Insulin 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
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.
Taking lisinopril and insulin together can sometimes make your blood sugar drop a little lower than usual. Lisinopril is a blood pressure medicine, and insulin lowers blood sugar. When used together, some people may notice more signs of low blood sugar, like feeling shaky, sweaty, dizzy, or suddenly hungry.
This isn't something to panic about. The evidence for this is fairly limited (more of a theoretical concern), and plenty of people take both safely. Your care team can manage it easily by keeping a closer eye on your sugar readings and adjusting your insulin if needed. If you notice low blood sugar more often, let your pharmacist or doctor know.
Effect: Possible additive risk of hypoglycemia when an ACE inhibitor (lisinopril) is combined with insulin. Neither agent is metabolically activated in a way that alters this; the interaction is pharmacodynamic, not a CYP/transporter issue.
- Mechanism: Unknown; ACE inhibitors may enhance insulin sensitivity.
- Direction: Increased glucose-lowering effect (enhanced hypoglycemia risk).
- Evidence: Theoretical; a self-controlled case series found no increased serious hypoglycemia with secretagogues (possible exception: glimepiride).
- Onset: Unspecified.
- Management: More frequent glucose monitoring during therapy and after ACE inhibitor withdrawal; individualize insulin dosing.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
Taking ACE inhibitors together with antidiabetic drugs can raise the likelihood of hypoglycemia231. When these agents must be used together, glucose should be checked more often, both throughout treatment and following discontinuation of an ACE inhibitor 4. Modifications to the insulin dose might also be required 23. Findings from a self-controlled case series indicate that combining ACE inhibitors with insulin secretagogues does not correlate with higher rates of serious hypoglycemia, though glimepiride may be an exception 5.
Why it happens (mechanism)
Unknown
How to manage this interaction
This is usually manageable, and both medicines are commonly used together. Here is what a care team typically does:
- Checks your blood sugar more often, especially when you first combine them or if the lisinopril is stopped.
- May adjust and individualize your insulin dose if your readings run low.
What you can do: Keep taking both exactly as prescribed. Learn the signs of low blood sugar (shakiness, sweating, confusion, hunger) and how to treat it quickly. Bring your glucose logs to appointments, and tell your pharmacist or doctor if you see more low readings than usual.
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 spanning 1999 to 2011 were examined for the simultaneous use of ACE inhibitors together with insulin secretagogues (glimepiride, glipizide, glyburide, nateglinide, and repaglinide) or metformin (used as a negative control). The endpoint assessed was hospital presentation for serious hypoglycemia. The count of serious hypoglycemic events over the observation period was 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 modestly raised for glimepiride (RR, 1.23; 95% CI, 1.11 to 1.37) and modestly lowered for 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 with an increased risk of serious hypoglycemia 5.
Common questions
Can I take Insulin and Lisinopril together?
Combining lisinopril and insulin may slightly raise the chance of low blood sugar, so monitor your glucose a bit more closely and report frequent lows to your care team, who can adjust your insulin if needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Insulin 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 and Lisinopril interaction managed?
This is usually manageable, and both medicines are commonly used together. Here is what a care team typically does: Checks your blood sugar more often, especially when you first combine them or if the lisinopril is stopped. May adjust and individualize your insulin dose if your readings run low. What you can do: Keep taking both exactly as prescribed. Learn the signs of low blood sugar (shakiness,… 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 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 Insulin
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