Lisinopril is an antihypertensive drug and is classified in the Angiotensin converting enzyme (ACE) inhibitor group of the drugs. Other drugs included in this group are; Captopril, Enalapril, Ramipril, Quinapril, Perindopril, Benazepril, Imidapril, Fosinopril, Zofenopril and Trandolapril. Lisinopril is marketed all over the world with different brand or trade names like Zestril, Prinivil and Tensopril.
Renin-angiotensin-aldosterone system plays a dominant role in the regulation of blood pressure in our body. Renin is released by the kidney which is converted to angiotensinogen in the liver. Angiotensinogen is further converted into angiotensin I and angiotensin II in the presence of angiotensin coverting enzyme (ACE) in the lungs. This angiotensin further stimulates the release of aldosterone for the adrenal glands that causes sodium and water retention. Moreover, Angiotensin causes constriction of blood vessels in human body. Angiotensin converting enzyme (ACE) inhibitors, as the name indicates inhibits the conversion of Angiotensin I to Angiotensin II in the lungs and thus plays an important role in lowering the blood pressure. Moreover, Lisinopril increases bradykinin levels by inhibiting kininase II and decreases the activity of sympathetic nervous system, imparting a role in lowering the blood pressure.
What is Lisinopril used for?
Common uses of Lisinopril are:
- Acute myocardial infarction or heart attack
- Right sided or congestive heart failure – L6isinopril has shown promising results in the management of chronic heart failure. It is indicated for both the asymptomatic and symptomatic patients having ejection fraction (EF) less than 40 % (normal >55%). Data has revealed that use of lisinopril has decreased the remodeling of left ventricle, improved the symptoms of congestive heart failure, decreased hospital stay and decreased the mortality rate of heart failure. Usual dose of Lisinopril for chronic heart failure is 2.5 to 5 mg four times daily. It may be increased to 35 mg four times daily.
- Diabetic retinopathy
- Diabetic nephropathy
Common side effects of Lisinopril
Side effects of Lisinopril can be divided into two categories;
1. Side effects attributable to the mechanism of action (class effects)
- Profound hypotension – it is usually seen in the individuals with malignant hypertension in which increased blood pressure is due to increased activity of Renin. It is also seen in the hypertensive patient already on diuretics because the combined effect of both the drugs leads to marked decrease in blood pressure.
- Renal insufficiency – Lisinopril can cause renal insufficiency due to profound hypotension. Moreover, it is contraindicated in patients with bilateral renal stenosis because it can cause acute renal failure in such cases
- Hyperkalemia – it is increased level of potassium in the blood. Lisinopril inhibits the synthesis of aldosterone which is responsible for excretion of potassium from the body. This leads to increased levels of potassium in the blood
- Cough – excessive dry cough occasionally associated with wheezing is another common side effect of Lisinopril. It usually occurs due to increased bradykinin in the body. Lisinopril can trigger dormant asthma
- Angioedema – it is reversible after discontinuing the drug
2. Additional side effects – these side effects occur due to the chemical structure or kinetics of the drug
- Allergic or anaphylactic reaction – it is the most common side effect that can occur with any drug. It may be accompanied by maculopapular rash and eosinophilia. The reaction is severe in patients who receive high doses or have renal disorder
- Drug fever – it is another common side effect of Lisinopril. It is accompanied by certain skin conditions like Steven-Johnson syndrome, lichenoid eruptions, aphthous ulcers, bullous pemphigus etc
- Bone marrow suppression – it may cause leucopenia, neutropenia, lymphocytopenia, aplastic anemia, pancytopenia and thrombocytopenia. Leucopenia may predispose an individual to multiple infections
- Nephrotic syndrome – Lisinopril may cause glomerulonephritis that must be differentiated from the acute renal failure associated with Lisinopril use.
- Chronic drug use is associated with cholestatic hepatitis impairing the liver function tests (LFTs) and drug induced hepatitis that may be toxic
- Drug induced Parkinsonism
- Certain neuropsychiatric disorders may also occur with the use of Lisinopril
Lisinopril side effects on children
Children usually have the same side effects as mentioned above; however, few side effects like anaphylaxis and precipitation of asthma may be very much disastrous in children.
Lisinopril side effects on men
Almost all the side effects of Lisinopril are encountered by men. Hyperkalemia is one of the side effects that are mostly seen in older men using this drug. In men, few cases of erectile dysfunction have also been reported. Moreover, altered sexual sensations may occur with the use of this drug.
Lisinopril side effects on women
Although women also experience similar side effects of the drug as men, however few side effects like stomach cramping, nausea, vomiting, abdominal discomfort, headache, dizziness, fainting and cough are more prominent in women as compared to men. In order to avoid abdominal discomfort women must take Lisinopril with a small meal.
Lisinopril side effects on pregnant women
The use of Lisinopril and other acngiotensin converting enzyme (ACE) inhibitors is absolutely contraindicated in the all the trimesters of pregnancy by the United States Food and Drug Administration.
During first trimester the use of Lisinopril is associated with certain major congenital malformations like:
- Cardiovascular malformations – atrial septal defect, ventricular septal defect, patent ductus arteriosus and pulmonic stenosis
- Musculoskeletal anomalies – craniofacial abnormalities, upper limb deformities and polydactyly
- Gastrointestinal abnormalities – pyloric stenosis and intestinal atresia
- Neurologic malformations – spina bifida, hydrocephalus and microcephaly
- Moreover genital, urologic and renal malformations may also occur
Lisinopril can be used safely in breast feeding mothers because numerous studies have shown that it is not secreted in the human milk.
Lisinopril side effects on elderly
In elderly having co-morbid conditions like ischemic heart disease, profound hypotension caused by Lisinopril can be disastrous as it may precipitate angina or other complications. Another common side effect in elderly male is hyperkalemia due to inhibition of synthesis of aldosterone in the adrenal glands. Hyperkalemia can be very dangerous in elderly diabetics.