Metformin and lisinopril why

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This content does not have an English version. This content does not have an Arabic version. See more conditions. Drugs and Supplements Lisinopril Oral Route. Products and services. Precautions Drug information provided by: IBM Micromedex It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Thank you for Subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information.

Please try again. Something went wrong on our side, please try again. The awareness of lactic acidosis as a complication to the use ofmetformin in predisposed individuals is important. General advice should be given to patients regarding reduction of dosage or withdrawal of the drugs during acute intercurrent illness with dehydration. Early diagnosis and treatment of metformin-associated lactic acidosis are crucial for the patient outcome.

Hemodialysis can be life-saving and should be started without delay. This section outlines the various uses of metformin and the different types and brand names of the drug. Metformin helps control blood sugar levels. It is a first-line treatment for type 2 diabetes in people ages 10 and older.

Doctors may also prescribe metformin for people taking antipsychotic medications. These medications can lower insulin resistance and cause people to gain weight. Metformin helps to counteract these side effects. Metformin may also help treat fertility issues in women with polycystic ovary syndrome PCOS. Doctors may prescribe either immediate- or extended-release metformin tablets.

Extended-release pills deliver metformin into the bloodstream more slowly and steadily than immediate-release pills. A person takes extended-release tablets less often throughout the day, but these pills take longer to be effective. Combination metformin medications are another option. They contain metformin and another antidiabetic medication. The following table lists the various brand names of metformin and combination metformin medications.

The available strengths of each drug are noted in milligrams mg. Most people who take metformin tolerate the drug well. Doctors usually prescribe a low dosage of metformin to people taking the drug for the first time.

If necessary, the doctor will increase the dosage, but this will be gradual to prevent side effects. In rare cases, metformin can cause lactic acidosis, a serious side effect. Lactic acidosis is the harmful buildup of lactic acid in the blood. It can lead to low blood pressure , a rapid heart rate, and even death.

Vomiting and dehydration increase the risk of lactic acidosis in people taking metformin. A doctor may recommend temporarily stopping the medication until vomiting subsides. People who are taking metformin should avoid consuming excessive amounts of alcohol. The combination of metformin and alcohol can increase the risk of lactic acidosis. Many people on metformin need to take the drug for an extended period. Certain side effects can occur only with long term use.

Metformin may affect the absorption of vitamin B Doctors will monitor B levels in people who have been taking metformin for more than 4 months. People with vitamin B deficiency have an increased risk of anemia , as well as certain neurological and psychological symptoms.

Clozapine: Moderate Lisinopril may decrease the renal elimination of clozapine and metabolites. Clozapine toxicity, including irritability, anger, insomnia, nightmares and sialorrhea may occur. The mechanism of this interaction is unclear; however, as lisinopril does not undergo metabolism, cytochrome P enzyme involvement is unlikely.

It is speculated that a decrease in renal elimination of clozapine occurs due to a lisinopril-induced reduction in glomerular filtration rate GFR. Plasma clozapine concentrations should be measured carefully during concomitant lisinopril therapy; another antihypertensive class may need to be selected. In addition, clozapine used concomitantly with the antihypertensive agents can increase the risk and severity of hypotension by potentiating the effect of the antihypertensive drug.

Cocaine: Major Use of cocaine with antihypertensive agents may increase the antihypertensive effects of the antihypertensive medications or may potentiate cocaine-induced sympathetic stimulation. Codeine; Guaifenesin; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors.

Codeine; Phenylephrine; Promethazine: Moderate The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors.

CoQ10 use in combination with antihypertensive agents may lead to additional reductions in blood pressure in some individuals. Patients who choose to take CoQ10 concurrently with antihypertensive medications should receive periodic blood pressure monitoring. Patients should be advised to inform their prescriber of their use of CoQ Cyclophosphamide: Moderate Closely monitor complete blood counts if coadministration of cyclophosphamide with angiotensin-converting enzyme inhibitors ACE inhibitors is necessary as there is an increased risk of hematologic toxicity specifically leukopenia and immunosuppression.

Cyclosporine: Moderate Several cases of acute renal failure have been associated with the addition of angiotensin-converting enzyme ACE inhibitors to cyclosporine therapy in renal transplant patients.

In response to cyclosporine-induced renal afferent vasoconstriction and glomerular hypoperfusion, angiotensin II is required to maintain an adequate glomerular filtration rate. Inhibition of ACE could reduce renal function acutely. Also, cyclosporine can cause hyperkalemia, and inhibition of angiotensin II leads to reduced aldosterone concentrations, which can increase the serum potassium concentration.

Closely monitor renal function and serum potassium concentrations in patients receiving cyclosporine concurrently with ACE inhibitors or potassium salts.

Dapagliflozin; Metformin: Moderate Angiotensin-converting enzyme ACE inhibitors may enhance the hypoglycemic effects of insulin or other antidiabetic agents by improving insulin sensitivity. Desloratadine; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. Dexbrompheniramine; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors.

Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. Dextromethorphan; Diphenhydramine; Phenylephrine: Moderate The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors.

Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. Dextromethorphan; Guaifenesin; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors.

Dextromethorphan; Quinidine: Moderate Quinidine can decrease blood pressure and should be used cautiously in patients receiving antihypertensive agents due to the potential for additive hypotension. Diazoxide: Moderate Additive hypotensive effects can occur with the concomitant administration of diazoxide with other antihypertensive agents.

This interaction can be therapeutically advantageous, but dosages must be adjusted accordingly. The manufacturer advises that IV diazoxide should not be administered to patients within 6 hours of receiving other antihypertensive agents. Diethylpropion: Major Diethylpropion has vasopressor effects and may limit the benefit of angiotensin-converting enzyme inhibitors. Although leading drug interaction texts differ in the potential for an interaction between diethylpropion and this group of antihypertensive agents, these effects are likely to be clinically significant and have been described in hypertensive patients on these medications.

Digoxin: Moderate Caution should be exercised when administering digoxin with drugs that may cause a significant deterioration in renal function including angiotensin-converting enzyme inhibitors ACE inhibitors.

A decline in glomerular filtration or tubular secretion may impair the excretion of digoxin. Close monitoring of serum digoxin concentrations is essential to avoid enhanced toxicity. Dihydrocodeine; Guaifenesin; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors.

Diphenhydramine; Hydrocodone; Phenylephrine: Moderate The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. Diphenhydramine; Phenylephrine: Moderate The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors.

Drospirenone: Moderate Drospirenone has antimineralocorticoid effects and may increase serum potassium. The concurrent use of ACE inhibitors may increase the risk of hyperkalemia, especially in the presence of renal impairment.

Monitor serum potassium during the 1st month of drospirenone treatment if an Angiotensin-Converting Enzyme inhibitor ACE inhibitor is used concurrently and thereafter as clinically indicated. Also monitor for any changes in blood pressure, fluid retention, or renal function. Drospirenone; Estetrol: Moderate Drospirenone has antimineralocorticoid effects and may increase serum potassium. Drospirenone; Estradiol: Moderate Drospirenone has antimineralocorticoid effects and may increase serum potassium.

Drospirenone; Ethinyl Estradiol: Moderate Drospirenone has antimineralocorticoid effects and may increase serum potassium. Drospirenone; Ethinyl Estradiol; Levomefolate: Moderate Drospirenone has antimineralocorticoid effects and may increase serum potassium. Duloxetine: Moderate Orthostatic hypotension and syncope have been reported during duloxetine administration.

The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. Monitor blood pressure if the combination is necessary.

Empagliflozin; Linagliptin; Metformin: Moderate Angiotensin-converting enzyme ACE inhibitors may enhance the hypoglycemic effects of insulin or other antidiabetic agents by improving insulin sensitivity. Empagliflozin; Metformin: Moderate Angiotensin-converting enzyme ACE inhibitors may enhance the hypoglycemic effects of insulin or other antidiabetic agents by improving insulin sensitivity. Enflurane: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents.

Entecavir: Moderate Because entecavir is primarily eliminated by the kidneys and ACE inhibitors can affect renal function, concurrent administration with ACE inhibitors may increase the serum concentrations of entecavir and adverse events. Monitor for adverse effects when these drugs are coadministered.

Ephedrine: Major The cardiovascular effects of sympathomimetics, such as ephedrine, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors.

Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved. Ephedrine; Guaifenesin: Major The cardiovascular effects of sympathomimetics, such as ephedrine, may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. Epinephrine: Moderate Antihypertensives, including angiotensin-converting enzyme inhibitors, antagonize the vasopressor effects of parenteral epinephrine.

Eplerenone: Major Monitor serum potassium and serum creatinine concentrations within 3 to 7 days of initiating coadministration of eplerenone and angiotensin-converting enzyme ACE inhibitors. Hyperkalemia risk is increased when eplerenone is used with ACE inhibitors. Patients who develop hyperkalemia may continue eplerenone with proper dose adjustment; eplerenone dose reduction decreases potassium concentrations. Eprosartan: Major Most patients receiving the combination of two renin-angiotensin-aldosterone system RAAS inhibitors, such as angiotensin-converting enzyme inhibitors ACE inhibitors and angiotensin II receptor antagonists ARBs do not obtain any additional benefit compared to monotherapy.

Ertugliflozin; Metformin: Moderate Angiotensin-converting enzyme ACE inhibitors may enhance the hypoglycemic effects of insulin or other antidiabetic agents by improving insulin sensitivity. Estradiol Cypionate; Medroxyprogesterone: Minor Estrogens can induce fluid retention and may increase blood pressure in some patients; patients who are receiving antihypertensive agents concurrently with hormonal contraceptives should be monitored for antihypertensive effectiveness.

Estradiol: Minor Estrogens can induce fluid retention and may increase blood pressure in some patients; patients who are receiving antihypertensive agents concurrently with hormonal contraceptives should be monitored for antihypertensive effectiveness.

Ethiodized Oil: Moderate Because the use of other nephrotoxic drugs, including ACE inhibitors, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, ACE inhibitor therapy should be withheld, when possible, during radiopaque contrast agent administration.

Etomidate: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents. Everolimus: Major Avoid coadministration of everolimus with angiotensin-converting enzyme inhibitors ACE inhibitors as the risk of angioedema, with or without respiratory impairment, may be increased.

In a pooled analysis of randomized, double-blind oncology clinical trials, angioedema was reported in 6. Fexofenadine; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. Finerenone: Moderate Monitor serum potassium concentrations closely if finerenone and angiotensin-converting enzyme inhibitors ACEI are used together.

Concomitant use may increase the risk of hyperkalemia. It is possible that additive reductions in blood pressure may be seen when fish oils are used in a patient already taking antihypertensive agents. Fluorescein: Moderate Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.

Fospropofol: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents. General anesthetics: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents. Glipizide; Metformin: Moderate Angiotensin-converting enzyme ACE inhibitors may enhance the hypoglycemic effects of insulin or other antidiabetic agents by improving insulin sensitivity.

Glyburide; Metformin: Moderate Angiotensin-converting enzyme ACE inhibitors may enhance the hypoglycemic effects of insulin or other antidiabetic agents by improving insulin sensitivity. Monitor closely for nitritoid reactions during co-therapy with gold and ACE inhibitor agents. Guaifenesin; Hydrocodone; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors.

Guaifenesin; Phenylephrine: Moderate The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. Guaifenesin; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. Haloperidol: Moderate In general, haloperidol should be used cautiously with antihypertensive agents due to the possibility of additive hypotension.

Halothane: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents. Hydralazine; Isosorbide Dinitrate, ISDN: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Hydrocodone; Phenylephrine: Moderate The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors.

Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. Hydrocodone; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors. Ibritumomab Tiuxetan: Major Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients renal impairment, cardiac disease, adrenal insufficiency.

If concomitant use is necessary, closely monitor serum potassium concentrations. Ibuprofen; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors.

Icatibant: Minor Although clinical data are lacking, icatibant is a bradykinin B2 receptor antagonist and may theoretically potentiate the antihypertensive effect of ACE inhibitors.

Iloperidone: Moderate Secondary to alpha-blockade, iloperidone can produce vasodilation that may result in additive effects during concurrent use with antihypertensive agents.

If concurrent use of iloperidone and antihypertensive agents is necessary, patients should be counseled on measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning and rising slowly from a seated position.

Iloprost: Moderate Further reductions in blood pressure may occur when inhaled iloprost is administered to patients receiving other antihypertensive agents. Incretin Mimetics: Moderate ACE inhibitors may enhance the hypoglycemic effects of insulin or other antidiabetic agents by improving insulin sensitivity. Indapamide: Moderate The effects of indapamide may be additive when administered with other antihypertensive agents or diuretics. In some patients, this may be desirable, but orthostatic hypotension may occur.

Patients with hyponatremia or hypovolemia are more susceptible to developing reversible renal insufficiency when given an angiotensin-converting enzyme inhibitors ACE Inhibitors and diuretic therapy concomitantly. Insulins: Moderate Monitor patients receiving angiotensin-converting enzyme inhibitors ACE inhibitors concomitantly with insulin for changes in glycemic control.

ACE inhibitors may enhance the hypoglycemic effects of insulin by improving insulin sensitivity. In addition, ACE inhibitors have been associated with a reduced incidence in the development of new-onset diabetes in patients with hypertension or other cardiac disease. Intravenous Lipid Emulsions: Moderate High doses of fish oil supplements may produce a blood pressure lowering effect.

Iodixanol: Moderate Because the use of other nephrotoxic drugs, including ACE inhibitors, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, ACE inhibitor therapy should be withheld, when possible, during radiopaque contrast agent administration. Iohexol: Moderate Because the use of other nephrotoxic drugs, including ACE inhibitors, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, ACE inhibitor therapy should be withheld, when possible, during radiopaque contrast agent administration.

Iopamidol: Moderate Because the use of other nephrotoxic drugs, including ACE inhibitors, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, ACE inhibitor therapy should be withheld, when possible, during radiopaque contrast agent administration. Iopromide: Moderate Because the use of other nephrotoxic drugs, including ACE inhibitors, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, ACE inhibitor therapy should be withheld, when possible, during radiopaque contrast agent administration.

Ioversol: Moderate Because the use of other nephrotoxic drugs, including ACE inhibitors, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, ACE inhibitor therapy should be withheld, when possible, during radiopaque contrast agent administration.

Irbesartan: Major Most patients receiving the combination of two renin-angiotensin-aldosterone system RAAS inhibitors, such as angiotensin-converting enzyme inhibitors ACE inhibitors and angiotensin II receptor antagonists ARBs do not obtain any additional benefit compared to monotherapy. Iron Dextran: Moderate The concomitant use of angiotensin-converting enzyme inhibitors ACE inhibitors with iron dextran may increase the risk for anaphylactic-type reactions.

The factors that affect the risk for anaphylactic-type reactions to iron dextran products are not fully known but limited clinical data suggest the risk may be increased among patients with a history of drug allergy or multiple drug allergies. Patients should be monitored for signs and symptoms of anaphylactic-type reactions during all iron dextran administrations.

Isocarboxazid: Moderate Additive hypotensive effects may be seen when monoamine oxidase inhibitors MAOIs are combined with antihypertensives.

Careful monitoring of blood pressure is suggested during concurrent therapy of MAOIs with angiotensin-converting enzyme inhibitors ACE inhibitors. Patients should be instructed to rise slowly from a sitting position, and to report syncope or changes in blood pressure or heart rate to their health care provider.

Isoflurane: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents. Isoproterenol: Moderate The pharmacologic effects of isoproterenol may cause an increase in blood pressure. If isoproterenol is used concomitantly with antihypertensives, the blood pressure should be monitored as the administration of isoproterenol can compromise the effectiveness of antihypertensive agents.

Isosorbide Dinitrate, ISDN: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Isosorbide Mononitrate: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects.

Isosulfan Blue: Moderate Because the use of other nephrotoxic drugs, including ACE inhibitors, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, ACE inhibitor therapy should be withheld, when possible, during radiopaque contrast agent administration. Kanamycin: Moderate Kanamycin is a nephrotoxic drug. Additive nephrotoxicity is possible if kanamycin is administered with other nephrotoxic medications such as angiotensin-converting enzyme inhibitors ACE inhibitors.

The manufacturer of kanamycin indicates that such combinations should be avoided. Ketamine: Moderate General anesthetics can potentiate the hypotensive effects of antihypertensive agents. Oral compounds known to interact with cationic antacids may similarly be bound with lanthanum carbonate and have their absorption reduced. If these agents are used concomitantly, separate the dosing intervals appropriately. Monitor the clinical condition of the patient to ensure the proper clinical response to the ACE inhibitor is obtained.

Levodopa: Moderate Concomitant use of antihypertensive agents with levodopa can result in additive hypotensive effects. Linagliptin; Metformin: Moderate Angiotensin-converting enzyme ACE inhibitors may enhance the hypoglycemic effects of insulin or other antidiabetic agents by improving insulin sensitivity.

Lisdexamfetamine: Minor Lisdexamfetamine may increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents, like angiotensin-converting enzyme inhibitors ACE inhibitors.

The risk of lithium toxicity may be increased in patients receiving ACEIs. ACE inhibitors decrease lithium clearance, possibly as a result of sodium depletion which leads to increased renal tubular reabsorption of lithium. According to the Beers Criteria, this drug interaction may be particularly relevant for older adults; the panel recommends avoiding concurrent use if possible due to an increased risk of lithium toxicity. If the combination is medically necessary, monitoring of lithium concentrations is recommended.

Loop diuretics: Moderate Coadministration of loop diuretics and Angiotensin-converting enzyme inhibitors ACE inhibitors may result in severe hypotension and deterioration in renal function, including renal failure. Hyponatremia or hypovolemia predisposes patients to acute hypotensive episodes following initiation of ACE inhibitor therapy. While ACE inhibitors and loop diuretics are routinely administered together in the treatment of heart failure, if an ACE inhibitor is to be administered to a patient receiving furosemide, initial doses should be conservative.

Loratadine; Pseudoephedrine: Moderate The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin-converting enzyme inhibitors.

Losartan: Major Most patients receiving the combination of two renin-angiotensin-aldosterone system RAAS inhibitors, such as angiotensin-converting enzyme inhibitors ACE inhibitors and angiotensin II receptor antagonists ARBs do not obtain any additional benefit compared to monotherapy.

Lovastatin; Niacin: Moderate Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents.

This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. Lurasidone: Moderate Due to the antagonism of lurasidone at alpha-1 adrenergic receptors, the drug may enhance the hypotensive effects of alpha-blockers and other antihypertensive agents.

If concurrent use of lurasidone and antihypertensive agents is necessary, patients should be counseled on measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning and rising slowly from a seated position. Magnesium Salts: Moderate Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors ACE inhibitors.

Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate: Moderate Use caution when prescribing sulfate salt bowel preparation in patients taking concomitant medications that may affect renal function such as angiotensin-converting enzyme inhibitors ACE inhibitors.

Meglitinides: Moderate ACE inhibitors may enhance the hypoglycemic effects of insulin or other antidiabetic agents by improving insulin sensitivity.