Generic Name

Lisinopril

Brand Names
Zestril, Zestoretic, Qbrelis
FDA approval date: July 01, 2002
Classification: Angiotensin Converting Enzyme Inhibitor
Form: Tablet, Solution

What is Zestril (Lisinopril)?

Zestril (Lisinopril): Cornerstone Therapy for High Blood Pressure and Heart Health

High blood pressure and heart disease are often called “silent killers” because they can quietly damage the heart, kidneys, and blood vessels without obvious symptoms. For millions of people, medications like Zestril (lisinopril) play a vital role in keeping these conditions under control and preventing serious complications such as heart attack, stroke, and kidney failure.

Zestril, the brand name for **lisinopril**, is a prescription medication classified as an **angiotensin-converting enzyme (ACE) inhibitor**. It’s one of the most commonly prescribed drugs for high blood pressure (hypertension) and heart failure, and it’s also used to protect kidney function in patients with diabetes. Zestril has been a trusted, first-line treatment for decades, backed by strong evidence showing its ability to lower blood pressure, reduce hospitalizations, and improve long-term survival in patients with heart disease.

What does Zestril (Lisinopril) do?

Zestril helps the heart and blood vessels work more efficiently. Its main purpose is to **lower high blood pressure**, reducing strain on the heart and arteries. Controlling blood pressure helps prevent complications such as stroke, heart attack, and kidney damage, conditions that can develop silently over time.

In addition to hypertension, Zestril is used in:

  • Heart failure: It helps the heart pump blood more effectively, improving breathing, reducing swelling, and increasing energy.
  • Post–heart attack care: Zestril helps the heart recover after a heart attack by easing the workload on the heart muscle.
  • Diabetic kidney protection: In people with diabetes, Zestril helps slow the progression of kidney disease by reducing pressure in the tiny blood vessels of the kidneys.

Clinical research consistently shows that ACE inhibitors like Zestril reduce the risk of cardiovascular events and death in people with high blood pressure and heart failure (Mayo Clinic, 2024). Many patients notice better blood pressure control within the first few weeks, though it can take longer to reach full effect.

How does Zestril work?

Zestril works by blocking an enzyme in the body called **angiotensin-converting enzyme (ACE)**. Normally, this enzyme produces a substance known as **angiotensin II**, which narrows blood vessels and causes the body to retain salt and water—both of which raise blood pressure.

By blocking this enzyme, Zestril helps **relax and widen blood vessels**, allowing blood to flow more freely. It also reduces the amount of water and salt retained by the kidneys, lowering overall blood volume. The combined effect is a gentle, steady reduction in blood pressure and less strain on the heart.

Clinically, this mechanism is important because it not only improves circulation but also helps protect the heart muscle and kidneys over time. That’s why Zestril is often prescribed long-term; it supports heart and vascular health beyond immediate blood pressure control.

Zestril Side Effects and Warnings

Most people tolerate Zestril well, but as with any medication, side effects can occur. Understanding what’s common versus what’s serious can help patients stay informed and safe.

Common Side Effects include:

  • Dry, persistent cough
  • Dizziness or lightheadedness (especially when standing)
  • Headache
  • Fatigue
  • Mild nausea

These symptoms are often temporary and may lessen as the body adjusts to the medication.

Serious Side Effects are rare but require immediate medical attention:

  • Swelling of the face, lips, tongue, or throat (angioedema)
  • Fainting or severe dizziness
  • High potassium levels (which can cause irregular heartbeat or muscle weakness)
  • Signs of kidney problems, such as dark urine or decreased urination

Warning: Patients with a history of **angioedema**, **pregnancy**, or certain kidney conditions should not take Zestril. Women who become pregnant while taking Zestril should stop the medication and contact their doctor immediately, as ACE inhibitors can harm the developing fetus.

If a patient develops a persistent cough or significant dizziness, their doctor may recommend an alternative blood pressure medication from another class.

Zestril Dosage and Monitoring

Zestril is a **once-daily tablet**, taken with or without food. Dosage varies by condition, age, and response. Consistent daily timing is crucial. Regular monitoring of blood pressure, kidney function, and potassium levels is essential, often requiring blood tests for electrolytes and kidney function, especially during initial treatment or after dose changes.

Special Considerations:

  • Older adults: May need lower starting doses due to increased sensitivity to blood pressure changes.
  • Kidney disease patients: May require dosage adjustments to prevent drug accumulation.
  • Hydration and salt intake: Discuss with a healthcare provider, as dehydration or high potassium can increase side effects.

Missing a dose is usually not dangerous, but do not double the next dose. Consult a doctor or pharmacist if uncertain.

Does Zestril have a generic version?

Yes. Zestril’s generic version, lisinopril, is widely available and FDA-approved. Generic lisinopril contains the same active ingredient, dosage strength, and effectiveness as the brand-name version but is typically more affordable.

Zestril and lisinopril, both available in tablet form, treat high blood pressure, heart failure, and protect kidneys. The FDA states generic medications like lisinopril meet the same quality and safety standards as brand-name drugs like Zestril. Patients can safely switch between them under a doctor’s supervision without losing therapeutic benefits.

Conclusion

Zestril (lisinopril) is a proven, reliable medication that helps millions of people manage high blood pressure, heart failure, and kidney complications from diabetes. By gently relaxing blood vessels and supporting heart function, it reduces the risk of serious cardiovascular events while improving overall quality of life.

While some patients experience mild, manageable side effects, Zestril remains a safe and effective cornerstone of cardiovascular care, empowering patients. Always take as prescribed and communicate openly with your healthcare team.

References

  • Mayo Clinic. (2024). Lisinopril (oral route) description and precautions. Retrieved from mayoclinic.org
  • MedlinePlus. (2024). Lisinopril: Drug information. National Library of Medicine. Retrieved from medlineplus.gov
  • U.S. Food and Drug Administration (FDA). (2023). Generic drugs: Questions and answers. Retrieved from fda.gov
  • National Institutes of Health (NIH). (2024). ACE inhibitors for hypertension and heart failure. Retrieved from nih.gov

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Brand Information

    Zestril (Lisinopril)
    WARNING: FETAL TOXICITY
    • When pregnancy is detected, discontinue ZESTRIL as soon as possible [see Warnings and Precautions (
    • Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus [see Warnings and Precautions (5.1)].
    1INDICATIONS AND USAGE
    1.1Hypertension
    Zestril is indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure. Lowering blood pressure lowers the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes.
    Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than 1 drug to achieve blood pressure goals. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC).
    Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly.
    Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension (for example, patients with diabetes or hyperlipidemia), and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal.
    Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (e.g., on angina, heart failure, or diabetic kidney disease). These considerations may guide selection of therapy.
    Zestril may be administered alone or with other antihypertensive agents
    1.2Heart Failure
    Zestril is indicated to reduce signs and symptoms of systolic heart failure
    1.3Reduction of Mortality in Acute Myocardial Infarction
    Zestril is indicated for the reduction of mortality in treatment of hemodynamically stable patients within 24 hours of acute myocardial infarction. Patients should receive, as appropriate, the standard recommended treatments such as thrombolytics, aspirin and beta-blockers
    2DOSAGE FORMS AND STRENGTHS
    2.5 mg are white, round, biconvex, uncoated tablets identified as “ZESTRIL 2 1/2” on one side and “135” on the other side.
    3CONTRAINDICATIONS
    Zestril is contraindicated in combination with a neprilysin inhibitor (e.g., sacubitril). Do not administer Zestril within 36 hours of switching to or from sacubitril/valsartan, a neprilysin inhibitor 
    Zestril is contraindicated in patients with:
    • a history of angioedema or hypersensitivity related to previous treatment with an angiotensin converting enzyme inhibitor
    • hereditary or idiopathic angioedema
    Do not co-administer aliskiren with ZESTRIL in patients with diabetes
    4OVERDOSAGE
    Following a single oral dose of 20 g/kg no lethality occurred in rats, and death occurred in one of 20 mice receiving the same dose.  The most likely manifestation of overdosage would be hypotension, for which the usual treatment would be intravenous infusion of normal saline solution.
    Lisinopril can be removed by hemodialysis
    5DESCRIPTION
    Lisinopril is an oral long-acting angiotensin converting enzyme (ACE) inhibitor.  Lisinopril, a synthetic peptide derivative, is chemically described as (S)-1-[N2-(1-carboxy-3-phenylpropyl)-L-lysyl]-L-proline dihydrate.  Its empirical formula is C
    Lisinopril is a white to off-white, crystalline powder, with a molecular weight of 441.53.  It is soluble in water and sparingly soluble in methanol and practically insoluble in ethanol.
    Zestril is supplied as 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg and 40 mg tablets for oral administration.
    Inactive Ingredients:
    2.5 mg tablets - calcium phosphate, magnesium stearate, mannitol, starch.
    5 mg, 10 mg, 20 mg and 30 mg tablets - calcium phosphate, magnesium stearate, mannitol, red ferric oxide, starch.
    40 mg tablets - calcium phosphate, magnesium stearate, mannitol, starch, yellow ferric oxide.
    6HOW SUPPLIED/STORAGE AND HANDLING
    Zestril is available as uncoated biconvex tablets in bottles of 90.
    Store at controlled room temperature, 20° to 25°C (68° to 77°F) [see USP].  Protect from moisture, freezing and excessive heat.  Dispense in a tight container.
    7PATIENT COUNSELING INFORMATION
    NOTE:  This information is intended to aid in the safe and effective use of this medication.  It is not a disclosure of all possible adverse or intended effects.
    Pregnancy: Advise pregnant women and females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to notify their healthcare provider with a known or suspected pregnancy
    Angioedema: Angioedema, including laryngeal edema may occur at any time during treatment with angiotensin converting enzyme inhibitors, including Zestril.  Tell patients to report immediately any signs or symptoms suggesting angioedema (swelling of face, extremities, eyes, lips, tongue, difficulty in swallowing or breathing) and to take no more drug until they have consulted with the prescribing physician.
    Lactation: Advise women not to breastfeed during treatment with Zestril
    Symptomatic Hypotension: Tell patients to report light-headedness especially during the first few days of therapy.  If actual syncope occurs, tell the patient to discontinue the drug until they have consulted with the prescribing physician.
    Tell patients that excessive perspiration and dehydration may lead to an excessive fall in blood pressure because of reduction in fluid volume.  Other causes of volume depletion such as vomiting or diarrhea may also lead to a fall in blood pressure; advise patients accordingly.
    Hyperkalemia: Tell patients not to use salt substitutes containing potassium without consulting their physician.
    Hypoglycemia: Tell diabetic patients treated with oral antidiabetic agents or insulin starting an ACE inhibitor to monitor for hypoglycaemia closely, especially during the first month of combined use [see
    Leukopenia/Neutropenia: Tell patients to report promptly any indication of infection (e.g., sore throat, fever), which may be a sign of leukopenia/neutropenia.
    Zestril has been selected.