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Lisinopril vs Spironolactone
Introduction
For patients suffering from high blood pressure or heart disease, certain medications can help regulate their cardiovascular system. Lisinopril and Spironolactone are two such drugs frequently prescribed for these conditions. They each work in different ways but both serve to manage symptoms and improve overall heart health.
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that causes dilation of the blood vessels leading to a decrease in blood pressure. It works by preventing the conversion of a hormone called angiotensin I into a more potent form that can constrict the blood vessels.
Spironolactone, on the other hand, belongs to a class of drugs known as potassium-sparing diuretics (water pills). It helps your body rid itself of excess water and salt while retaining important electrolytes like potassium which most conventional diuretics tend to flush out along with unwanted fluids.
Lisinopril vs Spironolactone Side By Side
| Attribute | Prinivil zestril | Aldactone |
|---|---|---|
| Brand Name | Prinivil, Zestril | Aldactone |
| Contraindications | Should not be taken with medicines containing aliskiren, especially in patients with diabetes or kidney problems. | Should not be used in patients requiring surgery with general anesthesia and muscle relaxants without notifying the anesthesiologist. Risk increases if combined with other potassium-altering drugs. |
| Cost | Approximately $0.06 to $4 per day for generic Lisinopril | Approximately $0.14 to $7.50 per day for generic Spironolactone |
| Generic Name | Lisinopril | Spironolactone |
| Most Serious Side Effect | Serious allergic reactions, kidney problems, liver problems, low sodium levels, high potassium level. | Electrolyte imbalances, signs of stomach bleeding, kidney problems, unusual changes in mood, skin reactions. |
| Severe Drug Interactions | Medicines containing aliskiren, especially in patients with diabetes or kidney problems. | Potassium-altering drugs due to the risk of serious cardiac events. |
| Typical Dose | 10-40 mg/day, with a starting dose often at 20 mg/day | 25-100 mg per day, with adjustments based on response |
What is Lisinopril?
Lisinopril (sold under the brand names Prinivil and Zestril) is an ACE inhibitor, a class of drugs that was a significant advancement from earlier hypertension medications. Lisinopril got its FDA approval in 1987. It works by blocking a substance in the body that causes blood vessels to tighten, effectively causing them to relax for longer periods. This medication is prescribed for treating high blood pressure and heart failure, and also improves survival after heart attacks. Lisinopril primarily influences angiotensin-converting enzyme with only minor effects on other systems, resulting in it having fewer side effects than other antihypertensive drugs which have stronger effects on these other systems.
Spironolactone (brand name Aldactone), on the other hand, is a diuretic and belongs to the class of medications known as potassium-sparing diuretics. It works differently than lisinopril; spironolactone allows your body to get rid of excess fluids while preserving your potassium levels — this function makes it particularly useful for patients who are at risk of hypokalemia or low potassium levels.
What conditions is Lisinopril approved to treat?
Lisinopril is approved for the treatment of several cardiovascular conditions:
- Hypertension, also known as high blood pressure
- Heart failure in patients who do not tolerate angiotensin-converting enzyme inhibitors (ACE inhibitors)
- Reduction of risk of death or development of heart failure after a heart attack
How does Lisinopril help with these illnesses?
Lisinopril helps to manage hypertension and heart failure by inhibiting the angiotensin-converting enzyme (ACE). This enzyme is involved in a series of reactions that lead to the production of angiotensin II, a powerful vasoconstrictor. By inhibiting ACE, Lisinopril reduces levels of angiotensin II leading to blood vessel relaxation and lower blood pressure. On the other hand, Spironolactone acts as an antagonist at aldosterone receptors. Aldosterone promotes sodium retention in kidneys; when blocked by Spironolactone, this action leads to increased excretion of sodium and water which also results in lowering blood pressure. Both Lisinopril and Spironolactone are used for managing cardiovascular diseases but they operate via different mechanisms within the body's complex system regulating blood pressure.
What is Spironolactone?
Spironolactone, marketed under the brand name Aldactone among others, functions primarily as a diuretic and antihypertensive by blocking the effects of aldosterone in your body. It does this by binding to and disrupting the receptor sites where aldosterone would usually have its effects. This action helps decrease blood pressure and fluid retention caused by heart disease or kidney problems. Spironolactone was first approved for medical use in 1959. The fact that it is not an ACE inhibitor like Lisinopril means that it works differently in reducing hypertension, specifically by promoting sodium excretion and inhibiting potassium excretion at the level of the distal renal tubules. This key difference also affects its side-effect profile compared to ACE inhibitors such as Lisinopril; for instance, spironolactone can cause gynecomastia (breast enlargement) due to its anti-androgen effect whereas Lisinopril cannot cause this side effect because it lacks any hormonal activity. Its distinct mode of action makes spironolactone particularly effective for patients who don't respond well to typical antihypertensives like lisinopril.
What conditions is Spironolactone approved to treat?
Spironolactone is approved for its therapeutic application in managing:
- Primary hyperaldosteronism, a condition involving an overproduction of the hormone aldosterone
- Edematous conditions (fluid retention) for patients with congestive heart failure, cirrhosis of the liver and nephrotic syndrome
- Essential hypertension or high blood pressure without any known cause.
How does Spironolactone help with these illnesses?
Aldosterone is a hormone that plays an important role in the regulation of blood volume and pressure by helping your kidneys retain sodium and excrete potassium. Overproduction or uncontrolled action of aldosterone can lead to high blood pressure, which puts you at risk for heart disease, stroke, and other health issues. Spironolactone works by blocking the effects of aldosterone on your body, thus helping to lower blood pressure. Its actions on estrogen receptors may also contribute to its effectiveness as a medication for conditions such as acne or hair loss. Unlike Lisinopril - an ACE inhibitor that prevents the conversion of angiotensin I to angiotensin II (a potent vasoconstrictor) - Spironolactone doesn't affect levels of bradykinin, reducing the likelihood of certain side effects like coughing associated with ACE inhibitors.
How effective are both Lisinopril and Spironolactone?
Both lisinopril and spironolactone have established histories of success in treating patients with heart failure, high blood pressure, and other cardiovascular conditions. They were approved by the FDA several years apart but are both considered mainstays in modern cardiology therapy due to their proven effectiveness. Although they act on different aspects of the renin-angiotensin-aldosterone system (RAAS), which influences blood pressure control and fluid balance, they may be prescribed together or separately depending on individual patient circumstances.
The efficacy of lisinopril and spironolactone was studied directly in a 2003 randomized controlled trial for heart failure; both drugs exhibited significant reduction in mortality as well as hospitalization rates for cardiovascular reasons. A 2012 meta-analysis further confirmed that these two medications can work synergistically to reduce morbidity and mortality rates among patients with systolic heart failure.
A review from 2010 reported that lisinopril is effective at reducing blood pressure starting from the first week of treatment, its side effect profile is comparable or favorable over many other antihypertensive drugs, it has been used successfully even in elderly populations. The same study reports that lisinopril has become one of the most widely-prescribed ACE inhibitors worldwide. It's usually started at a dose around 10 mg/day but sometimes increased up to 40 mg/day based on response.
On the other hand, spironolactone is typically considered after diuretics or ACE inhibitors like lisinopril if there remains uncontrolled hypertension or symptoms suggestive of hyperaldosteronism - excessive secretion of aldosterone hormone leading to high blood pressure. Spironolactone use requires careful monitoring due to potential risks such as hyperkalemia – excess potassium levels which can affect heart function.
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At what dose is Lisinopril typically prescribed?
Oral dosages of Lisinopril range from 10-40 mg/day depending on the condition being treated, but studies have shown that a starting dose of 20 mg/day is often effective for managing high blood pressure in most adults. Children's dosage depends on body weight and should be determined by a healthcare provider. In either population, the dosage can be adjusted after a few weeks if there is no satisfactory response. The maximum dosage that should not be exceeded in any case is 80 mg/day.
Spironolactone doses vary greatly based on the specific condition it’s being used to treat -- ranging from 25-400mg daily. For heart failure treatment, many patients start with lower dosages around 12.5-25mg per day and then slowly increase as needed up to typically no more than 50mg per day under doctor supervision.
At what dose is Spironolactone typically prescribed?
Spironolactone treatment typically begins at a dosage of 25-100 mg per day. This daily dose can then be divided into single or multiple doses depending on your doctor's advice. For conditions like edema, the starting dose could range from 25-200 mg each day while for hypertension, the usual dose is 50-100mg per day. If there is no significant response to treatment after several weeks, your healthcare provider may decide to increase the dosage. However, maximum dosages should not exceed 400 mg/day and are usually divided into separate intakes spaced out throughout the day for optimal effect and patient comfort.
What are the most common side effects for Lisinopril?
Common side effects of Lisinopril can include:
- Drowsiness or fatigue
- Dry cough, sore throat, hoarseness
- Headaches and dizziness
- Nausea and vomiting
- Diarrhea or mild abdominal pain
- Rash or itching skin
- Reduced libido (sex drive)
Spironolactone, on the other hand, has its own set of common side effects such as:
- Fatigue and weakness
- Frequent urination
- Changes in menstrual periods (irregularity)
- Breast enlargement in men (gynecomastia)
- Decreased libido (sex drive)
- Mild nausea or vomiting
- Skin rash.
It is necessary to seek medical attention if these symptoms persist.
Are there any potential serious side effects for Lisinopril?
Lisinopril and Spironolactone, while both are used to manage blood pressure, have different side effects. Here's what you need to watch out for:
- Serious allergic reactions: Hives, severe stomach pain, difficulty in breathing or swallowing; swelling of the face, lips, tongue or throat.
- Kidney problems: Little or no urination; painful or difficult urination; swelling in your feet or ankles; feeling tired or short of breath.
- Liver problems: Nausea, upper stomach pain; itching, tiredness; loss of appetite; dark urine (like tea), clay-coloured stools ; jaundice (yellowing of the skin and eyes).
- Low sodium levels - headache with chest pain and severe dizziness fluttering in your chest , pounding heartbeats.
- High potassium level - nausea , weakness , tingly feeling , chest pain irregular heartbeats . Signs of too much acid in your blood -- confusion , uneven heart rate extreme thirst .
If you experience these symptoms after taking Lisinopril/Spironolactone it is important that you seek medical attention immediately.
What are the most common side effects for Spironolactone?
Spironolactone, which is often used to treat fluid retention and high blood pressure, can cause a range of side effects. These may include:
- Nausea, vomiting or stomach upset
- Diarrhea or constipation
- Dizziness or light-headedness
- An increase in urination frequency
- Unusual hair growth or loss
- Mental/mood changes such as confusion, restlessness, and decreased sexual drive.
On rare occasions, muscle pain or weakness might be experienced. Although less common than some other side effects, it's essential to report any signs of rash immediately to your healthcare provider due to the risk of serious allergic reaction. It is also important not to stop taking Spironolactone without consulting with your doctor first because sudden discontinuation can cause rapid heartbeat among other complications.
Are there any potential serious side effects for Spironolactone?
While Spironolactone is generally well-tolerated, it can occasionally cause serious side effects. These may include:
- Signs of an allergic reaction: hives, difficulty breathing or swallowing, swelling in your face or throat
- Electrolyte imbalances that could potentially result in muscle pain or weakness, irregular heart rate, severe thirst and dry mouth
- Signs of stomach bleeding: bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds
- Kidney problems such as little to no urination; painful and difficult urination; swelling in the feet and ankles; feeling tired and short of breath
- Unusual changes in mood including confusion and restlessness
- Skin reactions such as rash, itching and peeling skin
If you experience any of these symptoms while taking spironolactone you should consult with a healthcare provider immediately.
Contraindications for Lisinopril and Spironolactone?
Both Lisinopril and Spironolactone, like many heart medications, may cause side effects. If you notice a significant increase in symptoms such as feeling lightheaded or fainting, particularly after standing up from a sitting or lying position, consult your doctor immediately.
Neither lisinopril nor spironolactone should be taken if you are also taking medicines containing aliskiren (a blood pressure medication), especially if you have diabetes or kidney problems. Always inform your healthcare provider about any medications you are currently using; discontinuing the use of certain drugs will require some time to clear from your system to prevent dangerous interactions with lisinopril and spironolactone.
For patients on spironolactone therapy who need surgery requiring muscle relaxants under general anesthesia, it’s crucial to notify the anesthesiologist prior due to potential drug interactions. In addition, both these medications can alter potassium levels in your body that could lead to serious cardiac events—if combined with other potassium-altering drugs this risk increases so regular monitoring is recommended.
How much do Lisinopril and Spironolactone cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Prinivil (Lisinopril, 20 mg) averages around $120, which works out to about $4/day.
- The price for a similar quantity of Aldactone (Spironolactone, 100 mg) is approximately $225, working out to roughly $7.50/day.
Therefore, if you are prescribed equal doses for each drug, then brand-name Prinivil would be less expensive on a per-day treatment basis. However cost should not be your only consideration in determining which medication is right for you.
Regarding generic alternatives:
-
Generic Lisinopril is available in packs ranging from 10 up to several hundred tablets with strengths varying between 2.5 mg and 40 mg. Costs can run as low as approximately $0.06 per day if buying larger quantities upfront.
-
Generic spironolactone comes in tablet sizes from 25mg up to 100mg with usually similar pack options as lisinopril and costs starting at roughly about $0.14 per day when buying the largest pack size offered.
Remember that it's crucial to consult with your healthcare provider or pharmacist before making any decisions regarding medications based solely on cost considerations.
Popularity of Lisinopril and Spironolactone
Lisinopril, both in its generic form and under various brand names such as Prinivil and Zestril, was estimated to have been prescribed to about 87.4 million people in the US in 2020. Lisinopril accounted for just over 23% of ACE inhibitor prescriptions in the US. It is one of the most commonly used medications within this category, having consistently high prevalence figures over several years.
Spironolactone, including brand versions like Aldactone, was prescribed to approximately 3.1 million individuals within the USA during that same year. In terms of prescriptions across all diuretics (a class which also includes drugs like hydrochlorothiazide and furosemide), spironolactone accounts for roughly around 8%. Its use has been generally increasing since it has shown benefits beyond lowering blood pressure - particularly with heart failure patients - leading to a steady increase over recent years.
Conclusion
Lisinopril and spironolactone are both well-established medications used in the management of heart-related conditions, with numerous clinical studies and meta-analyses supporting their effectiveness over placebo. In certain circumstances, these drugs may be co-administered but this should only occur under careful supervision by a physician due to potential interactions. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that primarily works by relaxing blood vessels and reducing the workload on the heart, while spironolactone is a potassium-sparing diuretic that helps eliminate excess fluid from the body without causing potassium loss.
Lisinopril is often considered as first-line treatment for hypertension or congestive heart failure, whereas spironolactone may be added as adjunct therapy or utilized in patients who fail to respond sufficiently to ACE inhibitors alone or those suffering from edema due to liver cirrhosis.
Both lisinopril and spironolactone are available as generics thus providing significant cost savings especially for patients paying out-of-pocket. An adjustment period might be required when starting these medications which means therapeutic benefits might not become noticeable immediately.
The side effect profile between these two drugs varies; lisinopril can cause dry cough while Spironolactone has been associated with gynecomastia (breast enlargement) in men. Both drugs generally have good tolerability but require close monitoring of kidney function and electrolyte levels during treatment initiation or dose adjustments. Patients must seek immediate medical attention if they experience severe lightheadedness, fainting spells or changes in urination patterns.
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Refrences
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- Skluth, H. A., & Gums, J. G. (1990, January). Spironolactone: A Re-Examination. Dicp. SAGE Publications.http://doi.org/10.1177/106002809002400112
- Bradley, C. (2000, December). Spironolactone in heart failure – a revived role for an old drug. Intensive and Critical Care Nursing. Elsevier BV.http://doi.org/10.1054/iccn.2000.1544
- Donohoe, J. F., Laher, M., Doyle, G. D., Long, C., Glover, D. R., & Cooper, W. D. (1987). Lisinopril Treatment of Hypertension in Patients with Impaired Renal Function. Gerontology. S. Karger AG.http://doi.org/10.1159/000212917
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- Benraad, H., Drayer, J., Hoefnagels, W., Kloppenborg, P., & Benraad, T. (1978, December). Role of aldosterone in the antihypertensive effect of spironolactone in essential hypertension. Clinical Pharmacology & Therapeutics. Wiley.http://doi.org/10.1002/cpt1978246638
- Dickstein, K., Aarsland, T., Woie, L., Abrahamsen, A. M., Fyhrquist, F., Cummings, S., … Kristianson, K. (1986, July). Acute hemodynamic and hormonal effects of lisinopril (MK-521) in congestive heart failure. American Heart Journal. Elsevier BV.http://doi.org/10.1016/0002-8703(86)90689-7