Lisinopril and Cyclosporine: 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
Cyclosporine
Lisinopril
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.
Cyclosporine is a medicine that calms your immune system, and lisinopril is a blood pressure medicine. When you take them together, two things can happen. First, both can raise the level of potassium in your blood, and too much potassium can affect your heart. Second, the combination can put extra strain on your kidneys and lower how well they work.
This concern is based mostly on how these drugs work rather than lots of real-world cases, but it is worth taking seriously. The good news is your care team can manage this easily by checking your potassium and kidney bloodwork and adjusting your doses. Please don't stop either medicine on your own, just talk with your doctor or pharmacist.
Effect: Additive hyperkalemia and potential acute renal dysfunction with concomitant cyclosporine and lisinopril.
Mechanism: Lisinopril reduces angiotensin II, lowering aldosterone and promoting potassium retention; this is additive to cyclosporine-induced hyperkalemia. ACE inhibition can also reduce efferent arteriolar tone, compounding cyclosporine's nephrotoxic, vasoconstrictive effect on renal perfusion.
- Direction: Additive/synergistic toxicity (renal + potassium).
- Evidence: Theoretical; severity rated major.
- Onset: Unspecified.
- Monitoring: Serum potassium, SCr/eGFR, blood pressure; cyclosporine trough levels.
Neither agent requires prodrug consideration for this interaction. Use caution; individualize dosing and monitor closely.
What happens
Acute renal dysfunction and an increased risk of hyperkalemia
Interaction Deep Dive
Avoid giving cycloSPORINE together with an ACE inhibitor or a potassium-sparing diuretic. When cycloSPORINE is combined with a potassium-sparing diuretic, the likelihood of hyperkalemia may rise; therefore, exercise caution and monitor potassium levels while the two are used together12. Additionally, taking ACE inhibitors alongside cycloSPORINE can reduce renal function3.
Why it happens (mechanism)
Reduced angiotensin II; additive hyperkalemia
How to manage this interaction
If both medicines are prescribed, keep taking them as directed unless your prescriber tells you otherwise. Your care team can manage this combination safely.
- Bloodwork: Expect your team to check your potassium and kidney function more closely, especially when starting or changing doses.
- Dosing: Doses may need to be adjusted and individualized by your care team.
- What to watch for: Report muscle weakness, an irregular or slow heartbeat, less urination, or swelling.
- Ask: Check with your pharmacist before adding potassium supplements, salt substitutes, or other blood pressure medicines.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) Two documented cases described renal transplant recipients who were taking enalapril at the same time as cycloSPORINE and furosemide. When the ACE inhibitor was stopped, renal function got better. The researchers hypothesized that prolonged use of cycloSPORINE might lead to renal hypoperfusion, which could then stimulate the renin-angiotensin system to preserve glomerular filtration. If these circumstances hold, then starting an ACE inhibitor might provoke an acute worsening of renal function 3.
Common questions
Can I take Lisinopril and Cyclosporine together?
Taking cyclosporine with lisinopril can raise potassium and reduce kidney function, so your care team will monitor your bloodwork and adjust doses. Keep taking both as prescribed and report any warning signs to your doctor or pharmacist. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lisinopril and Cyclosporine interaction?
It is rated major. Potentially serious — often needs a change or close 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 Cyclosporine interaction managed?
If both medicines are prescribed, keep taking them as directed unless your prescriber tells you otherwise. Your care team can manage this combination safely. Bloodwork: Expect your team to check your potassium and kidney function more closely, especially when starting or changing doses. Dosing: Doses may need to be adjusted and individualized by your care team. What to watch for: Report muscle wea… 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 Lisinopril or Cyclosporine 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 a safer alternative to one of these medications for me?
References (3)
- Product Information: NEORAL(R) oral soft gelatin capsules oral solution, cyclosporine modified oral soft gelatin capsules oral solution. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Product Information: SANDIMMUNE(R) oral capsules, oral solution, intravenous injection, cyclosporine oral capsules, oral solution, intravenous injection. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Murray BM, Venuto RC, Kohli R, et al: Enalapril-associated acute renal failure in renal transplants: possible role of cyclosporine. Am J Kidney Dis 1990; 16:66-69. PubMed
Keep reading about Cyclosporine
Keep reading about Lisinopril
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.
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