Lisinopril and Pramlintide: 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
Pramlintide
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, and pramlintide (Symlin) is a diabetes medicine you use along with insulin at mealtimes. When these two are taken together, there may be a slightly higher chance that your blood sugar drops too low (hypoglycemia). That can make you feel shaky, sweaty, dizzy, or confused.
The good news is this is easy for your care team to keep an eye on. They may check your blood sugar a little more often and adjust your insulin if needed. Keep taking both medicines as prescribed, know the signs of low blood sugar, and talk with your pharmacist or doctor if you have any questions.
Effect: Possible additive risk of hypoglycemia when an ACE inhibitor (lisinopril) is combined with an antidiabetic agent (pramlintide, an amylin analog used adjunctively with mealtime insulin).
- Mechanism: Unknown; ACE inhibitors may enhance insulin sensitivity. Neither agent is metabolized in a way that drives a PK interaction here.
- Direction: Enhanced glucose-lowering effect.
- Evidence: Theoretical; severity moderate; onset unspecified.
- Management: Increase frequency of self-monitored blood glucose during concurrent use and after ACE inhibitor withdrawal. Insulin/pramlintide doses may need individualization by the care team.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
Giving ACE inhibitors together with antidiabetic medications can heighten the likelihood of hypoglycemia231. When such combined use cannot be avoided, glucose levels should be checked more often, both while an ACE inhibitor is being taken and following its discontinuation4. Adjustments to the insulin dosage might also be required23. A self-controlled case series indicates that pairing ACE inhibitors with insulin secretagogues does not correlate with higher rates of serious hypoglycemia, although glimepiride may be an exception5.
Why it happens (mechanism)
Unknown
How to manage this interaction
This interaction is manageable, and you should not stop either medicine on your own.
- Keep taking both lisinopril and pramlintide exactly as prescribed.
- Monitor more closely: your care team may have you check your blood sugar more often, both while on lisinopril and for a period after it is stopped or changed.
- Dose tailoring: your insulin (and possibly pramlintide) dose may need to be adjusted and individualized by your care team.
- Know the warning signs of low blood sugar (shakiness, sweating, confusion) and how to treat it quickly.
Raise any low-blood-sugar episodes with your pharmacist or prescriber.
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 between 1999 and 2011 to assess the simultaneous use of ACE inhibitors with insulin secretagogues (glimepiride, glipizide, glyburide, nateglinide, and repaglinide) or with metformin (serving as a negative control). The measured outcome was hospital presentation for serious hypoglycemia. Over the observation period, the number of serious hypoglycemic events was 8159 for glimepiride, 14,353 for glipizide, 11,129 for glyburide, 1595 for nateglinide, 2901 for repaglinide, and 32,639 for metformin. The confounder-adjusted rate ratio (RR) showed no significant elevation for glipizide, glyburide, repaglinide, or metformin, but was slightly raised for glimepiride (RR, 1.23; 95% CI, 1.11 to 1.37) and slightly lowered for nateglinide (RR, 0.73; 95% CI, 0.56 to 0.96). Apart from glimepiride, these findings indicate that combined use of an ACE inhibitor and insulin secretagogues was not linked to an increased risk of serious hypoglycemia 5.
Common questions
Can I take Lisinopril and Pramlintide together?
Combining lisinopril with pramlintide may slightly raise the chance of low blood sugar, so monitor your glucose more closely; your care team can adjust your insulin dose as needed. Keep taking both as prescribed and report any low-sugar episodes. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lisinopril and Pramlintide 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 Pramlintide interaction managed?
This interaction is manageable, and you should not stop either medicine on your own. Keep taking both lisinopril and pramlintide exactly as prescribed. Monitor more closely: your care team may have you check your blood sugar more often, both while on lisinopril and for a period after it is stopped or changed. Dose tailoring: your insulin (and possibly pramlintide) dose may need to be adjusted and… 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 Pramlintide 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 Pramlintide
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