Lisinopril with Torsemide Interaction Details
Brand Names Associated with Lisinopril
- Lisinopril
- Prinivil®
- Qbrelis®
- Zestoretic® (containing Hydrochlorothiazide, Lisinopril)
- Zestril®
Brand Names Associated with Torsemide
- Demadex®
- Torsemide
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 13, 2023
Interaction Effect
Postural hypotension (first dose)
Interaction Summary
Severe postural hypotension has been reported when ACE inhibitors are added to loop diuretic therapy. First dose hypotension is commonly seen in patients with sodium depletion or hypovolemia due to diuretics or sodium restriction. This hypotensive response is usually transient. Although the combination should increase natriuresis, paradoxically, ACE inhibitors may also reduce glomerular filtration, diuresis and natriuretic responses to diuretics leading to edema and fluid retention . Clinically significant pharmacokinetic interactions have not been observed between these classes of drugs.
Severity
Moderate
Onset
Rapid
Evidence
Probable
How To Manage Interaction
If possible, discontinue the diuretic two to three days prior to adding an angiotensin converting enzyme (ACE) inhibitor. Then, if blood pressure or heart failure are not controlled with the ACE inhibitor alone, the diuretic may be restarted. If this is not possible, start with a very low dose of the ACE inhibitor in the evening and closely monitor blood pressure for a severe hypotensive response for four hours after the initial dose. Monitor for hypotension, fluid status, and body weight regularly for up to two weeks after dose adjustments.
Mechanism Of Interaction
Vasodilation and relative intra-vascular volume depletion
Literature Reports
A) In one study, renal excretion and the diuretic effect of furosemide was not altered by captopril in hypertensive patients . However, more recent data demonstrate that conventional doses of captopril blunt the natriuretic and diuretic effects of furosemide in patients with mild to moderate congestive heart failure. Sodium excretion increased 623% while on furosemide; this dropped to 242% upon addition of captopril . A number of authors have reported weight gain, sodium retention, and peripheral edema in patients on diuretic therapy upon initiation of ACE inhibitors .
B) In a single-dose study, oral benazepril (10 mg) and oral furosemide (40 mg) were administered alone and in combination to 12 healthy volunteers. There were no significant effects on the pharmacokinetics of benazepril. The urinary excretion of total furosemide was reduced by 10% to 20% during combination administration. With single doses of each drug alone, blood pressure and pulse were not significantly affected. However, a decrease in erect blood pressure and an increase in pulse rate was observed with the combination. Maximal effects occurred four hours post administration (122 to 104 mm Hg and 87 to 107 beats per minute, respectively). Dizziness was experienced in the majority of subjects receiving the combination, and occurred in association with blood pressure reductions .
C) Concomitant captopril and furosemide therapy has been reported to result in a potentiation of the hypotensive effects of captopril. Blood pressure dropped abruptly from 290/150 mm Hg to 135/60 mm Hg within 10 minutes in one patient with high plasma renin activity who received 50 mg captopril and intravenous furosemide .
Lisinopril Overview
-
Lisinopril is used alone or in combination with other medications to treat high blood pressure in adults and children 6 years of age and older. It is used in combination with other medications to treat heart failure. Lisinopril is also used to improve survival after a heart attack. Lisinopril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.
-
High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys, and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
Torsemide Overview
-
Torsemide is used alone or in combination with other medications to treat high blood pressure. Torsemide is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, or liver disease. Torsemide is in a class of medications called diuretics ('water pills'). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.
-
High blood pressure is a common condition, and when not treated it can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
Return To Our Drug Interaction Homepage
Feedback, Question Or Comment About This Information?
Ask Dr. Brian Staiger, PharmD, our medical editor, directly! He's always more than happy to assist.
Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.