Lisinopril

Uses

Lisinopril is prescribed for multiple cardiovascular and renal conditions. Its uses are backed by decades of clinical data:

• Hypertension: Lisinopril is one of the most commonly prescribed medicines for high blood pressure. It reduces systolic and diastolic blood pressure and lowers long-term risk of cardiovascular complications such as stroke, heart attack, and heart failure. It is effective in younger patients and those with co-existing diabetes or kidney disease.
• Heart failure: Lisinopril improves symptoms like breathlessness and fatigue, reduces hospital admissions, and prolongs life expectancy. It is considered part of the core treatment alongside beta-blockers and diuretics.
• Post–myocardial infarction: Initiation of lisinopril within a few days of a heart attack reduces the risk of further cardiac events and improves survival by limiting harmful remodelling of the heart muscle.
• Diabetic nephropathy and chronic kidney disease: ACE inhibitors, including lisinopril, slow the progression of kidney damage by lowering glomerular pressure and reducing proteinuria (leakage of protein into urine). This renal protective effect is especially important in patients with diabetes, where lisinopril can significantly delay the onset of end-stage kidney disease.
• Paediatric hypertension: In some regions, lisinopril is approved for use in children aged 6 years and older with high blood pressure, though careful monitoring and weight-based dosing are essential.

Dosing guidance

• Typical starting dose for hypertension: 10 mg once daily, titrated up to 20–40 mg depending on blood pressure response.
• For heart failure: start lower (2.5–5 mg once daily), with careful titration every 1–2 weeks.
• After heart attack: begin as soon as clinically stable, often with 5 mg, gradually increasing to 10 mg daily as tolerated.
• Dosing adjustments are required in patients with kidney impairment or on diuretics.

Lifestyle measures—low-salt diet, regular physical activity, weight management, and smoking cessation—are key partners to pharmacological therapy.

Side Effects

Like all medicines, lisinopril can cause side effects. Many are mild and transient, but some require medical attention.

Common

• Dry cough: a persistent, tickling cough that may affect quality of life but resolves after stopping the drug.
• Dizziness, especially after the first few doses.
• Headache, fatigue, or a general feeling of being unwell.
• Gastrointestinal upset such as nausea, diarrhoea, or abdominal pain.

Less common

• Rash, itching, or altered taste sensations.
• Mild elevations in kidney function tests (creatinine, urea).
• Muscle cramps or joint aches.

Serious—seek urgent help

• Angioedema: swelling of the lips, face, or throat that can obstruct breathing. This can occur at any time, even after years of use, and requires immediate emergency care.
• Severe kidney dysfunction: abrupt deterioration in kidney function, especially in patients with bilateral renal artery narrowing.
• Severe hypotension: fainting, collapse, or shock-like symptoms, more common after the first dose in dehydrated or diuretic-treated patients.
• Hyperkalaemia: dangerous rise in blood potassium, which can cause abnormal heart rhythms, palpitations, or muscle weakness.

Most side effects improve with dose adjustment or discontinuation. Always consult a healthcare provider before stopping the medicine.

Warnings & Precautions

• Pregnancy: Lisinopril must not be used during pregnancy. ACE inhibitors can cause severe harm to the developing foetus, including kidney failure, reduced amniotic fluid, bone malformations, and even foetal death. Effective contraception is essential in women of childbearing age.
• Breastfeeding: Lisinopril is not recommended for use during breastfeeding, as it may be passed in breast milk.
• Kidney disease: Patients with impaired kidney function require close monitoring and potential dose adjustment. Those with bilateral renal artery stenosis should avoid ACE inhibitors altogether.
• Hyperkalaemia risk: Extra caution in patients with diabetes, kidney impairment, or those taking potassium supplements or potassium-sparing diuretics.
• First-dose effect: Dizziness or fainting can occur after the initial dose, especially in dehydrated patients or those on high-dose diuretics.
• Surgery and anaesthesia: Lisinopril may increase the risk of low blood pressure during operations; inform your surgical team if you are taking it.
• Older adults: May be more sensitive to blood pressure changes, requiring lower starting doses.

Regular blood tests for kidney function and electrolytes are recommended during treatment.