Lisinopril
ACE inhibitor (antihypertensive)
Brand names: Prinivil, Zestril
Oral health effects
Angioedema (lips/tongue/face)
Uncommon but potentially serious swelling of the lips, tongue, or face that can present in the dental setting.
Mechanism: Bradykinin accumulation from ACE inhibition.
Clinical management: Recognize as a medical emergency if the airway is threatened; activate emergency services. Refer for medication review.
Dysgeusia / dry mouth
Altered or diminished taste and mild dry mouth are reported.
Clinical management: Symptomatic care; reinforce hygiene and hydration.
Persistent dry cough (ACE inhibitor cough)
A dry, tickly, non-productive cough is a class effect of ACE inhibitors caused by bradykinin accumulation; it can start weeks to months after starting and resolves within days to weeks of stopping. Label: cough was among the most common hypertension adverse reactions, exceeding placebo by 2.5%.
Clinical management: Ask about chronic cough at medical history review. Cough can be triggered by water spray, prophy paste or supine positioning: use high-volume suction, a more upright chair position and short breaks. Persistent cough is a reason for the patient to discuss alternatives (e.g. an ARB) with their prescriber; do not advise stopping the medication.
Sources
- A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI. Wolff A, Joshi RK, Ekström J, et al. Drugs in R&D, 2017.
- A review and guide to drug-associated oral adverse effects-Dental, salivary and neurosensory reactions. Part 1. Teoh L, Moses G, McCullough MJ. Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 2019.
- Adverse drug events in the oral cavity. Yuan A, Woo SB. Oral surgery, oral medicine, oral pathology and oral radiology, 2015.
- Lisinopril prescribing information (FDA label) Aphena Pharma Solutions - Tennessee, LLC / DailyMed, 2023.
- Angiotensin-converting enzyme inhibitor induced cough compared with placebo, and other antihypertensives: A systematic review, and network meta-analysis. Hu Y, Liang L, Liu S, Kung JY, Banh HL. Journal of clinical hypertension (Greenwich, Conn.), 2023.
- Rate of Cough During Treatment With Angiotensin-Converting Enzyme Inhibitors: A Meta-Analysis of Randomized Placebo-Controlled Trials. Vukadinović D, Vukadinović AN, Lavall D, Laufs U, Wagenpfeil S, Böhm M. Clinical pharmacology and therapeutics, 2019.