8 Lisinopril Interactions You Should Know About
Key takeaways:
Lisinopril (Zestril) is a common medication used for high blood pressure. It’s also used for other heart-related conditions.
Lisinopril can interact with several medications, including diuretics and lithium. Some interactions can be avoided with safer alternatives. Others can be managed with dosage changes or close monitoring.
Interactions can cause low blood pressure, low blood sugar, and high potassium levels. Some can increase the risk of a serious reaction called angioedema. Your healthcare provider can determine how to manage interactions that affect you.
Lisinopril (Zestril) is one of the most commonly prescribed medications in the U.S. It’s an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure and other heart-related conditions. And it has been researched for many other uses, too.
Since lisinopril is so common, there’s a good chance you may be taking it with other medications. But are these combinations safe? From other blood pressure pills to pain relievers in your medicine cabinet — lisinopril interactions are possible. Let’s review a few important ones to know about.
1. Diuretics
Diuretics (water pills) work by getting rid of extra fluids from the body. This can help with swelling (edema) from different health conditions, like heart failure. And it can help lower blood pressure, too. Examples include hydrochlorothiazide (Microzide), furosemide (Lasix), and bumetanide (Bumex).
Together, diuretics and lisinopril can cause blood pressure that’s too low (hypotension). This can make you feel dizzy, and potentially cause you to faint or fall. Your healthcare provider may lower your diuretic or lisinopril dosage to manage this effect. This interaction is pretty common. In fact, lisinopril is available in combination with hydrochlorothiazide as Zestoretic.
Potassium-sparing diuretics can also interact with lisinopril in another way. These are diuretics that cause your body to hold onto potassium. Examples include amiloride (Midamor), eplerenone (Inspra), and spironolactone (Aldactone).
Both potassium-sparing diuretics and lisinopril can increase potassium levels in your blood. Combining them can cause these levels to get too high (hyperkalemia). Signs and symptoms of this include feeling tired, muscle weakness, and tingling or numbness. Your healthcare provider should monitor your potassium levels while taking this combination.
2. Diabetes medications
If you have diabetes, you may be taking an oral or injectable medication for blood sugar control. Two examples are insulin and sulfonylureas.
Insulin helps sugar from your blood get into your tissues for energy. And sulfonylureas work by stimulating your pancreas to release more insulin. Examples of sulfonylureas include glipizide and glyburide (Diabeta, Glynase).
Insulin and sulfonylureas increase insulin levels in your blood. Lisinopril lowers your blood pressure by causing your blood vessels to relax and widen. But this effect can also make your tissues more sensitive to insulin. So, this combination might cause your blood sugar to get too low (hypoglycemia). If this happens, you may feel shaky, hungry, and sweaty.
ACE inhibitors have additional benefits in people with diabetes. So this is an interaction that can usually be managed. In doing so, you should regularly monitor your blood sugar during treatment. Your healthcare provider can tell you how to recognize and treat hypoglycemia.
3. NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain. They’re available over the counter (OTC) and with a prescription. Examples include ibuprofen (Advil, Motrin) and naproxen (Aleve).
NSAIDs have a reputation of being hard on your kidneys. Lisinopril can have some protective effects on your kidneys. But it can also worsen kidney function in some people. In this case, taking NSAIDs with lisinopril can potentially cause or worsen kidney problems. This tends to happen more often if you’re older, taking diuretics, and/or already have kidney problems.
Plus, NSAIDs like ibuprofen have been shown to increase blood pressure. So, your lisinopril dosage may not work as well with this combination, especially if you take NSAIDs like ibuprofen frequently.
There may be safer options available to treat your pain. For example, acetaminophen (Tylenol) doesn’t affect your kidneys like NSAIDs. And it’s not known to interact with lisinopril. Your healthcare provider can discuss alternatives with you
4. Angiotensin II receptor blockers
Angiotensin II receptor blockers (ARBs) work very similarly to lisinopril. In fact, they both work along the same pathway to lower your blood pressure. Examples include losartan (Cozaar), irbesartan (Avapro), and valsartan (Diovan).
But more of the same effects doesn’t always mean better. Your healthcare provider will recommend an ACE inhibitor or ARB — not both. That’s because this combination may cause more side effects without additional benefits. Your healthcare provider can determine the best treatment regimen for you.
5. Aliskiren
Aliskiren (Tekturna) also works along the same pathway as ARBs and lisinopril. And like ARBs, you may experience more side effects without additional benefits. This combination should be avoided, especially if you also have diabetes or kidney problems.
6. Entresto
Entresto (sacubitril/valsartan) is a combination medication used to help treat heart failure. It contains sacubitril, a neprilysin inhibitor. And it also contains valsartan, an ARB. We’ve already covered how ARBs and lisinopril interact.
Lisinopril (and other ACE inhibitors) can cause a serious reaction called angioedema. This is where your face, mouth, and neck swell up, which can make it difficult to breathe. Taking lisinopril with Entresto can increase the risk of angioedema. For this reason, this combination should be avoided altogether.
7. Certain cancer and transplant medications
Mammalian target of rapamycin (mTOR) inhibitors are a class of immunosuppresant medications. They’re used to prevent organ transplant rejection. And some are also used to treat certain cancers. Examples include sirolimus (Rapamune) and everolimus (Zortress, Afinitor).
Taking lisinopril with mTOR inhibitors can increase the risk of angioedema. Your healthcare provider will determine how best to manage this interaction.
8. Lithium
Lithium (Lithobid) is a medication approved to treat bipolar disorder. It has a narrow therapeutic index, which means even small changes in blood levels can have significant effects on your body. Because of this, your lithium blood levels are regularly monitored while taking it.
Changes in sodium levels can affect how lithium is removed from your body. For example, low sodium levels can result in more lithium in your blood. This can lead to lithium toxicity, which can be life-threatening. Signs and symptoms include confusion, blurry vision, and muscle weakness.
ACE inhibitors, like lisinopril, cause your kidneys to remove sodium from your blood. This can cause your lithium levels to get too high. If you’re taking this combination, your healthcare provider will want to monitor your lithium levels closely. Let them know about any changes to your sodium intake during treatment.
When should I contact my healthcare provider about a lisinopril interaction?
Your healthcare provider may be aware of lisinopril interactions that affect you. In fact, medications are sometimes prescribed together intentionally. These interactions are often managed with dosage changes and/or additional monitoring.
Even so, don’t hesitate asking your pharmacist or healthcare provider about potential lisinopril interactions. This is especially important when starting a new medication, OTC product, or supplement. And it helps to have your current medication list handy.
As described above, there are a few interactions that can be more serious. These can result in low blood pressure, low blood sugar, or angioedema. Contact your healthcare provider if signs or symptoms of these develop. Get immediate medical attention if they feel severe.
The bottom line
Lisinopril is a common medication used to treat high blood pressure and other heart-related conditions. But it can potentially interact with other medications you're taking. This can include diuretics, diabetes medications, and lithium. Interactions can result in low blood pressure, low blood sugar, and other signs and symptoms.
Your healthcare provider and pharmacist can check for potential interactions. This can ensure you’re taking lisinopril with other medications safely. Some interactions can be avoided with safer alternatives. Others may require dosage changes or monitoring.
Why trust our experts?
References
Bryant Ranch Prepack. (2020). Lisinopril [package insert].
Hedya, S. A., et al. (2021). Lithium toxicity. StatPearl.
Institute for Safe Medication Practices. (2017). FDA advise-ERR: Concomitant use of Entresto and ACE inhibitors can lead to serious outcomes.
Kuenzli, A., et al. (2010). Meta-analysis of combined therapy with angiotensin receptor antagonists versus ACE inhibitors alone in patients with heart failure. PLoS One.
May, M., et al. (2016). Clinically and pharmacologically relevant interactions of antidiabetic drugs. Endocrinology and Metabolism.
U. S. Food & Drug Administration. (2017). FY2015 regulatory science research report: Narrow therapeutic index drugs.
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