Prinivil: Effective Angiotensin-Converting Enzyme Inhibition for Hypertension Control
Prinivil
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| Product dosage: 2.5mg | |||
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Synonyms | |||
Prinivil (lisinopril) is an angiotensin-converting enzyme (ACE) inhibitor indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older, to improve survival after myocardial infarction in clinically stable patients, and for the treatment of symptomatic heart failure. As a once-daily oral medication, it works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in decreased systemic vascular resistance and blood pressure reduction without compensatory tachycardia. Its well-established pharmacokinetic profile and extensive clinical evidence support its role as a foundational antihypertensive therapy in diverse patient populations, including those with comorbid diabetes or chronic kidney disease.
Features
- Active pharmaceutical ingredient: Lisinopril
- Available in tablet formulations: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg
- Standard dosing: Once daily administration
- Bioavailability: Approximately 25%, with negligible first-pass metabolism
- Peak plasma concentration: Reached within 7 hours post-administration
- Elimination half-life: 12 hours, permitting 24-hour hemodynamic coverage
- Excretion: Primarily renal (unchanged drug)
- Special formulations: Scored tablets for dose titration
Benefits
- Provides sustained 24-hour blood pressure control with single daily dosing
- Demonstrates cardioprotective effects in post-myocardial infarction patients
- Shows nephroprotective properties in diabetic patients with proteinuria
- Reduces afterload in heart failure patients, improving functional capacity
- Exhibits favorable metabolic profile without adverse effects on glucose or lipids
- Offers flexible dosing options across various clinical indications
Common use
Prinivil is primarily prescribed for the management of essential hypertension, either as monotherapy or in combination with other antihypertensive agents. It is indicated for adjunctive therapy in the management of heart failure when added to conventional therapy including 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 slowing the progression of diabetic nephropathy and managing proteinuria in various renal conditions. The medication is particularly valuable in hypertensive patients with left ventricular hypertrophy, chronic kidney disease, or history of cerebrovascular accident.
Dosage and direction
Hypertension: Initial dose: 10 mg once daily in adults; maintenance dose: 20-40 mg once daily. Maximum dose: 80 mg daily. Heart failure: Initial dose: 2.5-5 mg once daily; maintenance dose: 5-40 mg once daily. Acute myocardial infarction: 5 mg within first 24 hours, then 5 mg after 24 hours, 10 mg after 48 hours, then 10 mg once daily. Pediatric hypertension (≥6 years): Initial dose: 0.07 mg/kg once daily (up to 5 mg); maximum dose: 0.61 mg/kg or 40 mg. Administer without regard to meals. Dose adjustment required in renal impairment: CrCl <30 mL/min requires reduced initial dosing. Titration should occur at 2-4 week intervals based on therapeutic response.
Precautions
Monitor blood pressure and renal function within two weeks of initiation and after dose increases. Assess serum potassium periodically, particularly 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 use in patients with hereditary angioedema or idiopathic angioedema. Exercise caution during surgery/anesthesia due to potential hypotension. Patients with volume depletion should have correction of volume status prior to initiation. Regular assessment of white blood cell counts is recommended in patients with impaired renal function or connective tissue disorders.
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 potential fetal injury and death. Concomitant use with sacubitril/valsartan. Patients with hereditary or idiopathic angioedema. Severe renal impairment requiring dialysis may necessitate alternative therapy considerations.
Possible side effect
Common (>10%): Dizziness (12%), headache (12%), cough (8-12%), fatigue (5%). Less common (1-10%): Orthostatic hypotension, diarrhea, nausea, rash, hyperkalemia, chest pain. Rare (<1%): Angioedema, neutropenia/agranulocytosis, hepatic failure, pancreatitis, photosensitivity, impotence. Laboratory abnormalities: Increased BUN and serum creatinine (2-4%), elevated liver enzymes, decreased hemoglobin/hematocrit. Most adverse effects are dose-dependent and may diminish with continued therapy. The characteristic dry, non-productive cough may persist and require discontinuation in some patients.
Drug interaction
Potassium supplements/potassium-sparing diuretics: Increased risk of hyperkalemia. Diuretics: Potentiated hypotensive effect, particularly with initial coadministration. NSAIDs: May diminish antihypertensive effect and increase risk of renal impairment. Lithium: Increased lithium levels and toxicity risk. Oral hypoglycemics/insulin: Enhanced hypoglycemic effect. Gold injections: Nitritoid reactions reported. Aliskiren: Increased risk of renal impairment, hyperkalemia, and hypotension in diabetic patients. Sacubitril/valsartan: Contraindicated due to increased angioedema risk.
Missed dose
If a dose is missed, it should be taken as soon as possible on the same day. If the day has passed, the missed dose should be skipped and the regular dosing schedule resumed. Do not double the next dose to make up for the missed dose. Patients should be educated about maintaining consistent dosing timing to ensure stable therapeutic coverage. The long elimination half-life provides some buffer against transient missed doses, but consistent adherence is crucial for optimal blood pressure control.
Overdose
Symptoms primarily relate to exaggerated pharmacological effects: severe hypotension, bradycardia, circulatory shock, electrolyte disturbances, and renal failure. Management includes supportive care with volume expansion with normal saline for hypotension. Atropine may be used for bradycardia. Lisinopril is poorly dialyzable, but hemodialysis may be considered in severe cases. Angiotensin II infusion has been used investigationally. Patients should receive continuous hemodynamic monitoring in an intensive care setting. Serum electrolytes and renal function should be monitored closely for several days post-overdose.
Storage
Store at controlled room temperature (20-25°C or 68-77°F) with excursions permitted between 15-30°C (59-86°F). Protect from excessive moisture and light. Keep container tightly closed. Dispense in original container with child-resistant closure. Do not store in bathroom medicine cabinet due to humidity fluctuations. Keep out of reach of children and pets. Do not use if tablets show evidence of discoloration, cracking, or other physical deterioration. Properly dispose of expired medication through medication take-back programs.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Prinivil is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual patient response may vary, and therapeutic decisions should be based on comprehensive clinical assessment. Patients should not alter their dosage or discontinue medication without consulting their healthcare provider. The full prescribing information contains complete details regarding indications, contraindications, warnings, and precautions.
Reviews
Clinical trials demonstrate Prinivil’s efficacy with 65-70% of hypertensive patients achieving blood pressure control (<140/90 mmHg) at 10-20 mg daily dosage. Meta-analyses of heart failure studies show 16% reduction in mortality risk and 26% reduction in hospitalizations. Post-MI studies indicate 11% reduction in 6-week mortality when initiated within 24 hours of infarction. Long-term extension studies confirm maintained efficacy over 4+ years of treatment. Patient satisfaction surveys report high adherence rates due to once-daily dosing and generally favorable side effect profile, though cough remains a notable cause of discontinuation in 3-5% of patients.