Lisinopril side effects, warnings, and interactions

In this article:

• Common side effects
• Serious side effects
• How long do lisinopril side effects last?
• Lisinopril contraindications and warnings
• Lisinopril interactions
• How to prevent lisinopril side effects
• Frequently asked questions about lisinopril

In this article

• Common side effects
• Serious side effects
• How long do lisinopril side effects last?
• Lisinopril contraindications and warnings
• Lisinopril interactions
• How to prevent lisinopril side effects
• Frequently asked questions about lisinopril

Lisinopril is a generic form of the brand-name drugs Zestril, Prinivil (discontinued), and Qbrelis, commonly used to treat high blood pressure. It also helps increase life expectancy after a heart attack (myocardial infarction), and can be used to improve symptoms in people with congestive heart failure. Lisinopril belongs to a family of drugs called angiotensin-converting enzyme inhibitors (ACE inhibitors) that work by preventing an enzyme from making angiotensin II. Although it is an effective and well-tolerated hypertension medication, side effects can occur. 

RELATED: What is lisinopril?

Common side effects of lisinopril

Most people taking lisinopril will experience few and only minor side effects. Lisinopril’s most common side effects are:

• Cough
• Dizziness
• Low blood pressure
• Headache
• Elevated levels of potassium in the blood
• Fainting
• Kidney problems
• Fatigue
• Sensitivity to light

The side effects experienced often depend on the condition being treated. People taking lisinopril for high blood pressure (hypertension) mostly experience dizziness, headache, and dry cough as side effects. Low blood pressure, kidney problems, and fainting are more commonly reported by people taking lisinopril for heart failure or a heart attack.

RELATED: How does lisinopril affect your kidneys?

Cough

Cough is a common side effect of all drugs in the ACE inhibitor class of drugs. An ACE inhibitor-associated cough is usually dry and persistent. The cough can appear right away or may appear weeks or months after the medication is started. People who develop this cough should consult their healthcare provider for medical advice if it interferes with daily activities or sleep.

Dizziness 

Dizziness is a common side effect associated with ACE inhibitors such as lisinopril. People who experience dizziness should stand up slowly while holding onto something sturdy for support. Dizziness can lead to falls and fractures, so patients who experience dizziness should report symtpoms immediately to their healthcare provider, to see if an alternative treatment may be needed. 

Serious side effects of lisinopril

Serious side effects of lisinopril may include:

• Severe allergic reactions (including Stevens-Johnson syndrome)
• High blood potassium
• Dangerously low blood pressure
• Kidney dysfunction or kidney failure
• Liver problems leading to liver failure (be alert for yellowing of the skin or whites of the eyes, fatigue, and stomach pain)
• Blood problems (low red blood cell or white blood cell counts) 
• Swollen pancreas
• Head, neck, face, throat, and digestive system swelling (angioedema)

Severe allergic and skin reactions

In rare cases, lisinopril can cause reactions that can be severe or life-threatening. Patients with symptoms of a severe allergic reaction (e.g., hives, difficulty breathing, or swelling around the face, lips, tongue, or throat) should get emergency medical help right away. Lisinopril can also cause severe skin reactions in rare cases. Patients should get emergency medical help if they notice symptoms of a severe skin reaction: red or purple rash, blistering or peeling skin, fever, burning eyes, or sore throat. 

High potassium levels

Lisinopril can cause increased levels of potassium, or hyperkalemia. Healthcare providers will monitor potassium levels in patients who take lisinopril. Symptoms of high potassium may include nausea, weakness, numbness and tingling, chest pain, irregular heartbeat, and muscle cramps or pain. People who have kidney problems, diabetes, or take certain medications (potassium supplements or potassium-sparing diuretics) are at higher risk of hyperkalemia. 

How long do lisinopril side effects last?

Most lisinopril side effects, such as headache, dry cough, dizziness, low blood pressure, elevated blood potassium, and other temporary side effects, will go away when the medication is discontinued. Other times, the side effects become less noticeable with continuing treatment. A dry cough is a common side effect that usually clears up in a few weeks to a few months when lisinopril is discontinued. People with a bothersome cough should consult their healthcare provider. 

Low blood pressure and high potassium are common side effects, but if blood pressure falls too low or potassium levels rise too high, immediate medical treatment is required. Even these severe conditions improve in a few hours or days with medical treatment. 

Other severe side effects, such as blood problems and severe allergic reactions, may take several days of medical treatment to resolve. Kidney and liver dysfunction are more serious and may develop into chronic conditions. To prevent this, blood tests will be regularly performed to spot any liver or kidney problems before they become too serious. 

Report side effects to your healthcare provider. If you have any serious side effects. such as difficulty breathing, seek emergency medical treatment. 

Lisinopril contraindications and warnings

For various reasons, some people may not be able to take lisinopril, and others may need to be monitored more vigilantly than others. You should not take lisinopril if you:

• Are pregnant: Because of the risk for birth defects and fetal death, pregnant women are never given lisinopril. 
• Are breastfeeding: Although its safety has not been studied in nursing infants, healthcare providers will either choose a different drug or ask the patient to discontinue nursing while taking lisinopril.
• Are allergic to ACE inhibitors: Anyone with a history of hypersensitivity reactions to lisinopril or any other ACE inhibitor will not be prescribed lisinopril or any other ACE inhibitor.
• Have hereditary or idiopathic angioedema: People with this condition are deficient in a protein that helps control how much fluid passes out of blood vessels. They periodically suffer bouts of angioedema, usually triggered by things like stress, foods, sunlight, injuries, or infections. People with hereditary angioedema or any unexplained bout of angioedema (called idiopathic angioedema) will never be given an ACE inhibitor. 

Lisinopril will require extra monitoring for side effects when given to people with kidney problems, low blood pressure, low blood volume, high blood potassium, low sodium, or who are on dialysis. Because of the risk for angioedema, lisinopril will require extra care when given to people with certain types of heart disease, blood vessel problems, or autoimmune diseases.

Lisinopril and other ACE inhibitors are less effective at lowering blood pressure in African American patients. It is also more likely to cause angioedema in this population.

Lisinopril interactions

Lisinopril has several effects on the body, so it can cause some problems when combined with other drugs. 

Some drugs are never combined with lisinopril because of the risk of low blood pressure, high blood potassium, angioedema, or kidney damage. Examples of drugs that interact with lisinopril include:

• Aliskiren 
• Marplan (isocarboxazid)
• Sacubitril
• Other ACE inhibitors

Some drugs may be taken with lisinopril in certain instances but require caution, monitoring, and dosing modifications. Examples include: 

• RAAS inhibitors
• Potassium drugs or supplements
• Potassium-sparing diuretics 
• Aminoglycoside antibiotics 
• Nonsteroidal anti-inflammatory drugs (NSAIDs) 
• Lithium 
• mTOR inhibitors 
• Diabetes medications 
• Blood pressure drugs 
• Medications that lower or raise blood pressure 

How to prevent lisinopril side effects

When taken for hypertension by otherwise healthy patients, lisinopril generally has few and mostly manageable side effects. People taking lisinopril for heart failure or heart attack, however, are more likely to experience side effects, especially serious side effects. A few tips can help minimize or manage lisinopril side effects while ensuring maximum benefit from the treatment.

1. Tell your healthcare provider about all medical conditions

When getting a lisinopril prescription from a healthcare professional, tell them about all your medical conditions, particularly:

• Liver problems
• Kidney disease
• Any history of angioedema (face, neck, or gastrointestinal swelling)
• Any history of high potassium
• Diabetes
• Pregnancy or any pregnancy plans
• Breastfeeding an infant
• Any history of allergic reactions to ACE inhibitors
• Any upcoming surgery involving anesthesia

2. Tell your healthcare provider about all medications and supplements you take 

Lisinopril side effects could be made worse by other drugs. Always carry a list of prescription drugs, over-the-counter medicines, and vitamins or supplements being taken and share it with both the prescribing healthcare professional and the pharmacist before filling a prescription for lisinopril, especially drugs like: 

• Sacubitril, aliskiren, or isocarboxazid 
• Any angiotensin receptor blocker (ARB) such as valsartan 
• Any other ACE inhibitor
• Diuretics or “water pills” such as hydrochlorothiazide or furosemide
• Lithium

3. Take lisinopril as directed

Follow all the directions on the prescription label or provided by your healthcare professional. Do not take more or less than prescribed. 

4. Drink plenty of fluids 

Many lisinopril side effects can be avoided by drinking plenty of fluids. ACE inhibitors affect kidney function, so dehydration is a common problem, causing side effects such as high blood potassium, low blood pressure (hypotension), and low blood volume. Excess sweating, vomiting, or diarrhea can also lower blood pressure.

5. Stand up and move slowly

If dizziness is a problem, try standing up and moving slowly to minimize this side effect and prevent fainting or falling. Do not drive or operate machinery until you know how lisinopril affects you.

6. Check blood pressure as recommended by your healthcare provider

Lisinopril lowers blood pressure. Check your blood pressure regularly to make sure the drug is working and to prevent your blood pressure from getting too low. Watch for signs of low blood pressure, such as dizziness, lightheadedness, and fainting. Call a healthcare provider if any of these side effects are experienced.

7. Watch for signs of high blood potassium

Lisinopril commonly causes blood potassium to increase, usually very slightly. Sometimes, though, blood potassium can rise too high and become a medical problem. To catch it early, look for signs of high blood potassium, such as abdominal pain, nausea, chest pain, irregular heartbeat, and muscle weakness. If you notice these symptoms, contact your healthcare provider as soon as possible for medical advice. 

8. Watch for signs of angioedema

Angioedema is swelling of the tissues under the skin. It’s similar to hives, but the swelling is deeper and usually doesn’t itch. Angioedema is often an allergic reaction, but lisinopril can cause angioedema by the way it works in the body. Angioedema is a serious and potentially life-threatening medical problem. If it gets too severe, it can block airways and cause death by asphyxiation. Get immediate medical attention at any sign of angioedema, such as:

• Swelling of the face, lips, tongue, or throat
• Trouble breathing or swallowing
• Stomach or chest pain

Frequently asked questions about lisinopril

Does lisinopril affect sleep?

Lisinopril is not expected to affect sleep directly. However, people who develop a persistent cough from lisinopril may find that the cough affects sleep. Patients taking lisinopril who develop a bothersome cough should consult their healthcare provider for medical advice.

Is it better to take lisinopril in the morning or at night?

Lisinopril is generally taken once daily and can be taken in the morning or evening. It is best to take lisinopril at the same time every day, at a time that is convenient and that you will remember to take it. If you have trouble remembering to take your medication, you can set a reminder or use an app to help you remember. 

What if you miss a dose of lisinopril?

If you miss a dose of lisinopril, take it as soon as you can. However, if it is almost time for the next dose, skip the missed dose. Do not take two doses to try to make up for a missed dose.