Medication · Cardiovascular · full clinical detail
Lisinopril
An ACE inhibitor that lowers blood pressure, protects the heart after a heart attack and in heart failure, and slows kidney damage in diabetes by stopping the body making angiotensin II; taken once daily, with kidney function and potassium checked at the start.
Lisinopril stops your body making angiotensin II, a hormone that tightens blood vessels and makes the kidneys hold on to salt and water. Without it, vessels relax and the heart pumps against less resistance, so blood pressure falls and a weak heart has an easier job.
NICE first-line for adults under 55 who are not of Black African or African-Caribbean family origin, and for adults with type 2 diabetes of any age
Licensed indications come from the product licence in the named country; guideline-supported and off-label uses are cited to the guideline that supports them. Licensing differs between countries.
How it works
Lisinopril stops your body making angiotensin II, a hormone that tightens blood vessels and makes the kidneys hold on to salt and water. Without it, vessels relax and the heart pumps against less resistance, so blood pressure falls and a weak heart has an easier job.
Blocks angiotensin-converting enzyme, the enzyme in the lungs and blood vessels that turns inactive angiotensin I into angiotensin II. Less angiotensin II means arteries relax, the adrenal glands release less aldosterone so the kidneys keep less salt and water, and the pressure inside the kidney's filters falls. The same enzyme normally breaks down bradykinin, so bradykinin builds up: that adds to the vessel relaxation but also causes the dry cough in about one in ten people. Unlike most ACE inhibitors lisinopril is not a prodrug and is not metabolised by the liver.
Mechanism of action
Lisinopril is a lysine analogue of enalaprilat that inhibits angiotensin-converting enzyme (kininase II) directly without needing hepatic activation. Reduced angiotensin II lowers arteriolar tone, aldosterone secretion, sodium retention and sympathetic drive, and dilates the efferent glomerular arteriole, lowering intraglomerular pressure and proteinuria. Accumulation of bradykinin contributes to vasodilation and to cough and angioedema. In heart failure the fall in afterload and preload and the interruption of neurohormonal activation improve symptoms and survival; after myocardial infarction, early treatment limits ventricular remodelling. Lisinopril is excreted unchanged by the kidney, so exposure rises as eGFR falls and doses are reduced accordingly.
Dry, tickly cough (about 1 in 10; does not improve with time and is the usual reason for switching to an ARB)
Dizziness and light-headedness, particularly on standing and after the first dose
Headache, tiredness, diarrhoea
A small rise in creatinine and potassium
Serious: seek help
Angioedema: swelling of the lips, tongue, face or throat, which can obstruct breathing and needs emergency treatment; more common in people of Black African origin and can occur after years of treatment
Acute kidney injury with dehydration, NSAIDs or narrowed renal arteries
High potassium, especially with kidney disease, potassium supplements or spironolactone
Severe hypotension, particularly in heart failure, on diuretics or when dehydrated
Harm to the fetus: stop as soon as pregnancy is confirmed
Yellowing of the skin or eyes (rare liver reaction)
Source: NHS: Lisinopril. Frequencies follow the source's categories; no percentages are invented.
Serious safety information
Boxed warning (US). US labelling carries a boxed warning on fetal toxicity: stop lisinopril as soon as pregnancy is detected, because drugs acting on the renin-angiotensin system injure and can kill the developing fetus. US
Special warning. Angioedema of the face, lips, tongue, glottis or larynx can occur at any time during treatment and may be fatal if the airway is involved; the risk is higher in people of Black African origin and with a history of angioedema. Intestinal angioedema presents as abdominal pain. UK
Warnings and precautions
Kidney. Kidney function can deteriorate, particularly with renovascular disease, heart failure, dehydration or NSAIDs; check creatinine and potassium before and 1-2 weeks after starting and after dose increases. UK
Precaution. First-dose hypotension: a marked fall in blood pressure can follow the first dose in people on diuretics, on a low-salt diet, dehydrated or with heart failure; treatment is started at a low dose, sometimes with the diuretic paused. UK
Precaution. Sick-day guidance: during vomiting, diarrhoea or fever with dehydration, UK information advises pausing lisinopril temporarily to protect the kidneys, restarting when eating and drinking normally. UK
Driving. Dizziness is common at the start; do not drive, cycle or use machinery until it has settled. UK
Contraindications
Factor
Detail
Strength
Country · source
Previous angioedema with an ACE inhibitor
Contraindicated after angioedema associated with previous ACE inhibitor therapy.
ACE inhibitors are avoided in bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney, where they can cause acute kidney failure.
"Absolute" and "relative" follow the wording of the cited source; where the source does not classify, the cell is blank.
Interactions
Check interactions
Taking Lisinopril with other medicines? Add them to the checker to see what the official sources say about each pair: the mechanism, general management and monitoring, never a bare "safe".
Interactions documented in the official sources cited on each card. The list covers the medicines represented on this site and is not exhaustive; how the interaction data is compiled.
Other medicines
Lisinopril + Sacubitril/valsartan (Entresto)
Contraindicated or avoidContraindicated in official information
Taking lisinopril with sacubitril/valsartan (Entresto), or within 36 hours of it, greatly increases the risk of angioedema (severe swelling of the face and airway).
Why it can occur
other · Both drugs reduce bradykinin breakdown (ACE and neprilysin inhibition)
What official information says
The BNF lists sacubitril/valsartan as a contraindication; US information advises not taking lisinopril within 36 hours of it.
What to discuss with a clinician
Official information: contraindicated; a 36-hour gap is required when switching in either direction.
What may be monitored
Signs of angioedema
Context
Onset: Hours to days
Basis of the status
BNF: Lisinopril contra-indications (concomitant sacubitril with valsartan)
Sources
BNF: Lisinopril(Contra-indications)UK MedlinePlus: Lisinopril(What special precautions should I follow?)US NHS: Lisinopril(Taking it with other medicines and herbal supplements · Medicines that interact with lisinopril)UK
Review
Facts checked against the cited sources; not yet clinically reviewed · last reviewed 12 September 2026
The BNF lists aliskiren as contraindicated in patients with diabetes or with eGFR below 60; US information advises against the combination in diabetes.
What to discuss with a clinician
Official information: contraindicated in diabetes or eGFR below 60; not recommended otherwise.
Contraindicated or avoidOfficial guidance: avoid the combination
Combining an ACE inhibitor with an angiotensin receptor blocker (dual renin-angiotensin blockade) adds low blood pressure, kidney injury and high potassium without extra benefit.
Why it can occur
pharmacodynamic antagonism · Additive blockade of the same hormone system
What official information says
NICE advises not combining an ACE inhibitor with an ARB to treat hypertension; UK information lists the other class among medicines to tell a doctor about.
What to discuss with a clinician
Official UK guidance: not recommended; a specialist may use the combination in rare circumstances with close monitoring.
NSAIDs such as ibuprofen can reduce the blood-pressure-lowering effect of lisinopril and, particularly with a diuretic or dehydration, cause acute kidney injury and high potassium.
Why it can occur
nephrotoxicity · Loss of the renal prostaglandins that keep the afferent arteriole open when angiotensin II is blocked; the 'triple whammy' with a diuretic
What official information says
UK information advises telling a doctor before taking anti-inflammatory painkillers such as ibuprofen with lisinopril; the BNF advises monitoring renal function.
What to discuss with a clinician
Official UK guidance: avoid regular NSAID use where possible; if used, kidney function and potassium are checked and the person stays well hydrated.
Lisinopril + Spironolactone, eplerenone and other potassium-sparing diuretics
ModerateMonitoring or dose adjustment advised
Spironolactone, eplerenone and other potassium-sparing diuretics with lisinopril increase the risk of hyperkalaemia, particularly with kidney impairment.
Why it can occur
hyperkalaemia risk
What official information says
The BNF advises monitoring serum potassium when these are combined.
What to discuss with a clinician
A common deliberate combination in heart failure under supervision; potassium and kidney function are monitored closely.
ACE inhibitors can enhance the glucose-lowering effect of diabetes medicines such as metformin, insulin and sulfonylureas, occasionally causing low blood sugar in the first weeks.
Why it can occur
additive hypoglycaemia risk
What official information says
UK information lists diabetes medicines among those to tell a doctor about because lisinopril can lower blood sugar.
What to discuss with a clinician
Documented; blood glucose may be checked more often when lisinopril is started or increased.
Contraindicated or avoidOfficial guidance: avoid the combination
Losartan with any ACE inhibitor (ramipril, lisinopril, enalapril, perindopril) duplicates renin-angiotensin blockade: more hypotension, kidney injury and hyperkalaemia without extra benefit.
Why it can occur
pharmacodynamic antagonism
What official information says
NICE: do not combine an ACE inhibitor with an ARB to treat hypertension.
Therapeutic duplication. Two ACE inhibitors together, or an ACE inhibitor with an ARB, duplicate renin-angiotensin blockade and increase the risk of kidney injury, hyperkalaemia and hypotension without extra benefit. UK
Food and drink
With
Effect
Official advice
Potassium-containing salt substitutes
Reduced aldosterone means lisinopril lowers potassium excretion; potassium-based salt substitutes can cause hyperkalaemia. (hyperkalaemia risk)
UK information advises avoiding salt substitutes containing potassium unless a doctor agrees. UK
Alcohol
Alcohol increases the blood-pressure-lowering effect and dizziness, especially when starting or increasing the dose. (Additive hypotension)
UK information states that drinking in moderation is usually acceptable once settled on the dose, but avoiding alcohol in the first days is advised. UK
Herbal remedies and supplements
With
Effect
Official advice
Potassium supplements
Hyperkalaemia, which can cause dangerous heart rhythms
UK information advises not taking potassium supplements with lisinopril unless prescribed, with blood monitoring if they are. UK
Monitoring
What
Why
Tests and markers
Source
Kidney function and potassium
Baseline, 1-2 weeks after starting and after each dose increase, then at least annually; a creatinine rise over 30% or potassium above 6 mmol/L prompts review of the dose and of interacting drugs
Not recommended: UK information states lisinopril can harm the baby, particularly from the second trimester, and women planning pregnancy are switched to another medicine; contraindicated in the second and third trimesters. UK
Breastfeeding
UK information advises against lisinopril while breastfeeding, particularly in the first weeks and for premature babies, because there is not enough information on its safety; other medicines are preferred. UK
Children
Licensed in the UK for hypertension in children aged 6 years and over under specialist supervision; not recommended below 6 years or with an eGFR under 30. UK
Older adults
Start at a low dose; older adults are more likely to have reduced kidney function, to be taking diuretics and to become hypotensive. UK
Kidney impairment
Lisinopril is excreted unchanged by the kidney, so the starting dose is reduced as eGFR falls (for example 2.5-5 mg daily when eGFR is below 30) and potassium is watched closely; it can be used down to dialysis with dose adjustment. UK
Liver impairment
No hepatic metabolism, so no dose adjustment for liver disease itself, though rare cholestatic jaundice is a class effect and prompts withdrawal. UK
Diabetes: lisinopril is often the first choice, but the combination with aliskiren is contraindicated, and ACE inhibitors can lower blood glucose with insulin or oral hypoglycaemics in the first weeks.
Educational summary of drug–condition cautions in the cited sources; not a personal screening.
Effects on tests and results
Creatinine: Creatinine rises slightly and eGFR falls when lisinopril is started, reflecting lower glomerular pressure; a rise of more than 30% needs investigation. UK
Potassium: Serum potassium rises; hyperkalaemia is more likely with kidney disease, potassium supplements or spironolactone. UK
Blood glucose: Blood glucose can fall in people on insulin or sulfonylureas, particularly in the first weeks of treatment. UK
Urine protein: Urine albumin excretion falls in diabetic kidney disease, the intended effect followed with the albumin-to-creatinine ratio. UK
Pharmacokinetics
Absorption
About 25% absorbed (range 6-60%); food has no effect
Peak
About 7 hours
Half-life
About 12 hours (effective half-life for accumulation); once-daily dosing
Metabolism
Not metabolised
Elimination
Excreted unchanged in urine; accumulates as kidney function falls; removed by haemodialysis
Dosing is intentionally not described: doses depend on the indication, the country's licence, kidney and liver function, age, weight and other medicines, and are set by a prescriber.
Medicines that share the class of Lisinopril. They are separate medicines with their own licences, doses and interactions, not alternative names for Lisinopril.
Medicines often discussed alongside Lisinopril: used together, compared with it, or acting on the same problem by a different route.
Educational content. Anatomy Nexus provides medical education and does not replace professional medical advice, diagnosis, treatment, prescribing or pharmacist review. Doses, choices and monitoring are decided by a prescriber for an individual; never start, stop or change a medicine on the basis of this page.
