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Lisinopril is mainly used to treat high blood pressure and other complications related to the heart, although it’s been studied for other uses since its approval in 1987. But did know it was derived from the venom of a poisonous snake found in Brazil, Paraguay, and Argentina? Keep reading to find out more about the uses, side effects, and dosage of lisinopril.

Note: By writing this post, we are not recommending this drug. Some of our readers who were already taking the drug requested that we commission a post on it, and we are simply providing information that is available in the scientific literature. Please discuss your medications with your doctor.

What is Lisinopril?

Lisinopril is used to treat high blood pressure, heart failure, and increase the survival after having a heart attack. Lisinopril is a drug that belongs to a class called angiotensin-converting-enzyme (ACE) inhibitors [R].

Other brand names include Zestril, Prinivil, and Qbrelis [R].

In the 1980s, scientists discovered a snake venom in the poisonous Brazilian viper snake. This led to making the first drugs that would mimic the effects of this snake poison — ACE inhibitors. Captopril was the first, and others like lisinopril followed [R, R].

Mechanism of Action

Lisinopril belongs to a class called angiotensin-converting-enzyme (ACE) inhibitors. ACE inhibitors interrupt a major role in the renin-angiotensin-aldosterone system (RAAS), which controls the body’s blood volume and blood pressure [R, R].

It all starts with renin cutting angiotensinogen to make angiotensin I. ACE then converts angiotensin I to angiotensin II and breaks down bradykinin, which is used to widen blood vessels and lower blood pressure [R, R].

Angiotensin II increases blood pressure by narrowing blood vessels and activating kidney cells to release the hormone aldosterone [R].

In addition, aldosterone retains sodium inside the body. Since water is attracted to high levels of sodium, it also remains in the body, increasing blood volume and blood pressure [R].

Lisinopril disrupts this cycle by [R, R, R]:

  • Directly blocking ACE, which decreases the conversion of angiotensin I to angiotensin II
  • Reducing release of aldosterone, so more sodium and water are flushed from the body
  • Reducing the breakdown of bradykinin, which relaxes blood vessels

Overall, lisinopril relaxes blood vessels and helps to remove more salt and water from the body. All other ACE inhibitors have the same mechanism of action. You can recognize if your medication is an ACE inhibitor by its name — they mostly end with “pril”, such as enalapril, captopril, quinapril, perindopril, benazepril, etc.

Uses of Lisinopril

1) Lisinopril Lowers Blood Pressure

Lisinopril Lowers Blood Pressure

In a large study (RCT) of 24,004 participants with high blood pressure, lisinopril was able to reduce blood pressure. But,  its beneficial effects varied more with each checkup compared to other drugs [R].

Lisinopril (up to 5mg) reduced blood pressure by ≥ 6 units in a study (open-label) of 22 children with kidney transplants and was well-tolerated [R].

2) Lisinopril May Improve Heart Failure

Lisinopril May Improve Heart Failure

The ATLAS study (DB-RCT) of 3,164 patients with heart failure assessed the difference between low and high doses of lisinopril (2.5-5mg and 32.5-35mg). Higher doses reduced the risk of death and risk of illness due to heart failure [R].

3) Lisinopril Improves Chance of Survival After Heart Attacks

Lisinopril (2.5-10 mg) decreased the risk of dying by 11% at the end of 6 weeks in a study (RCT) of 18,895 patients that had suffered from heart attacks, [R].

4) Lisinopril May Improve Kidney Disease

Lisinopril May Improve Kidney Disease

In a study of 18 patients with high blood pressure and kidney problems, lisinopril improved kidney functions independent of dose. In fact, as the dose of lisinopril was gradually reduced over the course of a year, kidney function and blood pressure stayed the same in a third of the patients [R].

In another study, 22 diabetic patients treated with lisinopril had reduced kidney damage (reducing urinary MCP-1, which is linked to proteinuria) [R].

5) Lisinopril Improves Migraine Headaches

Lisinopril Improves Migraine Headaches

In a study (RCT) of 60 patients experiencing 2-6 migraine episodes a month, lisinopril (20mg) reduced the duration and severity of migraines headaches by about 20% compared to placebo [R].

In another study (open-label) of 21 patients with migraines, lisinopril (5 mg) reduced the frequency of migraine attacks by 50% during the third month of treatment. A cough and dizziness were also reported [R].

6) Lisinopril May Be An Antioxidant

In a study with rats, lisinopril reduced a marker for oxidative stress (malondialdehyde), acting as an antioxidant in the brain [R].

In a later study (DB-RCT) of 49 patients who underwent brain surgery, lisinopril acted as an antioxidant given before surgery, reducing harmful compounds in the brain (nitrates and  MDA). These effects may help lower the dangerous complications of brain surgery [R, R].

Another study showed that lisinopril reduced inflammation (reducing TNF-a, IL-6, IL-1b and increasing IL-10) in rat brains, which may also reduce blood pressure and combat oxidative stress [R].

7) Lisinopril May Help Reduce Colon Cancer

Lisinopril May Help Reduce Colon Cancer

95% of colon cancers arise from the formation of abnormal tissue growth in the colon (so-called adenomatous polyps) [R].

In a study of 4,660 patients (retrospective), those who took lisinopril had a 41% lower incidence of advanced abnormal colon growth. Long-term usage may reduce colon cancer development [R].

8) Lisinopril May Improve Sperm Quality

Lisinopril May Improve Sperm Quality

Low-dose lisinopril (2.5mg) increased the quantity and quality of sperm cells in one study (RCT) in about half of the 33 men treated. The participants had normal blood pressure but suffered from infertility, due to semen with a low concentration of sperm [R].

Side Effects and Safety

Lisinopril may cause the following side effects [R]:

  • A sore throat or a dry cough — one of the most common side effects
  • Low blood pressure
  • Confusion, lightheadedness, headache, dizziness, or fainting
  • Weakness and fatigue
  • Decreased urine volume or concentrating ability.
  • Nausea, vomiting, or diarrhea
  • Severe stomach pain
  • Body aches, chills, or fever
  • Dark urine or pale stools
  • Yellow skin or eyes
  • Impotence

People who are allergic to lisinopril or other angiotensin-converting-enzyme (ACE) inhibitors may develop severe swelling (angioedema) of the face, lips, throat, abdomen, or other areas of the body [R].

Severe swelling (angioedema) of the tongue can be the most life-threatening symptom since it can block the airways. The occurrence of angioedema is low (0.1% – 0.2%), but it gets up to three times higher among Black Americans [R, R].

Hereditary angioedema has also been reported to be triggered by lisinopril when treating high blood pressure [R].

A cough develops in 5% to 20% of people who take ACE inhibitors. This symptom is associated with an increased accumulation of inflammatory compounds  (bradykinin and substance P), which arises from lisinopril blocking ACE. In these cases, other blood pressure medications are recommended [R].

Lisinopril and Pregnancy

ACE inhibitors have been associated with increased risk of death and risk of illness in fetuses. Physicians will usually discontinue women from taking an ACE inhibitor, including lisinopril, due to these risks. Other safer alternatives are available [R].

The birth defects can be debilitating. An 18-year-old pregnant woman who was taking lisinopril for her high blood pressure due to kidney failure (renovascular hypertension) gave birth to a premature baby who had severely damaged kidneys, could not produce urine (anuria), and had a growth delay even after getting a kidney transplant [R].

In another case, a woman gave birth to a premature baby who had similar symptoms but also developed a serious gut infection (necrotizing enterocolitis) [R].

Lisinopril and Kidney Injury

Lisinopril can cause serious kidney damage, especially in patients with heart failure. In others with high blood pressure or stents, it may raise markers of kidney damage. Further damage can be prevented by stopping the medication, but sometimes blood tests are needed when lisinopril is started to ensure no damage has occurred [R].

In a case study, a 52-year-old man with inflammation in his legs was given lasix (20 mg) and lisinopril (10 mg). When lasix was increased to 60 mg, very high levels of protein in the urine were present, indicating kidney injury. The study recommends caution when combining diuretics with angiotensin-converting-enzyme (ACE) inhibitors [R].

In another case study, a 51-year old male overdosed with 27 lisinopril (10 mg) tablets over the course of three days and developed sudden kidney injury, acidic blood, severe potassium levels in the blood (hyperkalemia), and destruction of muscle cells (rhabdomyolysis) [R].

Lisinopril Side Effects on Blood Lab Markers

Lisinopril may [R]:

Lisinopril and High Blood Potassium Levels (Hyperkalemia)

Hyperkalemia is associated with an increased risk of dying. In one study, a very small amount of people developed high potassium levels, and although rare, the highest occurrence (3.6%) happened mostly in patients taking lisinopril  [R, R].

Lisinopril and Low Blood Glucose Levels (Hypoglycemia)

In a study (DB-RCT) of 530 diabetes patients dependent on insulin, showed no difference between lisinopril and control groups in causing hypoglycemia events [R].

However, the Food and Drug Administration (FDA) suggests that insulins and other compounds used to treat diabetes may increase the risk of developing dangerously low blood sugar levels when combined with lisinopril, so patients should be monitored especially during the first month of treatment [R].

Lisinopril and Low Blood Cell Count

Low hemoglobin levels point to anemia [R].

Lisinopril was associated with decreased hemoglobin levels in a study (retrospective) of 701 patients with diabetes and high blood pressure. However, patients with heart failure were more likely to have increased hemoglobin levels [R].

There was a case of a 67-year-old woman with high blood pressure that was infrequently treated with lisinopril and developed anemia that was later resolved when treatment was discontinued [R].

In another case, all blood cells were low (pancytopenia) in a 79-year-old woman with high blood pressure during lisinopril and indapamide therapy [R].

Lisinopril has been used in rat studies to induce anemia [R].

Lisinopril and Liver Failure

Some angiotensin-converting-enzyme (ACE) inhibitors like lisinopril have been associated with rare cases of liver failure [R, R].

In a case study of a 56-year-old man, lisinopril caused liver failure and recovered only after stopping treatment [R].

Lisinopril Is Not Safe to Use in Children

The safety and effectiveness of Lisinopril in children below 6 years of age have not been established, but there are studies done by poison control centers that address lisinopril with this age range:

  • Out of 691 cases reported to Texas poison control centers, 26 of them (3.8%) had a serious outcome, which involved maximum doses equal to or greater than 80 mg [R].
  • In a 13-year retrospective study of 296 cases reported to the California Poison Control System, the mean total dose ingested by children under 6 years of age was 33.4 mg and only 8 of them experienced low blood pressure [R].
  • Another 10-year study  (retrospective) of 384 children under 6 years of age exposed to a single dose of blood-pressure-lowering drugs including lisinopril, only lead to mild poisoning symptoms; hospital evaluation was not a must [R].

Lisinopril Recall

According to the Food and Drug Administration’s (FDA) reports, there has been a total of 29 recalls involving lisinopril from 2012-2018 mostly due to mislabeling or contamination. Other more serious recalls were filed against some pharmaceutical companies for inadequately investigating customer complaints (a violation of the Current Good Manufacturing Practice).

Limitations and Caveats

Angiotensin-converting-enzyme (ACE) inhibitors like lisinopril have been reported to be ineffective in black Americans and more likely to cause an allergic reaction (angioedema) [R].

Treatment of chronic heart failure with lisinopril in children under 18 has not been studied [R].

Drug Interactions

Lisinopril and NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs), often used as painkillers, may reduce the effect of lisinopril when taken in combination [R].

For example, in a study of 88 patients (prospective), ibuprofen and piroxicam decreased the blood pressure-lowering effects of lisinopril/hydrochlorothiazide (7.7%-9%) [R].

However, not all NSAIDs have the same effects when combined with lisinopril [R].

Lisinopril and Aspirin

In an analysis of 15, 841 patients who suffered from heart attacks, aspirin did not increase the risk of harmful events nor did it add to the benefits of lisinopril when taken in combination [R].

Lisinopril and Low Blood Pressure (Hypotension)

According to the Food and Drug Administration (FDA), patients with kidney damage, heart failure, or low sodium levels, are more likely to experience low blood pressure from lisinopril. The combined effect of a diuretic may also have additional blood pressure lowering effects, so lisinopril can be reduced to stay at normal levels [R].

In a case study, the dual use of tizanidine with lisinopril has been associated with hypotension and low heart rate [R].

Another case study with a 48-year-old woman saw similar results and improved after discontinuation [R]

Lisinopril and Lithium Toxicity

In a study  (population-based case-control) of 10,615 elderly patients treated with lithium, 413 (3.9%) of them reported lithium toxicity. The risk of toxicity increased after treatment with angiotensin-converting-enzyme (ACE) inhibitors [R].

In some case studies, blood lithium levels increased in combination with lisinopril [R, R, R, R].

Lisinopril and Alcohol Consumption

A patient suffering from alcoholism suffered sudden inflammation of the pancreas (acute pancreatitis) after 3 hours of taking lisinopril [R].

Rats given alcohol and lisinopril had increased blood markers of heart failure (troponin-T) and increased risk of dying [R, R].

In another study in rats, lisinopril did not achieve the expected effect (reducing heart enlargement and thickening) when alcohol was used [R].

However, in other studies, lisinopril reduced damage (from nitric oxide and oxidative stress) accumulated from alcohol use in the lungs of rats  [R, R].

Lisinopril and Salt Consumption

High salt diets in rats also increased blood pressure and reduced the effects of lisinopril even after a 10-fold increase in dose [R, R].

Low sodium diets reduced blood pressure more effectively than lisinopril (40 mg) or valsartan (320 mg) in a study (DB-RCT) of 52 patients with kidney disease [R].

However, in patients with heart failure who have low concentrations of sodium (hyponatremia) in the blood or develop it due to lisinopril, adjustments to a lower dose (2.5 mg) or discontinuation is recommended [R, R, R].

Genetics/Genetic Predispositions

Angiotensin-converting-enzyme (ACE) is the main target of lisinopril. Some variations like the presence (I-allele) or absence (D-allele) of a DNA segment within the ACE gene may affect the way it interacts with inhibitors like lisinopril. People that have complete absences of the segment in both parental genes (DD genotype) are more likely to suffer from heart diseases [R].

However, in a study (SB-RCT) of 57 patients with kidney transplants, lisinopril was more effective in reducing the enlargement and thickening of the heart in those with DD genotypes [R].

Other mutations in ACE genes can lead to severe kidney disorders (renal tubular dysgenesis) [R].

So far, no other genes are affected by lisinopril since it is not metabolized by the body and is only released through flushing by the kidneys [R].

Lisinopril vs. Other ACE inhibitors

Lisinopril was more effective in reducing blood pressure than captopril [R, R].

Lisinopril (20 mg) and enalapril (20 mg) equally reduced blood pressure during exercise, at rest, and after 24 hours in a study (RCT) of 49 males and 9 females with high blood pressure. Another study (DB-RCT) of 169 patients with high blood pressure showed the dose range of lisinopril (10 to 40 mg) was more effective than enalapril (5 to 20mg) [R, R]

In a  study (cohort) of 20,252 patients, those who received prescriptions for lisinopril had higher admission rates to the hospital for any reason than those who were given perindopril [R].

Two studies (RCT) showed lisinopril reduced blood pressure more than quinapril, it had the opposite results in another (RCT)  [R, R, R].

In rat brains, trandolapril was more effective at lower doses than lisinopril but similar outside the brain [R].

Lisinopril vs. Amlodipine and Chlorthalidone

In a large study (DB-RCT) of 33,357 participants with high blood pressure, chlorthalidone was more effective in reducing blood pressure than lisinopril or amlodipine [R].

Taking a different perspective, lisinopril was less effective in preventing stroke among blacks and women than chlorthalidone or amlodipine [R].

Lisinopril vs. Atenolol

Lisinopril (10-40 mg) and atenolol (25-100mg) reduced the enlargement and thickening of the heart in a study of 200 dialysis patients with high blood pressure. There was with no significant difference between the drugs, however, blood pressure, risk of illness, and hospitalizations for any reason were higher in the lisinopril group [R].

Lisinopril vs. Losartan

In a study (RCT) of 25 non-diabetic patients with mild to moderate high blood pressure, lisinopril (25 mg) improved insulin sensitivity while losartan did not [R].

Lisinopril vs. Irbesartan

In a study (DB-RCT) of 15 patients with high blood pressure, irbesartan (150 to 300 mg) was more effective than lisinopril (10 to 20mg) at increasing blood vessel flexibility, which is associated with low risk of heart disease [R].

Lisinopril vs. Other Drugs

Aliskiren alone or combined with hydrochlorothiazide (HCTZ), had similar effects to lisinopril, or lisinopril combined with HCTZ, in patients with high blood pressure [R, R].

In a study (DB-RCT) of 75 Nigerian patients with mild to moderate high blood pressure, the extract Hibiscus sabdariffa and lisinopril (10mg) reduced blood pressure with no significant difference between the two [R].

Lisinopril in Combination with Drugs

Lisinopril with Hydrochlorothiazide

Lisinopril is commonly combined with the diuretic hydrochlorothiazide. In a study (retrospective) of 270 patients, the combination reduced blood pressure at two doses (10 and 20 mg). The combination can improve mild to moderate high blood pressure [R].

Lisinopril with Angiotensin Receptor Blockers (ARBs)

In an analysis (prospective cohort) of 819,491 patients (98% males) with heart disease, lisinopril combined with ARBs reduced the risk of dementia or admission to nursing homes more than lisinopril alone [R].

Lisinopril (40 mg) and losartan (50mg) therapy reduced kidney damage (urinary TGF-β) more than lisinopril alone in a study of 16 patients (RCT) [R].

In a study (prospective) of 75 diabetic patients with high blood pressure, lisinopril in combination with candesartan reduced the difference between systolic and diastolic blood pressures (pulse pressure), which is associated with eye, nerve, and kidney problems [R].

Lisinopril and telmisartan improved memory, inflammation, and oxidative stress in Alzheimer’s dementia mouse models [R].

Lisinopril with Statins

Lisinopril (10 mg) and amlodipine (5 mg), in combination with rosuvastatin, reduced blood pressure by 20% and total cholesterol by 32% in a study of 50 patients with high blood pressure and heart disease [R].

Lisinopril (10-20 mg) in combination with simvastatin (20 mg) reduced the same amount of blood pressure as with lisinopril alone in a study (RCT) of [R].

Lisinopril (40 mg) in combination with lovastatin (20 mg) or pravastatin (10 mg), reduced blood pressure more than lisinopril alone in a study (RCT) of 35 patients [R].

Lisinopril with Beta Blockers

Lisinopril (10-40 mg) in combination with nebivolol (5-20 mg) reduced blood pressure more than each drug did individually in a study (DB-RCT) of 664 patients with a more severe form of high blood pressure [R].

In another study (DB-RCT), a combination of lisinopril (10-40 mg) and carvedilol (20-80mg) in patients with moderate to severe high blood pressure, did not show benefits compared each drug alone [R].

In a study of 25 obese patients, the lisinopril and carvedilol combination was more effective in improving blood vessel health than the combination of lisinopril and hydrochlorothiazide. The combination may lower the risk of developing atherosclerosis [R, R].

Lisinopril in combination with valsartan reduced blood pressure by relaxing blood vessels, while the combination of lisinopril with carvedilol reduced blood pressure by lowering heart rate [R].

Lisinopril with Other Drugs

Lisinopril and natrium diethyldithiocarbamate NDDCT improved memory in rat models of dementia [R].

Lisinopril (2.5-20 mg) reduced the enlargement and thickening of the heart in 36 kidney transplant patients (RCT)  when combined with a drug that reduces the immune response, cyclosporine (100-300 mg/mL) [R].

Dosage

Initial therapy in patients with high blood pressure is started with 10mg and adjusted up to 40mg depending on blood pressure response.

Patients with heart failure are started with 5mg and then increase up to 10mg every two weeks depending on response.

If patients suffer from heart attacks or kidney damage, they start with 2.5mg and gradually increase to a maximum of 40mg if needed [R, R, R].

User Experiences

One user says lisinopril (10 mg) works well with his slightly elevated blood pressure and has completely stopped his migraine headaches.

Another user says she experienced a slight headache the first day of taking it, but now her blood pressure is low and feels fine. She feels “happy” and does not experience any other symptoms.

One user took lisinopril at a very low dose (2.5 mg) to protect her kidneys but had to change medications due to facial swelling (angioedema).

Another user said lisinopril made her feel “wonderful”, but then experienced a “horrible” cough at night that even made her gag and call her doctor for a change of prescription.

FDA Compliance

The information on this website has not been evaluated by the Food & Drug Administration or any other medical body. We do not aim to diagnose, treat, cure or prevent any illness or disease. Information is shared for educational purposes only. You must consult your doctor before acting on any content on this website, especially if you are pregnant, nursing, taking medication, or have a medical condition.

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4 COMMENTS

  • Cynthia A

    Would like to know how to get rid of the cough that I have had from taking this crap drug. I’ve been off of it for a couple of years but still have the cough.

    1. Ana Aleksic

      Hi Cynthia, sorry to hear. Indeed, one of the reported side effects of this drug and other so-called ACE inhibitors is a dry cough. However, since you stopped taking the drug years ago, I suggest you consult your doctor to see what may be causing you these issues.

  • Robert Coates

    That stuff is CRAP!! Poison! It will make you cough your head off non stop. How useful can any drug be with that (extremely) annoying side effect?

  • Mary

    So thrilled to have found this web sight… so enlightened.. I just know I can make myself well again…

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