Lisinopril and Icatibant: 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
Icatibant
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 take lisinopril to lower your blood pressure. Part of how it works is by boosting a natural substance in your body called bradykinin, which helps relax and widen your blood vessels.
Icatibant is a medicine used for sudden swelling attacks. It works by blocking the very receptor that bradykinin uses. Because of this, when the two are used together, icatibant may partly cancel out some of lisinopril's blood pressure lowering effect. In a small study the drop in blood pressure was a little smaller when both were given. The good news is this is usually a short-term concern, and your care team can simply keep an eye on your blood pressure.
Effect: Icatibant may attenuate the antihypertensive effect of lisinopril.
Mechanism (PD): ACE inhibitors reduce bradykinin breakdown, contributing to vasodilation via bradykinin B2 receptor activation. Icatibant is a selective B2 receptor antagonist, so it opposes this component of the ACE inhibitor's effect. This is a pharmacodynamic, not pharmacokinetic, interaction; neither agent's metabolism is affected.
- Direction: reduced lisinopril effect
- Magnitude: small (captopril trial, n=27: MAP fall -14 vs -10.5 mmHg with added icatibant, p
What happens
Reduced lisinopril effectiveness
Interaction Deep Dive
When icatibant is taken together with an ACE inhibitor such as lisinopril, the ACE inhibitor's blood pressure lowering action may be diminished because icatibant blocks the bradykinin B2 receptor1. In a clinical study involving 27 participants, captopril (an ACE inhibitor) alone produced a maximum reduction in mean arterial blood pressure of -14 +/- 1 mmHg, whereas the combination of captopril and icatibant produced a maximum reduction of only -10.5 +/- 1 mmHg (p less than 0.001)2. If lisinopril and icatibant are used at the same time, monitoring for inadequate blood pressure control should be considered.
Why it happens (mechanism)
Antagonism of bradykinin B2 receptors by icatibant
How to manage this interaction
This is typically an easy interaction to manage, and icatibant is often used only intermittently for swelling attacks.
- Keep taking both exactly as prescribed unless your prescriber tells you otherwise.
- Your care team may monitor your blood pressure more closely around times you use icatibant.
- If needed, your lisinopril dose may be adjusted and individualized by your care team.
- Tell your pharmacist or doctor if you notice signs of higher blood pressure, such as headaches, or if you get home readings that run higher than usual.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a single-blind, randomized, crossover trial, giving captopril, an ACE inhibitor, lowered mean arterial blood pressure slightly more than the combined administration of icatibant and captopril. Each of the participants (n=27) was given 4 treatments in random sequence separated by 2-day intervals: captopril 25 mg orally plus IV NS, captopril 25 mg orally plus 100 mcg/kg IV icatibant, losartan 75 mg orally plus IV NS, and oral placebo plus IV NS. The greatest reduction in mean arterial blood pressure was -14 +/- 1 mmHg after captopril administration versus -10.5 +/- 1 mmHg after captopril plus icatibant administration (p=0.001) 2.
Common questions
Can I take Lisinopril and Icatibant together?
Icatibant may slightly reduce lisinopril's blood pressure lowering effect, so your care team may check your blood pressure more closely while you use both. Keep taking both as prescribed and report any higher readings. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lisinopril and Icatibant 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 Icatibant interaction managed?
This is typically an easy interaction to manage, and icatibant is often used only intermittently for swelling attacks. Keep taking both exactly as prescribed unless your prescriber tells you otherwise. Your care team may monitor your blood pressure more closely around times you use icatibant. If needed, your lisinopril dose may be adjusted and individualized by your care team. Tell your pharmacist… 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 Icatibant 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 (2)
- Product Information: FIRAZYR(R) subcutaneous injection solution, icatibant subcutaneous injection solution. Shire Orphan Therapies (per Manufacturer), Lexington, MA, 2011. DailyMed
- Gainer JV, Morrow JD, Loveland A, et al: Effect of bradykinin-receptor blockade on the response to angiotensin-converting-enzyme inhibitor in normotensive and hypertensive subjects. N Engl J Med 1998; 339(18):1285-1292. PubMed
Keep reading about Lisinopril
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