Quick facts
| Fact | Lisinopril |
|---|---|
| Drug class[1] | Angiotensin-converting enzyme (ACE) inhibitor |
| Used for[1] | High blood pressure in adults and children 6 and older; systolic heart failure; lowering the risk of death when started within 24 hours of an acute heart attack in stable patients |
| Boxed warning[1] | Fetal toxicity: stop it as soon as pregnancy is detected |
| Check[1] | Blood pressure after starting; serum potassium and kidney function periodically |
| Emergency to spot[1] | Angioedema of the face, lips, tongue or throat, at any time during treatment |
| Not combined with[1] | Sacubitril/valsartan within 36 hours; aliskiren in patients with diabetes |
| Common reactions[1] | Headache, dizziness and cough |
Before giving lisinopril: blood pressure, potassium and kidney labs
- Check blood pressure after starting. Patients at risk of excessive hypotension, such as heart failure with systolic pressure under 100 mm Hg, high-dose diuretic therapy, dialysis, low sodium or volume depletion, are followed closely for the first 2 weeks and after any dose increase.[1]
- Starting lisinopril in a patient already on a diuretic may drop blood pressure too far.[1]
- Review the potassium. Lisinopril can cause hyperkalemia, and kidney disease, diabetes, potassium-sparing diuretics, potassium supplements and potassium salt substitutes add to the risk.[1]
- Review kidney function. Drugs that block the renin-angiotensin system can change it, up to acute renal failure, with particular risk in renal artery stenosis, chronic kidney disease, severe heart failure and volume depletion.[1]
- Rule out the contraindications: any past angioedema (from an ACE inhibitor, hereditary or idiopathic) and sacubitril/valsartan within the last 36 hours. Aliskiren isn't given with it to patients with diabetes.[1]
- Ask about pregnancy in patients who could become pregnant.[1]
Report swelling of the lips, tongue or throat right away
- Angioedema of the face, lips, tongue, glottis or larynx can occur at any point in treatment and has been fatal. Swelling of the tongue, glottis or larynx can obstruct the airway.[1]
- If angioedema appears, lisinopril is stopped, treatment is given, and the patient is monitored until the signs fully resolve.[1]
- Intestinal angioedema shows up as belly pain, sometimes with nausea or vomiting.[1]
- Cough is one of the common reactions. Report a persistent cough to the provider.[1][2]
- Light-headedness, especially in the first few days, should be reported. If the patient faints, the drug is held until the prescriber is consulted.[1]
- Jaundice or a marked rise in liver enzymes means the ACE inhibitor is stopped.[1]
- Sore throat or fever can signal a low white blood cell count.[1]
Teach the patient about pregnancy, potassium salt substitutes and fluid loss
- Tell the health care provider right away about a known or suspected pregnancy.[1]
- Don't use potassium salt substitutes without checking with the provider first.[1]
- Heavy sweating, vomiting, diarrhea or dehydration can make blood pressure fall too far.[1]
- Get emergency help for swelling of the face, eyes, lips or tongue, or trouble swallowing or breathing, and take no more doses until the prescriber says so.[1][2]
- Patients with diabetes on insulin or oral diabetes medicines should watch closely for low blood sugar, especially in the first month.[1]
Drill lisinopril, metoprolol, and furosemide in the Cardiovascular and renal medicines flashcard deck.
Browse flashcardsHow it shows up on nursing exams
- Both cough and angioedema come from ACE inhibitors; swelling of the lips, tongue or throat is the airway emergency, and the cough is the common nuisance.[1][2]
- ACE inhibitors can raise potassium, while loop diuretics like furosemide lower it.[1][2]
- All 10 ACE inhibitors on NIDDK LiverTox's list of those approved in the U.S., from benazepril to trandolapril, end in -pril.[3]
- ARBs such as losartan act on the same hormone system but are not likely to cause the ACE inhibitor cough.[2]
Practice question
A 58-year-old patient started lisinopril for hypertension 3 weeks ago. At a clinic visit, blood pressure is 128/80 mm Hg, heart rate 82/min, respiratory rate 18/min and SpO2 98% on room air. Which report should the nurse act on first?
- A. "I've had a dry, tickly cough most nights"
- B. "I got dizzy standing up yesterday morning"
- C. "My lips feel puffy and it's hard to swallow"
- D. "I've started using a potassium salt substitute"
Show the answer and why
Correct answer: C. "My lips feel puffy and it's hard to swallow"
- A. Incorrect. Cough is a common lisinopril reaction. A persistent cough should be reported, but it doesn't threaten the airway.
- B. Incorrect. Light-headedness should be reported, especially early in treatment, but today's blood pressure is 128/80 mm Hg and the airway isn't involved.
- C. Correct. Lip swelling with trouble swallowing points to angioedema, which can obstruct the airway and has been fatal. Lisinopril is stopped, and the patient needs treatment and monitoring now.
- D. Incorrect. Potassium salt substitutes raise the risk of hyperkalemia with lisinopril, so this needs teaching and a potassium check, but it isn't as urgent as a threatened airway.
Sources for this question: [1][2]
Memory hook: Lisinopril: the cough is common, swollen lips are an emergency, and potassium can climb.