CHF and arrhythmias:
Indications for: VASOTEC
Symptomatic CHF, usually with digitalis and diuretics. Asymptomatic left ventricular dysfunction (ejection fraction ≤35%).
Adult Dosage:
Initially 2.5mg 1–2 times daily. May increase to 5–20mg daily in 1–2 divided doses; max 40mg/day. Reduce diuretic dosage before 1st dose, if possible; observe patient for at least 2 hrs after 1st dose, until BP has stabilized for at least 1 hr. CHF with hyponatremia or renal dysfunction: see literature. Left ventricular dysfunction: Initially 2.5mg twice daily; max 20mg daily in divided doses.
Children Dosage:
Not established.
VASOTEC 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.
Boxed Warning:
Fetal toxicity.
VASOTEC Warnings/Precautions:
Fetal toxicity may develop; discontinue if pregnancy is detected. Renal impairment. Salt/volume depletion. CHF. Ischemic disease. Cerebrovascular disease. Dialysis (esp. high-flux membrane). Renal artery stenosis. Surgery. Diabetes. Monitor WBCs in renal or collagen vascular disease. Discontinue if neutropenia, angioedema, laryngeal edema, jaundice or marked elevations of hepatic enzymes develop. Monitor BP, electrolytes and renal function. Black patients may have higher rate of angioedema than non-Black patients. Neonates. Pregnancy, nursing mothers: not recommended.
VASOTEC Classification:
ACE inhibitor.
VASOTEC 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. Avoid concomitant aliskiren in renal impairment (CrCl <60mL/min). Potentiated by, and hypotension with, diuretics. Hyperkalemia with K+-sparing diuretics, K+ supplements, or K+-containing salt substitutes. May increase lithium levels. May be antagonized by, and renal toxicity potentiated by NSAIDs, including COX-2 inhibitors (monitor renal function periodically in elderly and/or volume-depleted). 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.
Adverse Reactions:
Cough, headache, dizziness, fatigue, diarrhea, rash, orthostatic hypotension, asthenia, hyperkalemia, renal impairment, nausea; rare: hepatic failure.
Drug Elimination:
Renal (primarily), fecal.
Generic Drug Availability:
YES
How Supplied:
Tabs 2.5mg, 5mg—30, 90; 10mg, 20mg—30, 90, 1000
Hypertension:
Indications for: VASOTEC
Hypertension.
Adult Dosage:
If on diuretics or CrCl <30mL/min: suspend diuretic for 2–3 days, if possible: initially 2.5mg daily; max 40mg. Monitor closely for first 2 wks. Others: initially 5mg daily. Usual range: 10–40mg daily in 1–2 divided doses.
Children Dosage:
Neonates or CrCl <30mL/min: not established. Initially 0.08mg/kg (up to 5mg) once daily; max 0.58mg/kg (or 40mg) daily. Suspension form may be prepared if unable to swallow tabs: see full labeling.
VASOTEC 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.
Boxed Warning:
Fetal toxicity.
VASOTEC Warnings/Precautions:
Fetal toxicity may develop; discontinue if pregnancy is detected. Renal impairment. Salt/volume depletion. CHF. Ischemic disease. Cerebrovascular disease. Dialysis (esp. high-flux membrane). Renal artery stenosis. Surgery. Diabetes. Monitor WBCs in renal or collagen vascular disease. Discontinue if neutropenia, angioedema, laryngeal edema, jaundice or marked elevations of hepatic enzymes develop. Monitor BP, electrolytes and renal function. Black patients may have higher rate of angioedema than non-Black patients. Neonates. Pregnancy, nursing mothers: not recommended.
VASOTEC Classification:
ACE inhibitor.
VASOTEC 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. Avoid concomitant aliskiren in renal impairment (CrCl <60mL/min). Potentiated by, and hypotension with, diuretics. Hyperkalemia with K+-sparing diuretics, K+ supplements, or K+-containing salt substitutes. May increase lithium levels. May be antagonized by, and renal toxicity potentiated by NSAIDs, including COX-2 inhibitors (monitor renal function periodically in elderly and/or volume-depleted). 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.
Adverse Reactions:
Cough, headache, dizziness, fatigue, diarrhea, rash, orthostatic hypotension, asthenia, hyperkalemia, renal impairment, nausea; rare: hepatic failure.
Drug Elimination:
Renal (primarily), fecal.
Generic Drug Availability:
YES
How Supplied:
Tabs 2.5mg, 5mg—30, 90; 10mg, 20mg—30, 90, 1000
