Knowing the potential lisinopril side effects is essential if you are among the tens of millions of Americans who take this blood pressure medication. As one of the most commonly prescribed drugs in the United States, lisinopril side effects range from a mild but persistent dry cough to rare but serious reactions that require immediate medical attention.
Lisinopril belongs to a class of medications called ACE inhibitors (angiotensin-converting enzyme inhibitors) and is used to treat high blood pressure, heart failure, and to improve survival after a heart attack. According to the CDC, nearly half of American adults have hypertension, and ACE inhibitors like lisinopril are among the most frequently prescribed treatments. The drug is available generically and is affordable, which contributes to its widespread use.
This guide covers the range of lisinopril side effects, from common annoyances to rare emergencies, along with practical, clinician-directed advice for managing symptoms and knowing when to seek help. It is general information and not a substitute for the guidance of your own prescriber or pharmacist. For more health information, visit our conditions guide.
Emergency warning: angioedema. The most dangerous reaction to lisinopril is angioedema, sudden swelling of the face, lips, tongue, or throat, sometimes with trouble breathing or swallowing, a tight throat, or a hoarse voice. This is a medical emergency. Call 911 immediately, stop taking the drug, and get emergency care. Do not wait to see if it improves. Angioedema can be life-threatening if it blocks the airway, it can be delayed and occur even after months or years of taking lisinopril without problems, and it is significantly more common in Black patients. Anyone who has had angioedema on an ACE inhibitor should generally never take one again; tell every clinician about it.
The short version: Most lisinopril side effects are mild, and a dry cough is the most common one. But a few reactions are serious and need urgent care, above all angioedema (swelling of the face, lips, tongue, or throat, or trouble breathing, call 911). Lisinopril can also raise potassium, affect the kidneys, and cause a large drop in blood pressure, which is why periodic blood tests and monitoring matter. It must not be used in pregnancy. Do not start, stop, or change your dose on your own; lisinopril also treats heart failure and protects the kidneys, so changes should always be clinician-directed. This article does not include dosing instructions by design.
Common Lisinopril Side Effects
Most lisinopril side effects are mild and may improve over time as your body adjusts. According to FDA prescribing information and clinical data, the following are among the more frequently reported.
Dry, persistent cough. This is the most characteristic side effect of all ACE inhibitors, including lisinopril. It affects a meaningful minority of patients (commonly cited in the range of roughly 5 to 20 percent) and is thought to result from the buildup of bradykinin, a substance that ACE inhibitors keep from being broken down. The cough is typically dry, tickling, and non-productive. It can start within a week of beginning the medication or develop months later, and it usually resolves within a few weeks of stopping the drug.
Dizziness and lightheadedness. Particularly common when starting the medication or after a change in therapy, dizziness is often related to a drop in blood pressure, especially when standing up quickly (orthostatic hypotension). It tends to be more pronounced in people who are also taking diuretics or who are dehydrated.
Headache. Headaches are reported by some patients and are usually mild. They tend to occur early in treatment and often resolve on their own.
Fatigue. Some people feel unusually tired, especially during the first few weeks. This may be partly related to the blood pressure-lowering effect as the body adjusts to a lower pressure than it is used to.
Nausea and diarrhea. Gastrointestinal symptoms occur in a small percentage of patients and are generally mild. Taking lisinopril at the same time each day, with or without food, can help minimize them.
Increased potassium levels. ACE inhibitors can cause potassium to build up in the blood (hyperkalemia). At mild levels this usually causes no noticeable symptoms and is picked up through routine blood tests. Higher levels can cause muscle weakness, numbness or tingling, and an irregular heartbeat, which is why monitoring matters (see below).
Serious Lisinopril Side Effects
While uncommon, some lisinopril side effects are potentially dangerous and require prompt or emergency medical attention.
Angioedema. As highlighted in the emergency box above, this is the most serious risk. Angioedema is sudden, severe swelling of the face, lips, tongue, throat, or extremities, and can also affect the intestines (causing abdominal pain). It occurs in well under 1 percent of patients but is more common in Black patients, with studies showing a several-fold higher incidence. It can be life-threatening if it affects the throat and airway, and it can occur at any point in treatment, even after years without problems. Call 911 immediately for swelling of the face, lips, tongue, or throat, or any difficulty breathing or swallowing.
Severe drop in blood pressure (hypotension). A significant drop in blood pressure can cause fainting, severe dizziness, or, rarely, shock. It is most likely early in treatment and in people who are volume-depleted from diuretics, vomiting, or diarrhea, or who have heart failure. Fainting or near-fainting is a reason to seek medical care.
Hyperkalemia (dangerously high potassium). Very high potassium can cause life-threatening heart rhythm problems. Risk is higher in people with kidney disease or diabetes, and in those taking potassium supplements, potassium-sparing diuretics, or salt substitutes containing potassium. Warning symptoms include muscle weakness, a slow or irregular heartbeat, and tingling.
Kidney problems. Lisinopril can affect kidney function, particularly in people who already have kidney disease, narrowing of the kidney arteries (renal artery stenosis), or who take other medications that affect the kidneys. Signs include decreased urination, swelling in the feet or ankles, and unexplained weight gain from fluid. Your clinician should monitor kidney function and potassium, especially around any change in therapy.
Liver problems. Rarely, ACE inhibitors can cause liver injury. Symptoms include yellowing of the skin or eyes (jaundice), dark urine, severe fatigue, and upper abdominal pain. Report these to your clinician right away.
Blood disorders. Very rarely, lisinopril can lower white blood cell counts, increasing infection risk. This is more likely in people with autoimmune disease or those taking immunosuppressant medications.
Severe allergic reaction. Beyond angioedema, a severe allergic reaction (anaphylaxis) can cause widespread hives, throat tightness, wheezing, and a drop in blood pressure. This is an emergency, call 911.
Who Is at Higher Risk for Side Effects
Several factors can increase your likelihood of experiencing lisinopril side effects.
Black patients. ACE inhibitors are generally less effective at lowering blood pressure in Black patients when used alone and carry a notably higher risk of angioedema. Guidelines from the American Heart Association and American College of Cardiology note that calcium channel blockers or thiazide-type diuretics may be preferred as initial therapy in this population, though ACE inhibitors are still used, particularly for people with diabetes or kidney disease. Any Black patient taking lisinopril should be especially alert to the signs of angioedema.
People with kidney disease. Pre-existing kidney impairment increases the risk of further decline in kidney function and of hyperkalemia. More frequent monitoring is required, and your clinician will tailor therapy accordingly.
People with diabetes. The combination of diabetes and an ACE inhibitor increases hyperkalemia risk. ACE inhibitors are often recommended for people with diabetes because they help protect the kidneys, but closer monitoring of potassium and kidney function is important.
People taking certain other medications. NSAIDs (such as ibuprofen and naproxen) can reduce lisinopril’s effectiveness and increase kidney risk. Potassium supplements, potassium-sparing diuretics (such as spironolactone or triamterene), potassium-containing salt substitutes, and certain other blood pressure drugs can raise hyperkalemia risk. Combining an ACE inhibitor with an ARB or a direct renin inhibitor is generally avoided. Always tell your clinician and pharmacist about everything you take, including over-the-counter products and supplements.
Pregnancy and Lisinopril: A Critical Warning
Lisinopril must not be used during pregnancy. ACE inhibitors can cause serious harm or death to a developing fetus, and the risk is well established in the second and third trimesters. If you become pregnant while taking lisinopril, or are planning to become pregnant, contact your clinician promptly to discuss a safer alternative; do not make changes without medical advice. Note that the FDA retired the old letter-based pregnancy categories (A, B, C, D, X) under its Pregnancy and Lactation Labeling Rule, so you may still see “category D” in older materials, that labeling system is outdated. What matters is the clear guidance that lisinopril should be stopped and replaced when pregnancy is detected or planned, under a clinician’s direction. If you could become pregnant, discuss reliable contraception and a blood-pressure plan with your clinician.
Managing Lisinopril Side Effects
Many lisinopril side effects can be managed or minimized with practical, clinician-directed strategies. These are general tips, not instructions to change your medication on your own.
For the cough: If the dry cough is tolerable, it may be worth continuing lisinopril given its blood-pressure and heart benefits. If the cough significantly affects your quality of life, your clinician can consider switching you to an ARB (angiotensin receptor blocker) such as losartan or valsartan, which provide similar benefits without the ACE-inhibitor cough because they do not cause bradykinin buildup. Any switch should be decided and directed by your clinician.
For dizziness: Rise slowly from sitting or lying positions, stay well hydrated, and limit alcohol, which can worsen dizziness. Avoid driving or operating machinery until you know how the medication affects you. If dizziness persists or you faint, contact your clinician.
For fatigue: Fatigue often improves after the first few weeks. If it does not, talk with your clinician rather than changing your regimen yourself.
For potassium: Avoid excessive intake of high-potassium foods and, importantly, salt substitutes that contain potassium chloride. Do not take potassium supplements unless your clinician specifically prescribes them, and keep all scheduled blood-work appointments.
For kidney function: Stay well hydrated, avoid NSAIDs when possible, and attend regular blood-work appointments. Report any changes in urination or new swelling to your clinician promptly.
If you are interested in complementary approaches to blood pressure management, read our guide on how to lower blood pressure naturally, and discuss any changes with your clinician before making them.
When to Call Your Doctor
Contact your healthcare provider if you experience:
- A persistent dry cough that significantly affects your sleep or daily activities
- Dizziness or lightheadedness that does not improve or that recurs
- Swelling of the ankles, feet, or hands, or unexplained rapid weight gain
- Decreased urination or changes in urine color
- Persistent nausea, vomiting, or diarrhea (which can cause dehydration and low blood pressure)
- Muscle weakness, cramping, or a sense of an irregular heartbeat
- Unexplained fatigue that worsens over time
- Any new or worsening symptoms after starting or changing therapy
Call 911 or go to the emergency room immediately if you experience:
- Swelling of the face, lips, tongue, or throat (angioedema)
- Difficulty breathing or swallowing, throat tightness, or a hoarse voice
- Fainting or severe dizziness
- A rapid, very slow, or irregular heartbeat
- Chest pain
- Signs of a severe allergic reaction (widespread hives, wheezing, swelling)
Never stop taking lisinopril suddenly without your clinician’s guidance. Lisinopril treats high blood pressure and also heart failure, and it helps protect the kidneys in some patients. Abruptly stopping it can cause a dangerous rebound in blood pressure or worsen an underlying condition. If you want to stop or change it, talk with your clinician first.
Frequently Asked Questions
How long does the lisinopril cough last?
The ACE-inhibitor cough can begin within the first week or develop after months of use. As long as you keep taking lisinopril, the cough typically persists. Once the medication is stopped or switched to an ARB (under your clinician’s direction), the cough usually resolves within a few weeks, though occasionally it can take longer. If the cough is bothersome, do not simply wait it out, talk to your clinician about options.
Can I drink alcohol while taking lisinopril?
Alcohol can lower blood pressure further, increasing the risk of dizziness, lightheadedness, and fainting, and this effect is most pronounced when you first start or change therapy. If you drink, keep it moderate, and the Cleveland Clinic and other sources generally advise limiting alcohol while on blood-pressure medication. Ask your clinician what is appropriate for you.
Does lisinopril cause weight gain?
Lisinopril itself is generally weight-neutral and does not typically cause weight gain. If you notice significant weight gain while taking it, it could reflect fluid retention, which may signal worsening heart failure or kidney problems. Report sudden weight gain (for example, more than a few pounds in a day or several pounds in a week) to your clinician promptly.
Can lisinopril cause erectile dysfunction?
ACE inhibitors, including lisinopril, are among the blood-pressure medications least likely to cause erectile dysfunction, and some evidence suggests they may be more favorable in this respect than certain other classes. If you experience erectile dysfunction while on lisinopril, it is often related to the underlying high blood pressure, other medications, or other health conditions rather than to the lisinopril itself. Discuss it with your clinician.
What should I do if I miss a dose of lisinopril?
If you miss a dose, general guidance is to take it when you remember, unless it is almost time for the next dose, in which case skip the missed one and continue your regular schedule. Do not take two doses to make up for a missed one. Follow your pharmacist’s or clinician’s specific instructions, and consider a pill organizer or a daily reminder if you often forget.
The Bottom Line
Lisinopril is an effective and affordable blood pressure medication with a well-established safety profile. The most common side effect, a dry cough, is annoying but not dangerous, and alternatives exist for those who cannot tolerate it. The reactions that truly demand attention are the serious ones, above all angioedema, which is an emergency, along with dangerous potassium levels, severe drops in blood pressure, and kidney effects. Lisinopril must not be used in pregnancy.
The key to using lisinopril safely is open communication with your clinician, regular monitoring of blood pressure, kidney function, and potassium, and knowing which symptoms require urgent care. Do not start, stop, or change your dose on your own. For most patients, the cardiovascular and kidney-protective benefits of lisinopril outweigh its risks when it is used and monitored under a clinician’s guidance. For more health information, explore our conditions guide.
Sources
- MedlinePlus / U.S. National Library of Medicine — lisinopril patient information
- DailyMed / FDA prescribing information — lisinopril label (including boxed warning on fetal toxicity and angioedema)
- Mayo Clinic — lisinopril and ACE inhibitors
- Cleveland Clinic — blood pressure medications and lifestyle guidance
- American Heart Association / American College of Cardiology — high blood pressure treatment guidance
- Centers for Disease Control and Prevention (CDC) — hypertension in the United States