Zestril (Lisinopril) for Heart Disease

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Zestril (lisinopril) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat systolic heart failure (a type of heart failure) and reduce the risk of death after a heart attack in certain people.

What Members Say

These insights are based on 60 comments about Zestril from MyHeartDiseaseTeam members. These are the experiences of a small number of people and are not meant to be medical advice.

Benefits:

Helps lower blood pressure and keep readings stable for some.
Fits into a once-daily routine, although doses may be adjusted.
May support heart failure treatment as an add-on to diuretics and other therapies.

Considerations:

Dizziness and lightheadedness can occur, especially when starting treatment or changing doses.
A dry cough may develop and be bothersome during the day and at night.
Kidney function and potassium levels need monitoring during treatment.

How Zestril Works and How It’s Taken

Zestril is a type of medication called an angiotensin-converting enzyme (ACE) inhibitor. It blocks a substance in the body that causes blood vessels to tighten. This helps blood vessels relax and lowers blood pressure.

In people with high blood pressure, this can reduce strain on the heart and lower the risk of stroke and heart attack.

Doctors prescribe Zestril when people have systolic heart failure, a condition in which the heart cannot pump blood as well as it should. Zestril can reduce the signs and symptoms of the condition. Doctors also prescribe Zestril to reduce the risk of death after an acute myocardial infarction (heart attack) in people whose blood pressure and blood flow are stable within 24 hours of the attack.

Zestril comes as a tablet taken by mouth, usually once daily. The recommended dosing schedule depends on whether Zestril is being used for heart failure or after a heart attack.

Typical Dosing for Heart Failure

The recommended starting dose is 5 milligrams once daily when Zestril is used with diuretics (water pills) and usually a medicine called digitalis.
For people with low blood sodium (below 130 milliequivalents per liter), the recommended starting dose is 2.5 milligrams once daily.
A doctor may gradually increase the dose, depending on how well the person tolerates it, up to a maximum of 40 milligrams once daily.
A doctor may also adjust the dose of water pills to help prevent dehydration and low blood pressure.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Typical Dosing After a Heart Attack

For people whose blood pressure and blood flow are stable, Zestril may be started within 24 hours of the first symptoms of a heart attack. The recommended dosing schedule is:

First dose — 5 milligrams by mouth within 24 hours of the start of symptoms
After 24 hours — Another 5 milligrams
After 48 hours — 10 milligrams
After that — 10 milligrams once daily

Treatment should continue for at least six weeks.

For people with low blood pressure after a heart attack, doctors may start with a lower dose, reduce the dose, or stop Zestril if blood pressure becomes too low. People with reduced kidney function may also need a lower starting dose.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Top Advice From Members on Zestril

These insights are based on 60 comments about Zestril from MyHeartDiseaseTeam members. These are the experiences of a small number of people and are not meant to be medical advice.

Members who use Zestril often talk about paying close attention to side effects, blood pressure changes, and how the medication fits into a broader heart care plan. Many also mention staying in touch with their cardiologist, giving treatment changes time, and supporting medication with exercise or lower-sodium habits.

1

Watch for side effects and tell your doctor about them.

“After a week, I developed frequent dry coughing, and it bothered me all night and daytime as well. She stopped and prescribed something else.”
2

Talk to your doctor if your blood pressure runs too low.

“Yes. I have congestive heart failure (CHF), and my blood pressure recently dropped to about 60/35. My doctor adjusted my Zestril dosage and treatment plan, and now my blood pressure is higher.”
3

Support treatment with exercise and lower-sodium habits.

“Exercise is life. Along with my medication, I have cut my sodium tremendously and only drink decaffeinated coffee and tea. I walk 3 miles four times a week.”

Connect with others who understand life with heart disease. Join MyHeartDiseaseTeam for free.

Zestril Side Effects

In clinical studies of people taking Zestril, side effects reported more often than in comparison groups included:

Hypotension (low blood pressure) in people with heart failure or a heart attack
Chest pain in people with heart failure

Serious Side Effects and Warnings

Zestril can cause serious side effects that may require immediate medical attention. These include:

Fetal harm — Zestril can cause harm or death to a developing baby if taken during pregnancy.
Angioedema — Sudden swelling of the face, lips, tongue, throat, or intestines can cause trouble breathing or severe belly pain.
Anaphylactoid reactions — Severe allergic-type reactions can be life-threatening.
Acute kidney failure or worsening kidney function — The kidneys may suddenly stop working well, especially in people at higher risk.
Hypotension — Low blood pressure can cause serious complications.
Hyperkalemia — High potassium levels can develop in the blood.
Liver failure — Serious liver injury can sometimes lead to liver failure or death.

Get medical help right away if you think you are having a serious reaction.

This drug has a boxed warning, the FDA's strongest safety warning, for some of the serious risks mentioned above. A boxed warning does not mean the drug is unsafe for everyone or that everyone faces the same level of risk.

If you experience serious side effects, you can report them to the FDA online or by calling 1-800-FDA-1088. You can also contact the drug's manufacturer.

How to Save on Zestril

Upsher-Smith Laboratories, the current distributor of Zestril, does not currently list a savings program. However, a Zestril Co-Pay Card previously offered by Almatica Pharma is described in a 2022 document, and its current availability has not been confirmed.

Under the older card, eligible people with commercial insurance could pay as little as $28 per month. The card stated that the offer covered remaining copay or out-of-pocket costs, up to a maximum benefit of $450 per month.

To learn more, review the Zestril Co-Pay Card details or call 866-498-1358.

What To Know Before Taking Zestril

Before starting Zestril, your doctor may check your blood pressure, kidney function, and potassium levels. People with heart failure may also need their sodium levels checked.

Tell your doctor if you have any allergies to lisinopril or other ingredients in Zestril.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.

Do not take Zestril if you:

Have had angioedema (severe swelling) caused by an ACE inhibitor, or have hereditary or idiopathic angioedema (swelling that runs in families or has no known cause).
Are allergic to lisinopril or any ingredients in Zestril.
Have diabetes and take a medicine called aliskiren.
Take a neprilysin inhibitor, such as sacubitril. Do not take Zestril within 36 hours of switching to or from sacubitril/valsartan.

Zestril is also FDA-approved to treat hypertension (high blood pressure) in adults and children ages 6 and older.

Tell your doctor if you are pregnant, think you may be pregnant, or become pregnant while taking Zestril. If pregnancy is detected, Zestril should be stopped as soon as possible. Zestril can cause serious harm or death to a developing baby.

Do not breastfeed while taking Zestril because of the risk of serious side effects in the baby.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Zestril for heart disease?

Clinical studies have shown that Zestril can help people with certain heart conditions, including systolic heart failure and heart attacks.

For systolic heart failure:

In two studies lasting 12 weeks, adding Zestril to digitalis and water pills helped reduce symptoms such as swelling, crackling sounds in the lungs, and sudden shortness of breath at night.
In one study, Zestril also helped people breathe more easily while lying down and improved their ability to exercise. It also reduced certain signs of more severe heart failure.
In another study involving more than 3,000 people with systolic heart failure, a higher dose of lisinopril produced results at least as favorable as a lower dose.

For acute myocardial infarction (heart attack):

In a large study involving more than 19,000 people who had a heart attack, those who received Zestril within 24 hours of their first symptoms had an 11 percent lower risk of death at six weeks compared with those who did not receive Zestril.
Death rates were 6.4 percent among those who received Zestril and 7.2 percent among those who did not.

How long does Zestril take to work for heart disease?

Zestril starts lowering blood pressure in most people within about one hour of taking a dose, with the greatest blood pressure reduction occurring around six hours later.

For people with systolic heart failure, studies have shown improvements in symptoms during treatment, but the prescribing information does not say exactly how soon these improvements may begin.

For people who have had a heart attack, a large study showed a lower risk of death at six weeks. However, the exact time when this benefit begins is not known from the prescribing information.

What tests or monitoring are needed with Zestril for heart disease?

Your doctor may perform certain tests and checks before and during treatment with Zestril to make sure it is safe for you. These include:

Blood pressure monitoring — Your doctor will check your blood pressure, especially when you start Zestril or your dose is increased, because it can cause blood pressure to drop too low.
Kidney function tests — Your doctor will check how well your kidneys are working with regular blood tests because Zestril can affect kidney function.
Potassium blood tests — Your doctor will check your potassium levels regularly because Zestril can cause high potassium levels in the blood.
Sodium blood tests — Your doctor may check your sodium levels, especially if you have heart failure, because low sodium levels can affect your starting dose.
Monitoring for liver problems — Your doctor may check for signs of liver problems, such as yellowing of the skin or eyes, because Zestril can rarely cause serious liver injury.