ACE inhibitors
ATC code: C09AA03 (Lisinopril)
Brand names
Zestril, Prinivil, Lisinopril Cinfa, Lisinopril Normon
Competitive ACE inhibitor. Blocks conversion of angiotensin I to active vasopressor angiotensin II, reduces aldosterone, slows bradykinin breakdown. Antihypertensive effect develops within 6 hours, peaks at 6 hours, lasts 24 hours – suitable for once-daily dosing. Unlike enalapril and ramipril, lisinopril is not a prodrug and does not require hepatic activation – convenient in liver disease. Minimal plasma protein binding, excreted unchanged by the kidneys.
First line
First-line for hypertension per 2023 and Spanish SEH-LELHA 2022. Starting dose 10 mg once daily, target 20-40 mg. Effective in patients with heart failure, post-MI, diabetic nephropathy. In Afro-Caribbean patients monotherapy is less effective than CCB or thiazide – ESC 2023 recommends combination.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Lisinopril is a long-acting once-daily ACE inhibitor. It is prescribed for hypertension, heart failure, and after myocardial infarction ( 2023, SEH-LELHA). In anti-aging regimens, lisinopril is given to healthy normotensives with promises of vessel protection and rejuvenation. In people with normal blood pressure, no clinical studies of prophylactic use exist. The drug causes a dry cough (10-20% of patients), hyperkalemia, angioedema in predisposed people, and teratogenicity. If lisinopril was prescribed to a person with normal blood pressure, consider seeking a second opinion.
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Contraindicated in all trimesters. In T2-T3 causes fetopathy: oligohydramnios, lung and skull hypoplasia, renal dysplasia, neonatal hypotension and hyperkalemia. Discontinue before planned pregnancy; switch to methyldopa, labetalol, nifedipine.
Milk levels are low. Acceptable in lactation for term infants with maternal BP and infant monitoring.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Lisinopril is evaluated for the following indications with varying evidence strength: Hypertension (evidence tier A), Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Lisinopril (≥ 1 in 100): Dry cough (10-15%), Dizziness, Fatigue, Hyperkalemia, Creatinine elevation. See the Safety section for uncommon and serious reactions.
FDA category D. Contraindicated in all trimesters. In T2-T3 causes fetopathy: oligohydramnios, lung and skull hypoplasia, renal dysplasia, neonatal hypotension and hyperkalemia. Discontinue before planned pregnancy; switch to methyldopa, labetalol, nifedipine.
Milk levels are low. Acceptable in lactation for term infants with maternal BP and infant monitoring.
Lisinopril is contraindicated in: ACE-I hypersensitivity; Prior ACE-I angioedema; Pregnancy (all trimesters – teratogenic); Bilateral renal artery stenosis; Aliskiren combination in diabetes or CKD. Full list in the Safety section.