From the FDA Drug Label
5.3 Impaired Renal Function Monitor renal function periodically in patients treated with lisinopril. Changes in renal function including acute renal failure can be caused by drugs that inhibit the renin-angiotensin system. Patients whose renal function may depend in part on the activity of the renin-angiotensin system (e.g., patients with renal artery stenosis, chronic kidney disease, severe congestive heart failure, post-myocardial infarction or volume depletion) may be at particular risk of developing acute renal failure on lisinopril.
Lisinopril for Renal Protection When taking Mobic, lisinopril can be prescribed for renal protection. However, it is crucial to monitor renal function periodically in patients treated with lisinopril, as it may cause changes in renal function, including acute renal failure. Key considerations include:
- Patients with pre-existing renal conditions may be at higher risk of developing acute renal failure on lisinopril.
- Concomitant use of other medications, such as Mobic, may increase the risk of renal impairment. 1
From the Research
Prescribing lisinopril for renal protection when taking Mobic (meloxicam) is a reasonable approach for patients at risk of kidney injury, as supported by the most recent evidence 2. Lisinopril, an ACE inhibitor, can help protect kidney function by reducing intraglomerular pressure and protein excretion while Mobic, a nonsteroidal anti-inflammatory drug (NSAID), can potentially impair kidney function, especially with long-term use. A typical starting dose of lisinopril for renal protection is 5-10 mg once daily, which can be titrated up to 20-40 mg daily based on blood pressure response and kidney function, as seen in studies such as 3 and 4. When initiating this combination, it's essential to monitor kidney function (serum creatinine, eGFR) and potassium levels at baseline and within 1-2 weeks of starting therapy, then periodically thereafter, considering the potential effects of both medications on renal function and electrolyte balance, as discussed in 5. Blood pressure should also be monitored as both medications can affect it. This protective strategy works because NSAIDs like Mobic can reduce prostaglandin production, which normally helps maintain renal blood flow, while lisinopril helps preserve renal function by reducing efferent arteriolar constriction. However, this combination may not be appropriate for all patients, particularly those with severe kidney disease, hyperkalemia, or history of angioedema. Key considerations include the patient's overall clinical status, the presence of any comorbid conditions that could affect kidney function or the metabolism of these drugs, and the potential for drug interactions, as highlighted in 6. Given the most recent evidence on medication dosing in patients with reduced lean body mass and kidney injury 2, it is crucial to carefully assess and adjust the dosing of lisinopril based on the patient's renal function and body composition to minimize the risk of adverse effects while maximizing the potential benefits of renal protection.