Lisinopril alternatives: What can I take instead of lisinopril?

In this article:

• What can I take instead of lisinopril?
• Top 5 lisinopril alternatives
• Compare lisinopril alternatives
• How to switch
• FAQs

In this article

• What can I take instead of lisinopril?
• Top 5 lisinopril alternatives
• Compare lisinopril alternatives
• How to switch
• FAQs

Lisinopril is one of the most prescribed medications for hypertension (high blood pressure) and is often known by the brand names Prinivil (discontinued) and Zestril. Besides being an antihypertensive, lisinopril is also approved by the Food and Drug Administration (FDA) for treating heart failure and improving survival after a heart attack. Although it’s effective, it may not be right for everyone. Lisinopril alternatives include other angiotensin-converting enzyme inhibitors (ACE inhibitors), as well as angiotensin II receptor blockers (ARBs), calcium channel blockers, and diuretics. The best alternative for you depends on your treatment goal and reason for switching.

What can I take in place of lisinopril?

There are many other options available to treat high blood pressure. These options may be more suitable for certain people due to their different uses, side effects, and dosages.

Top 5 lisinopril alternatives

1. Lotensin (benazepril)

Benazepril is an ACE inhibitor in the same class as lisinopril and works just as well to lower blood pressure. Both drugs share similar side effects, with cough, dizziness, and headache among the most common. If a side effect is your reason for switching away from lisinopril, benazepril may not be a good alternative since adverse reactions are usually the same amongst members of the drug class.

Although benazepril doesn’t carry FDA approval for heart failure or use after a heart attack, it is available in more combination products than lisinopril. Benazepril can be found as a combination drug with hydrochlorothiazide (Lotensin HCT) and amlodipine (Lotrel), while lisinopril is only paired with hydrochlorothiazide (Prinzide, Zestoretic). The convenience of getting both an ACE inhibitor and the calcium channel blocker amlodipine in one tablet could be enticing.

Related: Benazepril dosage

2. Diovan (valsartan)

A dry, tickling cough is a side effect that affects many people taking ACE inhibitors, often resulting in a search for alternatives. That search might land on valsartan, part of the ARB drug class that includes Cozaar (losartan), Benicar (olmesartan), and Atacand (candesartan). While ARBs avoid the common cough side effect of ACE inhibitors, they do have some adverse reactions in common with ACE inhibitors, namely elevated potassium and angioedema (rapid tissue swelling), along with being contraindicated in pregnancy.

ARBs work through a slightly different pathway but provide similar cardiovascular and kidney protection. Like lisinopril, valsartan is approved for high blood pressure, heart failure, and post–heart attack treatment, which makes it a versatile substitute.

Another advantage of valsartan is the availability of combination drugs. Valsartan is often paired with HCTZ (Diovan HCT), amlodipine (Exforge), and both HCTZ and amlodipine (Exforge HCT).

3. Hydrochlorothiazide (HCTZ)

Hydrochlorothiazide is a thiazide diuretic that lowers blood pressure by helping the kidneys remove excess salt and water. Unlike lisinopril, which can raise potassium, HCTZ may lower potassium levels. For those under treatment with lisinopril for hypertension but having a side effect of high potassium levels from the drug, HCTZ may be a viable alternative. Unfortunately, HCTZ does not have an FDA indication for use after a heart attack and is not used as often for heart failure.

HCTZ is widely available as a low-cost generic and is often used in combination with other blood pressure drugs for added effect. Pairing it with an ACE inhibitor such as lisinopril has a proven synergistic effect, but it can also be prescribed alone or in other fixed-dose combinations.

4. Norvasc (amlodipine)

Amlodipine is a calcium channel blocker that relaxes blood vessels to lower blood pressure. Unlike lisinopril, it does not affect potassium levels, making it a valuable alternative for patients with electrolyte imbalances. In addition, blood tests for kidney function can be altered by ACE inhibitors but are not typically changed by calcium channel blockers. Common side effects of amlodipine, however, include ankle swelling, flushing, and headache.

While amlodipine is a first-line option for hypertension, it is not approved for heart failure with reduced ejection fraction and may worsen edema in some patients. Still, its once-daily dosing, good tolerability, and availability in combination pills (such as with valsartan in Exforge) make it a practical substitute or add-on therapy.

RELATED: How does lisinopril affect your kidneys?

5. Toprol XL (metoprolol succinate)

Metoprolol succinate is a beta blocker that can lower blood pressure and decrease stress on the heart. Unlike lisinopril, it does not affect potassium levels or cause cough, but side effects can include fatigue, dizziness, and low heart rate.

Beta blockers are not usually the first choice for uncomplicated hypertension. However, metoprolol succinate is approved for hypertension, chest pain, and heart failure, which makes it a potential lisinopril alternative for those with coronary artery disease and congestive heart failure. Toprol XL’s once-daily dosing is also convenient for many when a beta blocker is needed.

Compare lisinopril alternatives
Drug name	Drug class	Advantages	Disadvantages	Savings options
Zestril (lisinopril)	ACE inhibitor	Once daily dosing	Cough and hyperkalemia side effects	Get coupon
Vasotec (enalapril)	ACE inhibitor	Intravenous form available	Same side effects and twice daily dosing	Get coupon
Lotensin (benazepril)	ACE inhibitor	Combination with amlodipine available	Same side effects	Get coupon
Microzide (HCTZ)	Thiazide diuretic	Does not cause hyperkalemia	Side effect of low potassium and not indicated after heart attack	Get coupon
Zestoretic (combination lisinopril/hydrochlorothiazide)	ACE inhibitor with thiazide diurectic	Reduction in pill burden by having two medicines in one product	Same side effects	Get coupon
Cozaar (losartan)	ARB	Much less risk of cough	Still has potential for angioedema and hyperkalemia	Get coupon
Diovan (valsartan)	ARB	Much less risk of cough	Still has potential for angioedema and hyperkalemia	Get coupon
Norvasc (amlodipine)	Calcium channel blocker	Does not cause cough or hyperkalemia	Side effect of leg swelling and not indicated for heart failure	Get coupon
Cardizem CD (diltiazem extended release)	Calcium channel blocker	Does not cause cough or hyperkalemia	Side effect of leg swelling and not indicated for heart failure	Get coupon
Toprol XL (metoprolol extended release)	Beta blocker	Does not cause cough or hyperkalemia and may be helpful for heart disease	Not a first line option for hypertension and side effects of low heart rate and wheezing	Get coupon
Cardura (doxazosin)	Alpha blocker	Does not cause cough or hyperkalemia	Not a first line option for hypertension and is not indicated for heart failure	Get coupon

Lifestyle measures for controlling blood pressure

Lifestyle changes are an important part of blood pressure treatment and may be used alone or with medication, depending on blood pressure and cardiovascular risk. Examples include:

• Weight loss and exercise
• Dietary salt restriction
• More involved dietary adjustments: For example, the Dietary Approaches to Stop Hypertension clinical trial showed that a diet rich in fruits and vegetables, with low-fat dairy and low saturated and total fat, effectively lowers blood pressure (now called the DASH diet).

Over-the-counter vitamins and supplements are often of interest, but they typically have little proof of efficacy and safety. Some can be hazardous. They should not be used as substitutes for prescription antihypertensives. Seek medical advice from a healthcare provider to see if any vitamin, supplement, or lifestyle change is advisable, as drug interactions may occur.

RELATED: Is salt bad for you?

How to switch to a lisinopril alternative

You may have reached the conclusion to switch from lisinopril to an alternative blood pressure medication, but it’s important to talk this over with a healthcare professional beforehand. Adverse effects are a common reason to change, particularly cough. Contact the prescribing provider if cough is experienced. Mild hyperkalemia from lisinopril warrants a call as well, whereas severe hyperkalemia requires urgent medical attention. Likewise, an angioedema reaction (swelling of the face, lips, or throat) to lisinopril is an emergency necessitating immediate treatment.

RELATED: Heart health resources and coupons

Sometimes the decision is based on added benefits. For example, drugs like Cardura (doxazosin) may help with both blood pressure and prostate symptoms. Still, it’s worth reviewing whether lisinopril is already offering other secondary benefits before making the switch. A provider can help weigh the trade-offs and recommend the safest alternative.

Cost may be another reason to compare alternatives to lisinopril. Although it’s a relatively affordable generic drug, lisinopril can still cost $30 for 90, 10 mg tablets without insurance. With a SingleCare prescription savings card, you could pay $10 for 90, 20 mg tablets, depending on your choice of pharmacy.

Frequently asked questions

What is the best lisinopril alternative if I have a cough?

An ARB, like valsartan, is often chosen to replace lisinopril when cough is experienced, because their mechanisms and uses are similar. Only a healthcare provider who is familiar with your medical conditions and drug list can make this determination.

What if lisinopril raises potassium?

Severe elevations in potassium require urgent medical care, and mild hyperkalemia calls for a discussion with the healthcare team. Dietary changes or a medication switch may be advised.

What lisinopril alternatives are used in pregnancy?

Lisinopril, as well as other ACE inhibitors and ARBs, are contraindicated in pregnancy. Talk to your healthcare professional about alternatives, like beta blockers and calcium channel blockers.