Two medicines, side by side
Lisinopril vs ramipril
Lisinopril and ramipril are both labeled for high blood pressure and heart attack and coronary artery disease. Drugs@FDA records approvals of lisinopril since 1987 and of ramipril since 1991. Pharmacies paid $0.0254 per lisinopril 20 mg tablet and $0.0707 per ramipril 10 mg capsule (NADAC, October 7, 2026); the strengths differ, so the two prices are not like for like. Lisinopril's other strengths are brand-only: $4.50 per mL (Qbrelis 1 mg/mL solution). How each works, in its label's words: Lisinopril, “Lisinopril inhibits angiotensin-converting enzyme (ACE) in human subjects and animals.”; Ramipril, “Ramipril and ramiprilat inhibit ACE in human subjects and animals.”
Check it at the source: the lisinopril FDA label on DailyMed (effective January 2, 2025); the ramipril FDA label on DailyMed (effective August 24, 2026).
Highlights of the lisinopril record
Lisinopril (Zestril) · label of January 2, 2025
FETAL TOXICITY When pregnancy is detected, discontinue ZESTRIL as soon as possible [see Warnings and Precautions ( 5.1 )]. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus [see Warnings and Precautions (5.1)]. WARNING: FETAL TOXICITY See full prescribing information for complete boxed warning. When pregnancy is detected, discontinue Zestril as soon as possible.
Used for
From the label: indicationsZestril is an angiotensin converting enzyme (ACE) inhibitor indicated for: Treatment of hypertension in adults and pediatric patients 6 years of age and older ( 1.1 ) Adjunct therapy for heart failure ( 1.2 ) Treatment of Acute Myocardial Infarction ( 1.3 ) 1.1 Hypertension Zestril is indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure. […]
On the market
- Earliest approval on file
- December 29, 1987
- Generic labelers
- 36 labelers
- Pharmacy cost
- $0.0254 per tablet
Supply and safety
- Shortage
- No current entry
- Recalls
- 28
Highlights of the ramipril record
Ramipril (Altace) · label of August 24, 2026
FETAL TOXICITY See full prescribing information for complete boxed warning. When pregnancy is detected, discontinue ramipril as soon as possible ( 5.6 ). Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus ( 5.6 ). WARNING: FETAL TOXICITY When pregnancy is detected, discontinue ramipril as soon as possible ( 5.6 ). Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus ( 5.6 ).
Used for
From the label: indicationsRamipril capsules are an angiotensin converting enzyme (ACE) inhibitor indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. It may be used alone or in combination with thiazide diuretics ( 1.1 ). […]
On the market
- Earliest approval on file
- January 28, 1991
- Generic labelers
- 17 labelers
- Pharmacy cost
- $0.0707 per capsule
Supply and safety
- Shortage
- No current entry
- Recalls
- 5
Source: FDA drug labels via openFDA (Lisinopril label of January 2, 2025, Ramipril label of August 24, 2026); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do lisinopril and ramipril differ on the record?
How each works, in its label's words: Lisinopril, “Lisinopril inhibits angiotensin-converting enzyme (ACE) in human subjects and animals.”; Ramipril, “Ramipril and ramiprilat inhibit ACE in human subjects and animals.”
Both are in FDA's class angiotensin converting enzyme inhibitors.
Half-life, in each label's words: Lisinopril, “Upon multiple dosing, lisinopril exhibits an effective half-life of 12 hours.”; Ramipril, “The initial rapid decline, which represents distribution of the drug into a large peripheral compartment and subsequent …”
Both labels carry a boxed warning; the records quote them.
Generics: lisinopril since 2002; ramipril since 2005 (Drugs@FDA).
| Lisinopril | Ramipril | |
|---|---|---|
| Labeled for | High blood pressure, Heart attack and coronary artery disease, Heart failure | High blood pressure, Heart attack and coronary artery disease |
| Pharmacologic class | Angiotensin Converting Enzyme Inhibitor | Angiotensin Converting Enzyme Inhibitor |
| How it works (label) | Lisinopril inhibits angiotensin-converting enzyme (ACE) in human subjects and animals. ACE is a peptidyl dipeptidase that catalyzes the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. | Ramipril and ramiprilat inhibit ACE in human subjects and animals. Angiotensin converting enzyme is a peptidyl dipeptidase that catalyzes the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. |
| Half-life (label) | Upon multiple dosing, lisinopril exhibits an effective half-life of 12 hours. | The initial rapid decline, which represents distribution of the drug into a large peripheral compartment and subsequent binding to both plasma and tissue ACE, has a half-life of 2 to 4 hours. |
| Earliest approval on file (Drugs@FDA) | December 29, 1987 | January 28, 1991 |
| First generic approved | July 1, 2002 | October 24, 2005 |
| Generic labelers (NDC) | 36 labelers | 17 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.0254 per tablet (Lisinopril 20 mg tablet) | $0.0707 per capsule (Ramipril 10 mg capsule) |
| 12-month price change | -3% | +1% |
| Boxed warning | Yes | Yes |
| Shortage now | No current entry | No current entry |
| Recalls recorded | 28 | 5 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 304,309 | 123,138 |
| DEA schedule | none | none |
Source: Drugs@FDA, FDA NDC Directory, CMS NADAC of October 7, 2026, FDA shortages and recalls, FAERS via openFDA (FDA files October 8, 2026)
What next?
- Alternatives to lisinopril
- every medicine labeled for the same conditions