Lisinopril (Prinivil, Zestril)
A first-line ACE inhibitor for high blood pressure and heart failure. Very effective and inexpensive, but comes with a famously annoying dry cough in about 10% of users.
What it's used for
Hypertension, heart failure, and kidney protection in diabetes. Often used after a heart attack to improve outcomes.
Typical dosing (adults)
- Starting: 5-10mg once daily.
- Range: 10-40mg daily.
- Taken at roughly the same time each day, with or without food.
Key interactions
- Potassium supplements / salt substitutes: moderate — risk of hyperkalemia.
- NSAIDs (ibuprofen, naproxen): moderate — reduced BP effect, possible kidney injury.
- Other diuretics (spironolactone, eplerenone): moderate — additive potassium elevation.
- Lithium: moderate — raised lithium levels.
Common side effects
Dry cough (classic, ~10% of users, may persist). Dizziness (especially at start), elevated potassium, elevated creatinine. Rare but serious: angioedema (swelling of face, lips, tongue — stop immediately and seek care).
Who should be cautious
- Pregnancy (avoid — switch before conception).
- Bilateral renal artery stenosis.
- History of angioedema with any ACE inhibitor.
What to ask your pharmacist
- Is my cough from lisinopril? Could I switch to an ARB?
- Should I avoid salt substitutes (most contain potassium)?
- When should I have my next kidney/potassium labs?