I'm not gonna swell up and die, am I?

June 23, 2008 5:33 PM

How afraid of side effects should I be while taking lisinopril for hypertension? You guys aren't my doctor, because I just saw her today.

32-year-old female, 198 pounds and working on losing 20 or 30, absolutely crazy stressful desk job (50+ hours a week, lots of screaming in my office, etc.) BP 138/90 at the doc today, despite spending the last month walking 4+ miles a week (trying for at least a mile a day). History of neurological migraines. Family members tend to kick from strokes, and my cholesterol is genetically screwy. My doc and I are going to talk about statins next month, when I have a followup to check electrolytes and kidney function and all that good stuff. My thyroid's fine and I have no signs of diabetes (normal A1c and all that).

Bonus: I've got very early signs of hypertensive retinopathy (my retinas suck anyhow, I'm a high myope and I've had one detach and two holes in the last three years). I'm willing to do pretty much anything to preserve my sight and reverse those issues. Given that, my GP opted for a low dose of lisinopril due to its positive effect on retinal complications, but I'm pretty scared of angioedema, hyperkalemia, and other ACE inhibitor side effects.

My doc mentioned the dry cough as a symptom that would require taking me off lisinopril immediately, but none of this other stuff. How worried should I be, realistically? Anyone else taking lisinopril and willing to share their subjective experience of the drug?

(I've read all the other blood pressure threads. I'm still spooked, and I'm kind of HURF DURF BUTTER EATER at myself to boot, since I've been trying to take off the weight and seem to keep gaining.)

posted by anonymous to health (15 comments total)

I take 10mg of lisinopril a day and haven't experienced any of the side effects I've read about. What I have seen is is my blood pressure is lower, now in the normal range. But I've been done a huge change to my diet and exercise so that may have had an impact too.
posted by birdherder at 6:02 PM on June 23

I take lisinopril and when I first read the side effects paperwork that came with my prescription I was freaked out too. But I have not experienced any of the side effects. The only thing is that sometimes I feel a leetle tingling in my fingertips right after I take it, or if I take it a little later than usual. My blood pressure is back to normal since taking the medication. I have changed my diet and exercise only mildly, but I'm working on that.
posted by rio at 6:11 PM on June 23

I've been on Lisinopril since November, and have had no side effects to speak of. I went through a week or so of dizziness and lethargy about a month and a half after starting it, and my doctor assured me it was not from the Lisinopril because any side effect would have shown up sooner (other than the coughing, which apparently is very common and can start at any time.

I am curious why you doctor would take you off the Lisinopril immediately because of the cough - my doctor said that the cough was harmless (though of course annoying to both the cougher and those who had to hear the coughing).

Good luck - I was very unhappy about having to go on a potentially lifelong medication (I'm only 29 but heredity has it in for me when it comes to blood pressure), but so far it has only impacted my life positively.
posted by DuckGirl at 6:14 PM on June 23

The cough annoyed me enough to ask to change meds. My doc moved me to Hyzaar. No side effects since.
posted by littleredwagon at 7:10 PM on June 23

Been on lisinopril for a couple years, no side effects whatsoever.
posted by Ike_Arumba at 7:19 PM on June 23

Beta-blockers and calcium channel blockers also prevent migraines, so if you're looking to switch, those are two options you might want to bring up with your doc.
posted by ikkyu2 at 7:21 PM on June 23

I took lisinopril for about a year total. My hypertension was secondary to my acute renal failure though; your kidneys are probably not failing.

Anyway, I had a dry cough which started about the same time I started taking lisinopril. My doctor thought it was a side effect from lisinopril and switched me to an ARB, Cozaar (losartan). I wasn't convinced the cough was from the lisinopril though, and when I got another doctor 6 months later, I tried lisinopril again and had no cough this time. (By the way, I, too, was led to believe the cough side effect was fairly benign, just annoying.)

I experienced hyperkalemia while on lisinopril. However, I was on other medications that affect kidney function and, as mentioned already, my kidneys weren't exactly 100%. So I wouldn't attribute the hyperkalemia solely to lisinopril.

At first, my doctor told me to keep a low potassium diet. I cut out bananas, citrus, tomatoes, and potatoes. He also gave me a prescription to take 3 doses of Kayexalate (sodium polystyrene sulfonate). It's a powder. I found it disgusting. (It's not so much the taste; it's just that there is so much powder, and therefore water, coupled with the fact that it didn't seem to dissolve all the way. It made for a bad experience.)

The next time it happened a couple of months later, I stopped taking Cozaar and again with the Kayexalate. Ugh.

I held steady for a while at 10mg while avoiding bananas and citrus. My doctor was ok with me eating potatoes and tomatoes again.

Eventually, my potassium levels started creeping up, and I went to 5mg.
A couple of months later, they started creeping up again, so I went to 2.5mg.
A couple of months after that, the same thing, so I stopped all together.

By this point, however, I didn't really need to be on it. I'd be willing to take it again if I needed to, though.

I also experienced severe edema, though not angioedema, at the beginning of this period. I swelled up, gaining 20% of my normal body weight in water, but I didn't die.

I wouldn't worry too much if I were you. When I took lisinopril, I considered it one of my "safe" medications because the other ones had worse side effects (Lipitor was the other one). The best thing to do is just to be aware of the side effects. Chances are you will not experience any. Even if you do, they will probably not be serious. Even if they are more serious or the ones you name, you and your doctor will probably notice it quickly, and it won't be a big deal.
posted by mathlete at 7:50 PM on June 23

I have been on lisinopril for 4 months. I had a minor cough at first, which my doctor thought was due to the medication, but it went away when I went on vacation for three weeks, so I think it was either a fluke or leftover postnasal drip from a recent cold I had a week before being on it. (My doctor characterized it as a nuisance cough and not a major side effect, just a common one.) I have not had any other side effects and my blood pressure is now close enough to normal to make my doctor happy (126/78 at last reading, and I get white-coat hypertension, too).

I started out at 10mg/day and my doctor raised it to 20 mg after seeing positive results. 20 mg gets me to the normal range for bp and I feel great.
posted by bedhead at 8:07 PM on June 23

I take 10mg a day along with a small dose of Toprol and have zero side effects. It has definitely lowered my BP.
posted by Fuzzy Skinner at 8:16 PM on June 23

Oops. I forgot to note that my edema was not caused by lisinopril.
posted by mathlete at 8:37 PM on June 23

I'm about your age and size, and I've been on 10 mg lisinopril for a bit over 3 years, along with a whole bunch of other meds. I've had plenty of side effects from my meds, but none of them seem to be caused by lisinopril except perhaps some of the fatigue. I get regular blood tests to monitor kidney function, but that's about it. As mathlete says, to me it's one of my safe medications. There's always the possibility of side effects, but I wouldn't freak out about it just yet.
posted by katemonster at 9:13 PM on June 23

Lisinopril/HCTZ has helped reduce my BP to the normal range, down from pretty high. Been taking it about 4 months. I had some minor fatigue at first but otherwise it's been fine, and now I don't really notice it. I'm 28, but the damn family history is unavoidable, ya know?

I recall being freaked out too about those side effects. They word the stuff pretty strongly. But as long as you know what to look for and your doctor is involved, I would think it would be much better to take the medication than to not.
posted by dosterm at 9:17 PM on June 23

I'm on Lisinopril and HCTZ, no noticeable side effects. I've been taking them for, um, about three years.
posted by shiny blue object at 5:05 AM on June 24

If you start to get angioedema, you'll probably know. It's pretty rare, 0.1 to 0.5%*, more commonly in people of african descent.

If you are worried of the possibility of a mild potassium elevation, then it's not uncommon to have ACEI+thiazide or ACEI+loop since they have opposite effects on potassium. You'd probably rather just check up on it rather than adding another potential set of side effects. It's really a pretty safe med.

* Slater EE, Merrill DD, Guess HA ,et al . Clinical profile of angioedema associated with angiotensin converting-enzyme inhibition. JAMA 1988; 260, 967 970

Kostis JB, Shelton B, Gosselin G ,et al . Adverse effects of enalapril in the Studies of Left Ventricular Dysfunction (SOLVD). SOLVD Investigators. Am Heart J 1996; 131, 350 355

Brown NJ, Ray WA, Snowden M, Griffin MR. Black Americans have an increased rate of angiotensin converting enzyme inhibitor-associated angioedema. Clin Pharmacol Ther 1996; 60, 8 13
posted by a robot made out of meat at 5:17 AM on June 24

I took one dose of lisinopril and had a HORRIBLE reaction to it. An allergic reaction or something, but also could have been because I have preexisting asthma/allergies/angioedema. But, that's me. Oh, I also have a history of migraine, and the one dose triggered a bad one.

The "ace cough" is the most common side effect, and some people tolerate it in exchange for the blood pressure management. But if it bothers you there are certainly other drugs to try.

Here's the thing, just take a dose or two and see how you feel. If you start to feel your throat swelling (unlikely) get to an ER immediately. If you have a different kind of non-emergency reaction call your doc immediately and have her call something else in.

I'm on a calcium channel blocker right now. It hasn't helped my blood pressure yet, but I haven't had a bad reaction to it either.

The thing with blood pressure meds is that there are so many different kinds that have different mechanisms and one might just not be it for you.
posted by misanthropicsarah at 8:18 AM on June 24