Can lisinopril cause hair loss? This is a question raised by many patients prescribed this widely used ACE inhibitor for hypertension, heart failure, or diabetic nephropathy. Alopecia is listed as a rare side effect in lisinopril's UK Summary of Product Characteristics, but the evidence for a direct causal link remains limited. Hair thinning in people taking lisinopril is often multifactorial, with underlying health conditions, other medications, and lifestyle factors all playing a role. This article explores what the evidence says, what else might be responsible, and what steps to take if you notice changes to your hair.

Does Lisinopril Cause Hair Loss?

Alopecia is listed as a rare side effect of lisinopril in its UK prescribing information, but there is no definitive, well-established causal link, and hair thinning in patients taking lisinopril is often attributable to other factors.

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Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor widely prescribed in the UK for conditions including hypertension, heart failure, and — in line with its UK Summary of Product Characteristics (SmPC) — hypertension in adults with type 2 diabetes and incipient nephropathy (characterised by microalbuminuria). It works by blocking the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby reducing blood pressure, decreasing the workload on the heart, and reducing aldosterone secretion.

Hair loss (alopecia) is listed as a rare side effect in the prescribing information for lisinopril, though it is not among the most commonly reported adverse effects. The exact mechanism by which ACE inhibitors may contribute to hair loss is not fully understood. One theoretical proposal is that alterations in bradykinin metabolism — a natural consequence of ACE inhibition — may affect hair follicle cycling; however, this remains speculative and is not supported by robust clinical evidence.

It is important to note that there is no definitive, well-established causal link between lisinopril and significant hair loss in the majority of patients. When hair thinning does occur in people taking lisinopril, it is often difficult to determine whether the medication, an underlying health condition, or other lifestyle factors are responsible. Patients should therefore approach this concern with measured consideration rather than alarm, and always seek professional advice before making any changes to their medication.

Further information is available in the lisinopril SmPC (via medicines.org.uk/emc) and the NHS Medicines A–Z entry for lisinopril.

How Common Is Hair Loss With ACE Inhibitors?

Hair loss with ACE inhibitors, including lisinopril, is classified as rare — occurring in fewer than 1 in 1,000 but more than 1 in 10,000 patients — and typically presents as diffuse telogen effluvium rather than patchy or complete hair loss.

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Within the class of ACE inhibitors, hair loss is considered a rare adverse effect. Using the standard MHRA and SmPC frequency categories, 'rare' is defined as occurring in ≥1 in 10,000 to fewer than 1 in 1,000 patients. Post-marketing surveillance data and spontaneous reporting schemes — including those managed by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK — have recorded cases of alopecia associated with ACE inhibitors, but the absolute numbers remain low relative to the millions of patients taking these medicines. The lisinopril SmPC lists alopecia within this rare frequency category.

The type of hair loss most commonly associated with medications is known as telogen effluvium — a diffuse, non-scarring shedding of hair that occurs when a physiological or pharmacological stressor pushes a large number of hair follicles prematurely into the resting (telogen) phase. This typically presents as generalised thinning rather than patchy or complete hair loss, and it usually becomes noticeable two to four months after the triggering event.

Comparative data across ACE inhibitors is sparse, and it is not clearly established whether lisinopril carries a higher or lower risk of hair loss than other agents in the same class, such as ramipril or perindopril. If hair loss is a significant concern, a clinician may consider whether switching to an alternative antihypertensive class — such as an angiotensin receptor blocker (ARB) or a calcium channel blocker — is clinically appropriate. This decision must always be made on an individual basis, taking into account comorbidities, contraindications (for example, ARBs share the same contraindication as ACE inhibitors in pregnancy), and the patient's overall cardiovascular and renal risk profile.

Other Medications and Conditions That Can Cause Hair Loss

Many medicines — including beta-blockers, anticoagulants, and statins — and conditions such as thyroid dysfunction and iron deficiency anaemia are well-recognised causes of hair loss that must be excluded before attributing alopecia to lisinopril.

Before attributing hair loss solely to lisinopril, it is essential to consider the wide range of other medications and medical conditions that are well-recognised causes of alopecia. Many patients taking lisinopril are also managing multiple health conditions and may be prescribed several medicines simultaneously, making it challenging to identify a single cause.

Medications commonly associated with hair loss include:

• Beta-blockers (e.g., atenolol, bisoprolol)

• Anticoagulants such as warfarin and heparin

• Lipid-lowering agents, particularly statins

• Antithyroid drugs (e.g., carbimazole)

• Retinoids (e.g., isotretinoin)

• Antiepileptic medicines (e.g., sodium valproate)

• Cytotoxic and chemotherapy agents

• Certain antidepressants and mood stabilisers

• Hormonal contraceptives in some individuals

Medical conditions that frequently cause hair thinning include:

• Hypothyroidism or hyperthyroidism — thyroid dysfunction is one of the most common reversible causes of hair loss

• Iron deficiency anaemia

• Polycystic ovary syndrome (PCOS)

• Autoimmune conditions such as alopecia areata or lupus

• Nutritional deficiencies, including low ferritin; deficiencies in zinc or vitamin D have been proposed as possible contributors, though the evidence is uncertain and routine testing for these is not generally recommended without a specific clinical indication

• Tinea capitis (a fungal scalp infection), which is an important cause of patchy hair loss particularly in children

• Scarring (cicatricial) alopecias, which are less common but require prompt specialist assessment

Significant psychological or physical stress, rapid weight loss, and major illness can also trigger telogen effluvium independently of any medication. A thorough clinical assessment — including targeted blood tests to evaluate thyroid function, full blood count, serum ferritin, and other markers selected on the basis of history and examination — is an important first step when investigating unexplained hair loss. Relevant UK resources include NICE Clinical Knowledge Summaries (CKS) on alopecia areata and female pattern hair loss, Primary Care Dermatology Society (PCDS) guidance on telogen effluvium, and British Association of Dermatologists (BAD) patient information.

What to Do If You Notice Hair Thinning on Lisinopril

Do not stop lisinopril without medical advice; instead, keep a record of the hair loss pattern and timeline, review all medications started in the preceding 2–4 months, and seek a GP assessment.

If you begin to notice increased hair shedding or thinning whilst taking lisinopril, the most important first step is not to stop your medication without medical advice. Lisinopril is often prescribed for serious cardiovascular or renal conditions, and abruptly discontinuing it can carry significant health risks, including a rebound rise in blood pressure.

Instead, consider taking the following practical steps:

• Keep a record of when the hair loss started, its pattern (diffuse thinning, patchy loss, or receding hairline), and any other symptoms you have noticed

• Review your full medication list — note any new medicines started in the two to four months before the hair loss began, as this timeframe is consistent with drug-induced telogen effluvium

• Assess lifestyle factors — consider whether you have experienced significant stress, illness, dietary changes, or weight loss recently

• Avoid aggressive hair treatments such as tight hairstyles, chemical processing, or excessive heat styling, which can worsen fragile hair

It is also worth noting that some degree of hair shedding is entirely normal — losing up to 100 hairs per day is considered within the physiological range. Concern is more warranted when shedding is noticeably increased, when hair density is visibly reduced, or when regrowth appears absent. Documenting these changes with photographs can be helpful when discussing the issue with a healthcare professional.

Seek prompt medical advice if you notice any of the following red-flag features, as these may indicate a condition requiring more urgent assessment:

• A painful, inflamed, or tender scalp

• Pustules, crusting, or scaling on the scalp

• Signs of scarring — areas where the scalp skin appears smooth, shiny, or permanently hairless

• Sudden patchy hair loss in a child (which may suggest tinea capitis)

• Rapid or extensive hair loss accompanied by systemic symptoms

The NHS Hair loss (Alopecia) page provides further patient-friendly guidance on when to seek help.

Speaking to Your GP or Pharmacist About Side Effects

Your GP or pharmacist is the appropriate first contact for hair loss concerns on lisinopril; they can review your medication history, arrange targeted blood tests, and advise on whether switching antihypertensive is clinically suitable.

Your GP or community pharmacist is the most appropriate first point of contact if you are concerned about hair loss whilst taking lisinopril. Both are well placed to review your full medical and medication history, assess the likelihood of a drug-related cause, and arrange any necessary investigations.

When you attend your appointment, it is helpful to bring:

• A list of all current medications, including over-the-counter products and supplements

• Details of when the hair loss started and how it has progressed

• Any relevant personal or family history of hair loss or thyroid disease

Your GP may arrange blood tests to help identify common treatable causes. Investigations are selected according to your individual history and examination findings, but may include thyroid function tests, full blood count, serum ferritin, and inflammatory markers. If a drug-induced cause is suspected, they may discuss whether an alternative antihypertensive agent is suitable for your clinical situation.

Pharmacists can provide valuable guidance on the likelihood of a medication-related cause and can liaise with your GP if a medication review is warranted. Any suspected adverse drug reactions can be reported directly to the MHRA via the Yellow Card scheme (yellowcard.mhra.gov.uk), which helps build the national evidence base for medication safety.

You should seek prompt medical advice if hair loss is accompanied by other symptoms such as fatigue, weight changes, palpitations, skin changes, or any of the red-flag scalp features described in the section above, as these may indicate an underlying systemic or dermatological condition requiring investigation.

When Hair Loss May Improve After Stopping Treatment

Drug-induced telogen effluvium is generally reversible; if lisinopril is identified as the cause and treatment is changed, visible regrowth usually begins within 2–6 months, with full recovery taking up to 12 months.

If a clinician determines that lisinopril is the likely cause of hair loss and decides it is safe to switch to an alternative medication, many patients can expect gradual improvement over time. Drug-induced telogen effluvium is generally considered a reversible condition, meaning that hair regrowth typically occurs once the offending trigger is removed. This is supported by BAD patient information and PCDS guidance on telogen effluvium.

However, recovery is rarely immediate. Hair follicles cycle through growth phases over several months, and visible regrowth following telogen effluvium usually begins two to six months after the causative factor has been addressed. Full restoration of hair density may take up to 12 months or longer in some individuals. It is important to have realistic expectations and to avoid pursuing unproven or costly hair loss treatments during this period without professional guidance.

If hair loss persists for more than six months despite switching medication and correcting any identified nutritional or hormonal deficiencies, or if the diagnosis remains uncertain, a referral to a dermatologist is appropriate. Dermatologists can perform more detailed assessments, including trichoscopy or scalp biopsy where indicated, to exclude other diagnoses such as androgenetic alopecia, alopecia areata, or scarring alopecia, which require different management approaches.

Ultimately, the decision to change or continue lisinopril must always balance the potential impact on hair against the well-established cardiovascular and renal benefits of the medication. For many patients, the clinical benefit of continuing treatment will outweigh the distress of mild hair thinning, particularly when other contributing factors have been identified and addressed.

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