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ACE inhibitors

Other names: lisinopril, Zestril, Prinivil, Qbrelis, enalapril, Vasotec, ramipril, Altace

The FAA's guidance for ACE inhibitors depends on what it is taken for. Each use is below, with its own FAA source and date.

Taken for high blood pressure

FAA guidance

Acceptable with conditions.

Wait

7 days

no-fly ground trial when starting a new blood pressure medication

Examiner

CACI: the examiner can issue when the condition's worksheet criteria are met. Applicants for first- or second-class must provide the worksheet's information annually; applicants for third-class with each required exam

FAA label

ACCEPTABLE

Source: FAA, Antihypertensive (HTN, blood pressure medication). FAA date 30 September 2026. Checked by Crosscheck 14 October 2026

The FAA lists ACE inhibitors as acceptable blood pressure medication when the certification criteria are met, with a seven-day ground trial when starting, and says the examiner should issue, if the pilot is otherwise qualified, when the pilot is on three or fewer medications.

Track your medications
Compare FAA documents: ACE inhibitorsWhat each of the three FAA documents says, in plain wordsOpen

The Guide's hypertension table says the number of medications counts each component (for example, lisinopril/HCTZ is 2 medications), and that with 4 or more acceptable medications the examiner should defer.

  • 7 days after starting: no flying

FAA rule for blood pressure medication: The FAA's hypertension worksheet (CACI) refers to the antihypertensive sheet for acceptable medications, and allows combinations of up to 3 of the classes it lists -- alpha blockers, beta-blockers, calcium channel blockers, diuretics, ACE inhibitors, ARBs, direct renin inhibitors and direct vasodilators -- and lists centrally acting antihypertensives, such as clonidine, as not acceptable. The Guide's hypertension table says the number of medications counts each component (for example, lisinopril/HCTZ is 2 medications), and that with 4 or more acceptable medications the examiner should defer. FAA, CACI – Hypertension Worksheet

Show the FAA's words: ACE inhibitorsThe official FAA wording: two passages, each with its document and dateOpen
FAA, Antihypertensive (HTN, blood pressure medication) · FAA date 30 September 2026
Seven-day (7) no fly/ground trial is required when starting a new hypertension (HTN) medication to verify no side effects.
AME should issue (if otherwise qualified) if the airman is on 3 or fewer medications
ACCEPTABLE HTN Medications (when certification criteria are met)
Angiotensin converting enzyme (ACE) inhibitors
FAA, Guide for Aviation Medical Examiners – Item 36. Heart – Hypertension · FAA date 23 March 2023
B . Treated with 3 or fewer* acceptable medications .
Follow the CACI – Hypertension Worksheet .
C . Any of the following:
Treated with 4 or more* acceptable medications;
DEFER
Notes: *Number of medications counts each component. (Example: lisinopril/HCTZ is 2 medications.)
Sources and dates: ACE inhibitorsThree FAA documents, with the FAA's date and when Crosscheck checked themOpen

Taken for migraine prevention

ACE inhibitors and ARBs for migraine prevention

FAA guidance

Acceptable with conditions.

Wait

7 days

ground trial when starting

There is more to this wait.

Examiner

CACI: the examiner can issue when the condition's worksheet criteria are met. Applicants for first- or second-class must provide the worksheet's information annually; applicants for third-class with each required exam

FAA label

CACI ACCEPTABLE

Source: FAA, Migraine Medication. FAA date 26 August 2026. Checked by Crosscheck 14 October 2026

The FAA lists ACE inhibitors such as lisinopril, and ARBs, as CACI-acceptable migraine prevention medication with a seven-day ground trial when starting.

More detail: ACE inhibitors and ARBs for migraine preventionThe rest of Crosscheck's reading, in plain wordsOpen

Wait

  • no wait after later doses

The FAA says the list is not all inclusive for individual medications in a noted class, and that a ground trial must verify no adverse effects and effectiveness from the medication before initial consideration.

  • 7 days after starting: ground observation

FAA rule for migraine medication: The FAA says migraine relief or rescue medication is acceptable when used occasionally and unacceptable for daily use, and that its post-dose observation time (no-fly warning) is based on the drug's half-life. It says that if several relief medications are needed on a recurring basis to stop symptoms, this is considered a complicated migraine, and the examiner should defer. For relief or rescue medication the worksheet lists, the FAA's CACI – Migraine and Chronic Headache Worksheet says the examiner can issue if the pilot meets all of its acceptable certification criteria, which include no more than one episode per month, no more than 2 outpatient clinic or urgent care visits for symptom exacerbation in the last 12 months (even if symptoms fully resolved), and no history of in-patient hospitalizations for headaches; it says narcotics, Fiorinal, Fioricet and Midrin are not acceptable for relief or rescue. FAA, Migraine Medication

Show the FAA's words: ACE inhibitors and ARBs for migraine preventionThe official FAA wording: one passage, each with its document and dateOpen
FAA, Migraine Medication · FAA date 26 August 2026
Must have ground trial to verify no adverse effects and effectiveness from medication prior to initial consideration.
CACI ACCEPTABLE – Migraine Prevention (Prophylaxis). This list is not all inclusive for individual medications in a noted class.
Angiotensin-converting enzyme (ACE) inhibitors: lisinopril (Prinivil; Qbrelis; Zestril), 7 days, None. Angiotensin II Receptor Blockers (ARB), 7 days, None
Sources and dates: ACE inhibitors and ARBs for migraine preventionOne FAA document, with the FAA's date and when Crosscheck checked itOpen

Taking it for something else? The entries here do not cover that use. The FAA may address it in the guidance for your condition. Ask your examiner.

See also

Medication guidance alone does not determine whether a pilot is medically qualified to fly. The underlying condition, dosage, side effects, medication combinations, and certification history may affect FAA eligibility.

For informational purposes only. Not legal or medical advice.