Can Lisinopril (Angiotensin-Converting Enzyme (ACE) inhibitor) cause stomach pain and nausea?

Lisinopril and Gastrointestinal Side Effects

Lisinopril can cause stomach pain and nausea as documented side effects, though they are not among the most common adverse reactions associated with this ACE inhibitor. 1

Gastrointestinal Side Effects of Lisinopril

• According to the FDA drug label for lisinopril, gastrointestinal symptoms including dry mouth, diarrhea, pancreatitis, constipation, and flatulence are reported adverse reactions in patients taking the medication 1
• While nausea is not specifically listed among the most frequent adverse reactions in the FDA label, it is documented as a potential side effect in clinical experience with the drug 2
• In clinical trials, approximately 5.7% of patients with hypertension discontinued lisinopril due to adverse reactions, with nausea being one of the reasons for discontinuation 1, 2

Frequency and Severity

• Gastrointestinal side effects with lisinopril are generally mild to moderate in severity and often transient 2
• In clinical experience studies with over 3,270 patients, nausea and diarrhea were among the most frequently reported adverse events, though not all cases were considered directly related to lisinopril 2
• The incidence of gastrointestinal symptoms appears to be lower with lisinopril compared to some other medications that commonly cause digestive issues 1

Management of Gastrointestinal Side Effects

• For mild and transient nausea or stomach pain, symptomatic relief and diet modification may be sufficient without requiring discontinuation of therapy 3
• Taking lisinopril with food may help mitigate nausea, and some patients benefit from taking it with the largest meal of the day 3
• For persistent or severe gastrointestinal symptoms, dose adjustment or switching to an alternative medication may be necessary 3

Important Considerations

• It's important to distinguish between common side effects and more serious conditions:

  • Intestinal angioedema (abdominal pain with or without nausea/vomiting) is a rare but serious adverse effect of ACE inhibitors like lisinopril that requires immediate discontinuation 1
  • Pancreatitis has been reported with lisinopril use and should be considered if abdominal pain is severe or persistent 1

• Gastrointestinal symptoms typically occur during the first month of therapy, though they can appear later in treatment 3

When to Seek Medical Attention

• Patients should seek medical attention if:
  • Stomach pain is severe or persistent 1
  • Nausea is accompanied by other symptoms like swelling, difficulty breathing, or severe abdominal pain 1
  • Gastrointestinal symptoms significantly impact quality of life or medication adherence 3

Alternative Medications

• If gastrointestinal side effects from lisinopril are intolerable, healthcare providers may consider:
  • Another ACE inhibitor that might be better tolerated
  • An angiotensin receptor blocker (ARB), which may have a different side effect profile
  • Other antihypertensive medication classes based on the patient's specific condition and comorbidities 1

Remember that while stomach pain and nausea can occur with lisinopril, these symptoms could also be related to other conditions or medications. Any persistent or concerning symptoms should be evaluated by a healthcare provider.