ACE Inhibitors: medications in this class

Overview

Angiotensin-converting enzyme inhibitors block the production of angiotensin II, a hormone that narrows blood vessels and makes the kidneys retain salt. Blocking it lowers blood pressure and reduces the strain on the heart and the pressure inside the kidney’s filters, which is why the class has outcome evidence in hypertension, heart failure, after heart attacks, and in diabetic kidney disease.

Lisinopril is the most prescribed; enalapril, ramipril and benazepril are close relatives with different dosing schedules. A dry cough affects a meaningful minority of people and is the usual reason for switching to an ARB, which has the same benefits without it. Rarely, the class causes swelling of the face or throat, which is an emergency.

Potassium and kidney function are checked after starting and after dose changes, and the class is not used in pregnancy.

How the drugs in this class differ when you pay cash

Every ACE inhibitor in common use is a commodity generic, so the cash price is almost entirely dispensing fee and margin. There is no clinical reason to pay for a brand. Lisinopril is on nearly every flat-price generic list; ramipril is sold as capsules and tablets that are priced differently; and the combination of lisinopril with hydrochlorothiazide is also generic and sometimes cheaper than the two components because of the single dispensing fee.

Because these are lifelong daily medicines, a ninety-day supply from a pharmacy with a flat generic price is where most of the saving is.

Ramipril is sold as capsules and tablets that are priced differently, and enalapril comes in a liquid for children and people who cannot swallow tablets; the pharmacy can tell you which form it stocks cheaply. If a prescription names a brand such as Zestril or Altace, ask the prescriber to allow generic substitution so the pharmacy can dispense whichever maker it has.

Medicines at a glance

How the medicines in this group are supplied and usually taken. Each guide has the full details.

• Lisinopril
  Tablet, Oral solution (Qbrelis), Combination tablet with hydrochlorothiazide
  Generic: Yes · Once a day
• Enalapril
  Tablets, Oral solution (Epaned and generics), Tablets with hydrochlorothiazide
  Generic: Yes · Once or twice a day
• Ramipril
  Capsules, Tablets (generic)
  Generic: Yes · Once or twice a day
• Benazepril
  Tablets, Capsules (with amlodipine), Tablets (with hydrochlorothiazide)
  Generic: Yes · Once or twice a day

Medications

Which of these is right for a given person is a decision for the prescriber. The guides explain what each drug is, how it is supplied, and why its cash price varies between pharmacies. No page on this site shows a price; prices come from pharmacies responding to your actual prescription.

Questions worth asking

• Should I switch to an ARB if the cough bothers me?
• When will my potassium and kidney function be checked?
• Should I avoid potassium supplements and salt substitutes?
• Is a ninety-day prescription appropriate?
• What swelling or breathing symptoms need emergency care?