Dulaglutide 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
Lisinopril
Dulaglutide
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.
You've been prescribed two medicines that work well together for many people: lisinopril (a blood pressure pill) and dulaglutide (Trulicity, a weekly diabetes injection). When taken together, there may be a slightly higher chance that your blood sugar drops too low. Low blood sugar can make you feel shaky, sweaty, dizzy, or confused.
The good news is this is only a theoretical concern, and it's very manageable. Your care team can simply check your blood sugar a bit more often, especially when starting or stopping either medicine, and adjust your diabetes doses if needed. Keep taking both as prescribed and let your doctor or pharmacist know if you notice signs of low sugar.
Effect: Possible additive increase in hypoglycemia risk when an ACE inhibitor (lisinopril) is combined with an antidiabetic agent (dulaglutide, a GLP-1 receptor agonist).
- Mechanism: Unknown; proposed enhanced insulin sensitivity with ACE inhibitors. Not a CYP-mediated PK interaction. Neither agent is a prodrug relevant here.
- Direction/magnitude: Potentiated hypoglycemic (PD) effect; magnitude not quantified.
- Onset: Unspecified. Evidence: Theoretical; case-series data suggest no increased serious hypoglycemia with ACEi plus secretagogues (except possibly glimepiride).
- Management: More frequent glucose monitoring during and after ACEi initiation/withdrawal; individualize antidiabetic dosing as needed.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
Taking ACE inhibitors together with antidiabetic drugs can heighten the likelihood of hypoglycemia231. When these agents must be used together, glucose levels should be checked more often, not only throughout therapy but also once an ACE inhibitor is discontinued 4. Modifying the insulin dose may likewise become necessary 23. 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 exception 5.
Why it happens (mechanism)
Unknown
How to manage this interaction
This combination is commonly used and is manageable. Here is what typically happens and what you can do:
- Keep taking both lisinopril and dulaglutide exactly as prescribed unless your doctor tells you otherwise.
- Your care team may monitor your blood sugar more often, especially when starting or stopping the lisinopril.
- Your diabetes medication doses may need to be adjusted and individualized by your care team.
- Learn the signs of low blood sugar (shakiness, sweating, dizziness, confusion) and treat quickly with a fast sugar source.
- Tell your pharmacist or prescriber if you have frequent lows or any medication changes.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) A self-controlled case series examined Medicare claims data collected across 5 states between 1999 and 2011 to assess 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 that was 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. After adjustment for confounders, the rate ratio (RR) was not meaningfully raised for glipizide, glyburide, repaglinide, or metformin, but it was slightly increased for glimepiride (RR, 1.23; 95% CI, 1.11 to 1.37) and slightly decreased for nateglinide (RR, 0.73; 95% CI, 0.56 to 0.96). Apart from glimepiride, these findings indicate that combined use of an ACE inhibitor and insulin secretagogues was not linked to a greater risk of serious hypoglycemia 5.
Common questions
Can I take Dulaglutide and Lisinopril together?
Combining lisinopril and dulaglutide may slightly raise the chance of low blood sugar, so check your glucose a bit more often and let your care team fine-tune your doses. This is a theoretical, well-managed concern, so keep taking both as prescribed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Dulaglutide 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 Dulaglutide and Lisinopril interaction managed?
This combination is commonly used and is manageable. Here is what typically happens and what you can do: Keep taking both lisinopril and dulaglutide exactly as prescribed unless your doctor tells you otherwise. Your care team may monitor your blood sugar more often, especially when starting or stopping the lisinopril. Your diabetes medication doses may need to be adjusted and individualized by you… 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 Dulaglutide 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: Zestril(R) oral tablets, lisinopril oral tablets. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2014. DailyMed
- Product Information: TOUJEO(R) subcutaneous injection, insulin glargine subcutaneous injection. sanofi-aventis (per manufacturer), Bridgewater, NJ, 2015. DailyMed
- Product Information: AFREZZA(R) oral inhalation powder, insulin human oral inhalation powder. MannKind Corporation(TM) (per manufacturer), Danbury, CT, 2014. DailyMed
- Product Information: AMARYL(R) oral tablets, glimepiride oral tablets. Sanofi-Aventis U.S. LLC (per FDA), Bridgewater, NJ, 2013. 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 Dulaglutide
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist