Insulin Aspart, Recombinant 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
Insulin Aspart, Recombinant
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 lisinopril (a blood pressure medicine) along with insulin aspart (a fast-acting insulin). When these two are used together, there's a chance your blood sugar could dip a little lower than expected. That means you might notice signs of low blood sugar, like shakiness, sweating, dizziness, or feeling suddenly hungry.
The good news is that this is easy for your care team to manage. They may ask you to check your blood sugar a bit more often, especially when you first start or stop the lisinopril, and they can fine-tune your insulin dose if needed. Keep taking both as prescribed and bring any low blood sugar episodes to their attention.
Effect: Possible additive risk of hypoglycemia when an ACE inhibitor (lisinopril) is combined with insulin aspart.
- Mechanism: Unknown; proposed to involve improved insulin sensitivity with ACE inhibition. Neither agent is enzymatically dependent on the other for clearance.
- Direction: Potential enhancement of the glucose-lowering (PD) effect of insulin.
- Evidence: Theoretical; a self-controlled case series found no increased serious hypoglycemia with ACE inhibitors plus insulin secretagogues (possible exception: glimepiride).
- Onset: Unspecified.
- Management: Increase glucose monitoring during co-therapy and after ACE inhibitor withdrawal; individualize insulin dosing as needed.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
Using ACE inhibitors together with antidiabetic drugs can raise the likelihood of hypoglycemia231. When such combined therapy cannot be avoided, glucose levels should be checked more often, not only while on treatment but also once an ACE inhibitor is stopped4. It may also be necessary to modify the insulin dose23. Evidence from a self-controlled case series indicates that combining ACE inhibitors with insulin secretagogues does not raise the incidence of serious hypoglycemia, though glimepiride may be an exception5.
Why it happens (mechanism)
Unknown
How to manage this interaction
This combination is commonly used and can be managed well. Keep taking both lisinopril and insulin aspart exactly as prescribed unless your care team tells you otherwise.
- Check your blood sugar more often, particularly when starting lisinopril and also if it is ever stopped.
- Your insulin dose may need to be adjusted and individualized by your care team based on your readings.
- Learn the signs of low blood sugar (shakiness, sweating, confusion) and how to treat it quickly.
- Tell your pharmacist or prescriber about any low blood sugar episodes so they can tailor your plan.
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 from 5 states between 1999 and 2011 to assess the simultaneous use of ACE inhibitors together with insulin secretagogues (glimepiride, glipizide, glyburide, nateglinide, and repaglinide) or with metformin (used as a negative control). The endpoint assessed was hospital presentation for serious hypoglycemia. During the observation period, the count of serious hypoglycemic events was 8159 for glimepiride, 14,353 for glipizide, 11,129 for glyburide, 1595 for nateglinide, 2901 for repaglinide, and 32,639 for metformin. The confounder-adjusted rate ratio (RR) showed no significant increase 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 combined use of an ACE inhibitor and insulin secretagogues was not linked to an increased risk of serious hypoglycemia 5.
Common questions
Can I take Insulin Aspart, Recombinant and Lisinopril together?
Combining lisinopril with insulin aspart may slightly increase the chance of low blood sugar, so monitor your glucose more closely (especially when starting or stopping lisinopril) and let your care team adjust your insulin as needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Insulin Aspart, Recombinant 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 Insulin Aspart, Recombinant and Lisinopril interaction managed?
This combination is commonly used and can be managed well. Keep taking both lisinopril and insulin aspart exactly as prescribed unless your care team tells you otherwise. Check your blood sugar more often, particularly when starting lisinopril and also if it is ever stopped. Your insulin dose may need to be adjusted and individualized by your care team based on your readings. Learn the signs of lo… 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 Insulin Aspart, Recombinant 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
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