Lisinopril (Zestril) - Uses, Dose, Side effects, MOA, Brands

Lisinopril (Zestril) is an ACE-inhibitor (angiotensin-converting enzyme inhibitor) that is used for treating hypertension and heart failure.

Indications of Lisinopril (Zestril):

Heart failure with reduced ejection fraction:
- To lessen the signs and symptoms of systolic heart failure, it is used as an adjuvant therapy.
Hypertension:
- It is approved for the treatment of hypertension in adults and children older than 6 years old.
ST-elevation myocardial infarction:
- In hemodynamically stable patients, it is successful in treating acute MI within 24 hours to increase survival.
Off Label Use of Lisinopril in Adults:
- Non-ST-elevation acute coronary syndrome
- Posttransplant erythrocytosis (renal transplant recipients)
- Proteinuric chronic kidney disease (diabetic or nondiabetic)
- Stable coronary artery disease

Lisinopril (Zestril) dose in adults:

Lisinopril (Zestril) dose in the treatment of acute coronary syndromes:

Non-ST-elevation acute coronary syndrome (off-label):

Note:

Patients should have stable hemodynamics prior to therapy.
Use as part of a health regimen that is suitable for you, which may include include statins, beta-blockers, and antiplatelet agents.
ACE inhibitors should be taken forever for individuals who also have concurrent diabetes, a left ventricular ejection fraction below 40%, hypertension, or stable chronic renal disease. Dose guidelines based on the manufacturer's labeling's general dosing range.

Initial: 2.5 to 10 mg per oral once daily (depending on initial blood pressure)
up to 40 mg/day, gradually titrate based on tolerance and response.
ST-elevation myocardial infarction:

Note:

Patients should have stable hemodynamics prior to treatment.
Use as part of a health regimen that is suitable for you, which may include include statins, beta-blockers, and antiplatelet agents.
The use of ACE inhibitors should never end.
Dosing guidelines based on the manufacturer's labeling's general dosing range
.
- Initial: To prevent hypotension, doses of 2.5 to 5 mg per mouth once daily, started within 24 hours of presentation, were gradually increased to 10 mg/day or higher as tolerated.
- maximum: 40 mg/day.
Heart failure with reduced ejection fraction:
- Initial: 2.5 to 5 mg per mouth once day; as tolerated, up to a target dose of 40 mg once daily, which may be increased every 1 to 2 weeks in increments of no more than 10 mg.
- In hospitalised patients, the dose may be increased or decreased every one to two days.

Lisinopril (Zestril) Treatment dose of Hypertension: Note:

For individuals whose blood pressure is greater than or equivalent to 20/10 mm Hg above target as initial therapy, it may be administered in conjunction with another suitable medication (such as a thiazide diuretic or a long-acting dihydropyridine calcium channel blocker).
Some doctors advise an initial trial of monotherapy for patients with blood pressure levels that are 20/10 mm Hg or above; however, many patients will eventually need combination therapy.
Initial dosage is 5 to 10 mg once daily; response is assessed every 4 to 6 weeks, and the dose is increased in 1-step increments (for example).

Lisinopril (Zestril) dose in the treatment of Post transplant erythrocytosis (renal transplant recipients) (off-label):

Note: For patients with a hemoglobin concentration >17 g/dl.

Initial: Once daily oral doses of 2.5 or 5 mg; titration up to 40 mg/day based on haemoglobin and blood pressure response if insufficient response is shown within 4 weeks.
If, after an additional 4 weeks, haemoglobin is still above 17 g/dl, a different therapy, such as phlebotomy, should be taken into consideration.

Lisinopril (Zestril) Treatment dose of proteinuric chronic kidney disease (diabetic or non-diabetic) (off-label):

Dosing recommendations based on expert opinion and general dosing range in manufacturer's labeling:

Initial: Depending on blood pressure, take 2.5 to 10 mg orally once daily; gradually increase the dose to 40 mg/day based on tolerance and response.
Target a proteinuria objective of less than 1 g per day and a suitable blood pressure target.
IgA nephropathy:
- In addition to a reasonable blood pressure target, a proteinuria target of less than 1 g per day is typically advised.
- A goal of 500 mg/day for proteinuria is used by certain experts.
- If the proteinuria target is not achieved with the current agent(s), additional agents should

Lisinopril (Zestril) dose in children:

Note:

Multiple concentrations are found in both compounded and commercially accessible oral solutions; care should be made to verify and prevent confusion between the various concentrations; the dose should be stated explicitly as mg.

Lisinopril (Zestril) Treatment dose of Hypertension:

Note:

The lowest dose should be administered and titrated in accordance with the patient's reaction in patients with hyponatremia, hypovolemia, severe CHF, impaired renal function, or those taking diuretics.
Children <6 years: Limited data available:
- Initial: 0.07 mg/kg/dose per oral once daily.
- maximum initial daily dose: 5 mg/day.
- maximum daily dose: 0.6 mg/kg/day or 40 mg/day.
Children ≥6 years and Adolescents:
- Initial: 0.07 mg/kg/dose per oral once daily.
- maximum initial daily dose: 5 mg/day.
- maximum daily dose: 0.6 mg/kg/day or 40 mg/day.

Lisinopril (Zestril) Treatment dose of proteinuria (eg, mild IgA nephropathy, focal segmental glomerulosclerosis): Limited data available:

Children ≥2 years and Adolescents:
- Initial: 0.1 to 0.2 mg/kg/dose per oral once daily;
- increase at 1- to 2-week intervals to target dose of 0.4 mg/kg/dose once daily.
- maximum dose: 40 mg/day.
- Dosing based on a prospective trial comparing mycophenolate to cyclosporine in patients with steroid-resistant FSGS (total patients: 138; paediatric patients: 93, age range: 2 to 17 years); the majority of patients got lisinopril (n=118) for its protein-sparing effects.
- Starting at 0.1 mg/kg/dose, lisinopril was increased by 0.4 mg/kg/dose (with a 40 mg/dose maximum) every two weeks.
- Children with moderate IgA nephropathy (n=40, mean age: 11.4 years; range: 4.4 to 15.4 years) were treated using a similar regimen, with an initial dose of 0.2 mg/kg/dose raised to 0.4 mg/kg/dose after 7 days (maximum dose: 20 mg/dose).

Lisinopril (Zestril) Pregnancy Risk Category: X

Lisinopril crosses the placenta to cause fetal death and oligohydramnios, which are both associated with fetal pulmonary hypoplasia and skeletal malformations.
It can also lead to anuria and hypotension during pregnancy.
ACE inhibitors should not be used during pregnancy.
Premature infants who are exposed to ACE inhibitors need to have their hyperkalemia, hypotension, and oliguria levels checked.
Dialysis and exchange transfusions may enhance renal function and reduce hypotension.
The severity and duration of maternal hypertension may have an impact on the actual fetal/neonatal risk.
If maternal diabetes is not treated, adverse maternal effects can include gestational diabetes and pre-eclampsia. It can also cause birth defects, low birthweight, premature birth, stillbirth and neonatal deaths.

This should only be considered during pregnancy or when planning for conception if there is refractory Hypertension.

Lisinopril use during breastfeeding:

It is unknown if breast milk secretes lisinopril.
According to the manufacturer, there is a risk of serious adverse reactions in breastfed babies. It is important to decide whether to stop breastfeeding or discontinue taking lisinopril.

Lisinopril (Zestril) Dose adjustment in renal disease:

Heart failure with reduced ejection fraction:
- CrCl >30 mL/minute:
  - No dosage adjustment is necessary.
- CrCl 10 to 30 mL/minute:
  - Initial: 2.5 mg once daily.
  - maximum: 40 mg/day.
- CrCl <10 mL/minute:
  - Initial: 2.5 mg once daily.
  - maximum: 40 mg/day.
- Hemodialysis:
  - Initial: 2.5 mg once daily (dialyzable).
  - maximum: 40 mg/day.
Hypertension:
- CrCl >30 mL/minute:
  - No dosage adjustment is necessary.
- CrCl 10 to 30 mL/minute:
  - Initial: 5 mg once daily.
  - maximum: 40 mg/day.
- CrCl <10 mL/minute:
  - Initial: 2.5 mg once daily.
  - maximum: 40 mg/day.
- Hemodialysis:
  - Initial: 2.5 mg once daily (dialyzable).
  - maximum: 40 mg/day.
ST-elevation myocardial infarction:
- CrCl >30 mL/minute:
  - No dosage adjustment is necessary.
- CrCl 10 to 30 mL/minute:
  - Initial: 2.5 mg once daily.
  - maximum: 40 mg/day.
- CrCl <10 mL/minute:
  - Initial: 2.5 mg once daily.
  - maximum: 40 mg/day.
- Hemodialysis:
  - Initial: 2.5 mg once daily (dialyzable).
  - maximum: 40 mg/day.
In addition, the following dosage adjustments have been recommended :
- GFR >50 mL/minute:
  - No dosage adjustment is necessary.
- GFR 10 to 50 mL/minute:
  - Administer 50% to 75% of the usual dose.
- GFR <10 mL/minute:
  - Administer 25% to 50% of the usual dose.
- Intermittent hemodialysis:
  - Dose after dialysis.
- CRRT:
  - Administer 50% to 75% of the usual dose.

Lisinopril (Zestril) Dose adjustment in liver disease:

The manufacturer's labelling does not mention dosage modifications; proceed with caution.

Common Side Effects of Lisinopril (Zestril):

Cardiovascular:
- Hypotension
Central nervous system:
- Dizziness
Renal:
- Increased blood urea nitrogen
- Increased serum creatinine

Rare Side Effects of Lisinopril (Zestril):

Cardiovascular:
- Chest Pain
- Orthostatic Effect
- Flushing
- Vasculitis
- Syncope
Central Nervous System:
- Altered Sense Of Smell
- Paresthesia
- Fatigue
- Vertigo
- Headache
Dermatologic:
- Toxic Epidermal Necrolysis
- Skin Photosensitivity
- Alopecia
- Erythema
- Diaphoresis
- Pruritus
- Stevens-Johnson Syndrome
- Urticaria
- Skin Rash
Endocrine & Metabolic:
- SIADH
- Diabetes Mellitus
- Hyperkalemia
- Gout
Gastrointestinal:
- Flatulence
- Constipation
- Pancreatitis
- Dysgeusia
- Xerostomia
- Diarrhea
Genitourinary:
- Impotence
Hematologic & Oncologic:
- Positive ANA Titer
- Eosinophilia
- Increased Erythrocyte Sedimentation Rate
- Leukopenia
- Hemolytic Anemia
- Neutropenia
- Thrombocytopenia
- Leukocytosis
- Bone Marrow Depression
Neuromuscular & Skeletal:
- Arthritis
- Weakness
- Myalgia
- Arthralgia
Ophthalmic:
- Diplopia
- Vision Loss
- Photophobia
- Blurred Vision
Otic:
- Tinnitus
Renal:
- Renal insufficiency
Respiratory:
- Cough

Side effects of Lisinopril (Zestril) (Frequency not defined):

Hematologic & oncologic:
- Decreased hemoglobin
- Decreased hematocrit
Hepatic:
- Increased serum bilirubin
- Increased liver enzymes

Contraindications to Lisinopril (Zestril):

Intolerance to lisinopril, other ACE inhibitors, or any other formulation ingredient
Angioedema brought on by previous ACE inhibitor therapy Idiopathic or hereditary angioedema
Patients with diabetes mellitus should take aliskiren simultaneously with, or no more than 36 hours after, a neprilysin inhibitor (such as sacubitril).

Canadian labeling: Additional contraindications not in US labeling

Pediatric patients under 6 years
Children aged 6-16 years old with severe renal impairment (GFR 60mL/minute/1.73m).
Planning for conception or pregnancy
Women who are pregnant or have not used adequate contraception in the past three years.
Breastfeeding
In patients with heart failure, hyperkalemia (+5 mmol/L), and moderate to severe renal impairment (GFR 60 mL/minute/1.73 m), combine aliskiren with angiotensin-receptor blockers (ARBs) or other ACE inhibitors (hypotensive).
concomitant use of ARBs and other ACE inhibitors in diabetic individuals with end-organ damage

Warnings and precautions

Angioedema
- At any point of the therapeutic process, ACE inhibitors can result in angioedema. It may impact the intestine, head and neck, which could compromise your airway (presenting as abdominal pain).
- Long-term monitoring is necessary for any obstructions in the tongue, glottis or larynx.
- Previous airway surgery increases the obstruction risk.
- Angioedema risk is higher in black patients, patients suffering from idiopathic angioedema or hereditary angioedema and patients who have received ACE inhibitor therapy, combination therapy with m-tor inhibitor (eg everolimus), dipeptidyl peptidase-4 inhibitors (eg sitagliptin) or a neprilysin inhibit (eg sacubitril).
- It is crucial to manage the situation in a responsible manner.
- It is not recommended for usage in those with genetic angioedema, idiopathic angioedema, or a history of angioedema brought on by ACE inhibitors.
Cholestatic jaundice
- ACE inhibitors may cause hepatic fulminant neoplasm, which can lead to cholestatic jaundice.
- If there is an increase in hepatic transaminases and jaundice, therapy should be stopped.
Cough:
- Initial treatment with ACE inhibitors results in a dry, persistent cough that usually disappears within a month.
- Before quitting the medication, it's crucial to rule out other diseases, such as pulmonary congestion in heart failure patients.
Hematologic effects
- Agranulocytosis, anaemia, thrombocytopenia, neutropenia, and myeloid hypoplasia have all been linked to captopril, another ACE inhibitor.
- Neutropenia is substantially more likely to occur in patients with renal impairment or collagen vascular disease, such as systemic lupus erythematosus.
- These patients require regular CBC monitoring.
Hyperkalemia:
- Hyperkalemia can be caused by ACE inhibitors
- Dehydration, DM and metabolic acidosis are all risk factors.
- These agents require continuous potassium monitoring.
Hypersensitivity reactions
- ACE inhibitors can result in anaphylactic/anaphylactoid reactions.
- In rare cases, anaphylactic reactions can also happen during low density lipoprotein apheresis using dextran sulfatecellulose and hemodialysis utilising high-flux dialysis membranes (such as polyacrylonitrile).
- Patients who get ACE inhibitors and have had Hymenoptera (bee or wasp) venom sensitization have a low incidence of anaphylactoid responses.
Hypotension/syncope
- ACE inhibitors have the potential to cause hypotension and syncope.
- Hypovolemia can increase the risk, so volume correction before beginning treatment is recommended.
- BP monitoring is important throughout therapy, particularly when dose escalation is involved.
- Particularly for patients with heart disease, hypotension shouldn't be used as a justification to stop receiving ACE inhibitor treatment in the future. A decrease in systolic pressure, though, might be preferred.
- Patients with hemodynamic instability following an acute MI shouldn't use it.
Renal function deterioration:
- This can cause an increase in serum creatinine.
- Patients with low renal function (eg, kidney artery stenosis or heart failure) can experience complications such as oliguria and acute renal failure.
- A significant impairment in renal function should not be considered a reason to stop taking the drug.
Aortic stenosis
- Patients with aortic Stenosis may experience decreased coronary perfusion, which can lead to ischemia.
Ascites:
- It should be avoided in patients suffering from ascites caused by cirrhosis, refractory or other causes.
- Patients with ascites from cirrhosis should be monitored regularly for BP and RFTs to prevent the rapid progression of renal failure.
Cardiovascular disease
- Patients with ischemic heart disease, cerebrovascular disease or heart failure can experience hypotension. Therefore, it is important to be closely monitored.
- Once the fluid replacement has been completed, therapy can be resumed.
- Patients with hypotension recurrence should stop therapy.
Collagen vascular disease:
- Collagen vascular disease, especially when combined with renal impairment, can increase the risk of hematological toxicities. Therefore, caution should be taken.
Hepatic impairment
- LFTs must be examined before starting therapy.
- Patients with severe hepatic impairment shouldn't use it.
Hypertrophic cardiomyopathy and outflow tract obstruction
- Reduced afterload can worsen hypertrophic cardiomyopathy symptoms and cause outflow obstruction. Therefore, it is important to use extreme caution.
Renal artery stenosis
- Lisinopril should not be taken by patients with unstented unilateral or bilateral renal artery stenosis.
- This should be avoided in the case of unstented bilateral kidney artery stenosis. There is a higher risk of renal dysfunction and it is best to avoid this procedure unless there are clear benefits.
Renal impairment
- It should not be used by patients with compromised renal function without the proper dosage modification.
- Increased renal impairment can result from rapid dosage escalation.
- A retrospective cohort analysis revealed that ACE inhibitors improved left ventricular function in elderly individuals over 65 with MI and improved survival. Patients having serum creatinine levels more than 3 mg/dl (25 micromols/l) were included.

Lisinopril: Drug Interaction

Risk Factor C (Monitor therapy)
Alfuzosin	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Alteplase	Angiotensin-Converting Enzyme Inhibitors may intensify Alteplase's harmful or hazardous effects. In particular, there may be an elevated risk for angioedema.
Amphetamines	May lessen the effectiveness of antihypertensive agents.
Angiotensin II	May lessen the effectiveness of antihypertensive agents.
Antipsychotic Agents (Second Generation [Atypical])	Antipsychotic drugs' hypotensive effects may be enhanced by blood pressure-lowering medications (Second Generation [Atypical]).
Aprotinin	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
AzaTHIOprine	AzaTHIOprine's myelosuppressive effects may be enhanced by angiotensin-converting enzyme inhibitors.
Barbiturates	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Benperidol	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Brigatinib	May lessen the effectiveness of antihypertensive agents.
Brimonidine (Topical)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Dapoxetine	Antihypertensive Agents' bradycardic action may be strengthened by brutinib.
Dexmethylphenidate	May increase the angiotensin-converting enzyme inhibitors' orthostatic hypotensive effects.
Diazoxide	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Dipeptidyl Peptidase-IV Inhibitors	Can lessen an antihypertensive drug's therapeutic impact.
Drospirenone	May worsen angiotensin-converting enzyme inhibitors' toxic or severe effects. Particularly, there may be a higher incidence of angioedema.
DULoxetine	Drospirenone's hyperkalemic impact may be enhanced by angiotensin-converting enzyme inhibitors.
Eplerenone	Angiotensin-Converting Enzyme Inhibitors might make their effect on hyperkalemia stronger.
Everolimus	May intensify angiotensin-converting enzyme inhibitors' harmful or hazardous effects. Particularly, there may be a higher incidence of angioedema.
Ferric Gluconate	Angiotensin-Converting Enzyme Inhibitors might make ferric gluconate more harmful or poisonous.
Ferric Hydroxide Polymaltose Complex	Ferric Hydroxide Polymaltose Complex may have a more negative or toxic effect when taken with angiotensin-converting enzyme inhibitors. In particular, there may be an elevated risk for angioedema or allergic responses.
Gelatin (Succinylated)	Ferric Hydroxide Polymaltose Complex may have a more negative or toxic effect when taken with angiotensin-converting enzyme inhibitors. In particular, there may be an elevated risk for angioedema or allergic responses.
Gold Sodium Thiomalate	Ferric Hydroxide Polymaltose Complex may have a more negative or toxic effect when taken with angiotensin-converting enzyme inhibitors. In particular, there may be an elevated risk for angioedema or allergic responses.
Heparin	Angiotensin-Converting Enzyme Inhibitors might make their effect on hyperkalemia stronger.
Heparins (Low Molecular Weight)	Angiotensin-Converting Enzyme Inhibitors might make their effect on hyperkalemia stronger.
Herbs (Hypertensive Properties)	May lessen the effectiveness of antihypertensive agents.
Herbs (Hypotensive Properties)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Hypotension-Associated Agents	The hypotensive action of hypotension-associated agents may be strengthened by blood pressure lowering medications.
Icatibant	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Levodopa-Containing Products	Levodopa-Containing Products' hypotensive effects may be strengthened by blood pressure-lowering medications.
Loop Diuretics	ay strengthen angiotensin-converting enzyme inhibitors' hypotensive effects. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by loop diuretics.
Lormetazepam	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Methylphenidate	May lessen the effectiveness of antihypertensive agents.
Molsidomine	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Naftopidil	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Nicergoline	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Nicorandil	Angiotensin-Converting Enzyme Inhibitors might make their effect on hyperkalemia stronger.
Nicorandil	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Nitroprusside	Nitroprusside's hypotensive impact may be strengthened by blood pressure-lowering medications.
Nonsteroidal Anti-Inflammatory Agents	Nonsteroidal Anti-Inflammatory Agents' negative/toxic effects may be increased by angiotensin-converting enzyme inhibitors. In particular, the combination may cause a marked decline in renal function. Angiotensin-Converting Enzyme Inhibitors' antihypertensive effects may be lessened by nonsteroidal anti-inflammatory drugs.
Pentoxifylline	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Pholcodine	Pholcodine's hypotensive impact may be strengthened by blood pressure lowering medications.
Phosphodiesterase 5 Inhibitors	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Potassium Salts	Angiotensin-Converting Enzyme Inhibitors might make their effect on hyperkalemia stronger.
Potassium-Sparing Diuretics	Angiotensin-Converting Enzyme Inhibitors might make their effect on hyperkalemia stronger.
Pregabalin	Angiotensin-Converting Enzyme Inhibitors may intensify Pregabalin's negative/toxic effects. Particularly, there may be a higher incidence of angioedema.
Prostacyclin Analogues	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Quinagolide	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Racecadotril	May intensify angiotensin-converting enzyme inhibitors' harmful or hazardous effects. In particular, this combination may make angioedema more likely.
Ranolazine	Angiotensin-Converting Enzyme Inhibitors might make their effect on hyperkalemia stronger.
Salicylates	May intensify angiotensin-converting enzyme inhibitors' nephrotoxic effects. The therapeutic benefit of angiotensin-converting enzyme inhibitors may be reduced by salicylates.
Sirolimus	Angiotensin-Converting Enzyme Inhibitors might make their effect on hyperkalemia stronger.
Tacrolimus (Systemic)	Tacrolimus's effect of making you more hyperkalemic may be enhanced by angiotensin-converting enzyme inhibitors (Systemic).
Temsirolimus	Angiotensin-Converting Enzyme Inhibitors might make their effect on hyperkalemia stronger.
Thiazide and Thiazide-Like Diuretics	May increase the angiotensin-converting enzyme inhibitors' hypotensive effects. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by thiazide and thiazide-like diuretics.
TiZANidine	May intensify Lisinopril's hypotensive effects.
Tolvaptan	Angiotensin-Converting Enzyme Inhibitors might make their effect on hyperkalemia stronger.
Trimethoprim	Angiotensin-Converting Enzyme Inhibitors might make their effect on hyperkalemia stronger.
Yohimbine	May lessen the effectiveness of antihypertensive agents.
Risk Factor D (Consider therapy modification)
Aliskiren	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. Angiotensin-Converting Enzyme Inhibitors' hypotensive effects may be strengthened by aliskiren. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be made worse by aliskiren. Treatment: It is not advised for diabetic patients to take aliskiren along with ACEIs or ARBs. Combination therapy should be avoided in other patients, especially when CrCl is less than 60 mL/min. If combined, keep a close eye on your blood pressure, potassium, and creatinine levels.
Allopurinol	Angiotensin-Converting Enzyme Inhibitors might make Allopurinol more likely to cause allergic or hypersensitive reactions.
Amifostine	Amifostine's hypotensive impact may be strengthened by blood pressure lowering medications. Treatment: Blood pressure-lowering drugs need to be avoided for 24 hours before amifostine is administered when used at chemotherapeutic doses. Amifostine should not be given if blood pressure lowering treatment cannot be stopped.
Angiotensin II Receptor Blockers	May worsen angiotensin-converting enzyme inhibitors' toxic or severe effects. Angiotensin-Converting Enzyme Inhibitors' serum levels may rise in response to angiotensin II receptor blockers. Management: According to US labelling, it is not advisable to take telmisartan and ramipril. It is unclear whether another ACE inhibitor and ARB combo would be any safer. When possible, take into account alternatives to the mix.
Grass Pollen Allergen Extract (5 Grass Extract)	Grass pollen allergen extract may have a more negative or toxic effect if angiotensin-converting enzyme inhibitors are used (5 Grass Extract). With regard to grass pollen allergen extract, ACE inhibitors may specifically enhance the likelihood of a severe allergic reaction (5 Grass Extract).
Iron Dextran Complex	Angiotensin-Converting Enzyme Inhibitors might make Iron Dextran Complex more harmful or poisonous. Patients taking an ACE inhibitor may be more susceptible to events of the anaphylactic variety. Management: Adhere strictly to the instructions for iron dextran administration, including the use of a test dose before the initial therapeutic dose and the availability of resuscitation tools and qualified people.
Lanthanum	May lower angiotensin-converting enzyme inhibitors' serum concentration. Angiotensin-converting enzyme inhibitors should be given at least two hours before or after lanthanum.
Lithium	The serum concentration of lithium may rise in response to angiotensin-converting enzyme inhibitors. Management: After adding an ACE inhibitor, lithium dosage decreases will probably be required. Following the addition or discontinuation of concurrent ACE inhibitor therapy, carefully monitor the patient's response to lithium.
Obinutuzumab	The hypotensive effects of blood pressure-lowering medications may be strengthened. Management: Take into account temporarily stopping blood pressure-lowering drugs 12 hours before the start of the obinutuzumab infusion and keeping them off until 1 hour after the infusion is finished.
Sodium Phosphates	The nephrotoxic impact of sodium phosphates may be enhanced by angiotensin-converting enzyme inhibitors. In particular, there may be an increased risk of acute phosphate nephropathy. Treatment: You might want to temporarily stop taking ACEIs or look into alternatives to the oral sodium phosphate bowel preparation in order to prevent this combo. Maintaining appropriate hydration and properly monitoring renal function should be done if the combination cannot be avoided.
Urapidil	Angiotensin-Converting Enzyme Inhibitors may interact with them through an unidentified method. Avoid taking urapidil and ACE inhibitors simultaneously as a management strategy.
Risk Factor X (Avoid combination)
Bromperidol	The hypotensive impact of bromperidol may be enhanced by blood pressure lowering medications. Blood Pressure Lowering Agents' hypotensive effects may be lessened by bromperidol.
Sacubitril	The negative or hazardous effects of sacubitril may be increased by angiotensin-converting enzyme inhibitors. In particular, this combination may raise the risk of angioedema.

Lisinopril: Drug Interaction

Risk Factor C (Monitor therapy)
Alfuzosin	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Alteplase	Angiotensin-Converting Enzyme Inhibitors may intensify Alteplase's harmful or hazardous effects. In particular, there may be an elevated risk for angioedema.
Amphetamines	May reduce the effectiveness of antihypertensive agents
Angiotensin II	The therapeutic efficacy of angiotensin II may be enhanced by angiotensin-converting enzyme inhibitors.
Antipsychotic Agents (Second Generation [Atypical])	Antipsychotic drugs' hypotensive effects may be enhanced by blood pressure-lowering medications (Second Generation [Atypical]).
Aprotinin	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.
AzaTHIOprine	AzaTHIOprine's myelosuppressive effects may be enhanced by angiotensin-converting enzyme inhibitors.
Barbiturates	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Benperidol	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Brigatinib	May lessen the effectiveness of antihypertensive agents. Antihypertensive Agents' bradycardic action may be strengthened by brutinib.
Brimonidine (Topical)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Dapoxetine	May increase the angiotensin-converting enzyme inhibitors' orthostatic hypotensive effects.
Dexmethylphenidate	Can lessen an antihypertensive drug's therapeutic impact.
Diazoxide	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Dipeptidyl Peptidase-IV Inhibitors	May worsen angiotensin-converting enzyme inhibitors' toxic or severe effects.Particularly, there may be a higher incidence of angioedema.
Drospirenone	Drospirenone's hyperkalemic impact may be enhanced by angiotensin-converting enzyme inhibitors.
DULoxetine	The hypotensive impact of DULoxetine may be enhanced by blood pressure lowering medications.
Eplerenone	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.
Everolimus	May intensify angiotensin-converting enzyme inhibitors' harmful or hazardous effects. Particularly, there may be a higher incidence of angioedema.
Ferric Gluconate	Angiotensin-Converting Enzyme Inhibitors might make ferric gluconate more harmful or poisonous.
Ferric Hydroxide Polymaltose Complex	Ferric Hydroxide Polymaltose Complex may have a more negative or toxic effect when taken with angiotensin-converting enzyme inhibitors. In particular, there may be an elevated risk for angioedema or allergic responses.
Gelatin (Succinylated)	Gelatin's harmful or toxic effects may be increased by angiotensin-converting enzyme inhibitors (Succinylated). Particularly, there may be a higher chance of a paradoxical hypotensive reaction.
Gold Sodium Thiomalate	Gold Sodium Thiomalate may have a more negative or toxic effect when used with angiotensin-converting enzyme inhibitors. Nitritoid responses are more likely now, it has been noted.
Heparin	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.
Heparins (Low Molecular Weight)	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.
Herbs (Hypertensive Properties)	May lessen the effectiveness of antihypertensive agents.
Herbs (Hypotensive Properties)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Hypotension-Associated Agents	The hypotensive action of hypotension-associated agents may be strengthened by blood pressure lowering medications.
Icatibant	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
Levodopa-Containing Products	Levodopa-Containing Products' hypotensive effects may be strengthened by blood pressure-lowering medications.
Loop Diuretics	May strengthen angiotensin-converting enzyme inhibitors' hypotensive effects. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by loop diuretics.
Lormetazepam	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Methylphenidate	May lessen the effectiveness of antihypertensive agents.
Molsidomine	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Naftopidil	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Nicergoline	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Nicorandil	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.
Nicorandil	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Nitroprusside	Nitroprusside's hypotensive impact may be strengthened by blood pressure-lowering medications.
Nonsteroidal Anti-Inflammatory Agents	Nonsteroidal Anti-Inflammatory Agents' negative/toxic effects may be increased by angiotensin-converting enzyme inhibitors. In particular, the combination may cause a marked decline in renal function. Angiotensin-Converting Enzyme Inhibitors' antihypertensive effects may be lessened by nonsteroidal anti-inflammatory drugs.
Pentoxifylline	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Pholcodine	Pholcodine's hypotensive impact may be strengthened by blood pressure lowering medications.
Phosphodiesterase 5 Inhibitors	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Potassium Salts	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.
Potassium-Sparing Diuretics	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.
Pregabalin	Angiotensin-Converting Enzyme Inhibitors may intensify Pregabalin's negative/toxic effects. Particularly, there may be a higher incidence of angioedema.May intensify angiotensin-converting enzyme inhibitors' harmful or hazardous effects. In particular, this combination may make angioedema more likely.
Prostacyclin Analogues	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.
Quinagolide	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.
Racecadotril	May intensify angiotensin-converting enzyme inhibitors' nephrotoxic effects.
Ranolazine	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.
Salicylates	The therapeutic benefit of angiotensin-converting enzyme inhibitors may be reduced by salicylates.
Sirolimus	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.
Tacrolimus (Systemic)	Tacrolimus's effect of making you more hyperkalemic may be enhanced by angiotensin-converting enzyme inhibitors (Systemic).
Temsirolimus	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by thiazide and thiazide-like diuretics.
Thiazide and Thiazide-Like Diuretics	May increase the angiotensin-converting enzyme inhibitors' hypotensive effects.
TiZANidine	May intensify Lisinopril's hypotensive effects.
Tolvaptan	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.
Trimethoprim	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.
Yohimbine	May lessen the effectiveness of antihypertensive agents.
Risk Factor D (Consider therapy modification)
Aliskiren	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. Angiotensin-Converting Enzyme Inhibitors' hypotensive effects may be strengthened by aliskiren. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be made worse by aliskiren. Treatment: It is not advised for diabetic patients to take aliskiren along with ACEIs or ARBs. Combination therapy should be avoided in other patients, especially when CrCl is less than 60 mL/min. If combined, keep a close eye on your blood pressure, potassium, and creatinine levels.
Allopurinol	Angiotensin-Converting Enzyme Inhibitors might make Allopurinol more likely to cause allergic or hypersensitive reactions.
Amifostine	Amifostine's hypotensive impact may be strengthened by blood pressure lowering medications. Treatment: Blood pressure-lowering drugs need to be avoided for 24 hours before amifostine is administered when used at chemotherapeutic doses. Amifostine should not be given if blood pressure lowering treatment cannot be stopped.
Angiotensin II Receptor Blockers	May worsen angiotensin-converting enzyme inhibitors' toxic or severe effects. Angiotensin-Converting Enzyme Inhibitors' serum levels may rise in response to angiotensin II receptor blockers. Management: Use of telmisartan and ramipril is not advised according to US labelling. It is unclear whether another ACE inhibitor and ARB combo would be any safer. When possible, take into account alternatives to the mix.
Grass Pollen Allergen Extract (5 Grass Extract)	Grass pollen allergen extract may have a more negative or toxic effect if angiotensin-converting enzyme inhibitors are used (5 Grass Extract). With regard to grass pollen allergen extract, ACE inhibitors may specifically enhance the likelihood of a severe allergic reaction (5 Grass Extract).
Iron Dextran Complex	Angiotensin-Converting Enzyme Inhibitors might make Iron Dextran Complex more harmful or poisonous. Patients taking an ACE inhibitor may be more susceptible to events of the anaphylactic variety. Management: Adhere strictly to the instructions for iron dextran administration, including the use of a test dose before the initial therapeutic dose and the availability of resuscitation tools and qualified people.
Lanthanum	May lower angiotensin-converting enzyme inhibitors' serum concentration. Angiotensin-converting enzyme inhibitors should be given at least two hours before or after lanthanum.
Lithium	The serum concentration of lithium may rise in response to angiotensin-converting enzyme inhibitors. Management: After adding an ACE inhibitor, lithium dosage decreases will probably be required. Following the addition or discontinuation of concurrent ACE inhibitor therapy, carefully monitor the patient's response to lithium.
Obinutuzumab	The hypotensive effects of blood pressure-lowering medications may be strengthened. Management: Take into account temporarily stopping blood pressure-lowering drugs 12 hours before the start of the obinutuzumab infusion and keeping them off until 1 hour after the infusion is finished.
Sodium Phosphates	The nephrotoxic impact of sodium phosphates may be enhanced by angiotensin-converting enzyme inhibitors. In particular, there may be an increased risk of acute phosphate nephropathy. Treatment: You might want to temporarily stop taking ACEIs or look into alternatives to the oral sodium phosphate bowel preparation in order to prevent this combo. Maintaining appropriate hydration and properly monitoring renal function should be done if the combination cannot be avoided.
Urapidil	Angiotensin-Converting Enzyme Inhibitors may interact with them through an unidentified method. Avoid taking urapidil and ACE inhibitors simultaneously as a management strategy.
Risk Factor X (Avoid combination)
Bromperidol	The hypotensive impact of bromperidol may be enhanced by blood pressure lowering medications. Blood Pressure Lowering Agents' hypotensive effects may be lessened by bromperidol.
Sacubitril	The negative or hazardous effects of sacubitril may be increased by angiotensin-converting enzyme inhibitors. In particular, this combination may raise the risk of angioedema.

Monitoring parameters:

Pulse
BP
Serum electrolytes
RFTs
LFTs
Periodic monitoring of CBC with differential is required if the patient has collagen vascular disease and/or renal impairment.
Heart failure:
- Reassess renal function and serum potassium in patients with preexisting hypotension, hyponatremia, diabetes mellitus, azotemia, or those using potassium supplements after 1 to 2 weeks of initiating medication and on an ongoing basis after that.

Hypertension:

The 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults:

Confirmed hypertension and known CVD or 10-year ASCVD risk ≥10%:

Target blood pressure <130/80 mm Hg is recommended.

Confirmed hypertension without markers of increased ASCVD risk:

Target blood pressure <130/80 mm Hg may be reasonable.

Diabetes and hypertension:

The American Diabetes Association (ADA) guidelines (ADA 2019):
- Patients 18 to 65 years of age, without ASCVD, and 10-year ASCVD risk <15%:
  - Target blood pressure <140/90 mm Hg is recommended.
- Patients 18 to 65 years of age and known ASCVD or 10-year ASCVD risk >15%:
  - Target blood pressure <130/80 mm Hg may be appropriate if it can be safely attained.
- Patients >65 years of age (healthy or complex/intermediate health):
  - Target blood pressure <140/90 mm Hg is recommended.
- Patients >65 years of age (very complex/poor health):
  - Target blood pressure <150/90 mm Hg is recommended.

How to administer Lisinopril (Zestril)?

It should be taken orally once daily, regardless of mealtime.

Mechanism of action of Lisinopril (Zestril):

Angiotensin-converting enzyme is competitively inhibited by lisinopril (ACE).
As a result, the synthesis of angiotensin 2 declines, plasma renin activity rises, and aldosterone levels drop.
It also prevents angiotensin I from angiotensin III (a powerful vasoconstrictor).
Angiotensin II may increase adrenergic output from the CNS.
This could explain why there is a hypotensive effect.
The vasoactive kallikreins in active hormones are converted by ACE inhibitors. This results in lower blood pressure.

The onset of action:

1 hour;
Peak effect: Hypotensive: Oral: ~6 hours

Duration:

24 hours

Metabolism:

Not metabolized

Bioavailability: Pediatric patients:

2 to 15 years: 20% to 36%
6 to 16 years: ~28%
Adults:
- ~25% (range: 6% to 60%); decreased to 16% with NYHA Class II-IV heart failure

Half-life elimination:

12 hours

Time to peak:

Pediatric patients 6 months to 15 years: Median (range): 5 to 6 hours
Adults: ~7 hours

Excretion:

Primarily urine (as unchanged drug)

International Brand Names of Lisinopril:

Prinivil
Qbrelis
Zestril
ACT Lisinopril
APO-Lisinopril
Auro-Lisinopril
DOM-Lisinopril
JAMP-Lisinopril
MYLANLisinopril
PMS-Lisinopril
Prinivil
PRO-Lisinopril-10
PRO-Lisinopril-20
PRO-Lisinopril-5
RAN-Lisinopril
RIVA-Lisinopril
SANDOZ Lisinopril
TEVA-Lisinopril
TEVA-Lisinopril
Acemin
Acepril
Acerbon
Acerdil
Aklis
Alapril
Albigone
Alfaken
Auroliza
Cipril
Coric
Dapril
Diroton
Dosteril
Doxapril
ES
Eucor
Fersivag
Fibsol
Genopril
Hypersil
Inhitril
Inopril
Irumed
Lestace
Linipril
Linopril
Linotor
Linvas
Lipril
Lisdene
Lisibeta
Lisidigal
Lisigamma
Lisihexal
Lisino
Lisipril
Lisir
Lisitens
Lisnoxl
Lisocard
Lisopress
Lisopril
Lisoril
Lispril
Listril
Longes
Nisirol
Nop
Noperten
Novatec
Odace
Omace
Pesatril
Presiten
Press
Prinil
Prinivil
Ranolip
Safepril
Sinopren
Sinopril
Skopryl
Stril
Tensikey
Tensiphar
Tensopril
Tensyn
Vitopril
Vivatec
Zenoril
Zestan
Zestril
Zinopril

Lisinopril Brand Names in Pakistan:

Lisinopril Tablets 5 mg in Pakistan
Bpmed	Medicraft Pharmaceuticals (Pvt) Ltd.
Corace	Bosch Pharmaceuticals (Pvt) Ltd.
Lace	Brookes Pharmaceutical Laboratories (Pak.) Ltd.
Lame	Atco Laboratories Limited
Liface	Hygeia Pharmaceuticals
Lisna	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Lisopril	Glaxosmithkline
Lispril	Werrick Pharmaceuticals
Lopress	Davis Pharmaceutical Laboratories
Lotide	Pharmatec Pakistan (Pvt) Ltd.
Nazipril	Nenza Pharmaceuticals (Pvt) Limited
Novatec	Obs
Renopril	Harmann Pharmaceutical Laboratories (Pvt) Ltd.
Sinopril	Obsons Pharmaceuticals
Trupril	Getz Pharma Pakistan (Pvt) Ltd.
Veskor	Raazee Theraputics (Pvt) Ltd.
Zenopril	Alliance Pharmaceuticals (Pvt) Ltd.
Zestril	Ici Pakistan Ltd.
Ziscar	Tabros Pharma

Lisinopril Tablets 10 Mg in Pakistan
Bepril	Unison Chemical Works
Bpmed	Medicraft Pharmaceuticals (Pvt) Ltd.
Corace	Bosch Pharmaceuticals (Pvt) Ltd.
Lace	Brookes Pharmaceutical Laboratories (Pak.) Ltd.
Lame	Atco Laboratories Limited
Liface	Hygeia Pharmaceuticals
Lisopril	Glaxosmithkline
Lispril	Werrick Pharmaceuticals
Lopress	Davis Pharmaceutical Laboratories
Lotide	Pharmatec Pakistan (Pvt) Ltd.
Nazipril	Nenza Pharmaceuticals (Pvt) Limited
Novatec	Obs
Renopril	Harmann Pharmaceutical Laboratories (Pvt) Ltd.
Sinopril	Obsons Pharmaceuticals
Trupril	Getz Pharma Pakistan (Pvt) Ltd.
Veskor	Raazee Theraputics (Pvt) Ltd.
Zenopril	Alliance Pharmaceuticals (Pvt) Ltd.
Zestril	Ici Pakistan Ltd.
Ziscar	Tabros Pharma

Lisinopril Tablets 20 Mg in Pakistan
Bpmed	Medicraft Pharmaceuticals (Pvt) Ltd.
Corace	Bosch Pharmaceuticals (Pvt) Ltd.
Gustorole	Pulse Pharmaceuticals
Lisna	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Lispril	Werrick Pharmaceuticals
Lopress	Davis Pharmaceutical Laboratories
Nazipril	Nenza Pharmaceuticals (Pvt) Limited
Zestril	Ici Pakistan Ltd.
Ziscar	Tabros Pharma

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Moexipril (Cardiotensin) - Uses, Dose, MOA, Brands, Side effects
13-12-2021

Lisinopril (Zestril) - Uses, Dose, Side effects, MOA, Brands

Indications of Lisinopril (Zestril):

Heart failure with reduced ejection fraction:

Hypertension:

ST-elevation myocardial infarction:

Off Label Use of Lisinopril in Adults:

Lisinopril (Zestril) dose in adults:

Lisinopril (Zestril) dose in the treatment of acute coronary syndromes:

Non-ST-elevation acute coronary syndrome (off-label):

ST-elevation myocardial infarction:

Heart failure with reduced ejection fraction:

Lisinopril (Zestril) Treatment dose of Hypertension: Note:

Lisinopril (Zestril) dose in the treatment of Post transplant erythrocytosis (renal transplant recipients) (off-label):

Lisinopril (Zestril) Treatment dose of proteinuric chronic kidney disease (diabetic or non-diabetic) (off-label):

IgA nephropathy:

Lisinopril (Zestril) dose in children:

Lisinopril (Zestril) Treatment dose of Hypertension:

Children <6 years: Limited data available:

Children ≥6 years and Adolescents:

Lisinopril (Zestril) Treatment dose of proteinuria (eg, mild IgA nephropathy, focal segmental glomerulosclerosis): Limited data available:

Children ≥2 years and Adolescents:

Lisinopril (Zestril) Pregnancy Risk Category: X

Lisinopril use during breastfeeding:

Lisinopril (Zestril) Dose adjustment in renal disease:

Heart failure with reduced ejection fraction:

Hypertension:

ST-elevation myocardial infarction:

In addition, the following dosage adjustments have been recommended :

Lisinopril (Zestril) Dose adjustment in liver disease:

Common Side Effects of Lisinopril (Zestril):

Cardiovascular:

Central nervous system:

Renal:

Rare Side Effects of Lisinopril (Zestril):

Cardiovascular:

Central Nervous System:

Dermatologic:

Endocrine & Metabolic:

Gastrointestinal:

Genitourinary:

Hematologic & Oncologic:

Neuromuscular & Skeletal:

Ophthalmic:

Otic:

Renal:

Respiratory:

Side effects of Lisinopril (Zestril) (Frequency not defined):

Hematologic & oncologic:

Hepatic:

Contraindications to Lisinopril (Zestril):

Warnings and precautions

Angioedema

Cholestatic jaundice

Cough:

Initial treatment with ACE inhibitors results in a dry, persistent cough that usually disappears within a month.

Hematologic effects

Agranulocytosis, anaemia, thrombocytopenia, neutropenia, and myeloid hypoplasia have all been linked to captopril, another ACE inhibitor.

Neutropenia is substantially more likely to occur in patients with renal impairment or collagen vascular disease, such as systemic lupus erythematosus.

Hyperkalemia:

Hyperkalemia can be caused by ACE inhibitors

Hypersensitivity reactions

ACE inhibitors can result in anaphylactic/anaphylactoid reactions.

Hypotension/syncope

ACE inhibitors have the potential to cause hypotension and syncope.

Renal function deterioration:

This can cause an increase in serum creatinine.

Aortic stenosis

Patients with aortic Stenosis may experience decreased coronary perfusion, which can lead to ischemia.

Ascites:

Cardiovascular disease

Collagen vascular disease:

Hepatic impairment

Hypertrophic cardiomyopathy and outflow tract obstruction

Renal artery stenosis

Renal impairment

It should not be used by patients with compromised renal function without the proper dosage modification.

Increased renal impairment can result from rapid dosage escalation.

A retrospective cohort analysis revealed that ACE inhibitors improved left ventricular function in elderly individuals over 65 with MI and improved survival. Patients having serum creatinine levels more than 3 mg/dl (25 micromols/l) were included.

Monitoring parameters:

How to administer Lisinopril (Zestril)?