angioedema or laryngeal edema, jaundice or marked elevations of liver enzymes occur. Black patients may have higher rate of angioedema than non-Black patients. Elderly. Neonates. Pregnancy: monitor. Nursing mothers: not recommended.
Zestril Pharmacokinetics
See Literature
Zestril Interactions
Interactions
See Contraindications. May cause hypotension or increased BUN with diuretics. May cause hyperkalemia with K+ sparing diuretics, K+ supplements, or K+-containing salt substitutes. Risk of hypoglycemia with concomitant antidiabetic agents; adjust doses. 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. May increase lithium levels; monitor frequently. Increased risk of angioedema with concomitant mTOR inhibitors (eg, temsirolimus, sirolimus, everolimus) or neprilysin inhibitors. Nitritoid reactions with concomitant injectable gold (eg, sodium aurothiomalate); rare.
Zestril Adverse Reactions
Adverse Reactions
Headache, dizziness, cough, hypotension, chest pain, hyperkalemia; renal impairment, angioedema, liver dysfunction, blood dyscrasias (rare).
Zestril Clinical Trials
See Literature
Zestril Note
Not Applicable
Zestril Patient Counseling
See Literature
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