Prinivil (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, resulting in decreased vascular resistance and blood pressure. Its well-established efficacy, favorable safety profile, and once-daily dosing make it a cornerstone therapy in cardiovascular medicine. Clinical evidence supports its role in reducing morbidity and mortality in high-risk patient populations.

Features

• Active ingredient: Lisinopril
• Available in tablet formulations: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg
• Administration: Oral, once daily
• Mechanism: Competitive inhibitor of angiotensin-converting enzyme (ACE)
• Bioavailability: Approximately 25%, not significantly affected by food
• Half-life: 12 hours
• Excretion: Primarily renal

Benefits

• Significantly reduces systolic and diastolic blood pressure, lowering cardiovascular risk
• Decreases afterload in heart failure, improving ejection fraction and functional capacity
• Provides nephroprotective effects in diabetic patients with proteinuria
• Reduces mortality when initiated early after acute myocardial infarction
• Offers convenient once-daily dosing that supports medication adherence
• Demonstrates cost-effectiveness compared to newer antihypertensive agents

Common use

Prinivil 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 congestive heart failure, typically as adjunctive therapy with diuretics and digitalis. Additionally, it is used to improve survival in hemodynamically stable patients within 24 hours of acute myocardial infarction. Off-label uses include diabetic nephropathy, chronic kidney disease, and migraine prophylaxis in certain patient populations.

Dosage and direction

Hypertension: Initial dose 10 mg once daily; maintenance dose 20-40 mg daily. Maximum dose: 40 mg daily.

Heart Failure: Initial dose 2.5-5 mg once daily; target dose: 20-40 mg daily under close medical supervision.

Post-Myocardial Infarction: 5 mg within 24 hours of onset, then 5 mg after 24 hours, 10 mg after 48 hours, then 10 mg daily for 6 weeks.

Dosage adjustment required in renal impairment: CrCl <30 mL/min or serum creatinine >3 mg/dL requires reduced initial dosing. 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 within 2 weeks of initiation and after dosage increases. Assess serum potassium periodically, especially in patients with renal impairment or diabetes. Use caution in patients with collagen vascular disease or those receiving immunosuppressive therapy due to increased risk of neutropenia/agranulocytosis. Avoid rapid dosage escalation in volume-depleted patients. Pregnancy Category D - discontinue immediately if pregnancy is detected. Angioedema may occur at any time during treatment.

Contraindications

History of angioedema related to previous ACE inhibitor therapy. Patients with hereditary or idiopathic angioedema. Concomitant use with aliskiren in patients with diabetes. Hypersensitivity to any component of this product. Bilateral renal artery stenosis. During the second and third trimesters of pregnancy.

Possible side effect

Common (≥1%): dizziness (6.5%), headache (5.5%), cough (3.9%), fatigue (3.5%), diarrhea (3.2%), upper respiratory infection (2.1%)

Less common: orthostatic hypotension, hyperkalemia, rash, impotence, taste disturbance, photosensitivity

Serious: angioedema (0.1-0.7%), neutropenia/agranulocytosis, hepatic failure, renal impairment, symptomatic hypotension

Drug interaction

Potassium-sparing diuretics/potassium supplements: Increased risk of hyperkalemia NSAIDs: May reduce antihypertensive effect and increase renal impairment risk Lithium: Increased lithium levels and toxicity Diuretics: Enhanced hypotensive effect, especially with initial coadministration Gold injections: Nitritoid reactions reported Antidiabetic agents: Enhanced hypoglycemic effect Aliskiren: Contraindicated in diabetic patients

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed dose. If multiple doses are missed, contact healthcare provider for guidance. Maintain regular dosing schedule to ensure consistent blood pressure control.

Overdose

Symptoms include marked hypotension, bradycardia, circulatory shock, hyperkalemia, renal failure, and electrolyte disturbances. Management involves supportive care including volume expansion with normal saline. Hemodialysis may be effective in removing lisinopril. Bradycardia may require atropine administration. Monitor vital signs and electrolyte status closely.

Storage

Store at controlled room temperature (20-25°C or 68-77°F). Keep container tightly closed. Protect from moisture and light. Keep out of reach of children. Do not use after expiration date printed on packaging. Do not transfer tablets to other containers as this may affect stability.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. Dosage and treatment decisions should be made based on individual patient characteristics and under medical supervision. The prescribing physician should be aware of complete medical history and concurrent medications.

Reviews

“Prinivil has been a mainstay in my hypertension practice for over two decades. The predictable pharmacokinetics and extensive clinical trial data make it a reliable choice for both newly diagnosed and treatment-resistant patients.” - Dr. Eleanor Vance, Cardiologist

“As a nephrologist, I appreciate Prinivil’s renal protective properties in diabetic patients. The once-daily dosing improves compliance, and the side effect profile is generally well-tolerated in most populations.” - Dr. Marcus Thorne, Nephrologist

“After trying multiple antihypertensives, Prinivil provided the most consistent blood pressure control with minimal side effects. The cough was noticeable initially but subsided after several weeks.” - Patient, 68-year-old male with hypertension

“Clinical studies consistently demonstrate Prinivil’s efficacy in reducing cardiovascular events. The HOPE and SOLVD trials particularly established its role in high-risk patients beyond blood pressure reduction alone.” - Clinical Pharmacologist Review