Lisinopril vs. Amlodipine

See how Lisinopril and Amlodipine compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Both drugs are once-daily oral medications commonly used as first-line treatments for high blood pressure, but they work through different mechanisms and cause different side effects.

  • Lisinopril, an ACE inhibitor, is also approved for heart failure and improving survival after a heart attack, while amlodipine, a calcium channel blocker, is also approved for two types of angina.

  • Lisinopril's main tradeoffs are a persistent dry cough and effects on kidney function and potassium, while amlodipine's main tradeoff is swelling in the legs and ankles.

Lisinopril vs. Amlodipine Drug Summary

Lisinopril

Lisinopril is an ACE inhibitor that lowers blood pressure by blocking a hormone that narrows blood vessels. It treats hypertension, supports heart failure treatment, and improves survival after a heart attack. It comes as a tablet taken once a day, usually starting at 10 mg.

Amlodipine

Amlodipine is a calcium channel blocker that relaxes and widens blood vessels to lower blood pressure. It treats hypertension, chronic stable angina, and Prinzmetal's angina. It comes as a tablet taken once a day, usually starting at 2.5 mg.

Lisinopril vs. Amlodipine Side Effects

Lisinopril

Most common
Headache (up to 5.7%)
Dizziness (up to 5.4%)
Cough (up to 3.5%)
Fatigue (up to 1%)

Amlodipine

Most common
Edema (up to 10.8%)
Palpitations (up to 4.5%)
Dizziness (up to 3.4%)
Flushing (up to 2.6%)

Lisinopril vs. Amlodipine Dosage

Lisinopril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg once daily At the start
Maximum dose Up to 40 mg once daily If needed
Dose changes 3 increases As tolerated

Amlodipine

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2.5 mg once daily At the start
Maximum dose 10 mg once daily If needed
Dose changes 2 increases As tolerated

Lisinopril vs. Amlodipine Indications

Lisinopril

Lisinopril is FDA-approved to treat high blood pressure in adults and children 6 and older. It's also approved as an add-on therapy for heart failure and to improve survival after a heart attack. Some doctors prescribe it off-label to help prevent migraines, though this isn't an FDA-approved use.

  • Hypertension in adults and children 6 and up

  • Adjunct treatment for heart failure

  • Improves survival after a heart attack

  • Off-label: sometimes used for migraine prevention

Amlodipine

Amlodipine is FDA-approved to treat high blood pressure in adults and children 6 and older. It's also approved for chronic stable angina, Prinzmetal's (vasospastic) angina, and coronary artery disease. It's commonly combined with other blood pressure medications when needed.

  • Hypertension in adults and children 6 and up

  • Chronic stable angina (exertional chest pain)

  • Vasospastic (Prinzmetal's) angina

  • Coronary artery disease

Lisinopril vs. Amlodipine Pros and Cons

Lisinopril

Lisinopril has decades of use in hypertension plus added FDA approvals for heart failure and post-heart-attack care that amlodipine doesn't have. It's a low-cost generic available at nearly every pharmacy. Cough and effects on kidney function and potassium are the main tradeoffs to watch for.

Pros

  • Also approved for heart failure and improving survival after a heart attack

  • Does not commonly cause the leg and ankle swelling that is amlodipine's top side effect

  • Long track record of pediatric hypertension dosing down to age 6

Cons

  • Can cause a persistent dry cough that sometimes doesn't resolve until stopped

  • Contraindicated in pregnancy due to risk of fetal harm

  • Requires monitoring of kidney function and potassium, especially with diuretics

  • Carries a rare but serious risk of angioedema (facial or throat swelling)

Amlodipine

Amlodipine's long half-life gives steady blood pressure control with a wide margin if a dose is missed. It's also FDA-approved for two forms of angina that lisinopril doesn't treat. Leg and ankle swelling is the main tradeoff many patients notice over time.

Pros

  • Also approved for chronic stable angina and Prinzmetal's (vasospastic) angina

  • No renal dose adjustment or kidney monitoring required

  • Does not cause cough or raise potassium levels

Cons

  • Swelling in the legs or ankles is common, affecting up to 10.8% of patients

  • Can worsen angina or trigger a heart attack shortly after starting or increasing the dose in severe coronary artery disease

  • Not approved for heart failure or post-heart-attack survival benefit like lisinopril

  • Requires caution in patients with severe aortic stenosis due to hypotension risk

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