Lisinopril interactions
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Lisinopril Interactions: A Comprehensive Overview
Lisinopril and ACE2 Expression
ACE2 Protein Levels and COVID-19 Implications
Lisinopril, an ACE inhibitor, has been shown to increase tissue levels of ACE2, the receptor for SARS-CoV-2, in various organs including the small intestine, lung, kidney, and brain in mice. This increase was significant across all tissues studied, suggesting a potential impact on COVID-19 transmission and pathogenesis. Interestingly, the combination of lisinopril with losartan, an angiotensin receptor blocker, did not increase ACE2 levels and even decreased ACE2 gene expression in tissues.
Lisinopril and Cardiovascular Interactions
Interaction with Nifedipine
A study investigating the interaction between lisinopril and nifedipine, a calcium channel blocker, found no significant pharmacokinetic or pharmacodynamic interactions. Both drugs lowered blood pressure, with nifedipine having a short-term effect and lisinopril a longer-term effect. The combination of the two drugs resulted in additive blood pressure-lowering effects without altering each other's pharmacokinetics.
Interaction with Hydralazine
When co-administered with hydralazine, a vasodilator, lisinopril showed increased bioavailability, as evidenced by a significant rise in the area under the plasma concentration-time curve (AUC). This interaction did not occur with enalapril, another ACE inhibitor, suggesting a unique interaction profile for lisinopril.
Lisinopril and Renal Function
Interaction with Diclofenac Sodium
In hypertensive osteoarthritic patients, the concomitant use of lisinopril and diclofenac sodium, a nonsteroidal anti-inflammatory drug (NSAID), reduced the antihypertensive efficacy of lisinopril. This combination also led to increased serum creatinine levels and altered renal function markers, indicating a potential risk for renal impairment.
ACE Gene Polymorphism and Renal Disease
The efficacy of lisinopril in slowing the progression of renal disease in insulin-dependent diabetes mellitus (IDDM) patients may be influenced by ACE gene polymorphisms. Patients with the II genotype showed a more significant reduction in albumin excretion rate (AER) when treated with lisinopril compared to those with the DD genotype, highlighting the importance of genetic factors in treatment outcomes.
Lisinopril and Metabolic Interactions
Interaction with Gliclazide
In diabetic patients, the combination of lisinopril and gliclazide, a sulfonylurea, showed enhanced blood glucose-lowering effects. Chronic use of lisinopril increased the efficacy of gliclazide, suggesting a beneficial interaction for managing diabetes and hypertension concurrently. However, dose adjustments may be necessary to avoid potential hypoglycemia.
Interaction with Metformin
In vitro studies have shown that lisinopril can affect the dissolution profile of metformin, a common antidiabetic drug, at various pH levels. This interaction could potentially alter the bioavailability of both drugs, necessitating careful consideration when formulating combination therapies.
Lisinopril and Drug Transporters
Interaction with JBP485
Lisinopril interacts with JBP485, a dipeptide with antihepatitis activity, by inhibiting the same transporters in the intestinal mucosa (PEPT1) and kidneys (OATs). This interaction reduces the plasma concentrations of both drugs when administered orally, indicating a significant pharmacokinetic interaction that could affect therapeutic efficacy.
Conclusion
Lisinopril interacts with various drugs and biological systems, influencing its pharmacokinetics, pharmacodynamics, and therapeutic outcomes. These interactions can affect cardiovascular, renal, and metabolic functions, necessitating careful management and monitoring in clinical practice. Understanding these interactions is crucial for optimizing treatment regimens and ensuring patient safety.
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