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Prinivil

Prinivil
Prinivil is an angiotensin-converting enzyme (ACE) inhibitor that is used in the treatment of hypertension and to manage heart failure. Prinivil helps blood vessels relax and may also be prescribed to improve the chances of survival post a heart attack.

Brand: Lisinopril

Availability: In Stock
Average Delivery Time: 9 Days
Exp. Date: March 2024
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Package Price Per pill Save Order
Prinivil 10 mg
270 pills - 10 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$249.03 $0.92 $228.42 Add to cart
180 pills - 10 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$175.95 $0.98 $142.35 Add to cart
120 pills - 10 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$126.99 $1.06 $85.21 Add to cart
90 pills - 10 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$102.99 $1.14 $56.16 Add to cart
60 pills - 10 mg $77.03 $1.28 $29.07 Add to cart
30 pills - 10 mg $53.05 $1.77 No Add to cart
Prinivil 5 mg
270 pills - 5 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$183.55 $0.68 $178.70 Add to cart
180 pills - 5 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$129.99 $0.72 $111.51 Add to cart
120 pills - 5 mg $93.95 $0.78 $67.05 Add to cart
90 pills - 5 mg $76.93 $0.85 $43.82 Add to cart
60 pills - 5 mg $59.95 $1.00 $20.55 Add to cart
30 pills - 5 mg $40.25 $1.34 No Add to cart
Prinivil 2.5 mg
270 pills - 2.5 mg $61.55 $0.23 $95.73 Add to cart
180 pills - 2.5 mg $49.99 $0.28 $54.86 Add to cart
120 pills - 2.5 mg $41.95 $0.35 $27.95 Add to cart
90 pills - 2.5 mg $37.97 $0.42 $14.46 Add to cart
60 pills - 2.5 mg $34.95 $0.58 No Add to cart

Product description

Drug Title

Prinivil (Lisinopril)

Pharmacological action

ACE inhibitor, reduces the formation of angiotensin II from angiotensin I. Reduction of angiotensin II leads to a direct reduction of aldosterone secretion. Reduces bradykinin degradation and increases prostaglandin synthesis.


Reduces total peripheral vascular resistance, blood pressure (BP), preload, pulmonary capillary pressure, causes an increase in minute blood volume and increases myocardial exercise tolerance in patients with chronic heart failure. Dilates arteries to a greater extent than veins. Some effects are explained by the effect on tissue renin-angiotensin systems. Long-term use reduces myocardial hypertrophy and resistive arterial wall hypertrophy. It improves the blood supply to the ischemic myocardium.


ACE inhibitors prolong life expectancy in patients with chronic heart failure, slow the progression of left ventricular dysfunction in patients who have had myocardial infarction without clinical manifestations of heart failure. Antihypertensive effect starts after approximately 6 hours and lasts for 24 hours. The duration of the effect also depends on the dose. Onset of action is in 1 hour. The maximum effect is determined after 6-7 hours. In case of arterial hypertension, the effect is noted during the first days after the start of treatment, the stable effect develops after 1-2 months. No pronounced increase in BP was observed when the drug was abruptly withdrawn.


In addition to BP reduction, Prinivil (Lisinopril) reduces albuminuria. In patients with hyperglycemia, it normalizes the function of the damaged glomerular endothelium.


Prinivil (Lisinopril) does not affect blood glucose concentration in diabetic patients and does not lead to increased incidence of hypoglycemia.


Pharmacokinetics

Absorption


After oral administration, about 25% of Prinivil (Lisinopril) is absorbed from the gastrointestinal tract. Food intake does not affect absorption of the drug. Absorption is on average 30%, bioavailability 29%.


Distribution


Almost not bound to plasma proteins. Cmax in blood plasma (90 ng/ml) is reached after 7 hours. Low permeability through the blood-brain and placental barrier.


Metabolism


Prinivil (Lisinopril) is not biotransformed in the body.


Excretion


It is excreted unchanged by the kidneys. T1/2 is 12 hours.


Pharmacokinetics in selected groups of patients


Absorption and clearance of lisinopril are decreased in patients with chronic heart failure.


In patients with renal failure, lisinopril concentrations are several times higher than plasma concentrations in volunteers, with increased time to reach Cmax in plasma and increased T1/2.


In elderly patients, plasma concentrations and area under the curve are twice as high as in younger patients.



Contraindications to use

  • History of angioedema, including from the use of ACE inhibitors;
  • hereditary Quincke's edema;
  • Under 18 years of age (efficacy and safety have not been established);
  • Hypersensitivity to lisinopril or other ACE inhibitors.


The tablets contain lactose; therefore, the drug should not be taken by patients with rare hereditary diseases, such as galactose intolerance, lactase deficiency or glucose-galactose malabsorption.


Caution: marked renal dysfunction, bilateral renal artery stenosis or stenosis of the artery of the single kidney with progressive azotemia, conditions after renal transplantation, renal failure, azotemia, hyperkalemia, aortic stenosis, hypertrophic obstructive cardiomyopathy, primary hyperaldosteronism, arterial hypotension, cerebrovascular disease (including cerebrovascular insufficiency). including insufficiency of cerebral circulation), coronary heart disease, coronary insufficiency, autoimmune systemic connective tissue diseases (including scleroderma, systemic lupus erythematosus); inhibition of bone marrow hematopoiesis; diet with sodium restriction: hypovolemic states (including those due to diarrhea, vomiting); old age.


Administration during pregnancy and lactation

The use of lisinopril during pregnancy is contraindicated. If pregnancy is established, the drug should be discontinued as soon as possible. Administration of ACE inhibitors in II and III trimester of pregnancy has adverse effects on the fetus (marked BP decrease, renal failure, hyperkalemia, cranial hypoplasia, fetal death are possible). There are no data on the negative effects of the drug on the fetus in case of its use during the first trimester. Newborns and infants who have been intrauterine exposed to ACE inhibitors are recommended to be closely monitored for timely detection of marked BP decrease, oliguria, hyperkalemia.


Lisinopril penetrates through the placenta. There are no data on permeation of Lisinopril into breast milk. Breast-feeding should be stopped during treatment with the drug.


Administration in renal dysfunction

Caution: expressed renal dysfunction, bilateral renal artery stenosis or stenosis of artery of a single kidney with progressive azotemia, conditions after renal transplantation, renal failure, azotemia, hyperkalemia.

Administration in children

contraindication: age under 18 years (efficacy and safety have not been established);

Indications of the drug Lisinopril

  • Arterial hypertension (in monotherapy or in combination with other antihypertensive agents);
  • chronic heart failure (as part of combination therapy for the treatment of patients taking foxglove drugs and/or diuretics);
  • early treatment of acute myocardial infarction (in the first 24 h with stable hemodynamic parameters to maintain these parameters and prevent left ventricular dysfunction and heart failure);
  • diabetic nephropathy (reduction of albuminuria in insulin-dependent patients with normal BP and insulin-independent patients with arterial hypertension).

Dosing regimen

Orally, regardless of meals. In patients with arterial hypertension who are not receiving other hypotensive agents, 5 mg once daily is prescribed. If there is no effect, the dose is increased every 2-3 days by 5 mg to an average therapeutic dose of 20-40 mg/day (an increase in dose over 40 mg/day usually does not lead to further BP reduction). The usual daily maintenance dose is 20 mg. The maximum daily dose is 40 mg.


The full effect usually develops in 2-4 weeks from the beginning of treatment, which should be taken into account when increasing the dose. In case of insufficient clinical effect, the drug may be combined with other hypotensive agents.


If the patient has received prior treatment with diuretics, the intake of such drugs should be discontinued 2-3 days before the start of Lisinopril. If this is not feasible, the initial dose of Lisinopril should not.exceed 5 mg/day. In this case, after the first dose, medical supervision for several hours (maximum action is achieved after about 6 hours) is recommended, as a marked decrease in BP may occur.


In renovascular hypertension or other conditions with increased activity of renin-angiotensin-aldosterone system it is reasonable to administer also low initial dose - 2.5-5 mg/day, under increased medical supervision (BP control, renal function, serum potassium concentration). The maintenance dose, while continuing close medical supervision, should be determined depending on the dynamics of BP.


In renal failure, due to the fact that lisinopril is excreted through the kidneys, the initial dose should be determined according to creatinine clearance, then according to the response, the maintenance dose should be set under frequent monitoring of renal function, serum potassium, sodium levels.

In persistent arterial hypertension, long-term maintenance therapy of 10-15 mg/day is indicated.


In chronic heart failure, start with 2.5 mg once daily, then increase the dose by 2.5 mg after 3-5 days to the usual, maintenance daily dose of 5-20 mg. The dose should not exceed 20 mg/day.


Elderly people often have a more pronounced long-term hypotensive effect due to a decreased excretion rate of lisinopril (it is recommended to start treatment with 2.5 mg/day).


Acute myocardial infarction (as part of combination therapy)


On the first day, 5 mg orally, then 5 mg every other day, 10 mg after two days and then 10 mg once daily. In patients with acute myocardial infarction, the drug should be used for at least 6 weeks. At the beginning of treatment or during the first 3 days after acute myocardial infarction in patients with low systolic blood pressure (120 mm Hg or lower) a lower dose of 2.5 mg should be administered. In case of BP decrease (systolic BP below or equal to 100 mmHg), the daily dose of 5 mg may be temporarily reduced to 2.5 mg, if necessary. In case of prolonged marked BP lowering (systolic BP below 90 mmHg for more than 1 hour), treatment with Lisinopril should be stopped.


Diabetic nephropathy.


In patients with insulin-independent diabetes mellitus, 10 mg of Lisinopril once daily is used. The dose can be increased to 20 mg once daily, if necessary, in order to achieve a diastolic BP below 75 mmHg in sitting position. In patients with insulin-dependent diabetes mellitus, the dosage is the same, in order to achieve diastolic BP values below 90 mmHg in sitting position.