Lisinopril and Choline Salicylate: 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
Choline Salicylate
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 what's going on. Lisinopril is a blood pressure medicine, and choline salicylate is a salicylate pain reliever that works much like other NSAIDs (think ibuprofen). When you take them together, the salicylate can blunt how well lisinopril lowers your blood pressure. It can also affect your kidneys, especially if you are older, dehydrated, or already have kidney trouble.
The good news is this is very manageable. Your care team can keep an eye on your blood pressure and check your kidney function with simple lab tests. Staying well hydrated helps too. Please don't stop either medicine on your own, just talk with your pharmacist or doctor about using them together.
Mechanism: Salicylates (choline salicylate) inhibit renal prostaglandin synthesis, reducing the natriuretic and vasodilatory effects that support lisinopril's antihypertensive action. Additive effects on renal hemodynamics can impair GFR.
- Direction: Reduced antihypertensive/natriuretic efficacy of lisinopril; potential renal deterioration, including rare acute renal failure.
- Evidence: Established; onset unspecified.
- At-risk: Elderly, volume-depleted, preexisting renal impairment, treatment initiation.
- Management: Monitor BP for efficacy, assess renal function (SCr, eGFR) at initiation and periodically, ensure adequate hydration. Individualize therapy; consider alternative analgesia if BP or renal control is compromised.
What happens
Reduced antihypertensive effect and renal dysfunction and/or increased blood pressure
Interaction Deep Dive
The natriuretic and blood pressure lowering actions of ACE inhibitors or angiotensin receptor blockers (ARBs) can be diminished by NSAIDs. In certain patients, using these agents together may also cause worsening renal function, up to and including acute renal failure. If the combination cannot be avoided, evaluate whether renal function should be checked when therapy begins, watch for adequate antihypertensive control, and periodically reassess renal function for indications of declining function or failure. This is particularly important in the elderly, at the start of therapy, in those who are volume-depleted, and in patients with existing renal impairment. Confirm that patients maintain adequate hydration1234.
Why it happens (mechanism)
Additive effects on renal function; decreased renal prostaglandin production
How to manage this interaction
What your care team may do:
- Check your blood pressure to confirm your lisinopril is still working well.
- Order periodic kidney (renal function) blood tests, especially when you first start using both, and more often if you are older or have kidney concerns.
- Make sure you stay adequately hydrated.
What you can do: Keep taking both medicines as prescribed unless told otherwise. Tell your pharmacist or prescriber that you use choline salicylate, and ask whether it's the best pain option for you. Your dose or choice of pain reliever may be adjusted and individualized by your team.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) A 48-year-old man with hypertension that had previously been well-controlled on enalapril 10 mg/day developed severe hypertension, psychosis, disorientation, and generalized anasarca four days after starting indomethacin 100 mg/day for gout 5. Raising the enalapril dose to 20 mg/day failed to control the hypertension, and indomethacin was stopped. One day afterward, the patient underwent rapid diuresis and lost a considerable amount of weight. The enalapril dose was subsequently lowered to 10 mg/day, achieving good hypertension control with no lingering psychosis 6.
b) The antihypertensive action of captopril was counteracted by indomethacin in a randomized, double-blind, parallel-design multicenter study of 141 hypertensive patients. One week of combined indomethacin and captopril therapy raised 24-hour systolic blood pressure by 4.6 mmHg and diastolic by 2.7 mmHg (p less than 0.001). Overall, ambulatory diastolic blood pressure increased in 67% of patients receiving captopril while on indomethacin 7.
c) A 59-year-old man who had been treated with lisinopril 10 mg/day for 5 years experienced worsening hypertension after rofecoxib 25/day was started for arthritic pain. After 5 weeks, blood pressure rose from 130 to 135/80 to 85 to 168/98. Rofecoxib was stopped. Blood pressure fell over the next 18 days (average, 127/78 mmHg). Because of increased joint pain, rofecoxib was resumed at 25 mg/day. Following 2 days of treatment, blood pressure rose, and over the ensuing 2 weeks it averaged 143/89 mmHg. Lisinopril was increased to 20 mg/day, producing an average blood pressure of 121/81 mmHg over the following 21 days 8.
d) Celecoxib did not diminish the antihypertensive effect of lisinopril in 178 hypertensive patients in a double-blind, placebo-controlled, parallel-group trial. Patients received either celecoxib 200 mg twice daily or placebo in addition to their usual lisinopril therapy (10 to 40 mg daily) for 4 weeks. Changes from baseline in the 24-hour systolic and diastolic blood pressure (BP) were nonsignificant. The proportion of patients whose 24-hour BP rose by at least 5, 10, 15, or 20 mmHg was also comparable between celecoxib and placebo. The placebo-subtracted changes seen in 24-hour BP (1.6/1.2 mmHg) were smaller than what has been reported for NSAIDs in ACE inhibitor-treated patients 9.
Common questions
Can I take Lisinopril and Choline Salicylate together?
Choline salicylate can weaken lisinopril's blood pressure effect and strain the kidneys, so your team may monitor your blood pressure and kidney function and keep you well hydrated. Don't stop either medicine on your own, check with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lisinopril and Choline Salicylate 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 Lisinopril and Choline Salicylate interaction managed?
What your care team may do: Check your blood pressure to confirm your lisinopril is still working well. Order periodic kidney (renal function) blood tests, especially when you first start using both, and more often if you are older or have kidney concerns. Make sure you stay adequately hydrated. What you can do: Keep taking both medicines as prescribed unless told otherwise. Tell your pharmacist o… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Lisinopril or Choline Salicylate 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 (9)
- Product Information: Dynastat intravenous injection, intramuscular injection, parecoxib sodium intravenous injection, intramuscular injection. Pfizer Australia Pty Ltd (per Australian Register of Therapeutic Goods), West Ryde, Australia, 2017. DailyMed
- Product Information: SPRIX(R) nasal spray, ketorolac tromethamine nasal spray. Egalet US Inc. (per FDA), Wayne, PA, 2016. DailyMed
- Product Information: CALDOLOR(R) intravenous injection, ibuprofen intravenous injection. Cumberland Pharmaceuticals Inc. (per FDA), Nashville, TN, 2016. DailyMed
- Product Information: meloxicam oral tablets, meloxicam oral tablets. Apotex Corp. (per DailyMed), Weston, FL, 2016. DailyMed
- Ahmad S: Indomethacin-enalapril interaction: an alert (letter). South Med J 1991; 84:411-412. PubMed
- Morgan T, Anderson A, & Bertram D: Effect of indomethacin on blood pressure in elderly people with essential hypertension well controlled on amlodipine or enalapril. Am J Hypertens 2000; 13:1161-1167. PubMed
- Conlin P, Moore T, Swartz S, et al: Effect of indomethacin on blood pressure lowering by captopril and losartan in hypertensive patients. Hypertension 2000; 36:461-465. PubMed
- Brown C: Effect of rofecoxib on the antihypertensive activity of lisinopril (letter). Ann Pharmacother 2000; 34:1486. PubMed
- White W, Kent J, Taylor A, et al: Effects of celecoxib on ambulatory blood pressure in hypertensive patients on ACE inhibitors. Hypertension 2002; 39:929-934. PubMed
Keep reading about Lisinopril
Keep reading about Choline Salicylate
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