7 Lisinopril Alternatives: Losartan, Amlodipine, and More

If you’re living with hypertension (high blood pressure), there’s a good chance you’ve been prescribed an angiotensin-converting enzyme (ACE) inhibitor. These medications are top treatments for a variety of heart-related health conditions, including high blood pressure, heart failure, and chronic kidney disease (CKD).

While there are a number of ACE inhibitors to choose from, some are more popular than others. The most commonly prescribed ACE inhibitor in the U.S. is lisinopril (Zestril, Qbrelis). It’s available as an oral tablet and oral liquid.

Many people benefit from taking lisinopril. But there are several reasons someone may need to take an alternative to it. Fortunately, there are many other medications to choose from. Let's discuss seven of these further.

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1. Other ACE inhibitors

There are many ACE inhibitors available aside from lisinopril. All ACE inhibitors are considered equally effective and manage blood pressure in the same way. They work by blocking ACE proteins to prevent the formation of angiotensin II.

Other common ACE inhibitors include:

• Enalapril (Vasotec, Epaned)

• Ramipril (Altace)

• Benazepril (Lotensin)

• Quinapril (Accupril)

• Captopril

• Fosinopril

Generally speaking, all ACE inhibitors are well tolerated and safe to take as prescribed. They carry the same risks and share similar side effect profiles. Common ACE inhibitor side effects include a dry cough, low blood pressure, and dizziness. Rare but serious side effects include high potassium levels and angioedema (swelling of the face, mouth, and neck). 

Some studies have shown, however, that quinapril may be better tolerated than other ACE inhibitors. If lisinopril isn’t working for you because of bothersome side effects, quinapril or another ACE inhibitor may be worth a try.

Qbrelis, another lisinopril dosage form

Lisinopril also comes as an oral liquid called Qbrelis. This form of lisinopril is a great alternative for children and adults who have difficulty swallowing pills. 

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2. Angiotensin II receptor blockers

Another common class of blood pressure medications is angiotensin II receptor blockers (ARBs). Common ARBs include losartan (Cozaar), irbesartan (Avapro), and valsartan (Diovan). Similar to ACE inhibitors, ARBs are preferred medications for treating high blood pressure and other heart-related conditions.

ACE inhibitors and ARBs share many similarities. ARBs work on the same pathway in the body that ACE inhibitors do; ARBs just work at a different spot. Evidence shows that these medication classes are similarly effective at regulating blood pressure and reducing the risk of heart-related health complications. They’re also taken in a similar manner: by mouth, 1 to 2 times daily.

One major difference between these classes is their side effects. ACE inhibitors tend to cause slightly more side effects than ARBs. This makes ARBs a possible alternative for people having a hard time tolerating ACE inhibitors due to side effects such as an ACE inhibitor-induced cough.

Of course, ARBs also have side effects. Common ARB side effects include dizziness, headaches, and tiredness.

3. Calcium channel blockers

Calcium channel blockers (CCBs) are another popular class of blood pressure medications. CCBs treat many of the same heart-related conditions as ACE inhibitors. Notable CCBs include diltiazem (Cardizem), verapamil, and amlodipine (Norvasc, Katerzia). 

CCBs work differently than ACE inhibitors, though. They prevent calcium from narrowing your arteries, allowing for more oxygen to get to your heart. This means they also cause different side effects, making them a possible choice if you’re finding it difficult to tolerate lisinopril.

CCBs are also considered to be preferred medications for treating high blood pressure in Black adults. High blood pressure is more common in this population and tends to be more severe at a younger age. CCBs are an alternative to lisinopril (and other ACE inhibitors) in Black adults because some ACE inhibitor side effects, such as angioedema, are more common.

CCBs are common blood pressure medications for pregnant women, too. ACE inhibitors and ARBs carry boxed warnings — the FDA’s strictest type of medication warning — for their potential to cause harm to a fetus if taken during pregnancy. Nifedipine (Procardia), a CCB, is a preferred blood pressure medication during pregnancy.

4. Beta blockers

Beta blockers (BBs) are another class of blood pressure medications. They’re potential alternatives to lisinopril and other ACE inhibitors. Common BBs include carvedilol (Coreg), metoprolol (Lopressor), and atenolol (Tenormin).

In general, these medications aren’t used as frequently to manage blood pressure as ACE inhibitors. In fact, some evidence shows that BBs don’t provide the same protection against strokes as other blood pressure medications. They can also cause side effects of their own, such as fatigue and a lower heart rate. They may also worsen breathing problems in people with respiratory conditions like asthma.

That said, BBs can be effective medications for people who experience angina, or chest pain. They’re also an option for managing high blood pressure during pregnancy. Labetalol is a go-to choice in this situation.

5. Diuretics

Diuretics (water pills) are another group of medications that can help manage high blood pressure. Several types of diuretics are available, but thiazide and thiazide-like diuretics are the ones that are typically prescribed for high blood pressure. Two examples are hydrochlorothiazide and chlorthalidone (Thalitone).

Another class of diuretics sometimes used to manage high blood pressure is loop diuretics. Examples are furosemide (Lasix), torsemide, and bumetanide (Bumex). These water pills are most skilled at removing fluid from the body, though, making them go-to choices for relieving edema (swelling).

Potassium-sparing diuretics are another group of water pills. There are two types of potassium-sparing diuretics: 

1. Aldosterone antagonists: Water pills such as spironolactone (Aldactone) and eplerenone (Inspra) aren’t very good at lowering blood pressure or swelling on their own. They’re typically used in combination with other blood pressure medications.

2. Epithelial sodium channel blockers: Medications in this group, such as amiloride (Midamor) and triamterene (Dyrenium), aren’t very effective when used on their own either. They can help prevent low potassium levels from other diuretics, though.

6. Alpha blockers

Alpha blockers are another group of blood pressure medications. They’re occasionally prescribed as alternatives to lisinopril. Doxazosin (Cardura), prazosin (Minipress), and tamsulosin (Flomax) are three common alpha blockers.

When they were first FDA approved in the 1970s and 1980s, alpha blockers were considered first-choice options for managing high blood pressure. Since then, their use has decreased. Generally speaking, these medications are considered second-choice options due to the risk of side effects. Low blood pressure, weakness, and changes in heart rate are all possible. 

Some people still benefit from their use, though. Alpha blockers are often prescribed to men who have benign prostatic hyperplasia (BPH), a condition involving tissue changes around the prostate. Alpha blockers work to relax this tissue. These medications can be effective alternatives for people who need dual treatment for BPH and high blood pressure. 

Alpha blockers are also frequently used in people who have resistant hypertension. This condition is defined as having high blood pressure despite taking at least three different blood pressure medications.

7. Other options

Some medications that manage blood pressure don’t fit into the medication classes above. 

One of these is aliskiren (Tekturna), which works on the same pathway as ACE inhibitors and ARBs. It’s not considered to be a preferred medication, but it does have less side effects compared to other blood pressure medications. However, it should be avoided in people who are pregnant, have diabetes, or are already taking an ACE inhibitor or ARB. 

Some blood pressure medications are available as combination products. Most combination pills pair an ACE inhibitor, such as lisinopril, or ARB with a thiazide diuretic. One example is Zestoretic. These medications can be convenient options if you’re taking two or more blood pressure medications.

The list doesn’t stop there. Additional alternatives, such as clonidine (Catapres TTS) and hydralazine, are also available.

Why trust our experts?

Written by:

Cassandra Pardini, PharmD, MS

Cassandra Pardini has been a freelance medical writer for 7 years. In that time, she has concentrated on publishing articles on medication-related information for healthcare professionals and patients.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Ferras Bashqoy, PharmD, BCCCP, BCPPS

Ferras Bashqoy, PharmD, BCCCP, BCPPS, is a clinical pharmacotherapy specialist in the Neonatal Intensive Care Unit (NICU) at Hassenfeld Children’s Hospital in New York City. His favorite part of the job is working with preterm newborns because they are strong and mighty despite their size.

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