Lispril

Introduction
Lispril belongs to a group of medicines known as angiotensin converting enzyme (ACE) inhibitor. It is widely used to treat high blood pressure and heart failure and may be prescribed after a heart attack. It also lowers the chances of having a heart attack or stroke. Lispril can be prescribed either alone or in combination with other medicines. It should be taken on an empty stomach. This medicine should be taken at the same time each day to get the most benefit. It is important to continue taking it regularly even if you feel well or even if your blood pressure is controlled. Most people with high blood pressure do not feel ill, but if you stop taking this medicine, your condition could get worse. This medicine is considered safe for long-term use. Making some changes in your lifestyle will also help lower your blood pressure. These may include regular exercise, losing weight, smoking cessation, reducing alcohol intake, and reducing the amount of salt in your diet as advised by your doctor. The most common side effects of this medicine include feeling dizzy or drowsy, headache, dry cough, fatigue, nausea, vomiting, diarrhea, stomach pain, and low blood pressure. Most of these are temporary and resolve with time. Talk to your doctor if any of the side effects bother you or do not go away. Before taking this medicine, let your doctor know if you have any kidney or liver problems. Pregnant or breastfeeding mothers should also consult their doctor before taking it. Your doctor may check your kidney function, blood pressure and potassium levels in your blood at regular intervals while you are taking this medicine.

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Uses of Lispril
Hypertension (high blood pressure)
Prevention of heart attack and stroke
Heart failure
Side effects of Lispril
Common
Decreased blood pressure
Cough
Increased potassium level in blood
Fatigue
Weakness
Dizziness
How to use Lispril
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Lispril may be taken with or without food, but it is better to take it at a fixed time.
How Lispril works
Lispril is an angiotensin converting enzyme (ACE) inhibitor. It works by reducing stress on the heart and relaxing blood vessel so that blood flows more smoothly and the heart can pump blood more efficiently.
What if you forget to take Lispril?
If you miss a dose of Lispril, skip it and continue with your normal schedule. Do not double the dose.
Quick Tips
Lispril can make you feel dizzy for the first few days, so rise slowly if you have been sitting or lying down. You can also prefer taking it at bedtime to avoid dizziness throughout the day.
Let your doctor know about any cough, or throat irritation that does not go away.
It may increase the level of potassium in blood. Avoid taking potassium supplements and potassium-rich foods such as banana and broccoli.
Inform your doctor if you are pregnant, planning pregnancy or breastfeeding.
Brief Description
Indication
Heart failure, Myocardial infarction, Diabetic nephropathy, Hypertension
Administration
May be taken with or without food.
Adult Dose
Oral Hypertension Adult: Initially, 10 mg/day, 1st dose given preferably at bedtime to avoid precipitous fall in BP. Patient w/ renovascular HTN, volume depletion, severe HTN: Initially, 2.5-5 mg once daily. Patient on diuretic: Initially, 5 mg once daily. Maintenance: 20 mg once daily, up to 80 mg/day may be given if needed. Heart failure Adult: As adjunct: Initially, 2.5 or 5 mg/day, increased by increments of >10 mg at intervals of at least 2 wk to max maintenance dose of 40 mg/day. Post myocardial infarction Adult: Initially, 5 mg once daily for 2 days started w/in 24 hr of the onset of symptoms. Increase to 10 mg once daily. Patients w/ low systolic BP: Initially, 2.5 mg once daily. Diabetic nephropathy Adult: Hypertensive type 2 diabetics w/ microalbuminuria: 10 mg once daily, may increase to 20 mg once daily to achieve a sitting diastolic BP <90 mmHg. _ Child Dose Oral Hypertension Child: >6 yr Initially, 0.07 mg/kg, up to 5 mg once daily.

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Renal Dose
Hypertension Renal impairment: Adult: CrCl <10 mL/min or on dialysis: Initially, 2.5 mg once daily. CrCl 10-30 mL/min: Initially, 2.5-5 mg once daily. CrCl 31-80 mL/min: Initially, 5-10 mg once daily. Dose can be adjusted up to max 40 mg once daily based on patient's response. Child: Do not give if GFR <30 mL/min/1.73 m2. CrCl (ml/min) <10 Initially, 2.5 mg once daily. 10-30 Initially 2.5-5 mg once daily. 31-80 Initially, 5-10 mg once daily. _ Contraindication History of angioedema related to previous treatment with ACE inhibitors, hereditary or idiopathic angioedema. Bilateral renal artery stenosis. Pregnancy (2nd or 3rd trimester), lactation. Mode of Action Lisinopril competitively inhibits ACE from converting angiotensin I to angiotensin II (a potent vasoconstrictor) resulting in increased plasma renin activity and reduced aldosterone (a hormone that causes water and Na retention) secretion. This promotes vasodilation and BP reduction. Precaution Hypovolaemia, hyperkalaemia, collagen vascular disease, valvular stenosis; before, during or immediately after anaesthesia, preexisting renal insufficiency, unilateral renal artery stenosis. Children <6 yr. Assess renal function. May impair ability to drive or operate machinery. Lactation: Not known if excreted into breast milk; not recommended _ Side Effect >10% Dizziness (5-12%) 1-10% Cough (4-9%),Headache (4-6%),Hyperkalemia (2-5%),Diarrhea (3-4%),Hypotension (1-4%),Chest pain (3%),Fatigue (3%),Nausea/vomiting (2%),Kidney disease, of AMI patients (2%),Rash (1-2%) <1% Immune hypersensitivity reaction,Psoriasis,Angioedema of the face, lips, throat; intestinal angioedema,Anuria,Atrial tachycardia,Acute renal failure,Arthralgia,Alopecia,Atrial fibrillation,Bone marrow suppression,Cutaneous pseudolymphoma,Hypersomnia,Leukopenia,Mood changes,Pancreatitis,Skin infections Potentially Fatal: Severe hypotension, angioedema. _ Interaction May enhance hypotensive effect w/ diuretics. May increase risk of renal function deterioration and decrease antihypertensive effect w/ NSAIDs. May increase serum levels and toxicity of lithium. Increased risk of hyperkalaemia w/ K-sparing diuretics and K supplements. May increase nitritoid reactions of gold Na thiomalate. Potentially Fatal: Increased risk of hypotension, hyperkalaemia and changes in renal function w/ aliskiren in patients w/ diabetes or renal impairment. _