Understanding Lisinopril
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor, a class of medication widely prescribed for managing high blood pressure (hypertension), treating heart failure, and improving survival after a heart attack. It works by blocking the formation of a hormone called angiotensin II, which causes blood vessels to constrict. By preventing this constriction, lisinopril helps blood vessels relax and widen, lowering blood pressure and reducing the workload on the heart.
While lisinopril is highly effective, its mechanism of action also makes it susceptible to various drug-drug and drug-food interactions. These interactions can affect the medication's efficacy, increase the risk of side effects, and, in some cases, cause serious, life-threatening complications. It is imperative for anyone taking lisinopril to be aware of these potential risks and always consult a healthcare provider before combining it with another substance.
Significant medication interactions to avoid
Other drugs that affect the renin-angiotensin system
Taking multiple medications that all target the renin-angiotensin-aldosterone system (RAAS), the same pathway lisinopril affects, significantly increases the risk of side effects like very low blood pressure, high potassium levels, and kidney problems.
Neprilysin Inhibitors (e.g., sacubitril/valsartan [Entresto]): This combination is contraindicated. You should not take lisinopril within 36 hours before or after taking sacubitril/valsartan due to a significantly increased risk of angioedema (swelling of the face, lips, and tongue).
Angiotensin II Receptor Blockers (ARBs) (e.g., losartan, valsartan): In most cases, taking an ACE inhibitor and an ARB together is not recommended. Dual blockade of the RAAS system should be avoided unless specifically deemed necessary and closely monitored by a healthcare provider, especially in those with kidney issues.
Aliskiren (Tekturna): This direct renin inhibitor should not be used with lisinopril in patients who have diabetes or kidney impairment due to an increased risk of severe side effects.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Many people use over-the-counter NSAIDs like ibuprofen (Advil, Motrin) and naproxen (Aleve) for pain relief and inflammation. However, combining them with lisinopril can be particularly harmful, especially for older adults or those with existing kidney problems.
Mechanism of interaction: NSAIDs can decrease the effectiveness of lisinopril in lowering blood pressure. In addition, when taken with lisinopril, they increase the risk of kidney damage or acute kidney failure by constricting the blood vessels in the kidneys.
Potassium-sparing diuretics and potassium supplements
Lisinopril can increase potassium levels in the blood, a condition known as hyperkalemia. This risk is compounded by adding other sources of potassium.
Potassium-sparing diuretics (e.g., spironolactone, amiloride): These 'water pills' work differently than other diuretics and cause the body to retain potassium. Combining them with lisinopril can lead to dangerously high potassium levels, which can cause abnormal heart rhythms.
Potassium supplements and salt substitutes: Many salt substitutes are made with potassium chloride instead of sodium chloride. Patients taking lisinopril should avoid these products unless directed by their doctor, as they significantly raise the risk of hyperkalemia.
Other interacting medications
- Lithium: Lisinopril can reduce the excretion of lithium, increasing its levels in the body and potentially causing toxicity.
- mTOR inhibitors (e.g., sirolimus, everolimus): Concurrent use can increase the risk of angioedema.
- Injectable Gold (sodium aurothiomalate): This combination can cause a reaction with symptoms including flushing, nausea, vomiting, and low blood pressure.
- Diabetes medications (e.g., insulin, sulfonylureas): The combination may increase the blood sugar-lowering effect, raising the risk of hypoglycemia (low blood sugar).
Table of common lisinopril interactions
| Interacting Substance | Potential Risk | Mechanism of Interaction | Clinical Management |
|---|---|---|---|
| Potassium Supplements/Salt Substitutes | Hyperkalemia (High Potassium) | Lisinopril increases potassium levels; additional sources can be dangerous. | Avoid unless directed by a doctor; regular monitoring of potassium levels. |
| NSAIDs (Ibuprofen, Naproxen) | Kidney Damage, Reduced Lisinopril Efficacy | NSAIDs can constrict kidney blood vessels and cause the body to retain salt and water. | Use acetaminophen (Tylenol) instead; monitor kidney function if concurrent use is necessary. |
| ARBs (Valsartan, Losartan) | Hyperkalemia, Low Blood Pressure, Kidney Issues | Dual blockade of the RAAS pathway. | Avoid combination in most cases; strict monitoring if used together. |
| Sacubitril/Valsartan (Entresto) | Angioedema | Increases the risk of severe facial and throat swelling. | Avoid combination; observe a 36-hour washout period. |
| Lithium | Lithium Toxicity | Lisinopril reduces lithium excretion. | Monitor serum lithium levels frequently. |
| Potassium-Sparing Diuretics | Severe Hyperkalemia | Both drugs increase blood potassium. | Use cautiously with frequent potassium monitoring. |
| Diabetes Medications | Hypoglycemia (Low Blood Sugar) | Lisinopril may increase insulin sensitivity. | Closely monitor blood sugar levels and adjust diabetes medication dosage. |
Other things to be aware of
Food and drink
While lisinopril does not have many specific food interactions, a cautious approach is recommended. Avoid excessive intake of potassium-rich foods and beverages and be mindful of your overall sodium intake. Excessive alcohol can also increase the risk of low blood pressure and dizziness when taking lisinopril.
Pregnancy
Lisinopril has a boxed warning against use during pregnancy. It can cause serious harm or even death to an unborn baby, particularly during the second and third trimesters. Patients who become pregnant should discontinue lisinopril immediately and consult their doctor for a safer alternative.
Certain medical conditions
Your doctor will consider pre-existing conditions before prescribing lisinopril. It is contraindicated in patients with a history of angioedema. Extra caution and monitoring are necessary for patients with diabetes, kidney disease, liver disease, or collagen vascular diseases like lupus.
Conclusion
Understanding potential drug and food interactions is a critical component of safely managing treatment with lisinopril. The most important rule is to inform your doctor and pharmacist of all medications, supplements, vitamins, and herbal products you are taking. Pay particular attention to avoiding potassium supplements, certain diuretics, NSAIDs, and other medications that affect the RAAS system, as these can lead to serious adverse effects. Regular monitoring of kidney function and electrolyte levels may be necessary, and following a heart-healthy diet can further support your treatment plan. Open communication with your healthcare team is your best defense against harmful interactions. For comprehensive information on drug interactions, consult a reliable medical resource like MedlinePlus Drug Information.
What are the key takeaways for taking lisinopril safely?
- Disclose all medications and supplements: Always provide a complete list of your prescription drugs, over-the-counter medications, vitamins, and herbal supplements to your healthcare provider before starting or changing your lisinopril regimen.
- Avoid potassium supplements and salt substitutes: Since lisinopril can increase blood potassium levels, combining it with potassium supplements or potassium-containing salt substitutes can cause dangerously high potassium levels (hyperkalemia).
- Exercise caution with NSAIDs: Common pain relievers like ibuprofen and naproxen can both increase the risk of kidney damage and reduce the effectiveness of lisinopril, especially in at-risk individuals.
- Never double up on RAAS-affecting drugs: Do not take lisinopril concurrently with other ACE inhibitors, ARBs, or aliskiren without strict medical supervision, as this significantly increases the risk of side effects.
- Be aware of angioedema risk: The combination of lisinopril with sacubitril/valsartan (Entresto) or mTOR inhibitors is specifically contraindicated due to a high risk of angioedema.
- Monitor for potential low blood pressure: Combining lisinopril with diuretics or alcohol can increase the risk of symptomatic low blood pressure, causing dizziness or fainting.
- Consult your doctor before making dietary changes: Discuss high-potassium foods and overall sodium intake with your doctor to understand how they may affect your treatment.
FAQs
Q: Can I take ibuprofen or other NSAIDs with lisinopril? A: No, it is generally not recommended to take NSAIDs like ibuprofen or naproxen with lisinopril without consulting a doctor. This combination can increase the risk of kidney problems and make lisinopril less effective at lowering blood pressure. Safer alternatives, like acetaminophen (Tylenol), may be available.
Q: What about potassium supplements or salt substitutes? A: You should avoid taking potassium supplements or using potassium-containing salt substitutes while on lisinopril, as this can cause hyperkalemia (high potassium levels). Discuss all sources of potassium with your doctor or pharmacist.
Q: Is it safe to drink alcohol while taking lisinopril? A: While there are no reported direct interactions, excessive alcohol consumption can increase the risk of side effects like dizziness and low blood pressure. It is best to use alcohol in moderation and discuss appropriate levels with your healthcare provider.
Q: What are the risks of combining lisinopril with other blood pressure medications? A: Taking lisinopril with other medications that affect the same pathway, such as ARBs (losartan, valsartan) or aliskiren, can significantly increase the risk of low blood pressure, high potassium, and kidney issues. This is typically avoided unless under strict medical supervision.
Q: What is the risk of angioedema with lisinopril? A: Angioedema is a rare but serious side effect of lisinopril that causes swelling of the face, lips, tongue, or throat. The risk is significantly increased when taken with medications like sacubitril/valsartan (Entresto) or mTOR inhibitors. You should not take lisinopril if you have a history of angioedema.
Q: Do I need to avoid any specific foods? A: While no specific food interactions are widely reported, you should be mindful of consuming a very high intake of potassium-rich foods like bananas, potatoes, and tomatoes. It is best to discuss your diet with your doctor or a registered dietitian.
Q: Can lisinopril affect my blood sugar if I have diabetes? A: Yes, if you have diabetes and are on medication like insulin or sulfonylureas, lisinopril can increase the risk of hypoglycemia (low blood sugar). Close monitoring of your blood sugar is recommended.
