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.


  • 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.

This article was updated on June 6, 2016.

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  1. Clay

    I woke up about 1:00 am wanting a drink, I sipped some water and couldn’t swallow. It was apparent that my throat was swollen. I tried to speak all I could do is grunt. My tongue was about the size of a baseball and I could hardly close my mouth. I went to the ER, they took me to a treatment room, the Dr asked me 2-3 times if I took lisinopril. I had been talking it for over 10 years. All I could do was grunt weak yes. I began to caugh and the next thing I remember was waking up in ICU . I had been on a respirator for 2 1/2 days. My wife showed me pictures of me with a tube down my throat. I was told if I hadn’t gotten to the ER when I did, I could have died. I had an irritating rash around my midsection and mildly swollen hands and feet for about 3 weeks. My Dr. changed me to Nifedipine which so far with no problem.

  2. Rudolf

    I was prescribed lisinopril in January to treat high blood pressure 180-110, discovered in a dentist chair. After 7 months It only had a marginal effect on my blood pressure, so the doctor prescribed increasing the dosage gradually from 10 mg to 15 mg (cutting a pill in half to add) to eventually build it up to 20 mg per day.
    During the first 7 months, I developed a raspy voice and difficulty speaking. But thinking nothing of it, suspecting just a flue. But then, after 3 days of being on 15 mg, I experienced extremely painful constipation, loss of voice and breathing problems. I finally wised up and did an on line search on lisonipril’s side effects. I was shocked what I found since it described exactly what I was experiencing. I immediately discontinued taking it. I self remedied the bowel problem with drinking high dosage vegetable oil. Did more research on alternative ways to treat hyper tension and put myself on a combo of Hawthorne, L-Arginine, CoQ10, Turmeric, Curcumin, Beet. After only 1 week doing that my blood pressure came down from 180 over 110 … 135 over 70. Needless to say I am continuing this regiment. My raspy voice is still there after not taking Lisonipil for 2 weeks now, but getting better. After all, that snake venom, where lisonipril is derived from, takes time to leave the system.
    What big pharma and lisonipril could not accomplish over many months, was taken care off in a short time by doing it the natural way. Without the potential horrible side effects. Yes, I did spent 100 bucks in the health food store for a months supply, but gee, it has been worth it. Of course everybody is different. And not everybody reacts the same to either a pharma drug or to the above alternatives. But in my case it was worth it to discontinue lisonipril and try the alternative way. Hope this helps somebody.

  3. Michelle

    I have been taking lisinopril for many years. Just (08/17) recently I had an episode where I woke up to get ready for work to find that I could not open my left eye!! My left eye and face was swollen. I attributed it to a reaction to a new medication I was prescribed a few days earlier. So I went back to the doctor that prescribed the new medication and he was shocked, but could provide no answer as to why my left eye & face was swollen. Then early this morning 09/10/17, I had swelling of my lips, face, cheeks, chin & started to notice a little difficulty swallowing.

    I immediately went to the ER. The ER doctor asked if I was taking any blood pressure medications like an ACE inhibitor/lisinopril. I immediately replied yes. He stated that ACE inhibitor medications have the side effect of angioedema. Well after a shot of epinephrine, I.V. medications of Pepcid, Benadryl & a steroid, my swelling started to subside a little. After my 3.5 hour ER stay the ER doctor was able to discharge me to home, but reiterated with me to stop taking my lisinopril NOW because he thought the lisinopril was causing the angioedema! Why after so many years would I react now? His response was “there is no rhyme or reason to a reaction to a medication sometimes, just please do NOT take any more lisinopril!” Well needless to say I am done taking my lisinopril.

    To anyone that reads this, please do NOT take any swelling to the face lightly, seek medical attention immediately before it progresses to breathing difficulties!

  4. Carmen I S
    Rhode Island

    I have been on Lisinopril for years. For months Im been having serious stomach pain and diahrreas all the time. Heart strong palpitations. Yesterday, half hour after taked the Lisinopril, my lips, face and neck swollen.

    The ER doctor said that was a bad reactión to that Medicine. After months of lab tests and studies. My head doctor donsnt know yet what is wrong with me….

  5. Sylvia

    I feel the need to speak out about my recent experience with lisinopril….for about a month now…i have had a weird headache that just came out of nowhere…also ive felt confusion and depression.

    No specific reason for any of these symptoms..just a overall bad feeling come over me. I’ve also had puffiness in my eyelids…and swelling in my feet. And also…I gained 15 pounds out of nowhere since I wasn’t overeating.

    I also have experienced major hair loss….another symptom. I believe this medication is responsible for all of my sypmtoms..and I have discontinued it. They say it takes 3 to 4 days after stopping it to have it out of your system but even up to 2 weeks. I am waiting to feel better.

  6. Cate
    Bethlehem PA

    Many comments on the problems from using Lisinopril. Has any one any information about whether monopril is the same, or could it be better? My cardiologist prescribed monopril in 1998, and I am still taking it, 10mg daily, only problem seems to be the throat issues, some coughing. I tried to find information online about monopril vs Lisinopril, but there is no intelligent discussion of the possible differences.

    It seems as if everybody is prescribing Lisinopril by robotic default. Does anybody prescribe monopril these days? years ago, the twerps in the cardiology office substituted Lisinopril 10 for my monopril, without asking me or telling me why, after I called for a refill, and I was sick instantly after the first day I took lisinopril, with severe “cold” symptons. After digging around, I realized that giving a patient 10 mg of Lisinopril is equivalent to 20 mg monopril, and was equivalent to doubling my dose of ACE inhibitor. I was furious.

    Never got a good explanation for why someone would take it upon themselves to substitute one drug for another. Not to mention prescribing while ignorant of the starting dosages of each drug. My excellent cardiologist left that practice, and soon thereafter, so did I . Just because both are ACE inhibitors, does not mean they are exactly alike. Meanwhile, I see that Dr. Healy in his book Pharmageddon points out that the earlier class of anti-hypertensives called thiazides is superior to all the faddy new stuff that has replaced them — including the ACE inhibitors.

    He is talking about the antihypertensive action, not any of the other issues for which ACE inhibitors are prescribed, ie, my husband is on them with heart failure, and when we stopped his Lisinopril for a week, because his blood pressure was too low, his heart failure symptoms returned.

  7. Lena

    I have been taking Lisinopril for 6 weeks. I started having “asthma cough” about a week ago. Woke up this morning and though I had mosquito bites – no they were hives. Got to work at 7AM, talked to my boss, went to my office, logged in and I started getting itchy and my tongue started swelling.

    At 7:15, I took a benadryl. At 7:30 our company driver was taking me to the hospital – my tongue encompassed my mouth it was so huge and my throat started to itch. Half way to the hospital I told driver to Hurry now. He drove like speed racer to the ER. Got me inside and I couldn’t talk and breathing rough.

    They got me back, started 2 IVs, and shot me in the thigh with an Epi-Pen. I was fortunate – it took an hour for the meds to start really working and before I could swallow. But then by third hour I was getting discharged to go home.

    Dr. said a lot of people aren’t that lucky. That with the “pril” drugs you can take for 3 days or 5 years and one day your body starts to reject. When it does it goes into anaphylaxis… deadly.

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