Lisinopril interactions: Alcohol, medications, and other factors

Lisinopril interactions with other medications  

Before you start treatment with lisinopril, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether lisinopril interacts with supplements, herbs, or vitamins, see the “Lisinopril and other interactions” section.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with lisinopril. Keep in mind that this table doesn’t include all drugs that may interact with lisinopril. Some of these interactions are described in detail in “Drug interactions in depth.”

When to avoid lisinopril

In some cases, factors or conditions could prevent your doctor from prescribing lisinopril due to the risk of harm. These are known as contraindications. The contraindications of lisinopril include:

Having diabetes and taking aliskiren

Doctors typically won’t prescribe lisinopril for people with diabetes who take aliskiren (Tekturna).

This is because lisinopril and aliskiren work in similar ways to treat high blood pressure. Taking them together may increase the risk of side effects from either drug. Examples include low blood pressure, kidney problems, and high blood potassium levels. Having diabetes further increases the risk of high potassium.

If you have diabetes and take aliskiren, talk with your doctor before taking lisinopril. They’ll likely prescribe a treatment other than lisinopril for your condition.

Taking a neprilysin inhibitor

Doctors typically will not prescribe lisinopril in combination with a type of heart failure treatment called a neprilysin inhibitor. An example is sacubitril/valsartan (Entresto).

This is because taking lisinopril with a neprilysin inhibitor can increase your risk of angioedema (severe, rapid swelling under your skin). Both lisinopril and neprilysin inhibitors can cause angioedema when taken individually. Taking these medications together may further increase this risk.

Before you start lisinopril treatment, it’s important to tell your doctor if you take a neprilysin inhibitor. They’ll likely have you stop taking the drug and wait at least 36 hours to start lisinopril treatment. Likewise, after you stop taking lisinopril, your doctor will typically have you wait at least 36 hours before starting treatment with a neprilysin inhibitor.

Having had angioedema

Doctors typically will not prescribe lisinopril if you’ve had angioedema (severe, rapid swelling under your skin). This includes angioedema that happened for any reason, such as:

• angioedema due to taking an ACE inhibitor
• an inherited condition called hereditary angioedema
• angioedema that occurred without a known cause

Lisinopril is a type of ACE inhibitor. The drug may cause angioedema as a side effect, so taking lisinopril could increase your risk of having angioedema again.

If you’ve had angioedema, talk with your doctor before taking lisinopril. They can tell you about other treatments that may be better choices for you.

Having had an allergic reaction to an ACE inhibitor, lisinopril, or any of its ingredients

Doctors likely will not prescribe lisinopril if you’ve had an allergic reaction to an ACE inhibitor, lisinopril, or any of its ingredients. (Lisinopril is a type of ACE inhibitor.) Taking lisinopril could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Note: Before you start treatment with lisinopril, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe lisinopril.

Lisinopril interactions with alcohol

There aren’t any known interactions between lisinopril and alcohol.

However, drinking alcohol while taking the drug may worsen some of lisinopril’s side effects. For example, you may have worsened dizziness or headache.

If you have questions about drinking alcohol while taking lisinopril, talk with your doctor.

Drug interactions in depth

Here’s a closer look at certain drug interactions of lisinopril.

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to ease pain, inflammation, and fever.

Interaction result: Taking lisinopril with an NSAID could make lisinopril less effective for managing blood pressure. Taking these drugs together may also increase the risk of kidney problems.

Interaction explained: NSAIDs may cause your body to hold on to more sodium (salt) and fluid, which could raise your blood pressure. They can also narrow your blood vessels, further elevating your blood pressure. So taking lisinopril with an NSAID could reduce lisinopril’s effectiveness in lowering blood pressure.

In addition, taking these medications together could lead to kidney problems. This risk is particularly high for people who are dehydrated or already have a kidney condition. In some cases, this could result in temporary kidney failure.

Examples of NSAIDs: Here are some NSAIDs that may interact with lisinopril:

• celecoxib (Celebrex, Elyxyb)
• diclofenac (Cambia, Zipsor, others)
• ibuprofen (Advil, Motrin)
• meloxicam
• naproxen (Aleve, Naprosyn, others)

Steps you or your doctor may take: Before taking an NSAID during lisinopril treatment, talk with your doctor or pharmacist. They can advise you on whether it’s safe to take these medications together. They can also recommend alternatives to NSAIDs for easing pain, inflammation, or fever.

If you take an NSAID with lisinopril, your doctor may check your blood pressure or kidney function more often than usual. If your blood pressure becomes too low or tests show signs of kidney problems, your doctor will advise you on how to manage these effects. For example, they may have you stop treatment with lisinopril or the NSAID.

To learn more about lisinopril and NSAIDs, talk with your doctor or pharmacist.

Diabetes drugs

Diabetes drugs are prescribed to help manage blood sugar levels in people with diabetes.

Interaction result: Taking lisinopril with diabetes drugs may increase the risk of low blood sugar.

Interaction explained: Lisinopril could make your body more sensitive to the blood sugar-lowering effects of a diabetes drug. Taking these drugs together could increase the risk of your blood sugar becoming too low. Low blood sugar may cause symptoms such as dizziness, headache, shaking, and sweating.

Examples of diabetes drugs: Here are some diabetes drugs that may interact with lisinopril:

• glipizide (Glucotrol XL)
• glyburide (Diabeta, Glynase)
• insulin (Humalog, NovoLog, others)
• metformin (Fortamet, Glumetza)
• pioglitazone (Actos)

Steps you or your doctor may take: Before starting lisinopril treatment, tell your doctor if you take any diabetes drugs. They may advise you to check your blood sugar more often than is typical. If your blood sugar becomes too low, your doctor may adjust your dosage of the diabetes drug.

Your doctor can recommend ways to manage symptoms of low blood sugar. For example, they may advise you to eat at least 15 grams of carbohydrates when your blood sugar is low. Examples of carbohydrate sources that can quickly increase your blood sugar include fruit juices, glucose tablets, hard candies, and non-diet sodas.

Keep in mind that severely low blood sugar may be life threatening or cause you to lose consciousness. If you have severely low blood sugar, you or a bystander should call 911 or a local emergency number immediately.

To learn more about lisinopril and diabetes drugs, talk with your doctor or pharmacist.

Diuretics

Like lisinopril, diuretics are prescribed for heart-related conditions, including heart failure and high blood pressure.

Interaction result: Taking lisinopril in combination with a diuretic could increase the risk of low blood pressure. In addition, taking lisinopril with certain diuretics may lead to high blood potassium levels.

Interaction explained: Both lisinopril and diuretics can lower your blood pressure when taken individually. Taking them together may lower your blood pressure further.

Lisinopril and certain diuretics can also raise your blood potassium levels. Taking lisinopril with these diuretics could increase your levels even more.

Examples of diuretic drugs: Here are some diuretics that may interact with lisinopril:

• eplerenone (Inspra)
• furosemide (Furoscix, Lasix)
• hydrochlorothiazide (Microzide)
• spironolactone (Aldactone, Carospir)
• triamterene (Dyrenium)

Keep in mind that lisinopril is also available in combination with hydrochlorothiazide as brand-name Zestoretic.

Steps you or your doctor may take: Before taking lisinopril with a diuretic, talk with your doctor. They can advise you on whether it’s safe to take these medications together.

If you take lisinopril with a diuretic, your doctor may check your blood pressure or potassium levels more often than usual. If your blood pressure becomes too low or tests show high potassium, your doctor will advise you on how to manage these effects. For example, they may lower your lisinopril dosage or switch you to a different diuretic.

To learn more about lisinopril and diuretics, talk with your doctor or pharmacist.

Lisinopril and other interactions

Lisinopril may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with lisinopril.

Lisinopril interactions with supplements

Lisinopril may interact with the following supplements:

• fish oil supplements, which may increase the risk of low blood pressure
• potassium supplements, which may increase the risk of high blood potassium levels
• magnesium sulfate (Epsom salt) supplements, which may increase the risk of kidney problems

Before you start treatment with lisinopril, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Lisinopril and herbs

There are no specific reports of herbs interacting with lisinopril. However, that doesn’t mean herbal interactions won’t occur or be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during lisinopril treatment.

Lisinopril and vitamins

There are no specific reports of vitamins interacting with lisinopril. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with lisinopril.

Lisinopril interactions with food

Lisinopril may interact with salt substitutes that contain potassium. Using these products while taking lisinopril can increase your risk of high blood potassium levels.

Because of this interaction, your doctor will likely recommend that you avoid potassium salt substitutes during lisinopril treatment.

If you want more information about eating certain foods during lisinopril treatment, talk with your doctor.

Lisinopril and vaccines

There aren’t any known interactions between lisinopril and vaccines. Talk with your doctor or pharmacist to see whether you’re due for any vaccines.

Lisinopril and lab tests

Lisinopril isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

LISINOPRIL AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with lisinopril. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with lisinopril. The impact of cannabis may affect how well you stick to your lisinopril treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Lisinopril and health-related interactions

Certain medical conditions and other factors may increase the risk of interactions with lisinopril. Before you take this drug, be sure to talk with your doctor about your health history. Lisinopril may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with lisinopril include:

Angioedema: Doctors typically will not prescribe lisinopril if you’ve had angioedema (severe, rapid swelling under your skin). For details, see the “When to avoid lisinopril” section.

Diabetes: If you have diabetes, talk with your doctor before starting lisinopril treatment. Having diabetes may increase the risk of high blood potassium levels as a side effect of lisinopril.

In addition, be sure to tell your doctor if you take any diabetes drugs. Lisinopril may increase the risk of low blood sugar if taken with these medications. For details, see the “Drug interactions in depth” section.

Keep in mind that doctors typically will not prescribe lisinopril for people with diabetes who take aliskiren (Tekturna). For details, see the “When to avoid lisinopril” section.

Kidney conditions: If you have a kidney condition, such as kidney failure, talk with your doctor before taking lisinopril. The drug may cause kidney problems as a side effect, which could worsen your kidney condition. Talk with your doctor about whether lisinopril is a safe treatment option. In some cases, your doctor may prescribe a lower lisinopril dosage than is typical.

Liver conditions: If you have a liver condition, such as liver failure, talk with your doctor before taking lisinopril. The drug may cause liver problems as a side effect, which could worsen your liver condition. Your doctor can advise you on whether lisinopril is a safe treatment option.

Factors that increase the risk of low blood pressure: Before starting lisinopril treatment, your doctor may check for factors that could increase your risk of low blood pressure. Examples include low blood sodium levels, heart disease, and the use of dialysis.

If you have any of these factors, your doctor may check your blood pressure more often than is typical during lisinopril treatment. If your blood pressure becomes too low, they may adjust your lisinopril dosage.

Allergic reaction: Doctors likely will not prescribe lisinopril if you’ve had an allergic reaction to an ACE inhibitor, lisinopril, or any of its ingredients. (Lisinopril is a type of ACE inhibitor.) Taking lisinopril could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Breastfeeding: It’s not known whether it’s safe to take lisinopril while breastfeeding. There isn’t enough information to determine whether the drug passes into breast milk or what effects lisinopril may have on a child who is breastfed. To be safe, your doctor will likely advise you not to breastfeed during lisinopril treatment. If you’re breastfeeding or planning to, talk with your doctor before taking lisinopril. They can talk with you about treatment options and ways to feed your child.

Risk of fetal harm if taken during pregnancy: Lisinopril has a boxed warning about the risk of harm to a fetus or pregnancy loss if taken during pregnancy. This is a serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous. For details, see the boxed warning at the top of this article.

Preventing interactions

You can take certain steps to help prevent interactions with lisinopril. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the lisinopril label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If lisinopril doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with lisinopril by taking it exactly as your doctor prescribes.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.