Drugs List

Therapeutic Indications

Uses

Acute myocardial infarction if given within 24 hours of onset of symptoms
Congestive heart failure
Diabetic nephropathy
Hypertension

Unlicensed Uses

Nephritis

Contraindications

Children under 6 years
Within 36 hours of discontinuing a sacubitril containing product
Breastfeeding
Cardiogenic shock
Haemodialysis with high flux membranes
Haemodynamic instability
Hereditary angioneurotic oedema
Hypotension - if treating myocardial infarction
Idiopathic angioneurotic oedema
Pregnancy
Renal artery stenosis
Renal impairment in children under 18 years where eGFR <30ml/min/1.73m sq

Precautions and Warnings

Children aged 6 to 18 years
Desensitisation therapy
Immunosuppression
Aortic stenosis
Atherosclerosis
Cerebral ischaemia
Collagen vascular disease
Hyperkalaemia
Hypertrophic cardiomyopathy
Hyponatraemia
Hypotension
Hypovolaemia
Ischaemic heart disease
Left ventricular outflow obstruction
Mitral stenosis
Peripheral vascular disease
Renal impairment - creatinine clearance below 80ml/min
Renovascular disorder
Severe renin-dependent hypertension
Uncontrolled cardiac failure

Adjustment of hypoglycaemic therapy may be necessary in diabetes mellitus
Anaesthetist should be made aware patient is taking this medication
Patients with primary aldosteronism may not benefit from this treatment
Reduce dose in patients with creatinine clearance below 80ml/min
Advise ability to drive/operate machinery may be affected by side effects
Advise patient that first dose hypotension may occur
Afro-Caribbean or black patients may show reduced response
Correct volume and/or salt depletion before initiating therapy
Exclude renovascular disorder before treatment
Not all available brands are licensed for all age groups
Place patient in supine position if severe hypotension occurs
Evaluate renal function before and during treatment
Monitor serum electrolytes before and during treatment
Consider monitoring white blood cell counts in collagen vascular disease
Monitor serum potassium regularly
Advise patient to report symptoms of infection immediately
Higher incidence of angioedema in black patients
Increased risk of hyperkalaemia with K+ suppl. and K+ sparing diuretic
Withdraw before apheresis
Withdraw before desensitisation
Advise patient to seek advice at first indications of pregnancy
Discontinue if jaundice or other evidence of hepatic impairment occurs
Discontinue if laryngeal stridor/angioedema of face/tongue or glottis
Discontinue or reduce dose if renal impairment worsens
Dosage must be individualised for each patient, especially children
Not licensed for all indications in all age groups
Advise patient not to take NSAIDs unless advised by clinician
Hypotensive effect enhanced by alcohol
Advise on problems of salt substitutes/high intake of potassium-rich food
Female: Ensure adequate contraception during treatment

Initiate treatment with caution in patients receiving diuretics.

Renal function must be monitored before and during treatment in all patients. Although ACE inhibitors have a specialised role in the management of some forms of renal disease, they also occasionally cause impairment of renal function which may be progressive and severe. The elderly are at particular risk. If renal dysfunction (serum creatinine exceeding 265micromol/l or a doubling from pre-treatment levels - whichever is greater) develops during treatment with lisinopril, the physician should consider withdrawal of therapy. Renal failure has been associated with ACE inhibitors and has been mainly observed in patients with severe congestive heart failure or underlying renal disease including renal artery stenosis. If recognised promptly and treated, renal failure is usually reversible. Use with caution in patients with bilateral renal artery stenosis or with stenosis of an artery to a solitary functioning kidney.

Angioedema of the extremities, face, lips, tongue, glottis and/or larynx may occur at any time during treatment with ACE inhibitors and in some cases can be fatal. In all cases, lisinopril should be discontinued promptly and appropriate treatment and monitoring instituted to ensure complete resolution of symptoms prior to dismissing the patient. Patients may require prolonged observation since treatment with antihistamines and corticosteroids may not be sufficient. Patients with a history of angioedema unrelated to ACE inhibitors may be at increased risk of angioedema while receiving an ACE inhibitor.

Pregnancy and Lactation

Pregnancy

Lisinopril is contraindicated in pregnancy.

Lisinopril is not teratogenic in mice, rats and rabbits with doses below 55, 33 and 0.15 times, respectively, the maximum recommended human daily dose. However, the use of ACE inhibitors is not recommended during the first trimester of pregnancy. Foetal exposure to lisinopril after the first trimester has been associated with teratogenicity and severe toxicity, similar to that seen with captopril and enalapril. The cause of this toxicity is thought to be due to foetal hypotension and decreased renal blood flow. Lisinopril may lead to in utero renal failure due to the prevention of conversion of angiotensin I to angiotensin II. Prolonged hypotension may follow as the primary method of removal of this drug is via the kidneys and impairment of this system in the newborn prevents elimination of the drug (Briggs, 2011).

ACE inhibitors are contraindicated during the second and third trimesters of pregnancy as exposure during these trimesters is known to induce human foetal toxicity (renal dysfunction, oligohydramnios, pulmonary hypoplasia, patent ductus arteriosus, delay in skull ossification, hypoxia, renal tubular dysgenesis, neonatal toxicity and even death). Severe and sometimes fatal anuria in the foetus and in the newborn have been observed and is thought to be caused by the compromise of the foetal renal system. Foetal renal failure resulting from in utero exposure to ACE inhibitors has been reported where dialysis has been required shortly after birth. Evidence of a risk of teratogenicity after first trimester exposure is conflicting, however, the MHRA recommends that a risk cannot be excluded. The MHRA states that the use of ACE inhibitors in late pregnancy has been associated with adverse effects on the kidney and other congenital anomalies, therefore ACE inhibitors should not be used at any stage during of pregnancy unless absolutely necessary and only then after the potential risks and benefits have been discussed with the patient. Spontaneous abortions and premature births have also been reported following administration with ACE inhibitors.

If exposure has occurred in the first trimester a detailed ultrasound diagnosis is advisable. Exposure to an ACE inhibitor during pregnancy is not an indication for either invasive diagnostic procedures or termination of pregnancy. In cases involving long term prenatal therapy in the second and/ or third trimesters, the foetus should be monitored for the potential development of oligohydramnios, and foetal growth should be assessed with detailed ultrasound scans (Schaefer, 2007). Infants whose mothers have taken ACE inhibitors should be closely monitored for hypotension and renal dysfunction.

Unless treatment with an ACE inhibitor is considered absolutely essential, women who are planning to become pregnant should be switched to an alternative drug with an established safety record. Guidelines advise that women who are taking ACE for chronic hypertension in pregnancy, or are planning pregnancy, are told that there is an increased risk of congenital abnormalities if these drugs are taken and other antihypertensive treatments should be discussed and offered.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Lisinopril is contraindicated in breastfeeding.

It is unknown whether lisinopril is excreted in human milk, however, because of its low molecular weight its passage into breast milk should be expected. The drug is excreted in the milk of lactating rats. Hale states that no paediatric concerns have been reported following the use of lisinopril. Schaefer (2007) comments that accidental prescribing of lisinopril does not require limiting of breastfeeding but therapy should be changed. Guidelines advise that women who still need antihypertensive treatment in the post natal period are informed that there is insufficient evidence on the safety in babies receiving breast milk from a mother taking ACE inhibitors other than enalapril and captopril.

The MHRA concludes that although ACE inhibitors are not generally recommended for use by breastfeeding mothers they are not all absolutely contraindicated and some may be prescribed if treatment is considered essential, however ACE inhibitors should not be used by breastfeeding mothers in the first few weeks after delivery because of possible profound neonatal hypotension particularly in preterm infants. The MHRA has stated that lisinopril is not recommended during breastfeeding. If ACE inhibitor therapy is considered essential for the mother the use of captopril, enalapril or quinapril may be considered when the infant is older. The infant should be carefully followed up for signs of hypotension should ACE inhibitor treatment be deemed necessary. Hale (2014) suggests that the newborn is also observed for weakness.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Accelerated erythrocyte sedimentation
Acute renal failure
Agranulocytosis
Allergic alveolitis
Alopecia
Altered liver function tests
Anaemia
Angioedema
Anuria
Arthralgia
Asthenia
Autoimmune disorders
Blood urea increased
Bone marrow depression
Bronchospasm
Cerebrovascular accident
Confusion
Cough
Decrease in haematocrit
Decrease in haemoglobin
Depressive symptoms
Diarrhoea
Dizziness
Dry mouth
Dyspepsia
Eosinophilia
Eosinophilic pneumonia
Erythema multiforme
Fatigue
Fever
Gynaecomastia
Haemolytic anaemia
Hallucinations
Headache
Hepatic failure
Hepatitis
Hyperkalaemia
Hypersensitivity reactions
Hypoglycaemia
Hyponatraemia
Hypotension
Impotence
Inappropriate secretion of antidiuretic hormone
Increase in antinuclear antibodies (ANA)
Jaundice
Leucocytosis
Leucopenia
Lymphadenopathy
Mood changes
Myalgia
Myocardial infarction
Nausea
Neutropenia
Olfactory senses altered
Oliguria
Orthostatic hypotension
Palpitations
Pancreatitis
Paraesthesia
Pemphigus
Photosensitivity
Pruritus
Pseudolymphoma
Psoriasis
Rash
Raynaud's phenomenon
Renal impairment
Rhinitis
Serum bilirubin increased
Serum creatinine increased
Sinusitis
Sleep disturbances
Stevens-Johnson syndrome
Sweating
Syncope
Tachycardia
Taste disturbances
Thrombocytopenia
Toxic epidermal necrolysis
Uraemia
Urticaria
Vasculitis
Vertigo
Vomiting

Presentation

Oral formulations of lisinopril as lisinopril dihydrate

Drugs List

Therapeutic Indications

Uses

Acute myocardial infarction if given within 24 hours of onset of symptoms
Congestive heart failure
Diabetic nephropathy
Hypertension

Unlicensed Uses

Nephritis

Dosage

Doses should be individualised according to patient profile and blood pressure response.

Adults

Elderly

Children

Patients with Renal Impairment

Additional Dosage Information

Contraindications

Children under 6 years
Within 36 hours of discontinuing a sacubitril containing product
Breastfeeding
Cardiogenic shock
Haemodialysis with high flux membranes
Haemodynamic instability
Hereditary angioneurotic oedema
Hypotension - if treating myocardial infarction
Idiopathic angioneurotic oedema
Pregnancy
Renal artery stenosis
Renal impairment in children under 18 years where eGFR <30ml/min/1.73m sq

Precautions and Warnings

Children aged 6 to 18 years
Desensitisation therapy
Immunosuppression
Aortic stenosis
Atherosclerosis
Cerebral ischaemia
Collagen vascular disease
Hyperkalaemia
Hypertrophic cardiomyopathy
Hyponatraemia
Hypotension
Hypovolaemia
Ischaemic heart disease
Left ventricular outflow obstruction
Mitral stenosis
Peripheral vascular disease
Renal impairment - creatinine clearance below 80ml/min
Renovascular disorder
Severe renin-dependent hypertension
Uncontrolled cardiac failure

Adjustment of hypoglycaemic therapy may be necessary in diabetes mellitus
Anaesthetist should be made aware patient is taking this medication
Patients with primary aldosteronism may not benefit from this treatment
Reduce dose in patients with creatinine clearance below 80ml/min
Advise ability to drive/operate machinery may be affected by side effects
Advise patient that first dose hypotension may occur
Afro-Caribbean or black patients may show reduced response
Correct volume and/or salt depletion before initiating therapy
Exclude renovascular disorder before treatment
Not all available brands are licensed for all age groups
Place patient in supine position if severe hypotension occurs
Evaluate renal function before and during treatment
Monitor serum electrolytes before and during treatment
Consider monitoring white blood cell counts in collagen vascular disease
Monitor serum potassium regularly
Advise patient to report symptoms of infection immediately
Higher incidence of angioedema in black patients
Increased risk of hyperkalaemia with K+ suppl. and K+ sparing diuretic
Withdraw before apheresis
Withdraw before desensitisation
Advise patient to seek advice at first indications of pregnancy
Discontinue if jaundice or other evidence of hepatic impairment occurs
Discontinue if laryngeal stridor/angioedema of face/tongue or glottis
Discontinue or reduce dose if renal impairment worsens
Dosage must be individualised for each patient, especially children
Not licensed for all indications in all age groups
Advise patient not to take NSAIDs unless advised by clinician
Hypotensive effect enhanced by alcohol
Advise on problems of salt substitutes/high intake of potassium-rich food
Female: Ensure adequate contraception during treatment

Initiate treatment with caution in patients receiving diuretics.

Renal function must be monitored before and during treatment in all patients. Although ACE inhibitors have a specialised role in the management of some forms of renal disease, they also occasionally cause impairment of renal function which may be progressive and severe. The elderly are at particular risk. If renal dysfunction (serum creatinine exceeding 265micromol/l or a doubling from pre-treatment levels - whichever is greater) develops during treatment with lisinopril, the physician should consider withdrawal of therapy. Renal failure has been associated with ACE inhibitors and has been mainly observed in patients with severe congestive heart failure or underlying renal disease including renal artery stenosis. If recognised promptly and treated, renal failure is usually reversible. Use with caution in patients with bilateral renal artery stenosis or with stenosis of an artery to a solitary functioning kidney.

Angioedema of the extremities, face, lips, tongue, glottis and/or larynx may occur at any time during treatment with ACE inhibitors and in some cases can be fatal. In all cases, lisinopril should be discontinued promptly and appropriate treatment and monitoring instituted to ensure complete resolution of symptoms prior to dismissing the patient. Patients may require prolonged observation since treatment with antihistamines and corticosteroids may not be sufficient. Patients with a history of angioedema unrelated to ACE inhibitors may be at increased risk of angioedema while receiving an ACE inhibitor.

Pregnancy and Lactation

Pregnancy

Lisinopril is contraindicated in pregnancy.

Lisinopril is not teratogenic in mice, rats and rabbits with doses below 55, 33 and 0.15 times, respectively, the maximum recommended human daily dose. However, the use of ACE inhibitors is not recommended during the first trimester of pregnancy. Foetal exposure to lisinopril after the first trimester has been associated with teratogenicity and severe toxicity, similar to that seen with captopril and enalapril. The cause of this toxicity is thought to be due to foetal hypotension and decreased renal blood flow. Lisinopril may lead to in utero renal failure due to the prevention of conversion of angiotensin I to angiotensin II. Prolonged hypotension may follow as the primary method of removal of this drug is via the kidneys and impairment of this system in the newborn prevents elimination of the drug (Briggs, 2011).

ACE inhibitors are contraindicated during the second and third trimesters of pregnancy as exposure during these trimesters is known to induce human foetal toxicity (renal dysfunction, oligohydramnios, pulmonary hypoplasia, patent ductus arteriosus, delay in skull ossification, hypoxia, renal tubular dysgenesis, neonatal toxicity and even death). Severe and sometimes fatal anuria in the foetus and in the newborn have been observed and is thought to be caused by the compromise of the foetal renal system. Foetal renal failure resulting from in utero exposure to ACE inhibitors has been reported where dialysis has been required shortly after birth. Evidence of a risk of teratogenicity after first trimester exposure is conflicting, however, the MHRA recommends that a risk cannot be excluded. The MHRA states that the use of ACE inhibitors in late pregnancy has been associated with adverse effects on the kidney and other congenital anomalies, therefore ACE inhibitors should not be used at any stage during of pregnancy unless absolutely necessary and only then after the potential risks and benefits have been discussed with the patient. Spontaneous abortions and premature births have also been reported following administration with ACE inhibitors.

If exposure has occurred in the first trimester a detailed ultrasound diagnosis is advisable. Exposure to an ACE inhibitor during pregnancy is not an indication for either invasive diagnostic procedures or termination of pregnancy. In cases involving long term prenatal therapy in the second and/ or third trimesters, the foetus should be monitored for the potential development of oligohydramnios, and foetal growth should be assessed with detailed ultrasound scans (Schaefer, 2007). Infants whose mothers have taken ACE inhibitors should be closely monitored for hypotension and renal dysfunction.

Unless treatment with an ACE inhibitor is considered absolutely essential, women who are planning to become pregnant should be switched to an alternative drug with an established safety record. Guidelines advise that women who are taking ACE for chronic hypertension in pregnancy, or are planning pregnancy, are told that there is an increased risk of congenital abnormalities if these drugs are taken and other antihypertensive treatments should be discussed and offered.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Lisinopril is contraindicated in breastfeeding.

It is unknown whether lisinopril is excreted in human milk, however, because of its low molecular weight its passage into breast milk should be expected. The drug is excreted in the milk of lactating rats. Hale states that no paediatric concerns have been reported following the use of lisinopril. Schaefer (2007) comments that accidental prescribing of lisinopril does not require limiting of breastfeeding but therapy should be changed. Guidelines advise that women who still need antihypertensive treatment in the post natal period are informed that there is insufficient evidence on the safety in babies receiving breast milk from a mother taking ACE inhibitors other than enalapril and captopril.

The MHRA concludes that although ACE inhibitors are not generally recommended for use by breastfeeding mothers they are not all absolutely contraindicated and some may be prescribed if treatment is considered essential, however ACE inhibitors should not be used by breastfeeding mothers in the first few weeks after delivery because of possible profound neonatal hypotension particularly in preterm infants. The MHRA has stated that lisinopril is not recommended during breastfeeding. If ACE inhibitor therapy is considered essential for the mother the use of captopril, enalapril or quinapril may be considered when the infant is older. The infant should be carefully followed up for signs of hypotension should ACE inhibitor treatment be deemed necessary. Hale (2014) suggests that the newborn is also observed for weakness.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Accelerated erythrocyte sedimentation
Acute renal failure
Agranulocytosis
Allergic alveolitis
Alopecia
Altered liver function tests
Anaemia
Angioedema
Anuria
Arthralgia
Asthenia
Autoimmune disorders
Blood urea increased
Bone marrow depression
Bronchospasm
Cerebrovascular accident
Confusion
Cough
Decrease in haematocrit
Decrease in haemoglobin
Depressive symptoms
Diarrhoea
Dizziness
Dry mouth
Dyspepsia
Eosinophilia
Eosinophilic pneumonia
Erythema multiforme
Fatigue
Fever
Gynaecomastia
Haemolytic anaemia
Hallucinations
Headache
Hepatic failure
Hepatitis
Hyperkalaemia
Hypersensitivity reactions
Hypoglycaemia
Hyponatraemia
Hypotension
Impotence
Inappropriate secretion of antidiuretic hormone
Increase in antinuclear antibodies (ANA)
Jaundice
Leucocytosis
Leucopenia
Lymphadenopathy
Mood changes
Myalgia
Myocardial infarction
Nausea
Neutropenia
Olfactory senses altered
Oliguria
Orthostatic hypotension
Palpitations
Pancreatitis
Paraesthesia
Pemphigus
Photosensitivity
Pruritus
Pseudolymphoma
Psoriasis
Rash
Raynaud's phenomenon
Renal impairment
Rhinitis
Serum bilirubin increased
Serum creatinine increased
Sinusitis
Sleep disturbances
Stevens-Johnson syndrome
Sweating
Syncope
Tachycardia
Taste disturbances
Thrombocytopenia
Toxic epidermal necrolysis
Uraemia
Urticaria
Vasculitis
Vertigo
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: October 2015

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Martindale: The Complete Drug Reference (online) London: Brayfield A (ed). Pharmaceutical Press Accessed on 15 October 2015.

Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

Summary of Product Characteristics: Lisinopril 2.5mg tablets. Actavis UK Ltd.Revised July 2015.
Summary of Product Characteristics: Lisinopril 5mg tablets. Actavis UK Ltd. Revised July 2015.
Summary of Product Characteristics: Lisinopril 10mg tablets. Actavis UK Ltd. Revised July 2015.
Summary of Product Characteristics: Lisinopril 20mg tablets. Actavis UK Ltd. Revised July 2015.

Summary of Product Characteristics: Lisinopril 1mg/1ml tablets. Essential Pharmaceuticals Ltd. Revised July 2015.

Summary of Product Characteristics: Zestril 2.5mg, 5mg, 10mg and 20mg tablets. AstraZeneca UK Ltd. Revised May 2015.

The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.

MHRA Drug Safety Update: Volume 2, Issue 10, May 2009.
https://www.mhra.gov.uk/Publications/Safetyguidance/DrugSafetyUpdate/CON046451
Last accessed: 15 October, 2015.

MHRA Drug Safety Update: Volume 1, Issue 5, December 2007
https://www.mhra.gov.uk/Publications/Safetyguidance/DrugSafetyUpdate/CON2033216
Last accessed: 15 October, 2015.

National Institute for Health and Clinical excellence (NICE) clinical guidance 107: Hypertension in pregnancy. Issue date August 2010
Available at: https://guidance.nice.org.uk/CG107
Last accessed: 15 October, 2015.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 25 August 2017

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Lisinopril. Last Revised: 7 September, 2013.
Last accessed: 15 October, 2015.