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Lisinopril Nursing Considerations & Implications | Bioavailable

Compound database
ACE inhibitors
Lisinopril

LisinoprilNursing considerations

Known brand names include Zestril, Prinivil, and Qbrelis.

An ACE inhibitor taken by mouth once a day. It relaxes blood vessels to lower blood pressure, and it is also used in heart failure and after a heart attack.

Nursing implications

Hold parameters

Stop and do not give more if signs of angioedema appear
After an MI, withdraw if systolic BP stays below 90 mm Hg for more than 1 hour
Consider holding or stopping if kidney function drops meaningfully
Stop if jaundice or a marked rise in liver enzymes appears
Stop as soon as pregnancy is detected

Sources: [1][2][3][4][5]

Administration

Oral, once daily
Food does not change absorption, so it can be taken with or without meals
Watch blood pressure closely for the first 2 weeks in high-risk patients and after any dose increase

Sources: [1][2][3]

Assess and report

Side effects by what to assess

Vital signs

Dizziness
Hypotension, especially in heart failure and after MI

Neuro and mental status

Headache

Respiratory

Cough

Airway and skin

Angioedema of the face, tongue, or throat, or of the intestine (serious)

Labs

Hyperkalemia (serious)
Worsening kidney function, including acute renal failure (serious)

Liver

Cholestatic jaundice progressing to liver failure (rare) (serious)

Infection signs

Leukopenia or neutropenia (rare) (serious)

Sources: [1][2][3][4][5]

Labs and vitals

ALT (liver enzyme)

Why: Rare cholestatic liver injury
When: If jaundice or liver symptoms appear
Act on: Stop if jaundice or marked enzyme rise
Normal: 4 to 36 U/L.

Sources: [1][2]

Blood pressure

Why: Hypotension and response
When: Closely for the first 2 weeks in high-risk patients and after dose increases
Act on: After MI: withdraw if systolic BP stays below 90 mm Hg for more than 1 hour
Normal: Below 120/80 mm Hg.

Sources: [1][2][3]

Potassium

Why: Hyperkalemia
When: Periodically, and frequently with potassium-sparing diuretics
Normal: 3.7 to 5.2 mEq/L.

Sources: [1][2][3]

Serum creatinine

Why: Kidney function
When: Periodically
Act on: Consider holding or stopping if kidney function falls meaningfully
Normal: 0.7 to 1.3 mg/dL in men and 0.5 to 0.95 mg/dL in women.

Sources: [1][2]

Safety

High-alert status

ACE inhibitors are not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

Fetal toxicity. Drugs acting on the renin-angiotensin system can injure or kill a developing fetus. Stop lisinopril as soon as pregnancy is detected.

Sources: [1]

Antidote or reversal

No specific antidote. Overdose mainly causes hypotension, treated with IV normal saline. Lisinopril can be removed by hemodialysis.

Sources: [1]

Patient teaching

Report swelling of the face, lips, tongue, or throat, or trouble swallowing or breathing, right away and take no more doses until a prescriber is consulted
Report lightheadedness, especially in the first few days. If fainting occurs, stop and call the prescriber
Heavy sweating, dehydration, vomiting, or diarrhea can drop blood pressure too far
Do not use potassium-containing salt substitutes without asking the prescriber
People with diabetes should check for low blood sugar, especially in the first month
Report sore throat or fever, which can signal low white cells
Tell the prescriber about a known or possible pregnancy, and do not breastfeed while taking it

Sources: [1]

Sound-alike and look-alike names

Zestril and Zegerid
Zestril and Zetia
Zestril and ZyPREXA

Sources: [1]

Dosing

Doses come from the FDA label. Study tool, not for clinical decisions.

Adult dose

Hypertension: Start 10 mg once daily (5 mg if already on a diuretic). Usual range 20 to 40 mg per day. Doses up to 80 mg add little effect.
Heart failure: Start 5 mg once daily (2.5 mg if serum sodium is below 130 mEq/L). Titrate up to 40 mg once daily at most.
Acute MI: First dose 5 mg within 24 hours of symptom onset, a second 5 mg dose 24 hours later, 10 mg at 48 hours, then 10 mg daily for at least 6 weeks. Start at 2.5 mg if systolic BP is above 100 and at or below 120 mm Hg in the first 3 days.

Sources: [1][2][3]

Renal adjustment

CrCl above 30 mL/min: no change. CrCl 10 to 30 mL/min: halve the usual starting dose (5 mg for hypertension, 2.5 mg for heart failure or MI), then titrate to a maximum of 40 mg daily. CrCl below 10 mL/min or on hemodialysis: start 2.5 mg once daily.

Sources: [1]

Hepatic adjustment

The label gives no hepatic dose adjustment. Stop the drug if jaundice or a marked rise in liver enzymes develops.

Sources: [1]

How it works

Mechanism

Blocks angiotensin-converting enzyme, so less angiotensin II forms. Vessels relax and aldosterone falls, which lowers blood pressure and can nudge potassium up. The same enzyme breaks down bradykinin, so bradykinin levels can rise.

Sources: [1]