Buy Prinivil Online

Prinivil (lisinopril)

BOXED WARNING

D/C when pregnancy is detected. Drugs that act directly on the renin-angiotensin system (RAS) can cause injury and death to the developing fetus.

View FDA-Approved Full Prescribing Information for Prinivil

THERAPEUTIC CLASS

ACE inhibitor

DEA CLASS

RX

INDICATIONS

Treatment of HTN in adults and pediatric patients ≥6 yrs of age alone or w/ other antihypertensive agents. To reduce signs/symptoms of heart failure in patients not responding adequately to diuretics and digitalis. Reduction of mortality in treatment of hemodynamically stable patients w/in 24 hrs of acute myocardial infarction.

ADULT DOSAGE

Hypertension

Initial: 10mg qd or 5mg qd in patients taking diuretics
Titrate: Adjust dose according to BP response
Usual Range: 20-40mg qd. Doses up to 80mg have been used but do not appear to give a greater effect

May add a low-dose diuretic (eg, hydrochlorothiazide 12.5mg) if BP is not controlled

Heart Failure

Reduce Signs/Symptoms in Patients Not Responding Adequately to Diuretics and Digitalis:
Adjunct w/ Diuretics and (Usually) Digitalis:
Initial: 5mg qd
Titrate: Increase as tolerated
Max:
40 qd

Diuretic dose may need to be adjusted to help minimize hypovolemia

Acute Myocardial Infarction

Reduction of Mortality in Treatment of Hemodynamically Stable Patients w/in 24 Hrs of Acute Myocardial Infarction (AMI):
5mg w/in 24 hrs of onset of symptoms, followed by 5mg after 24 hrs, 10mg after 48 hrs, and then 10mg qd for at least 6 weeks

PEDIATRIC DOSAGE

Hypertension

≥6 Years:
GFR >30mL/min/1.73m2:
Initial: 0.07mg/kg qd (up to 5mg total)
Titrate: Adjust dose according to BP response
Max: 0.61mg/kg (up to 40mg) qd

DOSING CONSIDERATIONS

Renal Impairment
CrCl 10-30mL/min:
Reduce initial dose to 1/2 of the usual recommended dose (eg, HTN, 5mg; heart failure [HF] or AMI, 2.5mg)
Hemodialysis or CrCl <10mL/min:
Initial:
2.5mg qd

Pediatric Patients:
GFR <30mL/min/1.73m2: Not recommended

Other Important Considerations
HF:
W/ Hyponatremia (Serum Na+ <130mEq/L):
Initial: 2.5mg qd
Titrate: Increase as tolerated
Max: 40mg qd

AMI:
Low Systolic BP (SBP) (100-120mmHg) During First 3 Days After Infarct:
Initial:
2.5mg
Consider doses of 2.5mg or 5mg if hypotension occurs (SBP ≤100mmHg). D/C therapy if prolonged hypotension occurs (SBP <90mmHg for >1 hr)

ADMINISTRATION

Oral route

HOW SUPPLIED

Tab: 5mg*, 10mg*, 20mg* *scored

CONTRAINDICATIONS

History of ACE inhibitor-associated angioedema, hereditary or idiopathic angioedema. Coadministration w/ aliskiren in patients w/ diabetes.

WARNINGS/PRECAUTIONS

Head/neck angioedema reported; d/c and administer appropriate therapy. Intestinal angioedema reported; monitor for abdominal pain. Patients w/ a history of angioedema unrelated to ACE inhibitor therapy may be at increased risk of angioedema during therapy. Higher rate of angioedema in blacks than nonblacks. Anaphylactoid reactions reported during desensitization w/ hymenoptera venom, dialysis w/ high-flux membranes, and LDL apheresis w/ dextran sulfate absorption. May cause changes in renal function, including acute renal failure, especially in patients whose renal function may depend in part on the activity of the RAS; consider withholding or discontinuing therapy if a clinically significant decrease in renal function develops. May cause symptomatic hypotension, sometimes complicated by oliguria, progressive azotemia, acute renal failure or death; closely monitor patients at risk of excessive hypotension for the first 2 weeks of treatment and whenever therapy and/or diuretic dose is increased. Avoid in patients who are hemodynamically unstable after AMI. Symptomatic hypotension may occur in patients w/ severe aortic stenosis or hypertrophic cardiomyopathy. Hypotension may occur w/ major surgery or during anesthesia. May cause hyperkalemia; periodically monitor serum K+ during therapy. Associated w/ a syndrome that starts w/ cholestatic jaundice or hepatitis and progresses to fulminant hepatic necrosis and sometimes death; d/c therapy if jaundice or marked hepatic enzymes elevations develop. May increase BUN and SrCr in patients w/ renal artery stenosis.

ADVERSE REACTIONS

Headache, dizziness, cough, hypotension, chest pain, increased creatinine, hyperkalemia, syncope.

DRUG INTERACTIONS

See Contraindications. Initiation of therapy in patients on diuretics may result in excessive reduction of BP. Decrease or d/c diuretic or increase the salt intake prior to initiation of therapy; if this is not possible, reduce the starting dose of lisinopril. Attenuates K+ loss caused by thiazide-type diuretics. K+-sparing diuretics (eg, spironolactone, amiloride, triamterene) may increase hyperkalemia risk; frequently monitor serum K+ if concomitant use of such agents is indicated. Increased risk of hyperkalemia w/ K+ supplements or K+-containing salt substitutes. May cause an increased blood-glucose-lowering effect w/ risk of hypoglycemia w/ antidiabetic medicines (insulins, oral hypoglycemic agents). NSAIDs, including selective COX-2 inhibitors, may result in deterioration of renal function, including possible acute renal failure. Antihypertensive effect may be attenuated by NSAIDs. Dual blockade of the RAS is associated w/ increased risks of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure); avoid combined use of RAS inhibitors, and monitor BP, renal function, and electrolytes w/ other agents that affect the RAS. Avoid w/ aliskiren in patients w/ renal impairment (GFR <60mL/min). Lithium toxicity reported; monitor serum lithium levels during concurrent use. Nitritoid reactions reported w/ injectable gold. Increased BUN and SrCr w/ diuretics.

PREGNANCY AND LACTATION

Category D, not for use in nursing.

MECHANISM OF ACTION

ACE inhibitor; decreases plasma angiotensin II, which leads to decreased vasopressor activity and decreased aldosterone secretion.

PHARMACOKINETICS

Absorption: Tmax=7 hrs (adults), 6 hrs (pediatric patients). Elimination: Urine (unchanged); T1/2=12 hrs.

ASSESSMENT

Assess for hypersensitivity to the drug, hereditary or idiopathic angioedema, history of ACE inhibitor-associated angioedema, risk factors for hyperkalemia, risk of excessive hypotension, renal artery stenosis, severe aortic stenosis or hypertrophic cardiomyopathy, renal impairment, pregnancy/nursing status, and possible drug interactions.

MONITORING

Monitor for angioedema, anaphylactoid reactions, hyperkalemia, and other adverse reactions. Monitor BP, LFTs, serum K+, and renal function.

PATIENT COUNSELING

Inform of pregnancy risks and discuss treatment options for women planning to become pregnant; instruct to report pregnancy to physician as soon as possible. Instruct to immediately report signs/symptoms of angioedema and to avoid drug until they have consulted w/ prescribing physician. Counsel to report lightheadedness, especially during 1st few days of therapy; if syncope occurs, advise to d/c therapy until physician is consulted. Advise that excessive perspiration, dehydration, and other causes of volume depletion (eg, vomiting, diarrhea) may lead to excessive fall in BP; instruct to consult w/ a physician. Advise not to use salt substitutes containing K+ w/o consulting physician. Advise diabetic patients treated w/ oral antidiabetic agents or insulin to closely monitor for hypoglycemia, especially during the 1st month of combined use. Instruct to report promptly any indication of infection, which may be a sign of leukopenia/neutropenia.

STORAGE

15-30°C (59-86°F). Protect from moisture.

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