Lisinopril: Uses, Side Effects, and What to Know
Lisinopril is one of the most commonly prescribed medications in the United States. It belongs to a class called angiotensin-converting enzyme (ACE) inhibitors, which work by relaxing blood vessels and reducing the
Written By: DocAi Health Editorial Team
Last Updated: 2026-07-15
Medically Reviewed By: DocAi Health Medical Review Team
Lisinopril is one of the most commonly prescribed medications in the United States. It belongs to a class called angiotensin-converting enzyme (ACE) inhibitors, which work by relaxing blood vessels and reducing the workload on the heart. It is used for a broad range of cardiovascular and kidney-related conditions. This guide explains what lisinopril does, what to expect when taking it, and the important precautions to be aware of.
What Lisinopril Is Used For
Hypertension (high blood pressure): Lisinopril is a first-line treatment for high blood pressure. Lowering blood pressure reduces the risk of stroke, heart attack, and kidney damage.
Heart failure: Lisinopril reduces the heart's workload, decreases symptoms (breathlessness, leg swelling), and significantly reduces hospitalizations and mortality in heart failure with reduced ejection fraction.
After heart attack (post-MI): Starting an ACE inhibitor within the first 24 hours of a heart attack improves survival outcomes, particularly in those with reduced heart function.
Diabetic nephropathy: Lisinopril has kidney-protective effects in patients with diabetes and proteinuria (protein in the urine). It slows the progression of diabetic kidney disease even beyond its blood pressure-lowering effect.
How Lisinopril Works
Angiotensin-converting enzyme (ACE) converts angiotensin I to angiotensin II, a potent blood vessel-constricting hormone that also stimulates aldosterone release (which causes sodium and water retention). By blocking ACE, lisinopril:
- Reduces levels of angiotensin II, relaxing blood vessel walls and lowering blood pressure
- Reduces aldosterone, promoting sodium and water excretion (mild diuretic effect)
- Reduces the heart's workload in heart failure
- Reduces pressure within kidney filtering units (protective in diabetic nephropathy)
- Causes accumulation of bradykinin, which is responsible for one of its characteristic side effects (dry cough)
Common Side Effects
Dry Persistent Cough
The most common side effect, occurring in 5-20% of patients, and more frequently in women and people of Asian descent. The cough results from bradykinin accumulation in the airways. It is a dry, tickling, persistent cough that typically begins weeks to months after starting the medication. It resolves within 1-4 weeks of stopping. If the cough is intolerable, switching to an ARB (angiotensin receptor blocker, a related class that does not cause cough) provides the same cardiovascular and kidney benefits without the cough.
Dizziness and Lightheadedness
Particularly with the first dose or after dose increases, blood pressure can drop more than expected, causing dizziness when standing (orthostatic hypotension). Starting at a low dose and taking the first dose at night can minimize this effect.
Elevated Potassium (Hyperkalemia)
ACE inhibitors reduce aldosterone, which normally drives potassium excretion. This can cause potassium to rise, particularly in patients with kidney disease or those taking potassium-sparing diuretics. Regular monitoring of potassium and kidney function is recommended.
Elevated Creatinine
A modest rise in creatinine (up to 30%) is expected and acceptable when starting an ACE inhibitor, it reflects the intended reduction in glomerular pressure. A rise above 30% from baseline, or a very high creatinine, may indicate bilateral renal artery stenosis and requires evaluation.
When to Seek Medical Care
Emergency, call 911 or go to the emergency room immediately if you develop:
- Signs of angioedema: rapid swelling of the lips, tongue, face, or throat, or sudden difficulty breathing or swallowing. This can occur weeks to years after starting the medication and airway swelling can be fatal. People who have had angioedema from any ACE inhibitor should never take this drug class again.
- Signs of severe high potassium (hyperkalemia): an irregular or pounding heartbeat (palpitations), chest pain, sudden or severe muscle weakness, numbness or tingling in the hands, feet, or lips, confusion, or difficulty breathing. Severe hyperkalemia can trigger a dangerous, potentially fatal heart rhythm, especially if you also take a potassium supplement or a potassium-sparing diuretic.
See a doctor soon (not an emergency, but don't ignore it):
- Mild or intermittent tingling/numbness, unusual tiredness, or mild muscle weakness without chest pain, palpitations, or confusion, call your provider promptly so potassium and kidney function can be checked.
Important Precautions
Pregnancy: Lisinopril is absolutely contraindicated in pregnancy (all trimesters). It can cause severe fetal kidney malformations and death in the second and third trimesters. Women of childbearing age should use effective contraception while taking lisinopril and stop it immediately if pregnancy is discovered.
Kidney function and potassium monitoring: Blood pressure, creatinine, and potassium should be checked within 1-2 weeks of starting or changing the dose, and periodically thereafter.
NSAIDs: Regular NSAID use (ibuprofen, naproxen) reduces the effectiveness of lisinopril's blood pressure-lowering and kidney-protective effects and increases the risk of kidney injury when combined with ACE inhibitors.
Potassium supplements and potassium-sparing diuretics: Combined use increases hyperkalemia risk, monitor carefully.
Overdose: Taking more lisinopril than prescribed can cause dangerously low blood pressure, severe dizziness, fainting, or shock. If you suspect an overdose, call Poison Control at 1-800-222-1222 (US) or go to the emergency room immediately. If the overdose was intentional or you are having thoughts of self-harm, call or text 988 (US) (Suicide & Crisis Lifeline), or call 911 for immediate danger.
Dosing
Typical starting dose for hypertension: 5-10 mg once daily. Usual maintenance: 10-40 mg once daily. For heart failure, dosing starts lower (2.5-5 mg) and is titrated based on blood pressure and kidney function. Lisinopril is taken once daily and can be taken with or without food.
Frequently Asked Questions
Can I stop taking lisinopril if I feel fine?
No. High blood pressure usually has no symptoms, feeling well does not mean your blood pressure is controlled. Stopping lisinopril without guidance can allow blood pressure to rise back to dangerous levels, increasing the risk of stroke and heart attack. Always discuss stopping or changing any blood pressure medication with your provider first.
Does lisinopril cause weight gain?
Lisinopril itself does not cause weight gain. However, leg swelling (edema) can occur in some patients, swelling in the ankles should be reported to a provider, though it is less common with lisinopril than with calcium channel blockers like amlodipine.
What is the difference between lisinopril and losartan?
Both lisinopril (ACE inhibitor) and losartan (ARB) block the renin-angiotensin system and lower blood pressure through related mechanisms. Losartan does not cause the characteristic cough because it does not affect bradykinin. If an ACE inhibitor cough develops, switching to losartan is the standard alternative.
Can lisinopril cause kidney damage?
Lisinopril can transiently raise creatinine slightly, but this is expected and generally protective of the kidneys long-term in patients with diabetes or proteinuria. Significant kidney injury can occur in dehydrated patients or those with bilateral renal artery stenosis, which is why hydration and periodic kidney function monitoring are important.
When is the best time to take lisinopril?
Lisinopril can be taken at any time of day. Some providers recommend taking it at night to reduce the first-dose dizziness effect and to address the slight rise in blood pressure that naturally occurs in the morning hours (the "morning surge").
Related Articles:
Hypertension (High Blood Pressure) |
High Creatinine: What It Means for Kidney Function |
High Potassium (Hyperkalemia) Explained |
Causes of Persistent Cough
Sources
- FDA: Lisinopril prescribing information.
- MedlinePlus (National Library of Medicine, NIH): Lisinopril.
- American Heart Association: ACE inhibitors for hypertension and heart failure.
- National Heart, Lung, and Blood Institute (NIH): High blood pressure management.
- Mayo Clinic: Lisinopril, side effects and precautions.