Lisinopril is mainly used to treat high blood pressure and other heart-related complications. Scientists first derived it from the venom of a snake found in South America. Keep reading to learn about lisinopril, along with the possible side effects.
What is Lisinopril?
Lisinopril (brand name Zestril or Prinivil) is a prescription medication used to treat high blood pressure, reduce symptoms of heart failure, and increase survival odds after a heart attack.
Lisinopril is one of the most commonly prescribed medications in the United States .
Lisinopril is sometimes used off-label for several other conditions, including kidney disease, diabetic nephropathy, and migraines .
Mechanism of Action
Lisinopril belongs to a class of drugs called angiotensin-converting enzyme inhibitors (ACEIs).
ACEIs, including lisinopril, primarily work by inhibiting the ACE enzyme. This enzyme is responsible for converting angiotensin I to angiotensin II .
Angiotensin II has several effects on the body, including narrowing the blood vessels, remodeling the heart, and promoting the release of aldosterone and vasopressin. All of these effects can increase blood pressure .
By blocking ACE, lisinopril can reduce all of these effects from angiotensin II, ultimately leading to lower blood pressure. One of the most important effects of lisinopril is the reduction of aldosterone, which allows more salt and water to be excreted from the body. This lowers total blood volume, which leads to lower blood pressure .
Uses of Lisinopril
High Blood Pressure (Hypertension)
Lisinopril is very commonly used to treat high blood pressure, which is medically referred to as hypertension. ACEIs, like lisinopril, are one of the first-line drugs used to treat high blood pressure. However, ACEIs are not the drug of choice in specific populations, such as African Americans, due to possibly lower effectiveness [4, 5].
A randomized controlled trial of 24,004 found that lisinopril is effective at reducing blood pressure. However, the researchers also found that those taking lisinopril had more variable blood pressure readings with each checkup compared to other blood pressure medications .
A systematic review of 24 clinical trials including 58,040 patients suggests that lisinopril may help reduce blood pressure, risk of death, risk of stroke, and coronary heart disease. However, this is based on evidence of low to moderate quality .
Heart Failure Symptoms
Lisinopril is sometimes prescribed to those with heart failure as an add-on medication if patients do not respond to standard therapy. A number of clinical trials have found that the addition of ACEIs may slow the progression of heart failure and reduce the risk of death associated with heart failure .
For example, the ATLAS study (a randomized trial of 3,164 patients with heart failure) found that high dose lisinopril (32.5-35 mg) may be more effective than low dose lisinopril (2.5-5 mg) for reducing hospitalizations and risk of death .
Heart Attack Survival
Lisinopril is sometimes used to improve the chance of survival in those who have had a heart attack. For this use, lisinopril should be given immediately (within 24 hours) after a heart attack, along with other standard treatments .
A randomized multicenter clinical trial of 19,394 heart attack patients found that lisinopril may significantly reduce heart dysfunction and risk of death. Patients were given lisinopril within 24 hours of a heart attack and continued the medication for up to 6 weeks .
Lisinopril is used for several off-label conditions, which we’ll discuss in the following sections. If you are prescribed lisinopril, always take the medication as directed by your doctor.
ACEIs, like lisinopril, have a protective effect on the kidneys. By reducing the pressure inside the kidneys, lisinopril may prevent or slow the progression of kidney disease .
Lisinopril is sometimes used in patients that have a high risk for kidney failure, such as those with diabetes. Diabetic nephropathy refers to the gradual loss of kidney function due to damage associated with diabetes .
A 4-year long randomized controlled trial of 51 patients with diabetic nephropathy found that lisinopril may slow the progression of kidney failure .
A systematic review of 28 clinical trials examined the various off-label uses of lisinopril. In regards to kidney disease, the researchers concluded that lisinopril demonstrates significant positive effects and may offer better outcomes compared to other standard treatments for diabetic nephropathy .
Lisinopril is sometimes used to help prevent migraines in those that are unresponsive to conventional treatment.
In a randomized placebo-controlled trial of 60 patients experiencing 2-6 migraine episodes a month, lisinopril reduced the duration and severity of migraine headaches by about 20% compared to placebo .
An open-label study of 21 patients with migraines suggests that lisinopril may reduce the frequency of migraine attacks by 50% during the third month of treatment. However, researchers also state that the side effects of lisinopril may limit its use .
Lisinopril can cause several side effects. If any side effects persist or worsen, let your doctor know. This is not a complete list of possible side effects. Tell your doctor if you experience any serious side effects or notice any effects not listed here.
Some common side effects include :
- Dry cough
Some serious side effects include :
- Angioedema (rapid swelling of the face, neck, and/or tongue)
- Severe stomach pain
- Trouble breathing or swallowing
- Irregular heartbeat
Pregnancy and Breastfeeding
Lisinopril can cause injury and death to the developing fetus. According to the FDA, those who are pregnant or planning to become pregnant should not take lisinopril. If you are taking lisinopril and plan to become pregnant, consult your doctor about other possible treatments .
It’s unclear if lisinopril is present in breast milk. A doctor will weigh the benefits and risks when determining if the use of lisinopril is appropriate during breastfeeding.
ACEI medications, including lisinopril, may cause a type of swelling called angioedema. This condition can be life-threatening when swelling of the tongue and throat make breathing difficult. If you suspect you may be experiencing angioedema, seek medical help immediately .
Although lisinopril may have protective effects on the kidneys, there is also evidence that lisinopril may cause a significant decrease in kidney function as well. Those on lisinopril should have their kidney function monitored periodically .
Some ACEIs are associated with rare cases of liver failure. Any patient showing signs or symptoms of liver failure should seek medical attention .
The following drugs have been reported to interact with lisinopril. However, this is not a complete list, let your doctor know of all the medications you are currently taking to avoid any unexpected interactions.
- Diuretics, such as spironolactone, amiloride, and triamterene
- NSAIDs, such as ibuprofen and naproxen
- Other blood pressure-lowering medications
The dosing of lisinopril can vary. Always take this medication as directed by a doctor.
Lisinopril is available as an oral tablet and liquid solution.
Lisinopril is available in a number of strengths, including 2.5, 5, 10, 20, 30, and 40 mg.
For high blood pressure, lisinopril is typically started at 5-10 mg per day and is adjusted up to 40 mg depending on blood pressure response.
Patients with heart failure are usually started with 5 mg per day, which can be increased up to 40 mg depending on response.
For heart attacks, 5 mg of lisinopril is given within 24 hours of the heart attack and another 5 mg is given after 24 hours. After that, 10 mg is given daily.
Combinations with Other Drugs
Lisinopril is commonly combined with the diuretic hydrochlorothiazide.
A multicenter randomized placebo-controlled trial of 505 patients suggests that this combination may reduce blood pressure better than each medication alone. However, the study also found that combinations with lisinopril may cause more cough side effects .
Angiotensin Receptor Blockers (ARBs)
In an analysis of 819,491 elderly patients (98% males) with heart disease, lisinopril combined with ARBs reduced the risk of dementia or admission to nursing homes more than lisinopril alone .
According to a placebo-controlled trial of 664 patients with severe high blood pressure, lisinopril, in combination with nebivolol, may reduce blood pressure more than each drug did individually .
In another study, a combination of lisinopril and carvedilol in patients with moderate to severe high blood pressure did not show benefits compared to each drug alone .