Telmisartan 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
Telmisartan
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.
Telmisartan and lisinopril work in very similar ways. Both lower your blood pressure by calming the same body system (called the renin-angiotensin system). Lisinopril is an ACE inhibitor and telmisartan is an ARB, so taking them together is like pressing the same brake twice.
Using both at once usually doesn't give extra benefit, but it does raise the chance of side effects: blood pressure dropping too low, feeling dizzy or faint, higher potassium levels, and stress on your kidneys. The good news is your care team can manage this by checking your blood pressure, kidneys, and blood tests, and adjusting your medicines. Please don't stop or change anything on your own. Just talk with your doctor or pharmacist.
Interaction: Combining an ARB (telmisartan) with an ACE inhibitor (lisinopril) produces dual RAAS blockade. Neither is a prodrug relevant here; both act directly, so combined use is additive.
- Direction: Additive RAAS suppression, increasing risk of hypotension, syncope, hyperkalemia, and declining renal function (including acute renal failure).
- Evidence: Established; documented in atherosclerotic disease, heart failure, and diabetes with end-organ damage (e.g., ONTARGET-type data).
- Benefit: Most patients gain no added efficacy over monotherapy.
- Management: Avoid coadministration. If combined, closely monitor BP, serum potassium, and renal function (SCr/eGFR); individualize and adjust dosing. Higher risk in severe CHF or renal impairment.
What happens
Increased risk of adverse events (ie, hypotension, syncope, hyperkalemia, changes in renal function, acute renal failure)
Interaction Deep Dive
Combining an ACE inhibitor with an angiotensin receptor blocker (ARB) to achieve dual suppression of the renin-angiotensin-aldosterone system has been linked to a greater frequency of adverse effects. Among individuals with confirmed atherosclerotic disease, heart failure, or diabetes accompanied by end organ damage, giving an ACE inhibitor together with an ARB produced more hypotension, syncope, hyperkalemia, and alterations in renal function (acute renal failure included) than either drug used by itself5. This combination should be avoided; when the two are given together, monitor blood pressure, renal function, and electrolytes closely 23, adjusting the dose when necessary. For the majority of patients, pairing two renin-angiotensin-aldosterone system (RAAS) inhibitors yields no benefit beyond that of monotherapy. Suppression of the RAAS or diuresis may bring on renal dysfunction, oliguria, and acute renal failure. The risk is heightened in those with severe congestive heart failure or renal dysfunction 4.
Why it happens (mechanism)
Dual blockade of the renin-angiotensin-aldosterone system
How to manage this interaction
What your care team typically does: Because two similar blood pressure medicines together usually add risk without adding benefit, prescribers generally avoid using them at the same time. If your doctor does decide you need both, they will manage it carefully.
- Check your blood pressure regularly to catch it dropping too low.
- Monitor kidney function and potassium with blood tests.
- Adjust your doses as needed, individualized to you.
What you should do: Keep taking both exactly as prescribed. Ask your pharmacist or doctor whether you truly need both, and report dizziness, fainting, muscle weakness, or reduced urination.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
3 reports — tap to read
a) A systematic review and meta-analysis involving 18,160 patients with heart failure or left ventricular dysfunction drawn from 9 randomized trials showed that adding an angiotensin receptor blocker (ARB) to ACE inhibitor therapy was linked to a greater risk of adverse events leading to treatment discontinuation than ACE inhibitor therapy alone. All patients had NYHA functional class II to IV heart failure, an ejection fraction of 45% or below, or left ventricular dysfunction acutely postmyocardial infarction. The agents involved were losartan, candesartan, valsartan, irbesartan, and telmisartan. Follow-up ranged from 4 weeks to 41 months. The analysis showed that combination therapy raised the risk of any adverse effect by 2.3%. The risk of hypotension rose 1.1%, the risk of worsening renal function rose 1%, and the risk of hyperkalemia rose 0.6%. However, the risk of angioedema or cough was not significantly different between the treatment groups. When a combination approach is required, patients should be observed closely for possible adverse effects 1.
b) Giving ramipril and telmisartan together led to greater exposure to ramipril and its metabolite, ramiprilat. Ramipril Cmax and AUC rose 2.3 and 2.1 fold, respectively, and ramiprilat Cmax and AUC rose 2.4 and 1.5 fold when telmisartan 80 mg once daily and ramipril 10 mg once daily were coadministered to healthy subjects. Telmisartan Cmax and AUC fell by 31% and 16%, respectively. In addition, concurrent use led to a higher incidence of clinically important renal dysfunction (eg, acute renal failure) and offered no added benefit over monotherapy with either drug 3.
c) Dual blockade of the renin-angiotensin-aldosterone system through concurrent use of an ACE inhibitor and an angiotensin receptor blocker (ARB) was linked to a higher incidence of side effects. In patients with established atherosclerotic disease, heart failure, or diabetes with end organ damage, coadministering an ACE inhibitor and an ARB produced a higher incidence of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure) than either agent alone 5.
Common questions
Can I take Telmisartan and Lisinopril together?
Taking telmisartan and lisinopril together doubles up on the same blood pressure mechanism, raising the risk of low blood pressure, high potassium, and kidney problems without extra benefit for most people. Do not change your medicines on your own; ask your doctor or pharmacist if you really need both. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Telmisartan 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 "unspecified". The timing of this interaction is not well characterized.
How is the Telmisartan and Lisinopril interaction managed?
What your care team typically does: Because two similar blood pressure medicines together usually add risk without adding benefit, prescribers generally avoid using them at the same time. If your doctor does decide you need both, they will manage it carefully. Check your blood pressure regularly to catch it dropping too low. Monitor kidney function and potassium with blood tests. Adjust your doses… 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 Telmisartan 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 (5)
- Lakhdar R, Al-Mallah MH, & Lanfear DE: Safety and tolerability of angiotensin-converting enzyme inhibitor versus the combination of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker in patients with left ventricular dysfunction. J Card Fail 2008; 14(3):181-188.
- Product Information: Lotensin(R) oral tablets, benazepril HCl oral tablets. Validus Pharmaceuticals LLC (per FDA), Parsippany, NJ, 2014. DailyMed
- Product Information: MICARDIS(R) oral tablets, telmisartan oral tablets. Boehringer Ingelheim Pharmaceuticals, Inc. (per FDA), Ridgefield, CT, 2014. DailyMed
- Product Information: WIDAPLIK(TM) oral tablets, telmisartan amlodipine indapamide oral tablets. George Medicines Pty Limited (per FDA), Pithampur, Pradesh, India, 2025. DailyMed
- Product Information: COZAAR(R) oral tablets, losartan potassium oral tablets. Merck Sharp & Dohme Corp. (per FDA), Whitehouse Station, NJ, 2011. DailyMed
Keep reading about Telmisartan
Keep reading about Lisinopril
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