Lisinopril does not typically cause gout. Unlike diuretics, which are well-known gout triggers, lisinopril belongs to a class of blood pressure medications (ACE inhibitors) that appear largely neutral when it comes to uric acid levels. That said, gout is listed as an uncommon side effect on the FDA-approved prescribing label, occurring in about 1% of patients in clinical trials. So while the risk is low, it’s not zero.
What the Clinical Data Shows
The most direct evidence comes from the ALLHAT trial, one of the largest blood pressure studies ever conducted. Researchers tracked gout development in older adults assigned to different medications over five years. The gout rate for lisinopril was 1.93 per 100 person-years, compared to 2.47 for the diuretic chlorthalidone and 1.59 for the calcium channel blocker amlodipine. In other words, lisinopril fell in the middle: better than diuretics, but not quite as favorable as amlodipine.
When researchers directly compared lisinopril to chlorthalidone, people on lisinopril had about 15% lower gout risk during the trial period. That difference didn’t quite reach statistical significance, meaning it could partly be due to chance, but the trend was consistent across every time window the researchers examined. Meanwhile, amlodipine showed a statistically significant 26% lower gout risk compared to lisinopril.
How Lisinopril Affects Uric Acid
Gout happens when uric acid builds up in the blood and forms crystals in your joints. Some blood pressure drugs raise uric acid levels, which increases gout risk. Lisinopril generally does not do this. In a randomized trial comparing lisinopril to a diuretic combination over six months, uric acid rose significantly in the diuretic group but stayed essentially unchanged in the lisinopril group.
ACE inhibitors as a class may actually help your kidneys clear uric acid slightly more efficiently. Research on related drugs like captopril and enalapril has found they modestly increase uric acid excretion through the kidneys, both in healthy volunteers and in people with high blood pressure. This appears to be related to how these drugs affect the renin-angiotensin system, the hormonal pathway that regulates blood pressure and fluid balance. Whether lisinopril shares this mild uric acid-lowering effect to the same degree isn’t fully pinned down, but its metabolic profile is considered favorable compared to diuretics.
Why Some People on Lisinopril Still Get Gout
If lisinopril doesn’t raise uric acid, why is gout listed on its label at all? The answer likely comes down to the population taking it. People prescribed lisinopril already have high blood pressure, which itself is a strong risk factor for gout. They’re often older, may be overweight, and frequently take other medications that do raise uric acid, particularly diuretics. Many blood pressure regimens combine lisinopril with a low-dose thiazide diuretic, and that combination is one of the most common in clinical practice.
So if you started lisinopril around the same time as a diuretic and then developed gout, the diuretic is the far more likely culprit. Thiazide diuretics reduce the kidneys’ ability to flush out uric acid, causing it to accumulate in the bloodstream. This is one of the most well-documented drug-related causes of gout.
How Lisinopril Compares to Other Blood Pressure Drugs
Not all blood pressure medications carry the same gout risk. Here’s a general ranking from highest to lowest risk based on available evidence:
- Thiazide and loop diuretics: Highest risk. These reliably raise uric acid levels and are the blood pressure drugs most strongly linked to gout.
- Beta-blockers: Moderate risk. Some evidence suggests they can raise uric acid modestly.
- ACE inhibitors (including lisinopril): Low risk. Metabolically neutral or slightly beneficial for uric acid.
- Calcium channel blockers (like amlodipine): Lowest risk among common options, with the ALLHAT data showing the lowest gout incidence.
- Losartan: A specific ARB (angiotensin receptor blocker) that has a well-documented uric acid-lowering effect, sometimes recommended specifically for people with both high blood pressure and gout.
If you have gout or high uric acid and need blood pressure treatment, the choice of medication can make a meaningful difference. Lisinopril is a reasonable option, though calcium channel blockers or losartan may offer a slight additional advantage for keeping uric acid in check.
A Note on Lisinopril and Allopurinol
If you take lisinopril and are prescribed allopurinol (a common gout prevention drug), there’s one interaction worth knowing about. Rare but serious allergic skin reactions, including a condition called Stevens-Johnson syndrome, have been reported when ACE inhibitors and allopurinol are used together. There’s no confirmed pharmacokinetic interaction between the two drugs, meaning one doesn’t change how the other is absorbed or processed. But case reports describe hypersensitivity reactions ranging from mild (fever, joint pain, skin peeling) to severe, typically appearing three to five weeks after starting both medications. This combination is used safely in many patients, but the possibility of a serious skin reaction is something your prescriber should be aware of when choosing medications.