Key takeaways:
Angiotensin-converting enzyme (ACE) inhibitors are a class of blood pressure medications that can also treat heart failure and kidney disease. While these medications are similarly effective, they have some notable differences.
Lisinopril (Zestril, Qbrelis), benazepril (Lotensin), and enalapril (Vasotec, Epaned) are three of the most commonly prescribed ACE inhibitors. Ramipril (Altace), captopril, and quinapril (Accupril) are other examples of ACE inhibitors.
There are ways to save on ACE inhibitors. Most options are available as lower-cost generics or have copay savings opportunities. A GoodRx coupon may also be able to help make your prescription more affordable.
Save on related medications
If you’re living with a health condition like high blood pressure, heart failure, or chronic kidney disease (CKD), there’s a good chance you’re taking an angiotensin-converting enzyme (ACE) inhibitor. These medications are among the most commonly prescribed in the U.S. And they’re recommended as first-choice treatment options for a variety of heart-related conditions.
Even if you’re not currently taking an ACE inhibitor, you’re likely familiar with common medications in this class, such as lisinopril (Zestril, Qbrelis). Below, we dive into more details about this ACE inhibitor and others.
What are ACE inhibitors and how do they work?
ACE inhibitors are best known by many people as blood pressure medications. That’s because all medications in this class are FDA approved to treat hypertension (chronic high blood pressure). They work by blocking ACE, a protein that changes the hormone angiotensin I into angiotensin II.
Angiotensin II tightens blood vessels. A certain amount of angiotensin II is necessary for balancing blood pressure. But too much can contribute to hypertension and potentially lead to heart or kidney problems in the long run.
ACE inhibitors lower the amount of angiotensin II in the body. This helps relax the blood vessels and take stress off the heart and kidneys.
Read these personal accounts. Three people share their experiences with taking lisinopril, a beneficial medication for many people at risk for heart attacks or strokes.
Know what to expect with ACE inhibitors. Pharmacists review eight things to know about ACE inhibitors, so you can get the most out of your medication.
Find out about possible side effects. Learn about seven of the most common ACE inhibitor side effects — from a cough to high potassium — and how to manage them.
Examples of ACE inhibitors
Below is a list of ACE inhibitors that are currently available in the U.S.:
Lisinopril
Benazepril (Lotensin)
Enalapril (Vasotec, Epaned)
Enalaprilat (injectable form of enalapril)
Ramipril (Altace)
Captopril
Quinapril (Accupril)
Fosinopril
Perindopril
Trandolapril
Moexipril
Some ACE inhibitors are more commonly prescribed than others. Below, we discuss six common ACE inhibitors on this list in more detail.
Good to know: ACE inhibitors are also available in combination with other blood pressure medications, such as diuretics (“water pills”). For more information, check out this GoodRx Health article on some of the most common combination blood pressure pills.
1. Lisinopril
Lisinopril is the most commonly prescribed ACE inhibitor in the U.S. It’s available as an oral tablet and an oral liquid. Typically, lisinopril dosages range from 5 mg to 40 mg once a day. It’s ideal to take lisinopril at the same time each day, and it can be taken with or without food.
Lisinopril is FDA approved to treat hypertension in adults and children age 6 and older. It’s also approved to treat heart failure in adults and help lower the risk of death after a heart attack. While it’s often prescribed for CKD — including kidney disease in people with diabetes — this is an off-label use. But taking it for kidney protection is recommended by experts and strongly supported by clinical evidence.
Read more like this
Explore these related articles, suggested for readers like you.
2. Benazepril
Another common ACE inhibitor, benazepril is also usually taken once a day. Typical dosages range from 10 mg to 40 mg per day. But some people may take up to 80 mg per day. You can take this medication with or without food.
Benazepril is approved to treat hypertension in adults and children age 6 and older. It has no other FDA-approved uses. But it’s sometimes prescribed off-label for heart failure.
While benazepril doesn’t come in a liquid form, the manufacturer provides a recipe that pharmacists can follow to make a liquid version. This can be helpful for people who have trouble swallowing pills. But, more importantly, it’s necessary for making the medication available to smaller children. Children’s benazepril dosages are based on their body weight and may require doses that aren’t commercially available.
3. Enalapril
Enalapril can be taken once or twice a day with or without food. In addition to being available as an oral tablet, enalapril also comes as an oral liquid. What’s more, enalapril tablets can be made into a liquid by a compounding pharmacy. This could be helpful if the commercially manufactured liquid is unavailable or if someone is allergic to an inactive ingredient in it.
Enalapril is approved to treat hypertension in adults and children who are 1 month and older. It’s also approved to treat heart failure and asymptomatic left ventricular dysfunction (ALVD) in adults.
ALVD is a condition in which one chamber of the heart isn’t working as expected but a person doesn’t have heart failure. ALVD often leads to people developing heart failure in the future. And enalapril is approved to help lower the risk of this happening.
4. Ramipril
Ramipril is available as an oral capsule. Typically, ramipril dosages range from 2.5 mg to 20 mg per day. You may take the medication once or twice a day, depending on why you’re taking it. But you can take it without regard to meals.
Ramipril is approved to treat hypertension and heart failure after a heart attack in adults. Unlike the ACE inhibitors listed above, it’s not approved for use in children.
If you’re having trouble swallowing ramipril capsules, there are ways to make the process easier. You can open up the capsules and sprinkle the contents on applesauce. You can also mix the contents with about 4 oz (½ cup) of water or apple juice. This flexibility with taking the medication makes ramipril unique among ACE inhibitors.
Interesting fact: Ramipril made medical history in 2000 when the Heart Outcomes Prevention Evaluation (HOPE) study was published. This was the first study that showed that an ACE inhibitor can lower the risk of heart attack, stroke, and cardiovascular death in people at risk for these events. The HOPE study changed the way ACE inhibitors are prescribed and is still referenced today by expert organizations when they provide guidance for treating hypertension and other heart conditions.
5. Captopril
Captopril comes as an oral tablet that’s taken 2 or 3 times a day. Typical dosages of captopril range from 25 mg to 150 mg daily. You should take captopril on an empty stomach at least 1 hour before meals.
Captopril is approved to treat hypertension, chronic heart failure, and heart failure after a heart attack. It’s also approved to treat kidney disease related to diabetes. It’s only approved for use in adults.
Captopril is less prescribed than other ACE inhibitors on this list. That’s likely because it needs to be taken more frequently and has to be separated from meals.
6. Quinapril
Quinapril comes as an oral tablet. You can take it once or twice a day, with or without food. Typically, quinapril dosages ranges from 5 mg to 80 mg per day.
Quinapril is approved to treat hypertension and heart failure in adults. Some studies suggest people may tolerate quinapril better than some other ACE inhibitors. But generally speaking, all ACE inhibitors have similar risks and side effects. These side effects include dizziness, a dry cough, and elevated blood potassium levels.
Is there a best ACE inhibitor for high blood pressure?
There’s no “best” ACE inhibitor for treating high blood pressure. The medications in this class are similarly effective. But there are distinctions that set certain ACE inhibitors apart from others:
How frequently doses are taken: Many ACE inhibitors are taken once a day. But some, such as captopril, need to be taken more frequently.
How they are broken down in the body: The liver needs to activate most ACE inhibitors in order for them to work. Lisinopril and captopril don’t require this step. So they may be preferred if you have liver problems.
Different approved uses: As discussed above, all ACE inhibitors are approved to treat hypertension. But some are also approved to treat other health conditions, such as heart failure. Depending on your health history, your prescriber may prefer an ACE inhibitor that’s approved for multiple uses.
How to save on ACE inhibitors
There are many ways to save on ACE inhibitors, most of which are available as lower-cost generics. GoodRx can help you navigate your options, which may include GoodRx coupons, copay savings cards, and patient assistance programs. For example, you may be able to pay as little as $5 for your ACE inhibitor prescription with a free GoodRx coupon.
Here’s some additional ways your can save on a few brand-name ACE inhibitors:
Qbrelis: If you have commercial insurance, you may be eligible to pay as little as $30 per prescription for Qbrelis using a savings card from the manufacturer. If you’re uninsured or underinsured, you may be eligible for Qbrelis’ patient assistance program, which offers the medication free of cost.
Zestril: If you have commercial insurance, you may be eligible to pay as little as $28 per month for Zestril using a savings card from the manufacturer.
The bottom line
Some of the most commonly prescribed angiotensin-converting enzyme (ACE) inhibitors are lisinopril (Zestril, Qbrelis), benazepril (Lotensin), and enalapril (Vasotec, Epaned). Notable but less common ACE inhibitors include ramipril (Altace), captopril, and quinapril (Accupril). All medications in this class are similarly effective. But differences in dosage recommendations and what conditions the medications are approved to treat may make certain ACE inhibitors a better fit for you than others.
Why trust our experts?
References
American College of Cardiology Foundation. (2005). The Heart Outcomes Prevention Evaluation Study - HOPE - Ramipril.
Ascend Laboratories, LLC. (2022). Enalapril maleate oral solution [package insert].
Aurobindo Pharma Limited. (2022). Lisinopril tablet [package insert].
Avet Pharmaceuticals Inc. (2024). Benazepril hydrochloride tablet [package insert].
Azurity Pharmaceuticals, Inc. (2023). Qbrelis - lisinopril solution [package insert].
Camber Pharmaceuticals, Inc. (2023). Captopril - captopril tablet [package insert].
Chartwell RX, LLC. (2023). Ramipril capsule [package insert].
ClinCalc DrugStats. (n.d.). Angiotensin converting enzyme (ACE) inhibitors. ClinCalc.com.
ClinCalc DrugStats. (n.d.). The top 200 of 2021. ClinCalc.com.
Dahal, S. S., et al. (2023). Benazepril. StatPearls.
Herman, L. L., et al. (2023). Angiotensin-converting enzyme inhibitors (ACEI). StatPearls.
Lupin Pharmaceuticals, Inc. (2023). Quinapril tablet [package insert].
Patel, P., et al. (2023). Angiotensin II. StatPearls.
Sara, J. D., et al. (2020). Asymptomatic left ventricle systolic dysfunction. European Cardiology Review.
Tandan, N., et al. (2022). Quinapril. StatPearls.
