Lisinopril

Do not co-administer with lisinopril in patients with diabetes. Avoid use in patients with renal impairment (GFR <60 mL/min) due to risks of hypotension, hyperkalemia, and acute renal failure.

Potassium-sparing diuretic can increase risk of hyperkalemia when used with lisinopril; requires frequent monitoring of serum potassium.

Dual blockade of RAS is associated with increased risks of hypotension, hyperkalemia, and changes in renal function including acute renal failure.

Antihypertensive drug whose effect may be enhanced by aripiprazole's alpha adrenergic antagonism. Avoid concomitant use.

Initiation of lisinopril in patients on diuretics may result in excessive reduction of blood pressure and hypotensive effects.

Nitritoid reactions have been reported with concomitant use of lisinopril and gold.

Concomitant use may increase lithium levels and cause symptoms of lithium toxicity.

Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and acute kidney injury compared to monotherapy.

Dual RAS blockade increases risks of hypotension, syncope, hyperkalemia, and acute kidney injury compared to monotherapy. Combined use provides no additional benefit.

Combined use did not provide additional benefit versus monotherapy but increased incidence of hyperkalemia and acute kidney injury.

Coadministration may result in deterioration of renal function including possible acute renal failure; may attenuate antihypertensive effect.

May result in deterioration of renal function including possible acute renal failure, especially in elderly or volume-depleted patients. Attenuates antihypertensive effect. Monitor renal function periodically.

Potassium-sparing diuretic can increase risk of hyperkalemia when used with lisinopril; requires frequent monitoring of serum potassium.

Potassium-sparing diuretic can increase risk of hyperkalemia when used with lisinopril; requires frequent monitoring of serum potassium.

Concomitant administration with lisinopril may cause increased blood-glucose-lowering effect with risk of hypoglycemia.

Concomitant administration may cause increased blood-glucose-lowering effect with risk of hypoglycemia.

Co-administration with ACE inhibitors may result in deterioration of renal function including possible acute renal failure in elderly, volume-depleted, or renal impaired patients.

NSAIDs may diminish antihypertensive effect. In elderly, volume-depleted, or renal-impaired patients, may result in deterioration of renal function including acute renal failure.

Concomitant administration may cause increased blood-glucose-lowering effect with risk of hypoglycemia.

Renin-angiotensin system antagonist increases steady-state serum lithium concentrations.

Lisinopril: bioavailability may be increased, monitor patient's blood pressure and adjust dose of lisinopril if needed (‎ 7 ). Lisinopril Clinical Impact: Concomitant administration of MYCAPSSA increases lisinopril bioavailability [see Clinical Pharmacology (‎12.3) ] . Intervention: Monitor patient's blood pressure and adjust the dosage of lisinopril if needed.

Lisinopril attenuates potassium loss caused by thiazide-type diuretics; monitor potassium levels.

No clinically important pharmacokinetic interactions occurred when lisinopril was used concomitantly with propranolol or hydrochlorothiazide.

Drug Interactions Lisinopril Hypotension - Patients on Diuretic Therapy: Patients on diuretics and especially those in whom diuretic therapy was recently instituted, may occasionally experience an excessive reduction of blood pressure after initiation of therapy with lisinopril. The possibility of hypotensive effects with lisinopril can be minimized by either discontinuing the diuretic or increasing the salt intake prior to initiation of treatment with lisinopril. If it is necessary to continue the diuretic, initiate therapy with lisinopril at a dose of 5 mg daily, and provide close medical supervision after the initial dose for at least two hours and until blood pressure has stabilized for at least an additional hour.

Table 3: No observed clinically important drug interactions of Veltassa Angiotensin-converting enzyme (ACE) inhibitors Benazepril, captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, trandolapril Angiotensin II receptor blockers (ARB) Azilsartan, candesartan, irbesartan, losartan, olmesartan, valsartan β-adrenoceptor blockers (β-blocker) Metoprolol Loop diuretics Furosemide, bumetanide, torasemide Mineralocorticoid receptor antagonists (MRA) Eplerenone, finerenone, spironolactone Neprilysin inhibitors Sacubitril Sodium-glucose cotransporter-2 (SGLT-2) inhibitors Canagliflozin, dapagliflozin, empagliflozin Antibiotics Trimethoprim, amoxicillin, cephalexin Anticoagulants Warfarin, apixaban, rivaroxaban Anti-parathyroid agents and Thyroid preparations Cinacalcet Antithrombotic agents Clopidogrel, acetylsalicylic acid Blood glucose lowering drugs Glipizide Calcium channel blockers Amlodipine, verapamil Immunosuppressants Tacrolimus Others Lithium, allopurinol, atorvastatin, digoxin, phenytoin, riboflavin, sevelamer

No clinically important pharmacokinetic interactions occurred when lisinopril was used concomitantly with propranolol or hydrochlorothiazide.

7.7 Mammalian Target of Rapamycin (mTOR) Inhibitors Patients taking concomitant mTOR inhibitor (e.g.

Sixteen (16) drugs tested did not show an in vitro interaction with LOKELMA (allopurinol, apixaban, aspirin, captopril, cyclosporine, digoxin, ethinyl estradiol, lisinopril, magnesium, metformin, phenytoin, prednisone, propranolol, quinapril, spironolactone and ticagrelor).