General Toxicity Notes
Blood pressure is the best guide to dose and interval. Hypotensive effects magnified by natriuretic agents or sodium depletion. May cause hyperkalemia, metabolic acidosis. Acute renal dysfunction with bilateral or transplant renal artery stenosis, low renal perfusion pressure. Dry cough in 5-10% of patients.
Excreted Unchanged %
88-100
Half-Life (Normalesrd) Hours
30/40-50
Plasma Protein Binding %
0
Volume Of Distribution L/Kg
1-3.8
Dose For Normal Renal Function
5-10 mg q24h
Second Dose
Second Dose: 20-40 mg q24h
Adjustment For Renal Failure Method
D
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
50-75% [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
25-50% [A]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: Dose after dialysis, [A]
Supplement For Dialysis [Recommendation Level]: Pd
PD: None, [D]
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50, titrate, [D]
References
Greenbaum R, Zucchelli P, Caspi A, Nouriel H, Paz R, Sclarovsky S, et al. Comparison of the pharmacokinetics of fosinoprilat with enalaprilat and lisinopril in patients with congestive heart failure and chronic renal insufficiency. Br J Clin Pharmacol. 2000; 49: 23-31. [PMID: 10606834] / Hoyer J, Schulte KL, Lenz T. Clinical pharmacokinetics of angiotensin converting enzyme (ACE) inhibitors in renal failure. Clin Pharmacokinet. 1993; 24: 230-54. [PMID: 8462229] / Lancaster SG, Todd PA. Lisinopril. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension and congestive heart failure. Drugs. 1988; 35: 646-69. [PMID: 2844497] / Neubeck M, Fliser D, Pritsch M, Weisser K, Fliser M, Nussberger J, et al. Pharmaco-kinetics and pharmacodynamics of lisinopril in advanced renal failure. Consequence of dose adjustment. Eur J Clin Pharmacol. 1994; 46: 537-43. [PMID: 7995322] / Sica DA, Cutler RE, Parmer RJ, Ford NF. Comparison of the steady-state pharmacokinetics of fosinopril, lisinopril and enalapril in patients with chronic renal insufficiency. Clin Pharmacokinet. 1991; 20: 420-7. [PMID: 1652404]