Prinivil (lisinopril) is an angiotensin-converting enzyme (ACE) inhibitor prescribed for the management of hypertension, heart failure, and post-myocardial infarction care. As a first-line antihypertensive agent, it works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby reducing peripheral arterial resistance and decreasing blood pressure. Its well-established efficacy, favorable safety profile, and cardioprotective benefits make it a cornerstone therapy in modern cardiovascular medicine. Prinivil is available in tablet form and is typically administered once daily for consistent 24-hour hemodynamic control.

Features

• Active ingredient: Lisinopril
• Drug class: Angiotensin-converting enzyme (ACE) inhibitor
• Available strengths: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg tablets
• Administration: Oral, once-daily dosing
• Bioavailability: Approximately 25% (unaffected by food)
• Half-life: 12 hours
• Excretion: Primarily renal (unchanged)
• FDA-approved indications: Hypertension, heart failure, acute myocardial infarction

Benefits

• Provides sustained 24-hour blood pressure control with single daily dosing
• Reduces afterload in heart failure patients, improving cardiac output and functional capacity
• Demonstrates nephroprotective effects in diabetic patients with proteinuria
• Decreases mortality risk following acute myocardial infarction
• Shows proven cardiovascular risk reduction in long-term clinical studies
• Generally well-tolerated with minimal metabolic interference

Common use

Prinivil is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also approved for the management of heart failure as adjunctive therapy when diuretics and digitalis prove insufficient. Additionally, Prinivil is used to improve survival in hemodynamically stable patients within 24 hours of acute myocardial infarction. Off-label uses include diabetic nephropathy management and prevention of migraine headaches in certain patient populations.

Dosage and direction

Hypertension: Initial dose 10 mg once daily; maintenance dose 20-40 mg once daily (maximum 80 mg daily)
Heart Failure: Initial dose 2.5-5 mg once daily; titrate to maximum tolerated dose up to 40 mg daily
Acute MI: 5 mg within 24 hours of onset, then 5 mg after 24 hours, 10 mg after 48 hours, then 10 mg daily for 6 weeks

Take at approximately the same time each day, with or without food. Crushed tablets may be administered in water or apple juice for patients with swallowing difficulties. Dosage adjustment required in renal impairment: CrCl <30 mL/min or serum creatinine >3 mg/dL requires reduced initial dosing.

Precautions

Monitor blood pressure within 1-2 weeks of initiation and after dosage adjustments. Assess renal function and serum potassium before initiation and periodically during therapy. Exercise caution in patients with renal artery stenosis, collagen vascular diseases, or those taking potassium supplements or potassium-sparing diuretics. Avoid use during pregnancy (FDA Pregnancy Category D). May cause symptomatic hypotension, particularly in volume-depleted patients. Use with caution in patients undergoing major surgery or anesthesia.

Contraindications

History of angioedema related to previous ACE inhibitor treatment. Patients with hereditary or idiopathic angioedema. Concomitant use with aliskiren in patients with diabetes. Hypersensitivity to any component of Prinivil or other ACE inhibitors. Bilateral renal artery stenosis or stenosis in a solitary kidney.

Possible side effects

Common (>1%): Cough (dry, persistent), dizziness, headache, fatigue, nausea
Less common (0.1-1%): Orthostatic hypotension, rash, hyperkalemia, impaired renal function
Rare (<0.1%): Angioedema, neutropenia/agranulocytosis, hepatitis, pancreatitis
Very rare: Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Drug interaction

Potassium-raising agents: Potassium supplements, potassium-sparing diuretics, heparin - increased risk of hyperkalemia
NSAIDs: May reduce antihypertensive effect and increase renal impairment risk
Diuretics: Enhanced hypotensive effect, especially with initial coadministration
Lithium: Increased lithium levels and toxicity risk
Antidiabetics: Enhanced hypoglycemic effect
Gold injections: Nitritoid reactions reported with sodium aurothiomalate

Missed dose

Take the missed dose as soon as remembered, unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed one. If multiple doses are missed, contact healthcare provider for guidance on resumption. Maintain regular dosing schedule to ensure consistent blood pressure control.

Overdose

Symptoms may include severe hypotension, bradycardia, circulatory shock, electrolyte disturbances, and renal failure. Management involves supportive care with volume expansion with normal saline and vasopressors if needed. Lisinopril is not effectively removed by hemodialysis due to extensive tissue binding. Monitor vital signs, electrolyte levels, and renal function closely in cases of suspected overdose.

Storage

Store at controlled room temperature (20-25°C or 68-77°F) in original container. Protect from moisture and light. Keep tightly closed and out of reach of children. Do not use if tablets show signs of discoloration or deterioration. Discard unused medication properly according to local regulations.

Disclaimer

This information is 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 response to therapy may vary. Always follow your healthcare provider’s instructions regarding dosage, administration, and monitoring. Report any adverse effects or concerns to your physician promptly.

Reviews

Clinical studies demonstrate Prinivil’s efficacy in blood pressure control, with approximately 70-80% of hypertensive patients achieving target BP goals. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) confirmed lisinopril’s effectiveness as first-line therapy. Cardiology guidelines consistently recommend ACE inhibitors like Prinivil for heart failure with reduced ejection fraction, showing 20-30% mortality reduction. Patient satisfaction surveys indicate good tolerability, though the characteristic dry cough remains a notable reason for discontinuation in 5-10% of users.