Moderate
enalapril × metformin
Angiotensin-converting enzyme inhibitors (ACEi)×Biguanides. Oral antihyperglycemic agents
Mechanism
ACE inhibitors improve tissue insulin sensitivity and potentiate metformin's glucose-lowering effect. ACE inhibitors alone do not cause hypoglycemia, but when combined with insulin or sulfonylureas, hypoglycemia risk rises.
Management
Standalone metformin dose adjustment is usually not needed. In patients on insulin or sulfonylureas, be prepared to adjust insulin when starting the ACE inhibitor. Check HbA1c at 3 months.
Sources
- Lexicomp: Lexicomp Drug Interactions (2024)— Wolters Kluwer Clinical Drug Information, Inc. Lexi-Interact Online, 2024
- Pharmaceutical Press: Stockley's Drug Interactions, 12th edition (2024)— Preston CL (ed.). Stockley's Drug Interactions. 12th ed. London: Pharmaceutical Press; 2024