Ecopril

Indications

Lisinopril is used to treat:

• High blood pressure (hypertension).
• Heart failure, together with other medicines.
• Heart attack, starting within the first days to help protect the heart, as decided by the doctor.
• Kidney problems caused by diabetes in people with high blood pressure.

How It Works

Lisinopril is an ACE inhibitor. It blocks an enzyme the body uses to make angiotensin II, a hormone that narrows blood vessels. With less angiotensin II, blood vessels relax and widen, blood pressure falls, and the heart does not have to work as hard.

Dosage and Administration

• High blood pressure (adults): usually starts at 10 mg once a day (5 mg or less in older people, those with kidney problems or those already taking a diuretic). The usual maintenance dose is 20 mg once a day; the doctor may adjust it.
• Heart failure: usually starts at 2.5 mg once a day and is increased slowly by the doctor.
• After a heart attack and for diabetic kidney disease: as prescribed.
• Children: as prescribed by a specialist.

Take once a day at about the same time, with or without food. The first dose may cause dizziness, so it is often taken at bedtime. Keep taking it even when you feel well.

Interactions

• Potassium supplements, salt substitutes containing potassium, and potassium-sparing diuretics (Spironolactone, Eplerenone, Amiloride) can raise potassium to dangerous levels.
• Painkillers such as Ibuprofen, Diclofenac and other NSAIDs can reduce its effect and harm the kidneys.
• It can raise blood levels of Lithium.
• Do not take with Sacubitril/Valsartan, or within 36 hours of it.
• Do not combine with Aliskiren if you have diabetes or kidney problems.
• Diuretics and other blood pressure medicines can lower blood pressure too much.
• Insulin and diabetes tablets may lower blood sugar more.

Contraindications

• Allergy to lisinopril or any other ACE inhibitor.
• Past angioedema (sudden swelling of the face, lips, tongue or throat), whatever the cause.
• Pregnancy.
• Use with Aliskiren in people with diabetes or kidney impairment, or within 36 hours of Sacubitril/Valsartan.

Side Effects

Common: dizziness (especially when standing up), headache, a dry tickly cough, tiredness, nausea, and changes in kidney function or potassium on blood tests.

Get urgent medical help if you have:

• Swelling of the face, lips, tongue or throat, or difficulty swallowing or breathing.
• Fainting or severe light-headedness.
• Chest pain or a fast, irregular heartbeat.
• Yellow skin or eyes, or severe tummy pain.
• Passing very little urine, or muscle weakness with an irregular heartbeat (possible high potassium).
• Fever, sore throat or mouth ulcers that do not go away.

Pregnancy and Lactation

Do not use in pregnancy. It can harm the unborn baby, especially after the first 3 months. If you become pregnant or plan to, tell your doctor straight away so the medicine can be changed. It is not recommended during breastfeeding, especially for newborn or premature babies; the doctor may choose another medicine.

Precautions and Warnings

• Have kidney function and potassium checked before starting and regularly afterwards.
• If you have vomiting, diarrhoea or are not drinking enough, you may become dehydrated and very dizzy; ask your doctor whether to pause the medicine until you recover.
• Tell the doctor or dentist that you take it before surgery or anaesthesia.
• Use with care in narrowed heart valves, narrowed kidney arteries, and kidney or liver disease.
• Get up slowly from sitting or lying to avoid dizziness.

Overdose

Too much can cause very low blood pressure, severe dizziness, fainting, a slow or fast heartbeat and kidney problems. Seek urgent medical help.

Therapeutic Class

ACE inhibitor (antihypertensive).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.