Quinapril and Acarbose: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Quinapril
Acarbose
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 quinapril (a blood pressure medicine) along with acarbose (a diabetes medicine that helps control blood sugar after meals). When these are taken together, there may be a slightly higher chance of your blood sugar dropping too low, which is called hypoglycemia. Signs can include shakiness, sweating, dizziness, or feeling suddenly hungry or confused.
I want to reassure you that this concern is mostly theoretical, and it's something your care team can easily keep an eye on. They may simply check your blood sugar a bit more often. Please don't stop either medicine on your own, and let your pharmacist or doctor know if you notice any low-sugar symptoms.
Effect: Coadministration of ACE inhibitors (quinapril) with antidiabetic agents (acarbose) may theoretically increase the risk of hypoglycemia.
Mechanism: Unknown; possibly enhanced insulin sensitivity with ACE inhibition. Neither agent is a prodrug relevant here in a way that flips direction.
Evidence: Theoretical. A self-controlled case series found no increased serious hypoglycemia with ACE inhibitors plus insulin secretagogues, except possibly glimepiride (not applicable to acarbose).
- Onset: Unspecified
- Monitoring: More frequent glucose monitoring during therapy and after ACE inhibitor withdrawal
- Management: 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 hypoglycemia134. When such combined therapy cannot be avoided, glucose should be checked more often, throughout treatment as well as after an ACE inhibitor is discontinued2. It may also become necessary to modify insulin dosing13. Findings from a self-controlled case series indicate that combining ACE inhibitors with insulin secretagogues does not correspond to higher rates of serious hypoglycemia, although glimepiride may be an exception5.
Why it happens (mechanism)
Unknown
How to manage this interaction
This interaction is manageable, and your care team has clear ways to handle it.
- Keep taking both medicines exactly as prescribed unless your doctor tells you otherwise.
- Your team may check your blood sugar more often, both while you take quinapril and for a while after if it's ever stopped.
- Your diabetes medication dose may need to be adjusted and individualized by your care team.
- Learn the signs of low blood sugar (shakiness, sweating, dizziness) and know how to treat it quickly.
Raise any low-sugar episodes 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 between 1999 and 2011 to assess the combined use of ACE inhibitors with insulin secretagogues (glimepiride, glipizide, glyburide, nateglinide, and repaglinide) or with metformin (used as a negative control). The measured outcome 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. After adjustment for confounders, the rate ratio (RR) was not significantly raised for glipizide, glyburide, repaglinide, or metformin, but was slightly increased 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). Apart from glimepiride, these findings indicate that concurrent use of an ACE inhibitor with insulin secretagogues was not linked to a greater risk of serious hypoglycemia 5.
Common questions
Can I take Quinapril and Acarbose together?
Taking quinapril with acarbose may slightly raise the chance of low blood sugar, so your care team may monitor your glucose more closely and adjust your diabetes medicine if needed. Keep taking both as prescribed and report any low-sugar symptoms. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Quinapril and Acarbose 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 Quinapril and Acarbose interaction managed?
This interaction is manageable, and your care team has clear ways to handle it. Keep taking both medicines exactly as prescribed unless your doctor tells you otherwise. Your team may check your blood sugar more often, both while you take quinapril and for a while after if it's ever stopped. Your diabetes medication dose may need to be adjusted and individualized by your care team. Learn the signs… 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.
Questions for your pharmacist
- Does my dose of Quinapril or Acarbose 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: TOUJEO(R) subcutaneous injection, insulin glargine subcutaneous injection. sanofi-aventis (per manufacturer), Bridgewater, NJ, 2015. DailyMed
- Product Information: AMARYL(R) oral tablets, glimepiride oral tablets. Sanofi-Aventis U.S. LLC (per FDA), Bridgewater, NJ, 2013. DailyMed
- Product Information: AFREZZA(R) oral inhalation powder, insulin human oral inhalation powder. MannKind Corporation(TM) (per manufacturer), Danbury, CT, 2014. DailyMed
- Product Information: Zestril(R) oral tablets, lisinopril oral tablets. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2014. 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 Quinapril
Keep reading about Acarbose
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