Lisinopril and Insulin Bovine: 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 Bovine
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.
You've been prescribed lisinopril (a blood pressure medicine) along with your insulin. When these are taken together, your blood sugar may drop a little lower than usual, which is called hypoglycemia. Signs can include feeling shaky, sweaty, dizzy, or confused.
The good news is this is an easy thing for your care team to stay on top of. They may ask you to check your blood sugar a bit more often, especially when you start or stop the lisinopril, and they may fine-tune your insulin dose if needed. Keep taking both exactly as prescribed, and let your pharmacist or doctor know if you have low sugar readings.
Effect: Additive risk of hypoglycemia when an ACE inhibitor (lisinopril) is combined with insulin. Neither agent is a prodrug relevant here; the direction is enhanced glucose-lowering (a PD interaction, not CYP-mediated).
- Mechanism: Unknown; proposed increased insulin sensitivity with ACE inhibition.
- Onset: Unspecified.
- Evidence: Theoretical; self-controlled case series data suggest no increased serious hypoglycemia with ACE inhibitors plus insulin secretagogues (possible exception: glimepiride).
- Management: More frequent glucose monitoring during therapy and after ACE inhibitor withdrawal; individualize and adjust insulin dose as needed.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
Taking ACE inhibitors together with antidiabetic drugs can heighten the likelihood of hypoglycemia231. Should combined therapy be necessary, glucose levels should be checked more often, not only while the patient is on treatment but also once an ACE inhibitor is discontinued 4. It may also become necessary to modify the insulin dose 23. Findings from a self-controlled case series indicate that using ACE inhibitors alongside insulin secretagogues does not correlate with higher rates of serious hypoglycemia, although glimepiride may be an exception 5.
Why it happens (mechanism)
Unknown
How to manage this interaction
This interaction is very manageable, and you should keep taking both medications as prescribed unless your care team tells you otherwise.
- Monitor more closely: Check your blood sugar more often, both when starting lisinopril and after stopping it.
- Dose tailoring: Your insulin dose may need to be adjusted and individualized by your care team.
- Know the low-sugar signs: Shakiness, sweating, dizziness, or confusion. Treat a low as you've been taught.
- Speak up: Tell your pharmacist or doctor about frequent or unusual low readings.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) A self-controlled case series examined Medicare claims data drawn from 5 states covering 1999 to 2011 to assess the combined use of ACE inhibitors with insulin secretagogues (glimepiride, glipizide, glyburide, nateglinide, and repaglinide) or with metformin (used as a negative control). The endpoint assessed was hospital presentation for serious hypoglycemia. During the observation period, the counts of serious hypoglycemic events were 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 increased for glipizide, glyburide, repaglinide, or metformin, but it was slightly increased for glimepiride (RR, 1.23; 95% CI, 1.11 to 1.37) and slightly decreased 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 to a greater risk of serious hypoglycemia 5.
Common questions
Can I take Lisinopril and Insulin Bovine together?
Taking lisinopril with insulin may slightly increase the chance of low blood sugar, so check your glucose more often (especially when starting or stopping lisinopril) and let your care team adjust your insulin if needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lisinopril and Insulin Bovine 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 Insulin Bovine interaction managed?
This interaction is very manageable, and you should keep taking both medications as prescribed unless your care team tells you otherwise. Monitor more closely: Check your blood sugar more often, both when starting lisinopril and after stopping it. Dose tailoring: Your insulin dose may need to be adjusted and individualized by your care team. Know the low-sugar signs: Shakiness, sweating, dizziness… 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 Insulin Bovine 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 Bovine
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