Zestril is a brand-name prescription drug. It’s FDA-approved to:

  • Treat high blood pressure. Zestril is used to treat high blood pressure in adults and in children ages 6 years and older. For this purpose, the drug may be used alone or in combination with other blood pressure medications.
  • Treat heart failure. Zestril is used as an adjunct treatment for heart failure in adults. As an adjunct treatment, Zestril is given as an add-on therapy with other heart failure drugs.
  • Reduce the risk of dying after a heart attack. Zestril is used to lower the risk of death in adults who’ve had a heart attack.

Zestril contains the active drug lisinopril. It belongs to a group of drugs called angiotensin converting enzyme (ACE) inhibitors. ACE inhibitors widen your blood vessels, increasing the amount of blood that flows to your heart. This helps to lower your blood pressure and also decreases the amount of work your heart has to do.

Zestril comes as a tablet that you swallow. It’s available in the following strengths: 2.5 milligrams (mg), 5 mg, 10 mg, 20 mg, 30 mg, 40 mg. You’ll likely take this drug once each day.

Effectiveness

For information on the effectiveness of Zestril, see the “Zestril uses” section below.

Zestril contains the active drug lisinopril, which is available as a generic drug. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

In some cases, the brand-name drug and the generic version may come in different forms and strengths.

Lisinopril also comes in other brand-name medications, such as Prinivil.

Zestril can cause mild or serious side effects, which should be the same in both men and women. The following lists contain some of the key side effects that may occur while taking Zestril. These lists don’t include all possible side effects.

For more information on the possible side effects of Zestril, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Zestril, you can do so through MedWatch.

Mild side effects

Mild side effects of Zestril can include:*

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Zestril. To learn about other mild side effects, talk with your doctor or pharmacist, or visit Zestril’s prescribing information.
† For more information on these side effects, see “Side effect details” below.

Serious side effects

Serious side effects from Zestril aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

* For more information on these side effects, see “Side effect details” below.
Zestril has a boxed warning for this side effect. A boxed warning is the most serious warning from the FDA. For more information, see the “Zestril and pregnancy” section below.

Side effects in children

Zestril is approved for use in children with high blood pressure who are ages 6 years and older. The side effects of Zestril in children are thought to be similar to those in adults. See the “Mild side effects” and “Serious side effects” lists above for more information on the drug’s side effects.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on certain side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Zestril. But it isn’t known how many people had an allergic reaction to Zestril during clinical studies.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth, swelling, or redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can be similar to symptoms of angioedema (rapid, severe swelling that forms underneath your skin). And angioedema is a possible serious side effect of Zestril. (For more information, see the “Serious side effects” section above.)

Symptoms of a severe allergic reaction may also include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have symptoms of angioedema or a severe allergic reaction after taking Zestril. But call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Cough

While you’re taking Zestril, you may develop a dry, long-lasting cough. With this cough, you may also have a scratchy feeling or tickling in your throat.

In clinical studies, 2.5% of people had a cough after using Zestril to treat high blood pressure. It isn’t known how many people had a cough after using a placebo in these studies. (A placebo is a treatment that doesn’t contain an active drug.) And it isn’t known how many people had a cough after using Zestril for either heart failure or heart attack.

Your risk for having a cough after taking Zestril isn’t related to your dosage or the length of time that you take the drug. Instead, cough can be a side effect of any dosage of Zestril. And cough may occur after your very first dose of Zestril, or it may happen after you’ve taken the drug for weeks or months. But keep in mind that not everyone taking Zestril develops a cough.

If you do get a cough with Zestril, this side effect usually won’t go away until you stop taking the drug. But even after stopping Zestril, it may take several months for your cough to go away.

If you have a bothersome cough while you’re taking Zestril, talk with your doctor. They may suggest a treatment other than Zestril for your condition.

Low blood pressure

While Zestril is used to help reduce high blood pressure, it may actually cause low blood pressure in some people.

With low blood pressure, some people may not have any symptoms. But possible symptoms of low blood pressure can include:

You may be more likely to have low blood pressure with Zestril if you sweat a lot, such as during exercise. It’s also more likely that you’ll develop low blood pressure with Zestril if you become dehydrated. (With dehydration, you have a low fluid level.)

You may also have a higher risk for low blood pressure with Zestril if you take certain other medications or have certain health conditions. For more information, see the “Zestril interactions” and “Zestril precautions” sections below.

In addition, keep in mind that having low blood pressure with Zestril may lead to other health problems, such as:

If you have any symptoms of low blood pressure while you’re taking Zestril, tell your doctor. They may want to check your blood pressure more often than usual during treatment.

How often low blood pressure occurred in people taking Zestril

Of adults taking Zestril in clinical studies, 3.8% to 11% had low blood pressure. (This percentage range varied depending on the condition being treated and the dose being taken.) It isn’t known how many adults in these studies who weren’t taking Zestril had low blood pressure.

Chest pain

Chest pain is a possible side effect of Zestril.

In clinical studies, chest pain occurred in 2.1% of adults taking Zestril for heart failure. However, it isn’t known how many adults had chest pain after taking a placebo (treatment with no active drug). And the percentage of adults who had chest pain after taking Zestril to treat conditions other than heart failure isn’t known.

Keep in mind that chest pain can also be a sign of more serious side effects of Zestril, such as high potassium levels or worsening kidney function. (For more information, see the “Serious side effects” section above.)

If you have chest pain while using Zestril, tell your doctor right away. They may want to check to see what’s causing your chest pain. But if your chest pain feels life threatening or if you think you’re having a medical emergency, call 911 or your local emergency number.

Headache

Headache is a common side effect of Zestril.

In clinical studies, of people who took Zestril for high blood pressure, 3.8% had a headache. It isn’t known how many people had a headache after taking a placebo (treatment with no active drug). It’s also not known how many people taking Zestril to treat conditions other than high blood pressure had a headache.

The length of time that people had a headache after taking Zestril in these studies isn’t known. And it isn’t known if their headaches went away as they kept using Zestril.

Keep in mind that headaches can also be a sign of very high blood pressure, which Zestril is used to treat. So be sure to tell your doctor if you have headaches while you’re taking Zestril. They may want to check your blood pressure to make sure Zestril is working for you.

Dizziness

Zestril may cause dizziness in some people.

In clinical studies, 3.5% to 19% of adults taking Zestril had dizziness. (This percentage range varied depending on the condition being treated and the dose being taken.) It isn’t known how many adults in these studies who weren’t taking Zestril had dizziness.

Tell your doctor if you have dizziness while taking Zestril. They may suggest ways to help lessen this side effect.

The Zestril dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you’re using Zestril to treat
  • your age
  • other medications you be taking with Zestril
  • other medical conditions you may have

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Zestril comes as a tablet that you swallow. It’s available in the following strengths: 2.5 milligrams (mg), 5 mg, 10 mg, 20 mg, 30 mg, 40 mg.

Dosage for high blood pressure

Zestril is used to treat hypertension (high blood pressure). For this purpose, the drug may be taken either:

The recommended dosage of Zestril, which is different for each of these uses, is described below. Your doctor may recommend a different dosage depending on several factors, including whether you have kidney disease. Talk with your doctor about the dosage that’s right for you.

Dosage for high blood pressure when Zestril is used alone

When used alone for high blood pressure, the typical starting dose of Zestril is 10 mg once each day. The usual maintenance dosage range is 20 mg to 40 mg once per day. The maximum recommended dosage of Zestril for high blood pressure is 80 mg each day.

Dosage for high blood pressure when Zestril is used with other blood pressure medications

If you take Zestril in combination with diuretics for high blood pressure, the typical starting dose of Zestril is 5 mg once each day. Examples of diuretics include the drugs hydrochlorothiazide and furosemide (Lasix).

If you start taking a diuretic after you’ve been already using Zestril, your doctor may lower your Zestril dosage.

If you take blood pressure drugs other than diuretics with Zestril, your doctor may also adjust your Zestril dosage based on your response to the treatment. See the “Zestril use with other drugs” section below for more details.

Dosage for adjunct treatment of heart failure

Zestril is used as an adjunct treatment for heart failure in adults. As an adjunct treatment, it’s given as an add-on therapy with other heart failure drugs.

The typical starting dosage of Zestril for heart failure is 5 mg once each day. The maximum recommended dosage of Zestril for heart failure is 40 mg once per day.

Your doctor may recommend a different dosage depending on several factors. These include whether you have kidney disease, low sodium levels, or dehydration (low fluid level). Talk with your doctor about the dosage that’s right for you.

Dosage for heart attack

Zestril is used to lower the risk of death in adults who’ve had a heart attack.

Typically, Zestril is started right after you’ve had a heart attack. In fact, you may take your first few doses of Zestril while you’re in the hospital being treated for heart attack.

The usual starting dose of Zestril after a heart attack is 5 mg. It’s given as one dose within 24 hours of the heart attack. Another 5-mg dose may be given within 24 hours of the first dose. And a 10-mg dose is usually given 48 hours after that.

After these first few doses are given, the usual dosage of Zestril that you’ll continue taking for at least 6 weeks is 10 mg once each day.

Your doctor may recommend a different dosage depending on several factors, including whether you have kidney disease or low blood pressure. Talk with your doctor about the dosage that’s right for you.

Dosage adjustments in people with kidney problems

If you have kidney disease, your doctor may adjust your dosage of Zestril to half of the usual starting dosage for your condition. And your doctor may slowly increase your dosage up to a maximum of 40 mg once daily.

For example, the typical starting dosage of Zestril for high blood pressure is 10 mg once per day. So if you have kidney disease and you’re taking Zestril for high blood pressure, your starting dosage will likely be 5 mg once each day.

The recommended starting dosage of Zestril for people who use dialysis* therapy is 2.5 mg once each day. This recommended dosage is the same whether you’re treating high blood pressure or heart failure, or preventing death after heart attack.

Be sure to take the dosage that your doctor prescribes. If you have kidney disease or use dialysis, talk with your doctor about the dosage that’s safest for you.

* Dialysis is a process that’s used to get rid of the waste products in your blood. It’s used when your kidneys aren’t working properly and they aren’t able to filter and clean your blood.

Pediatric dosage

Zestril is approved to treat high blood pressure in children ages 6 years and older.

The typical starting dose of Zestril for high blood pressure in children is 0.07 milligrams of drug per kilogram (mg/kg) of body weight. And this dose is given once each day.

For example, a 50-pound child weighs about 23 kg. If the child’s doctor prescribes Zestril 0.07 mg/kg once each day, the child’s dose would be about 1.6 mg daily.

The maximum starting dose of Zestril in children is 5 mg once per day. Over time, your child’s doctor may increase their dose to up to 40 mg once each day.

Your child’s doctor may also recommend a different dosage depending on several factors, including whether they have kidney disease. Talk with your child’s doctor about the dosage of Zestril that’s right for them.

What if I miss a dose?

If you miss a dose of Zestril, take the missed dose as soon as you remember. If it’s almost time for your next dose, just skip the missed dose. Then take your next dose on your regular schedule.

Don’t double up on doses to make up for a missed dose. This could increase your risk for having side effects. (For more information about the drug’s side effects, see the “Zestril side effects” section above.)

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Will I need to use this drug long term?

Zestril is meant to be used as a long-term treatment. If you and your doctor determine that Zestril is safe and effective for you, you’ll likely take it long term.

The Food and Drug Administration (FDA) approves prescription drugs such as Zestril to treat certain conditions. Zestril may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Zestril for high blood pressure

Zestril is FDA-approved to treat hypertension (high blood pressure) in adults and in children ages 6 years and older. For this purpose, it may be given alone or in combination with other blood pressure medications.

Blood pressure describes the force of blood pushing against the walls of your blood vessels. With high blood pressure, this force is higher than normal.

High blood pressure can increase your risk for having a heart attack, stroke, or other types of heart disease. Lowering your blood pressure can help to lower your risk for these problems.

Most people with high blood pressure have no symptoms of the condition. For this reason, it’s often called a “silent killer.” But possible symptoms of high blood pressure may include:

To find out if your blood pressure is high, your doctor can measure it. You may also check your blood pressure at home with a home blood pressure monitor or at your local pharmacy with an automatic blood pressure monitor. Check out these tips from the American Heart Association on how to use a home blood pressure monitor.

For most people, a normal blood pressure is less than 120/80 millimeters of mercury (mm Hg). If your blood pressure is consistently above 130/80 mm Hg to 139/89 mm Hg, your doctor may give you a diagnosis of high blood pressure.

Zestril helps to lower your blood pressure and also decreases the amount of work your heart has to do.

Effectiveness for high blood pressure

Zestril has been found effective for treating high blood pressure in adults and in children ages 6 years and older.

Effectiveness of Zestril in adults with high blood pressure

In clinical studies of adults with high blood pressure, Zestril was compared with several other blood pressure medications. Researchers wanted to know if Zestril would lower people’s blood pressure as well as these other drugs did.

In these studies, Zestril lowered people’s blood pressure:

However, exact blood pressure measurements from adults in these studies aren’t known.

Effectiveness of Zestril in children with high blood pressure

For information about Zestril’s effectiveness in children with high blood pressure, see the “Zestril and children” section below.

Zestril for adjunct treatment of heart failure

Zestril is approved as an adjunct treatment for heart failure in adults. As an adjunct treatment, Zestril is given as an add-on therapy with other heart failure drugs.

With heart failure, your heart doesn’t pump enough blood to provide your body with the oxygen that it needs. (Your blood carries oxygen throughout your body.) When this happens, your body makes several changes to try to increase blood flow. These changes include:

  • raising your heart rate
  • building more muscle around your heart
  • increasing the size of your heart
  • narrowing your blood vessels
  • shifting blood flow away from certain organs so that more blood flows to your heart and brain

At first, these changes may keep you from having symptoms of heart failure. However, over time, heart failure will continue to get worse. And eventually, your heart and the rest of your body aren’t able to keep up.

You may have heart failure for a while before you start to have symptoms from the condition. But possible symptoms of heart failure may include:

Zestril helps to treat heart failure by decreasing the amount of work your heart has to do.

Effectiveness for heart failure

In clinical studies, Zestril was effective as an adjunct (add-on) treatment of heart failure in adults.

In 12-week clinical studies, Zestril was used in combination with digitalis and a diuretic drug. (Digitalis is another drug used to treat heart failure.) The specific diuretics that were used in the study weren’t reported.

Researchers wanted to know if the combination of Zestril, digitalis, and a diuretic would improve people’s symptoms of heart failure.

The study showed that this combination of drugs was effective in improving the following symptoms of heart failure:

  • swelling in the abdomen (belly), ankles, feet, or legs
  • clicking or rattling sounds in the lungs
  • shortness of breath that happened at night or while lying down
  • jugular vein distention

Zestril for heart attack

Zestril is approved to lower the risk of death in adults who’ve had a heart attack.

A heart attack occurs when there’s low blood flow to your heart. Blood flow can be decreased when the vessels that provide blood flow to your heart are blocked.

Blockages in these vessels can be caused by a buildup of fat, cholesterol, or other substances in your blood. This buildup is called plaque. It forms as part of a process called atherosclerosis (hardening of your arteries).

You may not have any symptoms of hardened arteries until a heart attack happens. A heart attack can feel like a pain, pressure, squeezing, or tightness in your chest. And this feeling may spread to your back, jaw, or neck. Other symptoms of a heart attack can include:

A heart attack is a medical emergency. Call 911 or your local emergency number right away if you experience any of these symptoms.

Zestril helps to lower your risk for death after a heart attack by decreasing the amount of work your heart has to do.

Effectiveness for heart attack

In clinical studies, Zestril was effective in lowering the risk of death in adults who’d had a heart attack.

In a 6-week clinical study, Zestril was used either alone or in combination with nitrates to treat heart attack. (Nitrates are another group of drugs used to treat heart attack. Isosorbide dinitrate is an example of a drug in this group.)

Researchers wanted to know if adults who were given Zestril after a heart attack would have a lower risk of death than adults who were given another drug. (The specific drugs that were compared to Zestril weren’t reported.)

After 6 weeks of treatment, adults who were given Zestril, either alone or with nitrates, had an 11% lower risk of death than did adults who weren’t given Zestril.

Zestril and children

Zestril is approved to treat high blood pressure in children ages 6 years and older. For this purpose, it may be given alone or in combination with other blood pressure medications.

Effectiveness of Zestril for high blood pressure in children

In clinical studies, Zestril was given to children ages 6 years and older for 2 weeks. After 2 weeks of treatment, Zestril was effective at lowering their blood pressure. But the exact blood pressure measurements from children in these studies aren’t known.

After the first 2 weeks of treatment, some of these children continued taking Zestril. Other children were switched from Zestril to a placebo (treatment with no active drug).

At the end of the study, the children who continued using Zestril had a lower blood pressure than did children who were switched to a placebo. Specifically, children taking Zestril had a diastolic blood pressure* that was 9 millimeters of mercury (mm Hg) lower than that of children who were switched to the placebo.

* Diastolic blood pressure is the bottom number reported on blood pressure measurements. It’s the pressure inside your blood vessels when your heart muscle is relaxed.

Zestril is approved to:

When it’s used to treat high blood pressure, Zestril may be given in combination with other blood pressure medications, such as diuretics and calcium channel blockers.

When it’s used for heart failure, Zestril is given as an adjunct treatment. As an adjunct treatment, Zestril is used as an add-on therapy with other heart failure drugs.

If you have multiple health conditions, your doctor may recommend that you take other medications with Zestril. Talk with your doctor about the best treatment options for you.

Here are answers to some frequently asked questions about Zestril.

Is Zestril classified as a beta-blocker?

No, Zestril isn’t a beta-blocker. Instead, Zestril belongs to a group of drugs called angiotensin converting enzyme (ACE) inhibitors.

Both beta-blockers and ACE inhibitors help to lower your blood pressure and decrease the amount of work your heart has to do. Beta-blockers work by preventing certain hormones from attaching to beta receptors.* ACE inhibitors, on the other hand, work by widening your blood vessels and increasing the amount of blood that flows to your heart.

If you have questions about using either Zestril or a beta-blocker to treat your condition, talk with your doctor.

* Beta receptors are proteins on the surface of cells in your heart, blood vessels, and lungs. Substances attach to these proteins and relay a chemical message.

Will Zestril affect my body differently given my race?

Yes, Zestril may work differently for you depending on your race. In fact, Zestril may be less effective in lowering blood pressure in Black people versus people who aren’t Black. However, when used together with a diuretic, Zestril may be as effective in lowering blood pressure in both Black people and people who aren’t Black.

Also, Black people may have a higher risk for angioedema with Zestril compared with people who aren’t Black. (With angioedema, you have rapid, severe swelling underneath your skin.)

If you have questions about the effectiveness or possible side effects of Zestril given your race, talk with your doctor.

Is Zestril safe for older people to use?

Yes, in most cases, Zestril is safe for older people to use.

A clinical study looked at adults ages 75 years and older who took Zestril after having a heart attack. This study showed that people ages 75 years and older may have a higher risk for problems with kidney function when using Zestril. But no other differences in side effects were noticed for older people compared with younger people.

However, in this study, Zestril was found to work just as well for older people as it did for younger people.

If you’re age 75 years or older, talk with your doctor about the risks and benefits of using Zestril to treat your condition.

Do I need to watch my salt intake while I’m taking Zestril?

Yes, you may need to watch your salt intake while you’re using Zestril.

Having low sodium blood levels can increase your risk for having low blood pressure with Zestril. (While Zestril is used to reduce high blood pressure, the drug can actually cause low blood pressure in some people.) So your doctor may have you increase the amount of salt that you eat before you start taking Zestril. Because salt is made from sodium, eating salt will increase your sodium level.

However, with high blood pressure, you may need to reduce your sodium intake. In fact, for most adults with high blood pressure, the American Heart Association recommends using less than 1,500 milligrams (mg) of salt each day.

In some cases, you may decide to use a salt substitute, which is a form of salt that doesn’t contain sodium. Doing so can help you lower your sodium intake. But using salt substitutes that contain potassium can raise your risk for high potassium levels as a side effect of Zestril. (For more information, see the “Zestril side effects” section above.)

Talk with your doctor about the best way to manage your salt intake while you’re using Zestril.

As with all medications, the cost of Zestril can vary. To find current prices for Zestril tablets in your area, check out GoodRx.com.

The cost you find on GoodRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Zestril, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Zestril, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Zestril, help may be available.

Medicine Assistance Tool is a website that lists programs that may help lower the cost of Zestril. For more information and to find out if you’re eligible for support, visit the website.

Generic version

Zestril is available in a generic form called lisinopril. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. And generics tend to cost less than brand-name drugs. To find out how the cost of lisinopril compares to the cost of Zestril, visit GoodRx.com.

If your doctor has prescribed Zestril and you’re interested in using lisinopril instead, talk with your doctor. They may have a preference for one version or the other. You’ll also need to check your insurance plan, as it may only cover one or the other.

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Zestril, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Alternatives for high blood pressure

Examples of other drugs that may be used to treat hypertension (high blood pressure) include:

Alternatives for heart failure

Examples of other drugs that may be used to treat heart failure include:

  • aldosterone antagonists, such as:
    • spironolactone (Aldactone)
  • angiotensin II receptor blockers (ARBs), such as:
    • losartan (Cozaar)
    • valsartan (Diovan)
  • beta-blockers, such as:
    • carvedilol (Coreg)
    • metoprolol (Lopressor)
  • isosorbide dinitrate/hydralazine (BiDil)
  • ivabradine (Corlanor)
  • sacubitril/valsartan (Entresto)
  • angiotensin converting enzyme (ACE) inhibitors other than Zestril, such as:
    • enalapril (Vasotec)
    • ramipril (Altace)

Alternatives for heart attack

Examples of other drugs that may be used to lower the risk of death after heart attack include:

  • angiotensin II receptor blockers (ARBs), such as:
    • valsartan (Diovan)
  • beta-blockers, such as:
    • carvedilol (Coreg)
    • metoprolol (Lopressor)
  • calcium channel blockers, such as:
  • statins, such as:
  • angiotensin converting enzyme (ACE) inhibitors other than Zestril, such as:
    • enalapril (Vasotec)
    • ramipril (Altace)

You may wonder how Zestril compares with other medications that are prescribed for similar uses. Here we look at how Zestril and Lopressor are alike and different.

Ingredients

Zestril contains the active drug lisinopril, while Lopressor contains the active drug metoprolol.

Zestril belongs to a group of drugs called angiotensin converting enzyme (ACE) inhibitors. Lopressor, on the other hand, belongs to a group of drugs called beta-blockers.

Uses

Here’s a list of conditions that the Food and Drug Administration (FDA) has approved Zestril and Lopressor to treat.

Drug forms and administration

Both Zestril and Lopressor come as tablets that you swallow.

You’ll likely take Zestril once each day, with or without food. But you’ll likely take Lopressor twice per day, either with food or shortly after eating.

Side effects and risks

Zestril and Lopressor both contain drugs that treat similar conditions. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with each drug, or with both Zestril and Lopressor (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Zestril, with Lopressor, or with both drugs (when taken individually).

* Zestril has a boxed warning for this side effect. A boxed warning is the most serious warning from the FDA. For more information, see the “Zestril and pregnancy” section below.

Effectiveness

Zestril and Lopressor have different FDA-approved uses, but they’re both used to treat high blood pressure and heart attack.

The use of Zestril and Lopressor in treating high blood pressure in adults has been directly compared in a clinical study. Researchers wanted to know if Zestril would lower blood pressure as well as Lopressor did. In this study, Zestril lowered blood pressure about the same amount as Lopressor did. However, the exact blood pressure measurements from adults in this study wasn’t reported.

Costs

Zestril and Lopressor are both brand-name drugs. Zestril is also available as a generic drug called lisinopril. Lopressor is also available as a generic drug called metoprolol. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

According to estimates on GoodRx.com, brand-name Zestril costs significantly more than brand-name Lopressor. Generic Zestril and generic Lopressor generally cost about the same. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Like Lopressor, discussed above, other medications are prescribed for similar uses as Zestril. Here we look at how Zestril and Diovan are alike and different.

Ingredients

Zestril contains the active drug lisinopril, while Diovan contains the active drug valsartan.

Zestril belongs to a group of drugs called angiotensin converting enzyme (ACE) inhibitors. Diovan belongs to a group of drugs called angiotensin II receptor blockers (ARBs).

Uses

Both Zestril and Diovan are FDA-approved to:

Drug forms and administration

Both Zestril and Diovan come as tablets that you swallow.

You’ll likely take Zestril once each day. However, you’ll likely take Diovan once or twice per day.

Side effects and risks

Zestril and Diovan both contain drugs that treat similar conditions. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with each drug, or with both Zestril and Diovan (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Zestril, with Diovan, or with both drugs (when taken individually).

* Both Zestril and Diovan have a boxed warning for this side effect. A boxed warning is the most serious warning from the FDA. For more information, see the “Zestril and pregnancy” section below.

Effectiveness

The only conditions both Zestril and Diovan are used to manage are:

  • high blood pressure
  • heart failure
  • heart attack

These drugs haven’t been directly compared in clinical studies. But separate studies have found both Zestril and Diovan to be effective for these conditions.

Costs

Zestril and Diovan are both brand-name drugs. Zestril is available as a generic drug called lisinopril. Diovan is available as a generic drug called valsartan. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

According to estimates on GoodRx.com, the cost of treatment with either or Diovan will vary based on the condition you’re treating. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Using more than the recommended dosage of Zestril can lead to serious side effects. Do not use more Zestril than your doctor recommends.

Overdose symptoms

Symptoms of a Zestril overdose can include low blood pressure.

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

There aren’t any known interactions between Zestril and alcohol. However, drinking alcohol can cause dizziness and low blood pressure. And dizziness and low blood pressure are also possible side effects of Zestril. So drinking alcohol while taking Zestril can raise your risk for having these side effects. (For more information, see the “Zestril side effects” section above.)

If you drink alcohol, talk with your doctor about an amount that’s safe for you to drink while you’re taking Zestril.

Zestril can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Zestril and other medications

Below are lists of medications that can interact with Zestril. These lists don’t contain all the drugs that may interact with Zestril.

Before taking Zestril, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Zestril and diuretics

Taking Zestril with medications called diuretics can increase your risk for low blood pressure. But keep in mind that diuretics are often used with Zestril to treat high blood pressure.

If you take these medications together, your doctor will closely monitor your blood pressure. If your blood pressure gets too low, they may change your dosage of Zestril, the diuretic, or both.

In addition, certain diuretics cause your body to hold on to more potassium than other diuretics do. Taking Zestril with these diuretics can increase your risk for high potassium levels. (For more information, see the “Zestril side effects” section above.)

Examples of these diuretics include:

Before starting Zestril, be sure to tell your doctor about any diuretics you’re taking.

Zestril and drugs used to treat diabetes

Taking Zestril with drugs that are used to treat diabetes can increase the ability of diabetes drugs to lower your blood sugar level. So taking Zestril may increase your risk for low blood sugar if it’s taken with diabetes drugs.

Examples of medications used to treat diabetes include:

If you’re taking diabetes medications, talk with your doctor about the risks and benefits of using Zestril.

Zestril and drugs that affect the kidneys

Problems with kidney function is a possible side effect of Zestril. So taking other medications that also affect your kidney function can increase the risk of this side effect even more.

In addition, if these drugs are taken together, you may also have a higher risk for low blood pressure and high potassium levels.

Examples of pain medications that can affect your kidney function include:

And examples of blood pressure medications that can affect your kidney function include:

If you take any of these medications with Zestril, your doctor may sometimes order kidney function tests to check how your kidneys are working. Your doctor may also check your blood pressure and potassium levels more often than usual during treatment.

If you take any of these medications, be sure to tell your doctor before starting Zestril.

* This drug should be avoided in people who are taking Zestril and who have diabetes.

Zestril and lithium

Taking Zestril with lithium can increase your blood lithium levels. (Lithium is sometimes used in people with bipolar disorder.)

Make sure your doctor knows if you take lithium before starting Zestril. They’ll want to monitor your lithium levels more closely.

Zestril and gold injections

Taking Zestril while receiving gold injections* may cause the following reactions:

If you receive gold injections, tell your doctor before you start taking Zestril. They may recommend a treatment option other than Zestril for you.

* Gold injections are used to treat conditions such as rheumatoid arthritis (RA).

Zestril and mTOR inhibitors

If you take Zestril with medications called mTOR inhibitors, you may have an increased risk for angioedema with Zestril. (With angioedema, you have rapid, severe swelling that forms underneath your skin.) For more information about this side effect, see the “Zestril side effects” section above.

Examples of mTOR inhibitors include:

  • everolimus (Afinitor), which is used to treat cancer
  • sirolimus (Rapamune), which is used after organ transplants
  • temsirolimus (Torisel), which is used to treat cancer

If you take any of these medications, tell your doctor before you start using Zestril.

Zestril and neprilysin inhibitors

Taking Zestril with medications called neprilysin inhibitors can increase your risk for angioedema with Zestril. (With angioedema, you have rapid, severe swelling that forms underneath your skin.) For more information about this side effect, see the “Zestril side effects” section above.

The heart failure drug sacubitril/valsartan (Entresto) is an example of a neprilysin inhibitor.

If you take a neprilysin inhibitor, be sure to tell your doctor before you start using Zestril.

Zestril and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Zestril. However, you should still check with your doctor or pharmacist before using any of these products while taking Zestril.

Zestril and foods

There aren’t any foods that have been specifically reported to interact with Zestril. If you have any questions about eating certain foods with Zestril, talk with your doctor.

Zestril comes as a tablet that you swallow. You should take Zestril according to your doctor’s or healthcare provider’s instructions.

When to take

You can take Zestril at any time of day. But it’s important to take Zestril at the same time each day.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Taking Zestril with food

You can take Zestril with or without food.

Can Zestril be crushed or split?

Zestril tablets can be crushed and made into a liquid suspension that you can take by mouth. Or the tablets can be split in half before they’re taken.

If you have trouble swallowing Zestril tablets, talk with your doctor or pharmacist. They may suggest other ways to take this drug.

Zestril is approved to:

Zestril belongs to a group of drugs called angiotensin converting enzyme (ACE) inhibitors. These drugs work by inhibiting (blocking) the action of ACE in your body. ACE is responsible for converting a hormone called angiotensin I into a different hormone called angiotensin II.

Angiotensin II causes your blood vessels to narrow. And narrow blood vessels cause an increase in blood pressure. Angiotensin II also causes your body to hold on to more water than usual, which can increase both your blood pressure and the amount of work your heart has to do.

By blocking ACE, Zestril prevents angiotensin I from being converted into angiotensin II. Without angiotensin II, your blood vessels can stay widened. And your body can get rid of water like usual.

By doing these things, Zestril increases the amount of blood that flows to your heart, helping to both:

  • lower your blood pressure
  • decrease the amount of work your heart has to do

How long does it take to work?

The amount of time it takes for Zestril to work can depend on your dosage of the drug and the condition being treated.

It may take several weeks for you to notice that Zestril has lowered your blood pressure or improved your symptoms of heart failure. On the other hand, you may not notice any effects of Zestril if you’re taking it to reduce your risk for death after a heart attack.

It’s important to keep taking Zestril even if you aren’t noticing any effects of the drug.

If your condition doesn’t improve after several weeks of treatment, your doctor may increase your dosage of Zestril. (For more information on dosing, see the “Zestril dosage” section above.)

It isn’t safe to use Zestril during pregnancy. In fact, Zestril has a boxed warning regarding the risk of using this drug during pregnancy. A boxed warning is the strongest warning required by the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.

Zestril can cause harm to a developing fetus if it’s used during pregnancy. Using the drug during pregnancy can lead to low levels of amniotic fluid. And this can cause skeletal deformities and lung problems for the fetus. In addition, using Zestril during pregnancy can also result in a miscarriage.

Stop taking Zestril and tell your doctor right away if you become pregnant while using this drug. And if you’re considering becoming pregnant, talk with your doctor about treatment options other than Zestril.

It isn’t safe to take Zestril during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Zestril.

For more information about taking Zestril during pregnancy, see the “Zestril and pregnancy” section above.

It’s recommended that you don’t breastfeed while you’re using Zestril.

Animal studies have shown that Zestril may pass into the breast milk of females taking the drug. Keep in mind that animal studies don’t always predict what will happen in humans. But it’s best to avoid breastfeeding while taking this drug because it may have an effect on a child who’s breastfed.

If you’re breastfeeding or planning to breastfeed while taking Zestril, talk with your doctor about the risks and benefits.

This drug comes with several precautions.

FDA Warning: Risks if used during pregnancy

This drug has a boxed warning regarding its use during pregnancy. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.

If used during pregnancy, Zestril may cause harm to a developing fetus. The drug may also lead to miscarriage if it’s taken during pregnancy. For more information about these risks, see the “Zestril and pregnancy” section above.

Other precautions

Before taking Zestril, talk with your doctor about your health history. Zestril may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Dialysis. Taking Zestril while receiving a certain type of dialysis can cause a severe reaction that’s similar to an allergic reaction. Be sure to tell your doctor if you’re using dialysis before you start taking Zestril. They can help you decide if you need to use either a different type of dialysis or a different drug to treat your condition.
  • Heart disease. Tell your doctor about any heart disease you may have before starting Zestril. Heart disease can increase your risk for low blood pressure as a side effect of Zestril. (For more information, see the “Zestril side effects” section above.) If you have heart disease and take Zestril, your doctor may want to check your blood pressure more often than usual during treatment.
  • Kidney disease. Having kidney disease while using Zestril can increase your risk for low blood pressure as a side effect of Zestril. You may also have sudden problems with kidney function as a side effect of this drug. (For more information, see the “Zestril side effects” section above.) Your doctor may want to check your blood pressure and kidney function more often than usual if you have kidney disease and take Zestril.
  • Diabetes. If you have diabetes and use diabetes medications, taking Zestril with these drugs can increase your risk for low blood sugar. For more information about this, see the “Zestril interactions” section above. Before starting Zestril, be sure to tell your doctor if you’re using diabetes medications.
  • Low sodium levels. Having low sodium levels can increase your risk for low blood pressure as a side effect of Zestril. (For more information, see the “Zestril side effects” section above.) If you have low sodium and you take Zestril, your doctor may want to check your blood pressure more often than usual. They may also want to try to increase your sodium levels.
  • Surgery. Receiving anesthesia during surgery can lower your blood pressure. If you take Zestril around the time you receive anesthesia, it may be difficult to increase your blood pressure after the anesthesia is stopped. Be sure to tell your doctor or surgeon that you use Zestril before having surgery. Knowing this will help them to better manage your recovery after surgery.
  • History of angioedema. You shouldn’t take Zestril if you have a history of angioedema that occurred for any reason. This includes angioedema that happened after taking a different type of angiotensin converting enzyme (ACE) inhibitor. Having a history of angioedema can raise your risk for having angioedema with Zestril. Be sure to tell your doctor if you’ve ever experienced angioedema.
  • Allergic reaction. If you’ve had an allergic reaction to Zestril or any of its ingredients, you shouldn’t take Zestril. Ask your doctor what other medications are better options for you.
  • Pregnancy. Zestril shouldn’t be used during pregnancy. In fact, Zestril has a boxed warning* regarding the risk of using this drug during pregnancy. For more information, please see the “Zestril and pregnancy” section above.
  • Breastfeeding. It isn’t recommended to use Zestril while breastfeeding. For more information, please see the “Zestril and breastfeeding” section above.

Note: For more information about the potential negative effects of Zestril, see the “Zestril side effects” section above.

* A boxed warning is the most serious warning from the FDA. Boxed warnings alert doctors and patients about drug effects that may be dangerous.

When you get Zestril from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Zestril tablets should be stored at room temperature between 68°F and 77°F (20°C and 25°C). It should be kept in a tightly sealed container. Avoid storing this medication in areas where it could get damp or wet, such as bathrooms.

Disposal

If you no longer need to take Zestril and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

The following information is provided for clinicians and other healthcare professionals.

Indications

Zestril is approved for the treatment of hypertension in adults and in children ages 6 years and older. It is also approved for use in adults as adjunct therapy for heart failure and for the reduction of mortality after heart attack.

Administration

Zestril is taken orally with or without food. It’s typically taken once daily.

Mechanism of action

Zestril works by inhibiting the angiotensin-converting enzyme (ACE). ACE stimulates the conversion of angiotensin I to angiotensin II.

Angiotensin II is responsible for vasoconstriction and stimulation of the adrenal cortex, resulting in increased blood pressure and fluid retention. By inhibiting ACE, Zestril prevents the conversion of angiotensin I to angiotensin II, thereby lowering blood pressure and reducing fluid retention.

Pharmacokinetics and metabolism

In adults, Zestril reaches peak serum concentrations within 7 hours of administration. In children, Zestril reaches peak plasma concentrations within 6 hours of administration.

In both adults and children, Zestril has an estimated half-life of 12 hours. The drug is not metabolized; it is excreted unchanged into the urine.

Elimination is affected by reduced renal function and becomes clinically significant when the glomerular filtration rate is < 30 mL/min.

Contraindications

Zestril is contraindicated under the following conditions:

  • combined use with a neprilysin inhibitor, such as sacubitril*
  • combined use with aliskiren (Tekturna) in people with diabetes
  • use in people with a history of angioedema or allergic reaction involving another ACE inhibitor
  • use in people with a history of any angioedema or with hereditary angioedema (HAE)

* Zestril administration should also be avoided within 36 hours of switching to or from sacubitril/valsartan (Entresto).

Storage

Zestril should be stored at room temperature between 68°F and 77°F (20°C and 25°C). The drug should be kept a tightly sealed container and should be protected from moisture.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.