ModerateAngiotensin-converting enzyme inhibitors (ACEi)×Biguanides. Oral antihyperglycemic agents
Updated · Methodology
Mechanism
ACE inhibitors improve tissue insulin sensitivity and potentiate metformin's glucose-lowering effect. They do not cause hypoglycaemia alone but lower the threshold on insulin or sulfonylureas.
Symptoms
Signs of hypoglycaemia: sweating, tremor, hunger, tachycardia, confusion. Symptoms appear at glucose below 3.9 mmol/L.
Management
On metformin alone, no dose adjustment needed. In patients on insulin or sulfonylureas, intensify glucose self-monitoring for the first 2 weeks after starting enalapril. The effect is helpful in type 2 diabetes with arterial hypertension.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
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
- AEMPS: Ficha técnica: Metformina (nº registro 82700), sección 4.5 (2025)– AEMPS, CIMA, nº registro 82700, revisión 04/2025, sección 4.5