BLACK BOX WARNING
- fetal toxicity
lisinopril
Brand: Prinivil, Zestril
⚠ BBW Prototype Drug
Drug Class: ACE inhibitor
Drug Family: antihypertensive
Subclass: long-acting ACE inhibitor
Organ Systems: cardiovascularrenal
Mechanism of Action
Inhibits ACE, preventing conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion.
ACE (angiotensin-converting enzyme)
Indications
- hypertension
- heart failure
- post-MI cardioprotection
- diabetic nephropathy
Contraindications
- pregnancy
- history of ACE-inhibitor-induced angioedema
- bilateral renal artery stenosis
- concomitant use of aliskiren in diabetics
Adverse Effects
Common
- dry cough
- hyperkalemia
- first-dose hypotension
Serious
- angioedema
- acute kidney injury
- teratogenicity
Pharmacokinetics (ADME)
| Absorption | 25% oral bioavailability, not affected by food |
| Distribution | does not cross BBB |
| Metabolism | not hepatically metabolized; excreted unchanged |
| Excretion | renal; dose adjustment required if CrCl <30 mL/min |
| Half-life | 12 hours |
| Onset | 1 hour |
| Peak | 6-7 hours |
| Duration | 24 hours |
| Protein Binding | <5% |
| Vd | low |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| potassium-sparing diuretics | additive hyperkalemia | major |
| NSAIDs | reduced antihypertensive efficacy; AKI risk | moderate |
| lithium | reduced renal clearance of lithium | major |
Nursing Considerations
- Monitor BP (hold if systolic <90) and serum potassium
- Monitor creatinine; hold if rises >30% from baseline
- Report cough or signs of angioedema immediately
- Confirm absence of pregnancy before use
Clinical Pearls
- Preferred in diabetic nephropathy due to efferent arteriolar dilation reducing glomerular pressure
- Cough due to bradykinin accumulation; switch to ARB if intolerable
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.