For many patients, a single medication may not be enough to control high blood pressure (hypertension) effectively. In such cases, healthcare providers may prescribe a combination of drugs, such as lisinopril and amlodipine. Lisinopril is an ACE (angiotensin-converting enzyme) inhibitor, while amlodipine is a calcium channel blocker (CCB). This combination works synergistically to relax blood vessels and decrease blood pressure. While this is an effective treatment strategy, patients should be aware of the potential side effects that can arise from taking both medications simultaneously.
Common Side Effects of Lisinopril and Amlodipine
Many of the side effects that occur when taking these two medications together are a result of each drug's individual profile. However, some effects, like dizziness, are compounded by the presence of both drugs.
Lisinopril-Related Common Side Effects
- Dry Cough: This is one of the most well-known side effects of ACE inhibitors like lisinopril. The cough is often persistent and tickly and is caused by an increase in certain proteins in the body. It usually disappears after discontinuing the medication, though it may take several weeks.
- Dizziness and Lightheadedness: Lisinopril can cause a drop in blood pressure, especially when starting the medication or increasing the dose, leading to feelings of dizziness.
- Headache: Mild headaches can be a common side effect as the body adjusts to the medication.
- Fatigue: Some patients report feeling unusually tired or weak, which may be related to the blood pressure-lowering effect.
- Nausea and Diarrhea: Gastrointestinal upset, though less common, can occur with lisinopril.
Amlodipine-Related Common Side Effects
- Ankle Edema (Swelling): Amlodipine is well-known for causing swelling in the hands, feet, and ankles. This is a very common side effect and occurs because the medication causes blood vessels to widen, leading to fluid pooling in the lower extremities.
- Flushing: Patients may experience a feeling of warmth or redness in the face, ears, and neck.
- Dizziness and Headaches: Similar to lisinopril, amlodipine can cause dizziness and headaches, especially when treatment begins. Taking them together can increase this effect.
- Fatigue: Excessive tiredness is a known side effect of amlodipine.
- Heart Palpitations: Some individuals may experience a racing or pounding heartbeat.
Potential Serious Side Effects
While the combination of lisinopril and amlodipine is generally safe for most, there are rare but serious side effects to be aware of. Immediate medical attention is required if any of these symptoms appear.
- Angioedema: This is a rare but life-threatening swelling of the face, tongue, lips, and throat caused by lisinopril. It can occur at any time, even after taking the medication for a while. People of Black/African descent are at a higher risk. If angioedema occurs, the medication must be stopped immediately and emergency care sought.
- Hyperkalemia (High Blood Potassium): Lisinopril can cause an increase in potassium levels, which can be dangerous and affect heart rhythm. Patients with kidney problems or those taking potassium supplements or certain diuretics are at higher risk.
- Low Blood Pressure (Hypotension): The combined blood pressure-lowering effect of both medications can lead to excessive drops in blood pressure, causing severe dizziness, fainting, and lightheadedness. This risk is heightened when starting treatment or increasing the dose.
- Liver Problems: In very rare cases, liver damage, including hepatic failure, can occur with lisinopril. Amlodipine can also cause liver issues. Symptoms include jaundice (yellowing of the skin or eyes).
- Worsening Angina or Heart Attack: While rare, some patients with severe cardiovascular disease may experience a worsening of chest pain or even a heart attack when first starting amlodipine or increasing the dose.
- Kidney Problems: Lisinopril can affect kidney function, especially in those with pre-existing kidney disease. Regular monitoring is recommended.
Comparison of Lisinopril vs. Amlodipine Side Effects
Understanding the specific effects of each drug helps in pinpointing the cause of a side effect, as they have different mechanisms of action and, consequently, distinct adverse effects. The table below highlights some key differences.
| Feature | Lisinopril (ACE Inhibitor) | Amlodipine (Calcium Channel Blocker) |
|---|---|---|
| Mechanism of Action | Inhibits the enzyme that produces angiotensin II, a potent vasoconstrictor. | Blocks calcium from entering heart and blood vessel cells, allowing them to relax and widen. |
| Common Side Effects | Dry cough, dizziness, headaches, fatigue, high potassium. | Ankle swelling (edema), flushing, headaches, dizziness, palpitations. |
| Serious Side Effects | Angioedema (face/tongue swelling), severe hypotension, kidney issues. | Worsening angina, heart attack, severe hypotension. |
| Specific Risk Groups | Higher risk of angioedema in individuals of Black/African descent. | Higher risk of edema in women. |
Management and When to See a Doctor
Many of the common side effects associated with the combined therapy can be managed at home, but some require medical consultation or immediate care.
Managing Common Side Effects
- Dizziness: Rise slowly when changing positions (sitting to standing). Lying down until the dizziness passes can prevent fainting. Staying hydrated also helps.
- Ankle Swelling (Edema): Elevating the legs can help reduce fluid retention. While diuretics typically don't address this specific type of swelling, a doctor may adjust the dose or medication.
- Dry Cough: If the cough is bothersome and persistent, a doctor may switch the patient to an angiotensin II receptor blocker (ARB), which works similarly but is much less likely to cause a cough.
- Headaches: Resting and drinking plenty of fluids can help. Over-the-counter painkillers like acetaminophen may be used, but NSAIDs (ibuprofen, naproxen) should be avoided as they can interact with lisinopril.
When to Contact a Healthcare Provider
It is important to contact a doctor if side effects are persistent, severe, or interfere with daily life. For instance, if the dry cough does not improve or is severe, a medication change may be necessary. You should also contact your doctor if ankle swelling is severe or worsening.
When to Seek Emergency Medical Attention
Certain symptoms are a sign of a medical emergency and require immediate care. These include:
- Sudden swelling of the face, lips, tongue, or throat.
- Difficulty breathing or swallowing.
- Severe chest pain or pressure.
- Fainting or severe lightheadedness.
- Yellowing of the skin or eyes (jaundice), which could indicate liver problems.
Conclusion
The combination of lisinopril and amlodipine is a highly effective treatment for high blood pressure, but patients should be aware of their combined side effect profile. While most side effects are manageable or resolve over time, it is vital to know the warning signs of more serious reactions, such as angioedema, kidney dysfunction, or severe hypotension. Consistent communication with a healthcare provider is the best way to manage these risks and ensure the continued efficacy and safety of the treatment. For anyone considering or currently taking this combination, it is essential to discuss potential adverse effects with a doctor to make informed decisions about their health. For more comprehensive details on the different types of blood pressure medications and their effects, the American Heart Association provides a useful resource.
