Lisinopril

What is Lisinopril?

Lisinopril is a type of medication known as an Angiotensin Converting Enzyme (ACE) inhibitor. Lisinopril is used to treat high blood pressure (hypertension) and heart failure. It is prescribed to patients at risk of heart attack or stroke and is also used as treatment following a heart attack and in diabetic kidney disease.

How does Lisinopril work?

When blood pressure is too high, your heart and arteries are forced to work much harder to pump blood around the body, which can lead to damaged vessels in the brain, heart and kidneys, heart failure, stroke, or kidney failure. ACE inhibitors like Lisinopril work by blocking the production of a substance in the body (angiotensin) which causes blood vessels to constrict. Relaxing the blood vessels helps to lower blood pressure and increase the supply of oxygen to the heart.

Active ingredients

The active ingredient in Lisinopril is lisinopril dihydrate.

Inactive ingredients

The inactive ingredients in Lisinopril are mannitol, calcium hydrogen phosphate dihydrate, maize starch, pregelatinised starch, magnesium stearate and colloidal anhydrous silica. 

Please note: different generic brands of Lisinopril may contain different inactive ingredients than those stated above.

Which ingredients can cause an allergic reaction?

Lisinopril is not known to cause a severe allergic reaction. If using the medication for the first time, look out for these symptoms including face/lip swelling, throat tightening, rash, severe dizziness and difficulty breathing. This is a medical emergency so it is imperative you get medical help right away.

How to start taking Lisinopril?

Never start taking Lisinopril without the instruction of a doctor. You will be prescribed a low dose to start with to reduce the risk of side effects. Your dose can then be increased gradually until your blood pressure is controlled. Take Lisinopril once a day at the same time each day. Tablets should be swallowed whole with water and should not be crushed or split.

Lisinopril side effects

Like all medications, Lisinopril can cause side effects in some people. Stop taking Ramipril and see a doctor immediately if you experience any of the following serious side effects:

• A severe allergic reaction to Lisinopril, including swelling of the face, lips or throat, difficulty breathing, itching or rashes.
• A severe skin reaction, including rash, ulcers in your mouth, worsening of pre-existing skin disease, reddening, blistering or detachment of skin.
• Yellow skin or eyes – this can be a sign of liver problems
• Unexpected bleeding or bruising, catching infections more easily, or feeling tired – this can indicate a blood disorder
• Faster, uneven or forceful heart rate, chest pain or tightness – this can be signs of a heart problem
• Shortness of breath, wheezing or a persistent cough – this can be a lung problem
• Severe stomach pain that may reach through to your back – this can indicate a problem with the pancreas
• Not passing as much urine as normal – this can be a sign of kidney problems
• Weakness in the arms or legs, or problems speaking – these may indicate a stroke

Common side effects (affecting up to 1 in 10 people) include:

• Dry, tickly cough
• Feeling dizzy
• Fainting, hypotension (abnormally low blood pressure)
• Headache
• Nausea or vomiting
• Diarrhoea, or constipation
• Mild skin rash
• Blurred vision
• Hair loss
• Sinusitis or bronchitis
• Dry mouth
• Breathlessness
• Stomach upset or gut pain
• Chest pain or angina
• Muscle pain or cramps
• Blood tests showing more potassium than usual in the blood
• Angioedema (rapid swelling of the skin)
• Palpitations or an irregular heartbeat
• Fatigue
• Drowsiness
• Sensory changes e.g. pins and needles or numbness
• Changes in kidney function
• Runny nose
• Sleep disorders
• Altered taste
• Tinnitus (ringing in the ears)

Uncommon side effects can affect up to 1 in 100 people and include:

• Joint pain
• Confusion
• Erectile dysfunction
• Fever
• Anaemia
• Hyperhidrosis (increased sweating)
• Heart attack 
• Pancreatitis
• Peripheral oedema (swelling in the hands or feet)
• Sensitivity to sunlight
• Respiratory (lung) disorders
• Stroke
• Mood changes
• Hallucinations
• Raynaud's phenomenon

The following rare side effects can affect up to 1 in 1,000 people:

• Blood tests showing a decrease in red blood cells, white blood cells, platelets or haemoglobin
• Hepatitis (liver inflammation)
• Stevens-Johnson syndrome (a red rash typically causing blisters)
• Anaemia
• Autoimmune disorders
• Gynaecomastia (breast enlargement)
• Liver disorders
• Hypersensitivity
• Hypoglycaemia (low blood sugar)
• Swollen lymph glands
• Changes in sense of smell olfactory nerve disorder
• Syndrome of inappropriate ADH (a problem with the kidney and regulation of urine)
• Sinusitis
• Toxic epidermal necrolysis (a severe blistering skin condition)

Other side effects (frequency not known)

• Depression
• Vasculitis (inflammation of the vessels, causing rash)

Contraindications

Do NOT take Lisinopril if you:

• Are allergic to any of the ingredients in this medication
• Have a history of angioedema, a severe allergic reaction that includes itching, hives, red marks on the hands, feet and throat, swelling around the eyes or lips, difficulty breathing and swallowing
• Are pregnant or breastfeeding

Before taking Lisinopril, tell your doctor if any of the following applies to you:

• You have heart problems, including cardiomyopathy and valvular heart disease
• You have liver problems
• You have kidney problems, including if you are having dialysis
• You have diabetes 
• You are of black African or Caribbean origin
• You have any problem with the salts in your blood (e.g. potassium, sodium)
• You have lost a lot of salts or fluids through vomiting, diarrhoea, sweating more than usual, being on a low-salt diet, taking diuretics or having dialysis
• You have primary aldosteronism
• You are going to receive an anaesthetic
• You might become pregnant
• Your blood pressure is abnormally low or unstable
• You have severe or symptomatic aortic stenosis
• You have a collagen vascular disease such as scleroderma or systemic lupus erythematosus
• You have peripheral vascular disease or generalised atherosclerosis

Drug interactions

Before taking Lisinopril, tell your doctor if you take any other medicines, including those purchased over the counter without a prescription. 

In particular, tell your doctor if you are taking any of the following:

• Angiotensin receptor blockers (ARB) e.g. Candesartan, Lorsaran
• Calcium channel blockers, e.g. Amlodipine
• Diuretics e.g. Indapamide, Bendroflumethiazide, Furosemide
• Aliskiren
• Anti-inflammatory medicines such as Ibuprofen 
• Allopurinol (used for gout)
• Bee/wasp venom extracts
• Antacids (used for indigestion)
• Amiloride
• Eplerenone
• Heparins
• Potassium salts
• Trimethoprim
• Medicines for heart rhythm such as Digoxin or Procainamide
• Alpha-blockers e.g. Doxasocin 
• Medicines for diabetes, e.g. Insulin, Metformin, and Sulfonylureas
• Lithium
• Steroid medicines for inflammation such as prednisolone
• Sacubitril/valsartan for treatment of long-term chronic heart failure
• Drugs used for the treatment of low blood pressure, shock, cardiac failure, asthma or allergies such as ephedrine, noradrenaline or adrenaline
• Chemotherapy medicines
• Medicines to stop the rejection of organs after surgery such as Ciclosporin, Temsirolimus, Sirolimus, Everolimus
• Spironolactone
• Racecadotril

How to cope with Lisinopril side effects?

Lisinopril does not cause side effects in most patients. However, it can cause some dizziness, particularly at first, so your doctor will start you on a low dose so that your body can adjust. If you feel dizzy, stop what you are doing and find somewhere to lie down until the feeling passes. Do not try to drive, ride a bike or operate heavy machinery. In addition, some people report experiencing a dry, tickly cough while taking Lisinopril. If your cough persists, speak to your doctor about the possibility of switching to a different ACE inhibitor. Likewise, consult your doctor if you experience severe or prolonged headaches that persist for longer than a week. Mild headaches can be managed by drinking plenty of fluids and taking painkillers where necessary.

Will Lisinopril affect my fertility?

Lisinopril does not affect fertility in men or women. However, you should let your doctor know if you are female and trying to get pregnant, as they may prescribe an alternative form of high blood pressure treatment.

Will Lisinopril affect my contraception?

Lisinopril does not affect any type of contraception. However, if you have high blood pressure, some types of hormonal contraceptives (such as the combined oral contraceptive pill) may not be suitable for you, and you should speak to your doctor about alternative forms of contraception.

Lisinopril and pregnancy

It is not advised to take Lisinopril while pregnant. Before starting Lisinopril, you must tell your doctor if you are planning on becoming pregnant. Lisinopril is also not suitable for women who are breastfeeding.

Lifestyle changes to make when taking Lisinopril

Lisinopril itself does not require you to make any lifestyle changes, but altering your lifestyle can help to reduce blood pressure and improve your overall wellbeing. Too much salt in the diet is one of the main causes of high blood pressure, so try limiting your intake to around 6g per day. Cut back on fatty foods and include plenty of fruit and vegetables, whole grains and lean proteins in your diet. Exercise regularly to keep your heart and blood vessels in good condition and help relieve stress, another leading cause of high blood pressure. Where possible, reduce the impact of stress in your life by spending time with family and friends, going for walks and finding the time to relax. If you haven’t already done so, quit smoking and try to limit the amount of alcohol you drink to less than the recommended limit of 14 units per week.

Lisinopril vs ACE inhibitors

Lisinopril is an ACE inhibotor. All ACE inhibitors work in the same way and tend to have similar side effects. You may be switched to a different ACE inhibitor-based on your side effect profile or medical background.

Lisinopril vs other high blood pressure medications

If you need treatment for high blood pressure, there are a few different options available. If you are experiencing troublesome side effects with ACE inhibitors or over the age of 55 or of Afro-Caribbean descent, an alternative treatment may be better suited to you. Diuretics, angiotensin receptor blockers and beta-blockers are other options. Diuretics work by altering the amount of salt and water excreted from the kidney, and beta-blockers reduce the heart rate and blood pressure. Angiotensin receptor blockers (ARBs) Losartan, Irbesartan, Candesartan and Valsartan work by blocking the action of angiotensin II. Finally, calcium-channel blockers such as Amlodipine, Felodipine and Lercanidipine work by preventing calcium from causing blood vessels to constrict.

A doctor will be able to help you decide which treatment is right for you.

How is high blood pressure diagnosed?

The only way to diagnose the condition is by a blood pressure test that you can request from your doctor or some pharmacies. You are more likely to have high blood pressure if you are obese or overweight, consume too much salt or alcohol, don’t exercise enough or are of African-Caribbean or South-Asian origin. Lisinopril can help to reduce blood pressure by widening blood vessels and easing the strain on the heart.

Will I need to take Lisinopril forever?

Lisinopril is intended for long-term use and is usually taken for life. 

Is Lisinopril addictive?

Lisinopril is not addictive.

Can I take Lisinopril before surgery?

Lisinopril can reduce your blood pressure too much when taken in combination with an anaesthetic, so you should tell your doctor if you are scheduled to undergo surgery while taking this medication. They may advise you to stop taking it 24 hours before surgery.