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Lisinopril side effects, warnings, and interactions

Lisinopril is a generic medication used to treat high blood pressure but can come with side effects. Know the warnings and drug interactions of lisinopril before taking this medication.
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By | Updated on Aug. 13, 2024 Medically reviewed by Karen Berger, Pharm.D.
Pill bottle and prescription pad: Lisinopril side effects

Key takeaways

  • Lisinopril, a generic drug also known under brand names such as Zestril and Prinivil, is primarily used to treat high blood pressure and is effective in increasing life expectancy post-heart attack and improving symptoms of congestive heart failure.

  • Common side effects of lisinopril include cough, dizziness, elevated potassium levels, low blood pressure, and in rare cases, serious side effects like severe allergic reactions, kidney failure, and liver problems.

  • Lisinopril contraindications include pregnancy due to the risk of birth defects, history of ACE inhibitor allergies, and conditions like hereditary or idiopathic angioedema, with special monitoring required for individuals with kidney problems or those taking RAAS inhibitors or potassium-sparing diuretics.

  • To minimize lisinopril side effects, patients should disclose all medical conditions and medications to their healthcare provider, follow the prescribed dosage, stay hydrated, monitor blood pressure and potassium levels, and watch for signs of angioedema.

Lisinopril side effects | Cough | Dizziness | Serious side effects | Severe allergic and skin reactions | High potassium levels | How long do side effects last? | Warnings | Interactions | How to avoid side effects | FAQs

Lisinopril is a generic drug commonly used to treat high blood pressure. Also available under the brand names Zestril, Prinivil, and Qbrelis, lisinopril (in combination with other medications) 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. Angiotensin II narrows blood vessels, increases blood pressure, and makes the heart work harder. By relaxing blood vessels, lisinopril lowers blood pressure and allows more blood to flow. Lisinopril and other ACE inhibitors are known for being effective and well-tolerated, so they are often the first drugs prescribed for hypertension. Still, side effects, drug interactions, and other problems are possible when taking lisinopril.

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:

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 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. The cough can be very bothersome, and can interfere with daily activities as well as sleep. People who develop this cough should consult their healthcare provider for medical advice.

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 or toxic epidermal necrolysis)
  • High blood potassium
  • Dangerously low blood pressure
  • Kidney dysfunction or kidney failure
  • Liver problems leading to liver failure  (watch 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—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 symptoms of a severe skin reaction occur—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 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.

Abuse and dependence

Lisinopril is not a controlled substance, and does not cause physical dependence or withdrawal, and is not associated with drug abuse.

Overdose

A lisinopril overdose is not expected to be toxic but will cause blood pressure to fall. Extremely low blood pressure is a serious and potentially fatal medical condition, so if an overdose is suspected, seek emergency medical care. 

Restrictions

A contraindication is any condition that makes lisinopril too hazardous to take, so the drug will never be used in a person with a contraindication. Lisinopril contraindications are:

  • Pregnancy. Because of the risk for birth defects and fetal death, pregnant women are never given lisinopril.
  • ACE inhibitor allergies. Anyone with a history of hypersensitivity reactions to lisinopril or any other ACE inhibitor will not be prescribed lisinopril or any other ACE inhibitor.
  • ACE inhibitor-associated angioedema. Angioedema is swelling of the head, neck, and even the digestive system. Normally an allergic reaction, angioedema can be a side effect of lisinopril and other ACE inhibitors. Anyone who has experienced angioedema taking lisinopril or any other ACE inhibitor will never be given lisinopril. 
  • Hereditary or idiopathic angioedema. Some people are born with a condition called hereditary angioedema where they 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. 

Other people may require close monitoring to avoid serious side effects. Because of the risk of kidney problems, low blood pressure, high blood potassium, low blood sodium, and dehydration, 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.

In general, contraindications, restrictions, and cautions specific to any single ACE inhibitor, such as lisinopril, almost always apply to all ACE inhibitors. Someone having problems with one ACE inhibitor will rarely be prescribed another. 

Race

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.

Pregnancy and nursing

Lisinopril should never be taken by pregnant women. Lisinopril can cause birth defects and fetal or newborn death. If you take lisinopril and find out that you are pregnant or think you may be pregnant, notify your doctor immediately.

Women who are breastfeeding should generally avoid taking lisinopril or other ACE inhibitors. Although its safety has not been studied in nursing infants, healthcare providers will either choose a different drug or ask the woman to discontinue nursing while taking lisinopril.

Children

The U.S. Food and Drug Administration (FDA) has approved lisinopril as safe and effective in children as young as 6 years of age as treatment for high blood pressure. Healthcare providers occasionally prescribe lisinopril off-label for children as young as 1 year old, but the drug has not been established as safe and effective for children this young.

Seniors

People aged 65 years and older can be given lisinopril. Dosage reductions will not be required, but healthcare providers may monitor elderly patients carefully for side effects.

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:

Other types of drugs will also interact with lisinopril and require caution, monitoring, or dosing modifications.

  • RAAS inhibitors. ACE inhibitors act on a delicate hormone system called RAAS that governs blood pressure as well as the body’s elimination of water and electrolytes. Lisinopril should not be used with other ACE inhibitors such as enalapril, benazepril, captopril, ramipril, or quinapril. RAAS inhibitors also include a family of blood pressure drugs called angiotensin receptor blockers (ARBs) which include valsartan and losartan. Lisinopril (or any ACE inhibitor) is generally not taken in combination with an ARB, but the combination may be prescribed in rare, specific cases. Taking more than one RAAS inhibitor increases the risk of low blood pressure, high potassium, dehydration, angioedema, and kidney problems.
  • Potassium. Because of the risk of high potassium, anyone taking lisinopril will be advised to avoid eating too much potassium or taking potassium supplements, potassium drugs, or using potassium salt substitutes.
  • Potassium-sparing diuretics. Some diuretics—drugs that increase the body’s elimination of water and electrolytes through the urine—are designed to prevent the kidneys from eliminating potassium. Taking potassium-sparing diuretics with lisinopril raises the risk of high serum potassium.
  • Aminoglycoside antibiotics. Aminoglycoside antibiotics treat bacterial infections but can damage, sometimes severely, the ears and the kidneys. Combining them with lisinopril increases the likelihood of ear or kidney damage.
  • NSAIDs (nonsteroidal anti-inflammatory drugs). Healthy patients should be able to take NSAIDs such as aspirin, naproxen, ibuprofen, or indomethacin when taking lisinopril. NSAIDs can damage the kidneys, so people who are elderly, dehydrated, or have kidney problems will be advised to avoid NSAIDs while taking lisinopril. 
  • Lithium. Used to treat bipolar disorder, lithium damages the kidneys, so the combination with lisinopril raises the risk of kidney problems.
  • mTOR inhibitors. This very small class of drugs is used to either suppress the immune system after an organ transplant (everolimus or sirolimus) or treat advanced kidney cancer (temsirolimus). Combining these drugs with lisinopril raises the risk of angioedema.
  • Diabetes medications. Lisinopril increases the effects of drugs designed to lower blood sugar, raising the risk of hypoglycemia (low blood sugar). Monitor blood sugar carefully when taking lisinopril.
  • Blood pressure drugs. Taking more than one blood pressure drug is normal. However, there’s always a danger that blood pressure may fall too far. Any combination therapy will require regular blood pressure monitoring.
  • Tricyclic antidepressants, antipsychotics, sedatives, benzodiazepines, barbiturates, opioids, muscle relaxers, alpha-2 agonists, and erectile dysfunction medications. All of these medications lower blood pressure as a side effect, so combining them with lisinopril or any other blood pressure medication might cause hypotension. Blood pressure will need to be monitored when combining these drugs with lisinopril.
  • Medications that raise blood pressure. Many common drugs raise blood pressure. The most common are stimulants, ADHD medications, wakefulness agents, decongestants, corticosteroids, antidepressants, sympathomimetic drugs (like epinephrine), and migraine drugs. By raising blood pressure, they neutralize the benefits of blood pressure-lowering drugs such as lisinopril. Again, blood pressure will need to be monitored and treatments or dosing modified.

How to avoid 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 the 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 the healthcare provider about all medications being taken

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 a healthcare professional. Do not take more or less than prescribed until you’ve consulted with a doctor or healthcare professional. 

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. To make sure the drug is working and to prevent blood pressure from getting too low, purchase a blood pressure monitor and check blood pressure regularly. 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

What is the most common side effect of lisinopril?

The most common side effects in people taking lisinopril for high blood pressure are dry cough, dizziness, and headache. People taking lisinopril for heart failure or heart attack tend to experience low blood pressure, fainting, and kidney problems as the most common side effects. 

What is the safest blood pressure medication?

Blood pressure medications, like any other medications, come with various risks and benefits. What works well and is tolerated well in one person may not work as well or not be tolerated in another. Your healthcare provider will take a detailed health history and review all the medications you take in order to determine which blood pressure medication is safest for you. 

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 cough that is bothersome should consult their healthcare provider for medical advice.

Is it better to take lisinopril in the morning or 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. 

Does lisinopril help anxiety?

Lisinopril is not used to treat anxiety. There is no mention of anxiety treatment or relief in the drug information for lisinopril. In some cases, a drug from a different type of blood pressure medication class, called beta blockers (such as metoprolol or atenolol), may be used off-label to help with anxiety symptoms. 

How should I store lisinopril? 

Store lisinopril at room temperature, away from heat, light, and moisture. Keep lisinopril out of reach and out of sight of children and pets. 

What if I 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.

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