Lisinopril vs. Ramipril

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

Key Takeaways

  • Lisinopril and ramipril are both ACE inhibitors that lower blood pressure by relaxing blood vessels, and both commonly cause a dry cough, headache, and dizziness.

  • Lisinopril is approved for children 6 and older and comes as a tablet or liquid, while ramipril is approved for adults only and comes only as a capsule.

  • Ramipril carries an added FDA indication for lowering heart attack, stroke, and cardiovascular death risk in high-risk older adults, based on the HOPE trial.

Lisinopril vs. Ramipril Drug Summary

Lisinopril

Lisinopril is an ACE inhibitor prescribed for high blood pressure, heart failure, and to improve survival after a heart attack. It is taken by mouth once a day, usually starting at 10 mg, with doses adjusted every few weeks up to a maintenance range of 20 to 40 mg. It is approved for both adults and children 6 and older.

Ramipril

Ramipril is an ACE inhibitor used for high blood pressure, to lower heart attack, stroke, and cardiovascular death risk in high-risk adults, and to treat heart failure after a heart attack. It is taken by mouth, starting at 2.5 mg once daily, with doses adjusted over several weeks up to a maintenance range of 2.5 to 20 mg. It is approved for adults only.

Lisinopril vs. Ramipril Side Effects

Lisinopril

Most common
Headache (up to 3.8%)
Dizziness (up to 3.5%)
Cough (up to 2.5%)
Hypotension (up to 1.2%)

Ramipril

Most common
Headache (up to 5.4%)
Dizziness (up to 4%)
Cough (up to 8%)
Fatigue (up to 2%)

Lisinopril vs. Ramipril Dosage

Lisinopril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg once daily At the start
Maximum dose Up to 80 mg once daily If needed
Dose changes 3 increases As tolerated

Ramipril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2.5 mg once daily At the start
Maximum dose 2.5-20 mg once daily If needed
Dose changes 2 increases As tolerated

Lisinopril vs. Ramipril Indications

Lisinopril

Lisinopril treats high blood pressure in both adults and children ages 6 and up, and it is also used for heart failure and to improve survival after a heart attack. Some clinicians also prescribe it off-label to lower urine protein in diabetic kidney disease.

  • Hypertension in adults and children ages 6+

  • Heart failure, used with diuretics and digitalis

  • Improves survival after a heart attack

  • Off-label: lowering urine protein in diabetic kidney disease

Ramipril

Ramipril treats high blood pressure in adults, lowers the risk of heart attack, stroke, or cardiovascular death in high-risk older adults, and treats heart failure after a heart attack. It does not have a pediatric indication like lisinopril. Some clinicians also prescribe it off-label to slow diabetic kidney disease progression.

  • Hypertension in adults only, not children

  • Reduces MI, stroke, or CV death risk in adults 55+

  • Treats heart failure after a heart attack

  • Off-label: slowing diabetic kidney disease progression

Lisinopril vs. Ramipril Pros and Cons

Lisinopril

Lisinopril is an ACE inhibitor with decades of use in hypertension, heart failure, and post-heart-attack care, backed by a large body of clinical trial data. It comes in tablet and liquid forms and is the only one of the two approved for children with high blood pressure.

Pros

  • Approved for children 6 and older with high blood pressure, unlike ramipril

  • Available as a tablet or oral liquid for people who have trouble swallowing pills

  • Always taken once a day, no matter which approved use it treats

  • One of the most prescribed ACE inhibitors, with decades of outcomes data

Cons

  • Not FDA-approved to lower cardiovascular risk in high-risk adults the way ramipril is

  • Blood pressure control can fade before the next dose, especially at 10 mg or less

  • Doses above 40 mg have not been shown to add meaningful benefit

Ramipril

Ramipril is an ACE inhibitor with a specific FDA indication for lowering cardiovascular risk in high-risk adults, based on the HOPE trial. It is only available as a capsule and is approved for adults only, with dosing that can vary between once and twice a day depending on the condition.

Pros

  • Carries a specific FDA indication for lowering heart attack, stroke, and CV death risk in high-risk adults 55+

  • Capsules can be opened and sprinkled on food for people who have trouble swallowing pills

  • Can be split into twice-daily dosing if blood pressure control fades before the next dose

  • Backed by large outcome trials (HOPE, AIRE) beyond blood pressure lowering alone

Cons

  • Not approved for children; adults only

  • Only available as a capsule, with no liquid formulation

  • Dosing schedule can vary between once and twice daily, more complex than lisinopril's single daily dose

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