Lisinopril pregnancy category
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Lisinopril Pregnancy Category: Risks and Considerations
Introduction to Lisinopril and Pregnancy
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is commonly used to manage hypertension and heart failure. However, its use during pregnancy is highly controversial due to significant risks to the fetus, particularly in the second and third trimesters.
Risks Associated with Lisinopril Use in Pregnancy
Fetal and Neonatal Complications
The use of lisinopril during pregnancy has been linked to severe fetal and neonatal complications. These include renal dysfunction, which is likely due to fetal hypotension and decreased glomerular filtration. In a study of 14 cases, six neonates experienced renal failure leading to death, while the remaining eight required peritoneal dialysis, with some suffering from residual renal impairment3. This highlights the critical risks associated with lisinopril use beyond the first trimester.
Case Report: Severe Hypertension Management
A case report detailed the treatment of a 39-year-old pregnant woman with chronic hypertension who was initially managed with lisinopril. Despite the known risks, the patient continued with the pregnancy, resulting in the birth of a preterm infant at 26 weeks. The neonate experienced initial renal failure and necrotizing enterocolitis but eventually recovered. This case underscores the potential for severe neonatal complications and the necessity for careful consideration and counseling when using ACE inhibitors during pregnancy1.
Recommendations for Lisinopril Use in Pregnancy
First Trimester Use
While ACE inhibitors, including lisinopril, are generally considered acceptable during the first trimester, their use is not without risks. Fetal malformations and neonatal complications have been documented, necessitating a thorough risk-benefit analysis and close monitoring1.
Beyond the First Trimester
The consensus among healthcare professionals is that lisinopril should not be used beyond the first trimester due to the high risk of adverse fetal outcomes. In exceptional cases where severe hypertension cannot be controlled with other medications, lisinopril may be considered, but only with comprehensive counseling about the potential risks and close monitoring of both mother and fetus1 3.
Conclusion
Lisinopril poses significant risks when used during pregnancy, particularly in the second and third trimesters. The potential for severe fetal and neonatal complications, including renal failure and death, necessitates extreme caution. Healthcare providers must weigh the benefits against the risks and ensure that patients are fully informed about the potential adverse outcomes. In most cases, alternative treatments should be sought to manage hypertension during pregnancy.
Sources and full results
Most relevant research papers on this topic
Low‐Dose Lisinopril in Normotensive Men With Idiopathic Oligospermia and Infertility: A 5‐Year Randomized, Controlled, Crossover Pilot Study
Prolonged treatment with 2.5 mg/day oral lisinopril may be well-tolerated in normotensive men with idiopathic oligospermia, improve sperm quantity and quality, and enhance fertility in approximately half of those treated.
RCT
Rigorous JournalFetal Exposure to Lisinopril: Neonatal Manifestations and Management
Early dialysis is recommended for infants with renal failure after maternal lisinopril therapy, as the drug has a prolonged half-life and suppresses ACE activity and renal function.
Case ReportLisinopril
Lisinopril is a prescription drug used to treat high blood pressure, protect kidneys in diabetes, and reduce the risk of death during a heart attack.
Early dialysis in a neonate with intrauterine lisinopril exposure
Early peritoneal dialysis can effectively treat lisinopril-induced multiorgan failure in neonates, with potential for better drug clearance through haemodialysis or haemofiltration.
Case ReportTeratogenic Effect of Ace Inhibitor (Lisinopril) and Chrysanthemum Indicum(Guldaudi) on Head and Face Region of Mice Fetuses
Lisinopril and Guldaudi, both ACE inhibitors, can cause malformations in mice fetuses when administered to pregnant mice, with oligohydramnios and hypoxia as potential causes.
Non-RCT
Animal StudyEffect of the ACE inhibitor lisinopril on mortality in diabetic patients with acute myocardial infarction: data from the GISSI-3 study.
Early treatment with lisinopril in diabetic patients with acute MI is associated with a decreased 6-week mortality.
RCT
Large Human Trial
Highly CitedOral Lisinopril Raises Tissue Levels of ACE2, the SARS-CoV-2 Receptor, in Healthy Male and Female Mice
Oral lisinopril increases ACE2 in tissues relevant to COVID-19 transmission and pathogenesis, but the addition of losartan prevents these increases in ACE2 levels.
RCTAnimal StudyEffect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes
Lisinopril may slow retinopathy progression in non-hypertensive patients with type 1 diabetes and little or no nephropathy.
RCTLarge Human TrialHighly CitedEffect of angiotensin-converting enzyme (ACE) gene polymorphism on progression of renal disease and the influence of ACE inhibition in IDDM patients: findings from the EUCLID Randomized Controlled Trial. EURODIAB Controlled Trial of Lisinopril in IDDM.
ACE inhibitor treatment can slow renal disease progression in type II diabetes mellitus patients, with lisinopril showing the most significant benefit for this group.
RCTLarge Human TrialHighly Cited