Like any other drug, lisinopril can interact with other medications—both over the counter and prescription. Always consult with a physician before taking lisinopril with any other prescription drug, over-the-counter medication, herbal supplements, or substance like alcohol.
According to the U.S. National Library of Medicine, drugs that may interact with lisinopril include, but are not limited to, the following.
- NSAIDs/Non-Steroidal Anti-Inflammatory Agents Including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors)
- Dual Blockade of the Renin-Angiotensin System (RAS)
- Gold [injectable gold (sodium aurothiomalate)]
- mTOR Inhibitors
Note that this list may not be complete, and other drug interactions may occur. Always tell your doctor about any over-the-counter drugs, prescriptions medications, and supplements you are taking before starting lisinopril.
There are many types of diuretics and all of them can increase how often you need to urinate. Taking lisinopril and SOME diuretics like spironolactone or eplerenone can result in greater retention of potassium, thereby increasing the risk of hyperkalemia (high electrolyte potassium levels in blood)
SOME diuretics like furosemide, hydrochlorothiazide, can decrease the potassium in the body and can be commonly prescribed with lisinopril.
All diuretics when taken with lisinopril can have an adverse effect of hypotension, which is why it is important to monitor your blood pressure especially when starting new blood pressure medications.
Examples of commonly prescribed diuretics that may interact with lisinopril include:
- Spironolactone (CaroSpir, Aldactone)
- Triamterene (Dyrenium)
- Hydrochlorothiazide (Microzide)
- Furosemide (Lasix)
Antidiabetics are medications that people with diabetes take to help manage their condition. Concomitant use of these drugs may result in increased risk of hypoglycemia (low glucose/blood sugar).
Diabetic medications that may interact with lisinopril include:
- Oral hypoglycemic agents (helping to lower blood sugar), like sulfonylureas (glipizide, glyburide, gliclazide, glimepiride) and biguanides (metformin)
NSAIDs/Non-Steroidal Anti-Inflammatory Agents Including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors)
Non-steroidal anti-inflammatory drugs (NSAIDs) are medications that primarily work by reducing inflammation. NSAIDs may reduce the antihypertensive effects of lisinopril and similar drugs, so concomitant use is typically not recommended. Furthermore, decreased renal (kidney) function—including renal failure—may occur. These risks usually apply to elderly patients with decreased renal function and/or are on diuretics for this condition.
Popular NSAIDs include:
The only legally available COX-2 inhibitor (a type of NSAID) in the United States is celecoxib (Celebrex).
Dual Blockade of the Renin-Angiotensin System (RAS)
Lisinopril is a renin-angiotensin system (RAS) inhibitor since it directly inhibits the conversion of angiotensin I to angiotensin II. Concomitant use of lisinopril and other RAS inhibitors is not recommended, as it can increase the risk of:
- Hypotension (low blood pressure)
- Hyperkalemia (high electrolyte potassium levels in blood)
- Changes in renal (kidney) function
RAS inhibitors include:
- ACE inhibitors, like lisinopril
- Aliskiren (Tekturna)
- Angiotensin receptor blockers, like azilsartan (Edarbi) and valsartan (Diovan)
Lithium is commonly used for psychiatric conditions like bipolar disorder or even major depressive disorder. Taking lisinopril and lithium together may increase the risk of lithium toxicity (lithium overdose).
Symptoms of lithium overdose include:
- Ataxia (incoordination)
- Delirium (confusion)
- Hyperreflexia (overactive reflexes)
- Muscle weakness
- Nystagmus (involuntary eye movement)
Note that this list may not be complete, and there may be additional symptoms of lithium toxicity.
Gold [injectable gold (sodium aurothiomalate)]
Gold injections (of sodium aurothiomalate) are sometimes used to suppress the immune system to alleviate symptoms of rheumatic conditions like rheumatoid arthritis. Rarely, people receiving these injections while using ACE inhibitors experienced nitritoid reactions, which includes symptoms like:
- Facial flushing
- Hypotension (low blood pressure)
- Lightheadedness or fainting
- Nausea and vomiting
- Tachycardia (rapid heart beat)
Mammalian target of rapamycin (mTOR) inhibitors, as the name indicates, inhibit the mammalian target of rapamycin, which regulates certain kinds of growth, including cell growth and development of new blood vessels. Therefore, mTOR inhibitors function as a sort of immunosuppressive drug, typically used in the treatment of certain kinds of cancer.
People taking mTOR inhibitors and lisinopril may have an increased risk of angioedema, a type of swelling mucous membranes and subcutaneous tissue that typically presents around the face, tongue or even extremities.
Examples of mTOR inhibitors include:
- Temsirolimus (Torisel)
- Sirolimus (Rapamune)
- Everolimus (Zortress, Afinitor Disperz, Afinitor)
Lisinopril and Aspirin
Aspirin (Aspirin Childrens, Durlaza, Aspir-81) is a non-steroidal anti-inflammatory drug (NSAID). Therefore, use of lisinopril and aspirin at the same time is not recommended. However, many patients take Aspirin 81 mg daily for platelet reduction, and at this dose the interaction between lisinopril and aspirin should not be harmful. Always consult your pharmacist/ physician about all of your medications, and follow directions closely.
Lisinopril and Xanax
Alprazolam (Xanax) is a benzodiazepine (“benzo”), which effectively works to calm the central nervous system (CNS). Xanax and other CNS-calming drugs can have hypotensive (blood pressure-lowering) effects. In fact, one study found that alprazolam can lower blood pressure as effectively as captopril—an ACE inhibitor like lisinopril—in emergency department patients.
Because of this hypotensive effect, there may be an increased risk of hypotension in people who use lisinopril and Xanax simultaneously. As always, patients who take Xanax or any other medication should notify their doctor before taking lisinopril.
Negative interactions with alcohol can occur. Please read our page on alcohol interactions with lisinopril for more information.
- Potassium-rich foods and supplements
Note that this list may not be complete, and other interactions with other foods may occur.
Lisinopril and Potassium
Potassium-rich foods, potassium supplements, or salt substitutes with potassium
Always talk to your doctor about eating foods and taking supplements containing moderate to high amounts of potassium while taking ACE inhibitors like lisinopril. After all, lisinopril can increase potassium retention, so pairing these foods with this drug may increase the risk of high levels of potassium (hyperkalemia).
Symptoms of hyperkalemia may include:
- Shortness of breath
Foods with high levels of potassium include:
- Lima beans
Lisinopril and Grapefruit
ACE inhibitors like lisinopril are currently not known to interact with grapefruit juice; however, interactions may occur with other types of RAS-inhibitors.