Lisinopril, what is it, and what are its side effects?
Blood flow pushes the walls of the arteries and creates pressure. When the heart pumps more blood or the arteries are narrower than usual, the pressure increases and causes high blood pressure (1-2). High blood pressure (hypertension) affects nearly half of the adults in the U.S. It is when the blood flowing through the blood vessels consistently makes pressure higher than normal (>130/80 mmHg). Hypertension is a health condition that is mostly without symptoms, and it should be continuously treated because it increases the risk of heart attack and stroke. These are leading causes of death in the U.S. Yet, only one-fourth of adults have this condition under control (3-4). Effective medication therapy can keep blood pressure under control (4).
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor and is a proven antihypertensive drug that lowers blood pressure. It blocks the substance in the body that tightens the blood vessel and relaxes them and reduces the pressure. As a result, the body gets the necessary blood supplies and oxygen to the heart, brain, and kidneys (5-6).In addition to hypertension, lisinopril is prescribed for the treatment of heart failure as well as heart attacks (6). Although it mostly presents good tolerance, people using lisinopril should know and recognize side effects that might occur. Some can be serious and require immediate discontinuation.
Keep on reading to find out what lisinopril is and its possible side effects. In this article, you will learn when to contact your doctor and stop taking the medication immediately.
What is its presentation?
Lisinopril, known under Zestril and Prinivil brand names but also generic names (Acebitor, Acemin, Acinopril, Fisopril, Tensopril, and others), is available in syrup 1mg/ml strength and tablets with the following strengths: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, and 40 mg, which makes dosage more convenient.
For hypertension, the initial dose in adults is 10 mg once daily. Then, according to the daily blood pressure measured values, the doctor will increase the dose to a maximal daily dose of 40 mg. In children older than 6, the doctor will define the dose based on the body weight calculating 0.07 mg/kg, but not more than 5 mg (7-8).
The initial dose for heart failure treatment and acute myocardial infarction (MI) is 5 mg. In MI, the next day follows another 5 mg dose, after 10 mg daily. For heart failure, the doctor will increase the dose to a maximum of 40 mg daily, depending on how the patient tolerates it (4, 7, 8).
What side effects may lisinopril cause?
Lisinopril is a medication that positively affects high blood pressure regulation and, therefore, risk reduction of life-threatening conditions mentioned before. However, lisinopril may cause side effects that can be mild to serious and affect different systems in the body.
Common side effects
The following side effects may happen to 1-10% of people taking lisinopril:
- A dry, tickly cough – When lisinopril causes this cough, cough medicines usually do not help. It may get better after a while, but if it does not happen and keeps bothering you and waking you up while sleeping, call your doctor. Another medication for hypertension might be more appropriate for you. Be aware that after you stop taking lisinopril, the cough may continue to bother you even a month after;
- Dizziness and lightheaded – This effect may happen when you begin with the treatment or increase the dose. If it happens to you when you stand up, sit until you feel better and get up slowly. Lying down also helps; sit after and stay like that until you feel better. Dizziness can be unsafe, so don’t ride a bike, drive, or operate machines;
- Headaches – If you experience headaches more than before, drink water and avoid alcohol. Painkillers can help, but before you take them, even out-of-the-counter (OTC) ones, consult the pharmacist about which one. If headaches are bothering you longer than a week or are severe to stand, talk to your doctor;
- Vomiting – If you feel sick, take small sips of water to avoid dehydration. Your pharmacist can advise you if some medications can help you.
- Diarrhea – In case of diarrhea, drink water to keep your body hydrated. If you notice dark pee with a strong smell or pee less, it can be a sign of dehydration. Taking any medication for diarrhea should be only by a doctor’s recommendation;
- Skin rash or itching – When this mild allergy symptom occurs, an antihistamine, recommended by a pharmacist, may help;
- Blurred vision – Avoid driving or operating with the machine while this happens to you. You should talk to your doctor if the blurred vision doesn’t disappear after two days (7-9).
Serious side effects
If you experience some of the following symptoms, call your doctor immediately or emergency services at 911 because, although rare (1 in 1,000 – 1 to 10,000 patients), those are serious:
- Yellowing of the skin or eyes – This can be a sign of a liver problem when the whites of the eyes become yellow or the skin;
- Feel tired, dizzy, easily bleeding, fever, sore through, or signs of infection – These signs may be a result of a blood or bone marrow disorder;
- Severe stomach pain – When the pancreas is inflamed, it causes severe stomach pain;
- Swelling in hands, feet, ankles, or lower legs – These might be the signals that occur when there are kidney problems. Long-term therapy with lisinopril might cause kidneys not to work; (7-9)
- Hoarseness and difficulty breathing or swallowing, swelling of the face, throat, tongue, rash, itching – These signs could be a result of an allergic reaction (6) and require immediate attention;
- Continuous nausea, vomiting, or diarrhea – These conditions may cause the body to lose too much water or salt and result in low blood pressure (6);
- Seizures.
You can find the complete list of side effects in the Medication Guide (7-8). Read it carefully and ask your doctor about the side effects you want to know more about.
Tell your doctor if you experience any event that seems like the described side effects. You can also report side effects to the United States Food and Drug Administration (FDA) by phone (1-800-332-1088) or at the following link: MedWatch: The FDA Safety Information and Adverse Event Reporting Program.
Symptoms of overdose
Hypotension is the most likely manifestation of an overdose that requires a saline solution to be taken intravenously in the hospital. Symptoms of overdose may include the following:
- Lightheadedness (5)
- Fainting (5)
In such cases, call the poison center helpline at 1-800-222-1222.
Fetal toxicity: Important warning
Women must know that lisinopril or any other drug that acts directly on the renin-angiotensin system (a physiological system that regulates blood pressure) can cause injury and death to the developing fetus. Therefore, if pregnancy is detected, stop taking lisinopril immediately, and call your doctor for recommendations on how to continue the high blood pressure treatment (7-8).
Additional precautions and measures
Follow the recommendations and precautions measures to be sure that your lisinopril treatment will be safe:
- Tell your doctor if you have any other medical problems such as angioedema caused by other ACE inhibitors, diabetes, kidney problems, low sodium in the blood (electrolyte imbalance), heart or blood vessel problems, or liver disease, etc.;
- Tell your doctor about any medication that you take even OTC; some drugs may interact with lisinopril; therefore, the treatment should not cause any harm to you;
- If you miss a dose, take it as soon as possible; if the time is close to the next dose, then wait for the time to come. Do not take a double dose to make up for a missed one (5).
- Reduce intake of salt if you eat salty food;
- Consult your doctor about diet changes and consuming alcohol (6).
Medications cannot do their job alone in hypertension regulation. Regular blood pressure measurement is essential to determine when it is high because of no symptoms and to monitor how the medication works.
Lifestyle changes are necessary for a comprehensive approach to keeping blood pressure values in a healthy range, recommends the American Heart Association. Physical activity of at least 30 minutes a day or at least 150 minutes weekly is the first change you should make. Healthy eating, quitting smoking, and stress management can also help in blood pressure regulation (10-11).
Conclusion
High blood pressure is a condition that needs regular and effective treatment to prevent kidney failure, stroke, or heart attack. Many medications are available for hypertension treatment; your doctor may recommend lisinopril which can significantly help your blood pressure regulation.
Take lisinopril regularly as your doctor prescribed you, and follow all other recommendations. You will need to take lisinopril for a long time, so be aware of possible side effects and tell your doctor about any adverse event that might occur. If the event is linked to your medication, the doctor will know what to do with your therapy.
Medication treatment lasts for years and should go together with lifestyle changes. With proper treatment and a healthy lifestyle, you can control your hypertension and live a healthy and long life.
References:
1. William J. High blood pressure (hypertension): Everything you need to know. Independently Published; 2021.
2. CDC. High blood pressure symptoms and causes [Internet]. Centers for Disease Control and Prevention. 2021. Disponible en: https://www.cdc.gov/bloodpressure/about.htm
3. CDC. Facts about hypertension [Internet]. Centers for Disease Control and Prevention. 2022. Disponible en: https://www.cdc.gov/bloodpressure/facts.htm
4. The facts about high blood pressure [Internet]. www.heart.org. 2017. Disponible en: https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure
5. Lisinopril: Angioedema: case report. React Wkly [Internet]. 2021 ;1387(1):24–24. Disponible en: https://medlineplus.gov/druginfo/meds/a692051.html
6. Lisinopril (oral route) [Internet]. Mayoclinic.org. 2021. Disponible en: https://www.mayoclinic.org/drugs-supplements/lisinopril-oral-route/side-effects/drg-20069129?p=1
7. Highlights of prescribing information Zestril (lisinopril) tablets, for oral use Initial U.S. [Internet]. FDA.gov. 2022. Disponible en: https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/019777s064lbl.pdf
8. Highlights of prescribing information Prinivil ® (lisinopril) tablets, for oral use Initial U.S. Fda.gov. 2022. Disponible en: https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019558s060lbl.pdf
9. Side effects of lisinopril. nhs.uk. 2021. Disponible en: https://www.nhs.uk/medicines/lisinopril/side-effects-of-lisinopril/
10. CDC. Manage high blood pressure. Centers for Disease Control and Prevention. 2020 . Disponible en:https://www.cdc.gov/bloodpressure/manage.htm
11. Changes you can make to manage high blood pressure [Internet]. www.heart.org. 2017. Disponible en: https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure
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