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Content:
What is Lisinopril and how does it work?
Lisinopril is an ACE inhibitor that reduces blood pressure by blocking the enzyme that makes angiotensin II, a hormone that makes blood vessels narrower. This drug, which has been approved by the FDA, is an angiotensin-converting enzyme inhibitor. It is one of the first-line treatments for high blood pressure and heart failure.
Some of the main reasons to use Lisinopril are high blood pressure, heart failure, acute myocardial infarction, and diabetic nephropathy. The medicine usually starts to decrease blood pressure within 1 to 2 hours. The strongest effects happen 6 to 8 hours after taking it and can last for up to 24 hours.
The drug acts by blocking the renin-angiotensin-aldosterone system (RAAS), which is an important route that controls blood pressure and fluid balance. When ACE is blocked, blood vessels stay relaxed and open, which makes it easier for blood to circulate and lessens the strain on the heart. Lisinopril is not a prodrug like some other ACE inhibitors, such as enalapril. This means that it doesn't need to be changed into an active form in the body.
How do ACE inhibitors lower blood pressure?
ACE inhibitors, such as lisinopril, reduce blood pressure in a number of methods that have various effects on the heart and blood vessels.
- Blocking the synthesis of angiotensin II: The major way this works is by blocking angiotensin-converting enzyme, which inhibits angiotensin I from changing into angiotensin II. Angiotensin II is a potent vasoconstrictor that makes blood vessels narrow extremely quickly.
- Lisinopril decreases the release of aldosterone, a hormone that makes the kidneys keep sodium and water, which would otherwise raise blood pressure. It does this by preventing the production of angiotensin II.
- The medicine elevates levels of bradykinin, a peptide that relaxes and opens blood vessels.
- Long-term use makes the inner lining of blood vessels work better, which makes the vascular system healthier and more responsive.
ACE inhibitors are great at keeping blood pressure stable over time because they do two things: they diminish vasoconstriction and boost vasodilation. Studies show that this mechanism does more than only lower blood pressure; it also protects the heart and kidneys.
What is the correct dosage for Lisinopril?
For high blood pressure, the normal starting dose of lisinopril is 10 mg once a day. Depending on how well the blood pressure reacts and how well the patient can handle it, the maintenance dose can be between 20 and 40 mg a day. People who have heart failure or are at high risk for heart disease may need to start with smaller dosages, between 2.5 and 5 mg per day, to protect their blood pressure from dropping too low.
Patient Category | Starting Dose | Maintenance Dose | Maximum Dose |
---|---|---|---|
Hypertension (Adults) | 10 mg daily | 20–40 mg daily | 80 mg daily |
Heart Failure | 2.5–5 mg daily | 20–35 mg daily | 35 mg daily |
Elderly Patients (>65) | 2.5–5 mg daily | 10–20 mg daily | 40 mg daily |
Kidney Disease | 2.5–5 mg daily | 5–10 mg daily | 20 mg daily |
Important dosing advice:
- Best Time to Take: Take it at the same time every day, preferably in the morning so you don't get low blood pressure at night.
- With or without food: You can take it with or without food because it doesn't change how well your body absorbs it.
- If you forget to take your dose, take it as soon as you recall, unless it's almost time for the next dose. Never take two doses at once.
- Managing the patient before, during, and after surgery: Healthcare practitioners may change the timing dependent on the surgical schedule and the patient's risk of heart disease.
You should check your blood pressure every 2 to 4 weeks while you are changing your dose. You need to check your kidney function and potassium levels from time to time, especially in older people or people who already have kidney disease.
When should you adjust Lisinopril dosage?
If you don't reach your blood pressure goals after 2 to 4 weeks of treatment, or if you start to have adverse effects that are connected to the dose, you need to change the dose of lisinopril.
- If your blood pressure stays above 130/80 mmHg for 2–4 weeks, you might want to double the dose.
- If the patient's systolic blood pressure drops below 100 mmHg or they start to feel dizzy, lower the dose.
- Changes in how the kidneys work: If serum creatinine rises by more than 30% from the baseline, lower the dose.
- Hyperkalemia: If potassium levels go beyond 5.5 mEq/L, lower the dose.
- Side Effects That Don't Go Away: Lower the dose if you get side symptoms that are connected to the dose, including too much tiredness.
- Interactions between drugs: Make changes when you start taking drugs that lower blood pressure.
If your blood pressure stays high even after taking 40 mg of antihypertensive medicine every day, it's usually better to add a second one than to raise the amount to the greatest level. You might wish to switch to ARBs (like losartan) or add additional medicines that function together if Lisinopril stops working even when the dose is right.
Can you take Lisinopril with other medications?
Most common drugs can be safely taken with lisinopril, however some drug interactions need to be watched closely or the dose needs to be changed. Medications that change how the kidneys work or the amounts of potassium in the body have the most important interactions.
Safe combinations that make things work better:
- Thiazide Diuretics: Hydrochlorothiazide and lisinopril act together to help regulate blood pressure better.
- Calcium Channel Blockers: You can safely mix amlodipine and nifedipine.
- Beta-blockers: ACE inhibitors are often used with metoprolol and atenolol.
- Statins: No interactions with cholesterol drugs like atorvastatin
Drugs that need to be used with care:
- NSAIDs: Ibuprofen and naproxen can make the medicine less effective and raise the risk of renal damage.
- Supplements of potassium: Can lead to serious hyperkalemia
- Lithium: Lisinopril can raise lithium levels, therefore you need to check them often.
- Drugs for diabetes: May make insulin work better, which could mean changing the dose.
How much does Lisinopril cost?
In the US, generic lisinopril is one of the cheapest blood pressure drugs. A 30-day supply usually costs $10 to $30 without insurance.
Purchase Option | 30-Day Supply Cost | 90-Day Supply Cost |
---|---|---|
Generic (without insurance) | $10–30 | $25–75 |
With Insurance / Medicare | $5–15 copay | $10–30 copay |
Discount Programs (Walmart, CVS) | $4–10 | $10–25 |
Brand Name (Prinivil / Zestril) | $100–200 | $250–500 |
GoodRx / Coupons | $8–20 | $20–50 |
The cost-effectiveness goes beyond the price of the prescription because controlling blood pressure well can stop pricey heart problems. Studies reveal that for every dollar spent on ACE inhibitor medication, $3 to $7 in healthcare costs are avoided. Generic drugs work the same way as brand-name drugs and offer the same health advantages at a far lower cost.
Do you need a prescription for Lisinopril?
Lisinopril only comes by prescription in the U.S.—you won’t find it over‑the‑counter. That’s not just red tape: ACE inhibitors can have serious side effects, so you need a healthcare professional watching over your treatment.
Before your doctor writes a lisinopril script, they’ll check your kidney function, review any other meds you’re on, confirm you’re not pregnant (if there’s any chance), and assess your cardiovascular risk. That usually means baseline labs—serum creatinine, electrolytes, and sometimes an EKG if your risk profile calls for it.
Once you’re on lisinopril, you’ll have regular follow‑ups to make sure it’s doing its job, fine‑tune your dose, and catch any side effects early.
In many states, pharmacists can now tweak ACE inhibitor doses under established protocols, which makes long‑term management more convenient for patients while keeping safety front and center.
What are the side effects of Lisinopril?
Dry cough (10–15% of patients), dizziness, headache, and tiredness are the most common adverse effects of lisinopril. Most of these are moderate and become better over time. Serious adverse effects are rare, but they need to be treated right away.
Side effects that happen to a lot of people (1–15%):
- Dry cough: a cough that doesn't produce anything and gets worse at night
- Dizziness or lightheadedness, especially when you stand up rapidly
- Headache: Usually minor and gets better over time
- Fatigue: May get better as the body gets used to the medicine
- Nausea: Taking it with food could make your stomach feel better.
Side effects that are very bad and need medical attention right away:
- Angioedema is when the face, lips, tongue, or throat swell up. It can be deadly.
- Severe hypotension: Blood pressure drops so low that you faint or go into shock.
- Hyperkalemia: A dangerous rise in potassium that makes the heart pulse irregularly.
- Kidney Dysfunction: A sudden drop in urine flow or kidney function.
- Neutropenia: A very low white blood cell count that raises the risk of infection.
Most people can handle lisinopril well, and the side effects usually become better during the first few weeks of medication. Regular checks help find major problems early on.
Why does Lisinopril cause dry cough?
About 10–15% of people taking lisinopril end up with a dry, tickling cough. Here’s why: ACE normally breaks down a peptide called bradykinin. When you block ACE, bradykinin builds up in your lungs and airways, causing inflammation and that nagging, non‑productive cough.
Most folks notice this cough within one to eight weeks of starting lisinopril. It tends to hit women and non‑smokers harder, and it’s more common in certain ethnic groups. You’ll usually feel it more at night, and no amount of over‑the‑counter cough syrup seems to help—because there’s no mucus to clear, just that constant throat tickle and coughing fits.
Unlike the cough you’d get with a cold or flu, this one won’t fade away on its own as long as you keep taking the ACE inhibitor. The only surefire fix is to switch to another type of blood‑pressure med—most doctors reach for an ARB (like losartan), which doesn’t let bradykinin pile up.
If you’re on lisinopril and a cough shows up, don’t shrug it off as “just a cold.” Your healthcare provider will want to know about any new respiratory symptoms so they can distinguish an ACE‑inhibitor cough from asthma, allergies, or an infection.
Who should not take Lisinopril?
Some categories of patients should not take lisinopril because it raises the risk of major side effects or reactions that could be life-threatening.
Absolute contraindications (never use):
Never use these:
- Previous Angioedema: A history of swelling of the face, lips, tongue, or throat from any ACE inhibitor
- Pregnancy: Can cause major birth abnormalities and death of the fetus, especially in the second and third trimesters.
- Bilateral Renal Artery Stenosis: When both kidney arteries are restricted, there is a risk of sudden kidney failure.
- Hereditary Angioedema: A genetic disorder that raises the risk of swelling reactions that could be fatal.
Relative contraindications (use with extreme caution):
- Severe Aortic Stenosis: A narrowing of the heart valve that can lead to hazardous reductions in blood pressure
- Severe Kidney Disease: Creatinine clearance below 30 mL/min raises the risk of toxicity.
- Hyperkalemia: High potassium levels that are already there (>5.5 mEq/L)
- Severe liver disease: drugs don't break down properly, which makes their effects last longer.
- Volume Depletion: Being dehydrated raises the risk of severe hypotension after the first dose.
Elderly people and people with diabetes need to be watched closely since they are more sensitive to the effects of blood pressure-lowering drugs and have a higher risk of kidney problems. Before starting lisinopril, you should always tell your doctor about all of your medical problems and medications.
Should you stop Lisinopril before surgery?
These days, most rules suggest keeping patients on lisinopril right up to surgery—if their blood pressure’s well controlled, the heart‑protective effects usually outweigh the risk of low blood pressure during the operation. Of course, it’s not one‑size‑fits‑all: you still need to tailor the decision to the type of surgery, the patient’s cardiovascular risk, and what the anesthesiologist prefers.
For big operations or procedures where you might lose a lot of blood, many anesthesiologists opt to pause ACE inhibitors 12–24 hours beforehand. Since lisinopril has a long half‑life, you’ll still see some blood pressure lowering even if you miss a dose. In emergencies, though, patients often stay on their usual meds, and the anesthesia team adjusts to manage any unexpected drops in pressure.
If it’s a minor outpatient procedure—say, a hernia repair—you can usually keep taking your regular lisinopril dose, especially if you’ve had heart disease or a stroke. The key is good communication between you, your surgeon, and the anesthesia team so everyone’s on the same page. Abruptly stopping lisinopril can trigger rebound hypertension, which might up the cardiovascular risk around surgery.
Bottom line: continue lisinopril for low‑risk cases, think about a temporary hold for high‑risk surgeries, and never just stop it cold without medical guidance. Most experts now lean toward keeping therapy going, with careful blood pressure checks and fluid management during the operation to keep things steady.

Dr. Brian Jacob
Hernia Surgery & Minimally Invasive Surgery
Dr. Brian Jacob is a board-certified hernia surgeon in New York City and Professor of Surgery at the Icahn School of Medicine at Mount Sinai. He is the founder of the International Hernia Collaboration and internationally recognized for his expertise in hernia repair, groin pain, and surgical education. Dr. Jacob has performed thousands of hernia operations and is consistently ranked among New York’s Top Doctors by Castle Connolly and The New York Times Magazine.