Does lisinopril cause weight gain?

In this article:

• Can lisinopril cause weight gain?
• Tips for managing your weight on lisinopril
• Alternatives to lisinopril
• The bottom line: Lisinopril doesn’t usually cause weight gain

In this article

• Can lisinopril cause weight gain?
• Tips for managing your weight on lisinopril
• Alternatives to lisinopril
• The bottom line: Lisinopril doesn’t usually cause weight gain

If you’ve been diagnosed with hypertension (high blood pressure), your healthcare provider may prescribe Zestril (lisinopril)—a widely-used ACE inhibitor—to help manage your condition. On top of lowering blood pressure, it can treat heart failure and help improve survival after a heart attack.

For high blood pressure, this medication is taken daily, on a long-term basis. If you notice the numbers on the scale creeping up after starting lisinopril, you might wonder: Does lisinopril cause weight gain? It’s not a common side effect of the medication. However, managing your weight is an important part of keeping your blood pressure under control—  these strategies can help.

Can lisinopril cause weight gain?

Weight gain is not a common side effect of lisinopril. It is typically caused by a co-occurring factor, such as another blood pressure medication, health condition, or lifestyle change. “I have had a few patients report cases of weight increase after beginning to take lisinopril,” says Michael O. McKinney, MD, a weight-loss expert at Healthy Outlook in Jacksonville, Florida. “This is relatively rare and often confounded by other factors.”

“Most patients do not experience significant weight changes attributable directly to this medication,” agrees Eldad Einav, MD, cardiologist and Clinical Assistant Professor at SUNY Upstate Medical University.

In other words, if you start packing on the pounds after starting lisinopril, it’s typically not caused by the medication itself, but rather one or more of the following:

• Lifestyle factors: A sedentary lifestyle is linked to both hypertension and weight gain.
• Co-occurring medical conditions: Some medical conditions that commonly cooccur with hypertension are also associated with obesity, such as metabolic disorders, diabetes, and high cholesterol. Other health issues that are associated with obesity include heart disease, liver disease, sleep apnea, and certain cancers.
• Other medications: Certain medications are commonly associated with weight gain, especially mental health medications, such as some antidepressants or antipsychotics, says Dr. Einav. Unlike these medications, “lisinopril does not typically interfere with metabolic processes or appetite regulation in a way that would promote weight gain,” he says.
• Edema: “People with hypertension may retain water,” says Dr. McKinney. “However, this more commonly occurs with other classes of antihypertensives.” For example, certain ARBs (angiotensin II receptor blockers), calcium channel blockers, and beta blockers more commonly cause weight gain.

Although weight gain is not a common side effect of lisinopril, there are some adverse effects to be aware of.

Common side effects of lisinopril

Common side effects of lisinopril include:

• Dry cough
• Dizziness or lightheadedness
• Headache
• Fatigue
• Nausea
• Low blood pressure

Serious side effects of lisinopril

In rare cases, serious side effects of lisinopril can occur. They include:

• Allergic reactions including angioedema (swelling under the skin, commonly affecting the face, lips, tongue, throat, hands, or feet)
• High potassium levels
• Kidney problems
• Kidney failure
• Liver problems
• High blood sugar
• Severe hypotension (severely low blood pressure)

Contraindications and warnings of lisinopril

• Pregnant and breastfeeding individuals: The FDA issued a black box warning for lisinopril during pregnancy. It should not be used in pregnancy due to the increased risk of fetal harm. Lisinopril should not be used in breastfeeding women.
• People with a history of allergic reactions, including angioedema, to an ACE inhibitor—or by individuals with any history of angioedema should not take lisinopril. 
• People who take a neprilysin inhibitor (sacubitril) should not take lisinopril. 
• People who take aliskiren and have diabetes should not take lisinopril.
• Those taking over-the-counter potassium supplements, potassium-sparing diuretics, or who use salt substitutes that contain potassium should check with their healthcare provider as increased blood levels of potassium could occur, potentially leading to heart problems.
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Tips for managing your weight on lisinopril

If you’re gaining weight while taking lisinopril, these strategies can help to manage your blood pressure and maintain a healthy weight:

1. Follow a heart-healthy diet: Eating a diet rich in fruits, vegetables, lean proteins, and whole grains while avoiding processed foods can make a significant difference. Many experts recommend the DASH diet or the Mediterranean diet as heart-healthy options. 
2. Exercise regularly: Research shows that 150 minutes of moderate activity each week can lower blood pressure in three months. It’s also an effective way to maintain your weight.
3. Stay hydrated: Drinking plenty of water helps prevent water retention, a possible side effect of lisinopril that can sometimes be mistaken for weight gain. Aim to drink at least eight glasses of water a day unless advised otherwise by your healthcare professional.
4. Decrease your sodium intake: Consuming too much salt can cause water retention, which looks a lot like weight gain. It can also raise your blood pressure. Just be careful with salt substitutes. Many contain potassium, which can lead to high potassium levels and exacerbate the side effects of lisinopril.
5. Rule out other medical conditions: Work with your healthcare provider or an obesity specialist to determine if another underlying health issue is making you gain weight.
6. Ask about an alternative medication. Lisinopril is generally well-tolerated, but there are other treatment options. “These could involve shifting to any other ACE inhibitor that has different characteristic side effects or trying out other classes of antihypertensive medicines such as ARBs,” says Dr. McKinney.

Alternatives to lisinopril

If the side effects of lisinopril are intolerable, several other medications are effective for managing blood pressure, including:

• ARBs (angiotensin receptor blockers): These medications, such as losartan and valsartan, are less likely to cause side effects like cough and angioedema and are often used when patients experience adverse effects from ACE inhibitors.
• Calcium channel blockers: These drugs, such as amlodipine, help lower blood pressure by relaxing the muscles of your heart and blood vessels.
• Beta blockers: Older beta blockers commonly cause weight gain, such as Tenormin (atenolol) and Lopressor (metoprolol). However, newer beta blockers, like carvedilol and nebivolol, are less likely to cause weight gain and are effective in managing hypertension, heart disease, and heart failure.
• Diuretics (water pills): These medications, such as hydrochlorothiazide, help reduce excess fluid in the body, which can lower blood pressure, prevent water retention, and avoid weight gain.

The bottom line: Lisinopril doesn’t usually cause weight gain

Lisinopril is an effective medication for high blood pressure and heart failure as well as for improving heart attack survival rates. Weight gain is not a common side effect of lisinopril, but it can occur while taking the medication—usually due to another medical condition, medication, or lifestyle factor. Seek medical advice from your healthcare provider while managing your blood pressure and your weight while taking lisinopril.

“Weight management in antihypertensive patients is not a problem easily defined,” says Dr. McKinney. “Among other approaches, the medicines may be of help, but lifestyle changes are most required to control and minimize weight gain.”