Lisinopril

What is Lisinopril?

Lisinopril is an Angiotensin Converting Enzyme (ACE) inhibitor which is used to treat high blood pressure (hypertension) and heart failure. It 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 function of a substance in the body 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. 

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 Lisinopril and see a doctor immediately if you experience any 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.
• An infection with fever and serious deterioration of your general condition, or with local infection symptoms such as sore throat or urinary problems
• Angioedema with symptoms such as a sudden buildup of fluid in the skin and mucous membranes, breathing difficulties, itching and skin rash.
• Jaundice (yellowing of the skin or whites of the eyes)
• Blood disorder with a lack of white blood cells, increased susceptibility to infections, sudden high fever, severe sore throat and mouth ulcers.

Speak to a doctor if any of the following less serious side effects persist for longer than a few days. Common side effects (affecting up to 1 in 10 people) include:

• Headache
• Feeling dizzy or lightheaded
• Diarrhoea
• A dry, persistent cough
• Vomiting
• Kidney problems shown in a blood test

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

• Mood swings
• Change of colour, numbness or tingling in the fingers or toes
• Change in sense of taste
• Feeling sleepy
• Vertigo
• Difficulty sleeping
• Stroke
• Fast or irregular heartbeat
• Rhinitis
• Nausea
• Stomach pain or indigestion
• Skin rash or itching
• Impotence
• Feeling tired or weak
• Changes in blood test results regarding urea, serum creatinine and liver enzymes that demonstrate liver or kidney function
• Heart attack
• Hallucinations

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

• Confusion
• Hives
• Dry mouth
• Hair loss
• Psoriasis
• Change in sense of smell
• Breast enlargement in men
• Blood disorders
• Changes to the cells in your blood
• Low levels of sodium in the blood
• Sudden renal failure
• Mental confusion

Very rarely (1 in 10,000), patients may experience:

• Muscle spasms in the airways causing a tightness in the chest, inflammation of the paranasal sinuses, sinusitis, pneumonia
• Wheezing
• Hyperglycaemia (low blood sugar level), with symptoms such as feeling hungry or weak, sweating, dizziness and increased heart rate
• Inflammation of the liver, with symptoms such as loss of appetite, yellowing of the skin and whites of the eyes and dark coloured urine.
• Inflammation of the pancreas, causing pain in the upper stomach radiating to the back, nausea, vomiting, fluid buildup in the intestinal wall, inflammation of the liver and jaundice
• BLood and lymphatic disorders with increased susceptibility to infections, anaemia or haemolytic anaemia
• Sweating
• Urinating less frequently than usual
• Liver failure
• Lumps
• Inflamed gut

The following side effects have been reported, although their frequency is unknown:

• Feeling of depression
• Fainting
• Inflamed blood vessels
• Muscle or joint pain 
• Inflamed joints
• Hypersensitivity to sunlight

Contraindications

Do NOT take Lisinopril if:

• You are allergic to any of the ingredients in this medication
• You have ever had an allergic reaction to another ACE inhibitor
• You have ever had 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.
• You have kidney problems where the blood supply to your kidneys is reduced
• You are more than 3 months pregnant
• You are breastfeeding
• You have diabetes or impaired kidney function

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

• You are prone to fainting or dizziness from occasional low blood pressure
• 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
• If you have stenosis (narrowing) of the aorta, renal artery or mitral valve in the heart, or hypertrophic cardiomyopathy (thickening of the heart muscle)
• You have stenosis (narrowing) of the kidney artery
• You have problems with your blood vessels
• You have kidney problems
• You have liver problems
• You are of Afro-Caribbean origin, as this medication may be less effective
• You are receiving dialysis with a ‘high-flux’ membrane
• You have high levels of cholesterol and are receiving LDL apheresis treatment
• You experience a persistent dry cough
• You have diabetes
• You are thinking of becoming pregnant
• You are having desensitization treatment for wasp stings

Drug Interactions

Before taking Lisinopril, tell your doctor if you are taking 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:

• Aliskiren
• Medicines containing potassium or salt substitutes
• Diuretics
• Medicines used to break up blood clots
• Medicines used to prevent the body rejecting a transplant
• Beta-blockers
• Nitrate medicines
• Lithium
• Painkillers with an anti-inflammatory and fever-reducing effect
• Medicines used to treat asthma
• Other high blood pressure medications
• Procainamide
• Medicines used to treat depression or psychosis
• Sympathomimetics (medicines that have a stimulating effect on parts of the central nervous system)
• Immunosuppressants
• Cold remedies and medicines used to treat sinus congestion
• Medicines that contain gold
• Allopurinol for gout
• Insulin, or medicines taken orally in the treatment of diabetes

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. 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, if you experience severe or prolonged headaches which persist for longer than a week, consult your doctor. 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 choose to prescribe an alternative form of high blood pressure treatment. 

Lisinopril and Pregnancy

It is not advised to take Lisinopril while pregnant, and should not be taken at all after the third month of pregnancy. 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.

Will Lisinopril affect my contraception?

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

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 if you are over the age of 55 or of Afro-Caribbean descent, an alternative treatment may be better suited to you. Diuretics can be prescribed to relax the walls of blood vessels, allowing blood to flow more easily, and are sometimes taken in combination with the ACE inhibitor Enalapril. Another alternative is beta-blockers, which work by slowing your heart rate and blocking the hormone angiotensin II, which causes vasoconstriction (narrowing of the arteries). The angiotensin receptor blockers (ARBs) losartan, Irbesartan, Candesartan and Valsartan also work by blocking angiotensin II. Finally, calcium-channel blocker 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.  

Lisinopril vs ACE inhibitors

All ACE inhibitors work in the same way and have similar side effects. Lisinopril is more suitable for patients with kidney problems, as it is the only ACE inhibitor to be passively excreted by the kidneys.

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 the main cause of high blood pressure, so try and limit your intake to around 6g per day. Cut back on fatty foods and try to include plenty of fruit and vegetables, wholegrains and lean proteins in your diet. Exercise regularly to keep your heart and blood vessels in good condition and to 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. Quit smoking if you haven’t already done so and try to limit the amount of alcohol you drink to less than the recommended limit of 14 units per week.

How is high blood pressure diagnosed?

The only way to diagnose the condition is by a blood pressure test from your doctor, which you should request if you are at risk of developing the condition. 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 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 when taken in combination with an anaesthetic, so you should tell your doctor if your scheduled to undergo surgery while taking this medication. They may advise you to stop taking it 24 hours before surgery.

Sources

• Patient Information Leaflet
• NHS > Lisinopril
• NHS > High Blood Pressure