Lisinopril

1. About lisinopril

Lisinopril is a medicine to treat high blood pressure and heart failure. It's also prescribed after a heart attack and in diabetic kidney disease.

Lisinopril helps to prevent future strokes and heart attacks. It also improves your survival if you're taking it after a recent heart attack or for heart failure. It also slows down diabetic kidney disease.

This medicine is only available on prescription. It comes as tablets. It also comes as a liquid for people who find it hard to swallow tablets, but this has to be ordered specially by your doctor.

Lisinopril is also available combined with another blood pressure medicine called hydrochlorothiazide.

2. Key facts

  • Lisinopril lowers your blood pressure and makes it easier for your heart to pump blood around your body.
  • Your very first dose of lisinopril may make you feel dizzy, so it's best to take it at bedtime. After that you can take lisinopril at any time of day.
  • Some people get a dry, irritating cough with lisinopril.
  • Drinking alcohol with lisinopril can make you feel dizzy or lightheaded.
  • Lisinopril is also called by the brand name Zestril. When it's mixed with hydrochlorothiazide it can be called Carace Plus, Lisoretic and Zestoretic.

3. Who can and can't take lisinopril

Lisinopril can be taken by adults and children aged 6 years and over.

If you have diabetes, check your blood sugar (glucose) more often, particularly in the first few weeks. This is because lisinopril can lower the sugar level in your blood.

Lisinopril isn't suitable for everyone.

To make sure lisinopril is safe for you, tell your doctor if you:

  • have had an allergic reaction to lisinopril or any other medicine in the past
  • are trying to get pregnant, are already pregnant or you are breastfeeding
  • are having dialysis or any other type of blood filtration
  • have heart, liver or kidney problems
  • have unstable or low blood pressure
  • have diabetes
  • have recently had diarrhoea or vomiting
  • are on a low-salt diet
  • are going to have desensitisation treatment to reduce your allergy to insect stings
  • are going to have a major operation or a general anaesthetic (to put you to sleep)
  • have a blood problem such as too few white blood cells (neutropenia or agranulocytosis)

4. How and when to take it

It's usual to take lisinopril once a day.

Your doctor may suggest that you take your first dose before bedtime, because it can make you dizzy. After the very first dose, you can take lisinopril at any time every day. Try to take it at the same time every day.

How much will I take?

The dose of lisinopril you take depends on why you need the medicine. Take it as instructed by your doctor.

To decide your dose, your doctor will check your blood pressure and ask you if you are getting any side effects. You may also have blood tests to check how well your kidneys are working and the amount of potassium in your blood.

Depending on why you're taking lisinopril, the usual starting dose is between 2.5mg and 10mg once a day. This will be increased gradually over a few weeks to a usual dose of:

  • 20mg once a day for high blood pressure (the maximum dose is 80mg once a day)
  • 10mg once a day after a recent heart attack
  • 20mg to 35mg once a day for heart failure
  • 10mg to 20mg once a day for diabetic kidney disease

Doses are usually lower for children.

How to take it

You can take lisinopril with or without food. Swallow lisinopril tablets whole with a drink.

If you're taking lisinopril as a liquid, it will come with a plastic syringe or spoon to help you measure out the right dose. If you don't have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount of medicine.

Will my dose go up or down?

You will probably be prescribed a low dose of lisinopril at first so it doesn't make you feel dizzy. This will usually be increased gradually until you reach the right dose for you. If you have side effects with lisinopril you may stay on a lower dose.

Important

Take lisinopril even if you feel well, as you will still be getting the benefits of the medicine.

What if I forget to take it?

If you miss a dose of lisinopril, take it as soon as you remember. If you don't remember until the following day, skip the missed dose. Do not take a double dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

If you take too many lisinopril tablets, contact your doctor or nearest hospital straight away.

An overdose of lisinopril can cause dizziness, sleepiness and a pounding heartbeat.

The amount of lisinopril that can lead to an overdose varies from person to person.

Call your doctor or go to A&E straight away if you take too much lisinopril by accident

If you need to go to a hospital A&E department, do not drive yourself - get someone else to drive you or call for an ambulance.

Take the lisinopril packet or leaflet inside it plus any remaining medicine with you.

5. Side effects

Like all medicines, lisinopril can cause side effects in some people but many people have no side effects or only minor ones.

Common side effects

These common side effects happen in more than 1 in 100 people. Talk to your doctor or pharmacist if these side effects bother you or don't go away:

  • dry, tickly cough that does not go away
  • feeling dizzy or light headed, especially when you stand up or sit up quickly. This is more likely to happen when you start taking lisinopril or move onto a higher dose
  • headache
  • diarrhoea and vomiting
  • a mild skin rash
  • blurred vision

Serious side effects

It happens rarely, but some people may have serious side effects when taking lisinopril.

Tell a doctor straight away if you get:

  • weak arms and legs or problems speaking - these can be signs of a stroke
  • yellow skin or eyes - this can be a sign of liver problems
  • paleness, feeling tired, faint or dizzy, any sign of bleeding (for example bleeding from the gums or bruising more easily than usual), sore throat and fever and getting infections more easily - these can be signs of blood or bone marrow disorder
  • a faster heart rate, chest pain and tightness in your chest - these can be signs of heart problems
  • shortness of breath, wheezing and tightening of the chest - these can be signs of lung problems
  • severe tummy pain - this can be a sign of an inflamed pancreas
  • swollen ankles, blood in your pee or not peeing at all - these can be signs of kidney problems

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction to lisinopril.

Contact a doctor straight away if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

These are warning signs of a serious allergic reaction. A serious allergic reaction is an emergency.

These are not all the side effects of lisinopril. For a full list see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

  • dry irritating cough - cough medicines don't usually help for coughs caused by lisinopril. Sometimes, the cough gets better on its own. Talk to your doctor if it bothers you or stops you from sleeping as another medicine may be better. Even if you stop taking lisinopril, the cough may take up to a month to go away.
  • feeling dizzy - if lisinopril makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you don't faint, then sit until you feel better.
  • headaches - make sure you rest and drink plenty of fluids. Don't drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if they last longer than a week or are severe.
  • diarrhoea and vomiting - drink plenty of water in small, frequent sips. It may also help to take oral rehydration solutions. You can buy these from a pharmacy or supermarket to prevent dehydration. Don't take any other medicines to treat diarrhoea or vomiting without speaking to a pharmacist or doctor. If you get diarrhoea or vomiting from a stomach bug, or illness, tell your doctor. You may need to temporarily stop taking lisinopril until you feel better.
  • itching or a mild rash - it may help to take an antihistamine which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.
  • blurred vision - avoid driving or using tools or machines while this is happening. If it lasts for more than a day or two speak to your doctor as they may need to change your treatment.

7. Pregnancy and breastfeeding

Lisinopril is not normally recommended in pregnancy or when breastfeeding. However, it may be prescribed if your doctor thinks the benefits of the medicine outweigh the risks.

If you're trying to get pregnant or you're already pregnant, talk to your doctor about the benefits and possible harms of taking lisinopril. These will depend on how many weeks pregnant you are and the reason why you're taking it. There may be other treatments that are safer for you.

Lisinopril and breastfeeding

Small amounts of lisinopril may get into breast milk. This can cause low blood pressure in the baby.

Talk to your doctor, as other medicines might be better while you're breastfeeding.

Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

8. Cautions with other medicines

There are some medicines that may interfere with the way lisinopril works.

Tell your doctor if you're taking:

  • anti-inflammatory medicines such as ibuprofen, indomethacin or aspirin for pain relief. (A low-dose aspirin - 75mg a day - is safe to take with lisinopril.)
  • medicines to treat low blood pressure, heart failure, asthma or allergies, such as ephedrine, noradrenaline or adrenaline
  • medicines to treat high blood pressure, such as aliskeren
  • other medicines which can lower your blood pressure such as some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), anaesthetics or medicines for an enlarged prostate gland
  • medicines that damp down your immune system, such as ciclosporin or tacrolimus
  • water tablets such as furosemide
  • medicines which can increase the amount of potassium in your blood such as spironolactone, triamterene, amiloride, potassium supplements, trimethoprim (for infections) and heparin (for thinning blood)
  • steroid medicines such as prednisolone
  • allopurinol (for gout)
  • procainamide (for heart rhythm problems)
  • medicines for diabetes
  • racecadotril (for diarrhoea)
  • lithium (for mental health problems)

Mixing lisinopril with herbal remedies or supplements

There's very little information about taking herbal remedies and supplements with lisinopril.

For safety, speak to your pharmacist or doctor before taking any herbal or alternative remedies with lisinopril.

Important

Tell your doctor or pharmacist if you are taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions

How does lisinopril work?

Lisinopril is a type of medicine called an ACE (angiotensin-converting enzyme) inhibitor.

Like other ACE inhibitors, lisinopril relaxes and widens the blood vessels. This lowers your blood pressure and makes it easier for your heart to pump blood around your body. This can improve the symptoms of heart failure.

In diabetic kidney disease, it helps to protect your kidneys and slows down the disease. It does this by reducing the amount of protein you lose through your kidneys and by reducing high blood pressure.

How long does lisinopril take to work?

Lisinopril starts to work within a few hours to reduce high blood pressure but it may take a few weeks for full effect.

If you're taking lisinopril for heart failure, it may take weeks, even months, before you feel better.

If you're taking lisinopril for high blood pressure or after a heart attack, you may not have any symptoms. In these cases, you may not feel any different when you take lisinopril. This doesn't mean that the medicine isn't working and it's important to keep taking it.

How long will I take lisinopril for?

After a heart attack, you usually take lisinopril for 6 weeks. Your doctor will then decide if you need to keep taking it for longer.

For high blood pressure, heart failure and diabetic kidney disease, treatment with lisinopril is usually long term, even for the rest of your life.

Is lisinopril safe to take for a long time?

Lisinopril is generally safe to take for a long time. In fact, it works best when you take it for a long time.

Taking lisinopril for a long time can sometimes cause your kidneys to not work as well as they should. Your doctor will check how well your kidneys are working with regular blood tests.

What will happen if I stop taking it?

Talk to your doctor if you want to stop taking lisinopril.

Stopping lisinopril may cause your blood pressure to rise - and this can increase your chances of having a heart attack or stroke.

If you're bothered by side effects, your doctor may be able to prescribe you a different medicine.

Can I come off lisinopril now my blood pressure is lower?

Even if your blood pressure is successfully lowered by lisinopril, it's best to carry on taking it. If you stop taking lisinopril, your blood pressure could rise back up again.

If you need blood pressure-lowering medicines, you'll probably need to take them for the rest of your life.

Remember, by keeping your blood pressure low, you're protecting yourself against having a heart attack or stroke in the future.

Can I drink alcohol with it?

Drinking alcohol can increase the blood pressure-lowering effect of lisinopril, which can make you feel dizzy or light headed.

During the first few days of taking lisinopril or after increasing the dose, stop drinking alcohol until you see how the medicine affects you.

If lisinopril makes you feel dizzy, it's best to stop drinking alcohol while you're taking it.

Are there similar medicines to lisinopril?

There are lots of other ACE inhibitor medicines which work in the same way as lisinopril. They include enalapril, captopril, ramipril and perindopril.

There are also lots of other types of blood pressure-lowering medicines:

  • calcium-channel blockers - for example amlodipine
  • angiotensin receptor blockers - for example candesartan
  • beta-blockers - for example bisoprolol diuretics (water tablets) - for example bendroflumethiazide

If you can't take lisinopril or other ACE inhibitor medicines because of side effects such as a dry cough, you may be able to switch to another type of blood pressure-lowering medicine. This will usually be a medicine called an angiotensin receptor blocker such as candesartan, irbesartan, losartan or valsartan.

What are the differences between lisinopril and other ACE inhibitors?

Lisinopril works as well as other ACE inhibitors when you take it to lower blood pressure and for heart failure.

The side effects are also similar to those of other ACE inhibitors. You only need to take lisinopril once a day. Some other ACE inhibitors need to be taken 3 times a day.

Can I take lisinopril before surgery?

Tell your doctor that you're taking lisinopril if you're going to be put to sleep for an operation or are going to have a major operation, such as a caesarean section, without a general anaesthetic.

Lisinopril can reduce your blood pressure when it's used with a general anaesthetic.

Your doctor may advise you to stop taking it 24 hours before surgery.

Is lisinopril addictive?

No, there's no evidence that lisinopril is addictive.

Will it affect my contraception?

Lisinopril won't affect any type of contraception.

However, some types of hormonal methods of contraception, like the combined contraceptive pill and contraceptive patch, aren't usually recommended for women taking lisinopril and other medicines for high blood pressure. This is because some hormonal contraceptives can raise your blood pressure and stop lisinopril working properly.

Talk to your doctor if you're taking combined hormonal contraceptives.

Will it affect my fertility?

There's no evidence that lisinopril reduces fertility in men or women.

However, if you're a woman and you're trying to get pregnant, talk to your doctor first. This medicine is usually not recommended in pregnancy.

Is there any food or drink I need to avoid?

Don't use salt substitutes such as Lo-Salt. This is because they are high in potassium. When mixed with lisinopril they may make the level of potassium in your blood too high.

There's nothing else you need to avoid while taking lisinopril. Eating a healthy, balanced diet can help if you have high blood pressure or heart failure.

Can I drive or ride a bike?

Lisinopril can cause blurred vision and make some people feel dizzy or tired - especially when you first start taking it or after an increase in dose. If this happens to you, don't drive a car, ride a bike, or use tools or machines.

Can lifestyle changes help?

You can boost the health of your heart by making some key lifestyle changes. These will also help if you have high blood pressure or heart failure.

  • Stop smoking - smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try and avoid secondhand smoke.
  • Drink alcohol sensibly - drinking too much alcohol raises blood pressure over time. It makes heart failure worse too. Men and women shouldn't drink more than 14 units of alcohol a week.
  • Be more active - regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It doesn't need to be too energetic - walking every day is enough.
  • Eat healthily - aim to eat a diet that includes plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products and lean proteins. It's a good idea to cut down on salt too. Eating too much salt is the biggest cause of high blood pressure - the more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
  • Manage stress - when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help avoid stress.
  • Vaccinations - if you have heart failure, it's recommended that you have a flu jab every year and a pneumonia vaccination every 5 years. Ask your doctor about these vaccinations. You can have them free on the NHS.

Page last reviewed: 20/06/2017
Next review due: 20/06/2020