angioedema, choking, man sticks out his tongue while coughing

Keeping blood pressure under control is extremely important, since hypertension (high blood pressure) is a risk factor for both stroke and heart disease. Finding the correct blood pressure medication for a given individual may not be easy, however. The prescriber may have to resort to trial and error to find one that is effective without causing unwanted reactions. In many cases, the best medication may be an ACE inhibitor. But these popular drugs are not innocuous for everyone.

ACE Inhibitors:

Lisinopril (Prinivil, Zestril) is one of the most commonly prescribed blood pressure medications in the world. It belongs to a class of drugs called ACEis (angiotensin converting enzyme inhibitors) that includes:

  • Benazepril (Lotensin)
  • Captopril (Capoten)
  • Enalapril (Vasotec)
  • Fosinopril (Monopril)
  • Lisinopril (Prinivil, Zestril)
  • Moexipril (Univasc)
  • Perindopril (Aceon)
  • Quinapril (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik)

Such drugs are effective for helping control hypertension and many people take these medications without experiencing any side effects. That’s the good news.

Angioedema Is a Serious Reaction to ACE Inhibitors:

The bad news is that some people are susceptible to a potentially lethal complication of ACE inhibitors called angioedema. In this condition tissues around the face and neck can swell rapidly. Without immediate emergency treatment angioedema can be life threatening. The symptoms can surface within a few hours or days after starting on the drug. But even people who have been on an ACE inhibitor for months or years can develop angioedema.

Medical Emergency!

At the very first symptoms of swelling do not delay: CALL 911 and be transported to an emergency department instantly! Don’t just take our word for it. Here is a recent report posted to our website from Dennis:

“On October 8 I saw my doctor and was prescribed 20 mg of lisinopril 3 times a day. I thought, ‘Great, now I have some meds to help with my high blood pressure.’ I think I was around 185 over 110 which the doctor said was pretty high.

“By the 12th of October my tongue had been swelling every day to the point that breathing was getting very difficult. This was all happening by the fourth day of taking my new blood pressure medicine.

“My son took me to the ER on the 12th. The nurse in ER took my readings and said my blood pressure was in heart attack territory at 225 over 170. I was taken back to a room to be examined, as my tongue was swelling so much. Not one doctor knew what to do. I really thought I was going to die from suffocation, as breathing was almost impossible at this point.

“By this time other family members were arriving and for two weeks I don’t remember anything other than what I was later told by family and doctors. The doctors put me in an induced coma. Doctors had to do surgery and perform a tracheotomy so I could breathe during my coma.

“They diagnosed me with angioedema caused by taking lisinopril!

“During my coma I developed pneumonia and also had to be put on dialysis. The doctors told my family that they should all be nearby because I wasn’t expected to live through this ordeal. They told family members only about a half percent of patients make it through a situation like mine.

“When I woke up from my coma after two weeks I couldn’t walk, talk, or even write a simple sentence. I started my therapy in the hospital and it sure was difficult. After great hospital care and help from family and rehab I was able to walk and talk and write again. It seemed like it took forever but my goal was to do my rehab and be home by Thanksgiving. I pushed hard and did accomplish my goal but I don’t think I deserved to almost die and lose two months of my life for something that was not my doctor’s fault or mine.

“When my doctor saw me next he let me know he was so sorry and told me he kept checking up on my health daily. He even cried when we talked about my ordeal. People taking lisinopril need to know about the hazards of this drug.”


Dennis was lucky indeed to have survived. His angioedema reaction came on within days of starting lisinopril. Other people may let down their guard because they have taken an ACE inhibitor safely for years. Here is Ruth’s story:

“My brother was on lisinopril for two to three years with no problems other than a irritating cough. However, last month, he woke up with a very swollen tongue. By the time he got to the ER, his respirations were down to about 85% and he was having trouble talking.

“The ER called for an emergency triage and the ER doctor came out, rushed him into a room, actually helping strip his clothes on the way. They gave him adrenaline, and IVs. They told him if he had been a little later waking up he might not have made it, and that most people with this serious a reaction can end up on a ventilator.

“Don’t mess with swelling of the mouth or trouble breathing. It could be a bad reaction. We are only five minutes from the hospital, and he was terribly close to stopping breathing and ending up on a ventilator.”


 Symptoms of Angioedema

Any swelling of tissues around the face, mouth and throat are a tip-off that something bad is happening. Some people report numbness or decreased feeling in the affected area. The eyes and lips can also be involved. If the throat and tongue swell, there can be the sensation of throat tightness and breathing can become difficult or impossible.

Abdominal Angioedema

Angioedema is not restricted to the head and neck. Hands and genitals can also be affected. When angioedema strikes the intestines, it can cause abdominal swelling or distension and in some cases bowel obstruction. We have heard from many patients that this condition can be hard to diagnose. Here are some stories:

“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.”

Another visitor to our website responded: “I feel your pain, trust me. This reaction to lisinopril is the worst pain I’ve ever had, worse even than labor. It was ridiculous that they did so many tests and still couldn’t figure it out for so long.

“I know doctors think this is really rare. I had to look up the exact words ‘intestinal angioedema lisinopril’ to find it online. But I think all of the side effects should be listed. My doctors were considering removing part of my intestine at one point. If only they had realized sooner that lisinopril was the cause, I wouldn’t have suffered so long.”


“I too have been experiencing a lot of mysterious abdominal pain after switching the brand of lisinopril I was taking. After months of abdominal attacks that came with ‘allergic type’ reactions, I finally had to go to the ER because of an anaphylactic reaction.

“I was referred to an allergist who listened carefully and told me that it could be from the lisinopril. It has now been two days since I stopped taking it and I have no abdominal pain at all. I have not been pain free for 5 months and am so grateful for an observant doctor.” N.G.


“Yes this drug does cause angioedema. At least you were lucky enough (considering all you dealt with) to be diagnosed and treated in a few weeks. I had angioedema in my intestine and it took over two and a half months for doctors to figure out that it was the Lisinopril because it’s such a rare reaction. They couldn’t believe I didn’t have the swelling in my mouth, throat, etc. as well.

“I don’t blame the doctors because not everyone reacts to medications the same. Unfortunately you don’t know if you’re allergic until you take it. There were only 22 reports of my allergy to it from 2000 to 2010 out of 80,000+ reports of various side effects.

“I wish pharmacies put the rare reactions on the info they give you about drugs but they usually only list the ‘common’ side effects. I am glad you are better. It’s a long road to recovery. I had two surgeries and spent a month in the hospital because of this medicine.” Christie


ACE inhibitors can trigger other side effects besides angioedema. The most notorious is a dry, hacking cough that is uncontrollable with cough medicine. This cough can be terribly disruptive and lead to vomiting. Getting a good night’s sleep can be challenging if you are susceptible to an ACEi-induced cough. To read more about this surprisingly misdiagnosed adverse drug reaction, check this link.

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 ACE inhibitor story (positive as well as negative) below in the comment section.

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  1. Lesa G.
    PA
    Reply

    My husband has taken lisinopril for 3 plus years. He recently underwent a severe back operation. A few weeks later, he started to experience swelling of his tongue and face. He was having a very hard time breathing took him to the ER. They admitted him and was given him Steroid and and another med to stop the swelling.

    He spent 3 days in the hospital and came home. He has continued to have swelling of his tongue, it is going on the 3 weeks. He was to take hydrocortisone 20 mg and Benadryl 25 mg 3 3x aday. He has also been seen by his PCP and still having swollen tongue and throat.

    He stopped taking most of the medication. His body is used to the hydrocortisone because he has Addison’s disease. So it has been over 3 weeks. He has continued to have the symptoms and has lost a total weight of 40lb due to not being able to swallow any food or tried protien drink. How long can the swelling last?

  2. fred m, md
    atlanta ga
    Reply

    I had been on Lisinopril for 15 years. one week ago, awoke in the middle of the night with the start of tongue swelling. I had my wife race me to the E.R. and notified that we would need anesthesia and ent to get a airway. By the time I got to E.R., my tongue was pushed out of my mouth. They were able to get a airway tube down my nose to larynx for an airway. Without the prompt action, my time was short for this world. I am a ENT doctor and knew what was happening. I thought that I had been on the drug for so many years, that I would not have a problem. Wrong!! I would not recommend this drug to anyone.

  3. AnklePainForever
    Colorado
    Reply

    I’ve been on lisinopril for three years with no side effects I thought. Last summer I got a freak ankle sprain stepping off a curb… Kind of like jamming a finger, but instead my ankle. Got an ankle boot, iced , put foot up, crutches, and boatloads of ibuprofen for two months. Finally ankle started getting better but then the other foot started hurting in top of ankle joint and side joint. Another month on crutches and constant rotation of ice, heat soaking, elevation. Finally improved.

    Doc went from claiming gout to “just another sprain.” Now I’m not so sure reading all of these stories because a couple of weeks ago I was coaching my girls basketball game and my knee started feeling tight. “Great!” I thought. Here we go again with a knee jam. Thank goodness it’s not my friggin ankle again! But here I sit at 2am agin for the third week in a row with my foot elevated because my stupid ankle joint is in pain. The knee was fine in a week. Only a little swelling and I’m sure it will be at least better for me to be functional by the time I wake up if I ever get to sleep. Tomorrow night at 11pm the ankle pain will return. Could this be a rare side effect of lisinopri? I thought maybe I just had some kind of loose tendon disease or something.

  4. Gertrude
    North Carolina
    Reply

    I am in the hospital with a swollen face from the medication. Blessed the doctor knew what was wrong when I Walk in. It has been 3 days and my lips are slowly going down. This medication should be taken off the market and not prescribed to African Americans. It seems to affect them more.

  5. Jeff
    Minneapolis
    Reply

    I am amazed at learning about this and now feel like a revelation happened. I went in to Urgent Care yesterday with severely swollen lips and had had throat swelling the night before, which did respond to Benadryl. One look, and the Dr. thought it was Lisinopril, and ordered me to stop taking. Got the steriod shot, but no pills because of diabetes worries.
    Swelling subsided within 30 minutes, and now, 24 hours later, almost back to normal.
    Reading up on symptoms, this might explain the distended abdomen I’ve had for several years. I’m heavy, but have lost weight while waistline grows. I’m anxious to see if this angioedema reduces in the abdomen over the next few weeks. Anyone have a clue as to how long that takes?
    I’ve been on Lisinopril for 10+ years without having this swelling happen. But, I did have a change of manufacturer to include a diuretic about a month ago. Hmmm.

  6. Donna
    Fleming Island FL
    Reply

    I am very grateful to have found this site that clearly explained the side effects of lisiniprol. I have been on this medication for over ten years. I have many of the side effects described but not until earlier this week did I have any swelling.

    On Monday, I was very uncomfortable around my lips and believed it was chapped lips but nothing was making them more comfortable. By Tuesday, they were worse and I could see some swelling. Products as simple as lotion made my lips feel like they were on fire.

    Wednesday came with additional swelling and I was becoming concerned. I knew if there was no improvement by Thursday than I would head to my PCP. Upon awaking, I hardly recognized myself from the swelling and it was now in my eyes and swallowing was becoming harder.

    My hands also had additional swelling than their normal. When my doctor entered the exam room, she knew exactly what this was….lisiniprol. I received a steroid shot of prednisone and sent home with a script for 7 days.

    My face is half as swollen as yesterday. I am also NOT to take any more lisiniprol!! My biggest wonder is how many of my symptoms from the past year are related to this medication. I look forward to see if my other issues improve. My last comment is to say the my Doctor told me how very grateful she was that I came in yesterday….I asked why….and she said let’s not even discuss that, just know you came on time. Until now, I have never heard of this medication causing any side effects????

  7. Keith Mckenzie
    Central Florida
    Reply

    I consider myself fortunate after reading these accounts. I too have been on Lisinopril for a couple of years. One morning with no change in my diet or habits, I went from a normal upper lip to one that increased in size about 300%. I was at a loss for the cause as I racked my brains to determine if it was something I did, ate, or anything. I tried Benydril which was ineffective. I was concerned but did not consider it an emergency as no other part of my face, head or tongue was swollen. I went to Urgent Care and the Dr. immediately diagnosed my problem and put me on a steroid Methylprednisolone. This is the second day and I am still swollen, but at least I know why. He said to cease the Lisinopril which is an Ace inhibiter and to take an Arb inhibiter, more expensive, higher dosage but he said no side effects. I will get the word out to my community as it seem half the population is on blood pressure medications.

    Keith (lucky in Central Florida, 1/12/17)

  8. Maria garza
    Seguin texas
    Reply

    I was admitted to the Hosptial with my eyes swollen shut because of lisinopril and my tounge I could not breath I can barley see right. Ow just click on side effects for this drug and thought I would share my story I’m sorry if anything is messed spelled I’m trying hard just to get the word out I hae pictures

  9. Mila
    Reply

    I’m allergic to ace inhibitors and my father passed away from allergic reaction to ace inhibitors Feb 1st of this year. I wish there was a lawsuit we could file against whomever is making this pill, because there are people passing away from this medicine and having bad side effects that can be deadly!!

  10. patsy c alford
    North Carolina
    Reply

    i was in the emergency room with my son who was sick with something else and i fell asleep in the emergency room when i woke up my tongue was swollen up real bad at first i though it was my tooth that cause my swelling but the nurse ask me what of blood pressure i take i told i was taking lisopril and she said that what was cause my lip to swell.

    • Gertrude
      North Carolina
      Reply

      This medication show not be on the market. I am not a patient with my face swollen and it’s been 3 days and very little change. I was not told that this could happen. Now, I am told it is high in African American. Totally disappointed that they would give this to a patient who is high risk.

    • Asata K
      Georgia
      Reply

      Please let me know if you found out

  11. Cheryl
    Wayland, NY 14572
    Reply

    My husband was put on lisinopril 10mg and just a few days after starting the medicine his stomach started to hurt…then his throat started swelling up, unable to swallow and very sore.Went back to his doctor and was told he had a virus & remember that i said his throat was almost swollen shut. Two days later he got worse so I called the doctor and he called a steroid into our pharmacy. Helped a bit but he continued with swollen sore throat and he was exhausted and slept most of the time thinking he had a virus. After seeing his doctor who told him it was a virus (about 2 weeks after the same doctor prescribed the lisinopril) he got worse and we went to the after hours clinic at the hospital. A PA, not a doctor said that the lisinopril dosage was a higher dose than he would have prescribed. Went back to his doctor who said that it was the lisinopril that was making him ill and had him stop the medicine. He is still coughing, choking, exhausted and can only be up and about for two hours before he gets exhausted again. He has now been sick for about 6 weeks and has no idea when and if his good health will ever return.

  12. Patti
    Ny
    Reply

    I was taking lisinopril for many years. About once a month the palms of my hands would become hot, I would get tingling in my arms and legs, the proceed to have diarrhea and vomiting at the same time. I would then break out in a sweat, like someone poured a bucket of water over me. Then came the lip swelling, tongue swelling and throat closing. It would all last about 45 mins to an hour. I never went to the ED but in hindsight I should have. The attacks started coming closer together and a friend told me her brother had the same symptoms while taking lisinopril. I stopped the immediately and have not had an attack since. All this time I thought they were panic attacks.

  13. Tanya
    Randolph, MA
    Reply

    I have been taking Lisinopril 25mgs for several years. I am on vacation with my family from MA. We drove to Virginia Beach on Saturday for a few days. My lips started swelling after I had an orange powerade. I assumed it was from the powerade and purchased some Benadryl from the local CVS. I took 3 25mg capsules and went to bed. I tossed and turned the entire night. I woke up at 5 am, and my lips and chin were larger now than they were before I went to bed. My sister drove me to the ER. Upon admission, the nurse asked me if I was taking Lisinopril. I asked her how did she know that because I didn’t tell her what medications I was taking. She stated it is a common side effect with individuals taking lisinopril. The doctor confirmed what the nurse said and told me to throw away my Lisinopril. She prescribed me a new blood pressure medicine and told me to follow up with my pcp when I return home. I think doctors should inform their patient about the side effects of any medication they want to prescribe to their patients.

  14. Becky
    Alabama
    Reply

    I had taken Lisinipril for several years with no problem. Then May 9,2013 I was in the hospital for a minor reason. I was given my Lisinipril that morning but my blood pressure was still high. The nurse came back a little later and I don’t remember anything after that. My neck had swollen and she immediately called a code and I had to be entubated.

    My blood pressure fell so low they thought I was going to die right then. Thank God I was at the hospital or I would not be writing this. I was completely sedated for the first three days the. Awoke with mittens for fear I would try to remove my vent.

    I was in ICU and had multiple complications. I was on a ventilator for 21 days. I developed pneumonia in both lungs, had a feeding tube, my central lines became infected, infiltration in my IV’s, and each time I was close to getting moved to a room, another antibiotic had to be introduced.

    My skin began to fall off the back of my body and the discomfort and not being able to talk was so overwhelming. Thank goodness for a Versed drip! After 21 days I had a tracheotomy and had the trache for another 20 days in a step down unit.

    The effects of the constant anesthesia and many drugs and not brushing my teeth for 5 weeks ravaged my body and lots of my hair fell out for months afterward. I spent 6 weeks in the hospital and had to have physical therapy to begin walking again. I passed out during my first shower although it felt wonderful! I now tell everyone that my allergies are Lisinipril and ALL Ace Inhibitors. Remember, I had been on this medicine for at least 5 years. It can happen at ANY time.

  15. shirley
    Knightdale, N.C
    Reply

    My only child nearly died as a result of the drug – Lisinopril. She too experienced anagioedema. of the stomach. with swelling of the mouth.
    The FDA needs to get to work asap. Someone is going to lose a life because of the drug.

  16. Tangela B.
    bowling green ky
    Reply

    I just had this same reaction last week. My lips swelled so bad and I was admitted into the hospital overnight!

  17. Lynne
    United States
    Reply

    I had a horrifying experience yesterday. I’ve been taking Lisinopril for about 7 years now for my High Blood Pressure and it was doing good but the last few weeks my Blood Pressure has been fluctuating in the double, Triple figures but yesterday it was 201/130 and my neck was swollen and my air passage was partially closed off so I went to the ER and they told me that it was allergic reaction to the Lisinopril and gave me a shot of Morphine which relaxed my neck and shoulders and actually eased the swelling off. It scared the heck out of me. This is what my Mother takes for her BP but at least we know what to look for or if she starts having weird symptoms, we know to look at this…

  18. John
    Lithia, Fl
    Reply

    My husband almost died from taking Lisinopril due to angioedema. This drug should be taken off the market. The cases of such reactions are becoming more numerous. The FDA should follow up on these cases and remove it from the market.

  19. Alice
    Statesville, North Carolina
    Reply

    I was given lisinopril last year and experienced angioedema of the abdomen. I spent a Friday night in the emergency room with my sister. The doctors tried to tell me I had chronic colon disease, but after stopping the lisinopril, the problem slowly went away. I only took two doses of lisinopril. Kept feeling worse. Belly swelled up unnaturally. The doctors told me my intestines were swollen but absolutely would not admit it was angioedema. I was 48 years old. I’m scared of heart medications now.

  20. Pat
    Reply

    I am age 76. Been taking Amlodipine (calcium channel blocker) 5mg. then pushed to taking an additional 5mg. by my primary care physician.

    The dosage doesn’t lower my blood pressure that much. It’s usually any where from 139 to 179/90. The doc wanted to add Benazepril along with the Amlodipine. I researched the side effects of Benazepril and didn’t pick up the RX. Benazepril has many of the same side effects of Amlodipine: headache, dizziness, sleepiness, heart palpitations, shortness of breath, abominal pain, feeling sick (nausea), ankle and foot swelling, (oedema), tiredness, dry cough, sneezing/running nose caused by inflamation of the lining of the nose (rhinitis), visual disturbances, double vision, ringing in the ears (tinnitus), altered bowel habits (diarrhea, constipation, vomiting, (being sick), numbness or tingling sensation in your limbs, loss of pain senation, hair loss, increased sweating, itchy skin, red patches on the skin, increased need to urinate at night, joint or muscle pain, back pain, muscle cramps, swelling of the gums. I’ve had most of these side effects, and I’ve looked into natural cures: beets, beet juice, garlic, onions, lemon in water, grapefruit juice, hybiscus tea, lemon balm tea.

    If my blood pressure stays around 140/80 I’ll be happy ,as it is not any lower with the medication. Thank you for your comments, and good luck to all of you with trial and error with these medications where there is no list of common side effects, or rare side effects. I had to do my own research online and in the library. The book on “Hypertension and You” by Dr. Mann gave me an explanation of the extreme peeing during the night. Until I received the info from the book, I thought there was something wrong with my bladder(infection). When you lie down in the evening, the water retention in the lower extremities travels back into the blood stream and has to be eliminated by the kidneys. My doc didn’t know anything about it. All he says is “all medications have side effects”! killer side effects!

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