Lisinopril and Ma Huang: 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
Ma Huang
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.
Lisinopril is a blood pressure medicine. Ma Huang (also called ephedra) is an herbal product that contains ephedrine, a natural stimulant that can raise blood pressure and heart rate. Because it pushes blood pressure up, it can work against lisinopril and make it less effective, so your blood pressure may not stay as controlled as it should.
This concern is based mostly on how ephedrine works rather than large studies, but it makes sense biologically. The good news is your care team can manage this easily. Please don't stop your lisinopril, but do tell your pharmacist or doctor if you take or are thinking about taking any product with Ma Huang or ephedra.
Effect: Ma Huang (ephedra) may reduce the antihypertensive effectiveness of lisinopril.
Mechanism: Pharmacodynamic antagonism. Ephedrine and pseudoephedrine in Ma Huang exert sympathomimetic activity, raising vascular tone and blood pressure, opposing ACE inhibitor effect. Neither agent requires prodrug activation here.
- Onset: rapid
- Evidence: theoretical; variable BP effects reported, with a suspected acute hypertensive response case
- Magnitude: not well quantified (alkaloid content 0.5 to 2.5%, ephedrine dominant)
Management: Concomitant use not advised in patients on antihypertensives. Contraindicated in ephedrine/pseudoephedrine sensitivity, renal failure, or pheochromocytoma. Monitor blood pressure if exposure occurs.
What happens
Reduced effectiveness of angiotensin converting enzyme inhibitors
Interaction Deep Dive
In theory, Ma Huang (ephedra) could reduce how well antihypertensive drugs work. Its effect on blood pressure in normotensive individuals has been inconsistent 1, and it may have been responsible for an acute hypertensive reaction in a patient who consumed an herbal product thought to contain Ma huang 2. Ma huang (ephedra) serves as a natural origin of both ephedrine and pseudoephedrine 1. The plant holds between 0.5 and 2.5% ephedra alkaloids, with ephedrine being the predominant one, accounting for 30% to 90% of the total ephedra alkaloid content according to growing conditions 3. While pseudoephedrine is considered generally safe, patients with hypertension should steer clear of ephedrine 4. Products that contain Ma huang should be avoided by anyone sensitive to ephedrine or pseudoephedrine, as well as by those with pheochromocytoma.
Why it happens (mechanism)
Antagonistic effect through sympathomimetic activity of ephedrine and pseudoephedrine in Ma huang
How to manage this interaction
Your care team can manage this concern:
- Keep taking your lisinopril exactly as prescribed. Do not stop or change it on your own.
- Combining Ma Huang (ephedra) with a blood pressure medicine is not advised, because its ephedrine content can push blood pressure up and work against your lisinopril.
- Tell your pharmacist or doctor about any herbal or over-the-counter product containing Ma Huang or ephedra before using it.
- Your team may want to monitor your blood pressure more closely if you have used such a product.
This is especially important if you have kidney problems, a pheochromocytoma, or are sensitive to ephedrine or pseudoephedrine.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) Inconsistent blood pressure responses were observed in 12 normotensive patients given 4 capsules of ma huang (each dose containing ephedrine 19.4 mg and pseudoephedrine 4.9 mg) at breakfast, with an additional 4 capsules taken nine hours later at the evening meal. Four subjects had a significant rise in systolic blood pressure three hours after ingestion, while two individuals showed a reduction in diastolic blood pressure. Six (50%) patients had a significant increase in mean 12-hour heart rate, from 81 to 94 beats per minute (bpm), 79 to 84 bpm, 87 to 97 bpm, 77 to 83 bpm, 69 to 74 bpm, and 77 to 84 bpm (p less than 0.05 for all) 1.
b) A 21-year-old man came to the emergency department with hypertension after consuming one glass of alcohol, one marijuana cigarette, and four capsules of "herbal ecstacy" reportedly containing ginseng, kola nut, and nutmeg (elapsed time: 90 minutes). His initial blood pressure recorded by paramedics was 220/110 mmHg and was 190/116 mmHg on arrival at the emergency department, together with ventricular dysrhythmias. His symptoms resolved within 9 hours after treatment with lidocaine and sodium nitroprusside. The urine screen was positive for ephedrine or pseudoephedrine, cannabinoid metabolites, and traces of opiate and caffeine. The authors ascribe the patient's condition to the ephedrine content of the herbal preparation. Because the entire product had been consumed, the herbal product was not assayed to determine its relative amounts of ephedrine and caffeine 2.
Common questions
Can I take Lisinopril and Ma Huang together?
Ma Huang (ephedra) can raise blood pressure and may make lisinopril work less well, so combining them is not advised. Keep taking your lisinopril and check with your pharmacist or doctor before using any ephedra product. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lisinopril and Ma Huang 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 Ma Huang interaction managed?
Your care team can manage this concern: Keep taking your lisinopril exactly as prescribed. Do not stop or change it on your own. Combining Ma Huang (ephedra) with a blood pressure medicine is not advised, because its ephedrine content can push blood pressure up and work against your lisinopril. Tell your pharmacist or doctor about any herbal or over-the-counter product containing Ma Huang or ephed… 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 Ma Huang 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 (4)
- White LM, Gardner SF, & Gurley BJ: Pharmacokinetics and cardiovascular effects of Ma-Huang (ephedra sinica) in normotensive adults. J Clin Pharmacol 1997; 37:116-122.
- Zahn KA, Li RL, & Purssel RA: Cardiovascular toxicity after ingestion of "herbal ecstasy.". J Emerg Med 1999; 17:289-291.
- Blumenthal M & King P: Ma huang: ancient herb, modern medicine, regulatory dilemma. Herbalgram 1995; 34:22-26, 43, 56-57.
- Chua SS & Benrimoj SI: Non-prescription sympathomimetic agents and hypertension. Med Toxicol Adverse Drug Exp 1988; 3:387-417. PubMed
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