From the Guidelines
If you're allergic to lisinopril, the best alternative is typically an Angiotensin II receptor blocker (ARB) like losartan or valsartan, as they work similarly to ACE inhibitors but rarely cause the same allergic reactions. According to the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1, ARBs such as losartan (25-50 mg once daily) or valsartan (20-40 mg once daily) are recommended for patients with heart failure with reduced ejection fraction (HFrEF). The 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure also supports the use of ARBs as an alternative to ACE inhibitors in patients who are intolerant to ACE inhibitors 1.
Some key points to consider when choosing an alternative to lisinopril include:
- The patient's specific health profile, including any other medical conditions they have and other medications they're taking
- The reason they were prescribed lisinopril in the first place
- The potential side effects of the alternative medication
- The need to work with a healthcare provider to find the most appropriate alternative and monitor for side effects when switching medications
Other options that may be considered include:
- Calcium channel blockers such as amlodipine (5-10 mg daily) or diltiazem (120-540 mg daily)
- Thiazide diuretics like hydrochlorothiazide (12.5-25 mg daily)
- Beta-blockers such as metoprolol (25-200 mg daily) However, the choice of alternative medication should be based on the individual patient's needs and medical history, and should be made in consultation with a healthcare provider.
From the FDA Drug Label
Losartan is contraindicated: • In patients who are hypersensitive to any component of this product. • For coadministration with aliskiren in patients with diabetes.
The FDA drug label does not answer the question.
From the Research
Alternatives to Lisinopril
When allergic to lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, alternative medications can be considered. Some options include:
- Angiotensin II receptor blockers (ARBs) such as losartan, valsartan, irbesartan, and telmisartan
- Calcium channel blockers (CCBs)
- Diuretics, such as hydrochlorothiazide (HCTZ)
Efficacy of Alternative Medications
Studies have shown that:
- Losartan is effective in lowering blood pressure and can be used as an alternative to ACE inhibitors 2, 3
- Combination therapy with an ARB and a CCB, such as valsartan/amlodipine, can be more effective than maximal doses of an ARB with HCTZ 4
- Different ARBs may have varying effects on the risk of myocardial infarction, heart failure, and cerebrovascular disease 5
Considerations for Alternative Medications
When choosing an alternative medication, consider the following:
- Efficacy in lowering blood pressure
- Potential side effects and interactions
- Patient-specific factors, such as kidney function and other medical conditions
- The need for combination therapy to achieve optimal blood pressure control
Comparison of ARBs
A study comparing the risks of cardio-cerebrovascular disease between ARBs of different half-lives found that: