Enalaprilat and Acarbose: 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
Acarbose
Enalaprilat
No brand names on record
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.
Here's the simple version. Acarbose is a diabetes medicine that helps keep your blood sugar from spiking after meals. Enalaprilat is a blood pressure medicine (an ACE inhibitor). When they're used together, there may be a slightly higher chance that your blood sugar drops too low. That's called hypoglycemia, and it can make you feel shaky, sweaty, dizzy, or confused.
The good news is that this is easy to manage. Your care team may just check your blood sugar a bit more often, especially when either medicine is started or stopped. Don't change anything on your own, but do talk with your pharmacist or doctor so they can keep an eye on things.
Effect: Possible increased risk of hypoglycemia with coadministration of an ACE inhibitor (enalaprilat) and an antidiabetic agent (acarbose). Neither drug requires bioactivation relevant to this interaction, so direction is toward enhanced glucose-lowering (additive PD effect).
- Mechanism: Unknown; proposed increased insulin sensitivity with ACE inhibition.
- Evidence: Theoretical; a self-controlled case series found no increased serious hypoglycemia with ACE inhibitors plus secretagogues (possible exception: glimepiride).
- Onset: Unspecified.
- Management: More frequent glucose monitoring during therapy and after ACE inhibitor withdrawal; individualize antidiabetic dosing.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
Using ACE inhibitors together with antidiabetic medications can raise the likelihood of hypoglycemia134. When such combined use cannot be avoided, glucose levels should be checked more often, not only throughout therapy but also once an ACE inhibitor is stopped 2. It may also be necessary to modify the insulin dose 13. Findings from a self-controlled case series indicate that combining ACE inhibitors with insulin secretagogues does not raise the incidence of serious hypoglycemia, though glimepiride may be a possible exception 5.
Why it happens (mechanism)
Unknown
How to manage this interaction
Keep taking both medicines as prescribed unless your care team tells you otherwise. This interaction is generally manageable.
- Your team may check your blood sugar more often, both while you're on both drugs and after the ACE inhibitor is stopped.
- Your diabetes medication dose may need to be adjusted and individualized by your care team.
- Know the signs of low blood sugar (shakiness, sweating, dizziness, confusion) and treat it promptly.
- Ask your pharmacist or prescriber before starting or stopping either medicine.
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 drawn from 5 states over the period 1999 to 2011 to assess the combined use of ACE inhibitors with insulin secretagogues (glimepiride, glipizide, glyburide, nateglinide, and repaglinide) or metformin (serving as a negative control). The endpoint evaluated was hospital presentation for serious hypoglycemia. Over 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) showed no significant increase for glipizide, glyburide, repaglinide, or metformin, but was modestly raised with glimepiride (RR, 1.23; 95% CI, 1.11 to 1.37) and modestly 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 a greater risk of serious hypoglycemia 5.
Common questions
Can I take Enalaprilat and Acarbose together?
Taking acarbose with enalaprilat may slightly raise the chance of low blood sugar, so watch for symptoms and let your care team monitor your glucose more closely. Keep taking both as prescribed unless told otherwise. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Enalaprilat and Acarbose 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 Enalaprilat and Acarbose interaction managed?
Keep taking both medicines as prescribed unless your care team tells you otherwise. This interaction is generally manageable. Your team may check your blood sugar more often, both while you're on both drugs and after the ACE inhibitor is stopped. Your diabetes medication dose may need to be adjusted and individualized by your care team. Know the signs of low blood sugar (shakiness, sweating, dizzi… 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.
Questions for your pharmacist
- Does my dose of Enalaprilat or Acarbose 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 Acarbose
Keep reading about Enalaprilat
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