An ACE inhibitor
Lisinopril
A common once-daily ACE inhibitor used for high blood pressure and heart failure, and to protect the kidneys.
What is Lisinopril?
Lisinopril is an ACE inhibitor that relaxes blood vessels to lower blood pressure and reduce strain on the heart. It is used for high blood pressure and heart failure, and to help protect the heart and kidneys after a heart attack or in people with diabetes.
Education and reference only. This is a plain-language guide to Lisinopril — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Lisinopril is a widely used ACE inhibitor. It lowers blood pressure, is used as a treatment for heart failure with a reduced pumping function, and helps protect the kidneys — for example in people with diabetes or chronic kidney disease who have protein in the urine. It is a long-term, once-daily tablet.
How it works
Lisinopril blocks the angiotensin-converting enzyme (ACE), which the body uses to make angiotensin II — a hormone that tightens blood vessels and makes the body hold on to salt and water. With less angiotensin II, blood vessels relax and fluid load falls, so blood pressure drops and the heart has less to work against. The same effect reduces the pressure inside the kidney's filters, which is how it offers kidney protection.
Company & origin
Originated / developed by: Merck & Co. and AstraZeneca (originated at Merck/Zeneca).
Lisinopril is an ACE inhibitor developed in the 1980s, derived from enalapril work at Merck & Co. and co-developed with Zeneca (now AstraZeneca). It was first approved by the FDA in 1987 and is marketed under brands including Zestril and Prinivil.
What it treats
Conditions Lisinopril is used for
Practical use
How to take Lisinopril
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Usually taken once a day; the first dose is often taken at bedtime because it can cause dizziness.
- Swallow the tablet with water, with or without food.
- A dry, tickly cough is a known side effect — tell your GP if it is troublesome.
- If you miss a dose, take it when you remember unless the next dose is near, then skip it.
- Avoid NSAID painkillers and potassium-based salt substitutes unless advised.
- Do not stop suddenly without medical advice, especially in heart failure.
Weighing it up
Advantages & disadvantages of Lisinopril
Advantages
- Strong outcome evidence in high blood pressure and heart failure.
- Simple once-daily dosing.
- Cheap, well-established generic.
- Helpful for kidney protection in diabetes and proteinuria.
Disadvantages
- Commonly causes a persistent dry cough.
- Can raise potassium and affect kidney function, needing blood-test monitoring.
- May cause dizziness, particularly when first started.
- Must be avoided in pregnancy.
Practical use
Good to know
It is taken once a day and is often started low and built up, with a blood-pressure and blood-test check after starting and after increases. A dry, tickly cough is the most recognised nuisance effect and, if troublesome, is usually solved by switching to an ARB. The first dose can cause dizziness, so it is sometimes taken at bedtime to begin with. Anti-inflammatory painkillers (NSAIDs), especially alongside a water tablet, can stress the kidneys.
Who should not take it / use with caution
- People who are pregnant or planning pregnancy — ACE inhibitors are avoided in pregnancy and switched beforehand.
- A history of angioedema (sudden swelling of the lips, tongue or throat), including from a previous ACE inhibitor — a reason never to take it again.
- Used with caution in significant kidney artery narrowing, low blood pressure, or a high blood potassium level.
Monitoring
- Blood pressure
- Kidney function and blood potassium before and after starting/increasing
- For cough or any swelling
Side effects
- A persistent dry cough (common and harmless, but can be annoying).
- Dizziness or light-headedness, especially on standing or after the first dose.
- A rise in blood potassium or a change in kidney function (watched with blood tests); rarely, angioedema — sudden swelling of the face or throat needs emergency care.
Key interactions
- NSAID painkillers (e.g. ibuprofen) can reduce its effect and stress the kidneys, especially alongside a diuretic ("triple whammy").
- Potassium supplements, potassium-based salt substitutes and certain diuretics can push potassium too high.
- Care with other blood-pressure-lowering medicines, with ARBs, and with lithium.
Available as: Tablets (several strengths). A liquid is available for those who cannot swallow tablets.
Answers
Lisinopril: frequently asked questions
Why does lisinopril make me cough?
ACE inhibitors can cause a persistent dry, tickly cough in some people because of the way they affect natural body chemicals in the airways. It is harmless but can be annoying; if it bothers you, your prescriber can usually switch you to an ARB, which rarely causes a cough.
What is angioedema and why does it matter?
Angioedema is sudden swelling of the face, lips, tongue or throat. With an ACE inhibitor it is rare but a medical emergency, because throat swelling can affect breathing — call 999 if it happens. Anyone who has had it should never take an ACE inhibitor again.
Should I take lisinopril in the morning or at night?
It can be taken once a day at a consistent time that suits you. Because the first dose (and dose increases) can cause dizziness, the very first dose is sometimes taken at bedtime. Follow your prescriber's advice.
Can I take ibuprofen with lisinopril?
Occasional use may be fine, but regular anti-inflammatory painkillers (NSAIDs) can reduce lisinopril's effect and, especially alongside a water tablet, can harm the kidneys (the "triple whammy"). Check with your pharmacist and prefer paracetamol where suitable.
What is the difference between lisinopril and Zestril?
They are the same medicine — lisinopril is the generic (active-ingredient) name and Zestril is a brand name. Generic lisinopril contains the identical active ingredient.
The wider class
About ACE inhibitors
Lisinopril belongs to the ace inhibitors class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF: Lisinopril.
- electronic Medicines Compendium (SmPC): Lisinopril (Zestril).
- NICE CKS: Lisinopril.
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