Can Lisinopril Cause Hair Loss?
Yes, lisinopril can cause hair loss (alopecia), though it is an uncommon adverse effect that is reversible upon discontinuation of the medication. 1
Evidence from FDA Drug Labeling
The official FDA prescribing information for lisinopril explicitly lists alopecia among the dermatologic adverse reactions occurring in 1% or higher of patients treated with lisinopril in controlled clinical trials. 1 This is the highest quality evidence available, as it comes directly from the drug label based on clinical trial data and post-marketing surveillance.
Clinical Case Evidence
A well-documented case report from 2017 describes a 53-year-old male who developed new-onset alopecia while taking lisinopril for heart failure. 2 When lisinopril was discontinued and switched to losartan (an angiotensin receptor blocker), the alopecia completely resolved within 4 weeks. 2 Using the Naranjo Adverse Drug Reaction Probability Scale, the causality assessment scored 6, indicating a probable relationship between lisinopril and the hair loss. 2
Mechanism and Pattern of Drug-Induced Hair Loss
- Drug-induced alopecia typically presents as a diffuse, non-scarring pattern that is reversible upon drug withdrawal. 3
- Hair loss from medications usually manifests as telogen effluvium, beginning 1-3 months after medication initiation. 3
- Resolution typically occurs within 3-6 months after discontinuation, with hair regrowth at approximately 1 cm per month. 3
Context Among ACE Inhibitors
While lisinopril-induced alopecia has limited documentation, other ACE inhibitors have been associated with hair loss in isolated case reports. 2 Among antihypertensive medications more broadly, beta-adrenoceptor antagonists (both systemic and topical) are recognized as possible causes of hair loss. 4
Clinical Management Approach
If a patient on lisinopril develops unexplained hair loss:
- Exclude other common triggers of telogen effluvium including fever, severe illness, stress, hemorrhage, or recent childbirth before attributing the hair loss to lisinopril. 5
- Consider discontinuation of lisinopril and switching to an alternative antihypertensive agent, such as an angiotensin receptor blocker (ARB), which may not cause the same adverse effect. 2
- Monitor for resolution over 4-6 weeks after medication change, as documented in the case report. 2
- Do not abruptly stop the medication without medical supervision, particularly if the patient is on other cardiovascular medications. 6
Important Caveats
- The incidence of lisinopril-induced alopecia appears to be low (≥1% based on FDA labeling), so it should not be assumed to be the cause without proper evaluation. 1
- Hair loss is a common complaint with multiple potential etiologies, and temporal association alone does not prove causation. 5
- The therapeutic benefit of lisinopril for cardiovascular conditions (hypertension, heart failure) is substantial, so the decision to discontinue should weigh the reversible cosmetic concern against cardiovascular risk. 2