What are the instructions for a patient with hypertension taking lisinopril?

Patient Instructions for Lisinopril in Hypertension

How to Take Your Medication

Take lisinopril exactly as prescribed, once daily at the same time each day, with or without food. 1

• Swallow the tablet whole with water 1
• You can take it with or without meals—food does not affect how well it works 2
• If you miss a dose, take it as soon as you remember unless it's almost time for your next dose; never double up 1
• Continue taking this medication even when you feel well—high blood pressure often has no symptoms 1

Starting Dose and Adjustments

• Your doctor will likely start you on 10 mg once daily 1
• Your dose may be adjusted based on your blood pressure response, typically ranging from 20-40 mg daily 1
• Some patients may need up to 80 mg daily, though higher doses don't always provide greater benefit 1
• It takes 2-3 hours for the medication to start working, with peak effect around 6 hours, and it lasts a full 24 hours 2, 3
• You should reach steady blood pressure control within 2-3 days of starting or changing your dose 2

If Your Blood Pressure Isn't Controlled

Your doctor may add a water pill (diuretic) like hydrochlorothiazide 12.5 mg if lisinopril alone doesn't control your blood pressure adequately. 1

• If a diuretic is added, your lisinopril dose may be reduced to 5 mg initially 1
• The combination works better than either medication alone 2, 4
• The diuretic helps lisinopril work more effectively 1

Expected Blood Pressure Reduction

• Lisinopril typically reduces systolic blood pressure by 11-15% and diastolic by 13-17% when used alone 2
• Your target blood pressure should be less than 140/90 mmHg at minimum, ideally less than 130/80 mmHg 5
• Your doctor will recheck your blood pressure within 2-4 weeks after starting or adjusting your dose 5

Important Side Effects to Watch For

Call your doctor immediately if you experience:

• Swelling of your face, lips, tongue, or throat, or difficulty breathing (signs of allergic reaction) 1
• Lightheadedness or fainting, especially when standing up quickly 1, 2
• Chest pain or irregular heartbeat 1
• Decreased urination or dark urine 1
• Yellowing of skin or eyes 1

Common side effects that usually improve:

• Dizziness or lightheadedness, especially in the first few days 2, 4
• Dry cough (occurs in some patients) 5
• Headache 4
• Fatigue 4

Special Monitoring Requirements

Your doctor will check blood tests periodically:

• Kidney function (creatinine) should be checked 2-4 weeks after starting or changing dose 5
• Potassium levels need monitoring, as lisinopril can increase potassium 5, 1
• If you have kidney problems, you may need more frequent monitoring 6

If You Have Kidney Problems

• Your starting dose will be lower (5 mg or 2.5 mg) if you have reduced kidney function 1, 6
• If you're on dialysis, you'll start with 2.5 mg once daily 1
• Your doctor will monitor your kidney function more closely 6

Important Drug and Food Interactions

Avoid or discuss with your doctor:

• NSAIDs like ibuprofen, naproxen, or aspirin—these can reduce lisinopril's effectiveness and harm your kidneys 5
• Potassium supplements or salt substitutes containing potassium—these can cause dangerous potassium levels 1
• Other blood pressure medications, especially other ACE inhibitors or ARBs—never combine these 5
• Diuretics—your doctor needs to monitor you closely when combining these 1

Safe to take together:

• Hydrochlorothiazide (water pill) 1, 2
• Propranolol (beta-blocker) 2
• Digoxin (heart medication) 2
• Diabetes medications like glibenclamide 2

Lifestyle Changes That Help

These changes work together with your medication to lower blood pressure:

• Limit salt intake to less than 2 grams per day (about 1 teaspoon) 5
• Maintain a healthy weight—losing 10 kg can reduce blood pressure by 6/4.6 mmHg 5
• Exercise regularly for at least 30 minutes most days 5
• Limit alcohol to no more than 2 drinks daily for men or 1 drink for women 5
• Follow a DASH diet rich in fruits, vegetables, and low-fat dairy 5

When to Contact Your Doctor

Contact your doctor before your next scheduled visit if:

• Your blood pressure at home is consistently above 135/85 mmHg 5
• You experience persistent dizziness or fainting 1
• You develop a persistent dry cough that bothers you 5
• You have any swelling of your face, lips, or tongue 1
• You become pregnant or are planning pregnancy—lisinopril can harm an unborn baby 1

Storage and Handling

• Store at room temperature away from moisture and heat 1
• Keep out of reach of children 1
• Do not use after the expiration date on the bottle 1

Home Blood Pressure Monitoring

• Check your blood pressure at home using a validated automatic device 5
• Take readings at the same time each day, preferably in the morning 5
• Take at least 2 readings per session, 1-2 minutes apart, and record the average 5
• Home readings of 135/85 mmHg or higher indicate your blood pressure needs better control 5