Blood pressure pills are perceived as generally safe medications. ACE (angiotensin converting enzyme) inhibitors in particular are considered highly effective with few adverse reactions. We calculate that at least 100 million prescriptions are filled for ACE inhibitors each year. Here is a list of commonly prescribed ACEi drugs:

  • Benazepril (Lotensin)

  • Captopril (Capoten)

  • Enalapril (Vasotec)

  • Fosinopril (Monopril)
  • 
Lisinopril (Prinivil, Zestril)

  • Moexipril (Univasc)

  • Perindopril (Aceon)

  • Quinapril (Accupril)

  • Ramipril (Altace)

  • Trandolapril (Mavik)

Although we have frequently written about an ACEi cough (which drives many patients crazy because it can keep them awake at night, cause incontinence and make them miserable), there is another reaction that worries us even more. It is called angioedema and it can be life threatening. We just received the following message from a visitor to this website.

“One night after taking lisinopril my lips began to swell as if I had a fever blister. Within two hours my face was extremely swollen and my throat began to feel like it was closing off my air passage. I went to the hospital and spent the night in the emergency room with an IV and other meds.

“The doctors identified that I had a reaction from the lisinopril. I still had some swelling a full 24 hours after the incident. I was told that I was lucky and that they were close to doing a tracheotomy.

“I had taken lisinopril for four years before the reaction. I would strongly advise alternative medications other than lisinopril, and recommend anyone who has been taking this for any length of time have a discussion with their physician.

“The final advice I have is that if you have a reaction seek medical attention immediately.” Gary


Angioedema is a somewhat mysterious reaction to ACE inhibitor blood pressure pills. It can happen within the first few days or weeks of starting treatment, or, as in Gary’s case, show up after years of taking the medication. There is no way to predict what will trigger such a hazardous reaction. When it happens, however, it requires emergency medical attention. If your airways close, breathing becomes impossible. That is why they were considering an emergency tracheotomy in Gary’s case.

Angioedema doesn’t always affect the face, tongue and neck, though. We have heard from other visitors that ACE inhibitors can affect the belly. Here is one poignant story:

“I was put on lisinopril for high blood pressure in January. That month I experienced severe stomach cramping and vomiting. I was rolling on the floor in agony. The doctor said it was most likely the flu but started me on two different antibiotics in case it was bacterial.

“A few weeks later I had another attack with severe stomach cramping and vomiting. I went to the ER, where I was given IV pain meds. A CT scan showed small intestine inflammation partially blocking off my bowel. I was sent home but returned the next day with pain that was a 10 on a 10-point scale. The doctor said that all the tests had been done and there was nothing he could do. I was sent home with pain medication.

“A few weeks later I was admitted to the hospital with increased small intestine inflammation and another blockage. I vomited and dry-heaved for 12 hours. I was released four days later with no definitive diagnosis.

“I was told most likely I had Crohn’s disease, but a colonoscopy was negative for Crohn’s. I underwent extensive tests, including endoscopy, and all were negative. None of the doctors made a connection with the drug lisinopril.

“After two months of missing work, three more ER visits and untold suffering, I found several other people who reported similar symptoms connected to lisinopril. I stopped the medication and have not had another attack. If you look on PubMed you can see reports on lisinopril and intestinal angioedema, but doctors don’t think to connect this with lisinopril because it is not listed as a common side effect.” 


 

Ace inhibitors can be very effective medications for many people. As long as you don’t experience an unrelenting cough, breathing difficulties or severe abdominal discomfort, you may be home free. No medicine should ever be stopped without medical supervision.

Here are some other side effects to aware of.

 ACE INHIBITOR (LISINOPRIL) SIDE EFFECTS:

  • Dry cough, uncontrollable cough, nausea, vomiting
  • Dizziness, excessively low blood pressure
  • Kidney function changes, BUN & creatinene elevations
  • Headache
  • Digestive distress, diarrhea, abdominal pain
  • Tiredness, fatigue, malaise
  • Excessive potassium levels (requires immediate medical attention!), irregular heart rhythms, chest pain
  • Elevated uric acid levels
  • Sensitivity to sunlight (photosensitivity), skin rash
  • Angioedema (swelling of face, lips, tongue, throat)
  • Angioedema (swelling in abdomen, severe abdominal pain)
  • Severe allergic reaction (anaphylaxis) requiring emergency treatment
  • Toxicity to liver or pancreas
  • Blood disorders
  • Potential birth defects if taken during early pregnancy
  • Sexual difficulties

Anyone who would like to learn more about non-drug approaches to controlling hypertension may find our Guide to Blood Pressure Treatment of interest. There is also information about other medications for dealing with blood pressure problems.

Share your own experiences below. Those who would like to learn more about ACE inhibitor cough will find this link of great interest.

 

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  1. Sidney
    Canada
    Reply

    I have been taking Ramipril 10mg 1 time a day for 3 and a half years. Since taking this medication I have felt like hell. Headaches tingling hands, feet and face and dizziness and now in the last 9 months severe skin rashes with hives. Today I feel awful severe abdominal cramps diarrhea and of course the horrid rash. I forgot to take my bp med this morning so I took it at 9 tonight within two hours severe itching and feel my palate itching. I am now sure it’s this medication. Saw my MD Friday gave me a cream prednisone yuck and hydroxyxine feel awful going to get this medication changed or go the natural route. Think these pills are killing us my bp was never that high to begin with. MD it was preventative family genetics not buying this now.

  2. Terri
    NC
    Reply

    I take lisinopril for my CHF and I’m experiencing the stomach bloating, cramping and vomiting. It seems like the doctors aren’t listening each and every time I go to the ER with these problems after I take Lisinopril. They always want to say its gastrointestinal which I know it isn’t. It’s becoming really frustrating, and there are times where I really don’t even want to take it. I’m sick of the stomach pain it causes.

    • Dick
      Ashland ne
      Reply

      Just wondered if anyone had this angioedema of the small intestine and how long it took to recover after stopping this god awful stuff? I’ve been off for 4 days and can only do liquids and not much of that.

  3. Toni A.
    Wichita, Kansas
    Reply

    I’ve been on Lisinopril and hydrchlorthiazide for 4 years. Started getting dizzy every now and again thought it was my ears. 6 months ago the clinic doctor raised my dosage from 10 mg/ 10mg to 20mg/25mg. I have noticed a weakening in my muscles especially my legs, I have fallen several times in past year. Pain from my toes to top of my head. Sometimes just an aching pain other times shooting pain. My body is tingling most of the time my vision hasn’t gotten really bad.

    Was diagnosed with cataracts 2 years ago but vision so much worse since dosage raised. I never read the side effects because I knew if I did I wouldn’t take the medicine there are natural ways to combat high blood pressure and water retention I haven’t done them because my prescription was much cheaper 4 dollars for the month at Walmart but I am going to start now I’d rather spend extra money then lose my life.

    I had my blood work got the results yesterday Dr thought maybe there was something going on but result show everything’s normal my gluclose is a little bit but that would not cause my body to be in this pain so I decided to look up the side effects of my medication everything I am feeling and have been going through are the side effects of this medication I hope that this helps someone please go see if you’re feeling any side effects

  4. Janey
    United Kingdom
    Reply

    I have been taking it for awhile (2.5mg), now have swollen and blistered lips, the blistering I thought was a simple cold sore, now my bottom lip has endless blisters and feel tingly and a little swollen…. Lisinopril was what caused my elder sister to have swollen lips and tongue and went to ER and that started the chain of events that lead to her death…so I am understandably concerned ..

  5. CMF
    Reply

    I have just started lisinopril for HBP(160/80) – have taken three 10 mg tablets and got diarrhea, a side effect. I’m also on metformin for diabetes even tho’ I weigh only 120 lbs. (Dr.. says I’m the skinny type of diabetic(genetic) not the obese type.)
    I don’t need to become dehydrated and lose nutrients from my food (I’m 2/3rds vegetarian raw food) so want to get off lisinopril. In the comments no one has said if they stopped it suddenly or tapered off it. Since I’ve just had 3 could I stop suddenly or should I go off gradually? Am going on vacation with my family for a week so don’t need this problem while I’m away!
    People’s Pharmacy response: The package insert for prescribers does not specify that lisinopril must be tapered. When someone has a bad reaction, they have to get off fast. But no prescription drug, especially for hypertension, should be stopped without medical supervision. Check with the prescriber!

  6. Torrence
    Reply

    I found out if I read something when the nurse takes my BP it doesn’t get as high. A couple of weeks ago when I went to see the doctor by PB was 130/82 without any kind of BP meds. I now know I never did have high BP after years of taking BP meds. It is so important we take care of ourselves with exercise and eating right. That alone will help our BP problems. GOOD LUCK TO ALL!!!!!

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