How does this medication work? What will it do for me?

Lisinopril belongs to a class of medications called angiotensin converting enzyme (ACE) inhibitors. It is used to treat high blood pressure and congestive heart failure. It works by relaxing blood vessels and helping the heart to pump blood that carries oxygen to the different parts of the body more efficiently. It is also used immediately after a heart attack in order to reduce the risk of having another heart attack.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

5 mg
Each pink, round, biconvex tablet marked "L" score line "5" on one side and a symbol on the other side contains 5 mg lisinopril as lisinopril dihydrate. Nonmedicinal ingredients: calcium hydrogen phosphate dihydrate, colloidal anhydrous silica, magnesium stearate, maize starch, mannitol, pregelatinized starch, and red iron oxide.

10 mg
Each pink, round, biconvex tablet marked "L" score line "10" on one side and a symbol on the other side contains 10 mg lisinopril as lisinopril dihydrate. Nonmedicinal ingredients: calcium hydrogen phosphate dihydrate, colloidal anhydrous silica, magnesium stearate, maize starch, mannitol, pregelatinized starch, and red iron oxide.

20 mg
Each pink, round, biconvex tablet marked "L" score line "20" on one side and a symbol on the other side contains 20 mg lisinopril as lisinopril dihydrate. Nonmedicinal ingredients: calcium hydrogen phosphate dihydrate, colloidal anhydrous silica, magnesium stearate, maize starch, mannitol, pregelatinized starch, and red iron oxide.

How should I use this medication?

The recommended adult dose of lisinopril ranges from 2.5 mg to 40 mg daily, depending on the condition being treated. It is taken in one daily dose with or without food.

People who take other medications that lower blood pressure (e.g., diuretics) or people who have kidney disease may need lower doses. It may take up to 2 weeks to see the full effects of the medication.

The dose of lisinopril for children is determined by the child's body weight. Children who weight 20 to 50 kilograms should start with 2.5 mg once daily. This may be gradually increased to a daily dose of 20 mg. Children who weigh more than 50 kilograms should start with 5 mg taken once daily. This may be gradually increased to a daily dose of 40 mg.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take lisinopril if you:

  • are allergic to lisinopril or any ingredients of the medication
  • are allergic to another ACE inhibitor (e.g., captopril, enalapril, quinapril, ramipril)
  • are pregnant or intend to become pregnant
  • has a history of angioedema (a serious allergic reaction which causes the area around the throat and tongue to swell) after taking any ACE inhibitors (e.g., captopril, enalapril, fosinopril, ramipril)
  • have been diagnosed with hereditary angioedema
  • have high blood pressure in the blood vessels leading to the kidneys
  • are taking aliskiren, and
    • have diabetes
    • kidney disease
    • high levels of potassium
    • congestive heart failure with low blood pressure
    • are taking a medication in the class of angiotensin receptor blockers (e.g., irbesartan, losartan, valsartan)
    • are taking another angiotensin converting enzyme inhibitor (e.g., captopril, lisinopril, ramipril)

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • cough (dry, persistent)
  • diarrhea
  • mild dizziness
  • headache
  • nausea
  • unusual tiredness

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • chest pain
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • signs of low blood pressure (e.g., dizziness, lightheadedness, or fainting)
  • signs of too much potassium in the body (e.g., confusion; irregular heartbeat; nervousness; numbness or tingling in hands, feet, or lips; shortness of breath or difficulty breathing; weakness or heaviness of legs)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of angioedema (e.g., swelling of face, mouth, hands, or feet)
  • trouble in swallowing or breathing (sudden)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

HEALTH CANADA ADVISORY

February 4, 2014

Health Canada has issued new restrictions concerning the use of lisinopril. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.

Angioedema: Angioedema (a serious allergic reaction which causes the area around the throat and tongue to swell) may occur with the use of lisinopril. If you experience swelling of the face, tongue, or throat, stop taking lisinopril at once and get immediate medical attention. Other medications in the class of medications known as ACE inhibitors should not be taken in the future. People who have had angioedema caused by other substances may be at increased risk of angioedema while receiving an ACE inhibitor.

Cough: People taking lisinopril may develop a dry, persistent cough that usually disappears only after stopping or lowering the lisinopril dose. Be sure to tell your doctor of any cough that does not seem to be related to a usual cause.

Diabetes: ACE inhibitors such as lisinopril may lead to hypoglycemia (low blood sugar levels) in people with diabetes. If you have diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Fluid and electrolyte balance: Increases in blood levels of potassium may occur for some patients who receive lisinopril. This rarely causes problems, but potassium levels should be monitored by your doctor.

Kidney function: Changes in kidney function have been seen for certain people (e.g., people with narrowed blood vessels in their kidneys, or those with severe congestive heart failure). The use of diuretics (water pills), nonsteroidal anti-inflammatory drugs (NSAIDs) or aliskiren may further increase risk of kidney problems for people already at risk for this problem. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you have kidney function impairment you may require lower doses of this medication.

Liver function: Lisinopril may reduce liver function and can cause liver failure. If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

Low blood pressure: Occasionally, blood pressure drops too low after taking lisinopril. This usually happens after the first or second dose or when the dose is increased. It is more likely to occur for those who take water pills or the medication aliskiren, have a salt-restricted diet, are on dialysis, are suffering from diarrhea or vomiting, or have been sweating excessively and not drinking enough liquids. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.

To reduce the risk of dizziness, get up slowly from a lying or sitting position. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.

Potassium levels: Increases in blood levels of potassium occur for approximately 2% of people who take this medication. This rarely causes problems, but your doctor will likely want to monitor your potassium levels through blood tests. Avoid using salt substitutes that contain potassium while you are taking lisinopril.

Reduced alertness: Lisinopril may cause drowsiness or dizziness, especially at the beginning of treatment or after a dose increase. This can affect your ability to drive or operate machinery. Avoid these and other hazardous tasks until you have determined how this medication affects you.

Pregnancy: ACE inhibitors such as lisinopril may cause severe harm or death to the developing baby if taken by the mother during pregnancy.

This medication should not be used during pregnancy. If you become pregnant while taking this medication, stop taking lisinopril immediately and contact your doctor.

Breast-feeding: It is not known whether lisinopril passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of lisinopril for children less than 6 years of age have not been established. Lisinopril is not recommended for this age group. This medication may be used by children more than 6 years old to reduce blood pressure.

What other drugs could interact with this medication?

There may be an interaction between lisinopril and any of the following:

  • alfuzosin
  • aliskiren
  • allopurinol
  • alpha agonists (e.g., clonidine, methyldopa)
  • alpha blockers (e.g., alfuzosin, doxazosin, tamsulosin)
  • amifostine
  • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
  • angiotensin converting enzyme inhibitors (ACEIs; e.g., captopril, enalapril, ramipril)
  • angiotensin II receptor blockers (ARBs; e.g., candesartan, losartan)
  • antacids (e.g., aluminum hydroxide, calcium carbonate, magnesium hydroxide)
  • aprotinin
  • azathioprine
  • beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
  • brimonidine
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
  • cyclosporine
  • diuretics (water pills; e.g., furosemide, amiloride, spironolactone, triamterene)
  • duloxetine
  • diazoxide
  • everolimus
  • "gliptin" diabetes medications (e.g., linagliptin, saxagliptin, sitagliptin)
  • grass pollen allergen extract
  • heparin
  • iron dextran
  • isosorbide mono- and dinitrates
  • lithium
  • low molecular weight heparins (e.g., dalteparin, tinzaparin)
  • metformin
  • methylphenidate
  • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
  • nonsteroidal anti-inflammatory medications (NSAIDs; e.g., ibuprofen, indomethacin, naproxen)
  • pentoxifylline
  • phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
  • rituximab
  • sirolimus
  • sodium phosphates
  • substances which increase potassium levels (e.g., potassium chloride, salt substitutes containing potassium)
  • temsirolimus
  • tizanidine
  • tolvaptan
  • trimethoprim
  • yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.