What to Know About Lisinopril

An ACE Inhibitor Used for High Blood Pressure and Heart Failure

Table of Contents
View All
Table of Contents

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension (high blood pressure) and heart failure and to improve survival after heart attacks. It is available in tablet or liquid form and works by interacting with the body's renin-angiotensin-aldosterone system, which regulates blood pressure.

Lisinopril is available as a generic medicine and under the brand names Prinivil and Zestril.  It is also known under the brand name Qbrelis as an oral liquid solution.

What Is a Generic Medicine?

The Food and Drug Administration (FDA) regulates that generic medicines use the same active ingredients as brand-name medicines and work the same way. They have the same risks and benefits as brand-name medicines.

Uses

Angiotensin II is a protein hormone that narrows the blood vessels and causes fluid retention—resulting in high blood pressure. Lisinopril lowers blood pressure as it relaxes the blood vessels by blocking the production of angiotensin II. 

By lowering high blood pressure, lisinopril helps prevent strokes, heart failure, heart attacks, and kidney problems.

Indications for lisinopril include:

  • Hypertension in adults and children six and over
  • Heart failure
  • To improve survival after acute myocardial infarction (heart attack)

Studies show that ACE inhibitors prescribed during a heart attack reduce the risk of death by 10%. In patients with high blood pressure, treatment with an ACE inhibitor results in a significant reduction of all-cause mortality.

These effects are due to the ACE inhibitor's improvement of left ventricular ejection fraction (LVEF). Ejection fraction is a measurement of how much blood the left ventricle pumps out with each contraction of the heart. It is expressed as a percentage, and a normal heart's ejection fraction is usually between 50 to 70%.

When ejection fraction is low, it may be evidence of heart failure or indicate a previous heart attack. Research shows that ACE inhibitors effectively treat heart failure with reduced left ventricular ejection fraction.

Off-Label Uses

Although not formally approved for such use, lisinopril and other ACE inhibitors are used to treat diabetic
nephropathy
. Diabetic nephropathy, also known as diabetic kidney disease, is kidney damage that results from having diabetes.

Lisinopril protects the kidneys of people with type 1 diabetes by reducing blood pressure and reducing albumin levels in the urine. Although the ACE inhibitor captopril is approved for this use, there is evidence that lisinopril and other ACE inhibitors may be just as effective for treating diabetic nephropathy.

What Is Albumin?

Albumin is a protein made in the liver and found in the blood. It carries essential nutrients and hormones and prevents fluid from leaking out of your blood vessels. If a kidney is damaged, it can cause albumin to pass into the urine, which is known as albuminuria. ACE inhibitors can help reduce the amount of albumin in urine due to kidney disease.

Before Taking

Both adults and children aged six years and over can take lisinopril, but it is not suitable for everyone. It is prescribed for specific conditions, most commonly as follows.

Hypertension

Hypertension is also known as high blood pressure. Blood pressure (BP) is measured in millimeters of mercury (mm Hg) and recorded with the systolic number first, followed by the diastolic number.

The American Heart Association lays out specific criteria defining hypertension stages and when treatment should be started as shown in the table below. It assesses the risk of atherosclerotic cardiovascular disease (ASCVD).

Stages of Hypertension Treatment Criteria
 Stage  Definition  Treatment
Stage 1 hypertension Systolic BP of 130-139 mmHg
Diastolic BP of 80-89 mmHg
ASCVD risk score less than 10%
Healthy lifestyle changes.
Monitor BP every 3-6 months.
Stage 1 hypertension Systolic BP of 130-139 mmHg
Diastolic BP of 80-89 mmHg
ASCVD risk score more than 10%
Healthy lifestyle changes.
Start BP-lowering medication.
Assess BP one month after starting medication. If stable, re-assess every 3-6 months. If unstable, adjust the dose and re-assess monthly until BP is controlled.
Stage 2 hypertension Systolic BP of ≥140 mmHg
Diastolic BP of ≥90 mmHg
Healthy lifestyle changes.
Start BP-lowering medication.
Assess BP one month after starting medication. If stable, re-assess every 3-6 months. If unstable, adjust the dose and re-assess monthly until BP is controlled.
Hypertensive urgency Systolic BP greater than 180 mmHg
or
Diastolic BP greater than 120 mmHg
No signs or symptoms indicating target organ damage
Antihypertensive drug therapy should be increased
Hypertensive emergency Systolic BP greater than 180 mmHg
or
Diastolic BP greater than 120 mmHg
Displays signs or symptoms indicating target organ damage
Admit to hospital for emergency treatment

Heart Failure

Heart failure is diagnosed clinically, when the heart is unable to provide adequate oxygenation to the body. The most common diagnostic test to evaluate heart failure and help determine the cause is an echocardiogram.

There are different types of heart failure. Heart failure with a reduced ejection fraction, known as HFrEF, (previously termed systolic heart failure) is when the left ventricular ejection fraction is less than 45%.

Lisinopril can be used in the treatment of HFrEF.

Diuretics are also first-line therapies used to treat heart failure.

Heart Attack

Lisinopril is used after a heart attack when the ejection fraction is reduced or there is elevated blood pressure

Lisinopril is typically given within 24 hours of a heart attack in tandem with other medications, such as aspirin, beta-blockers, and thrombolytic (clot-dissolving) medications.

Precautions and Contraindications

Lisinopril is not suitable for everyone and must be taken with precaution or avoided in certain
situations. Conditions under which lisinopril is contraindicated include:

  • Drug hypersensitivity: You cannot take lisinopril if you are allergic to it, or allergic to any inactive ingredient in the drug. Tell your doctor about any medication allergies, especially if you have been allergic to any other ACE inhibitors in the past. 
  • History of angioedema: Angioedema is an allergic reaction that causes swelling in the face, tongue, larynx, limbs, and abdomen. If you have a history of angioedema, even if unrelated to ACE inhibitor therapy, it may put you at an increased risk of angioedema while receiving lisinopril. 
  • When taking Tekturna (aliskiren): This is used for the treatment of diabetes and hypertension. If taken simultaneously with lisinopril, it can lead to severe hypotension (low blood pressure), kidney problems, and high potassium levels. 

Conditions under which lisinopril should be used with caution include:

  • Pre-existing hypotension: This includes people on high-dose diuretics or those with ischemic heart disease, cerebrovascular disease, hyponatremia, end-stage kidney disease, or heart failure with systolic blood pressure under 100.
  • Impaired kidney function: This includes people with chronic kidney disease or severe congestive heart failure. If lisinopril is used, a physician must perform renal function tests routinely.

 Other ACE Inhibitors

There are several other ACE inhibitors approved for use in the United States, including:

Lisinopril has a drug half-life of 12 hours, equivalent to that of Lotensin (benazepril) and Vasotec (enalapril). However, the half-life is longer than drugs like Capoten (captopril), which has a half-life of fewer than three hours, or Accupril (quinapril), which has a half-life within two hours.

Half-Life

The half-life of a drug is the time taken for the concentration of a drug to decrease to half its original value. Half-life is used to estimate how long it takes for a drug to be removed from your body. 

Dosage

The dosage of lisinopril varies depending on the patient's age, weight, the condition being treated, and other medications being used. Treatment usually begins with a low starting dose and then gradually increases until the diagnostic goals are met.  

Lisinopril tablets are available in 2.5 milligrams (mg), 5 mg, 10 mg, 20 mg, 30 mg, and 40 mg formulations. For children, the dosage is calculated based on milligrams per kilogram of body weight (mg/kg).

Lisinopril tablets can be dissolved in purified water and a sweetener called OraSweet for use in children and adults who cannot swallow pills (see "How to Take and Store").

Lisinopril Dosage
Condition Dosage
Hypertension (Adult) Starting dose: 10 mg
Maximum dose: 80 mg
Hypertension (Children) Starting dose: 0.07 mg/kg once daily (up to 5 mg)
Maximum dose: 0.61 mg/kg (up to 40 mg)
Heart Failure Starting dose: 5 mg
Maximum dose: 40 mg
Heart Attack Initial dose: 5 mg
Dose at 24 hours: 5 mg
Dose at 48 hours: 10 mg
Daily dose thereafter: 10 mg

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

Modifications

Lisinopril dosage may need to be reduced to 5 mg if used alongside a diuretic to treat hypertension. Alternatively, the diuretic dose may be lowered if lisinopril is added to the heart failure treatment plan.

How to Take and Store

You can take lisinopril with or without food. It is advised to swallow lisinopril tablets whole with a drink. Try to take it at the same time of day, every day. 

If you miss your dose of lisinopril, then take it as soon as you remember. If more than 24 hours pass before you remember to take your lisinopril, then do not make up the forgotten dose—skip it. It is important not to double the dose. 

If you need to make lisinopril into an oral solution, then follow the manufactures instructions for preparation of suspension for 200 milliliters (mL) of a 1.0 mg/mL suspension:

  • Add 10 mL of Purified Water USP to a polyethylene terephthalate (PET) bottle containing ten 20 mg tablets of ZESTRIL and shake for at least one minute. 
  • Add 30 mL of Bicitra diluent and 160 mL of Ora Sweet to the concentrate in the PET bottle and gently shake for several seconds to disperse the ingredients. 
  • The suspension should be stored at or below 25 degrees C (77 degrees F) and can be stored for up to four weeks. 
  • Shake the suspension before each use.

Before making lisinopril into an oral solution, discuss it with your physician first to ensure that you have the right materials, solutions, and understand the technique. 

Store at controlled room temperature 20-25 C (68-77 F), and protect from moisture, freezing, or excessive heat.

Side Effects

Side effects from taking lisinopril tend to be mild and usually improve or resolve as your body gets used to the medication. Some people may experience no symptoms at all. However, talk to your doctor if side effects persist, worsen, are unusual, or become intolerable.

Common

Common side effects can vary depending on the condition being treated. 

Side effects when using lisinopril for treatment of hypertension:

  • Cough 
  • Dizziness 
  • Headaches

Side effects when taking lisinopril for treatment of heart failure:

  • Hypotension
  • Chest pain
  • Dizziness
  • Increased creatinine
  • Hyperkalemia (high potassium levels)
  • Syncope (fainting)

Side effects when using lisinopril for treatment of a heart attack:

  • Hypotension
  • Endocrine dysfunction
  • Fatigue
  • Fizziness 
  • Syncope (fainting)
  • Constipation, flatulence, or diarrhea
  • Gout
  • Skins rashes, hives, itching, or photosensitivity
  • Impotence

A full list of common side effects can be seen in the manufacturer's prescribing information. 

Severe

Seek emergency care if any of the following severe side effects occur:

  • Swelling of the face, throat, tongue, or lips
  • Rash or hives
  • Swelling of the hands, feet, ankles, or lower legs
  • Difficulty breathing or swallowing
  • Irregular heartbeat
  • Dizziness or fainting
  • Difficulty urinating

These symptoms could be signs of anaphylaxis or acute kidney failure and require urgent attention.

Warnings and Interactions

It is not known whether lisinopril is secreted in human milk. Because of the potential for severe adverse reactions in nursing infants from ACE inhibitors, either nursing or the treatment must be stopped. 

Black Box Warning

Lisinopril is a Pregnancy Category D drug with a potential for birth defects and fetal death. Treatment must be stopped if pregnancy is detected.

In rare cases, lisinopril can cause a cascade of liver problems, which start with jaundice (yellowing of the skin or eyes) and progresses to liver failure and sometimes death. Seek immediate care if symptoms of hepatitis develop.

Drug interactions can affect how your other medications work or increase your risk for serious side effects. Drug interactions can occur when taking lisinopril with the following medications:

  • Diuretics
  • Antidiabetics
  • Non-steroidal anti-inflammatory agents (NSAIDs) including selective cyclooxygenase-2 inhibitors (COX-2 inhibitors) 
  • Dual blockade of the renin-angiotensin system (RAS) 
  • Lithium
  • Gold
  • Mammalian target of rapamycin (mTOR) inhibitors 

Inform your doctor of all medication that you are taking so that they can adjust your treatment accordingly and monitor drug interactions. 

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. U.S. Food and Drug Administration. QBRELIS (lisinopril) oral solution.

  2. U.S. Food and Drug Administration. Generic drug facts.

  3. Messerli F, Bangalore S, Bavishi C, Rimoldi S. Angiotensin-converting enzyme inhibitors in hypertension. J Am Coll Cardiol. 2018;71(13):1474-1482. doi:10.1016/j.jacc.2018.01.058

  4. MedlinePlus. Lisinopril. Updated July 15, 2017.

  5. van Vark L, Bertrand M, Akkerhuis K et al. Angiotensin-converting enzyme inhibitors reduce mortality in hypertension:
    a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158 998 patients.
     Eur Heart J. 2012;33(16):2088-2097. doi:10.1093/eurheartj/ehs075

  6. American Heart Association. Ejection fraction heart failure measurement. Updated May 31, 2017.

  7. Aronow WS. Update of treatment of heart failure with reduction of left ventricular ejection fraction. Arch Med Sci Atheroscler Dis. 2016;1(1):e106-e116. doi:10.5114/amsad.2016.63002

  8. Corbo J, Breslin T, Hill L, Rindfuss S, Nashelsky J. ACE inhibitors or ARBs to prevent CKD in patients with microalbuminuria. Am Fam Physician. 2016 Oct 15;94(8):652-653.

  9. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018 Jun;71(6):1269-1324. doi: 10.1161/HYP.0000000000000065

  10. U.S. Food and Drug Administration. PRINIVIL® (lisinopril) tablets, for oral use.

  11. Sanders GD, Coeytaux R, Dolor RJ, et al. Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor antagonists (ARBs), and direct renin inhibitors for treating essential hypertension: An update [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Jun. (Comparative Effectiveness Reviews, No. 34.) Table 1, Characteristics and labeled indications of ACEIs, ARBs, and direct renin inhibitors evaluated in this report.

  12. ZESTRIL (lisinopril). Accessdata.fda.gov. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019777s054lbl.pdf.