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Drug

Lisinopril

Pronounced

"lye-SIN-oh-pril"

Drug Interactions

See also Precautions section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug are: aliskiren, certain drugs that weaken the immune system/increase the risk of infection (such as everolimus, sirolimus), lithium, drugs that may increase the level of potassium in the blood (such as ARBs including losartan/valsartan, birth control pills containing drospirenone), sacubitril.

Some products have ingredients that could raise your blood pressure or worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).

A very serious reaction may occur if you are getting injections for bee/wasp sting allergy (desensitization) and are also taking lisinopril. Make sure all your doctors know which medicines you are using.

Negative Interactions
1
- Lisinopril
  Potassium
  Potential Negative Interaction
  A potentially serious side effect of taking ACE inhibitors is increased blood potassium levels. This problem is more likely to occur in people with advanced kidney disease. Taking potassium supplements, potassium-containing salt substitutes (No Salt®, Morton Salt Substitute®, and others), or large amounts of high-potassium foods (including noni juice) at the same time as ACE inhibitors could cause life-threatening problems. Therefore, people should consult their healthcare practitioner before supplementing additional potassium and should have their blood levels of potassium checked periodically while taking ACE inhibitors.
  Potassium
  Lisinopril
  ×
  1. Good CB, McDermott L, McCloskey B. Diet and serum potassium in patients on ACE inhibitors. JAMA 1995;274:538.
  2. Rush JE, Merrill DD. The Safety and tolerability of lisinopril in clinical trials. J Cardiovasc Pharmacol 1987;9(Suppl 3):S99-107.
  3. Sifton DW, ed. Physicians' Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1965-8.
  4. Burnakis TG, Mioduch HJ. Combined therapy with captopril and potassium supplementation. A potential for hyperkalemia. Arch Intern Med 1984;144:2371-2.
  5. Burnakis TG. Captopril and increased serum potassium levels. JAMA 1984;252:1682-3 [letter].
  6. Ray K, Dorman S, Watson R. Severe hyperkalemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction. J Hum Hypertens 1999;13:717-20.
  7. Stoltz ML. Severe hyperkalemia during very-low-calorie diets and angiotensin converting enzyme use. JAMA 1990;264:2737-8 [letter].
Supportive Interactions
2
- Lisinopril
  Zinc
  Replenish Depleted Nutrients
  In a study of 34 people with hypertension, six months of captopril or enalapril (ACE inhibitors related to lisinopril) treatment led to decreased zinc levels in certain white blood cells, raising concerns about possible ACE inhibitor–induced zinc depletion.
  While zinc depletion has not been reported with lisinopril, until more is known, it makes sense for people taking lisinopril long term to consider, as a precaution, taking a zinc supplement or a multimineral tablet containing zinc. (Such multiminerals usually contain no more than 99 mg of potassium, probably not enough to trigger the above-mentioned interaction.) Supplements containing zinc should also contain copper, to protect against a zinc-induced copper deficiency.
  Zinc
  Lisinopril
  ×
  1. Golik A, Zaidenstein R, Dishi V, et al. Effects of captopril and enalapril on zinc metabolism in hypertensive patients. J Am Coll Nutr 1998;17:75-8.
- Lisinopril
  Iron
  Reduce Side Effects
  In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.
  Iron
  Lisinopril
  ×
  1. Lee SC, Park SW, Kim DK, et al. Iron supplementation inhibits cough associated with ACE inhibitors. Hypertension 2001;38:166-70.