8 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 first-choice treatments for a variety of heart-related health conditions, including high blood pressure, heart failure, and chronic kidney disease (CKD).

Lisinopril (Zestril, Qbrelis) is the most commonly prescribed ACE inhibitor in the U.S. But it isn’t the best fit for everyone. Fortunately, there are many other medications to choose from. Let's discuss seven lisinopril alternatives to consider.

1. Other ACE inhibitors

There are many ACE inhibitors available. If lisinopril is working well but causing bothersome side effects, another ACE inhibitor may be worth a try.

Other common ACE inhibitors include:

• Enalapril (Vasotec, Epaned)

• Ramipril (Altace)

• Benazepril (Lotensin)

• Quinapril (Accupril)

• Captopril

• Fosinopril

ACE inhibitors all work the same way. They also have similar side effects, such as 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). But some studies show that quinapril may be better tolerated than other ACE inhibitors.

Talk to your prescriber about whether another ACE inhibitor might be a better fit for you than lisinopril. Keep in mind that if you experience angioedema or an allergic reaction from lisinopril, it’s likely best to avoid ACE inhibitors altogether.

2. Angiotensin II receptor blockers

Another possible lisinopril alternative is a class of blood pressure medications called angiotensin II receptor blockers (ARBs). Similar to ACE inhibitors, ARBs are preferred medications for treating high blood pressure and other heart-related conditions.

Common ARBs include:

• Losartan (Cozaar)

• Irbesartan (Avapro)

• Valsartan (Diovan) 

ACE inhibitors and ARBs share many similarities. ARBs work on the same pathway in the body that ACE inhibitors do, they just target 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.

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 lisinopril due to side effects, such as an ACE inhibitor-induced cough.

Of course, ARBs have side effects of their own. 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, so they may be a lisinopril alternative for some people.

Notable CCBs include:

• Diltiazem (Cardizem)

• Verapamil

• Amlodipine (Norvasc, Katerzia) 

CCBs work differently than ACE inhibitors. 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 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. Also, some ACE inhibitor side effects, such as angioedema, are more common in Black adults. So CCBs are a safer alternative to lisinopril for this population.

CCBs are a lisinopril alternative 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. Diuretics

Diuretics (water pills) are another possible lisinopril alternative. There are several types of diuretics, but thiazide and thiazide-like diuretics are the ones that are typically prescribed for high blood pressure. Two examples are hydrochlorothiazide and chlorthalidone (Thalitone).

Loop diuretics are another type of diuretic sometimes used to manage high blood pressure. Examples include furosemide (Lasix), torsemide, and bumetanide (Bumex). These water pills are most skilled at removing fluid from the body, 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: These aren’t very good at lowering blood pressure or swelling on their own. They’re typically used in combination with other blood pressure medications. Spironolactone (Aldactone) and eplerenone (Inspra) are common examples.

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. But they can help prevent low potassium levels caused by other diuretics.

5. Beta blockers

Beta blockers are another possible alternative to lisinopril and other ACE inhibitors. Common beta blockers include:

• Carvedilol (Coreg)

• Metoprolol (Lopressor)

• Atenolol (Tenormin).

In general, beta blockers aren’t used to manage blood pressure as often as ACE inhibitors. In fact, some evidence shows that beta blockers 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. Beta blockers may also worsen breathing problems in people with respiratory conditions like asthma.

That said, beta blockers can be effective medications for people who experience angina, or chest pain. Labetalol is a go-to beta blocker for managing high blood pressure during pregnancy.

6. Baxfendy

If lisinopril isn’t working well to control your blood pressure, your prescriber may decide to add another medication to help. Often, you’ll start with one of the medications described above. But if your blood pressure still needs managing, your prescriber may add Baxfendy (baxdrostat). Baxfendy is an add-on treatment that can help manage high blood pressure that hasn’t responded well to other medications.

Possible Baxfendy side effects include high potassium levels and low sodium levels. So your prescriber may keep a closer eye on these electrolytes if you add Baxfendy to your treatment regimen. 

7. Alpha blockers

Alpha blockers are occasionally prescribed as alternatives to lisinopril. Examples include:

• Doxazosin (Cardura)

• Prazosin (Minipress)

• Tamsulosin (Flomax)

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 low blood pressure, weakness, and changes in heart rate. 

Alpha blockers are often prescribed to men living with benign prostatic hyperplasia (BPH), an enlarged prostate. Alpha blockers work to relax this tissue. So these medications can be effective lisinopril 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.

8. 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 a preferred blood pressure medication. But it does have fewer side effects compared to lisinopril and some other blood pressure medications. However, people who are pregnant, have diabetes, or are already taking an ACE inhibitor or ARB should avoid aliskiren.

The list doesn’t stop there. Additional lisinopril alternatives, such as clonidine (Catapres TTS) and hydralazine, are also available. Your prescriber can help you find the right fit for your needs.

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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:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Ferras Bashqoy, PharmD, BCCCP, BCPPS

Ferras Bashqoy, PharmD, BCCCP, BCPPS, is a clinical pharmacotherapy specialist in the Neonatal Intensive Care Unit at Hassenfeld Children’s Hospital in NYC. He enjoys working with preterm newborns, as they are small but mighty.

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