CHF and arrhythmias:
Indications for: ZESTRIL
To reduce signs/symptoms of systolic heart failure. Adjunct to other therapies within 24hrs post-MI in hemodynamically stable patients, to reduce mortality.
Adult Dosage:
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 Dosage:
Not established.
ZESTRIL 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.
ZESTRIL 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 Classification:
ACE inhibitor.
ZESTRIL 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.
Adverse Reactions:
Headache, dizziness, cough, hypotension, chest pain, hyperkalemia; renal impairment, angioedema, liver dysfunction, blood dyscrasias (rare).
Drug Elimination:
Renal.
Generic Drug Availability:
YES
How Supplied:
Tabs—90, 100
Hypertension:
Indications for: ZESTRIL
Hypertension.
Adult Dosage:
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 Dosage:
<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:
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.
ZESTRIL 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 Classification:
ACE inhibitor.
ZESTRIL 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.
Adverse Reactions:
Headache, dizziness, cough, hypotension, chest pain, hyperkalemia; renal impairment, angioedema, liver dysfunction, blood dyscrasias (rare).
Drug Elimination:
Renal.
Generic Drug Availability:
YES
How Supplied:
Tabs—90, 100
