Lisinopril
| Evidence Level: L5 | Predicted Indications: 6 |
Table of Contents
- Lisinopril
- Pharmacist Assessment Report
- Lisinopril: Pulmonary hypertension owing to lung disease and/or hypoxia
- One-Sentence Summary
- Quick Overview
- Why is This Prediction Reasonable?
- Clinical Trial Evidence
- Literature Evidence
- Australia Market Information
- Safety Considerations
- Conclusion and Next Steps
- Disclaimer
Lisinopril: Pulmonary hypertension owing to lung disease and/or hypoxia
One-Sentence Summary
Lisinopril is an ACE inhibitor originally used for hypertension and myocardial infarction. The TxGNN model predicts it may be effective for pulmonary hypertension owing to lung disease and/or hypoxia. There are currently no clinical trials and no publications supporting this specific subtype, so the prediction rests on model output and mechanistic reasoning alone.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | Pulmonary hypertension owing to lung disease and/or hypoxia |
| TxGNN Prediction Score | 0.9989 |
| Evidence Level | L5 |
| Australia Market Status | Listed on the PBS Schedule (1 of 1 items) – TGA (ARTG) registration status is not included in this data |
| Number of PBS Items | 1 (valid: 1) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism of action data is not available in the data compiled for this report. Lisinopril belongs to the ACE inhibitor class. These drugs reduce angiotensin II formation, lower afterload and limit adverse ventricular remodelling after a heart attack.
The very high TxGNN score (0.9989) comes from the TxGNN model (deep learning) and may reflect similarities the model learned between related diseases, not biological evidence.
The same pattern appears in the other top predictions:
- Malignant hypertensive renal disease and malignant renovascular hypertension are extensions of the hypertension indication. ACE inhibitors can worsen renal function in bilateral renal artery stenosis or stenosis in a solitary kidney.
- Pulmonary hypertension and chronic pulmonary heart disease are mechanistically plausible but not guideline-supported. The evidence is mostly preclinical, apart from two small Russian-language clinical studies on chronic cor pulmonale (PMIDs 14524095 and 17047621) of uncertain design.
- Braddock syndrome and a rare COL4A1-related syndrome have no supporting evidence and no clear mechanistic link.
Clinical Trial Evidence
Currently no related clinical trials registered for posterolateral myocardial infarction.
Literature Evidence
Currently no related literature available for posterolateral myocardial infarction.
Australia Market Information
| ARTG Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| ARTG 13402J | Zestril | Tablet 20 mg (oral) | Not stated in the data compiled |
Safety Considerations
No label-based warnings or contraindications were available. The knowledge graph links lisinopril to the following conditions as contraindications (these are graph associations, not label text):
- Angioedema: including hereditary, acquired and RAAS-blocker-induced forms.
- Kidney and liver disease: kidney disease, liver disease, hepatic encephalopathy.
- Cardiovascular: aortic stenosis and hypotensive disorders.
- Metabolic and electrolyte: diabetes mellitus, diabetic ketoacidosis, potassium deficiency and hyperparathyroidism.
- Haematological and immune: neutropenia, agranulocytosis, systemic lupus erythematosus and connective tissue disease.
- Other: pancreatitis, gallbladder disease and bone disease.
Drug interactions: the interaction query returned 100 interactions; the first 20 are summarised here.
- Major: potassium citrate and potassium bicarbonate (risk of hyperkalaemia).
- Moderate: corticosteroids (hydrocortisone, dexamethasone, betamethasone, budesonide, triamcinolone), aspirin, morphine, bupropion, dronabinol, bowel preparations (picosulfuric acid, polyethylene glycol with electrolytes), and several diabetes medicines (metformin, alogliptin, saxagliptin, canagliflozin, dapagliflozin, empagliflozin, chlorpropamide).
A published case report also describes severe hypotension and bradycardia when lisinopril was combined with tizanidine (PMID 20852161).
Please refer to the TGA-approved Product Information (PI) for full safety information.
Conclusion and Next Steps
Decision: Hold
Rationale: Posterolateral MI is a subtype of an indication lisinopril already covers, so the prediction adds little beyond the existing approval. No trial or literature evidence exists for this subtype (Evidence Level L5).
To proceed, the following is needed:
- The approved indication wording from the TGA Product Information, to confirm whether MI subtypes are already covered
- Label-based warnings and contraindications from the PI, which are currently missing
- Mechanism of action data for lisinopril
- Subtype-specific data, such as post-hoc analyses of existing ACE inhibitor MI trials by infarct location
- If pursuing other predictions, the most developed is chronic pulmonary heart disease (L3), which would need controlled trial evidence and a hypotension safety review
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.