Understanding Lisinopril (Zestril) for Heart Health

People taking Lisinopril (Zestril) for heart health

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Lisinopril (Zestril) Medication Overview for Heart Health

Lisinopril, known by its brand name Zestril, belongs to the class of drugs known as angiotensin-converting enzyme inhibitors (ACE inhibitors). As an ACE inhibitor, it stops angiotensin I from converting to angiotensin II, leading to downstream effects that help to lower blood pressure.

Lisinopril has been on the US market with Food and Drug Administration (FDA) approval for several decades, boasting safety in efficacy in an array of both on-label and off-label conditions, including hypertension, heart failure, proteinuria, and more.

Lisinopril is distinct from other ACE inhibitors, such as captopril and enalapril, because of its pharmacological profile. It is hydrophilic (meaning it dissolves in water), does not undergo liver breakdown, and has a long half-life. These properties make it effective in treating a variety of diseases.

Medication Indicators

As aforementioned, lisinopril is used clinically in several conditions, including heart health. It has both on-label indications, meaning these indications have been approved by FDA, and off-label indications, meaning these indications have not been approved by FDA. As such, lisinopril can treat the following (including heart health):

FDA-Approved Indications

Hypertension (high blood pressure) in adults and children six years of age and up
Add-on treatment for heart failure
Therapy for ST-segment elevation myocardial infarction (STEMI), a severe form of heart attack, to increase chances of survival

Off-Label Indications

Diabetic nephropathy (poor kidney function)
Post-transplant erythrocytosis (increased blood cells)
Proteinuria (increased protein in the urine) (1)

Lisinopril (Zestril) Dosage and Administration

Lisinopril for heart health is available in two forms, both a tablet and oral solution. In the oral tablet formulation, lisinopril comes in 2.5, 5, 10, 20, 30, and 40 mg strengths. In the oral solution form, lisinopril comes in a 1 mg/mL strength.

The dose you take will depend on the condition being treated, your age, other pre-existing conditions, and more. As always, take medications only as directed by your provider. Typical adult dosing is as follows:

Hypertension: Start at 10 mg daily. The dose can be increased to a maximum of 40 mg daily.
Heart failure: Start at 2.5 mg daily. The dose can be increased to a maximum of 40 mg daily.
STEMI: Start at 2.5 to 5 mg daily. The dose can be increased by 10 mg daily to a maximally tolerated dose.
Proteinuria: Start at 2.5 to 10 mg daily. The dose can be increased to a maximum of 40 mg daily, depending on blood pressure.

Woman getting her blood pressure checked to see if she needs Lisinopril (Zestril) for heart health

The dose may need to be adjusted for each individual. For example, patients with impaired kidney function or those on hemodialysis will need a smaller starting dose. Always consult with your doctor for dosage and administration instructions.

Lisinopril (Zestril) Potential Side Effects

As with all drugs, lisinopril may cause both minor or serious side effects. Common side effects are those that occur in more than one percent of individuals. These include:

A dry, persistent cough that does not improve
Headache
Itching or skin rash
Dizziness or lightheadedness
Blurred vision
Diarrhea
Vomiting

Lisinopril can also cause more serious and rare side effects, such as those noted below.

Allergic reactions. Allergic reactions can occur with lisinopril, specifically those involving angioedema. Angioedema is a condition in which your skin swells due to fluid build-up in the body. It can occur in the head and neck (manifesting in the face, lips, tongue, extremities, or throat) or within the intestine (manifesting as stomach pain, nausea, and/or vomiting). This type of reaction would require immediate medical intervention and stopping therapy.
Hypotension. Hypotension, also referred to as low blood pressure, can occur with lisinopril. The risk usually exists when lisinopril is combined with other types of blood pressure-lowering medication, such as diuretics. Thus, concomitant use should be monitored carefully. Signs of hypotension include dizziness or lightheadedness.
Liver failure. In rare cases, ACE inhibitors have been implicated in liver injury. Signs of liver failure include jaundice (yellowing of the skin or eyes) or increases in enzyme levels, seen on labs.
Impaired kidney function. Because of lisinopril’s mechanism, it can affect kidney function.

The dry cough is one of the more common effects of ACE inhibitors. It typically starts within the first couple of months of treatment. Usually it subsides within four weeks of stopping the medication.

Lisinopril (Zestril) Precautions and Contraindications for Heart Health

There are several warnings associated with lisinopril that are important to look out for when starting treatment for heart health. In particular, lisinopril has the following precautions:

Poor kidney function
Increased potassium levels
ACE inhibitor-induced cough
Low blood pressure in those undergoing surgery or anesthesia
Use in certain heart conditions such as hypertrophic cardiomyopathy and aortic stenosis

In terms of contraindications, lisinopril should not be used in individuals with a previous history of angioedema with ACE inhibitors or any history of angioedema.

Interactions of Lisinopril (Zestril)

Lisinopril can interact with other drugs, affecting the safety and efficacy of both lisinopril and other medications. Be aware of lisinopril’s effects on the following types of medications:

Diuretics. There are several types of diuretics on the market, including potassium-sparing diuretics and thiazide-type diuretics. Examples include medications such as spironolactone or amiloride. When taken together with lisinopril, this combination can cause very low blood pressure that can be dangerous. Additionally, it could elevate levels of potassium in your body.
Non-steroidal anti-inflammatory agents (NSAIDs). NSAIDs include medications like ibuprofen, naproxen, and aspirin. With patients that are elderly or have impaired kidney function, taking lisinopril and NSAIDs together can cause acute renal injury (AKI).
mTOR inhibitors. These include medications like sirolimus and everolimus. Taken with lisinopril, these can increase your risk for angioedema.
Diabetes medications. Lisinopril, in conjunction with insulin and other blood sugar-lowering agents, can cause extremely low blood sugar.
Lithium. Lisinopril and lithium together can cause lithium toxicity.
Renin-angiotensin system (RAS) blockers. When you take these with lisinopril, there are several risks including impaired renal function, low blood pressure, and more.

Lisinopril (Zestril) Effectiveness and Expectations for Heart Health

Lisinopril is very effective in managing its on-label indications. For example, two studies enrolled 438 patients with mild to moderate hypertension. Doses of 10, 20, and 80 mg of lisinopril were associated with more profound blood pressure reductions versus a smaller dose of 5 mg.

For those with heart failure, lisinopril demonstrated improvement in heart failure-related symptoms such as edema, rales, and more in clinical trials. Another study indicated that patients on lisinopril had an 11 percent reduction in risk of death versus those not receiving lisinopril after a heart attack. Thus, lisinopril proves to be both safe and effective in clinical trials for an array of conditions.

Long-Term Use and Monitoring of Lisinopril (Zestril) for Heart Health

In terms of monitoring, patients and providers should watch for hypotension with the first dose, although it is a rare side effect. Providers should monitor blood pressure, potassium levels, and renal function within two to three weeks of starting therapy. Monitoring of liver function may be necessary in those with increased liver enzymes.

Lisinopril is often indicated for chronic conditions such as high blood pressure. In these instances, it can be used long-term.

Alternatives and Complementary Therapies

Lisinopril belongs to the drug class of ACE inhibitors, which includes medications such as captopril (Capoten), benazepril (Lotensin), enalapril (Vasotec), ramipril (Altace), quinapril (Accupril), and more. Thus, these all represent alternatives to lisinopril therapy while having a similar pharmacologic profile.

Lisinopril is also combined with hydrochlorothiazide under the brand name Zestoretic, providing potent antihypertensive effects. There are also several other types of drugs available to treat high blood pressure, including diuretics, beta-blockers, angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), vasodilators, and more.

In addition to adding more antihypertensive medication as a complementary therapy, you can also incorporate non-pharmacologic practices into your lifestyle to lower blood pressure. Things like exercise, weight loss, acupuncture, yoga, meditation, and low alcohol consumption can all help your blood pressure decrease. These things can be implemented in combination with pharmacologic therapy.

Frequently Asked Questions (FAQs) of Lisinopril (Zestril) for Heart Health

Can all people take ACE inhibitors like lisinopril?

Although most people can use ACE inhibitors safely, there are some contraindications. For example, pregnant women may not be able to take ACE inhibitors as it could harm the fetus. There are other medications available that are safer for hypertension during pregnancy.

Additionally, individuals who have serious kidney issues may not be able to take lisinopril. ACE inhibitors can affect kidney function, specifically if you have baseline kidney impairment. You may need a different type of medication or need to be monitored closely by your provider if you take lisinopril.

Additionally, individuals who have had a history of edema should steer clear of ACE inhibitors.

When will lisinopril start to work?

Although you may not feel it, lisinopril can begin working within a few hours of taking it for hypertension. However, it may take a few weeks to exert full efficacy. For heart failure, it may take up to a few months before you notice improvement in symptoms.

If my blood pressure improves, can I stop taking lisinopril?

You should usually stay on lisinopril even if your blood pressure becomes normal. If you stop therapy, your blood pressure may rise again.

Understanding Lisinopril (Zestril) for Heart Health

Lisinopril (Zestril) Medication Overview for Heart Health