Can Lisinopril Cause Shortness of Breath? Understanding the Risks

October 11, 2025 •

3 min read

While a persistent dry cough is a widely known side effect of lisinopril, a more serious, though rare, risk is a severe allergic reaction called angioedema, which can cause life-threatening difficulty breathing. Understanding the signs that distinguish a common cough from a medical emergency is critical when considering the question, can lisinopril cause shortness of breath?.

Quick Summary

Lisinopril can cause shortness of breath through serious allergic reactions like angioedema or indirectly via a persistent dry cough. It may also signal a worsening heart condition or kidney problems. Immediate medical attention is needed for severe symptoms like sudden swelling of the face, tongue, or throat.

Key Points

Angioedema is a serious, life-threatening allergic reaction to lisinopril that causes swelling of the face, tongue, and throat, which can lead to shortness of breath.
The persistent, non-productive dry cough associated with lisinopril, while not true shortness of breath, can create a sensation of breathing difficulty.
Shortness of breath could also signal a worsening of the underlying heart failure or new kidney problems, which require prompt medical evaluation.
Immediate emergency medical attention is required for any signs of angioedema, including sudden swelling or difficulty breathing.
If a persistent cough is bothersome, doctors can switch to alternative medications like ARBs, which have a much lower risk of causing a cough.
Do not stop taking lisinopril without consulting your doctor, as abrupt cessation can be dangerous.

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor prescribed for conditions such as high blood pressure and heart failure. It works by relaxing blood vessels, which helps the heart pump blood more easily. While generally safe, lisinopril can cause side effects, including respiratory issues like a dry cough, and in rare cases, a severe allergic reaction called angioedema that can lead to shortness of breath.

Understanding the Connection: Lisinopril and Shortness of Breath

Lisinopril can cause shortness of breath or the sensation of it through several mechanisms. It's important to distinguish between a common cough and a more serious issue.

Angioedema: The Critical Concern

Angioedema is an uncommon but life-threatening allergic reaction to ACE inhibitors like lisinopril. It causes significant swelling beneath the skin, often affecting the face, lips, tongue, and throat. Swelling in the throat and tongue can block the airway, leading to severe difficulty breathing or shortness of breath. This reaction is thought to be related to the buildup of bradykinin, a substance that lisinopril prevents from being broken down. Studies suggest that Black patients may have a higher risk of developing ACE inhibitor-induced angioedema. Any signs of swelling should be treated as a medical emergency.

The Persistent Dry Cough

A persistent, dry cough is a common side effect of ACE inhibitors. While not the same as shortness of breath, a severe cough can interfere with normal breathing and create a feeling of breathlessness. The cough is also linked to bradykinin accumulation. The cough is typically dry and irritating, can start anytime after beginning the medication, and usually stops within a few weeks of discontinuing lisinopril.

Worsening of Underlying Conditions

Sometimes, respiratory symptoms may not be a direct side effect of lisinopril but rather a sign that the underlying condition is worsening:

Heart Failure: If heart failure progresses, symptoms like shortness of breath and fatigue can increase.
Kidney Problems: Changes in kidney function due to lisinopril can lead to symptoms like swelling, fatigue, and shortness of breath.

What to Do If You Experience Shortness of Breath

If you experience shortness of breath while taking lisinopril, immediate action is necessary. The response depends on the severity of symptoms.

Emergency Symptoms: Call 911 immediately if you have signs of angioedema, such as swelling of the face, lips, tongue, or throat, difficulty breathing, or sudden dizziness.
Non-Emergency Symptoms: If you have a persistent dry cough without other concerning signs, contact your doctor. Do not stop lisinopril on your own. Your doctor can determine if the cough is from the medication and discuss other treatment options.

Treatment Options and Alternatives

If side effects like a cough become problematic, your doctor may recommend switching to an alternative medication. Angiotensin II receptor blockers (ARBs) are common alternatives.


Feature	ACE Inhibitors (e.g., Lisinopril)	Angiotensin II Receptor Blockers (ARBs)	Calcium Channel Blockers (e.g., Amlodipine)
Mechanism	Blocks enzyme producing angiotensin II and breaking down bradykinin.	Blocks angiotensin II receptors, not affecting bradykinin breakdown.	Blocks calcium in heart and artery muscle cells, relaxing blood vessels.
Risk of Cough	Significant risk (5-35%).	Very low risk.	Low risk.
Risk of Angioedema	Higher risk, especially in Black patients.	Much lower risk.	Very rare risk.
Bradykinin Accumulation	Yes.	No.	No.

Your doctor will select the best alternative based on your health needs. Other options may include calcium channel blockers or diuretics.

Conclusion

To summarize, while a persistent dry cough is a common side effect, the serious condition of angioedema is the primary reason lisinopril can cause shortness of breath. Patients must be aware of these potential respiratory issues and know when to seek emergency care. Always report any bothersome or worsening symptoms to your healthcare provider. Do not stop taking lisinopril without consulting your doctor, as this can lead to health risks associated with untreated conditions. Discussing concerns with your doctor can help find a safer and more comfortable treatment plan, potentially involving an alternative like an ARB. For further health information, you can visit the National Institutes of Health website. https://www.ncbi.nlm.nih.gov/books/NBK482230/

Disclaimer: This article provides general information and is not a substitute for professional medical advice. Always consult your healthcare provider for diagnosis and treatment.

Frequently Asked Questions

A lisinopril cough is typically a dry, non-productive, and persistent tickling sensation, while shortness of breath is a sensation of not getting enough air. Shortness of breath is a serious symptom that can indicate angioedema or worsening heart/kidney conditions, whereas the cough is a benign but irritating side effect.

You should seek emergency medical help immediately if shortness of breath is accompanied by sudden swelling of the face, lips, tongue, or throat, hives, or trouble swallowing, as these are signs of angioedema.

The incidence of the dry cough varies, with some studies reporting it in 5% to 35% of patients taking ACE inhibitors, though estimates for lisinopril specifically can be lower. It is more common in women and people of Asian descent.

The cough can appear within hours or months of starting lisinopril and usually subsides within 1 to 4 weeks after discontinuing the medication, though it can sometimes linger longer.

Yes, common alternatives include angiotensin II receptor blockers (ARBs) like losartan or valsartan, which work similarly but with a much lower risk of causing a cough or angioedema. Other options include calcium channel blockers and diuretics.

Besides the cough, lisinopril can rarely cause angioedema, which results in serious breathing difficulties. Furthermore, if you are being treated for heart failure, increasing shortness of breath may signal a worsening of that underlying condition.

No, you should never stop taking lisinopril without consulting your doctor first. Discontinuing the medication can cause a dangerous spike in blood pressure and pose a risk for heart attack or stroke. Your doctor will advise on the best course of action.