Metformin and lisinopril drug interactions

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Drug Interaction Mechanisms: Metformin and Lisinopril

Research shows that when metformin and lisinopril are taken together, there can be changes in how each drug dissolves and becomes available in the body. In laboratory studies simulating the human digestive system, lisinopril was found to decrease the amount of metformin released at different stomach and intestinal pH levels. Conversely, metformin increased the release of lisinopril at certain pH levels, but not all. These findings suggest that the presence of one drug can affect the absorption of the other, potentially altering their effectiveness when used together, especially in combination pills or close dosing schedules 13.

Pharmacokinetic Considerations: Simultaneous Measurement and Availability

Advanced laboratory methods have been developed to measure both metformin and lisinopril in the body at the same time. These methods confirm that both drugs can be accurately tracked together, which is important for understanding how they interact in real patients. Some studies indicate that while the availability of enalapril (another ACE inhibitor) is not affected by antidiabetic drugs, the availability of lisinopril can be altered when taken with drugs like metformin 34.

Clinical Effects: Blood Glucose and Blood Pressure

In animal studies, the combination of lisinopril and metformin was examined for its effect on blood glucose levels. The results suggest that the impact of ACE inhibitors like lisinopril on blood sugar is still unclear and may vary, but these drugs are often prescribed together in diabetic patients to protect the kidneys and eyes .

In people with high blood pressure and prediabetes, adding metformin to lisinopril therapy was shown to lower blood pressure variability and reduce average blood pressure, especially in the morning. This suggests a possible benefit of combining these drugs for better blood pressure control in certain patients .

Safety and Clinical Implications

Overall, the available research suggests that while there are measurable interactions between metformin and lisinopril at the level of drug absorption and availability, these do not necessarily translate into harmful effects. In fact, the combination may offer added benefits for blood pressure control in patients with both hypertension and prediabetes. However, the exact impact on blood glucose control remains uncertain and may require further study 1235.

Conclusion

Metformin and lisinopril can interact in ways that affect how much of each drug is available in the body, but these interactions are not likely to cause harm and may even provide added benefits for certain patients. Monitoring and individualized care are important when these drugs are used together, especially in people with both diabetes and high blood pressure.

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Most relevant research papers on this topic

In Vitro Drug Interactions Study of Lisinopril with Metformin

Lisinopril decreases metformin's dissolution at pH 1.2 and 6.8, while metformin increases lisinopril's release at pH 1.2 and 6.8.

In Vitro Study

2017·

2citations

·K. Amorha et al.

The effect of Lisinopril on blood glucose level given alone and in combination with oral anti-diabetic drugs in alloxan-induced diabetic rats

Lisinopril effectively lowers blood glucose levels in alloxan-induced diabetic rats when combined with oral anti-diabetic drugs metformin, gliclazide, and pioglitazone.

Non-RCTAnimal Study

2013·

2citations

·N. Agrawal et al.

Interaction Studies of ACE Inhibitors with Antidiabetic Drugs

ACE inhibitors' availability is unaffected by antidiabetic drugs, while captopril and lisinopril are altered in presence of NIDDMs.

2021·

0citations

·S. Naveed et al.

Concurrent determination of Metformin and some ACE inhibitors: Its application to Pharmacokinetics

The developed method successfully enables simultaneous determination of metformin and ACE inhibitors in bulk dosage form, aiding in pharmacokinetic studies.

2017·

14citations

·F. Siddiqui et al.

THE EFFECT OF METFORMIN ADMINISTRATION ON BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE SUBJECTS WITH PREDIABETES RECEIVING LISINOPRIL

Adding metformin to lisinopril significantly decreased morning blood pressure variability and mean blood pressure in hypertensive subjects with prediabetes.

RCTVery Rigorous Journal

2021·

1citation

·A. Hakim et al.

Effect of Oral Semaglutide on the Pharmacokinetics of Lisinopril, Warfarin, Digoxin, and Metformin in Healthy Subjects

Oral semaglutide increases metformin exposure by 32% when coadministered with SNAC, but does not affect lisinopril, warfarin, or digoxin exposure, and the higher metformin exposure is not clinically relevant.

2019·

44citations

·T. Bækdal et al.

Clinically and pharmacologically relevant interactions of antidiabetic drugs

Antidiabetic drug interactions are common, with metformin and saxagliptin showing low interaction potential, while incretin mimetics and SGLT-2 inhibitors have low interaction potential.

Rigorous JournalHighly Cited

2016·

135citations

·M. May et al.

The impact of drug-drug interactions between proton pump inhibitors and metformin: A systematic review of clinical evidence

The drug-drug interaction between proton pump inhibitors and metformin is minimal, but regular monitoring of glucose and vitamin B12 levels is advised for high-risk populations and those on long-term therapy.

Systematic Review

2025·

0citations

·Ria Andani Antong et al.

A Review: The pharmacokinetics and pharmacodynamics of metformin-herb interactions

Combining metformin with herbs shows potential for drug interactions in terms of both pharmacokinetics and pharmacodynamics, with both additive and synergistic effects in reducing blood glucose levels.

Systematic Review

2022·

1citation

·Ating Cicih et al.

Actions of metformin and statins on lipid and glucose metabolism and possible benefit of combination therapy

Combination therapy of metformin and statins may reduce cardiovascular risk in type 2 diabetes patients, but their molecular mechanisms of action must be considered.

Very Rigorous JournalHighly Cited

2018·

126citations

·Mariël F. van Stee et al.

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