Lisinopril and Repaglinide: 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
Repaglinide
Lisinopril
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're taking repaglinide (Prandin) to lower your blood sugar and lisinopril for blood pressure. There's a chance that using them together could make your blood sugar drop a little lower than expected, which we call hypoglycemia. It's worth knowing the warning signs: shakiness, sweating, dizziness, confusion, or a fast heartbeat.
The good news is this concern is mostly theoretical, and larger studies haven't shown a big jump in serious low-sugar events. Your care team can easily manage this by checking your blood sugar a bit more often, especially when you first start or stop the lisinopril. Keep taking both as prescribed, and let your pharmacist or doctor know if you feel any low-sugar symptoms.
Effect: Potential additive risk of hypoglycemia when the insulin secretagogue repaglinide is combined with the ACE inhibitor lisinopril.
- Mechanism: Unknown; ACE inhibitors have been theoretically associated with enhanced insulin sensitivity. Neither agent activates the other. This is a pharmacodynamic (not PK) concern.
- Direction/magnitude: Possible enhanced glucose-lowering effect; magnitude not quantified.
- Evidence: Theoretical. A self-controlled case series found no increased serious hypoglycemia with ACE inhibitors plus secretagogues, with the possible exception of glimepiride.
- Onset: Unspecified.
- Management: More frequent glucose monitoring during therapy and after ACE inhibitor withdrawal; antidiabetic dose may be individualized as needed.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
Taking ACE inhibitors together with antidiabetic drugs can raise the likelihood of hypoglycemia231. When these agents must be used together, glucose levels should be checked more often, both throughout therapy and following discontinuation of an ACE inhibitor4. Adjusting the insulin dose may also become necessary23. Findings from a self-controlled case series indicate that combining 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 is a low-level, mostly theoretical concern, and it is very manageable. Keep taking both medications exactly as prescribed unless your prescriber tells you otherwise.
- Your care team may ask you to check your blood sugar a bit more often, especially when you start or stop the lisinopril.
- Your repaglinide dose may be adjusted and individualized by your team based on those readings.
- Learn the signs of low blood sugar (shakiness, sweating, dizziness, confusion) and treat quickly with fast-acting sugar.
- Tell your pharmacist or doctor if you notice frequent lows.
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 concurrent use of ACE inhibitors together with insulin secretagogues (glimepiride, glipizide, glyburide, nateglinide, and repaglinide) or metformin (used as a negative control). The endpoint assessed was hospital presentation for serious hypoglycemia. The counts of serious hypoglycemic events during the observation period 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) showed no significant increase with glipizide, glyburide, repaglinide, or metformin, but was slightly raised with glimepiride (RR, 1.23; 95% CI, 1.11 to 1.37) and slightly lowered with nateglinide (RR, 0.73; 95% CI, 0.56 to 0.96). Aside from glimepiride, these findings indicate that concurrent 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 Repaglinide together?
Combining repaglinide and lisinopril may slightly raise the chance of low blood sugar, though the evidence is theoretical and serious events are uncommon. Keep taking both as prescribed and monitor your blood sugar a little more closely, especially when starting or stopping lisinopril. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lisinopril and Repaglinide 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 Repaglinide interaction managed?
This is a low-level, mostly theoretical concern, and it is very manageable. Keep taking both medications exactly as prescribed unless your prescriber tells you otherwise. Your care team may ask you to check your blood sugar a bit more often, especially when you start or stop the lisinopril. Your repaglinide dose may be adjusted and individualized by your team based on those readings. Learn the sig… 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 Repaglinide 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 Repaglinide
Keep reading about Lisinopril
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