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Lisinopril Disease Interactions

There are 7 disease interactions with lisinopril:

Ace Inhibitors (Includes Lisinopril) ↔ Angioedema

Severe Potential Hazard, Moderate plausibility

Applies to: Angioedema

Patients with a history of angioedema unrelated to ACE inhibitors may be at increased risk of angioedema while receiving an ACE inhibitor. Patients should be advised to immediately report any signs or symptoms suggestive of angioedema (swelling of face, extremities, eyes, lips, or tongue, or difficulty swallowing or breathing) and to stop taking the medication until otherwise directed by their physician. Emergency therapy and/or measures to prevent airway obstruction are required for angioedema involving the tongue, glottis, or larynx. Treatment with ACE inhibitors should be discontinued permanently if angioedema develops in association with therapy.

References

  1. Gianos ME, Klaustermeyer WB, Kurohara M, et al "Enalapril induced angioedema." Am J Emerg Med 8 (1990): 124-6
  2. Seidman MD, Lewandowski CA, Sarpa JR, et al "Angioedema related to angiotensin-converting enzyme inhibitors." Otolaryngol Head Neck Surg 102 (1990): 727-31
  3. Chin HL, Buchan DA "Severe angioedema after long-term use of an angiotensin-converting enzyme inhibitor ." Ann Intern Med 112 (1990): 312-3
View all 34 references

Ace Inhibitors (Includes Lisinopril) ↔ Bone Marrow Suppression

Severe Potential Hazard, Low plausibility

Applies to: Bone Marrow Depression/Low Blood Counts, Renal Dysfunction, Collagen Vascular Disease

ACE inhibitors may cause bone marrow suppression, rarely in uncomplicated individuals but more frequently in patients with renal impairment, especially if they also have a collagen-vascular disease such as systemic lupus erythematosus or scleroderma. Neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia, eosinophilia and thrombocytopenia have been reported, mostly with captopril. Therapy with ACE inhibitors should be administered cautiously in patients with preexisting blood dyscrasias or complications that may increase the risk of bone marrow depression during ACE inhibitor therapy. Monitoring of blood counts, particularly white blood cells, should be considered.

References

  1. Davies RO, Irvin JD, Kramsch PK, Walker JF, Moncloa F "Enalapril worldwide experience." Am J Med 77 (1984): 23-35
  2. Knapp LE, Frank GJ, McLain R, Rieger MM, Posvar E, Singer R "The safety and tolerability of quinapril." J Cardiovasc Pharmacol 15 (1990): s47-55
  3. "Product Information. Lotensin (benazepril)." Ciba Pharmaceuticals, Summit, NJ.
View all 38 references

Ace Inhibitors (Includes Lisinopril) ↔ Chf

Severe Potential Hazard, High plausibility

Applies to: Congestive Heart Failure

ACE inhibitors can cause marked renal impairment in patients whose renal function depends on the activity of the renin-angiotensin-aldosterone system. In addition, symptomatic and sometimes excessive hypotension can occur in susceptible individuals, particularly during the initiation of treatment, which may compromise renal and myocardial perfusion. In patients with severe congestive heart failure (CHF), treatment with ACE inhibitors may be associated with oliguria and/or progressive azotemia and, rarely, renal failure, myocardial ischemia and death. Therapy with ACE inhibitors should be initiated under very close medical supervision in patients with severe CHF, especially when accompanied by volume and/or sodium depletion. Patients should be monitored closely for several hours after an initial dose until blood pressure has stabilized, and followed closely for the first 2 weeks of treatment and whenever the dosage of ACE inhibitor or diuretic is increased. If feasible, the risk of severe hypotension may be minimized by reducing or temporarily withholding the dosing of diuretics and/or liberalizing dietary sodium intake for 2 to 3 days prior to starting ACE inhibitor therapy. In patients who experience a worsening of renal function, discontinuation of ACE inhibitor therapy is usually not required provided there is symptomatic improvement of the heart failure and renal deterioration is well-tolerated. Transient hypotension is also not a contraindication to further treatment with ACE inhibitors. After blood pressure stabilizes, therapy can usually be reinstated with caution, although a lower dosage of the ACE inhibitor and/or dosage reduction or discontinuation of concomitantly administered diuretics may be necessary.

References

  1. Moyses C, Higgins TJ "Safety of long-term use of lisinopril for congestive heart failure." Am J Cardiol 70 (1992): c91-7
  2. "Product Information. Altace (ramipril)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  3. "Product Information. Lotensin (benazepril)." Ciba Pharmaceuticals, Summit, NJ.
View all 21 references

Ace Inhibitors (Includes Lisinopril) ↔ Hemodialysis

Severe Potential Hazard, Moderate plausibility

Applies to: hemodialysis

Anaphylactoid reactions have been reported in patients undergoing hemodialysis with high-flux polyacrylonitrile membranes and treated concomitantly with an ACE inhibitor. The frequency and mechanism of this interaction have not been established, and it is not known whether the interaction occurs with other membrane types. Therapy with ACE inhibitors should be administered cautiously in patients requiring hemodialysis.

References

  1. "Product Information. Capoten (captopril)." Bristol-Myers Squibb, Princeton, NJ.
  2. "Product Information. Lotensin (benazepril)." Ciba Pharmaceuticals, Summit, NJ.
  3. "Product Information. Altace (ramipril)." Hoechst Marion-Roussel Inc, Kansas City, MO.
View all 10 references

Ace Inhibitors (Includes Lisinopril) ↔ Hyperkalemia

Severe Potential Hazard, High plausibility

Applies to: Hyperkalemia

In patients with hyperkalemia, especially that associated with impaired renal function or congestive heart failure, ACE inhibitors may further raise serum potassium levels. Therapy with ACE inhibitors should be administered cautiously in patients with or predisposed to hyperkalemia, and serum potassium levels should be carefully monitored. Risk factors for the development of hyperkalemia during ACE inhibitor therapy include renal insufficiency, diabetes mellitus, and the concomitant use of potassium-sparing diuretics, potassium supplements, and/or potassium-containing salt substitutes.

References

  1. "Product Information. Mavik (trandolapril)." Knoll Pharmaceutical Company, Whippany, NJ.
  2. Kostis JB, Shelton BJ, Yusuf S, Weiss MB, Capone RJ, Pepine CJ, Gosselin G, Delahaye F, Probstfield JL, Cahill L, Dutton D "Tolerability of enalapril initiation by patients with left ventricular dysfunction: results of the medication challenge phase of the studies of left ventricular dysfunction." Am Heart J 128 (1994): 358-64
  3. "Product Information. Vasotec (enalapril)." Merck & Co, Inc, West Point, PA.
View all 18 references

Ace Inhibitors (Includes Lisinopril) ↔ Hypotension

Severe Potential Hazard, High plausibility

Applies to: Dehydration, hemodialysis, Hyponatremia, Ischemic Heart Disease, Diarrhea, Vomiting, Cerebrovascular Insufficiency

ACE inhibitors can cause symptomatic hypotension, most often during the initiation of therapy and in patients who are volume- and/or sodium-depleted or treated for congestive heart failure (CHF). Therapy with ACE inhibitors should be administered cautiously in such patients and in those predisposed to hypovolemic or hyponatremic states (e.g., patients on diuretic therapy, especially if it was recently instituted; those on dietary salt restriction; those with severe or prolonged diarrhea or vomiting; and renal dialysis patients). Volume and/or sodium depletion should be corrected prior to initiating therapy with ACE inhibitors, and the patient should be hemodynamically stable. If concomitant diuretics and/or dietary sodium restriction are employed, reducing or temporarily withholding the dosing of diuretics and/or liberalizing dietary sodium intake for 2 to 3 days in advance can help minimize the risk of severe hypotension in patients who are able to tolerate such adjustments. ACE inhibitors should also be used cautiously in patients in whom excessive hypotension may have serious consequences, such as patients with coronary or cerebrovascular insufficiency. Patients at risk for excessive hypotension should initiate ACE inhibitor therapy under very close medical supervision, and followed closely for the first 2 weeks of treatment and whenever the dosage of ACE inhibitor or diuretic is increased.

References

  1. "Product Information. Vasotec (enalapril)." Merck & Co, Inc, West Point, PA.
  2. Kostis JB, Shelton BJ, Yusuf S, Weiss MB, Capone RJ, Pepine CJ, Gosselin G, Delahaye F, Probstfield JL, Cahill L, Dutton D "Tolerability of enalapril initiation by patients with left ventricular dysfunction: results of the medication challenge phase of the studies of left ventricular dysfunction." Am Heart J 128 (1994): 358-64
  3. Alderman CP "Adverse effects of the angiotensin-converting enzyme inhibitors." Ann Pharmacother 30 (1996): 55-61
View all 32 references

Ace Inhibitors (Includes Lisinopril) ↔ Renal Dysfunction

Moderate Potential Hazard, High plausibility

Applies to: Renal Dysfunction

With the exception of fosinopril, ACE inhibitors (and/or their active metabolites in some cases) are primarily eliminated by the kidney and may accumulate in patients with renal impairment. ACE inhibitors can also worsen renal function in some patients by blocking the effect of angiotensin II-mediated efferent arteriolar vasoconstriction, thereby decreasing glomerular filtration. Therapy with ACE inhibitors should be administered cautiously in patients with preexisting renal dysfunction, particularly those with renovascular disease. Patients with moderate to severe renal impairment usually require lower or less frequent doses and smaller increments in dose. In addition, a dosage reduction or discontinuation of any concomitantly administered diuretics may be helpful. Fosinopril probably does not require dosage adjustments unless hepatic function is also significantly impaired.
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<br />In patients with bilateral renal artery stenosis or renal artery stenosis in a solitary kidney, ACE inhibitors may reduce renal perfusion to a critically low level. Renal function should be monitored closely for the first few weeks of therapy.

References

  1. Champ JD "Case report: azotemia secondary to enalapril and diuretic use and the diagnosis of renovascular hypertension." Am J Med Sci 305 (1993): 25-7
  2. "Moexipril: another ace inhibitor for hypertension." Med Lett Drugs Ther 37 (1995): 75-6
  3. Forette B, Koen R, Vivaut E "Efficacy and safety of quinapril in the elderly hypertensive patient." Am Heart J 123 (1992): 1426-32
View all 32 references

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lisinopril drug Interactions

There are 623 drug interactions with lisinopril

lisinopril alcohol/food Interactions

There is 1 alcohol/food interaction with lisinopril

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2014 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

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