Lisinopril 40mg Tablets

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. It inhibits the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This leads to decreased angiotensin II levels, resulting in vasodilation, reduced aldosterone secretion (leading to decreased sodium and water reabsorption), and reduced sympathetic activity. It also inhibits the degradation of bradykinin, a vasodilator, which may contribute to its antihypertensive effect and the common side effect of cough.

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of kidney problems, including:
+ Inability to pass urine
+ Changes in urine output
+ Blood in the urine
+ Sudden significant weight gain
Signs of high potassium levels, such as:
+ Abnormal heartbeat
+ Confusion
+ Weakness, lightheadedness, or dizziness
+ Feeling like passing out
+ Numbness or tingling
+ Shortness of breath
Severe dizziness or fainting
Persistent cough
Severe stomach pain
Severe nausea or vomiting
Chest pain or pressure
Liver problems, which can be indicated by:
+ Dark urine
+ Fatigue
+ Decreased appetite
+ Stomach pain or upset
+ Light-colored stools
+ Vomiting
+ Yellowing of the skin or eyes (jaundice)

Note that liver problems have been reported with similar medications, and in some cases, have been fatal. If you experience any of these symptoms, contact your doctor immediately.

Other Possible Side Effects

As with any medication, you may experience side effects. While many people do not have any side effects or only minor ones, it is essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:

Dizziness or headache
* Cough

This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following conditions to ensure safe treatment:

Any allergies you have, including allergies to this medication, its components, or other substances. Describe the allergic reactions you have experienced, including any symptoms.
A history of angioedema, a severe and potentially life-threatening reaction characterized by swelling of the hands, face, lips, eyes, tongue, or throat, difficulty breathing, swallowing problems, or unusual hoarseness.
Kidney problems, as they may affect how your body processes this medication.
If you are taking a medication containing aliskiren, particularly if you have diabetes or kidney problems.
If you have taken a medication containing sacubitril within the last 36 hours.
If you are breastfeeding, as you should not breastfeed while taking this medication.

Special Considerations for Children:
If your child is under 6 years of age, do not administer this medication, as it is not recommended for children younger than 6 years old.

Additional Important Information:
This list is not exhaustive, and it is crucial to inform your doctor and pharmacist about all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you have. This will help ensure your safety while taking this medication. Never start, stop, or change the dose of any medication without consulting your doctor first.

Important Warnings and Cautions

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

Caution with Daily Activities
Until you understand how this medication affects you, avoid driving and other tasks that require alertness. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying position, and exercise caution when climbing stairs.

Special Considerations

If you have diabetes (high blood sugar), closely monitor your blood sugar levels.
Regularly undergo blood work, blood pressure checks, and other laboratory tests as advised by your doctor.
If you are taking a salt substitute containing potassium, a potassium-sparing diuretic, or a potassium product, consult your doctor.
If you follow a low-salt or salt-free diet, discuss this with your doctor.
If you have high blood pressure and are taking this medication, consult your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as:
+ Cough or cold medications
+ Diet pills
+ Stimulants
+ Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen
+ Certain natural products or aids
Discuss alcohol consumption with your doctor before drinking.

Precautions in Specific Situations
Be cautious in hot weather or during physical activity, and drink plenty of fluids to prevent dehydration. Inform your doctor if you experience excessive sweating, fluid loss, vomiting, or diarrhea, as these may lead to low blood pressure.

Effectiveness and Safety in Specific Populations
This medication may be less effective in lowering blood pressure in Black patients. In some cases, additional medication may be necessary. If you have questions, consult your doctor.

Rare but Serious Reactions
A severe and potentially life-threatening reaction called angioedema has been reported. The risk of angioedema may be higher in Black patients.

Infection Risk
Low white blood cell counts have been associated with captopril, a similar medication. This may increase the risk of infection, particularly in individuals with kidney problems and other underlying health conditions. Seek medical attention immediately if you experience signs of infection, such as fever, chills, or sore throat.

Use in Older Adults
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.

• Aliskiren (in patients with diabetes or moderate to severe renal impairment)
• Sacubitril/Valsartan (Entresto) - concomitant use or within 36 hours of switching due to increased risk of angioedema.

• Potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride) - increased risk of hyperkalemia.
• Potassium supplements - increased risk of hyperkalemia.
• NSAIDs (e.g., ibuprofen, naproxen) - may reduce antihypertensive effect and increase risk of renal impairment, especially in elderly or volume-depleted patients.
• Lithium - increased serum lithium levels and toxicity.
• Gold (parenteral) - nitritoid reactions (facial flushing, nausea, vomiting, hypotension) have been reported rarely.

• Other antihypertensives (e.g., diuretics, beta-blockers, calcium channel blockers) - additive hypotensive effects.
• mTOR inhibitors (e.g., sirolimus, everolimus, temsirolimus) - increased risk of angioedema.
• Racecadotril - increased risk of angioedema.
• Insulin and oral antidiabetic agents - increased risk of hypoglycemia, especially at initiation of ACE inhibitor therapy.
• Trimethoprim - increased risk of hyperkalemia.

• Alcohol - may enhance hypotensive effect.
• Corticosteroids - may reduce antihypertensive effect.

• Dizziness or lightheadedness (especially upon standing)
• Persistent dry cough
• Swelling of face, lips, tongue, throat (angioedema) - seek immediate medical attention
• Difficulty breathing or swallowing
• Signs of hyperkalemia (e.g., muscle weakness, irregular heartbeat)
• Signs of infection (e.g., fever, sore throat) - rare, but indicates neutropenia
• Signs of liver injury (e.g., yellowing of skin/eyes, dark urine, persistent nausea/vomiting)

Contraindicated during the second and third trimesters of pregnancy due to significant risk of fetal injury and death. Use during the first trimester should be avoided if possible, and alternative treatments considered.

Lisinopril is excreted in human milk in very low concentrations. Generally considered compatible with breastfeeding, especially for full-term, healthy infants. Monitor infant for adverse effects (e.g., hypotension).

Not recommended for children younger than 6 years or in pediatric patients with a glomerular filtration rate (GFR) less than 30 mL/min/1.73m². Use in children 6-16 years for hypertension requires careful dose titration and monitoring. Safety and efficacy for heart failure or post-MI in pediatric patients are not established.

Start with lower doses (e.g., 5 mg) and titrate slowly due to increased sensitivity to hypotensive effects and potential for age-related decline in renal function. Monitor renal function and electrolytes closely.

• Lisinopril is one of the most commonly prescribed ACE inhibitors due to its once-daily dosing and lack of hepatic metabolism.
• The most common side effect is a persistent, dry, non-productive cough, which occurs in 5-20% of patients and typically resolves within days to weeks after discontinuation.
• Angioedema is a rare but potentially life-threatening side effect. Patients should be educated on symptoms and instructed to seek immediate medical attention if it occurs.
• First-dose hypotension can occur, especially in patients who are volume-depleted (e.g., on diuretics, heart failure patients). Consider discontinuing diuretics 2-3 days prior to initiation if possible, or starting with a very low dose.
• Hyperkalemia is a risk, especially in patients with renal impairment, diabetes, or those taking potassium-sparing diuretics or potassium supplements.
• Lisinopril is a prodrug, but unlike enalapril, it is not metabolized by the liver; it is excreted unchanged in the urine. This makes it a good option for patients with liver dysfunction.

• Angiotensin Receptor Blockers (ARBs) e.g., Valsartan, Losartan (for patients intolerant to ACEI cough)
• Calcium Channel Blockers (CCBs) e.g., Amlodipine, Nifedipine
• Thiazide Diuretics e.g., Hydrochlorothiazide, Chlorthalidone
• Beta-blockers e.g., Metoprolol, Carvedilol
• Direct Renin Inhibitors e.g., Aliskiren (limited use)

If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.