Lisinopril !

A long-acting ACE inhibitor that is active as taken and cleared unchanged by the kidneys. Used for high blood pressure, heart failure and after a heart attack.

Updated 2026-11-01

Class: ACE inhibitors
Enzyme: Angiotensin-converting enzyme (ACE)
ATC code: C09AA03

Angiotensin-converting enzyme (ACE)Lisinopril

The figure shows lisinopril bound to the zinc active site of human testicular ACE (the C-domain form).

Target in 3D: Angiotensin-converting enzyme (ACE). PDB structure 1O86 (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Lisinopril, a lysine analogue of enalaprilat, binds the zinc in the ACE active site. Angiotensin II and aldosterone fall, arterioles dilate and sodium retention lessens; bradykinin builds up, adding vasodilation, cough and angioedema. It needs no activation in the liver and is not metabolised.

Lisinopril binds the zinc in the ACE active site
Less angiotensin II and aldosterone; bradykinin builds up
Arterioles dilate and blood pressure falls

Pharmacokinetics

Absorption: Food does not change absorption
Metabolism: Not a prodrug and not metabolised
Elimination: Excreted unchanged by the kidneys
Half-life: Effective half-life about 12 hours with repeated doses

Indications

High blood pressure Arterial hypertension →
Heart failure Heart failure →
Stable patients after acute myocardial infarction Myocardial Infarction (Heart Attack) →

Adverse effects

Common

Dry cough
Dizziness and hypotension
Headache
Hyperkalaemia
Rise in creatinine

Contraindications

Pregnancy
Previous angioedema with an ACE inhibitor, or hereditary or idiopathic angioedema
Use with sacubitril/valsartan or within 36 hours of it
Use with aliskiren in people with diabetes

Key interactions

Potassium-sparing diuretics, potassium supplements or salt substitutes: Hyperkalaemia
NSAIDs: Weaker effect and kidney injury
Lithium: Lithium toxicity
Diuretics: Marked hypotension when starting in volume-depleted patients

What is monitored

Blood pressure
Potassium and creatinine
Signs of angioedema

Administration and safety

Given by mouth once a day, with or without food
Several «-pril» names look alike: the name is checked on every order

Nursing care

Check blood pressure, especially after the first dose and in patients on diuretics
Check potassium and creatinine within the first weeks
Teach the patient that face, lip or tongue swelling is an emergency
Ask women of childbearing age about pregnancy plans

Pregnancy and breastfeeding

Contraindicated: drugs acting on the renin-angiotensin system can injure and kill the developing fetus; it is stopped as soon as pregnancy is detected.

Test yourself

Think of the answer, then tap the question to see it.

How does lisinopril differ from enalapril in its activation?

Lisinopril is active as taken; enalapril is a prodrug that must be hydrolysed to enalaprilat.

How is lisinopril eliminated?

Unchanged by the kidneys, so its dosing depends on kidney function.

How long after stopping sacubitril/valsartan can lisinopril be started?

At least 36 hours, because the combination with a neprilysin inhibitor greatly raises the risk of angioedema.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: DailyMed - LISINOPRIL tablet (DailyMed (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 30 (McGraw Hill, 2023).

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Representative model, for educational purposes only.