Side Effects of Lisinopril: What You Need to Know

Key Takeaways

• Lisinopril is commonly prescribed for high blood pressure, heart failure, and after heart attacks
• It is sold under the brand names Zestril and Prinivil
• Common side effects include dry cough, dizziness, headache, and low blood pressure
• Most side effects are mild and improve over time
• Serious risks include angioedema, kidney problems, high potassium levels, and liver damage
• Lisinopril carries a boxed warning and should not be used during pregnancy

What Is Lisinopril?

Lisinopril is a prescription medication that belongs to a class of drugs called ACE inhibitors (angiotensin-converting enzyme inhibitors). It works by relaxing and widening blood vessels, which lowers blood pressure and improves blood flow throughout the body.

The FDA first approved lisinopril in 1986 under the brand name Prinivil. The generic version was approved in 2002, and Zestril is the most widely recognized brand name today.

Because lisinopril directly affects blood pressure and circulation, most of its side effects connect back to those systems.

What Is Lisinopril Used For?

Doctors prescribe lisinopril to:

• Treat high blood pressure in adults and some children
• Manage heart failure in adults
• Reduce the risk of death following a heart attack

It may also be used off-label for kidney protection in people with diabetes. It manages these conditions while you take it but does not cure the underlying disease.

Most Common Side Effects of Lisinopril

Not everyone who takes lisinopril will experience side effects, but some are reported more often than others.[1]

For High Blood Pressure

• Dry cough
• Headache
• Dizziness

For Heart Failure

• Chest pain
• Low blood pressure

After a Heart Attack

• Low blood pressure
• Kidney-related issues

These effects can vary depending on your overall health and why you’re taking the medication.

Mild Side Effects

Many lisinopril side effects are mild and improve as the body adjusts to the medication.

These include:

• Fatigue or low energy
• Dry mouth
• Flushing or warmth in the skin
• Hair loss
• Blurry vision
• Changes in taste or smell
• Tingling or numbness
• Digestive issues such as nausea, gas, or constipation
• Headache
• Dizziness

If any of these are persistent or disruptive, your doctor can adjust your treatment.

Serious Side Effects

While less common, lisinopril can cause serious side effects that should not be ignored.[2]

• Kidney Problems: Lisinopril can affect kidney function, especially in people who already have kidney disease.
• Liver Problems: In rare cases, lisinopril may cause liver damage, which can lead to long-term complications if not addressed.
• Blood Disorders: Some people may develop low white blood cell counts, which can increase the risk of infections.
• High Potassium Levels (Hyperkalemia): Elevated potassium levels can affect heart rhythm and may become dangerous if untreated.
• Severe Allergic Reactions: A serious reaction called angioedema can cause swelling in the face, lips, tongue, or throat and may interfere with breathing.
• Pregnancy Risk (Boxed Warning): Lisinopril carries a boxed warning for fetal harm. It should not be used during pregnancy, as it can harm a developing fetus.

Lisinopril Side Effects in Women

Lisinopril affects men and women in many of the same ways, but there are some side effects and considerations that may be more relevant if you’re a woman.

Hormonal and Physical Differences

Because of differences in body composition and hormone levels, some women may be more sensitive to certain medications, including lisinopril. This can sometimes influence how side effects show up or how strongly they’re felt.

For example, dizziness or lightheadedness—especially when starting the medication or increasing your dose—may feel more pronounced for some women.

Dry Cough

One of the most commonly reported side effects of lisinopril is a persistent dry cough.[3] While this can happen to anyone, some reports suggest it may be more frequently experienced by women.

This cough can develop gradually and may become bothersome enough to interfere with sleep or daily life. If it doesn’t go away, your doctor may recommend switching to a different type of blood pressure medication.

Blood Pressure and Electrolyte Changes

Lisinopril works by relaxing blood vessels, which lowers blood pressure. In some cases, this can lead to symptoms like fatigue, weakness, or faintness.

Women who are smaller in body size or more sensitive to blood pressure changes may notice these effects more, especially early in treatment.

The medication can also affect potassium levels, so routine monitoring may be recommended to help prevent complications.

Pregnancy Risks

One of the most important considerations for women taking lisinopril is pregnancy.

Lisinopril is not considered safe during pregnancy and can cause harm to a developing fetus, particularly in the second and third trimesters. If you are pregnant, planning to become pregnant, or think you might be pregnant, it’s important to speak with your doctor right away.

Your provider can help you transition to a safer alternative if needed.

Pregnancy and Breastfeeding

Lisinopril should not be used during pregnancy. It carries a serious warning due to the risk of harm to a developing fetus.

If you become pregnant while taking lisinopril, contact your doctor right away. It is not fully known whether lisinopril passes into breast milk. Because of potential risks, your doctor may recommend alternative treatments if you are breastfeeding.

Reach out to your doctor if you experience:

• Side effects that don’t go away
• Symptoms that interfere with daily life
• Signs of serious reactions such as swelling, chest pain, or trouble breathing

Medication should support your health, not create new problems. Keep in mind that medication adjustments are always an option.

Lisinopril Side Effects in the Elderly

Older adults are among the most common users of lisinopril for hypertension and heart failure management, and they also face compounded risks compared to younger patients.

Kidney function naturally declines with age. Since lisinopril is processed and excreted by the kidneys without liver metabolism, reduced kidney function causes the drug to stay in the body longer at higher concentrations, increasing the likelihood of side effects.

Specific risks that are elevated in older adults include:

• Dizziness and falls: blood pressure drops from lisinopril can cause lightheadedness when standing, raising fall risk significantly in elderly patients
• Hyperkalemia: older adults are more likely to have reduced kidney clearance, making high potassium levels harder to manage
• Kidney function decline: pre-existing chronic kidney disease amplifies lisinopril's nephrotoxic potential
• Drug interactions: elderly patients often take multiple medications, increasing the chance of a dangerous combination

Doctors typically start older patients at the lowest effective dose and order routine blood work to monitor kidney function and potassium levels throughout treatment.

Management of Lisinopril Side Effects

If you’re experiencing side effects that feel persistent, uncomfortable, or unusual, it’s worth having a conversation with your healthcare provider. Small adjustments to your dosage or medication type can often make a big difference in how you feel.

Does Lisinopril Cause a Dry Cough?

Yes. A persistent dry cough is the most well-known side effect of lisinopril and one of the most common reasons patients request a medication change.[3][4]

Research puts the prevalence of ACE inhibitor-induced cough at up to 20% in women and around 10% in men. The cough is typically described as:

• Dry and nonproductive
• Tickling or scratchy
• Persistent throughout the day

The cough develops because ACE inhibitors prevent the breakdown of bradykinin, a substance that can accumulate in the lungs and trigger irritation. It usually appears within the first few weeks of treatment.

If the cough doesn't resolve or significantly disrupts daily life, your doctor may switch you to an ARB (angiotensin receptor blocker), a related class of blood pressure medication that doesn't cause this reaction.

Digestive Side Effects

Some people experience gastrointestinal symptoms while taking lisinopril, although these are less common.

These may include:

• Nausea or vomiting
• Diarrhea
• Gas
• Constipation

These symptoms can sometimes lead to dehydration, which may worsen dizziness or low blood pressure.

What You Can Do

• Drink enough fluids, especially if you have vomiting or diarrhea
• Talk to your doctor before using over-the-counter medications

High Potassium Levels

Lisinopril can raise potassium levels in your blood, which may not always cause noticeable symptoms at first.

When symptoms do occur, they may include:

• Muscle weakness or cramps
• Fatigue
• Nausea
• Irregular heartbeat

Risk Factors

You may be at higher risk if you:

• Have kidney problems
• Have diabetes
• Take potassium supplements
• Use potassium-based salt substitutes
• Take certain diuretics

Your doctor may monitor your potassium levels with routine blood tests.

Headaches and Dizziness

Headaches and dizziness are among the most commonly reported side effects.

Dizziness is often linked to lowered blood pressure and may be more noticeable:

• When you first start taking lisinopril
• After a dose increase
• When standing up quickly

What You Can Do

• Stand up slowly to reduce lightheadedness
• Stay hydrated
• Rest if symptoms occur

If dizziness is severe or persistent, your doctor may adjust your dosage.

Lisinopril and Alcohol

Mixing alcohol and lisinopril is not recommended. Alcohol increases blood pressure, which directly counteracts how lisinopril works. At the same time, the combination can cause an exaggerated drop in blood pressure in some people, leading to severe dizziness, fainting, or dangerous cardiovascular fluctuations.

Additional effects of combining lisinopril and alcohol include:

• Increased dizziness and headache
• Flushing
• Impaired coordination
• Greater risk of falls, particularly in older adults

If you drink, discuss safe limits with your doctor. Even moderate alcohol use can interfere with blood pressure control.

Drug Interactions and Food Interactions

Lisinopril interacts with a wide range of medications and some foods. Key interactions include:

• NSAIDs (ibuprofen, naproxen): Reduce lisinopril's blood pressure-lowering effectiveness and increase kidney strain when used together regularly
• Potassium supplements and potassium-based salt substitutes: Combine with lisinopril's potassium-raising effect to cause dangerous hyperkalemia
• Diuretics: Can cause excessive blood pressure drops when combined with lisinopril; require dose adjustment and monitoring
• Other antihypertensives: Additive blood pressure lowering increases the risk of dizziness and fainting
• Lithium: Lisinopril reduces lithium clearance, raising the risk of lithium toxicity
• Potassium-rich foods: Bananas, oranges, and other high-potassium foods can contribute to elevated potassium levels and should be consumed in moderation
• Grapefruit juice: Can increase lisinopril concentration in the bloodstream, amplifying side effects

Always give your doctor and pharmacist a complete list of medications, supplements, and dietary habits before starting lisinopril.

Can Lisinopril Cause Long-Term Side Effects?

Long-term side effects are possible but not common.[5] Most side effects either improve as the body adjusts or resolve after stopping the medication. With extended use, the risks that warrant ongoing monitoring are:

• Kidney function: Lisinopril's effect on renal blood flow can gradually affect kidney health, especially in people with pre-existing disease
• Cardiovascular effects: chronic use at high doses has been associated with arterial changes; your doctor will monitor blood pressure and heart function regularly
• Weight changes: some patients experience a gradual weight gain of around 1.2 kilograms on average, tied primarily to fluid retention

Routine lab work is standard practice for anyone on lisinopril long-term.

Does Dosage Affect Side Effects?

Yes. Higher doses increase the likelihood and intensity of certain side effects, particularly blood pressure drops, dizziness, and fainting. The relationship isn't straightforward, though; your overall health, kidney function, other medications, and age all influence how your body responds to a given dose. Your doctor will typically start at the lowest effective dose and adjust based on your response.

Does Lisinopril Cause Weight Gain?

Weight gain is not a primary side effect, but it does occur in some patients. It is most commonly tied to fluid retention rather than fat gain, and sudden or rapid weight gain while on lisinopril can signal a more serious issue, such as worsening heart failure or kidney problems. If you notice unexplained weight changes, especially alongside shortness of breath or swelling, contact your doctor promptly.

What Happens if You Stop Taking Lisinopril?

Stopping lisinopril does not usually cause withdrawal symptoms. However, the condition it was treating may return or worsen. For example:

• Blood pressure may increase
• Heart failure symptoms may come back

Always talk to your doctor before stopping the medication so they can guide you safely.

Overcoming Prescription Drug Abuse

According to the Substance Abuse and Mental Health Services Administration (SAMHSA) 2024 National Survey on Drug Use and Health, about 13.9 million people aged 12 or older misused prescription drugs in the past year.[6] While lisinopril is not a widely abused drug since it has no intoxicating effects, there are people who misuse or abuse it.

Structured addiction treatment programs include therapy to help you understand the root causes of substance use, build healthier coping strategies, and create a more stable, substance-free routine.