Sirolimus 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
Sirolimus
Lisinopril
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.
Taking sirolimus (Rapamune) together with lisinopril (a blood pressure medicine called an ACE inhibitor) can raise your chance of a reaction called angioedema. That means sudden swelling, often of the lips, tongue, face, or throat. In one study, this happened in about 6.6% of people on this combination.
This can be serious if the swelling affects breathing, but the good news is your care team is aware of it and can manage it. Often they may choose a related blood pressure drug (called an ARB) that carries much less risk. Please don't stop either medicine on your own, just talk with your doctor or pharmacist about the safest option for you.
Effect: Increased risk of angioedema with concurrent ACE inhibitor (lisinopril) and mTOR inhibitor (sirolimus).
- Direction/mechanism: Additive risk; precise mechanism unknown. Neither is a prodrug relevant here. Both agents independently affect bradykinin/vascular permeability pathways, and combined use appears to potentiate angioedema risk.
- Magnitude: Reported incidence ~6.6% with ACEi + mTOR inhibitor, vs ~0.8% with ARB + mTOR inhibitor.
- Onset: Delayed. Evidence: Established.
- Management: Consider substituting an ARB for the ACE inhibitor. Monitor for orofacial/airway swelling and counsel on urgent symptoms.
What happens
Increased risk of angioedema
Interaction Deep Dive
Exercise caution when an ACE inhibitor is given together with a mammalian target of rapamycin (mTOR) inhibitor, since the combination can raise the likelihood of angioedema. In one study, the rate of angioedema observed with this pairing was 6.6%. It may be preferable to avoid this combination by substituting an angiotensin receptor blocker (ARB) for the ACE inhibitor; among patients treated with an ARB along with either everolimus or sirolimus, the reported angioedema rate was 0.8%1.
Why it happens (mechanism)
Unknown
How to manage this interaction
Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. This combination is manageable, and your care team has good options.
- Your doctor may consider switching your ACE inhibitor (lisinopril) to an ARB, a similar blood pressure medicine that carries a much lower angioedema risk in this setting.
- Your team may monitor you more closely for any swelling.
- Seek emergency care right away if you notice swelling of the lips, tongue, face, or throat, or any trouble breathing or swallowing.
- Raise this interaction with your pharmacist or prescriber so they can tailor the safest plan for you.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a retrospective analysis, angioedema occurred in 6.6% of patients who were taking both an ACE inhibitor and a mammalian target of rapamycin (mTOR) inhibitor. The average time until symptoms appeared was 123 days, and the majority of episodes were mild to moderate in severity and resolved after treatment with steroids and/or stopping the drug. Among patients treated with mTOR inhibitors but not an ACE inhibitor, the angioedema incidence was 1.9%, while 2 earlier studies reported that ACE inhibitor-induced angioedema occurred at rates between 0.3% and 0.68%. For patients receiving an angiotensin receptor blocker together with an mTOR inhibitor, the incidence was 0.8% 1.
Common questions
Can I take Sirolimus and Lisinopril together?
Using lisinopril with sirolimus raises the risk of angioedema (dangerous swelling); ask your doctor whether switching lisinopril to an ARB is right for you, and get emergency help for any facial, mouth, or throat swelling. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sirolimus and Lisinopril interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How is the Sirolimus and Lisinopril interaction managed?
Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. This combination is manageable, and your care team has good options. Your doctor may consider switching your ACE inhibitor (lisinopril) to an ARB, a similar blood pressure medicine that carries a much lower angioedema risk in this setting. Your team may monitor you more closely for any swelling. Seek emerg… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Sirolimus 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 a safer alternative to one of these medications for me?
References (1)
- Duerr M, Glander P, Diekmann F, et al: Increased incidence of angioedema with ACE inhibitors in combination with mTOR inhibitors in kidney transplant recipients. Clin J Am Soc Nephrol 2010; 5(4):703-708. PubMed
Keep reading about Sirolimus
Keep reading about Lisinopril
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