Lisinopril

About Lisinopril

Lisinopril blocks the enzyme that makes angiotensin II, a hormone that tightens blood vessels, so vessels relax and blood pressure falls. The label covers high blood pressure in adults and children 6 and older; systolic heart failure, to reduce its signs and symptoms; and, in people whose circulation is stable, lowering the risk of death when it is started within 24 hours of a heart attack. For blood pressure, adults usually start at 10 mg once a day, or 5 mg if they take a diuretic, and the usual range is 20 to 40 mg a day; children start at 0.07 mg per kg, up to 5 mg. Heart failure starts at 5 mg, or 2.5 mg if blood sodium is low, alongside diuretics and usually digitalis, and can rise to 40 mg. After a heart attack it is 5 mg, 5 mg a day later, 10 mg the day after, then 10 mg daily for at least six weeks. Reduced kidney function calls for a lower starting dose.

The boxed warning is fetal toxicity: drugs acting on the renin-angiotensin system can injure and kill a developing baby, so lisinopril is stopped as soon as pregnancy is detected. Angioedema, swelling of the face, lips, tongue or throat that can block the airway and has been fatal, can occur at any time; it is reported more often in Black patients, and mTOR inhibitors such as sirolimus, or a neprilysin inhibitor, raise the risk. Swelling of the intestine can show up as stomach pain, sometimes in people who have never had facial swelling. It must not be taken after angioedema or a hypersensitivity reaction with an ACE inhibitor, with hereditary or idiopathic angioedema, within 36 hours of switching to or from sacubitril and valsartan (Entresto), or with aliskiren in diabetes. Blood pressure can drop too far, especially in heart failure or after fluid loss, so people at risk are watched closely for the first two weeks; it can raise potassium and change kidney function, so both are checked; and ACE inhibitors have been linked to jaundice that can progress to severe liver injury, so it is stopped if jaundice appears. Headache, dizziness and cough are its common side effects in high blood pressure.

Qbrelis, the oral solution, holds 1 mg per mL and is labeled for the same uses and doses as the tablets. The FDA lists Prinivil as discontinued in every strength, while Zestril is still sold. The label advises against breastfeeding. People with diabetes on insulin or diabetes pills watch their blood sugar closely in the first month, and a sore throat or fever should be reported, since it can signal a low white blood cell count. Lisinopril with hydrochlorothiazide is a separate product.

Taking Lisinopril

How to take it

Once a day at about the same time, with or without food. Measure the solution with an oral syringe, never a household spoon. Call the prescriber about ongoing vomiting or diarrhea or heavy sweating, which can drop blood pressure too far.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in a tightly closed container, protected from moisture, freezing and excessive heat, not in a bathroom, and out of reach of children.

Interactions to know about

Potassium supplements, potassium salt substitutes and potassium-sparing diuretics can raise potassium too high; NSAIDs such as ibuprofen and naproxen can blunt its effect and strain the kidneys; and it raises lithium levels. It is not taken within 36 hours of sacubitril and valsartan or with aliskiren in diabetes; insulin and diabetes pills can lower blood sugar further, and rare reactions have occurred with injectable gold.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Lisinopril differs from pharmacy to pharmacy

Generic lisinopril tablets have many makers and cost pharmacies little, so much of a quote is the dispensing fee and markup, which differ between pharmacies. A prescription that names Zestril and blocks substitution is priced as a brand.

Qbrelis is priced as a brand and comes in one bottle size, so a higher daily dose uses more bottles.

Ways to pay less for Lisinopril without insurance

• Ask for generic lisinopril, and make sure the prescription does not block substitution.
• Ask whether lisinopril is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Once your dose is stable, ask for a ninety-day supply.
• If the oral solution is prescribed, ask whether the generic is available, and if you can swallow tablets, ask the prescriber whether tablets would suit.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Lisinopril

1. 1.Which swelling, breathing or stomach symptoms mean I should stop it and get help?
2. 2.Should I avoid potassium supplements, salt substitutes or ibuprofen with it?
3. 3.When will my potassium and kidney function be checked?
4. 4.What should I do if I become pregnant or plan to?

Related medications