Lisinopril (HFrEF / Post-MI)

eMC source: Lisinopril 1 mg/ml oral solution. Heart failure: use as adjunctive therapy to diuretics and, where appropriate, digitalis or beta-blockers; patients at high risk of symptomatic hypotension (salt depletion with or without hyponatraemia, hypovolaemia, or vigorous diuretic therapy) should have these conditions corrected if possible before starting, and renal function and serum potassium should be monitored. Dose adjustment should be based on the clinical response of the individual patient. Acute MI: patients should receive standard recommended treatments such as thrombolytics, aspirin and beta-blockers; do not start if systolic blood pressure is lower than 100 mmHg, and do not initiate in patients at risk of further serious haemodynamic deterioration after a vasodilator or in cardiogenic shock. Patients with systolic blood pressure of 120 mmHg or less at initiation or during the first 3 days after infarction should be given 2.5 mg. If hypotension occurs (systolic blood pressure <=100 mmHg) a daily maintenance dose of 5 mg may be given, with temporary reductions to 2.5 mg if needed; if prolonged hypotension occurs (systolic blood pressure <90 mmHg for more than 1 hour) lisinopril should be withdrawn. Treatment should continue for 6 weeks and the patient then re-evaluated; patients who develop symptoms of heart failure should continue treatment. Absorption is not affected by food. Other indications on the same label: hypertension — usual starting dose 10 mg (2.5-5 mg where the renin-angiotensin-aldosterone system is strongly activated, or 5 mg if a diuretic cannot be discontinued; if possible stop the diuretic 2-3 days before starting), usual effective maintenance 20 mg once daily; renal complications of type 2 diabetes with incipient nephropathy — 10 mg once daily, increased to 20 mg once daily if needed. Elderly: no age-related change in efficacy or safety, but where advanced age is associated with decreased renal function use the renal starting-dose table. Not recommended in patients with recent kidney transplantation. Paediatric use on this label is limited to hypertension in children aged 6-16 years: initial 2.5 mg once daily for 20 to <50 kg and 5 mg once daily for >=50 kg, individually adjusted to a maximum of 20 mg daily (20 to <50 kg) or 40 mg daily (>=50 kg); doses above 0.61 mg/kg or in excess of 40 mg have not been studied. Lisinopril is not recommended in children for indications other than hypertension, nor below 6 years of age, nor in children with severe renal impairment (GFR <30 ml/min/1.73 m2); in children with decreased renal function a lower starting dose or increased dosing interval should be considered.