Introduction
Lisinopril is one of the most widely prescribed ACE inhibitors for high blood pressure and heart failure. While generally well tolerated, there are important side effects to recognize.
The ACE Inhibitor Cough
A persistent, dry, tickling cough affects approximately 5–20% of patients. It is a class effect of all ACE inhibitors and typically resolves within weeks of switching to an ARB.
Hyperkalemia
Lisinopril can raise potassium levels. Patients on potassium-sparing diuretics, ACE inhibitors, or with kidney disease require monitoring of serum potassium.
First-Dose Hypotension
Blood pressure may drop significantly after the first dose, especially in volume-depleted patients. Take the first dose at bedtime and rise slowly from a seated position.
Angioedema
Rare but potentially life-threatening swelling of the lips, tongue, throat, or face. Stop lisinopril immediately and seek emergency care. Never rechallenge with any ACE inhibitor.
Kidney Function Monitoring
A modest rise in serum creatinine (up to 30%) is expected and generally acceptable. Values exceeding this require dose adjustment or medication change.
Drug Interactions
Avoid concurrent NSAIDs, potassium supplements, and lithium without medical supervision. Aliskiren is contraindicated in diabetic patients taking lisinopril.
Who Should Not Take Lisinopril?
Contraindicated in pregnancy (all trimesters), history of ACE inhibitor-induced angioedema, and bilateral renal artery stenosis.
Conclusion
Lisinopril is a cornerstone blood pressure medication. Knowing its side effects helps patients identify problems early and stay safe on therapy.