Lisinopril and Rosiglitazone: 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
Rosiglitazone
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 rosiglitazone (a diabetes medicine). When these are taken together, there's a chance your blood sugar could drop a little lower than expected. That's called hypoglycemia, and it can make you feel shaky, sweaty, dizzy, or confused.
I want to be honest with you though: this is more of a theoretical concern than something we see often, and it's considered moderate. The good news is your care team can easily stay ahead of it by checking your blood sugar a bit more often. Please keep taking both medicines as prescribed, and talk with your pharmacist or doctor about how best to monitor your sugars.
Effect: Possible additive risk of hypoglycemia when an ACE inhibitor (lisinopril) is combined with an antidiabetic agent (rosiglitazone).
Mechanism: Unknown; ACE inhibitors are proposed to enhance insulin sensitivity, though a definitive mechanism is not established. Neither agent is affected by prodrug activation relevant here.
Evidence: Theoretical. Self-controlled case series data did not show increased serious hypoglycemia with ACE inhibitors plus insulin secretagogues (possible exception: glimepiride).
- Severity: Moderate
- Onset: Unspecified
- Management: Increase glucose monitoring during concomitant use and after ACE inhibitor withdrawal; individualize antidiabetic dosing as needed.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
Using ACE inhibitors together with antidiabetic drugs can raise the likelihood of hypoglycemia231. When such combined therapy is necessary, glucose levels should be checked more often, both while the patient is on treatment and following discontinuation of an ACE inhibitor 4. Adjusting the insulin dosage may likewise be required 23. 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 a possible exception 5.
Why it happens (mechanism)
Unknown
How to manage this interaction
This combination is commonly used and manageable. Your care team's main tools here are monitoring and, if needed, adjusting your diabetes medication.
- Keep taking both lisinopril and rosiglitazone exactly as prescribed unless your doctor tells you otherwise.
- Expect your team to check your blood sugar more often, both while you're on both drugs and if the lisinopril is ever stopped.
- Your diabetes dose may need to be adjusted and individualized by your care team.
- Learn the signs of low blood sugar (shakiness, sweating, dizziness, confusion) and tell your pharmacist or prescriber if you notice them.
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 joint 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. Over 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) showed no significant increase 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 Rosiglitazone together?
Taking lisinopril with rosiglitazone may slightly raise the chance of low blood sugar, so keep taking both as prescribed and check your glucose a bit more often. This is a manageable, theoretical concern your care team can handle with monitoring. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lisinopril and Rosiglitazone 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 Rosiglitazone interaction managed?
This combination is commonly used and manageable. Your care team's main tools here are monitoring and, if needed, adjusting your diabetes medication. Keep taking both lisinopril and rosiglitazone exactly as prescribed unless your doctor tells you otherwise. Expect your team to check your blood sugar more often, both while you're on both drugs and if the lisinopril is ever stopped. Your diabetes do… 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 Rosiglitazone 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 Rosiglitazone
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