Bumetanide and Lisinopril: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Bumetanide
Lisinopril
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.
Both of these medicines lower your blood pressure. Bumetanide (Bumex) is a water pill that pulls extra fluid and salt out of your body. Lisinopril relaxes and widens your blood vessels. When you add lisinopril while already taking a water pill, your blood pressure can drop quite a bit, especially with the very first dose. You might feel dizzy or lightheaded when you stand up too fast.
The good news is that this drop is usually short-lived, and your care team can plan for it. Don't stop or change either medicine on your own. Just talk with your doctor or pharmacist so they can time and dose things safely and keep an eye on you.
Effect: First-dose postural hypotension when an ACE inhibitor (lisinopril) is added to loop diuretic (bumetanide) therapy. This is a pharmacodynamic interaction; no clinically significant PK interaction is expected.
Mechanism: Additive vasodilation plus diuretic-induced intravascular volume/sodium depletion, unmasking an exaggerated hypotensive response on RAAS blockade. ACE inhibitors may also blunt GFR and natriuretic response, risking fluid retention.
Onset: rapid. Evidence: probable. Severity: moderate.
- Consider holding the diuretic 2 to 3 days before initiating lisinopril if feasible.
- If not, start a very low ACE inhibitor dose in the evening; monitor BP for 4 hours post-dose.
- Monitor BP, fluid status, and weight for up to 2 weeks after any dose change.
What happens
Postural hypotension (first dose)
Interaction Deep Dive
The introduction of ACE inhibitors to a regimen already containing loop diuretics has been associated with reports of severe postural hypotension. A drop in blood pressure following the initial dose is frequently observed in individuals who have become sodium depleted or hypovolemic as a result of diuretic use or restricted sodium intake. Typically, this hypotensive reaction resolves on its own91017. One might expect this pairing to enhance natriuresis; however, in a paradoxical fashion, ACE inhibitors can instead diminish glomerular filtration along with the diuresis and natriuretic effects produced by diuretics, which can result in edema and fluid retention64. No pharmacokinetic interactions of clinical significance have been identified between these two drug classes.
Why it happens (mechanism)
Vasodilation and relative intra-vascular volume depletion
How to manage this interaction
This combination is used often and can be managed well by your care team. The main concern is a big blood pressure drop when lisinopril is first started or increased.
- Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- Your team may hold the water pill for a couple of days before starting lisinopril, or start lisinopril at a very low dose (often in the evening) and watch your blood pressure closely for the first few hours.
- They may check your blood pressure, weight, and fluid status regularly for about two weeks after any change.
Tell your pharmacist or doctor if you feel dizzy, lightheaded, or faint when standing.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
3 reports — tap to read
a) In one study, captopril did not change the renal excretion or the diuretic action of furosemide in hypertensive patients 2. However, more recent findings show that standard doses of captopril reduce the natriuretic and diuretic actions of furosemide in patients with mild to moderate congestive heart failure. While on furosemide, sodium excretion rose by 623%; this fell to 242% when captopril was added 3. Several authors have described weight gain, sodium retention, and peripheral edema in patients receiving diuretic therapy when ACE inhibitors were started 456.
b) In a single-dose study, oral benazepril (10 mg) and oral furosemide (40 mg) were given both individually and together to 12 healthy volunteers. No significant effects were seen on the pharmacokinetics of benazepril. The urinary excretion of total furosemide decreased by 10% to 20% when the drugs were given together. When each drug was administered alone as a single dose, blood pressure and pulse were not significantly affected. However, with the combination, a reduction in erect blood pressure and a rise in pulse rate were observed. Peak effects occurred four hours after administration (122 to 104 mm Hg and 87 to 107 beats per minute, respectively). Most subjects receiving the combination experienced dizziness, which occurred together with blood pressure reductions 7.
c) Concurrent captopril and furosemide therapy has been reported to enhance the hypotensive effects of captopril. In one patient with high plasma renin activity who received 50 mg captopril and intravenous furosemide, blood pressure fell sharply from 290/150 mm Hg to 135/60 mm Hg within 10 minutes 8.
Common questions
Can I take Bumetanide and Lisinopril together?
Adding lisinopril to bumetanide can cause a sharp, usually short-lived blood pressure drop with the first dose, so let your care team start it low, time it carefully, and monitor you. Report any dizziness or fainting. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Bumetanide and Lisinopril interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How is the Bumetanide and Lisinopril interaction managed?
This combination is used often and can be managed well by your care team. The main concern is a big blood pressure drop when lisinopril is first started or increased. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. Your team may hold the water pill for a couple of days before starting lisinopril, or start lisinopril at a very low dose (often in the even… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Bumetanide 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 (10)
- Vlasses PH, Ferguson RK, & Chatterjee K: Captopril: clinical pharmacology and benefit-to-risk ratio in hypertension and congestive heart failure. Pharmacotherapy 1982; 2:1-17. PubMed
- Fujimura A, Shimokawa Y, & Ebihara A: Influence of captopril on urinary excretion of furosemide in hypertensive subjects. J Clin Pharmacol 1990; 30:538-542. PubMed
- McLay JS, McMurray JJ, Bridges AB, et al: Acute effects of captopril on the renal actions of furosemide in patients with chronic heart failure. Am Heart J 1993; 126:879-886. PubMed
- Cleland JGF, Gillen G, & Dargie HJ: The effects of frusemide and angiotensin-converting enzyme inhibitors and their combination on cardiac and renal haemodynamics in heart failure. Eur Heart J 1988; 9:132-141. PubMed
- Odemuyiwa O, Gilmartin J, Kenny D, et al: Captopril and the diuretic requirements in moderate and severe chronic heart failure. Eur Heart J 1989; 10:586-590. PubMed
- Flapan AD, Davies E, Waugh C, et al: Acute administration of captopril lowers the natriuretic and diuretic response to a loop diuretic in patients with chronic cardiac failure. Eur Heart J 1991; 12:924-927. PubMed
- De Lepeleire I, Van Hecken A, Verbesselt R, et al: Interaction between furosemide and the converting enzyme inhibitor benazepril in healthy volunteers. Eur J Clin Pharmacol 1988; 34:465-468. PubMed
- Case DB, Atlas SA, Laragh JH, et al: Clinical experience with blockade of the renin-angiotensin-aldosterone system by an oral converting-enzyme inhibitor (SQ 14,255, captopril) in hypertensive patients. Prog Cardiovasc Dis 1978; 21:195-206.
- Clementy J, Schwebig A, Mazaud C, et al: Comparative study of the efficacy and tolerance of Capozide and Moduretic administered in a single daily dose for the treatment of chronic moderate arterial hypertension. Postgrad Med J 1986; 62(suppl 1):132.
- Gluck Z, Beretta-Piccoli C, & Reubi FC: Long-term effects of captopril on renal function in hypertensive patients. Eur J Clin Pharmacol 1984; 26:315-323. PubMed
Keep reading about Bumetanide
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