Is lisinopril safe before trying to conceive?

What does the evidence say about lisinopril before trying to conceive while trying to conceive?

1. Lisinopril is an ACE inhibitor that relaxes blood vessels to lower blood pressure, and in healthy, non-pregnant adults it takes up to about 72 hours on average for most of the drug to clear the body. 1
2. It is not known whether lisinopril makes it harder to get pregnant, so there's no established fertility-based reason to delay trying to conceive while sorting out a medication plan with your prescriber. 2
3. A review of five breastfeeding infants whose mothers took lisinopril found no serious adverse effects, though the medication hasn't been well studied for use while breastfeeding. 2
4. Research on ACE inhibitors as a class has not established a proven increased risk of birth defects when use is limited to the earliest weeks of pregnancy, but the well-documented risk shows up with continued use later in pregnancy, when low amniotic fluid can lead to poor lung and kidney development, skull-bone problems, and in severe cases fetal death. 3
5. A large study found higher unadjusted rates of malformations among babies exposed to ACE inhibitors, but once researchers accounted for the mother's underlying high blood pressure itself, most of the excess risk disappeared, suggesting the health condition being managed, not just the medication, plays a role in earlier findings. 4

What to know about lisinopril before trying to conceive while trying to conceive

• If you're still in the early planning stages and haven't started actively trying yet, this is a reasonable time to bring lisinopril up at a routine visit. Whether the drug affects fertility itself isn't established, so the planning here is about timing a medication change, not about your chances of conceiving.
• Once you're actively trying to conceive, many prescribers use this window to move you to a blood pressure medication with a longer pregnancy track record, since the amniotic-fluid and kidney-related risks tied to ACE inhibitors like lisinopril are specific to pregnancy and become the bigger concern the longer pregnancy continues. Lisinopril clears the body in roughly 72 hours, but any switch should be planned with your prescriber rather than done on your own.
• If you conceive while still taking lisinopril, contact your prescriber promptly rather than stopping it on your own. Blood pressure that goes unmanaged carries its own risks, so your prescriber will weigh that against moving you to an alternative as pregnancy continues.