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Congestive Heart FailureLisinopril is to be used in conjunction with a diuretic and where appropriate digitalisTherapy must be initiated under close medical supervisionusually in a hospitalBlood pressure and renal function should be monitoredboth before and during treatment with lisinoprilbecause severe hypotension andmore rarelyconsequent renal failure have been reportedsee WarningsHypotension and PrecautionsRenal Impairment

Angiotensin converting enzymeACEis a peptidyl dipeptidase which catalyzes the conversion of angiotensin I to the pressor substanceangiotensin IIInhibition of ACE results in decreased plasma angiotensin IIwhich leads to increased plasma renin activitydue to removal of negative feedback of renin releaseand decreased aldosterone secretionAlthough the latter decrease is smallit results in a small increase in serum KIn patients treated with lisinopril and a thiazide diuretic there was essentially no change in serum potassiumsee Precautions

HypotensionSymptomatic hypotension has occurred after administration of lisinoprilusually after the first or second dose or when the dose was increasedIt is more likely to occur in patients who are volume depleted by diuretic therapydietary salt restrictiondialysisdiarrhea or vomiting or possibly in patients with renin-dependent renovascular hypertensionsee DosageIn patients with severe congestive heart failurewith or without associated renal insufficiencyexcessive hypotension has been observed and may be associated with oliguria and/or progressive azotemiaand rarely with acute renal failure and/or deathBecause of the potential fall in blood pressure in these patientstherapy should be started under very close medical supervisionusually in a hospitalSuch patients should be followed closely for the first 2 weeks of treatment and whenever the dose of lisinopril and/or diuretic is increasedSimilar considerations apply to patients with cheap Bentyl ischemic heart or cerebrovascular disease in whom an excessive fall in blood pressure could result in a myocardial infarction or cerebrovascular accidentsee Adverse Effects

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ace-inhibitors — enalapril maleate enacard, vasotec, prilenal , benazepril hydrochloride lotensin, fortekor, benefortin, benazecare, vetace, prilben , imidapril tanatril , ramipril altace, tritace, vasotop , captopril capoten , fosinopril, lisinopril zestril, prinivil , quinapril accupril , and alacepril — may also be prescribed by some cardiologists.

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