If you read my previous “Ask the Pharmacist” column, you might remember that my doctor recently prescribed a statin medication to help lower my cholesterol. After taking Lipitor (atorvastatin) for several weeks, I haven’t experienced any side effects, but I’m still monitoring my progress just the same. Now, to help lower my blood pressure, he wants me to start taking lisinopril, an angiotensin-converting enzyme (ACE) inhibitor. And, again, I’m concerned about possible side effects, especially taking it in combination with the cholesterol-lowering medication.
The ‘A’ in ACE Inhibitors
Angiotensin is a substance in your body that regulates blood pressure. But too much of it causes your blood vessels to squeeze down (vasoconstriction), which causes your blood pressure to rise and make your heart work harder to circulate blood through your body. ACE inhibitors reduce the amount of angiotensin in your body, helping to relax your blood vessels and lower your blood pressure. ACE inhibitors may also be used in patients with chronic kidney disease or congestive heart failure.
Medications like lisinopril and other ACE inhibitors (captopril, benazepril, fosinopril and others ending in “pril”) help to lower the amount of angiotensin in your body by preventing an enzyme in your body from producing angiotensin.
The Common Side Effects
ACE inhibitors are generally well tolerated but do have a few side effects worth looking out for. One of the most famous ones, cough, was seen with the much higher doses of captopril used in the past, but is also seen in some patients taking other ACE inhibitors at standard doses. If you experience a persistent dry cough, your doctor will likely prescribe another class of hypertension medication, angiotensin receptor blockers (ARBs).
For the most part, major side effects are not common with the doses of ACE medications prescribed today. But you should still watch out for a dry cough, fatigue, dizziness, headache or loss of taste. Your doctor may find high potassium levels in your system after taking ACE inhibitors, but this is uncommon in patients under 70 years of age with normal kidney function.
And Then There Are ARBs
ARBs are another group of medications that block the effects that angiotensin has in your body to help lower blood pressure. Azilsartan, candesartan, irbesartan and losartan (and others ending in “artan”) are prescribed for high blood pressure and other conditions much like the ACE inhibitors. They work a little differently — not by lowering the amount of angiotensin in your system, but by blocking the effects of angiotensin. If you block the blood vessel constriction angiotensin causes, you can prevent high blood pressure.
The potential but infrequent side effects of ARBs are similar to the ACE inhibitors and include dizziness, headache, drowsiness, nausea, vomiting, diarrhea, cough or elevated potassium levels. Rare side effects for both groups of medications are sexual dysfunction, kidney or liver failure, or tissue swelling (angioedema). Do not take these medications if you are pregnant or plan to become pregnant.
The good news — for me, anyway — is that ACE inhibitors and ARBs can be taken with the statin medications. The other good news is, I’ve experienced no side effects from using these medications together so far. In fact, I’ve felt better since I started taking the lisinopril to lower my blood pressure, having fewer headaches and more energy.
Dave Walker, RPh, is a pharmacist and a member of the MedShadow medical advisory board. He has practiced in multiple pharmacy settings as a pharmacy owner, hospital director of pharmacy, district manager for a pharmacy staffing agency, and currently director of pharmacy at a rural, nonprofit clinic and pharmacy. You can follow him on Twitter @drwalker_rph.