Nafordyl (Lisinopril Dihydrate)

• Lisinopril is an ACE inhibitor that acts on the renin‑angiotensin‑aldosterone system to control blood pressure and cardiac workload.
• Hypertension: reduces systolic and diastolic pressure, decreasing risk of cardiovascular events.
• Heart failure: improves symptoms and survival by lowering afterload and neurohormonal activation.
• Post‑myocardial infarction remodeling: limits adverse ventricular remodeling and reduces incidence of heart failure after an MI.

• Lisinopril selectively inhibits the angiotensin‑converting enzyme (ACE), preventing conversion of angiotensin I to the potent vasoconstrictor angiotensin II. This reduction diminishes vasoconstriction, aldosterone secretion, and sympathetic activation, leading to vasodilation, decreased peripheral resistance, and lowered blood pressure. The drug also increases bradykinin levels, contributing to its antihypertensive effect. By maintaining lower systemic vascular tone, it alleviates cardiac workload and supports renal perfusion.

Lisinopril may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Cough: persistent dry cough in some patients.
• Dizziness: light‑headedness, especially after standing.
• Hypotension: noticeable drop in blood pressure, particularly after first dose.

Serious or Rare Side Effects

• Angioedema: swelling of face, lips, tongue or airway, requiring immediate medical attention.
• Severe renal impairment: sudden rise in serum creatinine or reduced urine output.
• Hepatic injury: signs of liver dysfunction such as jaundice or elevated enzymes.

• Before initiating therapy with Lisinopril, clinicians should consider several safety measures.
• Monitor blood pressure: ensure target levels are achieved without excessive hypotension.
• Assess renal function: check baseline creatinine and eGFR, and monitor periodically.
• Check electrolytes: especially potassium, to avoid hyperkalaemia.
• Avoid in patients with prior angioedema: history of swelling may predispose to recurrence.
• Use caution during pregnancy: limited data; risk‑benefit assessment required.
• Store at below 25°C: keep in the original pack, protect from moisture.

Lisinopril can interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Aliskiren in diabetic patients: combined use may increase risk of renal dysfunction, hyperkalaemia, and hypotension.
• Concurrent ACE inhibitor with ARB: additive inhibition of the renin‑angiotensin system can cause severe hypotension and kidney injury.
• Potassium‑sparing diuretics: may lead to dangerous hyperkalaemia.

Moderate Interactions (Monitor Closely)

• Loop diuretics: can enhance the hypotensive effect, requiring dose adjustment.
• NSAIDs: may reduce antihypertensive efficacy and impair renal function.