Lisinopril and Nesiritide: 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
Nesiritide
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.
Both of these medicines lower your blood pressure, so using them together can push it down more than expected. Lisinopril is a daily pill for blood pressure and heart health, and nesiritide is a medicine given in the hospital when the heart is having trouble pumping. When they team up, some people feel dizzy, lightheaded, or faint, especially when standing up.
The good news is that this happens in a hospital setting where your care team watches you closely. They can check your blood pressure often and adjust things if needed. If you feel woozy or faint, tell your nurse or doctor right away so they can help.
Effect: Additive hypotension (increased symptomatic hypotension) when nesiritide is combined with the ACE inhibitor lisinopril. Both agents lower BP through complementary vasodilatory mechanisms (RAAS suppression plus natriuretic-peptide-mediated vasodilation); this is a pharmacodynamic, not pharmacokinetic, interaction. Neither is a prodrug relevant here.
- Direction/magnitude: In the VMAC trial, symptomatic hypotension occurred in 6% of ACE-inhibitor-treated patients vs 1% in those not on an ACE inhibitor.
- Onset: delayed. Evidence: probable. Severity: moderate.
- Management: Monitor BP closely during concomitant use; individualize nesiritide dosing/titration and treat hypotension per protocol.
What happens
Increase in symptomatic hypotension
Interaction Deep Dive
Patients on oral angiotensin converting enzyme inhibitors experienced a rise in symptomatic hypotension. Within the Vasodilation in the Management of Acute Congestive Heart Failure (VMAC) trial, which involved patients given either nesiritide or nitroglycerin, symptomatic hypotension was reported in 6% of those taking an oral ACE inhibitor, whereas the rate was only 1% among patients not receiving an oral ACE inhibitor1.
Why it happens (mechanism)
Additive hypotensive response
How to manage this interaction
This interaction is managed in the hospital, where nesiritide is given, so your team is already set up to handle it.
- Keep taking your medicines as prescribed unless your care team tells you otherwise.
- Expect closer blood pressure monitoring while you are on both.
- Your nesiritide dose may need to be adjusted and individualized by your care team based on your blood pressure.
- Tell a nurse or doctor promptly if you feel dizzy, lightheaded, faint, or unusually weak.
If you take lisinopril at home and are admitted, mention it so the team factors it into your care.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Lisinopril and Nesiritide together?
Combining lisinopril and nesiritide can add up to lower your blood pressure more, raising the chance of dizziness or fainting; this is monitored and managed in the hospital, so report any lightheadedness to your care team. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lisinopril and Nesiritide interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How is the Lisinopril and Nesiritide interaction managed?
This interaction is managed in the hospital, where nesiritide is given, so your team is already set up to handle it. Keep taking your medicines as prescribed unless your care team tells you otherwise. Expect closer blood pressure monitoring while you are on both. Your nesiritide dose may need to be adjusted and individualized by your care team based on your blood pressure. Tell a nurse or doctor p… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
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 Nesiritide 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 (1)
- Product Information: Natrecor(R), Nesiritide. Scios Inc. Sunnyvale, CA, 2001.
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