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Lisinopril alternatives: What can I take instead of lisinopril?

Lisinopril doesn't work for everyone. Lotensin, Diovan, hydrochlorothiazide, Norvasc, and Toprol XL are some lisinopril alternatives. Get the full list here.
By | Mar. 31, 2022
Tablet vs capsule: What can I take instead of lisinopril?

Key takeaways

  • Lisinopril is widely prescribed for hypertension and heart conditions, but alternatives like Lotensin, Diovan, hydrochlorothiazide, Norvasc, and Toprol XL exist for those who experience side effects or require different treatment approaches.

  • Each drug class (such as ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, and diuretics) has unique mechanisms of action, dosing, and side effects.

  • Natural alternatives and lifestyle changes like weight loss, exercise, and dietary adjustments (such as the DASH diet) could also help manage blood pressure before or alongside medication.

  • Switching from lisinopril to an alternative medication should involve a discussion with a healthcare professional, considering factors like side effects, cost, and the potential benefits of the current medication versus alternatives.

In this article:

Lisinopril is one of the most prescribed medications for hypertension (high blood pressure or BP). You may know it by the brand names Prinivil or Zestril, but generic versions are often used. Besides being an anti-hypertensive, lisinopril has a Food and Drug Administration (FDA) indication for treatment of congestive heart failure (CHF), specifically versions with a reduced ejection fraction (EF or heart squeeze), and treatment of acute myocardial infarction (MI or heart attack). The use of lisinopril is widespread, but fortunately, it is not irreplaceable. Several lisinopril alternatives exist, providing options for times when lisinopril is contraindicated in a patient or its side effects are intolerable.

What can I take in place of lisinopril?

There are many other options available to treat high blood pressure. These alternative prescription medications include other types of angiotensin-converting enzyme inhibitors (ACE inhibitors) or other classes of blood pressure medications such as angiotensin II receptor blockers (ARBs), calcium channel blockers, and diuretics. These options may be more suitable for certain individuals due to their different uses, side effects, and dosages.

Compare Lisinopril alternatives
Drug name Uses Side effects Dosage Savings options
Zestril (lisinopril) Hypertension, CHF with low EF, acute MI, migraine prevention (off-label) Cough, dizziness, hypotension (low blood pressure), renal (kidney) impairment, headache, hyperkalemia (high levels of potassium), angioedema (swelling under the skin often in the face) 2.5-40 mg once daily Zestril coupons
Vasotec (enalapril) Hypertension, CHF with low EF, acute MI (off-label), systolic dysfunction (reduced heart squeeze) without symptoms, nephropathy or kidney dysfunction (off-label) Cough, dizziness, hypotension, renal impairment, headache, hyperkalemia, angioedema 2.5-20 mg once or twice daily Vasotec coupons
Lotensin (benazepril) Hypertension, heart failure (off-label) Cough, dizziness, hypotension, renal impairment, headache, hyperkalemia, angioedema 5-40 mg once or twice daily Lotensin coupons
Hydrochlorothiazide (HCTZ) Hypertension, peripheral edema (swelling) Dizziness, hypotension, hypokalemia (low potassium), hyponatremia (low sodium), hypercalcemia (high calcium), hyperuricemia (high uric acid), sun sensitivity 12.5-50 mg once daily (higher doses up to 200 mg may be used for edema) Hydrochlorothiazide coupons
Zestoretic (combination lisinopril/hydrochlorothiazide) Hypertension Cough, dizziness, hypotension, renal impairment, headache, hyperkalemia, angioedema, hypokalemia, hyponatremia, hypercalcemia, hyperuricemia, sun sensitivity 10 mg/12.5 mg, 20 mg/12.5 mg, or 20 mg/25 mg once daily Zestoretic coupons
Cozaar (losartan) Hypertension, diabetic nephropathy, stroke prevention, CHF with low EF (off-label) Cough, dizziness, hypotension, renal impairment, hyperkalemia, angioedema 25-100 mg once daily Cozaar coupons
Diovan (valsartan) Hypertension, CHF with low EF, left ventricular dysfunction (reduced heart squeeze) after MI Cough, dizziness, hypotension, renal impairment, headache, hyperkalemia, angioedema 80-320 mg once daily (or daily dose divided into two doses) Diovan coupons
Avapro (irbesartan) Hypertension, diabetic nephropathy Cough, dizziness, hypotension, renal impairment, hyperkalemia, angioedema 75-150 mg once daily Avapro coupons
Norvasc (amlodipine) Hypertension, coronary artery disease (CAD) Dizziness, hypotension, peripheral edema, palpitations, flushing, angina (chest pain) 2.5-10 mg once daily Norvasc coupons
Lotrel (combination amlodipine/benazepril) Hypertension Cough, dizziness, hypotension, renal impairment, headache, hyperkalemia, angioedema, peripheral edema, palpitations, flushing, angina 2.5 mg/10 mg, 5 mg/10 mg, 5 mg/20 mg, 5 mg/40 mg, 10 mg/20 mg, or 10 mg/40 mg once daily Lotrel coupons
Cardizem CD (diltiazem extended release) Hypertension, angina Dizziness, hypotension, peripheral edema, bradycardia (slow heart rate), electrical heart block or rhythm abnormality 120-480 mg once daily Cardizem CD coupons
Toprol XL (metoprolol extended release) Hypertension, angina, CHF with low EF, migraine prevention (off-label) Dizziness, depression, bradycardia, shortness of breath, electrical heart block, CHF 25-400 mg once daily Toprol XL coupons
Coreg (carvedilol) Hypertension, CHF with low EF, left ventricular dysfunction after MI Dizziness, hypotension, bradycardia, shortness of breath, electrical heart block, CHF 3.125-25 mg twice daily Coreg coupons
Aldactone (spironolactone) Hypertension, CHF with low EF, edema, primary hyperaldosteronism (excess aldosterone from adrenal glands), diuretic-induced hypokalemia (off-label), idiopathic hirsutism (unexplained excess hair growth, off-label), acne vulgaris (off-label) Dizziness, hyperkalemia, breast pain, gynecomastia (male breast enlargement), menstrual irregularity, stomach irritation or ulcer, renal impairment 12.5-100 mg once daily for hypertension (or up to 200 to 400 mg daily for some indications) Aldactone coupons
Hydralazine Hypertension, CHF with low EF (off-label, given with isosorbide dinitrate) Hypotension, headache, tachycardia (fast heart rate), angina, palpitations, lupus erythematosus 10-50 mg four times daily (or up to 100 mg three times daily for CHF with low EF) Hydralazine coupons
Cardura (doxazosin) Hypertension, benign prostatic hypertrophy (BPH, enlarged prostate) Dizziness, hypotension, headache, palpitations, edema, shortness of breath, blurred vision 1-16 mg once daily (or maximum of 8 mg for BPH) Cardura coupons

Other alternatives to lisinopril

Top 5 lisinopril alternatives

1. Lotensin (benazepril)

Benazepril belongs to the same drug class as lisinopril of ACE inhibitors. Vasotec, quinapril, Altace, fosinopril, perindopril, and captopril are other examples of ACE inhibitors. The class is preferred for hypertension treatment in diabetic patients, and it is often a first-line choice for others. ACE inhibitors are available in low-priced generics and share similar adverse effect profiles. 

Lisinopril and benazepril can both be taken once daily for convenience. Therefore, when used as monotherapy without other antihypertensive medications, there is not much reason to choose one over another. 

However, hypertension often requires more than one drug class, so combination agents are commonplace to provide multiple treatment mechanisms in one pill. Benazepril has a slight advantage over lisinopril, in that benazepril is available in combination with HCTZ (Lotensin HCT) as well as with amlodipine (Lotrel), whereas lisinopril does not come combined with amlodipine.

2. Diovan (valsartan)

A dry, tickling cough is a side effect that affects up to 35% of those taking ACE inhibitors, frequently resulting in a search for alternatives. That search often lands on one of the ARBs, a drug class that includes Diovan, Cozaar, Benicar, Avapro, and Atacand. 

ARBs share similar cardiovascular and renal benefits with ACE inhibitors, and their mechanism is not too disparate from ACE inhibitors. For these reasons, if cough is the only problem with lisinopril, Diovan or another ARB is a prime alternative, based on only a 3% incidence of cough. 

Another advantage to valsartan is the combination possibilities. Valsartan is available in combination with HCTZ (Diovan HCT), amlodipine (Exforge), and both HCTZ and amlodipine (Exforge HCT).

3. Hydrochlorothiazide (HCTZ)

HCTZ is a thiazide diuretic, as is chlorthalidone. They have the opposite effect on potassium levels compared to ACE inhibitors, with thiazides potentially causing hypokalemia (low potassium) and ACE inhibitors potentially causing hyperkalemia (high potassium). Use of NSAIDs and salt substitutes can elevate potassium levels. If you have problems with hyperkalemia on lisinopril, then HCTZ may be a viable alternative. 

Thiazides may also be preferable if you have problems with edema (swelling from increased tissue fluid) because the diuretic action may be helpful. Of note, loop diuretics, like Lasix, are typically more effective for edema.

Other than being an alternative to lisinopril, HCTZ is a popular option to combine with it and other ACE inhibitors. Thiazides and ACE inhibitors have a synergistic effect for lowering blood pressure. 

4. Norvasc (amlodipine)

Dihydropyridine calcium channel blockers, like Norvasc, are another first-line options for treatment in hypertensive patients. Nifedical XL, Felodipine XR, and isradipine are others in this class. They do not have ill effects on potassium and do not alter kidney function tests, so in these circumstances, they can serve as a valuable alternative to lisinopril. They also avoid the bradycardia risk of non-dihydropyridine calcium channel blockers, such as Cardizem CD and Calan SR. Keep in mind that Norvasc and its cousins are not always preferable. They do not have an indication for CHF and can lead to peripheral edema.

RELATED: How does lisinopril affect your kidneys?

5. Toprol XL (extended-release metoprolol)

The beta blocker class of antihypertensives, including Toprol XL, is not a typical first choice for hypertension. Other beta blockers include Tenormin, Inderal LA, Coreg, Coreg CR, Bystolic, bisoprolol, and Trandate. While the lack of potassium effects and cough may be advantageous compared to lisinopril, their tendency to lower heart rate and create withdrawal symptoms when stopped make them second-line in many instances. An exception is the circumstance when one has had a heart attack in the past. Toprol XL or other beta blockers may be particularly beneficial for these individuals. The heart rate-limiting effects can also be helpful for those with atrial fibrillation.

Natural alternatives to lisinopril

Before resorting to lisinopril or other prescription drugs for hypertension, your healthcare professional may advise you to make some lifestyle changes. Even if not done exclusively and instead combined with drug therapy, these measures could still help your blood pressure get to goal. 

  • Weight loss and exercise are two common bits of advice. 
  • Dietary salt restriction can also be helpful. 
  • More involved dietary adjustments could prove useful. For example, the Dietary Approaches to Stop Hypertension clinical trial showed that a diet rich in fruits, vegetables, and low-fat dairy products and low in saturated and total fats was effective for lowering blood pressure, and this is now termed the DASH diet. One reason for fruit and vegetable effectiveness may be flavonoid content. A study showed flavonoid-rich cocoa to be associated with a small reduction in blood pressure.
  • Over-the-counter vitamins and supplements are often of interest, but they typically have little proof of efficacy and safety. Potassium, magnesium, fish oil, fiber, protein, and folate have all shown some promise in blood pressure reduction. Interestingly, pomegranate juice seems to lower blood pressure somewhat, possibly by inhibiting angiotensin converting enzymes. The supplements each have unique risks though for some individuals. You must seek medical advice from your 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 you need to talk this over with your healthcare professional beforehand. Adverse effects are a common reason to change, particularly cough. Certain side effects and allergic reactions require quick action though. Side effects like angioedema and hyperkalemia require immediate medical attention and changes. 

Looking for a secondary benefit, such as relief from prostatic hypertrophy symptoms from Cardura, may be another rationale for changing from lisinopril. Before jumping to another option for that reason, you may want to know if you are deriving other secondary benefits from lisinopril which you are unaware of. Again, a discussion with your healthcare provider before switching is essential. 

Cost may be another reason to compare alternatives to lisinopril. Although a relatively affordable generic drug, lisinopril can still cost $35 for 30, 10 mg tablets without insurance. Your SingleCare prescription savings card can help you save up to 80% off on your next lisinopril refill or an alternative.