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Lisinopril Side Effects: What Are They?

One hundred million American adults are struggling to manage their high blood pressure, and if you’re one of them, you’ve likely been told by your doctor that it's time to make some significant lifestyle changes, like eating right and exercising more. For some people, lifestyle changes are enough to lower blood pressure on their own, but others may require treatment with medication like an ACE inhibitor or beta-blocker in addition to lifestyle changes.  High blood pressure is the most common cause of cardiovascular disease-related deaths in the United States and is considered a “silent killer” because many people have no symptoms and do not know they have high blood pressure until it is too late. If you’re considering taking lisinopril in conjunction with living a healthy lifestyle to manage your high blood pressure, here’s what you need to know.

What Is Lisinopril?

Lisinopril, manufactured under the brand names Zestril and Prinivil, belongs to a class of medications called ACE inhibitors. Lisinopril was first approved for medical use in the United States by the Food and Drug Administration (FDA) in 1987. ACE inhibitors work by reducing the levels of angiotensin II and inhibiting its effects, which allows the blood vessels to widen and relax. As the blood vessels widen, blood flows through more easily and at reduced pressure. ACE inhibitors also reduce the amount of water your body retains, which also lowers blood pressure.

What Is Lisinopril Used to Treat?

Lisinopril is primarily used to treat high blood pressure, also known as hypertension. It is also used to treat congestive heart failure or heart disease and can be used to treat patients after a heart attack, helping to improve survival rates. When given to a patient who has suffered a heart attack, lisinopril has been shown to reduce the risk of death or another heart attack when administered immediately after a heart attack. 

High blood pressure
Patients are considered to have high blood pressure when your blood consistently pushes against the walls of your blood vessels too forcefully for an extended period of time. High blood pressure, also called hypertension, is considered dangerous because it increases the workload of the heart and blood vessels. Over time, the blood vessels and heart work less efficiently and have to work harder to provide the tissues and organs with the blood they need to function. If not treated or reduced, high blood pressure can cause a narrowing of the blood vessels by creating microtears in the walls of the arteries. When narrowing occurs, your blood is further prevented from reaching the different areas of the body and your blood pressure gets even higher. High blood pressure can be caused by any number of factors, including living an unhealthy lifestyle, medications, medical conditions, and genetics. About 95 percent of high blood pressure cases have no specific cause and are influenced primarily by lifestyle choices.

Congestive heart failure
Congestive heart failure is a chronic condition that gets worse over time. During congestive heart failure, the pumping ability of your heart muscles is affected by fluid building up around the heart, which causes it to pump less efficiently. During congestive heart failure, your ventricles, which pump blood to the organs and tissues, are not able to pump enough blood to the different parts of the body. This causes blood and other fluids to back up inside the lungs, abdomen, liver, and lower body, which can be life-threatening. There are four different stages of congestive heart failure, including:

  • Class I: No symptoms are experienced, and the condition can be managed through medication, lifestyle changes, and monitoring.
  • Class II: Experience shortness of breath, fatigue, and heart palpitations during normal physical activity, but feel fine during rest. The condition can still be managed through medication, lifestyle changes, and monitoring.
  • Class III: Even mild physical activity can cause shortness of breath, fatigue, and heart palpitations, but still feel ok at rest. Treatment options are limited and can be complex.
  • Class IV: Symptoms are present even at rest, and physical activity is impossible. No remaining treatment options are available. 

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How Does Lisinopril Work?

Like other medications in its class, lisinopril works by blocking or diminishing the effects of an enzyme called an angiotensin-converting enzyme, or ACE. ACE helps to produce angiotensin II, which is a powerful substance that narrows the arteries, which can contribute to high blood pressure. ACE also stimulates the release of a hormone called aldosterone that is produced by the adrenal glands and helps to increase blood pressure. ACE inhibitors like lisinopril open the arteries back up and reduce how hard the heart must work in order to get blood to the different parts of the body, which helps to reduce blood pressure.

What Is the Cost of Lisinopril?

Compared to its brand name counterpart, Zestril, lisinopril is highly affordable. The generic form of the medication is covered by nearly all commercial and Medicare drug insurance plans, and pharmacy discount cards can offer savings as well.  Manufacturers coupons and patient assistance programs may be available for the brand name version of the drug information through the manufacturer’s website. 

Approximate Costs of Zestril and Lisinopril

Zestril
Lisinopril

Per Pill
30 Day Supply
Per Pill
30 Day Supply
2.5 mg oral tablet
$13.98
$419.40
$0.41
$12.42
5 mg oral tablet
$13.98
$419.40
$0.52
$15.54
10 mg oral tablet
$13.98
$419.40
$0.42
$12.50
20 mg oral tablet
$13.98
$419.40
$0.44
$13.10
30 mg oral tablet
$13.98
$419.40
$0.54
$16.28
40 mg oral tablet
$13.98
$419.40
$0.55
$16.41

What Are the Benefits of Lisinopril?

Lisinopril has been around since the 1980s and has developed a reputation as a reliable, effective drug for treating high blood pressure and heart failure. Use of lisinopril has several benefits:

  • Lisinopril can be used to treat high blood pressure in children as young as six.
  • The medication is effective at reducing the signs and symptoms of congestive heart failure.
  • Taking lisinopril within 24 hours of a myocardial infarction (heart attack) can increase a patient’s odds of survival.
  • Studies have shown that mitral valve regurgitation, a condition that allows blood to flow backward into the heart, causing shortness of breath and lightheadedness, can be improved by taking lisinopril.
  • Patients taking lisinopril have been shown to have a significantly lower risk of developing diabetes than patients who take diuretic blood pressure medications.
  • Lisinopril can help prevent kidney disease in people with diabetes.
  • People with diabetes who take lisinopril see their diabetic retinopathy progression slowed by 50 percent compared to patients who do not take it.
  • About half of men with a low sperm count see their sperm count return to normal while taking lisinopril.
  • Migraine sufferers experience 20 percent fewer headache hours, 21 percent fewer migraine days, and a 20 percent reduction in the severity of their headaches when taking lisinopril.
  • Lisinopril is available in a generic form and is highly affordable and accessible for most patients.

Are There Any Risks Associated with Lisinopril?

Although there are many benefits associated with lisinopril, as listed above, taking the medication also poses some risks. Risks associated with lisinopril include:
Lisinopril can adversely affect kidney function, so all patients, regardless of their current kidney health, should have their kidney function and potassium levels monitored periodically while taking lisinopril. You may need to take potassium supplements if your levels are low. 

People of African-American descent and those who have already experienced angioedema (swelling of the facial areas and airways) unrelated to ACE inhibitor administration are considered more likely to experience an allergic reaction to lisinopril.
Lisinopril can cause a dry, persistent cough that bothers some people so much that they may decide to stop taking the medication.
Drinking alcohol while taking lisinopril can further lower your blood pressure and may increase certain side effects. 
Lisinopril can decrease your ability to sweat, making you more prone to heatstroke while exercising, in hot weather, or when dehydrated. Use caution to prevent becoming overheated or dehydrated while taking lisinopril.

What Dose of Lisinopril Do I Take?

The recommended dosage for lisinopril will depend on the condition being treated, the age of the patient, and several other factors. To treat hypertension in adults, doctors will typically start patients out on a dose of 10 mg taken once per day if the patient is not already taking a diuretic. Patients who are already taking a diuretic such as hydrochlorothiazide will start on a dosage of 5 mg taken once per day. A maintenance dose of lisinopril for hypertension in adults is about 20 to 40 mg orally once per day; your doctor will increase your dose to the level needed to control your symptoms. The maximum recommended dose for the treatment of adult hypertension is 80 mg once per day. Children will take a lower dose, usually starting at 5 mg taken once per day and adjusted according to blood pressure response. The maximum dose for treating hypertension in children is 40 mg per day.
Treatment for congestive heart failure begins at an initial dose of 2.5 mg to 5 mg once per day and should be increased by your doctor as tolerated. The maximum dosage of lisinopril for the treatment of congestive heart failure is 40 mg once per day.
Adults who have suffered a heart attack event should receive a 5 mg dose of lisinopril within 24 hours of the onset of the heart attack. An additional 5 mg will be given 24 hours later, with an additional 10 mg given 48 hours later. Patients are then put on a maintenance dose of 10 mg per day, with treatment lasting at least 6 weeks.
Overall, be sure to follow the medical advice of your doctor including informing them about any missed doses and storing the medication at room temperature. 

What Are the Side Effects of Lisinopril?

Side effects associated with lisinopril are categorized as either common, less common, or rare. Common side effects associated with lisinopril that usually do not need medical attention include:

  • Dizziness
  • Lightheadedness
  • Tiredness
  • Headache
  • Dry, persistent cough
  • Less common side effects associated with lisinopril that usually do not need medical attention include:
  • A decrease in libido/sex drive
  • Inability to get or keep an erection
  • Lack of strength or loss of strength
  • Loss in sexual ability or performance
  • Rash

Rare, but possible side effects of lisinopril that usually do not need medical attention include:

  • Acid or sour stomach
  • Belching
  • Burning, crawling, itching, numbness, or tingling feelings
  • A feeling of constant movement of surroundings or self
  • Heartburn
  • Indigestion
  • Muscle cramps
  • Spinning sensation
  • Stomach discomfort or upset
  • Swelling

Some side effects of lisinopril do require medical attention. Check with your health care provider immediately if you experience any of the following serious side effects while taking lisinopril:

  • Blurred vision
  • Cloudy urine
  • Confusion
  • A decrease in urine output
  • A decrease in urine concentration
  • Unusual fatigue or weakness
  • Dizziness, faintness, or lightheadedness when moving from lying down or sitting to standing
  • Sweating
  • Abdominal or stomach pain
  • Body aches or pain
  • Chest pain
  • Chills
  • Common cold
  • Dry cough
  • Diarrhea
  • Difficulty breathing
  • Ear congestion
  • Fever 
  • Headache
  • Loss of voice
  • Nasal congestion
  • Nausea
  • Runny Nose
  • Sneezing 
  • Sore throat
  • Vomiting
  • Arm, back or jaw pain
  • Chest discomfort, tightness, or heaviness
  • Fast or irregular heartbeat
  • Joint pain
  • Loss of appetite
  • Muscle aches and pains
  • Shivering
  • Trouble sleeping
  • Trouble breathing

Is Lisinopril Safe for Women Who Are Pregnant or Breastfeeding?

Lisinopril is not considered safe for pregnant women when taken during the second or third trimester of pregnancy. Women who find out they are pregnant should speak to their health care professional immediately about switching to another blood pressure medication, as stopping lisinopril abruptly can cause a dangerous rise in blood pressure, endangering the pregnancy. When taken during the second or third trimesters of pregnancy, lisinopril can cause low levels of amniotic fluid, leading to poor lung and skull development, growth restriction, fetal abnormalities, low blood pressure, and kidney failure in the unborn baby. 
Not enough research has been done about the effects of lisinopril on nursing infants to determine conclusively if the medication is safe for use by breastfeeding mothers as it may pass through breast milk. It is recommended that nursing mothers use a medication that has more conclusive studies.
<h3>Who Should Not Take Lisinopril?</h3>
If you are allergic to lisinopril or other ACE inhibitors,  you should not take lisinopril. It’s important to make your doctor aware of your complete medical history and any prescription drugs or over-the-counter drugs that you currently take, particularly if you have a history of any of the following:

  • Angioedema (swelling of the face/lips tongue/throat)
  • Blood filtering procedures, including LDL apheresis and dialysis
  • High levels of potassium in the blood
  • Organ transplant
  • Low levels of sodium in the blood
  • Hypertrophic cardiomyopathy
  • Kidney problems or liver problems or disease
  • Decreased blood volume

Taking lisinopril can make you feel dizzy or drowsy. The use of alcohol or marijuana can increase these feelings because of drug interactions. You should not drive or do anything that requires alertness until you know how lisinopril affects you. 

Published April 30th, 2020 by Bridget Reed
Fact Checked by Chris Riley

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