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Lisinopril Side Effects Can Be Lethal

Blood pressure pills like Lisinopril are perceived as generally safe medications, but mysterious lisinopril side effects called angioedema can be life threatening.
Lisinopril Side Effects Can Be Lethal
Lisinopril, ACE inhibitor

How do you keep your blood pressure under control? Managing blood pressure is an important pillar for maintaining good health and reducing the risk of strokes or heart disease. Regular exercise, a diet high in healthful vegetables and fruits and ways to relax and manage stress can help. But sometimes people need blood pressure medication to get hypertension into bounds. Lisinopril is one of the most popular prescription pills for hypertension, but what about lisinopril side effects?

ACE Inhibitors for Blood Pressure Control:

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:

ACE Inhibitors:

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

We have frequently written about an ACEi cough. This lisinopril side effect drives many patients crazy because it can keep them awake at night, cause incontinence and make them miserable. This is not a minor side effect. Some people throw up because of an ACEi-induced cough. Here are just a few stories:

Wendy had no idea her BP medicine could cause a cough:

I have been coughing to the point of vomiting for the last two years. My primary said it was post nasal drip, asthma or heartburn. When none of those proved true, I called an allergist who asked me right over the phone about my BP meds. I called back my GP and he said, Oh yes, that drug causes cough too! I could have screamed!”

D. Jones had the cough from hell:

I was taking lisinopril for about three months. It was crazy. The coughing was sooooo bad I too was unable to sleep or eat. My body was hurting all over and the coughing was so bad I started gagging with violent coughing spells. My back felt like someone was stabbing me with a knife. My body almost shut down. I was not able to sleep for three days, I was having panic attacks and was unable to eat.

“My husband and daughter stayed home for three days to take care of me. On the third day my doctor was able to see me. By that time my body was so weak and my skin was pale that it was hard to get dressed (THANK GOD for a wonderful husband). I had reached out to all my family and friends and asked them to pray for me. I was thinking… am I going crazy? I was not able to stop crying maybe due to no sleep or food.

“When my doctor walked in the room she was so surprised to see how I looked. My husband was very upset my doctor just said the coughing was from lisinopril but not the other symptoms.

“I have been off Lisinopril for two weeks now. WOW!!! I feel GREAT! No back pain, very little coughing and lots of sleep.”

Lisinopril Side Effects Can Be Life Threatening:

A lisinopril cough can ruin the quality of your life. It can disrupt sleep and lead to lots of other complications. It is rarely lethal. A far more worrisome lisinopril side effect is called angioedema. It can be life threatening.

A Turkish patient died from angioedema triggered by lisinopril despite emergency treatment (Iranian Journal of Allergy, Asthma, and Immunology, Dec., 2015).

We received the following message from Gary, 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 bad reaction, seek medical attention immediately.” Gary

Angioedema and Other Lisinopril Side Effects:

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.

Dee in Menifee, California had to have two tracheotomies:

I had been taking Lisinopril for 13 years. Over the last 5  years I had allergic reactions to what I thought were nuts. My left jaw would begin swelling in the middle of the night. The swelling would spread to my upper lip. The swelling would last up to 3 days.

“On Dec. 30th 2017, around 8 pm, I had a sensation in the interior of my jaw that felt like a sore throat was coming on. Around 10 pm, I felt a hard knot in my left jaw area. Around 10:30 my throat felt swollen. I drove to the nearest emergency room and waited to be seen.

“By the time I was seen, my tongue was swollen to the point that I could barely talk. They tried to intubate but my throat and tongue were too swollen. they performed a tracheotomy on me. My husband said that I was transferred to my hospital the following day where they waited for the swelling to go down to perform a second tracheotomy.

“I woke up 3 days later in intensive care not knowing what had happened. I spent a horribly uncomfortable week in the hospital and am still recovering after week 5. I may need to go back to have some cartilage repaired and some laser treatment for scar tissue removal.

“While in the ER, a nurse asked my husband if I was on lisinopril and if so, to stop taking it as she was aware of other people who had experienced the same reaction. A family member who is a nurse asked the same question and suggested we look into the side effects of taking lisinopril.

“Since then, we have spoken to two people who had been on lisinopril, one for over 20 years, and experienced the same reaction that I had. I am glad that we found out what caused the reaction. It was a frightening experience for myself and my family.”

person holding their stomach in pain, calm chronic diarrhea, IBS, low FODMAP diet

Lisinopril Side Effects in the Digestive Tract:

Angioedema doesn’t always affect the face, tongue and neck, though. We have heard from other visitors that ACE inhibitors can also 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.” 

Angioedema of the Abdomen:

Many physicians are aware that ACE inhibitors can cause angioedema in the lips, mouth and throat. Lisinopril side effects are not restricted to the upper airways, though. An equally serious c0mplication that often goes misdiagnosed for weeks or months involves angioedema of the abdomen (Journal of Emergency Medicine, April, 2016; GE Portuguese Journal of Gastroenterology, Dec. 2, 2015; Postgraduate Medicine, March, 2015). It too can be life threatening if the bowels become obstructed. Here is one story to help you understand the gravity of this condition:

Monique in Missouri was rushed to the hospital with abdominal angioedema:

On December 15, I had to be taken to the ER due to really bad stomach pains. The pains I felt were worse than labor pains. It felt like someone was stomping on my intestines with high heel shoes on.

“Once admitted, the doctors ran all of the tests including colonoscopy, upper GI, and different blood tests. Everything the doctors were looking for came back negative. While in the hospital they kept giving me my blood pressure med, lisinopril. My lips became swollen while I was there and I was told it was because of the test I had done earlier. I replied, ‘no something is not right,’ but they continued to say I was ok, it’s because of the test.

“I suffered in pain for a week and 2 1/2 days while lying in the hospital. The doctors could not find or figure out was going on and said ‘we feel like it would be safe to send you home.’ They then released me from the hospital with instructions, a 2 week follow up appointment and another colonoscopy and also with an added blood pressure pill to go with the lisinopril.

“Once at home I continued taking my blood pressure pills according to the doctors directions. The pain, vomiting, diarrhea and the horrible coughing, continued. I began having chest pains and shortness of breath, I thought it was because I was trying to do too much to fast.

“On January 17 my upper lip started to swell and later that night it got worse. The next day when I woke up I looked horrible. My face, upper lip and neck were swollen even more. I returned to the ER that’s when the ER Doctor said I was having an allergic reaction to the lisinopril. They began to give me steroids and other meds to stop what was going on and to keep my throat from swelling up as well. They then released me with a prescription for a 3 day steroid fix. I could have died. Feeling safe enough to send me home the first time almost cost my life.”

Taking ACE Inhibitors for Hypertension:

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. Nevertheless, it is essential to know about other lisinopril side effects. No medicine should ever be stopped without medical supervision.

Here are some other lisinopril side effects to aware of.

Lisinopril Side Effects:

  • Dry cough, uncontrollable cough, nausea, vomiting
  • Dizziness, excessively low blood pressure
  • Kidney function changes, BUN & creatinine 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 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

In one case report, lisinopril caused hair loss (Journal of Pharmacy Practice, online June 6, 2016). 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.

When Will Doctors Pay Attention to an ACE Cough?

Revised 2/8/18

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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