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-The antihypertensive effect may diminish toward the end of the dosing interval regardless of the administered dosebut most commonly with a dose of 10 mg or less dailyThis can be evaluated by measuring blood pressure just prior to dosing to determine whether satisfactory control is being maintained for 24 hoursIf it is notan increase in dose should be consideredIf blood pressure is not adequately controlled with lisinopril alonea diuretic may be addedAfter the addition of a diureticit may be possible to reduce the dose of lisinoprilIn all high risk patientssuch as patients with ischemic heart or cerebrovascular diseasein whom excessive falls in blood pressure may lead to myocardial infarction or cerebrovascular accident the manufacturer advises treatment initiation at lower dosagesDosage adjustments in the elderly should be made with particular cautionIn patients who are currently being treated with a diureticsymptomatic hypotension occasionally can occur following the initial doseTo reduce the likelihood of hypotensionthe diuretic shouldif possiblebe discontinued 2 to 3 days prior to beginning therapyThenif blood pressure is not controlled with lisinopril alonediuretic therapy should be resumedIf diuretic therapy cannot be discontinuedan initial dose of 5 mg should be used with careful medical supervision for several hours and until blood pressure has stabilized.
CommentsTherapy should be initiated at 2.5 mg in patients with a low systolic blood pressureless than or equal to 120 mm Hg and greater than 100 mmHgduring the first 3 days after the infarctIf prolonged hypotension occurssystolic blood pressure less than 90 mmHg for more than 1 hourtherapy should be withdrawn.
If you need to go to hospitaldon’t drive yourselfget someone else to drive you or call for an ambulanceTake the lisinopril packet or leaflet inside it plus any remaining medicine with you.
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