Lisinopril - an ACE inhibitor Zestril

About lisinopril

Lisinopril belongs to a class of medicines called angiotensin-converting enzyme inhibitors, or ACE inhibitors. It is prescribed for a number of different reasons. You may have been prescribed it to reduce high blood pressure (hypertension), or to treat heart failure, or to protect your heart and blood vessels from further damage following a heart attack, or to protect your kidneys if you have diabetes. Your doctor will tell you why it has been prescribed for you.

ACE inhibitors like lisinopril prevent your body from creating a hormone known as angiotensin II. They do this by blocking (inhibiting) a chemical called angiotensin-converting enzyme. They widen your blood vessels and help to reduce the amount of water put back into your blood by the kidneys.

These actions help to decrease blood pressure in people who have blood pressure which is higher than normal. Although people with high blood pressure often do not feel unwell, if left untreated, high blood pressure can harm the heart and damage blood vessels, leading to a heart attack or stroke. Lisinopril can be used on its own or alongside other medicines which reduce blood pressure (such as hydrochlorothiazide). Combination brands such as Lisoretic® and Zestoretic® can help to reduce the total number of tablets people with high blood pressure need to take each day.

Heart failure is a condition where your heart does not work as well as it should. Because of this, there may be too much circulating fluid in your blood vessels. Lisinopril helps to reduce this. It also appears to have a protective effect on the heart which slows the progression of the heart failure. Its protective action also helps to reduce the risk of heart, kidney or blood vessel problems in people who are at risk of these.

Before taking lisinopril

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking lisinopril it is important that your doctor knows:

• If you are pregnant or breastfeeding.
• If you have problems with the way your kidneys work.
• If you are lacking in fluid in the body (dehydrated) - for example, if you have had diarrhoea or sickness very recently.
• If you have been told you have a build-up of fatty deposits on the walls of your arteries, a condition called atherosclerosis.
• If you have a particular type of poor circulation called peripheral arterial disease.
• If you have collagen vascular disease; this includes conditions such as systemic lupus erythematosus (SLE) and scleroderma.
• If you have been told you have heart muscle disease (cardiomyopathy) or narrowing of the main blood vessel from your heart (aortic stenosis).
• If you have been told you have a high level of potassium in your blood.
• If you have ever had a reaction where your face, tongue or throat swells (angio-oedema).
• If you are having desensitisation treatment to protect against bee and wasp stings.
• If you are having dialysis treatment, or treatment to remove cholesterol from your blood by a machine (LDL apheresis).
• If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
• If you have ever had an allergic or unusual reaction to any other ACE inhibitor (such as captopril, ramipril or enalapril), or to any other medicine.

How to take lisinopril

• Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about lisinopril and will provide you with a full list of side-effects which you may experience from taking it.
• Take the tablets exactly as your doctor tells you to. Lisinopril is taken once daily. There are several different strengths of tablet available (2.5 mg, 5 mg, 10 mg and 20 mg) - the strength of your tablets will depend upon the reason for you taking them.
• Your doctor is likely to advise you to take your very first dose at bedtime. This is because the first dose can make you feel dizzy.
• After the first dose, you can take lisinopril at a time of day you find easy to remember. For most people this will be in the morning. Try to take your doses at the same time of day each day as this will help you to remember to take your doses regularly. You can take lisinopril tablets either with or without food. It is best to swallow the tablet with a drink of water.
• If you forget to take a dose, take it as soon as you remember. If you do not remember until the following day, leave out the forgotten dose from the previous day and take the dose that is due as normal. Do not take two doses at the same time to make up for a missed dose.

Getting the most from your treatment

• Try to keep your regular appointments with your doctor. This is so your progress can be monitored. Your doctor may want you to have some blood tests from time to time to check that your kidneys are working well.
• It is very important that you follow any dietary and lifestyle advice that you are given by your doctor. This may include advice about eating a healthy diet, not smoking, and taking regular exercise.
• If you buy any medicines, check with a pharmacist that they are suitable to take with lisinopril. This is because some medicines (such as anti-inflammatory painkillers and indigestion remedies) could interfere with your treatment.
• It is likely that your doctor will advise that you do not use salt substitutes while you are taking lisinopril. These products have a high content of potassium which could be harmful for you.
• If you drink alcohol, ask your doctor for advice about drinking alcohol while you are on lisinopril. Alcoholic drinks can make you feel light-headed or dizzy, and they may not be advisable for you.
• If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking lisinopril tablets. This is because some anaesthetics could cause your blood pressure to drop too low.
• Treatment with lisinopril is often long-term, although it is taken for short periods (up to six weeks) following a heart attack. Continue to take the tablets until you are advised otherwise.

If you are also taking hydrochlorothiazide in combination with this medicine

• Studies have suggested that taking higher doses of hydrochlorothiazide for long periods of time may increase the risk of certain skin cancers.
• Tell your doctor if you have ever been treated for skin cancer before.
• Tell your doctor about any new or changed moles or worrying marks on your skin.
• Use a sunscreen in strong sunlight. Do not use sunbeds.

Can lisinopril cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with lisinopril. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Important: if you experience any of the following rare but serious symptoms, stop taking lisinopril and contact your doctor for advice straightaway:

• Any difficulty breathing, or swelling of your face, mouth, tongue or throat. These are signs of an allergic reaction.
• Any yellowing of your skin or of the whites of your eyes. These may be signs of jaundice which is a rare side-effect.
• A severe skin rash.

If you experience any other symptoms which you think may be due to the tablets, speak with your doctor or pharmacist for further advice.

How to store lisinopril

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines