Lisinopril Nursing Considerations & Patient Teachings

Lisinopril is used to treat high blood pressure. Decreasing high blood pressure reduces the risk of heart attacks, kidney diseases, and strokes. Lisinopril is used to treat heart failure and increases survival rates following a heart attack. Lisinopril facilitates smooth blood flow by dilating blood vessels.

Generic names: Lisinopril

Brand names: Apo-Lisinopril, Prinivil, Qbrelis, Zestril

Pharmacologic class: Angiotensin-converting enzyme (ACE) inhibitor

Therapeutic class: Antihypertensive, vasodilator

Mechanism of action: Lisinopril reduces blood pressure by preventing the conversion of angiotensin I to angiotensin II (a potent vasoconstrictor). This causes decreased plasma angiotensin II and decreased aldosterone (a hormone that regulates salt and water) secretion. Lisinopril decreases preload and afterload to decrease how hard the heart must contract.

Indications for use: Mild to moderate hypertension, heart failure, adjunct therapy after acute myocardial infarction in hemodynamically stable patients, and left ventricular dysfunction following MI. Off-label uses include diabetic nephropathy/retinopathy, migraine headache prevention, and proteinuria.

Precautions and contraindications: Do not use when sensitive to other ACE inhibitors. Do not use with a history of angioedema. Take caution in patients with renal impairment, renal artery stenosis, ischemic heart disease, cerebrovascular disease, cardiomyopathy, aortic stenosis, hypotension, dialysis, hyponatremia, and hyperkalemia. African American patients may experience poorer cardiovascular outcomes. 

Drug interactions:

• Lisinopril with aliskiren, other ACE inhibitors, or angiotensin receptor blockers can cause hypotension, hyperkalemia, and renal impairment
• Allopurinol, bone marrow suppressants (such as methotrexate), procainamide, and systemic corticosteroids can cause neutropenia or agranulocytosis
• Cyclosporine, potassium-sparing diuretics, and potassium supplements can cause hyperkalemia
• Lisinopril taken with diuretics and other antihypertensives can have severe hypotensive effects
• Insulin or oral antidiabetic agents can increase the hypoglycemic effect
• Lithium can increase blood lithium levels and cause lithium toxicity
• NSAIDs can reduce the antihypertensive effect of lisinopril
• Hypotension may worsen when used with alcohol, ginseng, and licorice

Adverse effects:

• Vertigo, depression, stroke, insomnia, paresthesias, headache, fatigue, dizziness
• Chest pain, severe hypotension, sinus tachycardia
• Blurred vision, nasal congestion
• Nausea, vomiting, anorexia, constipation, flatulence, diarrhea
• Liver failure
• Proteinuria, decreased renal function
• Decreased libido, impotence
• Decreased in neutrophils and granulocytes (decreased immune function)
• Rash, pruritus
• Muscle cramps, hyperkalemia, myalgias
• Dry cough, dyspnea, asthma, respiratory tract infections

Administration Considerations

Available preparations: Oral tablets and solution (Qbrelis)

Dosages for adults: Dosage is dependent on use.

• For hypertension: 10-40 mg/day PO, with a maximum of 80 mg/day if required.
• For CHF along with digoxin and diuretics: 5-40 mg/ day.
• For acute MI who are hemodynamically stable: 5 mg PO within 24 hours of the onset of symptoms, followed by increasing dosage over days-weeks.
• For patients with renal impairment: Dose is dependent on creatinine clearance (CrCl): CrCl 30 ml/min: decrease dose by 50%, initially 5 mg/day, with maximum 40 mg/day. For CrCl 10 ml/min: 2.5 mg/day initially. 

Dosages for geriatric patients: 2.5-5 mg/day PO, increase weekly.

Dosages for children 6 years or older: Dose is dependent on weight and blood pressure response. For hypertension: 0.07 mg/kg PO up to 5 mg/day. 

Dosages for children < 6 years old: Safety and efficacy not established.

Nursing Considerations for Lisinopril

Related Nursing Diagnoses

• Decreased cardiac output
• Risk for infection
• Risk for imbalanced fluid volume
• Diarrhea, fatigue, insomnia, etc., as potential side effects of lisinopril

Nursing Assessment

1. Assess for allergies to ACE inhibitors.
2. Monitor blood pressure for hypotension prior to administration.
3. Assess for signs of severe hypotension like dizziness, excessive perspiration, vomiting, and diarrhea.
4. Monitor for signs of worsening CHF such as water retention and shortness of breath.
5. Assess for EKG changes.

Nursing Interventions

1. Monitor the effectiveness of lisinopril by reassessing blood pressure or pulse after administration.
2. Monitor glucose levels as medication may decrease glucose in diabetic patients.
3. Monitor lithium levels as lithium toxicity may occur.
4. Closely monitor potassium, protein, BUN, and creatinine levels in patients with kidney disease.
5. Monitor platelets, WBC with differential, and neutrophils due to the risk of infection when taking the medication.
6. Implement fall precautions with initial therapy as hypotension may occur. 
7. If severe hypotension occurs, position the patient in Trendelenburg with feet slightly elevated.

Patient Teaching Associated with Lisinopril

1. Teach patients to slowly rise from lying to sitting to standing to lessen the risk of orthostatic hypotension.
2. Do not take lisinopril with alcohol due to increased hypotensive effects.
3. Instruct patients to report any symptoms of worsening CHF such as nausea, swelling, and breathing difficulties.
4. Advise patients to limit potassium intake or avoid potassium supplements due to the risk of fluid and electrolyte imbalance.
5. Medication should be taken in the morning with or without food.
6. Alert the healthcare provider immediately for symptoms of allergic reactions particularly swelling in the face or tongue or difficulty breathing.
7. Female patients who become pregnant should immediately notify their provider.
8. A dry cough is the most common side effect of ACE inhibitors and may be so bothersome discontinuation is required. 
9. Muscle aches may occur due to hyperkalemia and should be discussed with a provider.

This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult further with a pharmacist for complete information.

References and Sources

1. Jones & Bartlett Learning. (2015). 2015 nurse’s drug handbook (14th ed.). Jones & Bartlett Learning, LLC.
2. Kizior, R. J., & Hodgson, K. J. (2020). Saunders Nursing Drug Handbook 2019. Elsevier Health Sciences.
3. Skidmore-Roth, L. (2015). Mosby’s drug guide for nursing students (11th ed.). Elsevier Health Sciences.