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Doctors' Answers to "Frequently Asked Questions" - Prinivil

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 04/22/2000]
Question: I have high blood pressure and take prinivil for it.
In the past couple years I have been experiencing severe
swelling of my tounge and face - especially my cheeks. The
doctors have not pinpointed what is causing this. I take
Diphenhydramine and the swelling goes away. I see that the
swelling is a possible side effect of prinivil. The
doctors took me off of the prinivil for a short time to
see if the swelling would stop and I still had some
swelling attacks and my blood pressure went up. My
question is this: Is it possible that I just wasn't off
the prinivil long enough or does it go out of your system
quickly? I have seen where there was a court case where
a doctor correctly diagnosed someone as having an allergic
reaction to prinivil and his symptoms were the same as
mine. The problem was that the nurse did not understand
that the patient wasn't supposed to take any more of the
Zestral and the patient took another dose and died. - So
obviously I am concerned about this. Isn't there some
other drug that I could be taking to control my blood
pressure that might not have this side effect?
Thanks for your time
Wilmer Peoples

allergic reaction to Zestral which I believe is the same
thing as prinivil.

Answer: You would need to be off the medication at least two weeks before you could be sure. There are lots of other classes of blood pressure medications that would not have any allergic effects. Discuss this with your md, but easily done.

[posted 03/22/2000]
Question: I take PRINIVIL 20mg right before bedtime. Every morning when I measure the blood pressure, it is 12x/9x (low ninties). I have been doing this for about one week. Is the PRINIVIL working? Also, one doctor (not my current one) said my blood pressure is caused by water retention, hence HYZAAR is better than PRINIVIL. For those whose blood pressure is caused by small arteries should take PRINIVIL. But my current doctor said PRINIVIL is a better drug simply because it is not a combo drug like HYZAAR. I am very confused. Please help.

Answer: First, ensure you have a correctly sized cuff. That is, a large arm will need a large cuff and a smaller arm a smaller cuff. If you have an "average" arm, then these blood pressures are too high, but not horrible. The lower number, the diasystolic, should be below 85. The upper below 135. So, you need to get the lower number a little lower. As to the medication, this is like arguing about the angels on the head of a pin. Judge by results. If prinivil is unable to lower the diasystolic below 90, most physicians would then add a diuretic. This has little to do with water retention. Diuretics cause a sodium diuresis(more in the urine)hence, I'm not sure if I would have a great deal of faith in a md who talks about water retention and hypertension. In any case, either can work, just increase the dosage until your diastolic is below 85. This needs to be treated,but is not serious at this point.

Possible Prinivil Reaction in Lupus Patient [posted 1/14/99]
Question: I am a 46-year old lupus patient currently on prednisone, zocor and prinivil. For the past 5 months I have been plagued with an itchy red rash that does not respond very well to antihistamines, topical creams and the like. I went to a dermatologist who felt that the rash was either lupus or a drug reaction to possibly prinivil. He did a skin biopsy and I am awaiting the results. Are you aware of any such reaction to this drug. It is unbearably itchy and uncomfortable and has managed to cover most of my entire body.

Answer: Haven't seen one, but it's listed in the PDR as a possible problem.

Prinivil and Breast Feeding [posted 1/6/99]
Question: I would like to know if it is okay to take Prinivil while nursing a baby? My doctor says it's fine to take it while nursing, but I am not sure. Can you let me know if there is any possible side effects for my baby if I take this drug. I have not begun taking the drug yet because I have concerns.

Answer:Would potentially affect the blood pressure. Probably not a big risk, but not zero.

Question: I am a 31 year old male with an uneventful medical history (only in hospital overnight for my birth, no broken bones, etc.). While undertaking a medical so I could scuba dive, my doctor noted a slightly raised blood pressure, which he checked a few times over eight weeks or so. Based on this and a kidney test, he placed me on 10 mg of Prinivil daily. I also have had (and passed) a kidney IVP, hear ultrasound and stress ECG. He has suggested I have mild familial hypertension. I trust my doctor but like to stay informed. Considering my age and my doctor's desire for me to stay on Prinivil indefinitely, is there anything I should be aware of? I am not the medical equivalent of a Luddite, but don't like the idea of taking drugs over the long term.

Answer: First, did your blood pressure ever get checked at home? Two thirds of patients have elevated blood pressure at the physician's office. Check it at home off the medication to see if it really is elevated. Secondly, did you try weight loss? Five to ten pounds will usually suffice for young men. Thirdly, try stopping alcohol. About 2 of 5 Caucasian men will have a prolonged elevation of blood pressure after only one or two drinks. This commonly lasts for 1-3 days following ingestion. Fourthly, a low salt, high fiber diet can occasionally lower blood pressure sufficiently to avoid medications. I usually give patients six months to try the above prior to starting low term medications.

Prinivil and Aspirin
Question: Just started taking Prinivil for high BP. 10mg. Occasionally I get headaches that only Extra Strength Excedrin can cure. Can I take the Excedrin with Prinivil? Also, taking .10mg Synthroid daily and occasionally Seldane-D. Tylenol does nothing for my headaches.

Answer: There should be no problem taking prinivil and any aspirin product. Be aware that aspirin can be toxic in doses above 8-10 regular Aspirins/day. Signs of aspirin toxicity are usually ringing in the ears,and occasionally vertigo. Seldane-D has an ingredient that can increase your blood pressure-I'd discuss this with your physician.

Prinivil Side Effects
Question: What are the benefits, and negative affects of the drug PRINIVIL? Of what value is 5mg/day?

Answer: Prinivil belongs to a class of drugs called Angiotensin Converting Enzyme Inhibitors(ACE). This class of drugs inhibits the enzyme in the lung(and some tissues) that converts the hormone Renin to Angiotensin. Renin is made in the kidney-goes to the lung where it is converted by an enzyme and emerges as Angiotensin(a potent vasoconstrictor). We use this class of drugs in several applications. First is hypertension, second treatment of diabetics to avoid or minimize long term kidney damage from diabetes, third treatment of congestive heart failure(regardless of the blood pressure). There are other uses; but, these are the main ones. Side effects are usually minimal-one of their main advantages. Cough is common and can be prevented by using one of the newer selective ACE inhibitors like Cozier. Rash is occasionally seen. After that there are occasional problems which require blood tests; but, are less common.

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