Monograph Details
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Cardiovascular System
> CHF and arrhythmias
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PRINIVIL |
| Manufacturer |
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Merck & Co., Inc. |
| Legal Classification |
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Rx
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| Pharmacological Class |
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ACE inhibitor. |
| Generic Name |
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Lisinopril 2.5mg, 5mg+, 10mg, 20mg, 40mg; tabs; +scored. |
| Indications |
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Heart failure inadequately controlled by diuretics +/or digitalis. Adjunct to other therapies within 24 hrs post-MI in hemodynamically stable patients, to reduce mortality. |
| Children |
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Not recommended. |
| Adults |
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CHF: initially 5mg once daily; range 5–20mg once daily; hyponatremia or moderate to severe renal impairment: initially 2.5mg once daily; supervise closely. Reduce diuretic dosage before 1st dose (if possible) and observe until BP is stabilized. Post-MI: 5mg within 24 hrs of onset of symptoms, then 5mg after 24 hrs, then 10mg after 48 hrs, then 10mg once daily for up to 6 weeks; if systolic BP ≤120mmHg at onset, start with 2.5mg daily for 3 days; or if systolic BP ≤100mmHg occurs, start with 5mg daily, then reduce to 2.5mg daily as needed; discontinue if prolonged hypotension (systolic BP ≤90mmHg for >1 hr) occurs. |
| Contraindications |
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History of ACEI-associated or other angioedema. Pregnancy (Cat.D in 2nd and 3rd trimesters). |
| Precautions |
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Renal impairment. Dialysis (esp. high-flux membrane). Salt/volume depletion. Hypertrophic cardiomyopathy. CHF. Ischemic heart disease. Cerebrovascular disease. Renal artery stenosis. Surgery. Monitor renal function, serum potassium in diabetics. Monitor WBCs in renal and collagen vascular disease patients. Discontinue immediately if angioedema or laryngeal edema occurs (have SC epinephrine available). Elderly. Pregnancy (Cat.C in 1st trimester). Nursing mothers: not recommended. |
| Interactions |
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May cause hypotension or increased BUN with diuretics, hyperkalemia with K+ sparing diuretics or K+ supplements. May increase lithium levels; monitor frequently. Antagonized by, and increased risk of renal failure with, NSAIDs. |
| Adverse Reactions |
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Dizziness, headache, fatigue, diarrhea, upper respiratory symptoms, cough, nausea, hyperkalemia, orthostatic hypotension, renal impairment, angioedema; liver dysfunction, blood dyscrasias (rare). |
| How Supplied |
Tabs 2.5mg—30, 100
Tabs 5mg—90, 100, 1000
Tabs 10mg, 20mg—30, 90, 100, 1000
Tabs 40mg—100 |
| Additional Resources |
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• Related Prescribing Note |
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