Can be used as monotherapy for initial management of uncomplicated hypertension; however, thiazide diuretics are preferred by JNC 7.
CHF
Management of symptomatic CHF, usually in conjunction with cardiac glycosides and diuretics.
AMI
Used in conjunction with thrombolytic agents, aspirin, and/or β-adrenergic blocking agents to improve survival in patients with AMI who are hemodynamically stable. Usually initiated within 24 hours of MI.
Diabetic Nephropathy
A first-line agent in the treatment of diabetic nephropathy† in hypertensive patients with type 2 diabetes mellitus.
Dosage and Administration
General
Hypertension
Lisinopril/hydrochlorothiazide fixed combinations should not be used for initial treatment of hypertension.
Administration
Oral Administration
Administer orally once daily without regard to meals. Administer as extemporaneously prepared oral suspension in patients unable to swallow tablets.
Reconstitution
Preparation of extemporaneous suspension containing lisinopril 1 mg/mL: Add 10 mL of purified water USP to a polyethylene terephthalate (PET) bottle containing ten 20-mg lisinopril tablets; shake contents for ≥1 minute. Add 30 mL of sodium citrate dihydrate (Bicitra®) and 160 mL of syrup (Ora-Sweet SF®) to the PET bottle; gently shake for several seconds to disperse ingredients. Shake suspension before dispensing each dose.
Dosage
Pediatric Patients
Hypertension
Oral
Children ≥6 years of age: Initially, 0.07 mg/kg (up to 5 mg) once daily. Adjust dosage until the desired BP goal is achieved (up to maximum dosage of 0.61 mg/kg or 40 mg daily).
Adults
Hypertension
Oral
Initially, 10 mg once daily as monotherapy. Adjust dosage to achieve BP control.
In patients currently receiving diuretic therapy, discontinue diuretic, if possible, 2–3 days before initiating lisinopril. May cautiously resume diuretic therapy if BP not controlled adequately with lisinopril alone. If diuretic cannot be discontinued, increase sodium intake and initiate lisinopril at 5 mg daily under close medical supervision for at least 2 hours and until BP has stabilized for at least an additional hour.
Usual dosage: 10–40 mg once daily.
If effectiveness diminishes toward end of dosing interval in patients treated once daily (particularly likely with daily dosage of 10 mg), consider increasing dosage or administering drug in 2 divided doses.
If BP is not adequately controlled by monotherapy with lisinopril or hydrochlorothiazide, can switch to the fixed-combination preparation containing lisinopril 10 mg and hydrochlorothiazide 12.5 mg or, alternatively, lisinopril 20 mg and hydrochlorothiazide 12.5 mg. Adjust dosage of either or both drugs according to patient’s response; however, dosage of hydrochlorothiazide should not be increased for about 2–3 weeks after initiation of therapy.
Can switch to the fixed-combination preparation if stable dosages of lisinopril or hydrochlorothiazide have been achieved.
If BP is controlled by monotherapy with hydrochlorothiazide 25 mg daily but potassium loss is problematic, can switch to fixed-combination preparation containing lisinopril 10 mg and hydrochlorothiazide 12.5 mg.
CHF
Oral
Initially, 2.5–5 mg daily. Monitor closely (especially patients with systolic BP <100 mg Hg) until BP has stabilized. To minimize risk of hypotension, reduce diuretic dosage, if possible.
Usual dosage: 5–40 mg once daily.
AMI
Oral
5 mg within 24 hours post-MI, followed by 5 mg 24 hours after initial dose, 10 mg 48 hours after initial dose, and then 10 mg daily. Recommended maintenance dosage: 10 mg daily for 6 weeks.
If low SBP (≤120 mm Hg) observed when lisinopril therapy is initiated or during the first 3 days post-MI, give lower dose (i.e., 2.5 mg).
If hypotension (SBP <100 mm Hg) occurs, reduce maintenance dosage to 5 mg daily; may temporarily reduce further to 2.5 mg daily if needed.
If prolonged hypotension (SBP <90 mm Hg lasting >1 hour) occurs, discontinue lisinopril.
Prescribing Limits
Pediatric Patients
Hypertension
Oral
Children ≥6 years of age: Maximum 0.61 mg/kg or 40 mg daily.
Adults
Hypertension
Oral
Dosages up to 80 mg daily have been used, but no additional benefit observed.
Dosage of lisinopril/hydrochlorothiazide fixed combination generally should not exceed lisinopril 80 mg and hydrochlorothiazide 50 mg daily.
Special Populations
Renal Impairment
Hypertension
Initially, 5 mg once daily in adults with Clcr 10–30 mL/minute or 2.5 mg once daily in adults with Clcr <10 mL/minute (usually on hemodialysis). Titrate until BP is controlled or to maximum of 40 mg daily. Manufacturers do not recommend use in hypertensive pediatric patients with Clcr <30 mL/minute per 1.73 m2.
Lisinopril/hydrochlorothiazide fixed combinations are not recommended in patients with severe renal impairment.
CHF
Initially, 2.5 mg once daily in CHF patients with moderate to severe renal impairment (Clcr ≤30 mL/minute or Scr >3 mg/dL) under close medical supervision.
AMI
Use with caution in AMI patients with Scr >2 mg/dL. If renal impairment (Scr >3 mg/dL or a doubling of baseline Scr) occurs during lisinopril therapy, consider discontinuing therapy.
Volume- and/or Salt-depleted Patients
CHF
Initially, 2.5 mg once daily in CHF patients with hyponatremia (serum sodium concentration <130 mEq/L) under close medical supervision.
Geriatric Patients
Generally titrate dosage carefully, initiate therapy at the low end of the dosage range.
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