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| ====== DRUG_NAME (BRAND1®, BRAND2®) ======<WRAP right 340px><WRAP infobox>| | {{ :PATH:TO:STRUCTURE.svg |}} |^ DRUG_NAME || Brand Names | BRAND1®, BRAND2® || Drug Class | [[NAMESPACE:CLASS|CLASS]] || Primary Indications | [[LINK1|INDICATION1]]; [[LINK2|INDICATION2]]; OTHER || Blood Pressure Effect | EFFECT || Mortality Benefit | Yes/No (DETAILS) || Elimination | Renal/Hepatic || Black Box Warning | YES/NO || FDA Approval | YEAR |</WRAP></WRAP>===== Overview =====DRUG_NAME is a CLASS used for INDICATIONS.Brief mechanistic and clinical overview. Include survival/organ benefit if relevant.<WRAP clear></WRAP>----===== Mechanism of Action =====Primary Molecular Target * TARGETPathway Effects * EFFECT 1 * EFFECT 2Net Physiologic Outcomes * OUTCOME 1 * OUTCOME 2----===== Indications ===== * [[LINK|INDICATION]] * [[LINK|INDICATION]] * OTHERSpecial use: * NOTE (e.g., renal protection, off-label)----<WRAP blackbox>===== Black Box Warning =====If applicable, summarize here.</WRAP>----<WRAP contra>===== Contraindications =====Absolute: * LISTRelative / Caution: * LIST</WRAP>----<WRAP details>===== Dosing =====Indication: * Initial: * Typical: * Max:Renal/Hepatic adjustment: * NOTES</WRAP>----<WRAP details>===== Pharmacokinetics =====Absorption: * Oral/IV/etc.Bioavailability: * %Metabolism: * PATHWAYHalf-life: * TIMEElimination: * Renal/Hepatic (unchanged/metabolized)</WRAP>----<WRAP details>===== Adverse Effects =====Common: * LISTSerious: * LIST</WRAP>----<WRAP details>===== Drug Interactions =====Increase risk: * LISTAvoid combination: * LIST</WRAP>----<WRAP monitoring>===== Monitoring =====Labs: * LISTVitals: * LISTClinical: * LIST</WRAP>----<WRAP pearls>===== Clinical Pearls ===== * PEARL 1 * PEARL 2 * PEARL 3</WRAP>----===== Comparison Within Class =====Compared to other [[NAMESPACE:CLASS|CLASS]]: * POINT 1 * POINT 2 * POINT 3----===== Related ===== * [[NAMESPACE:CLASS|CLASS]] * [[MODULE|MODULE]] * [[MODULE|MODULE]] | ====== Lisinopril (Prinivil®, Zestril®) ======<WRAP right 340px><WRAP infobox>| | {{ :cardio:raas:lisinopril_structure.svg |}} |^ Lisinopril || Brand Names | Prinivil®, Zestril® || Drug Class | [[cardio:raas:acei|ACE Inhibitor]] || Primary Indications | [[cardio:hypertension:start|Hypertension]]; [[cardio:heart_failure:start|Heart Failure (HFrEF)]]; Post-MI || Blood Pressure Effect | ↓ SVR || Mortality Benefit | Yes (HFrEF, post-MI) || Elimination | Renal || Black Box Warning | Fetal Toxicity || FDA Approval | 1987 |</WRAP></WRAP>===== Overview =====Lisinopril is a long-acting [[cardio:raas:acei|angiotensin-converting enzyme (ACE) inhibitor]] used in the treatment of [[cardio:hypertension:start|hypertension]], [[cardio:heart_failure:start|heart failure with reduced ejection fraction]], and post–myocardial infarction ventricular dysfunction.It reduces systemic vascular resistance, decreases aldosterone-mediated sodium retention, and mitigates maladaptive neurohormonal activation. Lisinopril improves survival in HFrEF and post-MI patients and remains a cornerstone agent in cardiometabolic therapy.<WRAP clear></WRAP>----===== Mechanism of Action =====**Primary Molecular Target** * Inhibition of angiotensin-converting enzyme (ACE)**RAAS Effects** * ↓ Conversion of Angiotensin I → Angiotensin II * ↓ Aldosterone secretion * ↓ Vasoconstriction**Bradykinin Effect** * ↑ Bradykinin levels (due to reduced breakdown)**Net Physiologic Outcomes** * ↓ Systemic vascular resistance (afterload) * ↓ Sodium and water retention * ↓ Ventricular remodeling * Improved cardiac output in HFrEF----===== Indications ===== * [[cardio:hypertension:start|Hypertension]] * [[cardio:heart_failure:start|Heart Failure (HFrEF)]] * Post–myocardial infarction with LV dysfunctionRenal protection: * Diabetic nephropathy (albuminuria reduction)----<WRAP blackbox>===== Black Box Warning =====ACE inhibitors can cause fetal toxicity when administered during pregnancy.Mechanism: * Disruption of fetal RAAS * Risk of renal failure, oligohydramnios, skull hypoplasiaDiscontinue immediately if pregnancy is detected.</WRAP>----<WRAP contra>===== Contraindications =====Absolute: * History of ACE inhibitor–induced angioedema * Pregnancy * Bilateral renal artery stenosisRelative / Caution: * Hyperkalemia * Severe renal impairment * Volume depletion</WRAP>----<WRAP details>===== Dosing =====Hypertension: * Initial: 10 mg daily * Typical: 20–40 mg daily * Max: 40 mg dailyHeart Failure: * Initial: 2.5–5 mg daily * Titrate upward as toleratedRenal adjustment: * Required in reduced eGFR</WRAP>----<WRAP details>===== Pharmacokinetics =====Absorption: * OralBioavailability: * ~25%Metabolism: * Not metabolizedHalf-life: * ~12 hoursElimination: * Renal (unchanged)</WRAP>----<WRAP details>===== Adverse Effects =====Common: * Dry cough (bradykinin-mediated) * Dizziness * HypotensionElectrolyte: * HyperkalemiaSerious: * Angioedema * Acute kidney injury (in bilateral RAS)</WRAP>----<WRAP details>===== Drug Interactions =====Increased hyperkalemia risk: * [[cardio:diuretics:mra|Potassium-Sparing Diuretics]] * Potassium supplementsRenal function risk: * NSAIDs * Volume depletionAvoid combination: * ACE inhibitor + [[cardio:raas:arb|ARB]] * ACE inhibitor + [[cardio:raas:direct_renin_inhibitor|Direct Renin Inhibitor]]</WRAP>----<WRAP monitoring>===== Monitoring =====Labs: * Serum creatinine * PotassiumVitals: * Blood pressureClinical: * Cough * Angioedema symptoms</WRAP>----<WRAP pearls>===== Clinical Pearls ===== * Mortality benefit in HFrEF * Renoprotective in diabetes * Cough due to bradykinin accumulation * First-line in many hypertension guidelines * Hold during acute kidney injury or dehydration</WRAP>----===== Comparison Within Class =====Compared to other [[cardio:raas:acei|ACE inhibitors]]: * Not a prodrug (active form) * Long duration (once-daily dosing) * Fully renally cleared * Similar mortality benefit to enalapril in HFrEF----===== Related ===== * [[cardio:raas:acei|ACE Inhibitors]] * [[cardio:hypertension:start|Hypertension Module]] * [[cardio:heart_failure:start|Heart Failure Module]] * [[cardio:intro:start|Cardiovascular Pharmacology]] |
