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Br J Clin Pharmacol. 2018 Nov;84(11):2502-2521. doi: 10.1111/bcp.13705. Epub 2018 Sep 11.

An evidence-based systematic review of the off-label uses of lisinopril.

Author information

1
Research Center for Evidence-Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
2
Iranian EBM Center: A Joanna Briggs Institute Affiliated Group.
3
Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
4
Faculty of Pharmacology, Tabriz University of Medical Sciences, Tabriz, Iran.
5
Research Development & Coordination Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
6
Division of Nephrology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
7
Mount Sinai Hospital, Sinai Health System, Toronto, Canada.
8
Faculty of Dentistry, University of Toronto, Toronto, Canada.
9
Clinical Epidemiology & Health Care Research, Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada.

Abstract

AIMS:

Lisinopril is an angiotensin-converting-enzyme inhibitor that is largely administered for off-label uses. This study aims to provide a comprehensive review of off-label uses of lisinopril to aid physicians to make evidence-based decisions.

METHODS:

The following bibliographic databases were searched from inception up to 30 March 2017: PubMed, EMBASE, the Cochrane Library, Cochrane Central Register of Controlled Trials, Scopus, Ovid and Proquest. This systematic review sought all randomized trials conducted on adult individuals comparing lisinopril on its off-label uses with alternative drugs or placebos and reported direct or alternative clinical outcomes. Risk of bias assessment by using the Cochrane Collaboration risk-of-bias tool and quality evaluation took place.

RESULTS:

Included studies demonstrated significant positive effects of lisinopril on proteinuric kidney disease; however, lisinopril caused a slight reduction of glomerular filtration rate (GFR) especially for patients with GFR < 90 ml min-1 . Lisinopril offered better outcomes in comparison to other standard treatments of diabetic nephropathy. Other studies showed positive effects of lisinopril for migraine, prevention of diabetes, myocardial fibrosis, mitral valve regurgitation, cardiomyopathy in patients with Duchenne muscular dystrophy, oligospermia and infertility, and diabetic retinopathy. Conversely, the studies reported that lisinopril was ineffective for five other off-label uses.

CONCLUSIONS:

The identified studies showed that lisinopril was highly effective for proteinuric kidney disease with a minor but inconsiderable decrease in GFR. Positive effects of lisinopril were demonstrated in seven other off-label uses; however, lisinopril cannot be recommended as the first choice for these until further clinical trials confirm these positive effects.

KEYWORDS:

ACE inhibitor; diabetes; diabetic nephropathy; left ventricular hypertrophy; nephropathy

PMID:
29971804
PMCID:
PMC6177695
DOI:
10.1111/bcp.13705
[Indexed for MEDLINE]
Free PMC Article

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