Zestril: Effective Angiotensin-Converting Enzyme Inhibition for Hypertension Control
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Synonyms | |||
Zestril (lisinopril) is an angiotensin-converting enzyme (ACE) inhibitor prescribed for the management of hypertension, heart failure, and post-myocardial infarction care. As a first-line antihypertensive agent, it works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby reducing peripheral arterial resistance and decreasing blood pressure. Its proven efficacy, once-daily dosing, and well-established safety profile make it a cornerstone in cardiovascular therapeutic regimens. This product card provides a comprehensive overview for healthcare professionals and informed patients.
Features
- Active ingredient: Lisinopril
- Available in tablet formulations: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg
- Pharmacological class: Angiotensin-converting enzyme (ACE) inhibitor
- Standard dosing: Once daily administration
- Bioavailability: Approximately 25%, not significantly affected by food
- Half-life: 12 hours
- Excretion: Primarily renal
Benefits
- Effectively lowers systolic and diastolic blood pressure, reducing the risk of stroke, myocardial infarction, and other cardiovascular events
- Demonstrates cardioprotective effects in patients with heart failure by decreasing afterload and improving cardiac output
- Shows nephroprotective properties in diabetic patients with proteinuria, slowing the progression of renal impairment
- Provides 24-hour blood pressure control with once-daily dosing, supporting medication adherence
- Has a generally favorable side effect profile compared to other antihypertensive classes when used appropriately
Common use
Zestril is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also approved for the management of heart failure as adjunctive therapy when diuretics and digitalis prove insufficient. Additionally, it is used to improve survival in hemodynamically stable patients within 24 hours of acute myocardial infarction. Off-label uses may include the prevention of migraine headaches and the management of diabetic nephropathy, though these applications require careful clinical consideration.
Dosage and direction
For hypertension: Initial dose typically ranges from 2.5-10 mg once daily, with maintenance doses of 20-40 mg daily. Dosage should be individualized based on blood pressure response, usually at 2-4 week intervals.
For heart failure: Starting dose is 2.5-5 mg once daily, with gradual titration to a maximum of 40 mg daily as tolerated.
Post-myocardial infarction: Initiate with 5 mg within 24 hours of onset, followed by 5 mg after 24 hours, 10 mg after 48 hours, then 10 mg once daily for 6 weeks.
Patients with renal impairment require dosage adjustment based on creatinine clearance. Tablets should be swallowed whole with water, with or without food, at approximately the same time each day.
Precautions
Monitor blood pressure and renal function regularly, especially during initiation and titration. Assess serum potassium levels periodically due to risk of hyperkalemia. Use with caution in patients with renal artery stenosis, as acute renal failure may occur. Sodium and/or volume depletion should be corrected before initiation to reduce risk of symptomatic hypotension. Elderly patients may require lower initial doses due to potentially increased sensitivity. Pregnancy should be excluded before starting therapy, and adequate contraception is recommended during treatment.
Contraindications
History of angioedema related to previous ACE inhibitor treatment. Hypersensitivity to lisinopril or any component of the formulation. Concomitant use with aliskiren in patients with diabetes. Second and third trimester of pregnancy due to risk of fetal injury and death. Bilateral renal artery stenosis or stenosis in a solitary kidney.
Possible side effect
Common (≥1%): dizziness (6-12%), headache (5-6%), cough (3-9%), fatigue (3-5%), nausea (2-4%), diarrhea (2-3%), orthostatic effects (2-3%)
Less common: rash (1-2%), impotence (1-2%), chest pain (1-2%), hyperkalemia (2-5%)
Rare but serious: angioedema (<1%), neutropenia/agranulocytosis, hepatic failure, pancreatitis, symptomatic hypotension
Drug interaction
Potassium supplements or potassium-sparing diuretics: Increased risk of hyperkalemia. Diuretics: Potentiated hypotensive effect. NSAIDs: May reduce antihypertensive effect and increase risk of renal impairment. Lithium: Increased lithium concentrations and toxicity risk. Oral hypoglycemics: Enhanced hypoglycemic effect. Gold injections: Nitritoid reactions reported. Antacids: May decrease bioavailability (separate administration by 2 hours).
Missed dose
If a dose is missed, it should be taken as soon as remembered on the same day. If it is near the time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed dose. Consistent daily administration is important for maintaining stable blood pressure control.
Overdose
Symptoms may include severe hypotension, bradycardia, circulatory shock, electrolyte disturbances, and renal failure. Management involves supportive care with volume expansion with normal saline to treat hypotension. Lisinopril is not effectively removed by hemodialysis. Bradycardia may require atropine administration. Close monitoring of vital signs, electrolyte balance, and renal function is essential.
Storage
Store at controlled room temperature (20-25°C or 68-77°F) in the original container. Protect from light and moisture. Keep tightly closed and out of reach of children. Do not use after the expiration date printed on the packaging. Do not transfer tablets to other containers as this may affect stability.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Healthcare professionals should consult official prescribing information before initiating therapy. Patients should not make changes to their medication regimen without consulting their physician. Individual response to medication may vary, and proper medical supervision is essential throughout treatment.
Reviews
Clinical trials demonstrate Zestril’s efficacy with 60-70% of hypertensive patients achieving blood pressure control (<140/90 mmHg) at recommended doses. In the GISSI-3 trial, lisinopril showed a 11% reduction in mortality at 6 weeks post-MI compared to no ACE inhibitor. The SOLVD treatment trial demonstrated a 16% reduction in mortality in heart failure patients. Patient satisfaction surveys indicate high adherence rates due to once-daily dosing and generally tolerable side effect profile, though the characteristic dry cough remains a common reason for discontinuation in approximately 3-5% of patients.