What To Know About Lisinopril (Prinivil and Zestril)

Lisinopril (brand names Prinivil and Zestril) is an angiotensin-converting enzyme (ACE) inhibitor. It used to treat hypertension and heart failure. Lisinopril also improves survival when it is taken after a recent heart attack or stroke.

ACE inhibitors cause the blood vessels to dilate (widen), lowering blood pressure. These medications block the activity of ACE, resulting in reduced angiotensin II production in the body. Angiotensin II acts directly on the blood vessels.

Lisinopril is available as an oral (by mouth) tablet as well as a liquid solution. The oral tablets are available in 2.5, 5, 10, 20, and 40 mg tablets. The liquid form of lisinopril must be special ordered by your healthcare provider. Sometimes lisinopril is combined with other blood pressure medications (such as hydrochlorothiazide) to help potentiate its effectiveness. Anxiety is a possible side effect of lisinopril.

Uses

The Food and Drug Administration (FDA) has approved lisinopril for the treatment of:

• Heart failure
• Hypertension
• Acute (sudden and severe) myocardial Infarction (heart attack)
• High blood pressure in children aged 6 and older

Off-Label Uses

Lisinopril is sometimes used off-label for the treatment of conditions not approved by the Food and Drug Administration (FDA).

Off-label uses for lisinopril include:

• Migraine headache prevention
• Myocardial fibrosis
• Infertility
• Diabetic retinopathy

Lisinopril is sometimes given for the treatment of kidney disease. Although there have been some clinical research studies to back the effectiveness of lisinopril for some types of kidney disease, such as proteinuric (high amounts of protein in the urine) kidney disease, more studies are needed before the drug will be considered a mainstream medication for the treatment of this condition.

Before Taking Lisinopril

Before giving you a prescription for lisinopril, your healthcare provider will evaluate your blood pressure readings and may do some blood tests to check your kidney function. Your blood potassium level may be checked as well because lisinopril can raise potassium levels.

Before taking lisinopril be sure to tell your healthcare provider if:

• You are taking any other prescription medications, over-the-counter (OTC) medications, vitamins, supplements, or any other type of drugs
• You are pregnant or plan to become pregnant or are breastfeeding
• You have kidney disease
• You have heart problems
• You have been diagnosed with low blood pressure
• You are scheduled for any type of major surgery
• You have had a recent bout of diarrhea or vomiting
• You are on a special diet, such as a low sodium diet
• You have had an allergic reaction to lisinopril
• You plan to have a desensitization treatment for allergies

Other ACE Inhibitors

Other ACE inhibitors include:

• Lotensin (benazepril)        
• Capoten (captopril)
• Vasotec (enalapril) 
• Monopril (fosinopril)         
• Aceon (perindopril) 
• Accupril (quinapril) 
• Altace (ramipril)     
• Mavik (trandolapril)

Dosage

Your healthcare provider will prescribe the dosage of lisinopril that is right for you depending on many factors, including the type of medical condition you have—such as high blood pressure or heart failure. Always take lisinopril exactly as instructed by your prescribing healthcare provider.

Average Dosage

The average starting dosage of lisinopril is between 2.5 mg and 10 mg. It is usually to be taken only once per day.

According to the FDA, lisinopril should be started at a low dosage and increased gradually over a time span of several weeks. 

The starting dose depends on the type of medical treatment you are taking lisinopril for, such as:

• High blood pressure: 10 mg one time per day
• Recent heart attack: 5 mg one time per day
• Heart failure: 5 mg one time per day

The maximum dosage of lisinopril is 80 mg one time per day.

Dosages are lower for children and depend on many factors such as the medical condition being treated, the child’s age, weight, and more.

How To Take and Store

How To Take Lisinopril

Lisinopril can be taken with food or on its own. Do not crush the tablet; swallow it whole with liquid. 

If you were prescribed the liquid form, you’ll receive a syringe to help you measure the precise dosage. If you are unsure about how to measure your dosage, be sure to talk to your nurse, the pharmacist, or another healthcare provider.

How To Store Lisinopril

Storage recommendations for lisinopril include:

• Keep it at room temperature
• Keep it out of the reach of small children
• Protect the bottle from getting wet
• Keep the lid tightly closed
• Throw away any unused tablets or liquid once it has reached its expiration date

Side Effects

Common

Common side effects of lisinopril that do not usually require immediate medical attention (unless they do not go away or are causing discomfort) include:

• A change in the perception of taste
• A cough (sometimes referred to as lisinopril cough)
• Dizziness
• Light sensitivity
• A headache
• A fever
• Anxiety

If your anxiety is severe or does not subside after taking lisinopril for a short time, you should tell your healthcare provider. Abruptly stopping lisinopril suddenly can cause or worsen lisinopril-associated anxiety.

Abruptly discontinuing lisinopril can also cause tachycardia (a fast heart rate) and sweating.

Severe

Severe side effects, that should be reported to your healthcare provider right away, include:

• Dysuria: Problems passing urine, which could be a sign of kidney problems.
• Signs of increased potassium levels: Weakness in the muscles, chest pain, or irregular heart rate.
• Signs of liver problems: Flu-like symptoms, light-colored stools, dark urine, general malaise, upper right abdominal pain, nausea, yellowing of the skin, or in the whites of the eyes.
• Dizziness, feeling faint, lightheadedness, or falling: These are signs of low blood pressure.
• Nausea and vomiting
• An allergic reaction: Including symptoms such as a rash, swelling in the face, lips, throat, hand, feet, or tongue
• Difficulty breathing

This list may not describe every possible side effect of lisinopril. If you experience any other side effects, be sure to contact your healthcare provider. You can also report side effects to the FDA by calling 1-800-FDA-1088.

Lisinopril Warnings and Interactions

Do not stand or sit up suddenly after taking lisinopril, particularly if you are a senior, as this could increase your risk of falls. Do not use heavy machinery or perform any type of activity that requires mental alertness.

Lisinopril should be used with caution in some conditions, including:

• Hyperkalemia (high potassium levels): ACE inhibitors can raise blood potassium levels
• African ancestry: Some studies have found that people of African ancestry do not respond well to ACE inhibitors, also, this population may be more at risk for angioedema, a potentially fatal complication of the drug.

Note, these do not represent all of the warnings for taking lisinopril; be sure to talk with your healthcare provider about any other precautions or warnings linked with ACE inhibitors.

What Is a Black Box Warning?

A black box warning (also referred to as a “boxed warning”), is a serious safety risk associated with a drug.

Lisinopril has a black box warning regarding use during pregnancy. ACE inhibitors (such as lisinopril) can cause injury or even death to the developing fetus during the second or third trimester of pregnancy. If you become pregnant, you need to talk to your healthcare provider about how to discontinue lisinopril as soon as possible.  If you are on lisinopril and you are planning to become pregnant, you should discuss medication changes PRIOR to conceiving,

Precautions and Contraindications

Medications that can interact with lisinopril include:

• Hymenoptera venom (venom from insects used to treat immune-related or inflammatory disease)
• Aliskiren
• Some diabetic medications
• Potassium supplements
• Salt substitute
• NSAIDs should be taken with caution

This list of medications is not all-inclusive, so be sure to provide your healthcare provider with a list of every type of medication you are taking, including the dosage and when you take the drug/s.

Don’t forget to including OTC medications, herbal and natural supplements (including vitamins), and any other type of mediation you take.

Other Contraindications

Other contraindications for lisinopril include:

• Pregnant or breastfeeding mothers
• History of angioedema
• Bilateral renal artery stenosis
• Kidney failure