Drug Class Guide
ACE Inhibitors
First-line blood pressure medicines that also protect the heart after a heart attack and the kidneys in diabetes.
How ACE Inhibitors Work
ACE inhibitors block angiotensin-converting enzyme, which the body uses to make angiotensin II, a hormone that tightens blood vessels and makes the body hold on to salt and water. With less angiotensin II, blood vessels relax, blood pressure falls, and the heart and kidneys work under less strain.
What ACE Inhibitors Treat
ACE Inhibitors in Our Medication Guide
Common Side Effects
A dry, tickly cough is the best-known side effect and a common reason people switch medicines. ACE inhibitors can also raise potassium, cause dizziness when blood pressure drops, and change kidney blood tests, so labs are checked after starting or changing the dose. Rarely, they cause angioedema: sudden swelling of the lips, tongue or throat, which is an emergency.
Important Cautions
- Do not take an ACE inhibitor during pregnancy; it can harm the developing baby.
- Avoid potassium supplements and potassium-based salt substitutes unless your doctor approves them.
- Regular NSAIDs such as ibuprofen can blunt the effect and strain the kidneys.
- Call 911 for swelling of the face, lips, tongue or throat.
Side-by-Side Comparisons
Common Questions About ACE Inhibitors
Why do ACE inhibitors cause a cough?
ACE also breaks down bradykinin, a substance that can irritate the airways. When ACE is blocked, bradykinin builds up and can trigger a dry cough. It does not harm the lungs, but it rarely goes away while you keep taking the drug. Switching to an ARB, which works on the same system without the bradykinin effect, usually solves it.
What is the difference between an ACE inhibitor and an ARB?
Both lower the effect of angiotensin II and protect the heart and kidneys. ACE inhibitors stop the hormone from being made; ARBs block it from acting. They work about equally well for blood pressure, but ARBs rarely cause cough. The two are generally not taken together.
Can I take ibuprofen with lisinopril?
An occasional dose is usually fine for people with healthy kidneys, but regular NSAID use can raise blood pressure and, especially when combined with a diuretic, injure the kidneys. Acetaminophen is often a safer choice for everyday pain. Ask us before taking an NSAID regularly.
This guide is general information, not a substitute for advice about your own medicines. Do not start, stop or switch a medication without talking with your doctor. Questions about a prescription? Our internal medicine team can help.
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Trusted Resources for ACE Inhibitors
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