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Home / High Blood Pressure / Understanding and managing the side effects of ACE inhibitors

Understanding and managing the side effects of ACE inhibitors

Discover the most common side effects of drugs like Lisinopril and Ramipril and how to manage them

High blood pressure can lead to heart disease, diabetes and stroke among other medical conditions. Because of this, managing blood pressure levels is important.

Angiotensin-converting enzyme (ACE) inhibitors are medicines that reduce blood pressure levels. ACE inhibitors help lower blood pressure by relaxing blood vessels and keeping the blood pressure within a healthy range. They may also be used after you experience a heart attack or heart failure.

However, side effects can occur. Continue reading this article to learn what these are, how to best prevent and manage them, and when to see a doctor about them.

an image of ramipril and a blood pressure monitor

The below is a list of ACE inhibitors:

  • Ramipril (Altace)
  • Lisinopril (Zestril)
  • Benazepril (Lotensin)
  • Captopril
  • Enalapril (Vasotec)
  • Fosinopril
  • Moexipril
  • Perindopril
  • Quinapril
  • Trandolapril

What are the most common side effects of ACE inhibitors and how can I manage them?

The most common side effects are rarely a cause for concern, but they may be affecting your daily life. Here are the most common side effects and ways you can manage them.

The most common ACE Inhibitors side effects:

  • dry cough
  • dizziness or blurred vision, and fainting
  • headaches
  • tiredness

Dry cough

A persistent dry cough is the most common side effect of ACE inhibitors like Lisinopril and Ramipril, affecting around 10-20% Trusted source National Center for Biotechnology Information (NCBI) Government Source Biomedical Research and Literature Go to source of users.

image of a young man coughing

It is common to experience a persistent cough that doesn’t go away until treatment is stopped. However, it is not recommended to stop taking treatment unless your GP has advised you to do so.

While NSAIDs like ibuprofen and naproxen (Aleve) may seem like the right solution, they are not effective. This study Trusted source PubMed Government Source Database of Biomedical Research Go to source shows that the use of ACE inhibitors with NSAIDs together can cause significant kidney damage, while this study shows that NSAIDs can reduce the effectiveness of ACE inhibitors on blood pressure.

If you're not sure what medications you can take with ACE inhibitors, you must talk to your doctor or healthcare provider.

If you stop taking ACE inhibitors, the cough should go away within one to four days. However, it may take a month or longer for the cough to disappear completely. If you resume treatment after the cough goes away, or switch medication, the cough is highly likely to come back.

Research into ACEI-induced coughs has not found a reliable solution for this side effect other than stopping treatment. However, you may find some relief with a warm cup of herbal tea, or by making sure not to shout, yell or sing while being treated with ACE inhibitors.

Ways to manage a dry cough

Dry cough:

  • Drink warm, herbal tea to soothe your throat
  • Use a humidifier to add moisture to the air
  • Avoid shouting or singing which can aggravate the cough

Dizziness or blurred vision, and fainting

Another side effect of ACE inhibitors is feeling dizzy and, in some cases, even fainting. This is because your blood pressure is being lowered by the drug, and your body may need time to adjust. Dizziness affects 12-19% Trusted source National Center for Biotechnology Information (NCBI) Government Source Biomedical Research and Literature Go to source of people.

image of a young woman fainting in a pharmacy

If you begin to feel faint or dizzy, you should sit down straight away or find a place to lie down if possible.

Make sure to drink plenty of fluids and eat enough food when you are taking one of these medicines. Certain foods are better to eat than others when dealing with high blood pressure.

To prevent lightheadedness from occurring, you could take your ACE inhibitor before you go to bed and after you have eaten. However, you should discuss this with your doctor or healthcare provider before changing how you take your medication.

Feeling dizzy and fainting may be signs of low blood pressure (hypotension). If your blood pressure drops too low when taking ACE inhibitors, then your doctor may reduce your dosage or suggest a different blood pressure medication.

If you often feel faint, light-headed, or have blurred vision, then you should seek emergency help.

Ways to manage dizziness

Here are some ways to manage dizziness, blurred vision and fainting:

  • Drink at least 8 glasses of water per day
  • Sit or lie down immediately if you feel dizzy
  • Avoid standing up too quickly from a seated or lying position


Lisinopril in particular is used in some cases Trusted source The BMJ Peer-reviewed Journals Medical Research Go to source to treat migraines. However, some people report headaches as a result of taking these drugs.

image of a young man in an office with a headache

If you experience headaches when taking your ACE inhibitor, you should be wary of anti-inflammatory pain medication such as ibuprofen and naproxen, as these may affect the way drugs like lisinopril and ramipril work.

Make sure to rest and drink plenty of fluids. If the headache doesn’t go away or is severe, then paracetamol is safe to take. However, always consult your doctor before using medications together.

Talk to your doctor about your headaches if they don’t go away or are unmanageable. He may suggest alternative blood pressure medication.

Ways to manage headaches

If you experience migraines or a severe headache, there are some home remedies you could try recommended by our doctors:

Tiredness and fatigue

Some people feel more tired than usual when on ACE inhibitors. This could be a result of blood pressure going too low or could be less effective blood circulation while your body gets used to the medication.

image of a tired man at work

Fatigue can make you less hardworking, and unable to complete the tasks you normally would.

Light-to-moderate exercise can help with tiredness and fatigue by getting your blood flowing more effectively. However, exercises where you are bending and rising quickly should be avoided.

Stress may also cause you to become tired and fatigued. If you feel stressed, try these activities as a way to calm yourself down:

  • Yoga or Tai Chi
  • Listening to music
  • Reading
  • Spending time with friends and family
  • Meditation

You should consult with your doctor if you feel tired or fatigued. If your blood pressure is too low because of the medication, then he may lower your dose or suggest alternative treatment.

Ways to manage fatigue

Here are some easy ways to manage fatigue:

  • Engage in light exercise like walking to boost your energy levels
  • Ensure you are getting at least 7-8 hours of sleep every night
  • Practice stress-relief techniques like yoga or meditation

What serious side effects are there?

It doesn’t happen often, but some people may experience side effects of ACE inhibitors that are serious and require immediate or emergency care. Here is a list of more serious side effects and what they could be a sign of.

Serious side effects: Could be a sign of: What to do:
The whites of your eyes or skin turn yellow Liver problems Consult a doctor immediately
Swollen ankles, blood in your pee or you’re not peeing Kidney disease Consult a doctor immediately
Feeling faint and/or unexpected bleeding Blood or bone marrow disorder Consult your doctor immediately
Diarrhoea and/or vomiting Hyperkalemia (high levels of potassium) Consult your doctor immediately
Inflamed face, shortness of breath, or a skin rash An allergic reaction to the drug (anaphylaxis) Seek emergency help
Face or throat swelling Angioedema Seek emergency help
Severe stomach pain Inflamed pancreas (acute pancreatitis) Seek emergency help

When should I consult with my doctor?

If you experience any of the serious side effects listed above, you must consult your doctor for treatment. If you feel it is an emergency, then you may require immediate medical attention. In this case, call your local emergency number or go to your nearest A&E.

Your doctor may suggest trying another medication or can prescribe you additional medication to take alongside your ACE inhibitor. Your doctor may also suggest stopping treatment or lowering your dose.

What alternative medications are there?

Your doctor may recommend other types of blood pressure medication if you are unable to manage the side effects of ACE Inhibitors. These include the following:

  • Angiotensin receptor blockers (ARBs)
  • Calcium blockers (such as Amlodipine)
  • Diuretics (such as Bendroflumethiazide)
  • Beta-blockers
  • Alpha-blockers

Who should not take ACE Inhibitors?

Who should NOT take ACE inhibitors?
  • Those who have had angioneurotic oedema
  • Those who are pregnant
  • Those with renal artery stenosis
  • Those with an allergy to ACE inhibitors

There are some people who should avoid taking ACE Inhibitors. If any of the following apply to you, you should ask your doctor or pharmacist for alternative treatment for high blood pressure.

  • Those who have had angioedema
  • Those who are pregnant
  • Those with renal artery stenosis
  • Those with a previous allergy to ACE Inhibitors

Want to learn more about blood pressure treatments?

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Medically reviewed by Dr. Caroline Fontana Written by our editorial team Last reviewed 14-06-2024
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