From the Guidelines
Lisinopril can cause several side effects, including a risk of angioedema, hyperkalemia, and acute renal failure, especially in patients with severe bilateral renal artery stenosis, as noted in the 2018 guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
Common Side Effects
- Persistent dry cough
- Dizziness
- Headache
- Fatigue
- Mild digestive issues like nausea or diarrhea
Serious Side Effects
- Angioedema (swelling of the face, lips, tongue, or throat), which requires immediate medical attention
- Hyperkalemia (high potassium levels)
- Acute renal failure in patients with severe bilateral renal artery stenosis
Special Considerations
- Lisinopril is contraindicated in patients with a history of angioedema with ACE inhibitors, as stated in the guideline 1
- Patients with pre-existing kidney disease or those taking NSAIDs concurrently should be monitored for changes in kidney function
- Lisinopril can cause a significant drop in blood pressure, especially when starting treatment or increasing the dose, leading to lightheadedness or fainting
- It is essential for patients to report persistent or severe side effects to their healthcare provider and not stop taking the medication abruptly without medical guidance, as emphasized in the context of managing high blood pressure and potential side effects of ACE inhibitors like Lisinopril 1
From the FDA Drug Label
ADVERSE REACTIONS 6. 1 Clinical Trials Experience The following adverse reactions (events 2% greater on lisinopril than on placebo) were observed with lisinopril alone: headache (by 3.8%), dizziness (by 3.5%), cough (by 2. 5%). The following adverse reactions (events 2% greater on lisinopril than on placebo) were observed with lisinopril: hypotension (by 3.8%), chest pain (by 2.1%). Other clinical adverse reactions occurring in 1% or higher of patients with hypertension or heart failure treated with lisinopril in controlled clinical trials and do not appear in other sections of labeling are listed below: Body as a whole: Fatigue, asthenia, orthostatic effects Digestive: Pancreatitis, constipation, flatulence, dry mouth, diarrhea. Hematologic: Rare cases of bone marrow depression, hemolytic anemia, leukopenia/neutropenia and thrombocytopenia. Endocrine: Diabetes mellitus, inappropriate antidiuretic hormone secretion. Metabolic: Gout Skin: Urticaria, alopecia, photosensitivity, erythema, flushing, diaphoresis, cutaneous pseudolymphoma, toxic epidermal necrolysis, Stevens-Johnson syndrome, and pruritus. Special Senses: Visual loss, diplopia, blurred vision, tinnitus, photophobia, taste disturbances, olfactory disturbance. Urogenital: Impotence Miscellaneous: A symptom complex has been reported which may include a positive ANA, an elevated erythrocyte sedimentation rate, arthralgia/arthritis, myalgia, fever, vasculitis, eosinophilia, leukocytosis, paresthesia and vertigo.
The side effects of Lisinopril include:
- Common adverse reactions: headache, dizziness, cough, hypotension, chest pain
- Body as a whole: fatigue, asthenia, orthostatic effects
- Digestive: pancreatitis, constipation, flatulence, dry mouth, diarrhea
- Hematologic: bone marrow depression, hemolytic anemia, leukopenia/neutropenia, thrombocytopenia
- Endocrine: diabetes mellitus, inappropriate antidiuretic hormone secretion
- Metabolic: gout
- Skin: urticaria, alopecia, photosensitivity, erythema, flushing, diaphoresis, cutaneous pseudolymphoma, toxic epidermal necrolysis, Stevens-Johnson syndrome, pruritus
- Special Senses: visual loss, diplopia, blurred vision, tinnitus, photophobia, taste disturbances, olfactory disturbance
- Urogenital: impotence
- Miscellaneous: symptom complex including positive ANA, elevated erythrocyte sedimentation rate, arthralgia/arthritis, myalgia, fever, vasculitis, eosinophilia, leukocytosis, paresthesia, vertigo 2
From the Research
Side Effects of Lisinopril
The side effects of Lisinopril, an Angiotensin-Converting Enzyme (ACE) inhibitor, have been reported in several studies 3, 4, 5, 6, 7. The most common side effects include:
- Cough: reported in multiple studies as a frequent side effect 3, 4, 5, 6, 7
- Dizziness: reported as a common side effect, especially in patients with impaired renal function 3, 4, 5, 6
- Rash: reported in a small number of patients 3, 4, 6
- Proteinuria: reported in some patients, although it is difficult to separate disease effects from true drug effects 3, 7
- Hypotension: reported, especially in patients with impaired renal function or those taking diuretics 4, 5, 6, 7
- Hyperkalemia: reported as a frequent occurrence, especially in patients with altered potassium excretion 7
- Diarrhea: reported as a common side effect 5, 6
- Fatigue: reported as a common side effect 5, 6
- Headache: reported as a common side effect 5, 6
- Nausea: reported as a common side effect 6
Class-Related Adverse Effects
Lisinopril, like other ACE inhibitors, can cause class-related adverse effects, including:
- Azotemia: reported as a class-related adverse effect 4
- Angioedema: reported as a class-related adverse effect 4
- Hematological abnormalities: not reported with Lisinopril, but reported with other ACE inhibitors 4, 7
- Neutropenia: reported to be prevalent only in patients with autoimmune or collagen-vascular disease 7
Special Considerations
Patients with impaired renal function may require dosage adjustment, as Lisinopril can accumulate in these patients 3, 4, 5, 6. Additionally, patients taking diuretics or potassium supplements may require careful monitoring, as Lisinopril can interact with these medications 3, 4, 7.