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PRINIVIL
CHF and arrhythmias
Hypertension
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Drug Name:

PRINIVIL Rx

Generic Name and Formulations:
Lisinopril 5mg, 10mg, 20mg; scored tabs.

Company:
Merck & Co., Inc.

Therapeutic Use:

Indications for PRINIVIL:

Heart failure inadequately controlled by diuretics +/or digitalis. Adjunct to other therapies within 24 hrs post-MI in hemodynamically stable patients, to reduce mortality.

Adult:

CHF: initially 5mg once daily; if hyponatremia: initially 2.5mg once daily; may increase as tolerated up to max 40mg 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. Renal impairment (CrCl 10–30mL/min): reduce initial dose to 50%; on hemodialysis or (CrCl <10mL/min): initially 2.5mg once daily.

Children:

Not recommended.

Contraindications:

History of ACEI-associated or other angioedema. Concomitant aliskiren in patients with diabetes. Concomitant neprilysin inhibitor (eg, sacubitril); do not give within 36 hours of switching to or from sacubitril/valsartan.

Warnings/Precautions:

Fetal toxicity may develop; discontinue if pregnancy is detected. Renal impairment. Dialysis (esp. high-flux membrane). Salt/volume depletion. Hypertrophic cardiomyopathy. CHF. Ischemic heart disease. Cerebrovascular disease. Post MI. Renal or aortic stenosis. Diabetes. Surgery. Discontinue and monitor if angioedema, laryngeal edema, marked elevations of liver enzymes, or jaundice occurs. Monitor BP, electrolytes and renal function. Black patients may have higher risk of angioedema than non-black patients. Elderly. Neonates. Pregnancy (Cat.D); avoid. Nursing mothers: not recommended.

Interactions:

See Contraindications. Increased risk of angioedema with concomitant neprilysin inhibitor or mTOR inhibitor (eg, temsirolimus, sirolimus, everolimus). Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Concomitant aliskiren in renal impairment (CrCl <60mL/min): not recommended. May cause hypotension or increased BUN with diuretics. May cause hyperkalemia with K+ sparing diuretics, K+ supplements, or K+ -containing salt substitutes. May increase lithium levels; monitor frequently. Antagonized by, and increased risk of renal failure with, NSAIDs including selective COX-2 inhibitors. Hypoglycemia with oral antidiabetics, insulin. Nitritoid reactions with concomitant injectable gold (sodium aurothiomalate); rare.

Pharmacological Class:

ACE inhibitor.

Adverse Reactions:

Dizziness, hypotension, headache, cough, chest pain, renal dysfunction, hyperkalemia, angioedema; rare: liver dysfunction, blood dyscrasias.

Elimination:

Renal.

Generic Availability:

YES

How Supplied:

Tabs—90

Indications for PRINIVIL:

Hypertension.

Adult:

Initially and if not on diuretics: 10mg once daily. Usual range: 20–40mg daily. If on diuretic: initially 5mg once daily. If BP not controlled on lisinopril alone, may add low dose diuretic. Usual max: 40mg/day. Renal impairment (CrCl 10–30mL/min): initially 5mg daily; (CrCl <10mL/min): initially 2.5mg daily.

Children:

<6yrs or GFR <30mL/min/1.73m2: not recommended. ≥6yrs: initially 0.07mg/kg (max 5mg) once daily; usual max 0.61mg/kg (40mg) once daily.

Contraindications:

History of ACEI-associated or other angioedema. Concomitant aliskiren in patients with diabetes. Concomitant neprilysin inhibitor (eg, sacubitril); do not give within 36 hours of switching to or from sacubitril/valsartan.

Warnings/Precautions:

Fetal toxicity may develop; discontinue if pregnancy is detected. Renal impairment. Dialysis (esp. high-flux membrane). Salt/volume depletion. Hypertrophic cardiomyopathy. CHF. Ischemic heart disease. Cerebrovascular disease. Post MI. Renal or aortic stenosis. Diabetes. Surgery. Discontinue and monitor if angioedema, laryngeal edema, marked elevations of liver enzymes, or jaundice occurs. Monitor BP, electrolytes and renal function. Black patients may have higher risk of angioedema than non-black patients. Elderly. Neonates. Pregnancy (Cat.D); avoid. Nursing mothers: not recommended.

Interactions:

See Contraindications. Increased risk of angioedema with concomitant neprilysin inhibitor or mTOR inhibitor (eg, temsirolimus, sirolimus, everolimus). Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Concomitant aliskiren in renal impairment (CrCl <60mL/min): not recommended. May cause hypotension or increased BUN with diuretics. May cause hyperkalemia with K+ sparing diuretics, K+ supplements, or K+ -containing salt substitutes. May increase lithium levels; monitor frequently. Antagonized by, and increased risk of renal failure with, NSAIDs including selective COX-2 inhibitors. Hypoglycemia with oral antidiabetics, insulin. Nitritoid reactions with concomitant injectable gold (sodium aurothiomalate); rare.

Pharmacological Class:

ACE inhibitor.

Adverse Reactions:

Dizziness, hypotension, headache, cough, chest pain, renal dysfunction, hyperkalemia, angioedema; rare: liver dysfunction, blood dyscrasias.

Elimination:

Renal.

Generic Availability:

YES

How Supplied:

Tabs—90

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