Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor (brand names Prinivil and Zestril) that relaxes and widens blood vessels, lowers blood pressure and reduces the workload of the heart. It is used to treat high blood pressure, help prevent strokes, kidney problems, and heart attacks, treat heart failure, and improve survival after a heart attack. It is taken orally once daily, with or without food, in doses ranging from 2.5 mg to 40 mg. Here are what to watch for and 10 practical tips to reduce your risk of long-term side effects.
Key takeaways
- Lisinopril should be avoided throughout pregnancy, not just in the second and third trimesters – stop taking it as soon as you plan or discover pregnancy.
- Green tea can reduce the absorption of lisinopril by approximately two-thirds, a well-documented interaction that can impair blood pressure control.
- Photosensitivity (increased sensitivity to the sun) is a real and currently recognized side effect of lisinopril.
- Taking lisinopril alone doesn’t significantly raise uric acid or worsen gout — but the combination pill (lisinopril/HCTZ) does, through its HCTZ component, so check any medication you’re already taking.
- Regular use of NSAIDs, high potassium intake, and rapid changes in position all carry documented and ongoing risks that are worth monitoring with your doctor.
Possible side effects to know about
Dizziness or vertigoespecially when standing.
Signs of kidney injury: Decreased urination, swelling of the feet and ankles, fatigue, and shortness of breath.
Signs of a liver problem: Yellowing of the skin or eyes, loss of appetite, nausea, vomiting, fatigue, and stomach pain.
Signs of high potassium: Nausea, chest pain, weakness, irregular heartbeat, unsteadiness.
Signs of an allergic reaction (Call your doctor right away): swelling of the lips, face, tongue, or throat, difficulty breathing, wheezing, rash, or itching.
Dry, persistent cough — one of the most common side effects, which can appear days, weeks, months or even years after starting the medication. Report it to your doctor if it develops.
Less common side effects: Headaches, impotence, blood disorders, ringing in the ears, and blurry vision.
Pregnancy warning
Angiotensin-converting enzyme inhibitors such as Lisinopril It should not be used during pregnancy. Use during the second and third trimesters carries a well-documented risk of complications in the fetus and newborn, including decreased kidney function, low amniotic fluid, and related developmental problems. Current guidelines also suggest a smaller but real risk during the first trimester of pregnancy – one large cohort study found a higher rate of cardiovascular and central nervous system birth defects with exposure to ACE inhibitors in the first trimester compared to no exposure. For this reason, it is recommended to avoid use of lisinopril throughout pregnancy where possible, and to discontinue it and switch to an alternative as soon as pregnancy is planned or detected, rather than waiting until the third trimester.
Drug interactions
Many drugs can interact with lisinopril. This is not an exhaustive list, so it is helpful to review your specific medications with your doctor or pharmacist.
10 tips to help avoid long-term side effects
1. Rise slowly
Especially in the first few days and weeks of treatment, any time you change your position from lying to sitting or sitting to standing, take your time. Standing up too quickly can cause dizziness and increase the risk of falling.
2. Avoid alcohol
It is not recommended to drink alcohol while taking lisinopril, because it can cause your blood pressure to drop further in addition to the effect of the medication.
3. Monitor your potassium intake
Lisinopril can raise potassium levels in the blood. If you are taking this medicine long-term, be careful when taking salt substitutes (most are potassium based) and with foods high in potassium such as bananas, oranges, potatoes, tomatoes and dark leafy greens – moderation is more important than elimination, and your doctor can advise what is suitable for you specifically.
4. Be aware of green tea interactions
This is well documented: Green tea can significantly reduce the amount of lisinopril your body actually absorbs — one study found a nearly two-thirds reduction in blood levels — which may make the drug less effective at controlling blood pressure. This is a greater concern when taking green tea or its extracts on a regular, concentrated basis compared to an occasional cup of tea. If you drink green tea regularly, it is worth discussing it with your doctor or pharmacist and monitoring your blood pressure at home.
5. Get regular monitoring
Your doctor should check your potassium levels and kidney function regularly while you are taking lisinopril, as both can be affected by the medication over time.
6. Start low and work your way up slowly in older people
When starting this medication in the elderly, the dose should be increased gradually. Titrating too quickly increases the risk of side effects and a sudden, excessive drop in blood pressure.
7. Monitor blood sugar
Lisinopril may affect blood sugar levels. If you notice changes in your blood or urine sugar test results, or have questions, consult your doctor.
8. Know the signs of intestinal angioedema
If you experience stomach pain or cramps while taking lisinopril, especially if it is a new symptom, it is worth considering a rare condition called intestinal angioedema, which can cause exactly these symptoms. This is a known, although uncommon, condition associated with ACE inhibitors, and is different from the more common facial/throat swelling.
9. Sun sensitivity is a real and documented effect
Lisinopril can increase photosensitivity, making the skin more likely to react to sun exposure – this is a real and now recognized side effect, not a long-standing concern. If you notice a rash or unusual reactions when exposed to sunlight, sun protection (sunscreen, protective clothing, limiting direct exposure) is a reasonable precaution and is worth mentioning to your doctor.
10. Be careful with regular use of NSAIDs
Regular use of NSAIDs such as ibuprofen along with lisinopril increases the risk of kidney injury — a combination worth discussing with your doctor if you rely on NSAIDs regularly to treat pain.
A note on an old claim: Gout and uric acid
Some older sources suggest that lisinopril and other ACE inhibitors should be used with caution in people with gout because of concerns about… Raising uric acid levels. Current evidence does not support this as a major concern for lisinopril alone – data from the large ALLHAT trial found that lisinopril was associated with a small (non-significant) reduction in gout risk compared with thiazide diuretics, and multiple studies have found that ACE inhibitors do not raise uric acid as measurably as diuretics do.
However, this comes with an important caveat which is covered in the next section: If you take the combination pill instead of lisinopril alone, the gout warning becomes real relevant again – just for a different reason.
Are you taking regular lisinopril, or a lisinopril/HCTZ combination?
Lisinopril is also sold with Hydrochlorothiazide (HCTZ)a diuretic, in one pill (brand names Zestoretic or Prinzide). This combination is prescribed when lisinopril alone cannot fully control blood pressure. It’s worth checking which medication you’re already taking, since HCTZ adds its own distinct considerations on top of all of the above:
- Gout and uric acid: Unlike lisinopril alone, HCTZ is well documented to raise uric acid levels and can trigger or exacerbate gout, especially at doses of 25 mg or higher. The 2020 American College of Rheumatology guidelines specifically recommend switching from HCTZ to an alternative blood pressure-lowering medication when possible for patients with gout. So, if you’re on the combined pill and have gout, this is a really relevant conversation to have with your doctor — it’s the HCTZ component that’s of concern, not the lisinopril.
- Sensitivity to light: While lisinopril alone carries some risk of sun sensitivity (see above), HCTZ has a stronger association with photosensitivity and, with long-term use, an increased risk of some skin cancers (particularly squamous cell carcinoma). Sun protection deserves to be taken seriously in both cases, but especially on a combination product.
- Potassium: Interestingly, these two ingredients can partially offset each other here – lisinopril tends to raise potassium, while HCTZ tends to lower it. This does not mean that potassium monitoring becomes unnecessary; Your doctor still needs to monitor it, since the net effect varies from one individual to another.
- blood sugar: HCTZ, like lisinopril, can also affect blood sugar levels, so this is worth monitoring no matter which version you use.
If you are not sure which medicine you are taking, check your pill bottle or ask a pharmacist – the combination product will list both ingredients (lisinopril and hydrochlorothiazide) on the label.
Frequently asked questions
Is it true that lisinopril is only dangerous during certain months of pregnancy?
Not quite – while risks are best documented in the second and third trimesters (affecting fetal kidney function and amniotic fluid), current research also shows a smaller but real increase in the risk of birth defects with exposure in the first trimester. The current recommendation is to avoid the use of lisinopril throughout pregnancy and to switch medications as soon as pregnancy is planned or detected.
Should I stop drinking green tea if I take lisinopril?
Not necessarily an occasional cup, but regularly consuming green tea or concentrated extracts can significantly reduce the amount of lisinopril your body absorbs, which may impair blood pressure control. If you drink it regularly, discuss it with your doctor and monitor your blood pressure at home.
Does lisinopril make gout worse?
Taking lisinopril alone does not significantly raise uric acid – large studies, including the ALLHAT trial, have found that it is associated with a slightly lower (but not higher) risk of gout compared with a thiazide diuretic. However, if you are taking combination pills (lisinopril/HCTZ), the HCTZ component raises uric acid and can aggravate gout, so caution is real for this product specifically.
How do I know if I’m taking regular lisinopril or combination pills?
Check the label of your pill bottle or ask your pharmacist. The combination product (brand names Zestoretic or Prinzide) will list both lisinopril and hydrochlorothiazide as ingredients, while regular lisinopril will list only lisinopril.
What should I do if I get a persistent dry cough when taking lisinopril?
Mention this to your doctor. It’s one of the most common side effects and can appear days, weeks, or even months to years after starting the medication — your doctor may switch you to a different class of blood pressure medication, such as an ARB, which usually doesn’t cause this side effect.
Checklist of the 10 tips
- ☐ Get up slowly from a sitting or lying position
- ☐ Avoid alcohol while taking lisinopril
- ☐ Monitor potassium intake and avoid salt substitutes containing potassium without medical guidance
- ☐ Reduce your regular consumption of green tea or discuss it with your doctor
- ☐ Check potassium and kidney function regularly
- ☐ Ensure that elderly people start on a low dose with gradual titration
- ☐ Monitor blood sugar if possible
- ☐ Report new stomach pain or cramps to your doctor
- ☐ Use sun protection due to the risk of photosensitivity
- ☐ Avoid regular use of NSAIDs without talking to your doctor
Disclaimer: This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Never stop or adjust your dose of lisinopril without consulting your doctor. If you experience signs of an allergic reaction, including swelling of the lips, face, tongue, or throat, or difficulty breathing, seek emergency medical care immediately. This article reflects current information as of the date of publication; Medical directions may change, so confirm details with your doctor or pharmacist.
