Lisinopril (Zestril) Side Effects in Pakistan

Complete guide to Lisinopril side effects — from common effects to serious warnings. It is essential to understand the specific risks of the ACE inhibitor class — angioedema and first-dose hypotension.

Compiled by the PakVita Editorial Team · AI-assisted drafting with editorial review · Sourced from DRAP, WHO, BNF · Last updated: 2026-06-17

Side Effects

Quick Answer

The most common side effect of Lisinopril (Zestril) is a dry, persistent cough — occurring in up to 20% of patients. If intolerable, the doctor may switch to Losartan (ARB). Serious side effect: swelling of the face, tongue, or throat (angioedema) — this is an EMERGENCY; stop the medicine immediately and go to hospital. Angioedema is different from cough — do not confuse them.

Side Effects at a Glance

Common

Dry persistent cough — in up to 20% of patients; a class effect of ACE inhibitors
Dizziness — especially at the start or when increasing the dose
Headache
Fatigue
Hyperkalemia — detected through muscle weakness or changes in heart rhythm

Serious — See a Doctor

Angioedema — swelling of the face, tongue, throat, or larynx
Severe hypotension — especially with the first dose
Acute kidney injury
Fetal toxicity — ABSOLUTELY CONTRAINDICATED in the 2nd-3rd trimester

When to See a Doctor Immediately

Swelling of the face, tongue, or throat — go to emergency IMMEDIATELY (angioedema)
Difficulty breathing or voice becoming hoarse
BP drops severely — fainting, severe dizziness, blackout
Muscle weakness or changes in heart rhythm
Decreased urine output or foot swelling
Pregnancy confirmed — stop the medicine IMMEDIATELY and see a doctor

Lisinopril (Zestril) Side Effects (Nuksanat)

Lisinopril (Zestril) is generally safe and well-tolerated at the correct dose as directed by the doctor. However, there are some specific side effects of the ACE inhibitor class that are important to understand — particularly angioedema, which can be life-threatening.

Common Side Effects (Aam Nuksanat)

Dry persistent cough — in up to 20% of patients; a characteristic side effect of the ACE inhibitor class. If intolerable, the doctor switches to an ARB (Losartan/Valsartan).
Dizziness — especially at the start
Headache
Fatigue
Hyperkalemia — muscle weakness or changes in heart rhythm

These side effects are generally mild. If they continue, inform your doctor.

Serious Side Effects (Sanjeedah Nuksanat — FORAN Action)

Angioedema — swelling of the face, tongue, throat — EMERGENCY: stop immediately + 1122/hospital — do not take any ACE inhibitor again
Severe hypotension
Acute kidney injury
Fetal toxicity — ABSOLUTELY CONTRAINDICATED in pregnancy (2nd-3rd trimester)

When to See a Doctor Immediately (Foran Doctor / Emergency)

Swelling of the face, tongue, or throat or difficulty breathing — IMMEDIATELY 1122 or hospital emergency
BP drops severely — fainting, blackout, severe dizziness
Severe muscle weakness or changes in heart rhythm
Decreased or absent urine output
Pregnancy confirmed — stop the medicine IMMEDIATELY and see a doctor

Angioedema vs. Khansi — Farq Samajhein

Cough (Common)	Angioedema (Emergency)
Frequency	Up to 20% of patients	Rare (0.1-0.3%)
Symptom	Dry, persistent cough	Swelling of face/tongue/throat
Action	Inform doctor; discuss ARB option	IMMEDIATE emergency — life-threatening

Side Effects Summary Table

Type	Side Effect	Action
Common	Dry cough	Monitor; discuss ARB switch
Common	Dizziness	Rise slowly; inform doctor
Common	Hyperkalemia	Lab test; stop potassium supplements
Serious	Angioedema	Stop immediately + EMERGENCY
Serious	Severe hypotension	Lie down + doctor/emergency
Serious	Fetal toxicity	STOP in pregnancy — EMERGENCY

Reporting Side Effects

If you notice any unexpected side effect, report it on the DRAP pharmacovigilance portal: https://www.dra.gov.pk/pharmacovigilance

The information in this guide is for educational purposes only. If you notice any side effect, contact your doctor or pharmacist.

Frequently Asked Questions

Lisinopril se khansi kyun hoti hai?

Lisinopril is an ACE inhibitor that prevents the breakdown of bradykinin — bradykinin triggers coughing. This occurs in up to 20% of patients. If the cough is mild or tolerable, the medicine can be continued. If intolerable, the doctor switches to Losartan (ARB) which does not cause this side effect.

Lisinopril se chehra soojne par kya karein?

This is angioedema — a MEDICAL EMERGENCY. Stop Lisinopril immediately, call 1122 or go to the hospital emergency. Never take an ACE inhibitor again. Angioedema is rare but can be life-threatening.

Kya Lisinopril se BP bohot gir sakta hai?

Yes — especially with the first dose, in patients taking high doses of diuretics, or with sodium depletion, BP can drop to a dangerous level. This is why doctors usually start with a small dose and monitor the patient after the first dose. If dizziness occurs on standing, sit or lie down immediately.

Kya Lisinopril gurdon ko nuqsaan pahuncha sakti hai?

Generally no — in fact it protects the kidneys in diabetic nephropathy. However, the kidneys can be affected if NSAIDs (such as Brufen) are taken alongside it or in cases of dehydration. The doctor monitors creatinine — have your tests done regularly.

Lisinopril se hyperkalemia kyun hoti hai?

Lisinopril blocks the effect of angiotensin-II, which plays a role in potassium excretion — the result is that potassium can increase in the blood. The risk is higher if potassium-sparing diuretics (Spironolactone) or potassium supplements are taken alongside. Symptoms: muscle weakness, irregular heartbeat.

Brand alternatives, same-class options, and other medicines used for the same conditions as Zestril Tablet (Lisinopril).

Other arbs, ace inhibitors and other bp medicines

Sibling medicines in the ARBs, ACE Inhibitors and Other BP Medicines class.

All in class →

Used for the same conditions

Other medicines commonly used for headache and overlapping conditions.

Headache hub →

Sources

DRAP Registered Products Database — Drug Regulatory Authority of Pakistan
WHO Model List of Essential Medicines, 23rd ed. (2023) — World Health Organization
British National Formulary (BNF) — Lisinopril — BMJ Group & Pharmaceutical Press

Medical disclaimer

This page is for educational use only and does not replace professional medical advice. Always confirm diagnosis, dose, and interactions with a qualified doctor or pharmacist before starting or changing any medicine.