Lixisenatide and Lisinopril: 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
Lixisenatide
No brand names on recordLisinopril
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 lixisenatide (a diabetes medicine that lowers blood sugar) along with lisinopril (a blood pressure medicine). When these two are taken together, there may be a slightly higher chance of your blood sugar dropping too low, which we call hypoglycemia. That can make you feel shaky, sweaty, dizzy, or confused.
I want to be clear: this is based on theory more than strong proof, so please don't worry. Keep taking both exactly as prescribed. It just means it's smart to check your blood sugar a bit more often. If you notice low-sugar symptoms, let your doctor or pharmacist know so we can keep things on track together.
Effect: Potential additive increase in hypoglycemia risk when the ACE inhibitor lisinopril is combined with the GLP-1 receptor agonist lixisenatide.
- Mechanism: Unknown; proposed improved insulin sensitivity with ACE inhibition. Neither agent is a prodrug, so this is a pharmacodynamic, not metabolic, consideration.
- Direction/magnitude: Enhanced glucose-lowering effect; magnitude undefined.
- Evidence: Theoretical. Self-controlled case series data suggest no increased serious hypoglycemia with ACE inhibitors plus insulin secretagogues (possible exception: glimepiride).
- Onset: Unspecified.
- Management: More frequent glucose monitoring during therapy and after ACE inhibitor withdrawal; individualize antidiabetic dosing as needed.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
Taking ACE inhibitors together with antidiabetic medications can heighten 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. It may also be necessary to modify insulin dosing23. Evidence from a self-controlled case series indicates that combining ACE inhibitors with insulin secretagogues does not correlate with higher rates of serious hypoglycemia, though glimepiride may be an exception5.
Why it happens (mechanism)
Unknown
How to manage this interaction
This combination is commonly used and is manageable. Here's what typically happens and what you can do:
- Keep taking both lixisenatide and lisinopril as prescribed unless your care team tells you otherwise.
- Your team may have you check your blood sugar more often, both while on both medicines and if the lisinopril is ever stopped.
- Your diabetes medicine dose may need to be adjusted and individualized by your care team.
- Learn the signs of low blood sugar (shakiness, sweating, dizziness, confusion) and treat them promptly.
Raise any low-sugar episodes or concerns with your pharmacist or prescriber so they can fine-tune your plan.
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 spanning 1999 to 2011 to evaluate simultaneous use of ACE inhibitors together with insulin secretagogues (glimepiride, glipizide, glyburide, nateglinide, and repaglinide) or metformin (serving as a negative control). The endpoint assessed was hospital presentation for serious hypoglycemia. During 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 concurrent use of an ACE inhibitor with insulin secretagogues was not linked to a heightened risk of serious hypoglycemia 5.
Common questions
Can I take Lixisenatide and Lisinopril together?
Taking lixisenatide with lisinopril may slightly raise the chance of low blood sugar, so monitor your glucose a bit more closely and keep taking both as prescribed. Tell your care team if you have low-sugar symptoms. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lixisenatide and Lisinopril 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 Lixisenatide and Lisinopril interaction managed?
This combination is commonly used and is manageable. Here's what typically happens and what you can do: Keep taking both lixisenatide and lisinopril as prescribed unless your care team tells you otherwise. Your team may have you check your blood sugar more often, both while on both medicines and if the lisinopril is ever stopped. Your diabetes medicine dose may need to be adjusted and individualiz… 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 Lixisenatide or Lisinopril 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 Lixisenatide
Keep reading about Lisinopril
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