Lisinopril Clozapine

Raised clozapine blood concentrations have been reported after the introduction of lisinopril (294). 

A 39-year-old man with schizophrenia and diabetes, who had taken clozapine 300 mg/day and glipizide 10 mg/day for a year, took lisinopril 5 mg/day for newly diagnosed hypertension. On several occasions afterwards he had roughly a doubling of his blood concentrations of clozapine and norclozapine. He had typical effects of clozapine toxicity. After replacement of lisinopril by diltiazem, the blood concentrations of clozapine and norclozapine returned to the values that were present before lisinopril was introduced. 

The information given here was sketchy and there was no information on the timing of blood samples relative to the dose of clozapine. Clozapine is metabolized by CYP1A2 and CYP3A4, but there is no evidence that lisinopril... 

Abraham G, Grunberg B, Gratz S. Possible interaction of clozapine and lisinopril. Am J Psychiatry 2001 158(6) 969. 

Minocycline Penicillamine Beta-blockers (e.g., propanolol, pindolol, atenolol, metoprolol, timolol) Hydrochlorothiazide Interferon-a Fluorouracil agents hydroxyurea, interferons, gemfibrozil, interleukin-2, clobazam, clozapine, tocainide, lisinopril, etanercept, infliximab, zafirlukast... 

A 39-year-old man with schizophrema and diabetes, who had taken clozapine 300 mg/day and glipizide 10 mg/day for a year, took lisinopril 5 mg/day for newly diagnosed hypertension. On several occasions... 

There are isolated cases of apparent hypotensive interactions between clozapine, and enalapril, lisinopril or propranolol. Additive hypotensive effects are possible with clozapine and any antihypertensive drug. 

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