Acarbose and Lisinopril: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Lisinopril
Acarbose
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Lisinopril is a blood pressure medicine, and acarbose helps control blood sugar after meals. When taken together, there is a chance your blood sugar could drop a little lower than expected (hypoglycemia). This is based on a theoretical concern with this type of blood pressure medicine, so it is not a strong or certain effect.
Watch for signs of low blood sugar like shakiness, sweating, dizziness, or feeling suddenly hungry. The good news is this is very manageable. Your care team can check your blood sugar a bit more often and adjust your medicines if needed. Keep taking both as prescribed and let your pharmacist or doctor know if you notice these symptoms.
Effect: Possible additive increase in hypoglycemia risk when ACE inhibitors are combined with antidiabetic agents.
- Direction: Enhanced glucose-lowering effect (PD interaction, not a CYP or transporter issue). Neither agent is affected by prodrug activation here.
- Mechanism: Unknown; proposed increased insulin sensitivity with ACE inhibitors.
- Evidence: Theoretical. A self-controlled case series showed no increased serious hypoglycemia with ACE inhibitors plus insulin secretagogues, except possibly glimepiride.
- Onset: Unspecified.
- Management: More frequent glucose monitoring during therapy and after ACE inhibitor withdrawal; individualize antidiabetic dosing as needed.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
Taking ACE inhibitors together with antidiabetic medications can heighten the likelihood of hypoglycemia134. When these drugs must be used together, glucose levels should be checked more often, both throughout treatment and following discontinuation of an ACE inhibitor2. Modifications to the insulin dose may likewise be required13. Findings from a self-controlled case series indicate that combining ACE inhibitors with insulin secretagogues does not raise the incidence of serious hypoglycemia, although glimepiride may be an exception5.
Why it happens (mechanism)
Unknown
How to manage this interaction
This combination is commonly used and is manageable. Keep taking both lisinopril and acarbose as prescribed unless your prescriber tells you otherwise.
- Your care team may monitor your blood sugar more often, both while you are on both drugs and if the lisinopril is ever stopped.
- Your diabetes medication dose may need to be adjusted and individualized by your team if your sugars run low.
- Know the signs of low blood sugar (shakiness, sweating, confusion, hunger) and how to treat it quickly.
Talk with your pharmacist or doctor about a monitoring plan and report any low blood sugar episodes.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a self-controlled case series, Medicare claims records from 5 states covering 1999 to 2011 were examined for the combined use of ACE inhibitors with insulin secretagogues (glimepiride, glipizide, glyburide, nateglinide, and repaglinide) or with metformin (serving as a negative control). The endpoint assessed was hospital presentation for serious hypoglycemia. During the observation period, the counts of serious hypoglycemic events were 8159, 14,353, 11,129, 1595, 2901, and 32,639 for glimepiride, glipizide, glyburide, nateglinide, repaglinide, and metformin, respectively. The confounder-adjusted rate ratio (RR) was not significantly raised for glipizide, glyburide, repaglinide, or metformin, but was slightly raised with glimepiride (RR, 1.23; 95% CI, 1.11 to 1.37) and slightly lowered with nateglinide (RR, 0.73; 95% CI, 0.56 to 0.96). Apart from glimepiride, these findings indicate that concurrent use of an ACE inhibitor and insulin secretagogues was not linked to an increased risk of serious hypoglycemia 5.
Common questions
Can I take Acarbose and Lisinopril together?
Taking lisinopril with acarbose may slightly raise the risk of low blood sugar, so check your glucose more often and tell your care team about any low readings. This is a theoretical concern and is easily managed with monitoring. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acarbose and Lisinopril interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Acarbose and Lisinopril interaction managed?
This combination is commonly used and is manageable. Keep taking both lisinopril and acarbose as prescribed unless your prescriber tells you otherwise. Your care team may monitor your blood sugar more often, both while you are on both drugs and if the lisinopril is ever stopped. Your diabetes medication dose may need to be adjusted and individualized by your team if your sugars run low. Know the s… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Acarbose or Lisinopril need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (5)
- Product Information: TOUJEO(R) subcutaneous injection, insulin glargine subcutaneous injection. sanofi-aventis (per manufacturer), Bridgewater, NJ, 2015. DailyMed
- Product Information: AMARYL(R) oral tablets, glimepiride oral tablets. Sanofi-Aventis U.S. LLC (per FDA), Bridgewater, NJ, 2013. DailyMed
- Product Information: AFREZZA(R) oral inhalation powder, insulin human oral inhalation powder. MannKind Corporation(TM) (per manufacturer), Danbury, CT, 2014. DailyMed
- Product Information: Zestril(R) oral tablets, lisinopril oral tablets. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2014. DailyMed
- Hee Nam Y, Brensinger CM, Bilker WB, et al: Angiotensin-converting enzyme inhibitors used concomitantly with insulin secretagogues and the risk of serious hypoglycemia. Clin Pharmacol Ther 2022; 111(1):218-226. PubMed
Keep reading about Lisinopril
Keep reading about Acarbose
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