Angiotensin converting enzyme inhibitors – lisinopril

Last updated on August 23, 2024

Generic name          

lisinopril, including in combination with hydrochlorothiazide

Strength

5 mg, 10 mg, 20 mg, 10 mg/12.5 mg, 20 mg/12.5 mg, 20 mg/25 mg                          
Form tablet

Criteria

Approval period

  1. Treatment failure on optimal doses of, or intolerance to, ramipril.

    OR
     
  2. Complex patient requiring medications for co-existing chronic condition(s).

Indefinite

Practitioner exemptions

Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:

  • Paediatric cardiology
  • Paediatrics 

Special notes

  • Individuals requiring a diuretic combination product must satisfy the same criteria.
  • Patients with co-existing chronic conditions requiring use of multiple medications will be considered complex for the purposes of Special Authority criteria.

Special Authority request form(s)