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Classification: A

Drug products: Lisinopril 2care4, Lisinopril Actavis, Lisinopril Alpharma, Lisinopril Alternova, Lisinopril Arrow, Lisinopril AstraZeneca, Lisinopril Copyfarm, Lisinopril EssPharm, Lisinopril Mylan, Lisinopril Orifarm, Lisinopril Ranbaxy, Lisinopril ratiopharm, Lisinopril Sandoz, Lisinopril STADA®, Lisinopril/Hydrochlorthiazid Alternova, Lisinopril/Hydrochlorthiazid Sandoz, Lisinopril/Hydroklortiazid Actavis, Lisinopril/Hydroklortiazid Copyfarm, Lisinopril/Hydroklortiazid STADA, Vivatec®, Zestoretic, Zestril, Zestril®

ATC code: C09AA03, C09BA03

Substances: lisinopril, lisinopril dihydrate


Lisinopril reduces the blood pressure as efficiently in men and women.
Cough is a common non-dose dependent side effect of ACE-inhibitors which is more common in women. Angiotensin receptor blockers may then be an alternative.
There are no clinically relevant sex differences in lisinopril efficacy or pharmacokinetics reported, but the non-dose dependent side effect cough is more common among women.

Additional information

Pharmacokinetics and dosing

A pharmacokinetic study (16 men, 16 women) examined the sex-related differences after a single 20 mg dose of lisinopril. There were no differences in plasma concentration between men and women, or in effects on blood pressure or heart rate [12]. No studies with a clinically relevant sex analysis regarding the dosing of lisinopril have been found and no sex differentiation in dosing has been recommended by the manufacturer [13].


Clinical trials have shown that men and women have similar antihypertensive responses to lisinopril [14-16]. However, in the large ALLHAT study, black men responded better to lisinopril compared to amlodipine than black women when receiving the same dose [17,18].Pulse pressure (the difference between systolic blood pressure and diastolic pressure) is suggested to be a predictor of cardiovascular disease, and may be influenced by genetics. A study examined whether RAAS polymorphism had different impact on pulse pressure in men and women taking lisinopril showed no sex differences [19].A double-blind, placebo-controlled dose-response study of lisinopril in hypertensive children (6-16 years) reported that the dose response was consistent between boys and girls [20].

Adverse effects

In a Norwegian double-blind multicenter study (206 men, 206 women), nearly three times more women than men spontaneously reported cough with lisinopril (12.6% vs. 4.4%) [9, 21].Several studies have reported a female predominance in the prevalence of ACE inhibitor induced cough [1-9]. The pathogenesis of the cough reaction is unknown. Different threshold for coughing in men and women have been proposed [10], as well as ethnic differences in cough tendency [11]. One study suggests that sex hormones do not have any influence on cough, since most of the women in the study were postmenopausal [1].

Drug interactions

Swedish users, please consult Janusmed Interactions (Janusmed interaktioner).

Birth defects

Lisinopril should not be used in pregnant women. Swedish users, please consult Janusmed Birth Defects (Janusmed fosterpåverkan).

Updated: 2017-03-28

Date of litterature search: 2013-12-16


  1. Coulter DM, Edwards IR. Cough associated with captopril and enalapril. Br Med J (Clin Res Ed). 1987;294:1521-3. PubMed
  2. Strocchi E, Valtancoli G, Ambrosioni E. The incidence of cough during treatment with angiotensin converting enzyme inhibitors. J Hypertens Suppl. 1989;7:S308-9. PubMed
  3. Kostis JB, Shelton B, Gosselin G, Goulet C, Hood WB, Kohn RM et al. Adverse effects of enalapril in the Studies of Left Ventricular Dysfunction (SOLVD) SOLVD Investigators. Am Heart J. 1996;131:350-5. PubMed
  4. Sharma S, Gupta U, Bapna JS, Sahai A. Tolerability of enalapril in mild to moderate hypertension. J Assoc Physicians India. 1995;43:475-6. PubMed
  5. Yeşil S, Yeşil M, Bayata S, Postaci N. ACE inhibitors and cough. Angiology. 1994;45:805-8. PubMed
  6. Yeo WW, Ramsay LE. Persistent dry cough with enalapril: incidence depends on method used. J Hum Hypertens. 1990;4:517-20. PubMed
  7. Just PM. The positive association of cough with angiotensin-converting enzyme inhibitors. Pharmacotherapy. 1989;9:82-7. PubMed
  8. Gibson GR. Enalapril-induced cough. Arch Intern Med. 1989;149:2701-3. PubMed
  9. Os I, Bratland B, Dahlöf B, Gisholt K, Syvertsen JO, Tretli S. Female sex as an important determinant of lisinopril-induced cough. Lancet. 1992;339:372. PubMed
  10. Dykewicz MS. Cough and angioedema from angiotensin-converting enzyme inhibitors: new insights into mechanisms and management. Curr Opin Allergy Clin Immunol. 2004;4:267-70. PubMed
  11. Morimoto T, Gandhi TK, Fiskio JM, Seger AC, So JW, Cook EF et al. An evaluation of risk factors for adverse drug events associated with angiotensin-converting enzyme inhibitors. J Eval Clin Pract. 2004;10:499-509. PubMed
  12. Sáenz-Campos D, Bayés MC, Masana E, Martín S, Barbanoj M, Jané F. Sex-related pharmacokinetic and pharmacodynamic variations of lisinopril. Methods Find Exp Clin Pharmacol. 1996;18:533-8. PubMed
  13. Zestril (lisinopril). Summary of Product Characteristics. Medical Products Agency Sweden; 2016.
  14. Alici G, Aliyev F, Bellur G, Okcun B, Türkoğlu C, Karpuz H. Effect of seven different modalities of antihypertensive therapy on pulse pressure in patients with newly diagnosed stage I hypertension. Cardiovasc Ther. 2009;27:4-9. PubMed
  15. Weir MR, Reisin E, Falkner B, Hutchinson HG, Sha L, Tuck ML. Nocturnal reduction of blood pressure and the antihypertensive response to a diuretic or angiotensin converting enzyme inhibitor in obese hypertensive patients TROPHY Study Group. Am J Hypertens. 1998;11:914-20. PubMed
  16. Oparil S, Davis BR, Cushman WC, Ford CE, Furberg CD, Habib GB et al. Mortality and morbidity during and after Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: results by sex. Hypertension. 2013;61:977-86. PubMed
  17. Falconnet C, Bochud M, Bovet P, Maillard M, Burnier M. Gender difference in the response to an angiotensin-converting enzyme inhibitor and a diuretic in hypertensive patients of African descent. J Hypertens. 2004;22:1213-20. PubMed
  18. Leenen FH, Nwachuku CE, Black HR, Cushman WC, Davis BR, Simpson LM et al. Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. Hypertension. 2006;48:374-84. PubMed
  19. Lynch AI, Arnett DK, Davis BR, Boerwinkle E, Ford CE, Eckfeldt JH et al. Sex-specific effects of AGT-6 and ACE I/D on pulse pressure after 6 months on antihypertensive treatment: the GenHAT study. Ann Hum Genet. 2007;71:735-45. PubMed
  20. Soffer B, Zhang Z, Miller K, Vogt BA, Shahinfar S. A double-blind, placebo-controlled, dose-response study of the effectiveness and safety of lisinopril for children with hypertension. Am J Hypertens. 2003;16:795-800. PubMed
  21. Os I, Bratland B, Dahløf B, Gisholt K, Syvertsen JO, Tretli S. Lisinopril or nifedipine in essential hypertension? A Norwegian multicenter study on efficacy, tolerability and quality of life in 828 patients. J Hypertens. 1991;9:1097-104. PubMed
  22. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-04-05.] länk

Authors: Linnéa Karlsson Lind, Desirée Loikas

Reviewed by: Mia von Euler

Approved by: Karin Schenck-Gustafsson