Common Lisinopril Side Effects
Many individuals taking lisinopril experience side effects, particularly when starting the medication or after a dosage adjustment. Most of these are mild and often temporary as the body adapts.
Dry, Persistent Cough
One of the most well-known side effects of ACE inhibitors like lisinopril is a dry, hacking, and non-productive cough. It is believed to be caused by a buildup of certain substances, such as bradykinin, in the airways due to the medication's mechanism of action. This cough can be very persistent and may not respond to traditional cough medicines, often only resolving after discontinuing lisinopril. While it is a common reason for switching medications, the cough itself does not cause long-term lung damage.
Dizziness and Lightheadedness
Lisinopril lowers blood pressure, which can cause dizziness, especially when standing up or sitting up quickly. This is more common at the beginning of treatment or with dose increases. Lying or sitting down when feeling dizzy can prevent fainting and potential injury.
Headache and Fatigue
Headaches and unusual fatigue or weakness are also reported side effects. These symptoms may diminish as the body adjusts to the medication. Staying well-hydrated and getting adequate rest can help manage headaches.
Gastrointestinal Issues
Less common gastrointestinal side effects include nausea, diarrhea, and stomach pain. Taking lisinopril with food may help mitigate some of these digestive issues.
Serious and Potentially Life-Threatening Side Effects
Although rare, certain adverse reactions to lisinopril require immediate medical attention.
Angioedema
Angioedema is a rare but serious side effect involving sudden and severe swelling of the face, lips, tongue, throat, and extremities. This can be life-threatening if the swelling restricts the airway and causes difficulty breathing. Angioedema can occur at any point during treatment, and individuals of African descent have a higher risk. Any signs of swelling should prompt immediate emergency care.
Hyperkalemia (High Potassium Levels)
Lisinopril can cause increased potassium levels in the blood, known as hyperkalemia. While often mild, severe hyperkalemia can lead to dangerous heart arrhythmias. Risk factors include pre-existing kidney problems, diabetes, dehydration, or concurrent use of potassium-sparing diuretics or potassium supplements. Regular blood tests are necessary to monitor potassium levels.
Severe Hypotension (Very Low Blood Pressure)
While a mild drop in blood pressure is expected, some individuals may experience a severe, symptomatic drop (hypotension), especially during initiation of therapy. Symptoms include severe dizziness, fainting, and confusion. It is more likely in volume-depleted patients, such as those taking diuretics, or those with heart failure.
Kidney Problems
Lisinopril generally benefits kidney health by protecting against damage from high blood pressure. However, in some cases, it can cause a temporary, reversible decline in kidney function, especially in individuals with pre-existing kidney disease or other risk factors. Regular monitoring of creatinine and blood urea nitrogen (BUN) is crucial.
Liver Damage
In rare instances, lisinopril can cause liver damage, which may present with symptoms like jaundice (yellowing of the skin or eyes), dark urine, abdominal pain, nausea, and loss of appetite. If these symptoms occur, the medication should be stopped immediately.
Severe Skin Reactions
Very rarely, lisinopril can cause severe skin reactions like Stevens-Johnson syndrome, which involves painful red or purple skin that looks burned and peels. Any rash or skin reaction should be reported to a doctor immediately.
Comparison of ACE Inhibitor Side Effects
Most ACE inhibitors share a similar side effect profile due to their common mechanism of action. However, individual patient response can vary.
| Feature | Lisinopril | Other ACE Inhibitors (e.g., Captopril, Enalapril) | Angiotensin Receptor Blockers (ARBs) (e.g., Losartan) |
|---|---|---|---|
| Mechanism | Inhibits ACE to prevent angiotensin II formation and bradykinin breakdown. | Same mechanism as lisinopril. | Blocks angiotensin II receptors, does not affect bradykinin breakdown. |
| Dry Cough | Common side effect; persistent in some patients. | Common side effect across the class. | Significantly lower incidence of cough compared to ACE inhibitors. |
| Angioedema | Rare but serious risk; higher risk in Black patients. | Rare but serious risk, common to the ACE inhibitor class. | Lower risk of angioedema compared to ACE inhibitors, but still a possibility. |
| Hyperkalemia | Common risk, especially with kidney issues, diabetes, or other medication interactions. | Risk is common to the class. | Potential risk, as ARBs affect potassium levels similarly to ACE inhibitors. |
Special Considerations and Precautions
- Pregnancy: Lisinopril is contraindicated in pregnancy and can cause fetal harm or death if taken during the second and third trimesters.
- Diabetes: Diabetic patients may have an increased risk of hyperkalemia and hypoglycemia (low blood sugar) with lisinopril.
- Kidney Function: Patients with pre-existing kidney disease, and older adults with age-related decline in kidney function, may require a lower dose and closer monitoring.
- Drug Interactions: Lisinopril interacts with NSAIDs (ibuprofen, naproxen), potassium supplements, and other RAAS-blocking agents. Always inform your doctor about all medications and supplements.
- Alcohol: Alcohol can worsen some side effects, such as dizziness and low blood pressure.
Management and Monitoring
Regular communication with your healthcare provider is key to managing lisinopril side effects.
- Report Side Effects: Immediately report any side effects to your doctor, especially concerning or persistent ones.
- Adjusting Dosage: For mild side effects like dizziness, your doctor may suggest a lower initial dose or a gradual increase.
- Alternative Medications: If a persistent cough or other severe side effect occurs, your doctor may switch you to an alternative medication, such as an ARB, which works similarly but often lacks the cough side effect.
- Routine Monitoring: Expect regular blood tests to check kidney function and potassium levels, especially when starting the medication.
- Hydration and Positioning: Stay hydrated, and move slowly when getting up to minimize dizziness.
Conclusion
Lisinopril is an effective medication for several cardiovascular conditions, but understanding its side effects is vital for patient safety. While common side effects like a dry cough and dizziness are manageable and often temporary, rare but serious events like angioedema and severe hypotension demand prompt medical attention. Open communication with a healthcare professional and routine monitoring are essential to navigating treatment successfully and determining if an alternative medication is necessary.
How does lisinopril affect your kidneys?
Lisinopril is generally protective for kidneys, particularly in those with high blood pressure or diabetes, by reducing pressure within the kidney's filtering units. However, it can temporarily decrease filtering function, especially at the start of treatment, requiring careful monitoring.
What to do if you get a cough from lisinopril?
If you develop a bothersome, persistent, dry cough, you should consult your doctor. Unlike a cough from an infection, this cough often doesn't respond to typical cough medicines. Your doctor may recommend switching to an angiotensin receptor blocker (ARB), which is far less likely to cause this side effect.
How can I manage dizziness caused by lisinopril?
To manage dizziness, particularly upon standing, make sure to stand up slowly from a sitting or lying position. Staying adequately hydrated can also help, as dehydration can contribute to low blood pressure. If dizziness is severe or persistent, contact your doctor, as it may indicate that your dosage is too high.
Is angioedema from lisinopril an allergic reaction?
Angioedema caused by lisinopril is technically not an allergic reaction but is a result of a different mechanism involving the buildup of certain proteins. However, the symptoms are similar, and because it can be life-threatening, it requires immediate emergency medical attention.
Can lisinopril cause a high potassium level?
Yes, lisinopril can cause an increase in blood potassium levels (hyperkalemia). This risk is higher for those with kidney problems, diabetes, or those taking other medications like potassium-sparing diuretics or potassium supplements. Regular blood tests are important for monitoring.
Why is lisinopril not recommended during pregnancy?
Lisinopril is not recommended during pregnancy because it carries a boxed warning indicating it can cause serious injury or death to an unborn baby, particularly when used during the second and third trimesters.
Can I take NSAIDs like ibuprofen with lisinopril?
You should consult your healthcare team before taking NSAIDs with lisinopril. Combining these medications can increase the risk of kidney damage, particularly in older patients or those with pre-existing kidney issues.
