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Lisinopril is a medication used to lower high blood pressure. And usually, that’s a good thing. But sometimes, the pendulum can swing too far in the other direction, making your blood pressure drop too low. The result? If your blood pressure is too low, it’s going to be hard for blood to reach your brain. This makes you feel dizzy, and can even cause fainting.
Other side effects of lisinopril include a dry or chronic cough. Actually, it’s the main reason people stop taking these drugs. About one in 10 people who take medications like lisinopril eventually develops a cough, which is more commonly seen in people who are older, female, or who are taking cholesterol-lowering drugs (Brugts, 2014).
Here’s more on what to expect in terms of side effects, drug interactions, and who should avoid lisinopril.
What are the side effects of lisinopril?
Lisinopril, part of a class of drugs known as ACE inhibitors, effectively treats cardiovascular conditions—including high blood pressure, heart failure, and heart attacks—but also has a wide range of potential side effects to be aware of (Lopez, 2020).
The most common one is a dry or chronic cough—a signature side effect of ACE inhibitors (Yilmaz, 2019). If you are older, female, or are taking medications to lower cholesterol, you may be more likely to develop a cough, which is also cited as the main reason people (roughly 4%) stop taking these drugs (Brugts, 2014). Other regularly reported side effects include dizziness, chest pain, headaches, fainting, and fatigue.
Serious reactions don’t happen as often, but can quickly evolve into severe or life-threatening situations. Here are the most important ones to note (FDA, 2014):
- Low blood pressure: Lisinopril can cause hypotension, or low blood pressure. If you have heart disease, heart failure, or kidney disease, taking this medication can put you at risk of blood pressure dropping too low.
- Worsening kidney function: Use this drug with caution if you have any type of kidney condition. Lisinopril may impact kidney function, pushing patients with fragile renal systems into kidney failure.
- High potassium levels: Also known as hyperkalemia occurs when there’s an excessive amount of potassium in the blood. Although many cases are mild and easy to correct, untreated hyperkalemia can lead to life-threatening heart problems (Simon, 2020). Risk factors for high potassium include diabetes, kidney problems, and using any supplements or substitutes that contain potassium.
- Severe allergic reactions: Lisinopril can trigger life-threatening allergic reactions including angioedema, which is rapid swelling in parts of the body, particularly the face and throat.
If you have an underlying health condition, talk to a healthcare provider before taking either of these medications as some conditions can increase your risk for side effects.
How lisinopril works in the body
What is high blood pressure, exactly?
Think of your blood vessels like highways. They carry your blood from place to place. High blood pressure is essentially traffic on those highways and when it’s too high, it can cause damage both to the blood vessels themselves and to the organs served by those blood vessels (kind of like filling a water balloon using a fire hose).
There are a few ways to lower high blood pressure. Lisinopril and other ACE inhibitors have two main effects. They both make the highways (blood vessels) wider, and they reduce the amount of water in your blood, reducing the “traffic.”
Why is it important to treat high blood pressure?
More than 108 million people in the United States have high blood pressure, which is among the biggest risk factors for heart disease, and heart disease is the leading cause of death in the country (Whelton, 2017; Kochanek, 2017).
Along with the risk for heart disease, untreated high blood pressure increases the likelihood for serious health complications, such as kidney failure and stroke.
What exactly causes high blood pressure? There are many risk factors for hypertension, including family history, age, and underlying health issues (AHA, 2017). Research has found that racial disparities in healthcare also affect how hypertension is diagnosed and treated. This is especially true in the United States, where Black, Indigenous, and people of color have a significantly higher risk for developing high blood pressure compared to white people (Whelton, 2017).
While some of these risk factors cannot be changed, others—like not getting enough exercise, eating an unhealthy diet, drinking too much alcohol, and smoking—can be changed by adopting a heart-healthy lifestyle (AHA, 2017).
Main uses of lisinopril
Lisinopril, also found under the brand name Zestril, works by relaxing blood vessels, which in turn lowers blood pressure and allows more oxygen-rich blood to reach the heart. Lisinopril comes in oral tablets taken daily, and is available in 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, and 40 mg doses (FDA, n.d.). This drug has been found to be safe when treating hypertension in adults and children ages 6 and up. Here are more details on the FDA-approved uses for lisinopril (FDA, 2014):
- Hypertension: By American Heart Association (AHA) standards, normal blood pressure levels are less than 120/80 mmHg (AHA, n.d.). If you have high blood pressure, ACE inhibitors like lisinopril can be prescribed to control levels and prevent heart disease from developing.
- Heart failure: Uncontrolled high blood pressure greatly increases the risk for heart failure. In combination with other treatments—such as hydrochlorothiazide, another common blood pressure medication—lisinopril can decrease the chance of death in people living with heart failure (Lopez, 2020).
- Myocardial infarction: Lisinopril is also used to treat myocardial infarction—or what’s commonly known as a heart attack. Giving lisinopril to a stable patient within 24 hours of a heart attack can help improve their survival rate.
What is lisinopril commonly used to treat?
Side effects: lisinopril and hydrochlorothiazide
Lisinopril is frequently prescribed with diuretics, or “water pills.” Diuretics help treat high blood pressure by removing excess fluid from your body through your pee. Hydrochlorothiazide (HCTZ), also known under the brand name Zestoretic, is a diuretic often used in tandem with lisinopril (FDA, n.d.). Here are the most common side effects of this combination medication (DailyMed, 2019):
- Low blood pressure
- Muscle cramps
- Gastrointestinal issues (indigestion, nausea, vomiting, diarrhea)
- Upper respiratory infection
- Erectile dysfunction
Who should not take lisinopril
There are groups of people who should stay away from lisinopril completely. If you have kidney problems, hypotension, a history of angioedema, liver disease, or have had allergic reactions to ACE inhibitors in the past, avoid using lisinopril (FDA, 2014).
ACE inhibitors of any kind are not safe for pregnant women, and could result in permanent damage or death to a fetus (FDA, 2014). The safety of lisinopril has not yet been established for women nursing infants. If you’re nursing, speak to a healthcare provider who may recommend another type of medication. Children under age 6 should not use lisinopril.
Drug interactions with lisinopril
There is a wide range of drugs lisinopril is known to interact with. Some interactions are insignificant, but others can trigger mild to severe reactions. Using lisinopril if you’re already taking medication for high blood pressure, for example, could result in an excessive drop in blood pressure. Below are some of the main drug interactions to watch out for (FDA, 2014):
- Diuretics (water pills): ACE inhibitors are sometimes combined with diuretics to improve symptoms. If you’re on diuretics, starting lisinopril can cause an excessive drop in blood pressure, as well as a spike in potassium levels.
- Antidiabetics: Drugs used to manage diabetes work by regulating blood sugar levels in the body. Mixing antidiabetics, like insulin and oral hypoglycemic medications, with lisinopril can enhance the effects and increase the risk for hypoglycemia (low blood sugar).
- Nonsteroidal anti-inflammatories (NSAIDs): NSAIDs are popular drugs used to treat pain and inflammation. Certain patient populations, like those with chronic kidney disease, are advised to avoid NSAIDs as the medication has been linked to kidney damage. Taking lisinopril with NSAIDs could further harm the kidneys, in some cases putting patients into renal failure.
- Aliskiren: Aliskiren is a generic drug that helps control high blood pressure. When combined with ACE inhibitors, aliskiren (which falls into a class of drugs called renin inhibitors) can cause severe problems, such as kidney failure, hypotension, and hyperkalemia. People living with diabetes or existing kidney problems should not use these medications together.
- Lithium: Lithium is a prescription medication used to manage bipolar disorder. There are a number of drugs, including ACE inhibitors, that when taken at the same time as lithium can cause a lithium overdose. Lithium toxicity is usually reversible, but to avoid it from occurring, lithium levels should be monitored while taking lisinopril.
- Gold: While not the most common therapy, people living with rheumatoid arthritis and other autoimmune diseases can be given gold injections to improve symptoms (UpToDate, 2019). Reactions between gold and lisinopril are rare, but they can happen. Reported side effects when taking these two medications together may cause facial flushing, nausea, vomiting, and low blood pressure.
- Alcohol: Drinking alcohol can amplify the effects of lisinopril, which may cause side effects like dizziness, lightheadedness, and fainting.
Heart-healthy diet: what is it and 9 tips to following one
This isn’t a full list of drugs that can interact with lisinopril. Beyond drug interactions, avoid taking any potassium supplements or salt substitutes containing potassium while using lisinopril.
As we’ve established, there are many risk factors for developing hypertension, including diabetes, a family history of high blood pressure, obesity, and lack of physical activity—to name a few (Oparil, 2018). There are also a number of steps you can take to improve your heart health, and lower your risk for hypertension. Eat a diet rich in fruits and vegetables. Keep physically active to help achieve and maintain a healthy weight. Stay away from smoking, and cut back on how much alcohol you drink. Making changes like these now can help prevent health problems in the future. Talk to a healthcare provider before taking lisinopril, or if you experience any adverse or unexpected reactions while on the medication.
- American College of Cardiology (ACC). (2020, April 6). Racial Disparities in Hypertension Prevalence and Management: A Crisis Control? Retrieved Oct. 18, 2020 from https://www.acc.org/latest-in-cardiology/articles/2020/04/06/08/53/racial-disparities-in-hypertension-prevalence-and-management
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- Centers for Disease Control and Prevention (CDC). (2020, February 24). Know Your Risk for High Blood Pressure. Retrieved Oct. 12, 2020 from https://www.cdc.gov/bloodpressure/risk_factors.htm
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- Kochanek, K. D., Murphy, S. L., Xu, J., & Arias, E. (2019). Deaths: Final Data for 2017. National Vital Statistics Reports, 68(9). Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf
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- National Institute on Alcohol Abuse and Alcoholism (NIH). (2014). Harmful Interactions. Retrieved on Oct. 20, 2020 from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines
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- UpToDate. (September 2020). Choice of drug therapy in primary (essential) hypertension. Retrieved on Oct. 18, 2020 from https://www.uptodate.com/contents/choice-of-drug-therapy-in-primary-essential-hypertension?topicRef=3815&source=see_link
- UpToDate. (October 2019). Major side effects of gold therapy. Retrieved on October 18, 2020 from https://www.uptodate.com/contents/major-side-effects-of-gold-therapy
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- U.S. Food and Drug Administration (FDA). (n.d.). ZESTORETIC (lisinopril and hydrochlorothiazide). Retrieved Oct. 15, 2020 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019888s045lbl.pdf
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- Yilmaz, I. (2019). Angiotensin-Converting Enzyme Inhibitors Induce Cough. Turkish Thoracic Journal, 20(1). Retrieved from doi: 10.5152/TurkThoracJ.2018.18014. Retrieved from https://turkthoracj.org/en/angiotensin-converting-enzyme-inhibitors-induce-cough-131056
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.