Lisinopril
Brand names: Zestril, Prinivil, Carace
ACE inhibitor (angiotensin-converting enzyme inhibitor)
Lisinopril is an ACE inhibitor widely used for high blood pressure, heart failure, and to protect the kidneys in diabetic patients. Its most common side effect — a persistent dry cough — affects up to 20% of patients and is the leading reason for switching to an ARB.
Drug Class
ACE inhibitor (angiotensin-converting enzyme inhibitor)
Category
Heart & Blood Pressure
Forms Available
Tablets (2.5 mg, 5 mg, 10 mg, 20 mg), Oral solution
How It Works
Lisinopril inhibits ACE, blocking the conversion of angiotensin I to angiotensin II. Angiotensin II causes vasoconstriction and aldosterone release. By blocking its production, lisinopril reduces vasoconstriction, lowers blood pressure, and decreases aldosterone-driven sodium and water retention. It also reduces cardiac afterload and preload in heart failure.
What It's Used For
- Hypertension
- Heart failure (reduces mortality after myocardial infarction)
- Post-myocardial infarction cardiac protection
- Diabetic nephropathy — slows progression of kidney disease
- Chronic kidney disease with proteinuria
Available Forms
Side Effects
Common Side Effects
- Dry persistent cough — the most common; caused by bradykinin accumulation; affects 10–20% (more common in Asian patients)
- Dizziness (especially with first dose — 'first-dose hypotension')
- Headache
- Fatigue
Serious Side Effects
- Angioedema — rapid facial, lip, tongue, or throat swelling; can be life-threatening; discontinue immediately
- Hyperkalaemia (raised blood potassium) — especially with kidney disease, potassium supplements, or potassium-sparing diuretics
- Acute kidney injury — when combined with NSAIDs and diuretics ('triple whammy')
- Severe hypotension in volume-depleted patients
Drug Interactions
- NSAIDs — reduce antihypertensive effect and increase kidney injury risk
- Potassium-sparing diuretics (spironolactone, eplerenone) — hyperkalaemia risk
- Potassium supplements — hyperkalaemia
- Lithium — ACE inhibitors raise lithium levels
- Aliskiren — avoid combination in diabetic or kidney disease patients
When to Avoid
- History of ACE inhibitor-induced angioedema
- Pregnancy — teratogenic in second and third trimesters (causes fetal renal toxicity)
- Bilateral renal artery stenosis
- Hereditary or idiopathic angioedema
Patient Tips
- Take the first dose at bedtime to reduce dizziness from first-dose hypotension
- If you develop a persistent cough, tell your doctor — switching to an ARB (e.g., losartan) eliminates this side effect
- Avoid potassium supplements, salt substitutes (which contain potassium chloride), and high-potassium foods unless advised otherwise
- If you develop lip, tongue, or throat swelling, call emergency services immediately — this is angioedema
- Monitor blood pressure at home
ACE inhibitors and the 'triple whammy'
Combining an ACE inhibitor, a diuretic, and an NSAID creates the 'triple whammy' — a well-documented risk for acute kidney injury. The three drugs together reduce renal perfusion pressure beyond what the kidneys can compensate.
If you are on lisinopril and a diuretic, avoid regular NSAID use (ibuprofen, naproxen, diclofenac). Paracetamol is a safer pain reliever choice.
ACE inhibitor cough: what to do
The cough caused by ACE inhibitors is not a sign of lung damage — it is caused by accumulated bradykinin irritating airway nerve endings. It is dry, tickly, and persistent. It resolves within a few weeks of stopping the medicine.
An ARB (angiotensin receptor blocker, such as losartan, valsartan, or candesartan) blocks the same pathway downstream without affecting bradykinin, so it does not cause cough and is an effective substitute.
Related Medicines
Medical disclaimer
This page is for educational reference only. Always follow the dosage and instructions given by your prescriber or pharmacist. Do not start, stop, or change medicines without medical advice.
Reviewed 2026-06-01 · Looms Medical Team