From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For a patient with a history of transient ischemic attack (TIA), lisinopril is the preferred ACE inhibitor to initiate at a low dose, given its efficacy and safety profile as demonstrated in recent studies 1. Start with 5 mg once daily and gradually titrate up to a target dose of 10 mg daily as tolerated. Lisinopril has been shown to be well tolerated and effective in reducing blood pressure in patients with acute ischemic stroke, with a significant decrease in systolic and diastolic blood pressure within 4 hours of administration 1. When initiating therapy, monitor blood pressure closely, check renal function and electrolytes within 1-2 weeks, and be alert for potential side effects like cough, hypotension, or hyperkalemia. Some key points to consider when using ACE inhibitors in patients with TIA include:
- Starting at a lower dose in elderly patients or those with renal impairment
- Monitoring for potential side effects such as dry cough, which is more common with ACE inhibitors compared to angiotensin receptor blockers (ARBs) 2
- Being aware of the potential for hyperkalemia, particularly in patients with renal insufficiency 3
- Considering the use of ARBs as an alternative to ACE inhibitors in patients who are intolerant of ACE inhibitors, although ACE inhibitors remain a preferred option due to their established benefits in reducing morbidity and mortality 4, 5