Lisinopril Drug Interactions
Also known as: Prinivil, Zestril, Zestoretic (with hydrochlorothiazide), Prinzide (with hydrochlorothiazide)
Lisinopril (Prinivil, Zestril) is one of the most widely prescribed medications in the United States and the most commonly used ACE inhibitor. It lowers blood pressure by relaxing blood vessels, reduces hospitalizations and death in heart failure, and improves survival after a heart attack. It is also used to slow kidney disease progression in people with diabetes. Generic lisinopril is available for as little as $4–$15 per month, making it one of the most cost-effective cardiovascular medications available.Lisinopril has 3 documented drug interactions in our database, including 0 contraindicated, 1 major, 2 moderate, and 0 minor interactions.
0
Contraindicated
1
Major
2
Moderate
0
Minor
Dual blockade of the renin-angiotensin system with an ACE inhibitor and ARB increases the risk of hypotension, hyperkalemia, and acute kidney injury.
Mechanism
Both drug classes independently block the RAAS pathway. Combined use provides no additional cardiovascular benefit but doubles the risk of adverse renal and electrolyte effects.
Clinical Management
Avoid combination in most patients. If used, monitor blood pressure, renal function, and potassium closely.
NSAIDs can reduce the antihypertensive effect of ACE inhibitors and increase the risk of acute kidney injury.
Mechanism
NSAIDs inhibit prostaglandin synthesis, reducing renal afferent arteriole dilation and blunting the renal protective effects of ACE inhibitors.
Clinical Management
Monitor blood pressure and renal function. Use acetaminophen as an alternative when possible.
Concomitant use of lisinopril and ibuprofen can increase the risk of acute kidney injury, particularly in elderly or volume-depleted patients. It may also reduce the antihypertensive effects of lisinopril, leading to uncontrolled blood pressure.
Mechanism
Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), inhibits prostaglandin synthesis. Prostaglandins are crucial for maintaining renal blood flow, especially when the renin-angiotensin-aldosterone system (RAAS) is inhibited by lisinopril. This can lead to impaired renal function and fluid retention.
Clinical Management
Avoid concomitant use if possible, especially in patients at high risk for renal impairment (e.g., elderly, dehydrated, heart failure). If co-administration is necessary, monitor renal function (serum creatinine, BUN) and blood pressure closely, particularly at initiation and dose changes. Advise patients to maintain adequate hydration.
For complete prescribing information:
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