Moexipril and Bupivacaine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Moexipril
Bupivacaine
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.
What happens
Bradycardia and hypotension with loss of consciousness
Interaction Deep Dive
Captopril administration resulting in the decreased availability of angiotensin II in the presence of bupivacaine spinal anesthesia may have contributed to profound bradycardia and hypotension with loss of consciousness. Patients receiving an ACE inhibitor until the time of surgery should be aggressively monitored and treated appropriately for hemodynamic instability1.
Why it happens (mechanism)
Suppression of the renin-angiotensin system
Literature reports
1 report — tap to read
a) A case report of an 86-year-old male receiving an ACE inhibitor (captopril) suffered from profound bradycardia and hypotension with disturbance of consciousness following spinal anaesthesia with bupivacaine. The severe bradycardia and hypotension which occurred in this patient may have been due to an enhanced 'negative Bainbridge effect' which resulted from the suppression of the RAS in the presence of an ACE inhibitor. The author concluded that captopril resulted in the decreased availability of angiotensin II to provide a protective effect in maintaining blood pressure during anaesthesia 1.
Common questions
Can I take Moexipril and Bupivacaine together?
Bradycardia and hypotension with loss of consciousness Always confirm with your pharmacist or prescriber before making any change.
How serious is the Moexipril and Bupivacaine interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Moexipril or Bupivacaine 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 (1)
- Williams N: Profound bradycardia and hypotension following spinal anaesthesia in a patient receiving an ACE inhibitor: an important 'drug' interaction?. Eur J Anaesthesiol 1999; 16:796-798. PubMed
Keep reading about Moexipril
Keep reading about Bupivacaine
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