Lisinopril (generic)
Class: ACE‑inhibitor (angiotensin‑converting enzyme inhibitor)
Mechanism: Blocks the conversion of angiotensin‑I → angiotensin‑II → ↓vasoconstriction, ↓renin release, ↑bradykinin → vasodilation
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1️⃣ Brand Names (2026)
| Region | Brand name(s) | Notes |
|--------|--------------|-------|
| United States | Prinivil, Zestril (both Merck & Co.) | Still the two most common brand names. |
| Canada | Lisopril | Available in 5 mg, 10 mg, 20 mg tablets. |
| United Kingdom | Lisopril (licensed by Pfizer) | Also sold as “Lisopril 5 mg” or “Lisopril 10 mg.” |
| Australia & New Zealand | Lisopril | 5 mg and 10 mg tablets, plus a 20 mg capsule (for advanced heart failure). |
| Europe (other countries) | Lisopril (some countries), Lisopril (many) | Same 5/10/20 mg strength. |
| India | Lisopril, Lisopren (generic & branded) | Multiple manufacturers, often 5 mg & 10 mg tablets. |
| Middle East & Africa | Lisopril | Usually generic, 5 mg & 10 mg. |
Tip: In many regions “Lisopril” is the sole brand name; the generic is simply lisinopril. Check local drug registries for the exact spelling.
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2️⃣ Generic Information (2026)
| Feature | Detail |
|---------|--------|
| Form | Oral tablet, 5 mg, 10 mg, 20 mg; 20 mg capsule (heart failure). |
| Dosage (Hypertension) | 5 mg once daily → titrate ↑5 mg every 2–4 weeks up to 40 mg/day (max 40 mg). |
| Dosage (Heart Failure) | Start 2.5 mg → ↑2.5 mg q4–7 days to 20 mg/day (often split BID). |
| Dosage (Post‑MI) | 5 mg daily → ↑5 mg q4–7 days to 10 mg. |
| Administration | With or without food, same time daily. |
| Onset | 30–60 min; peak effect 2–4 h. |
| Half‑life | 10 h (active metabolite). |
| Metabolism | Hepatic (CYP2C9). Excreted unchanged renally. |
| Renal Consideration | Reduce dose or discontinue in CrCl <30 mL/min. |
| Pregnancy | Category X – teratogenic; contraindicated in all trimesters. |
| Breastfeeding | Not recommended. |
| Age | Safe in pediatrics 6 y+ (heart failure); not FDA‑approved for hypertension in children <6 y. |
| Weight‑based dosing | No special dosing for obesity/under‑weight. |
| Contraindicated | • Prior angioedema from ACEI
• Bilateral renal artery stenosis
• Pregnancy |
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3️⃣ Key Clinical Points (2026)
| Category | Highlights |
|----------|------------|
| Indications | • Primary hypertension
• Stable chronic heart failure
• Post‑myocardial infarction (reduced EF)
• Diabetic nephropathy (proteinuria control) |
| Monitoring | • Blood pressure & pulse q1–2 weeks after dose change
• Serum potassium & creatinine q4–6 weeks after initiation & dose changes
• Watch for angioedema signs |
| Common Adverse Effects | • Dry cough (≈10–20 %)
• Hyperkalemia (especially with potassium‑sparing diuretics)
• Dizziness/orthostatic hypotension
• Angioedema (rare, but life‑threatening) |
| Rare but Serious | • Severe renal impairment
• Angioedema
• Severe hyperkalemia (≥6.5 mmol/L) |
| Drug Interactions | • Potassium supplements / K‑sparing diuretics (increase hyperkalemia risk)
• NSAIDs (reduce ACE‑I efficacy; ↑renal dysfunction)
• Digoxin (↓excretion → ↑levels)
• Lithium (↑renal retention)
• Metformin (↓renal clearance → ↑metformin levels)
• Other ACE‑I or ARB (additive effect; avoid concomitant use) |
| Patient Counseling | • Take at same time daily; keep a log of BP
• Report cough or swelling of lips/face/neck promptly
• Do not abruptly stop; taper if necessary
• Avoid excessive salt intake (may increase edema risk) |
| Lifestyle Adjuncts | • Low‑salt diet, weight loss, exercise, limit alcohol, quit smoking |
| Pregnancy Warning | Must stop before conception and maintain until delivery; switch to ARB or other class if needed |
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4️⃣ Economic & Accessibility Snapshot (2026)
| Aspect | Status |
|--------|--------|
| Patent | Expired 2013 (US); generics dominate. |
| Generic Competition | > 30 manufacturers worldwide (Pfizer, Bayer, Sun Pharma, Teva, etc.). |
| Cost (US) | 30‑day supply: <$10 (generic 5 mg) to <$20 (generic 20 mg). |
| Insurance Coverage | Usually “Tier 1” (lowest copay) on most formularies. |
| Access in Low‑Income Countries | WHO essential‑medicines list → free‑access in many public health systems; generic supply is robust. |
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5️⃣ Quick Reference Sheet
| Item | 5 mg | 10 mg | 20 mg |
|------|------|-------|-------|
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