Clinical beta

FMBM is currently in clinical beta. Content is for professional review/testing and must not replace local protocols, senior clinical judgment, or official prescribing references.

Drug Monograph

Lisinopril

Lisinopril

ACE inhibitor (active drug, once-daily profile)

AdultACEiHFHTNCKD

Indication

HTN β€’ HFrEF β€’ CKD proteinuria β€’ post-MI support

At a glance

INDICATIONS (CORE USE)

HFrEF, post-MI support, CKD with proteinuria, hypertension.

ADULT DOSE (STANDARD)

PO START at 2.5–10 mg daily and titrate with BP + labs.

MAX DOSE

Common max 40 mg/day.

Route

PO once-daily profile

PEDIATRIC DOSE

Specialist use only.

Do not miss

Must-not-miss safety points

Major warning

- Angioedema can be delayed and fatal β†’ DO NOT re-challenge any ACE inhibitor - Pregnancy is contraindicated β†’ DO NOT use

Indications

USE IF: HTN, HFrEF, CKD proteinuria. AVOID IF: pregnancy, prior ACEi angioedema, bilateral renal artery stenosis, hyperkalemia, or active hypoperfusion.

Primary

  • Hypertension
  • HFrEF
  • CKD with albuminuria/proteinuria

Secondary

  • Post-MI LV dysfunction context

Dosing

STANDARD (ADULT PO)

START low, then titrate by BP and renal/electrolyte response.

ADULT DOSE

HTN: START 5–10 mg daily. HFrEF: START lower (e.g. 2.5–5 mg daily), titrate gradually. Hold escalation if creatinine/potassium safety targets not met.

PEDIATRIC DOSE

N/A

MAX DOSE

Common max 40 mg/day.

Practical Note

Do not combine ACEi + ARB + aliskiren without specialist rationale.

Warnings

Clinical warnings

  • Angioedema can be delayed and fatal β€” DO NOT re-challenge. First-dose hypotension risk is higher with volume depletion / HF / high-renin states; correct volume before starting.

Adverse effects

  • Cough
  • hyperkalemia
  • hypotension
  • AKI trend
  • angioedema

Contraindications

  • Pregnancy
  • Prior ACE inhibitor-induced angioedema
  • Bilateral renal artery stenosis (known/suspected)
  • Baseline K+ β‰₯5.5 mmol/L

Drug interactions

  • ARB / aliskiren combination: avoid routine dual RAAS blockade (AKI, hyperkalemia, hypotension risk)
  • Potassium-sparing agents / supplements: hyperkalemia risk
  • NSAIDs β†’ ↑ AKI risk + ↓ ACEi effect β€” avoid or monitor closely
  • Diuretic-associated volume depletion amplifies hypotension risk.

Special populations

Pediatrics

Specialist use only.

Pregnancy

Pregnancy: contraindicated.

Lactation

specialist decision.

Renal impairment

START lower with reduced eGFR; monitor creatinine/potassium tightly.

Hepatic impairment

No major hepatic activation dependency; still titrate cautiously with systemic status.

Elderly

START low and reassess orthostasis/renal response early.

Administration

PO daily; maintain consistent administration time.

Monitoring

  • Recheck: - Check creatinine + potassium within 1–2 weeks after initiation - Recheck creatinine + potassium within 1–2 weeks after dose increase - Check earlier if CKD, elderly, volume depletion, or interacting drugs
  • Hold if:
    - HOLD if:
    - SBP <90–100
    - K+ β‰₯5.5 mmol/L
    - creatinine rise >30% from baseline
    - symptomatic hypotension
    - STOP permanently if angioedema
  • If targets not met after reassessment of dose, organ function, and interactions β†’ escalate per protocol (DO NOT continue blindly)

Overdose / toxicity

Clinical Picture

A) Mild β†’ dizziness, hypotension, fatigue B) Moderate β†’ persistent hypotension, AKI trend, hyperkalemia C) Severe β†’ refractory shock, severe hyperkalemia, respiratory compromise (e.g. angioedema context)

Immediate Actions

β€’ Airway + continuous monitoring (ABC, BP, telemetry) β€’ Hypotension β†’ IV fluids first-line β€’ Refractory hypotension β†’ early vasopressors (norepinephrine) β€’ Check potassium immediately β†’ treat per hyperkalemia protocol if elevated β€’ Stop ACE inhibitor

Antidote

- No specific antidote - Supportive care + hemodynamic stabilization - Hyperkalemia treatment β†’ calcium + insulin/dextrose + potassium-shifting protocol - Airway intervention β†’ if angioedema compromises respiration

Decontamination

β€’ Recent oral ingestion β†’ activated charcoal if protected airway and early presentation (toxicology-guided)

Escalation

- Refractory hypotension or airway compromise β†’ ICU + early vasopressors / airway team - Severe hyperkalemia / AKI β†’ nephrology + renal replacement planning if indicated

Clinical pearls

Common mistakes, resistance logic, and bedside traps

High-Yield Summary

Common outpatient ACEi: safe use depends on timely creatinine/potassium follow-up.

Clinical pearls

Do not ignore rising potassium in early titration windows.

ACE inhibitor safety

  • Repeat labs after every meaningful dose increase

Pharmacokinetics

Active molecule, long-enough profile for once-daily use in many adults.

Mechanism of action

ACE inhibition lowers angiotensin II and aldosterone effect.

Common brand names

Saudi Arabia

Zestril, Prinivil, Lisopril

Global

(placeholder β€” verify local formulation)

Common trade names are curated examples only β€” formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.

Country practice notes

Global data (no country-specific data available)

  • Follow local antimicrobial stewardship policy, hospital formulary, and national resistance guidance.
  • Confirm dosing, stock, and restrictions with institutional pharmacy and current product labeling.

References

Saudi Arabia

  • SFDA (Saudi Food & Drug Authority)
  • Saudi National Formulary / MOH (where available)

International

  • WHO Model List of Essential Medicines (verify current edition)
  • US FDA or EU EMA product information (when national SmPC is unavailable)
  • ACC / AHA HF, post-MI, and HTN guidance
  • KDIGO CKD and proteinuria guidance
  • FDA / SFDA product labeling

Do not miss

  • Angioedema can be delayed and fatal β†’ DO NOT re-challenge
  • Pregnancy contraindicated β†’ DO NOT use
  • First-dose hypotension risk (especially HF / volume depletion) β†’ correct volume before starting
  • Hyperkalemia risk β†’ monitor potassium early
  • Repeat labs after every meaningful dose increase