Medication Profile - Lisinopril Off-Label Use for Migraine

Patient Expert

There are a wide variety of medications used for the prevention of Migraine and headache, most of which are prescribed  off-label. If lisinopril has been prescribed for you, or if you and your doctor have been considering it, here's some information that may be helpful.



fetal/neonatal morbidity/mortality may occur when drugs that act directly on the renin-angiotensin system are used in pregnancy; D/C drug as soon as possible once pregnancy detected

Type of medication:

Lisinopril, brand name Prinivail or Zestril, is in a class of drugs called angiotensin converting enzyme, or ACE inhibitors. This type of medication is used to treat hypertension, diabetic nephropathy, and congestive heart failure.   It can help increase the chances of survival after a heart attack. It is also prescribed off-label for  Migraine and headache prevention.


  • Your blood pressure will need to be monitored regularly while taking lisinopril.
  • If you are pregnant, tell your doctor and stop using lisinopril right away. Lisinopril can harm a fetus.
  • Avoid alcohol; it may increase some of the side effects and your blood pressure could become dangerously low.
  • Using salt substitutes while using lisinopril, except under doctors orders, is not recommended.
  • Taking potassium supplements while using lisinopril, except under doctors orders, is not recommended.
  • Heavy sweating, vomiting and/or diarrhea can cause dehydration and may increase the chances of your blood pressure lowering.   This could lead to an electrolyte disorder and/or kidney failure. Be sure to drink plenty of water while taking lisinopril.
  • If you are allergic to any ACE inhibitor such as Lotensin, Capoten Momopril, Vasotec, Univasc, Aceon, Accupril, Altace or Mavik do not use lisinopril.
  • If you have a history of angioedema (the swelling of hands, face, lips, throat, eyes and tongue) or have had trouble swallowing or breathing, do not use lisinopril.
  • Do not use lisinopril if you are a pediatric patient with serious kidney issues.
  • Do not use lisinopril if you take aliskiren.
  • If you are having surgery or dental work done, make sure to tell the doctor you are taking lisinopril. You may need to discontinue it for a short while.
  • Even if you feel well when taking lisinopril for high blood pressure, you must continue to take this medication. High blood pressure may not have any symptoms and this is a medication you may need to take for the rest of your life.
  • Make sure your doctor knows about any prescription, over-the-counter medications, herbal and/or dietary supplements you take.

Pregnancy and Breastfeeding:

  • Lisinopril is FDA pregnancy category D during the second and third trimester and category C during the first trimester. Both animal and human information show that ACE inhibitors are connected with fetal death and malformation.
  • Using lisinopril during pregnancy could cause harm to a fetus and therefore should not be used.
  • There is not enough information available to know if lisinopril passes through breast milk or will harm a nursing baby. Therefore it is advised a nursing mother not take lisinopril without discussing it with her doctor if she plans on breastfeeding.
  • Because lisinopril may have severe harmful effects in nursing babies, mothers who take this medication should either stop it or stop nursing - whichever is better for the mother's health.

Other medical conditions: Be sure your doctor knows any other medical issues you may have including:

  • if you are receiving treatments to reduce your sensitivity to bees or wasps
  • if you have any connective tissue disease like Marfan syndrome, lupus, scleroderma, Sjogren's syndrome and/or rheumatoid arthritis
  • all other medications you may be taking for hypertension
  • heart disease or congestive heart failure
  • high potassium levels
  • any allergies to foods, medicines or certain other substances
  • kidney disease
  • if you have low blood volume or are dehydrated
  • liver disease
  • low blood sodium levels or other electrolyte problems
  • any surgery, dialysis or dental work you are having done

Other medications:

Make sure your doctor knows about ALL the medications you take. The following medications are contraindicated (should not be taken with) when taking lisinopril:

  • aliskiren and aliskiren combinations

The following medications should be avoided when taking lisinopril;

  • angiotensin converting enzymes and thiazide combinations
  • angiotensin II receptor blockers and angiotensin II receptor blocker/thiazide combinations
  • azthioprine
  • lithium

Medications that need to be monitored closely while taking lisinopril include;

  • acetaminophen and acetaminophen combinations
  • amifostine
  • amlodipine and angiotensin II receptor blocker combinations
  • amlodipine and angiotensin II receptor blocker/thiazide combinations
  • antipsychotics
  • aprotinin
  • aspirin and aspirin combinations
  • beta blockers and thiazide combinations
  • bismuth subsalicylate and combinations
  • celebrex
  • central nervous system depressants and aspirin and caffeine combinations
  • cyclosporine
  • diuretics and combinations
  • drospirenone
  • eplerenone
  • exenatide
  • heparin
  • hydrocodone and ibuprofen combinations; oxycodone and ibuprofen combinations
  • ibuprofen and famotidine
  • insulins
  • liragludite
  • metformin and combinations
  • nesiritide
  • NSAIDs and combinations
  • peginterferon alfa 2a
  • polyethylene glycol and electrolytes
  • potassium bicarbonate and potassium citrate, potassium salts
  • pramlintide
  • probenecid
  • salicylates
  • sodium phosphates and sodium sulfate combinations
  • sulfonylureas
  • sumatriptan and naproxen sodium
  • tacrolimus
  • telavancin
  • tizanidine
  • tolvaptan
  • topical diclofenac
  • trandolapril and verapamil combinations
  • trimethoprim and combinations

Please use caution when taking the lisinopril and the following medications;

  • aldesleukin
  • apomorphine
  • black cohosh
  • capsicum
  • gold sodium thiomalate
  • icatibant
  • iloprost inhaled
  • kava
  • maraviroc
  • nitrites and sodium thiosulfate combinations
  • non-selective MAOIs
  • PDE5 inhibitors
  • treprostinil

Potential side effects:

Seek immediate emergency help if you have any of the following signs that you may be having an allergic reaction to lisinopril;

  • difficulty breathing and swelling of the face, lips, tongue and/or throat
  • unbearable stomach pain
  • hives

Contact your doctor right away if you have any of the following potential serious side effects:

  • feeling faint
  • unusual urination or no urination
  • fast weight gain and/or swelling
  • symptoms of the flu including fever, chills and body aches
  • muscle weakness, uneven or pounding heartbeat and feeling fatigued
  • chest pain
  • symptoms of high potassium including muscle weakness, a slow heart rate, feeling tingly and a weak pulse.

Potential side effects that may be less severe include;

  • a cough
  • dizziness, feeling drowsy and having a depressed mood
  • headache
  • upset stomach
  • nausea and vomiting
  • mild skin rash and/or itching

Brand names:

  • Prinivil
  • Zestril

Related information:* _Migraine preventive medications - too many options to give up! _


  • Wolters Kluwer. "Lisinopril." Last revised July 5, 2012.
  • Cerner Multum, Inc. "Lisinopril." Last revised January 6, 2012.

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_ © The HealthCentral Network, 2012
Last Updated August 7, 2012._