Listril (Lisinopril)
Also sold as: Listril, Zestril, Lipril, Linvas, Hipril
Pregnancy
Cat D
Lactation
Caution
Schedule
H
Forms
Tablet 2.5mg, 5mg, 10mg, 20mg
Indications
- Hypertension (first-line)
- Heart failure with reduced ejection fraction (HFrEF)
- Acute MI with LV dysfunction (within 24 hours)
- Diabetic nephropathy (reduces proteinuria)
- Chronic kidney disease with proteinuria
Adult Dosing
Hypertension
5–10 mg PO once daily
Titrate to 20–40 mg once daily based on BP response. Start 2.5 mg in high-risk patients.
Heart failure
2.5–5 mg PO once daily
Titrate slowly up to 35 mg once daily as tolerated. Target dose for mortality benefit.
Acute MI
5 mg within 24 hours → 5 mg at 24 h → 10 mg at 48 h → 10 mg OD for 6 weeks
Start 2.5 mg if SBP 100–120 mmHg
Diabetic nephropathy
10–20 mg PO once daily
Ongoing — for renoprotective effect
Pediatric Dosing
Not for children < 6 years or GFR < 30 mL/min/1.73m²
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl 10–30 mL/min | Start 2.5–5 mg/day |
| CrCl < 10 mL/min (dialysis) | Start 2.5 mg/day; highly dialysable |
Hepatic Adjustment
No dose adjustment required (renally excreted, not hepatically metabolised)
Pregnancy & Lactation
Pregnancy: Category D
CONTRAINDICATED in 2nd and 3rd trimesters — causes fetal renal tubular dysplasia, oligohydramnios, neonatal renal failure, limb contractures, skull hypoplasia, death. Stop immediately if pregnancy detected. Category C in 1st trimester.
Lactation: Caution
Small amounts excreted in breast milk; generally considered compatible by WHO — monitor infant for hypotension and renal function
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Potassium-sparing diuretics / potassium supplements | Severe hyperkalaemia — avoid combination unless closely monitored | Major |
| NSAIDs (ibuprofen, naproxen) | Reduce antihypertensive effect; increase risk of acute kidney injury | Moderate |
| Aliskiren (in diabetics/CKD) | CONTRAINDICATED — dual RAAS blockade increases AKI, hyperkalaemia, hypotension | Major |
| Lithium | ACE inhibitors increase lithium levels — toxicity risk | Major |
| ARBs (valsartan, losartan) | Dual RAAS blockade — avoid (increased AKI risk); only exception: specialist HF care | Major |
| Sacubitril/valsartan | ABSOLUTELY CONTRAINDICATED together — angioedema risk; 36-hour washout required before switching | Major |
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Side Effects
Common
- Dry persistent cough (10–15% — class effect, bradykinin-mediated)
- Dizziness (first dose hypotension)
- Hyperkalaemia
- Headache
- Fatigue
Serious / Discontinue If
- Angioedema (rare but life-threatening — face, lips, tongue, larynx; stop immediately)
- Acute kidney injury (especially in bilateral RAS, volume depletion, NSAIDs)
- Hypotension (first dose — especially in HF, high-dose diuretics)
- Foetal harm in pregnancy
Contraindications
- History of ACE-inhibitor angioedema
- Hereditary/idiopathic angioedema
- Bilateral renal artery stenosis
- Pregnancy (2nd/3rd trimester)
- Concurrent sacubitril/valsartan
- Concurrent aliskiren in diabetics/CKD
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Listril 5mg | Sun Pharma | 30 tab ₹85 |
| Lipril 5mg | Cipla | 30 tab ₹80 |
| Linvas 5mg | Intas | 30 tab ₹75 |
| Hipril 5mg | Lupin | 30 tab ₹78 |
Monitoring Required
- Blood pressure (target < 130/80 mmHg)
- Serum creatinine and eGFR (at 1–2 weeks after start/dose change)
- Serum potassium (especially with diuretics, CKD, diabetes)
- Urine protein (nephroprotective use)
- Check for cough at each visit
Patient Counseling Points
- Take at the same time each day — with or without food
- Dry cough is common — if bothersome, an ARB (like losartan) can be substituted
- Rise slowly from sitting/lying — first-dose dizziness possible
- ⚠️ Stop immediately and go to emergency if lips, tongue, or throat swell (angioedema — rare but life-threatening)
- ⚠️ Must NOT be taken during pregnancy — inform doctor immediately if pregnant
- Avoid NSAIDs (ibuprofen, aspirin high-dose) — they reduce BP effect and harm kidneys
- Avoid potassium supplements or salt substitutes (contain potassium) without checking
Stop Googling drug references mid-consultation
EasyClinic auto-flags Listril interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Meenakshi Iyer, DM (Cardiology), Consultant Cardiologist
Last reviewed: 2026-04-01
References
- ESC Hypertension Guidelines 2023
- ESC Heart Failure Guidelines 2021
- BNF — Lisinopril
- JNC 8 Hypertension Guidelines