Abnormalities in unborn babies
Women using Lisinopril during the first, second and third trimesters of pregnancy
are at an increased risk. The use of Lisinopril in the second and third trimesters of pregnancy causes a decrease in the functioning of kidneys and increases the chances of fatality in the unborn baby. It can also result in a deficiency of amniotic fluid in womb associated with incomplete development of lungs and bone deformations. Other side effects caused by Lisinopril include skull abnormalities, less production of urine, low blood pressure, kidney failure, and other defects in the baby. When pregnancy is detected, stop using Lisinopril. Appropriate management of high blood pressure in the mother during pregnancy should be done. If no alternative therapy is available, tell the mother about the risk of deficiency of amniotic fluid and perform ultrasound
regularly. Closely observe babies with a history of in utero exposure to Lisinopril for symptoms of low blood pressure, less urine production, and increased potassium
Swelling of the lower layer of the skin
Patients with the history of swelling of the lower layer of the skin by using angiotensin-converting enzyme inhibitor drugs are at an increased risk when using this medicine. Also, black patients are at an increased risk as compared to non-black patients. These patients may suffer from swelling of the extremities, face, lips, tongue, glottis and larynx. Patients with a history of airway surgery
are at an increased risk of airway obstruction due to the involvement of tongue, glottis or larynx. In black patients, the effectiveness of Lisinopril may be reduced because of low level of an enzyme (known as renin). If this happens, stop using this medicine, and give proper treatment or monitoring to the patient. The treatment may involve the use of adrenaline, which is used to reduce the allergy
. Also, airway management is advised in the patient.
Severe allergy (anaphylactoid reactions) during desensitization
Patients treated with hymenoptera venom for desensitization while taking ACE inhibitors are at an increased risk. These patients may sustain life-threatening allergic reactions. The treatment with ACE inhibitors is temporarily stopped in such patients to avoid these reactions.
Severe allergy (anaphylactoid reactions) during dialysis
Patients undergoing dialysis
with high flux membranes while using ACE inhibitors are at an increased risk. Such patients may suffer from life-threatening allergic reactions. Severe allergic reactions also occur when taking dextran sulfate for removing low-density lipoprotein (LDL
from the blood while using ACE inhibitors. The dialysis should be stopped immediately and provide appropriate treatment to the patient for these allergic reactions. The use of a different type of dialysis membrane and medicine for high blood pressure is advised.
Patients suffering from narrowing of kidney arteries (renal artery stenosis
), kidney insufficiency, high blood pressure, severe congestive heart failure, severe kidney disease, syndrome
occurring after heart failure or volume depletion are at an increased risk while using this medicine. Patients are at risk of an increase in the level of urea and creatinine
in the blood. The patients with heart failure may suffer from kidney failure. In such patients, the treatment should be done only under medical supervision. Also, a low dosage of Lisinopril in carefully divided doses is recommended. The combined treatment with diuretics
should be discontinued and the functioning of the kidneys should be monitored during the first few weeks of Lisinopril therapy. The use of Lisinopril should be stopped if the patient suffers from kidney dysfunction during the treatment. In patients with kidney dysfunction, an initial dose of Lisinopril should be adjusted according to creatinine clearance and based on patient's response. The regular monitoring of potassium
and creatinine level is recommended in such patients. The kidney disease patients suffering from a heart attack should not use this medicine.
Low blood pressure
The patients with heart failure having low blood pressure (below 100 mmHg), reduced oxygen supply to heart (ischemic heart disease), brain damage from the obstruction of blood supply (cerebrovascular disease), low sodium
level, high dose of diuretics
, having limitation on dietary salt
, vomiting, high blood pressure, kidney disease, undergoing kidney dialysis
, excess salt and water excretion in the urine (volume-depletion), narrowed opening of heart valve (severe aortic stenosis
) or thickening of heart muscle (hypertrophic cardiomyopathy
) are at an increased risk. Such patients are at the risk of developing excessive low blood pressure. This may occur together with reduced urine production, kidney failure or abnormally high levels of nitrogen in the blood and it can be possibly fatal. The patient should be placed in lying position and if necessary an intravenous infusion of normal saline may be given. The use of this medicine should be done only under close supervision in such patients. Such patients should be observed closely for the first two weeks of treatment or whenever the dose of Lisinopril or diuretic is increased. The use of Lisinopril should be avoided or a low dose of Lisinopril should be used in patients with unstable blood pressure after a heart attack.
High blood potassium level (hyperkalemia)
The patients with kidney insufficiency and diabetes
mellitus are at an increased risk when using this medicine. Also, the combined use of potassium-sparing diuretics
, potassium-containing salt
substitutes, and potassium
supplements with this medicine are at an increased risk. These patients may suffer from increased blood potassium level. If using these combinations, the regular monitoring of blood potassium is recommended.
Patients undergoing surgery or using anesthesia
The patients undergoing surgery
or using anesthesia
that reduces the blood pressure are at an increased risk while using this medicine. Lisinopril may block the release of an enzyme causing low blood pressure in such patients. If this occurs, a rapid expansion of the blood volume is advised.
Patients who use angiotensin-converting enzyme inhibitor drugs are at an increased risk. These patients may have hepatitis
including decreased bile flow from the liver (cholestatic
jaundice) and leads to liver tissue death (necrosis) and sometimes fatality. If the patient develops jaundice or increase in the liver enzymes, this medicine should be discontinued and receive appropriate treatment.
Patients with narrowing of the heart blood vessel, blockage of blood flow in the heart, and abnormally thick heart muscle are at an increased risk while using this medicine. Such patients should take caution while taking Lisinopril.
Patients taking mTOR inhibitors
Patients taking mTOR inhibitors such as everolimus, sirolimus, or temsirolimus are at an increased risk while using this medicine. These patients may suffer from swelling due to fluid accumulation under the skin.
Abnormally low count of white blood cells
Patients using Lisinopril are at an increased risk. There is a risk of the abnormally low count of white blood cells, red blood cells, and platelets
while using this medicine. The stoppage of ACE inhibitors may reverse abnormally low count of white blood cells. Take Lisinopril with caution and monitor white blood cells counts in patients with inflammation of the tissues (collagen), suppression of the immune system, using procainamide or allopurinol, or having kidney dysfunction. These patients may develop serious infections that do not respond to antibiotic
therapy. Patients are advised to report signs of infection while using Lisinopril.
Blood pressure lowering agents
Patients with diabetic kidney disease are at an increased risk when using Lisinopril in combination with blood pressure lowering agents such as aliskiren, ACE inhibitors, or angiotensin two receptor blockers. These patients may have low blood pressure, raised potassium
level in the blood (hyperkalemia
), and changes in the functioning of kidneys. In patients with diabetic kidney disease, Lisinopril should not be used with these drugs. This combination should only be used under the specialist supervision and the close monitoring of electrolytes, blood pressure and functioning of the kidney are required.
Continuous dry cough production
Patients using ACE inhibitors are at an increased risk. These patients may suffer from a continuous and dry cough
. A cough may resolve after stopping the use of ACE inhibitors.
Patients who are pregnant and planning to become pregnant are at an increased risk when using this medicine. The use of Lisinopril in the second and third trimesters of pregnancy
causes a decrease in the functioning of kidneys and increases the chances of fatality in the unborn baby. It can also result in a deficiency of amniotic fluid in womb associated with incomplete development of lungs and bone deformations. Other side effects caused by Lisinopril include skull abnormalities, less production of urine, low blood pressure, kidney failure, and other defects in the baby. Angiotensin-converting enzyme inhibitors should not be used in pregnancy. In pregnant women use of an alternative therapy is recommended.