Lisinopril and Indapamide: 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
Indapamide
No brand names on recordLisinopril
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.
Indapamide is a water pill (diuretic) that helps your body get rid of extra fluid and salt, and lisinopril relaxes your blood vessels to lower blood pressure. Both bring your blood pressure down, so taking them together can sometimes lower it a little too much, especially with the very first doses of lisinopril.
You might feel dizzy or lightheaded, particularly when standing up quickly. The good news is this is usually temporary and settles as your body adjusts. Your care team can manage it easily by adjusting doses and keeping an eye on your blood pressure. If you feel faint, sit or lie down and let your pharmacist or doctor know.
Additive pharmacodynamic effect: combining the thiazide-like diuretic indapamide with the ACE inhibitor lisinopril can produce excessive BP reduction, notably first-dose and postural hypotension.
- Mechanism: ACE inhibitor vasodilation superimposed on diuretic-induced volume/sodium depletion; neither agent requires bioactivation.
- Direction: augmented antihypertensive/hypotensive response.
- Onset: rapid (first dose). Evidence: theoretical; effect usually transient.
- Management: before initiating the ACE inhibitor, consider reducing/withholding the diuretic or liberalizing salt intake; if not feasible, use a reduced lisinopril starting dose. Monitor BP, orthostatic vitals, renal function, and electrolytes.
What happens
Reduction of blood pressure
Interaction Deep Dive
Starting an ACE inhibitor in individuals already receiving diuretics can lead to an excessive drop in blood pressure3. Cases of severe postural hypotension have been documented following the addition of ACE inhibitors to a diuretic regimen. While this has been noted more often with loop diuretics, first dose hypotension frequently occurs in patients who are sodium depleted or hypovolemic as a result of diuretic use or restricted sodium intake. This hypotensive reaction tends to be transient6271. To reduce the likelihood of hypotensive effects, one may lower or stop the diuretic, or raise salt intake, prior to beginning ACE inhibitor treatment. When such steps cannot be taken, lower the initial dose of the ACE inhibitor3.
Why it happens (mechanism)
Vasodilation and relative intravascular volume depletion
How to manage this interaction
Keep taking both medications as prescribed unless your care team tells you otherwise. This is a well-recognized situation your team can plan around.
- Your team may lower or briefly hold the water pill, or adjust your salt intake, before starting or increasing lisinopril.
- If that isn't practical, they may start lisinopril at a lower dose and increase it slowly.
- Expect closer blood pressure checks, especially early on.
- Rise slowly from sitting or lying down to avoid dizziness.
Tell your pharmacist or doctor if you feel lightheaded, faint, or unusually weak, particularly in the first days after a change.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) In a randomized crossover study (N=19) involving older patients (62 to 84 years) who received hydrochlorothiazide together with enalapril, the pharmacokinetics of enalapril were relatively unaffected by hydrochlorothiazide, however there was a significant rise in AUC (0 to 24 hours) and a significant decrease in the renal clearance of enalaprilat 4.
b) A slight decrease in peak serum concentrations of perindoprilat, along with a reduction in the proportion of the perindopril dose excreted as perindoprilat in the urine, has been documented when perindopril is given concurrently with hydrochlorothiazide 5.
Common questions
Can I take Lisinopril and Indapamide together?
Taking indapamide with lisinopril can drop your blood pressure more than expected, especially with the first doses, so rise slowly and report dizziness. This is usually temporary and your care team can manage it with dose adjustments and monitoring. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lisinopril and Indapamide interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How is the Lisinopril and Indapamide interaction managed?
Keep taking both medications as prescribed unless your care team tells you otherwise. This is a well-recognized situation your team can plan around. Your team may lower or briefly hold the water pill, or adjust your salt intake, before starting or increasing lisinopril. If that isn't practical, they may start lisinopril at a lower dose and increase it slowly. Expect closer blood pressure checks, e… 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 Indapamide 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 (7)
- Vlasses PH, Ferguson RK, & Chatterjee K: Captopril: clinical pharmacology and benefit-to-risk ratio in hypertension and congestive heart failure. Pharmacotherapy 1982; 2:1-17. PubMed
- Gluck Z, Beretta-Piccoli C, & Reubi FC: Long-term effects of captopril on renal function in hypertensive patients. Eur J Clin Pharmacol 1984; 26:315-323. PubMed
- Product Information: QBRELIS(TM) oral solution, lisinopril oral solution. Silvergate Pharmaceuticals (per manufacturer), Greenwood Village, CO, 2016. DailyMed
- Weisser K, Schloos J, Jakob S, et al: The influence of hydrochlorothiazide on the pharmacokinetics of enalapril in elderly patients. Eur J Clin Pharmacol 1992; 43:173-177. PubMed
- Todd PA & Fitton A: Perindopril: a review of its pharmacological properties and therapeutic use in cardiovascular disorders. Drugs 1991; 42:90-114.
- Atkinson AB, Brown JJ, Morton JJ, et al: Captopril in a hyponatremic hypertensive; need for caution initiating therapy (letter). Lancet 1979; 1:557-558.
- Pandhi P, Mondal S, Sharma BK, et al: Low dose captopril alone and in combination with hydrochlorothiazide in treatment of mild to moderate essential hypertension. Int J Clin Pharmacol Ther Toxicol 1986; 24:294-297.
Keep reading about Indapamide
Keep reading about Lisinopril
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