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Lispril / Zestril / Lisinopril BP med Supply Chain Nightmare


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Posted (edited)

I've been told by multiple credible pharmacists that Lispril /  Zestril / Lisinopril is now completely unavailable in Thailand! Except if a random pharmacy has some stock left which is unlikely the pharmacies can't order new stock..

 

I was told an estimated date that they might have it again. July. Beginning or end of July? No guarantees.

 

So obviously each individual has their own medical details but after doing some research I learned that the most common substitute is Losartan generic brand Loranta.

 

Rather than another ace inhibitor 

 

Equivalent doses

Lisinopril 10 mg 

Losartan 50 mg 

 

This is NOT to be taken as medical advice!

 

Do what you feel you need to do as far as starting a substitute. See a doc / do your own research / consult a trusted pharmacist etc.

 

Anyway this topic is here for discussion for people impacted by this supply chain problem.

 

Edited by Jingthing
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interesting news.  my usual pharmacy guy in bkk appeared to imply the same about a month ago.  i tried getting the 10mg lispril (he's had it before) but he only had 20mg (i bought those) and he mumbled something but i wasn't sure what he was saying - i wondered, did he just say he isn't getting any more of this stuff.  i went in again to get some other meds and noticed the shelf still had only 20mg.  probably gone soon. 

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Posted (edited)
22 minutes ago, buick said:

interesting news.  my usual pharmacy guy in bkk appeared to imply the same about a month ago.  i tried getting the 10mg lispril (he's had it before) but he only had 20mg (i bought those) and he mumbled something but i wasn't sure what he was saying - i wondered, did he just say he isn't getting any more of this stuff.  i went in again to get some other meds and noticed the shelf still had only 20mg.  probably gone soon. 

Yes that is correct.

Pharmacies here can't order it now.

 

When did you see it? If its still there grab it. Its interesting that they can't get new supply of either the original or the generic. I wouldn't count on that July estimate either.

Edited by Jingthing
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There are several generic brands of Losartan, including Losaratn GPO as well as Loranta.

 

These and other ____sartans  are ARBs not ACE inhibitors. So not the closest substitution.

 

The closest  substitutions for lisinopril,  would be ramipril or enalapril. Enalapril is much cheaper but also more likely to cause side effects such as cough. Ramipril is generally better tolerated, and slightly more effective, than enalapril but also costs more and has fewer local brands

https://link.springer.com/article/10.1007/BF03258424

 

That said, most people taking it just for hypertension will do fine  on enalapril

 

It should be noted that people who have heart failure or history of a heart attack need to consult their cardiologist before changing BP meds, as meds that are essentially equievalent as antihypertensive can differ in their effect in heart function in such patients.

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Posted (edited)
2 hours ago, Sheryl said:

There are several generic brands of Losartan, including Losaratn GPO as well as Loranta.

 

These and other ____sartans  are ARBs not ACE inhibitors. So not the closest substitution.

 

The closest  substitutions for lisinopril,  would be ramipril or enalapril. Enalapril is much cheaper but also more likely to cause side effects such as cough. Ramipril is generally better tolerated, and slightly more effective, than enalapril but also costs more and has fewer local brands

https://link.springer.com/article/10.1007/BF03258424

 

That said, most people taking it just for hypertension will do fine  on enalapril

 

It should be noted that people who have heart failure or history of a heart attack need to consult their cardiologist before changing BP meds, as meds that are essentially equievalent as antihypertensive can differ in their effect in heart function in such patients.

I already noted that Losartan is not an ace inhibitor but surprisingly I am seeing it mentioned as the closest sub for Lisinopril in multiple sources!

 

Also no dry cough issues with Losartan. A patient may be fine with Lisinopril but have the cough with another ace inhibitor.

 

Keep this in mind.

 

This is about a STOPGAP fix for a presumed temporary supply chain issue. For perhaps a month or two.

 

I presume the vast majority will switch back to Lisinopril when the supply returns.

 

https://www.goodrx.com/conditions/hypertension/lisinopril-vs-losartan-how-are-they-different

 

 

It may come as no surprise, but many patients have asked me about how lisinopril and losartan differ. You see, the two drugs are pretty similar and healthcare providers use them interchangeably at times, especially for patients with heart problems. In fact, both drugs are recommended as first-line treatments for hypertension. Nonetheless, there are some differences I can highlight to help you better understand these two drugs.

 

https://walrus.com/questions/what-can-be-substituted-for-lisinopril-hctz

Summary

There are several alternatives for Lisinopril-HCTZ including the individual components. The closest alternative to lisinopril and other ACE inhibitors would be ARBs like losartan

Edited by Jingthing
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2 hours ago, Jingthing said:

 The closest alternative to lisinopril and other ACE inhibitors would be ARBs like losartan

"and other ACE inhibitors" i.e. they are talking about alternatives to ACE inhibitors altogether

 

The closest alternative to lisinoipril alone would be other ACE inhibitors. As afar as I know the supply issue is only for lisinopril.

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9 minutes ago, Sheryl said:

"and other ACE inhibitors" i.e. they are talking about alternatives to ACE inhibitors altogether

 

The closest alternative to lisinoipril alone would be other ACE inhibitors. As afar as I know the supply issue is only for lisinopril.

You're right as usual but still the Losartan doesn't risk coughing and it seems OK to me as a stopgap. It addresses BP just in a different way.

 

Fascino told me they only have 

Enalapril and Perindopril Ace inhibitors at my nearest branch. They mentioned the extra side effects risk with Enalapril. Do you have any comments about Perindopril?

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7 minutes ago, Jingthing said:

You're right as usual but still the Losartan doesn't risk coughing and it seems OK to me as a stopgap. It addresses BP just in a different way.

 

Fascino told me they only have 

Enalapril and Perindopril Ace inhibitors at my nearest branch. They mentioned the extra side effects risk with Enalapril. Do you have any comments about Perindopril?

All ACE inhibitors have similar side effect profile (cough, GI upset etc).  The incidence  is slightly higher with enalapril but difference is no huge and most people tolerate enalapril just fine. It will likely cost much less than perindopril.

 

Since you have already been on an ACE without apparent problems I would not be unduly worried about taking either one.

 

 

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  • 3 weeks later...
On 5/31/2022 at 6:12 PM, Jingthing said:

You're right as usual but still the Losartan doesn't risk coughing and it seems OK to me as a stopgap. It addresses BP just in a different way.

 

Fascino told me they only have 

Enalapril and Perindopril Ace inhibitors at my nearest branch. They mentioned the extra side effects risk with Enalapril. Do you have any comments about Perindopril?

I found this article specifically comparing and contrasting the two drugs … I don’t think it’s been referenced above.

 

Quote

Lisinopril vs. Losartan: What’s the Difference? -

 

https://www.goodrx.com/conditions/hypertension/lisinopril-vs-losartan-how-are-they-different

 

i read, or think I did somewhere, that AstraZeneca was aiming to stop production of Zestril and transition to permitting generics to replace it, which seemed to be what some Fascino pharmacists told me.

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On 5/31/2022 at 12:54 PM, Sheryl said:

Enalapril

I've taken this for over 15 years. No side effects. Dirt cheap. It's absolutely everywhere.

Edited by BonMot
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On 5/31/2022 at 6:23 PM, Sheryl said:

All ACE inhibitors have similar side effect profile (cough, GI upset etc).  The incidence  is slightly higher with enalapril but difference is no huge and most people tolerate enalapril just fine. It will likely cost much less than perindopril.

 

Since you have already been on an ACE without apparent problems I would not be unduly worried about taking either one.

 

 

Hello Sheryl. As I am taking 40mg Lisinopril daily, what would be the equivalent mg in Enalapril?

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I could not find Lispril in Pattaya-Jomtien today.

Two pharmacies awaiting a delivery next month.

So i bought Enalapril, better than nothing... i think...

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41 minutes ago, Mentors65 said:

I could not find Lispril in Pattaya-Jomtien today.

Two pharmacies awaiting a delivery next month.

So i bought Enalapril, better than nothing... i think...

I did the same thing

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3 hours ago, Mentors65 said:

I could not find Lispril in Pattaya-Jomtien today.

Two pharmacies awaiting a delivery next month.

So i bought Enalapril, better than nothing... i think...

Yeah me too.

Did they say about what day in July?

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1 hour ago, Jingthing said:

This suggests 10 mg. Lisinopril.equals 10.mg. Enalapril

.

mmc1.pdf 100.84 kB · 1 download

No, it does not.  It shows 10mg lisinopril as equivalent to 5 mg enalapril

 

 

Screen Shot 2022-06-29 at 8.54.52 PM.png

 

 

you will also see that on this site

https://globalrph.com/medcalcs/drug-comparisons-ace-inhibitors-medication-equivalents/

 

Whatever site you choose, lisinopril dosage is double that of enalapril for equivalence

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Posted (edited)
1 hour ago, Sheryl said:

No, it does not.  It shows 10mg lisinopril as equivalent to 5 mg enalapril

 

 

Screen Shot 2022-06-29 at 8.54.52 PM.png

 

 

you will also see that on this site

https://globalrph.com/medcalcs/drug-comparisons-ace-inhibitors-medication-equivalents/

 

Whatever site you choose, lisinopril dosage is double that of enalapril for equivalence

Thanks.

But I'm still confused.

 

The source I showed does appear to show 10 mg equals 10 mg. It doesn't say that?

 

So assuming it does show that, you're ssying it's wrong, yes?

 

IMG_20220629_221127_041.jpg

Edited by Jingthing
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16 hours ago, Jingthing said:

Yeah me too.

Did they say about what day in July?

No, i guess everyone is just hoping...

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14 minutes ago, Mentors65 said:

No, i guess everyone is just hoping...

Well if they were able to place orders that's good news. Before pharmacists were telling me that the suppliers weren't even accepting orders.

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14 hours ago, Jingthing said:

Thanks.

But I'm still confused.

 

The source I showed does appear to show 10 mg equals 10 mg. It doesn't say that?

 

So assuming it does show that, you're ssying it's wrong, yes?

 

IMG_20220629_221127_041.jpg

Yes, it is wrong (as regards enalapril). The equivalence shown for rampiril is correct.

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I was told today by a Boot's pharmacist that Zestril (Lisonopril) will not be available until DECEMBER at the earliest.

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  • 3 weeks later...

Lispril 5. Not available today. 

May have to try Enalapril (5?) when my supply runs out in a month.

 

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24 minutes ago, Thailand said:

Lispril 5. Not available today. 

May have to try Enalapril (5?) when my supply runs out in a month.

 

You should probably cut the Enalapril 5 in half then.

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