ACE inhibitors
A widely used family of tablets that relax blood vessels. Used for blood pressure, heart failure, after a heart attack and to protect the kidneys.
Brand names
- Perindopril (Coversyl), ramipril (Tritace)
- Enalapril (Renitec), lisinopril (Zestril)
- Captopril, trandolapril, quinapril, many generics and combination tablets
How it works
ACE inhibitors block angiotensin-converting enzyme, which makes angiotensin II, a hormone that tightens blood vessels and makes the body hold salt and water. Less angiotensin II means wider blood vessels, lower blood pressure and less strain on the heart and kidneys.
Used for
- High blood pressure and heart failure
- After a heart attack, and lowering heart attack and stroke risk in heart disease
- Protecting the kidneys in diabetes (approved uses vary by medicine)
Side effects
How often, from the official product information (e.g. perindopril). Bold = serious.
Common 1 in 10 to 1 in 100
- Dry, tickly cough (a common reason to switch)
- Dizziness, headache, vertigo or pins and needles
- Low blood pressure
- Blurred vision, ringing in the ears
- Shortness of breath
- Nausea, vomiting, tummy upset, altered taste
- Rash, itch, muscle cramps or weakness
Uncommon 1 in 100 to 1 in 1,000
- Angioedema (swelling of the face, lips, tongue or throat)
- High potassium, low sodium or low blood sugar
- Kidney impairment
- Low mood, poor sleep or drowsiness
- Fainting, palpitations
- Wheeze, dry mouth
- Hives, sweating or sun sensitivity
- Joint or muscle pain, erection problems
- Chest pain, ankle swelling or fever
Rare 1 in 1,000 to 1 in 10,000
- Acute kidney failure
- Low sodium (SIADH)
- Flushing, psoriasis flare
- Raised liver tests
Very rare fewer than 1 in 10,000
- Low blood counts (white cells, platelets, red cells)
- Heart attack, angina, irregular heartbeat or stroke
- Pancreatitis, hepatitis or erythema multiforme
- Confusion, runny nose
Frequency not known reported, rate unclear
- Cold, pale fingers (Raynaud’s)
Get help urgently if
- Swelling of the face, lips, tongue or throat, or trouble breathing (angioedema, even after years of use). Call 000
- Fainting, passing very little urine, or fever with mouth ulcers
Good to know
- Sick-day rule: if you are vomiting, have diarrhoea or are dehydrated, pause it and see your doctor. Restart once eating and drinking normally.
- Kidney function and potassium are checked after starting and dose changes.
- Avoid potassium supplements, salt substitutes and anti-inflammatories (e.g. ibuprofen) unless your doctor agrees.
- If cough is a problem, an ARB (e.g. candesartan, irbesartan) works similarly with much less cough.
- Avoid in pregnancy. Tell your doctor if planning pregnancy.
- Take care driving until you know if it makes you dizzy.
Information only. Not a recommendation or endorsement of any product. Whether a medicine suits you depends on your health and other medicines, so talk to your doctor or pharmacist. In an emergency, call 000.
More information
- Coversyl Arginine (perindopril) summary of product characteristics (UK)
- NPS MedicineWise: Medicine Finder
maladywise.com/medicines/ace-inhibitors/