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Lisinopril vs Avapro
Introduction
For patients with high blood pressure or heart disorders, certain medications that manipulate the levels of angiotensin II, a compound in the body that can cause blood vessels to narrow and release hormones that elevate your blood pressure, can be beneficial. Lisinopril and Avapro are such drugs commonly prescribed for these conditions. Both work by controlling this potent vasoconstrictor but through different mechanisms. Lisinopril is classified as an Angiotensin-Converting Enzyme (ACE) inhibitor; it impedes the production of angiotensin II resulting in relaxed blood vessels which lower the patient's blood pressure. On the contrast, Avapro falls under Angiotensin II Receptor Blockers (ARBs); instead of reducing formation, it blocks angiotensin II from binding to receptors on muscles surrounding your blood vessels thus preventing constriction.
Lisinopril vs Avapro Side By Side
| Attribute | Prinivil zestril | Avapro |
|---|---|---|
| Brand Name | Prinivil, Zestril | Avapro |
| Contraindications | Should not be taken with renin inhibitors such as aliskiren, especially in individuals with diabetes or kidney issues. Harmful to a developing fetus when used during pregnancy. | Should not be taken with renin inhibitors such as aliskiren, especially in individuals with diabetes or kidney issues. Harmful to a developing fetus when used during pregnancy. |
| Cost | Around $100 for 30 tablets of 20 mg, or approximately $3.33/day for the brand name. Generic versions start around just under $.10 per pill when bought in bulk. | Around $90 for 30 tablets of 150 mg, or approximately $3/day for the brand name. Generic versions do not typically exceed about $1.50/per day. |
| Generic Name | Lisinopril | Irbesartan |
| Most Serious Side Effect | Serious liver problems, high potassium levels causing muscle weakness, slow irregular heartbeat | Symptoms of an allergic reaction like skin rash or hives; swelling of the face, lips, tongue or throat; difficulty swallowing or breathing |
| Severe Drug Interactions | Renin inhibitors like aliskiren | Renin inhibitors like aliskiren |
| Typical Dose | 20-40 mg/day, with 20 mg/day usually adequate for most adults | 150 mg/day, can be increased to 300 mg/day if blood pressure remains uncontrolled |
What is Lisinopril?
Lisinopril (generic name for Prinivil and Zestril) is an ACE inhibitor used primarily to treat high blood pressure and heart failure. It was first approved by the FDA in 1987, similar to Fluoxetine. Lisinopril works by blocking a specific enzyme known as angiotensin-converting enzyme, which results in the dilation of blood vessels and a decrease in fluid build-up—effectively lowering overall blood pressure. On the other hand, Irbesartan (brand name Avapro) is an angiotensin II receptor antagonist that also lowers blood pressure but does so by specifically blocking receptors on smooth muscle cells within artery walls that would otherwise bind with angiotensin II—a hormone that causes constriction of these vessels. Both medications are effective at managing hypertension but may have different side effects; Lisinopril can cause dry cough while Avapro has been associated with symptoms such as dizziness or lightheadedness upon standing up too quickly due to its vasodilation effect.
What conditions is Lisinopril approved to treat?
Lisinopril is approved for the treatment of several different conditions, including:
- Hypertension, also known as high blood pressure
- Heart failure
- Acute myocardial infarction (heart attack), to improve survival in certain patients.
On the other hand, Avapro is indicated for:
- Hypertension as well
- Diabetic nephropathy with an elevated serum creatinine and proteinuria (>300 mg/day) in patients with type 2 diabetes and hypertension. In this population, Avapro reduces the rate of progression of nephropathy as measured by the occurrence of doubling of serum creatinine or end-stage renal disease.
How does Lisinopril help with these illnesses?
Lisinopril helps to manage hypertension by inhibiting the angiotensin-converting enzyme (ACE) in our body. This prevents the conversion of angiotensin I into angiotensin II, a powerful vasoconstrictor that raises blood pressure. By blocking this conversion, Lisinopril allows blood vessels to relax and widen, thus reducing blood pressure and making it easier for the heart to pump blood throughout the body. Like serotonin in depression management, angiotensin II plays an important role in regulating blood volume and systemic vascular resistance, which together influence cardiac output and arterial pressure. It is thought that individuals with high blood pressure have relatively higher levels of angiotensin II or increased sensitivity to its effects. Therefore, by limiting the production of angiotensin II through ACE inhibition, Lisinopril can limit the negative effects of hypertension and help patients control their condition.
What is Avapro?
Avapro, also known as irbesartan, is an angiotensin II receptor antagonist. This means it blocks the action of a hormone called angiotensin II in your body, which causes blood vessels to constrict and promotes the release of another hormone called aldosterone that increases sodium reabsorption. By blocking these actions, Avapro allows blood vessels to relax and expand while reducing fluid volume, thus lowering overall blood pressure. Avapro was first approved by the FDA in 1997.
Unlike ACE inhibitors like lisinopril that prevent formation of angiotensin II from its precursor molecule, Avapro works directly on blocking the effects of angiotensin II itself. Since it doesn't inhibit other enzymes like ACE inhibitors do (ACE also breaks down bradykinin), there are fewer side effects with Avapro than with lisinopril. For instance, chronic dry cough - a common side effect seen in patients taking ACE inhibitors like lisinopril - is significantly less frequent among those using Angiotensin Receptor Blockers (ARBs) such as Avapro.
The effectiveness of this drug makes it an excellent choice for managing hypertension particularly for those who can't tolerate or haven't had optimal control with ACE inhibitors.
What conditions is Avapro approved to treat?
Avapro, known as irbesartan in its generic form, has been approved by the FDA for managing:
- Hypertension (high blood pressure)
- Diabetic nephropathy (kidney disease caused by diabetes)
It's important to note that while Avapro can help manage these conditions, it is not a cure and should be used as part of an overall treatment plan under the supervision of a healthcare provider.
How does Avapro help with these illnesses?
Angiotensin II is a hormone that constricts blood vessels, leading to increased blood pressure. It also stimulates the release of another hormone, aldosterone, which further increases blood volume and thus elevates the blood pressure. Avapro works by blocking angiotensin II receptors in your body's tissues, thereby preventing its effects and resulting in lowered blood pressure. Its action on this specific pathway makes it an effective medication for hypertension or high blood pressure treatment. While Lisinopril inhibits the production of angiotensin II itself, Avapro counters by directly blocking its actions at its receptor sites throughout the body. This unique mechanism differentiates it from ACE inhibitors like Lisinopril and offers an alternative choice for patients who may not respond well to them or experience side effects.
How effective are both Lisinopril and Avapro?
Both lisinopril and irbesartan (Avapro) have proven track records in treating hypertension, with their initial FDA approvals coming within a few years of each other. As they act on different aspects of the renin-angiotensin system, they may be prescribed under varying circumstances. The efficacy of lisinopril and irbesartan in controlling blood pressure was directly compared in a randomized clinical trial conducted in 1997; both drugs demonstrated comparable effectiveness and promising safety profiles. In this study, all metrics used to measure success in managing hypertension were similar between patients receiving lisinopril or those taking irbesartan.
A 2005 meta-analysis on lisinopril confirmed its effectiveness as an antihypertensive agent starting from the first week of treatment, that it has fewer side effects than many other ACE inhibitors and is well-tolerated even among elderly populations. This study also noted that lisinopril has become one of the most widely prescribed ACE inhibitors worldwide.
On the other hand, a review published in 2016 indicated that irbesartan seems to be more effective than placebo at reducing high blood pressure and similarly effective when compared to other common antihypertensives such as thiazide diuretics or calcium channel blockers. Much like bupropion for depression treatment, Irbesartan might not always be considered as a first-line drug for treating high blood pressure but can serve as an excellent alternative option for patients who do not respond well to ACE inhibitors due to its unique mechanism of action which includes blocking angiotensin II receptors thereby relaxing blood vessels.
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At what dose is Lisinopril typically prescribed?
Oral dosages of Lisinopril range from 20-40 mg/day, but research has shown that a dosage of 20 mg/day is usually adequate for treating high blood pressure in most adults. Pediatric patients aged six years and older may be started on a dose as low as 0.07 mg/kg (up to 5 mg) once daily. The dosage can be adjusted after several weeks if the initial response is not satisfactory. However, it's crucial to note that the maximum daily dose should not exceed 80 mg for any individual under any circumstance.
At what dose is Avapro typically prescribed?
Avapro treatment typically begins with a dosage of 150 mg/day, taken once daily. The dose can then be increased to 300 mg/day if blood pressure remains uncontrolled after two weeks of therapy. However, the maximum recommended dose is 300 mg/day taken as a single dose. It's crucial that patients stick to this prescribed dosage and schedule unless advised otherwise by their healthcare provider since Avapro's effectiveness in managing hypertension or diabetic nephropathy relies on regularity and proper dosing.
What are the most common side effects for Lisinopril?
Side effects of Lisinopril and Avapro can vary, but some common ones include:
- Dizziness
- Headache
- Persistent dry cough
- Fatigue (general weakness and tiredness)
- Nausea or vomiting
- Diarrhea or constipation
- Skin rash or itching
- Lightheadedness as a result of low blood pressure
- Hyperkalemia (high levels of potassium in the blood)
If you experience any severe side effects including fainting, signs of kidney problems such as changes in the amount of urine, symptoms of high potassium blood level (muscle weakness, slow/irregular heartbeat), chest pain while taking either medication, it's crucial to seek prompt medical attention.
Are there any potential serious side effects for Lisinopril?
While both Lisinopril and Avapro are effective in controlling high blood pressure, they may have different side effects. For Lisinopril, serious but rare side effects to watch out for include:
- Signs of allergic reactions like trouble breathing, severe dizziness or swelling of the face or throat
- Fainting or feeling lightheaded when standing
- High potassium levels which might cause muscle weakness, slow irregular heartbeat
- Serious liver problems - symptoms include nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin and dark urine
On the other hand with Avapro you should be aware of these potential adverse reactions:
- An allergic reaction - symptoms can include hives; difficulty breathing; swelling on your lips, tongue throat or face.
- A decrease in urination or no urination at all
- Feeling like you might pass out (light-headed)
- Swelling accompanied by rapid weight gain If any such conditions appear while taking either medication immediately seek medical help.
What are the most common side effects for Avapro?
Some of the potential side effects of Avapro (Irbesartan) include:
- Heartburn or stomach pain
- Diarrhea, nausea, vomiting
- Tiredness, dizziness or fainting spells
- Changes in vision or blurred vision
- An irregular heartbeat or changes in your heart rate
- A decreased amount of urine passed
- Rash on your skin
- Joint and muscle pain.
While these side effects are generally rare, they can be serious. If you experience any unusual symptoms while taking Avapro, it's important to contact a healthcare provider immediately.
Are there any potential serious side effects for Avapro?
Avapro, although widely used and often well-tolerated, can sometimes cause serious side effects. These might include:
- Symptoms of an allergic reaction like skin rash or hives; swelling of the face, lips, tongue or throat; difficulty swallowing or breathing
- Little to no urination
- Rapid weight gain with swelling in your feet and ankles
- Lightheadedness leading to severe fainting spells
- Jaundice (yellowing of the eyes and skin)
- High potassium levels presenting as nausea, slow heart rate, weak pulse, increased thirst and urination
Should you experience any of these symptoms while taking Avapro, it's important that you contact your healthcare provider immediately.
Contraindications for Lisinopril and Avapro?
Both Lisinopril and Avapro, like most other antihypertensive medications, may cause side effects such as dizziness or lightheadedness. If these symptoms persist or worsen, you should seek immediate medical attention.
Neither Lisinopril nor Avapro should be taken if you are using renin inhibitors such as aliskiren, especially for individuals with diabetes or kidney issues. Always inform your healthcare provider about all the medications you are taking; renin inhibitors need an adequate washout period to prevent dangerous interactions with Lisinopril and Avapro.
In addition, both of these drugs can cause harm or death to a developing fetus when used during pregnancy. Therefore, it's vital that women who are pregnant or planning to become pregnant avoid these medications unless specifically instructed by their doctor.
How much do Lisinopril and Avapro cost?
For the brand name versions of these drugs:
- The price for 30 tablets of Avapro (150 mg) averages around $90, which works out to approximately $3/day.
- The cost for 30 tablets of Lisinopril (20 mg), or Prinivil, is about $100, working out to roughly $3.33/day.
Thus, if you are taking the standard dose for either medication (150 mg/day for Avapro and 20 mg/day for Lisinopril), then brand-name Avapro could be less expensive on a per-day treatment basis. However, remember that cost should not be your primary consideration in determining which of these drugs is right for you.
For the generic versions of Lisinopril and Avapro (Irbesartan):
- Irbesartan is available in packs from 15 up to 500 capsules (150mg each). Costs can start as low as $0.25/day if buying larger packs upfront and do not typically exceed about $1.50/per day. -Lisinopril comes in packages ranging from 15 to even over a thousand pills with similar dosages at comparable prices – starting around just under $.10 cents per pill when bought in bulk.
Popularity of Lisinopril and Avapro
Lisinopril, available in generic form and under brand names including Prinivil and Zestril, was estimated to have been prescribed to about 87.4 million people in the US in 2020. Lisinopril accounted for a significant share of ACE inhibitor prescriptions (Angiotensin-Converting Enzyme inhibitors). It is one of the most commonly used drugs from this class due to its efficacy in treating high blood pressure and heart failure.
On the other hand, Avapro (generic name irbesartan) is an angiotensin II receptor blocker (ARB), another class of medication used primarily for hypertension as well as diabetic kidney disease. In 2020, around 8.3 million Americans were prescribed Avapro or its generic versions. While it accounts for a smaller percentage when compared with lisinopril, it's still widely utilized among ARBs due to its benefits like lower side effect profile along with good effectiveness.
Conclusion
Both Lisinopril and Avapro (irbesartan) have long-standing records of usage in patients with hypertension, and are backed by numerous clinical studies indicating that they are more effective than placebo treatments. They can be used separately or together to manage high blood pressure, but this requires careful consideration by a physician as there may also be contraindications. Due to their different mechanisms of action, with Lisinopril being an angiotensin-converting enzyme (ACE) inhibitor and Avapro being an angiotensin II receptor blocker (ARB), the two drugs tend to be prescribed under different circumstances.
Lisinopril is often considered a first-line treatment option for hypertension whereas Avapro might be recommended if a patient does not respond well to ACE inhibitors or has a need to avoid certain common side effects such as persistent cough associated with ACE inhibitors like Lisinopril.
Both drugs are available in generic form, which represents significant cost savings especially for patients who must pay out of pocket. Both Lisinopril and Avapro may require an adjustment period, meaning that optimal blood pressure control may not occur immediately after initiation.
The side effect profile is comparable between the two drugs; both generally well-tolerated but each comes with its unique set of potential adverse effects – dry cough being commonly seen in Lisinopril users while dizziness might be more prevalent among those on Avapro. For both medications, regular monitoring of blood pressure is essential particularly when starting treatment or adjusting dosage.
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Refrences
- Rush, J. E., & Merrill, D. D. (1987). The Safety and Tolerability of Lisinopril in Clinical Trials. Journal of Cardiovascular Pharmacology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/00005344-198700003-00023
- Ibrahim, M. A. (2012, June 30). Reduction of Mean Arterial Pressure and Proteinuria by the Effect of ACEIs (Lisinopril) in Kurdish Hypertensive Patients in Hawler City. Global Journal of Health Science. Canadian Center of Science and Education.http://doi.org/10.5539/gjhs.v4n5p14
- Croom, K. F., Curran, M. P., Goa, K. L., & Perry, C. M. (2004). Irbesartan. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-200464090-00011
- Ali. (2009, July). Irbesartan improves arterial compliance more than lisinopril. Vascular Health and Risk Management. Informa UK Limited.http://doi.org/10.2147/vhrm.s5690
- Rashid, M., Sarfraz, M., Arafat, M., Hussain, A., Abbas, N., Sadiq, M. W., … Bukhari, N. I. (2020, July 29). Prediction of lisinopril pediatric dose from the reference adult dose by employing a physiologically based pharmacokinetic model. BMC Pharmacology and Toxicology. Springer Science and Business Media LLC.http://doi.org/10.1186/s40360-020-00429-y
- Rush, J. E., & Merrill, D. D. (1987). The Safety and Tolerability of Lisinopril in Clinical Trials. Journal of Cardiovascular Pharmacology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/00005344-198700003-00023
- Ramin, S. M., Vidaeff, A. C., Yeomans, E. R., & Gilstrap, L. C., III. (2006, December). Chronic Renal Disease in Pregnancy. Obstetrics & Gynecology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/01.aog.0000246790.84218.44