Is It Safe to Take Lisinopril and Metoprolol Together?

Taking lisinopril and metoprolol together is not only safe for most people but is one of the most common drug pairings in cardiovascular medicine. Doctors routinely prescribe both at the same time for conditions like heart failure, high blood pressure, and recovery after a heart attack. The two drugs work through different biological pathways, which is exactly why combining them tends to produce better results than either one alone. That said, using two blood-pressure-lowering medications simultaneously does require some monitoring, and there are situations where the combination needs extra caution.

Why These Two Drugs Are Prescribed Together

Lisinopril is an ACE inhibitor. It blocks an enzyme that produces a hormone called angiotensin II, which narrows blood vessels and raises blood pressure. Metoprolol is a beta-blocker. It slows the heart rate and reduces the force of each heartbeat by blocking adrenaline’s effects on the heart. Because one drug targets the hormone system that tightens blood vessels while the other dials down the nervous system’s stimulation of the heart, the combination covers two separate drivers of high blood pressure and heart strain.

This dual-pathway approach is well supported. A review of beta-blocker and ACE inhibitor combinations notes that beta-blockers act on the sympathetic nervous system while ACE inhibitors act on the renin-angiotensin system, and that this pairing is recommended for most patients whose hypertension is complicated by cardiovascular disease or other conditions.¹ In practice, the vast majority of patients with heart failure or post-heart-attack care end up on both drug classes as part of their standard regimen, sometimes alongside additional medications.

Conditions Where the Combination Is Standard Care

The pairing of an ACE inhibitor and a beta-blocker shows up in treatment guidelines for several overlapping conditions. Understanding which ones helps explain why your doctor may have put you on both.

Heart Failure

Heart failure is the condition where the evidence for combining these two drug classes is strongest. A systematic review found that combining beta-blockers and ACE inhibitors provides additive benefits, improving long-term survival and reducing hospitalizations related to heart failure.² In studies of patients with chronic congestive heart failure, the combination led to measurable improvements in how well the heart pumps, including increases in ejection fraction and cardiac output, compared with using either drug alone.³ For someone with a weakened heart, these improvements translate directly into feeling less short of breath, retaining less fluid, and spending fewer days in the hospital.

After a Heart Attack

Patients who have survived a heart attack face an elevated risk of developing heart failure afterward. Both beta-blockers and ACE inhibitors are among the drug classes shown to help prevent that progression.⁴ The beta-blocker reduces the heart’s workload during recovery, while the ACE inhibitor helps prevent harmful remodeling of the heart muscle. Starting both drugs early after a heart attack is a cornerstone of post-discharge care in most hospitals.

Hypertension With Additional Risk Factors

For straightforward high blood pressure with no other complications, guidelines usually start with a different combination, such as an ACE inhibitor paired with a calcium channel blocker or a diuretic. But when hypertension coexists with heart failure, a fast resting heart rate, certain arrhythmias, or a history of heart attack, the beta-blocker and ACE inhibitor combination becomes a logical choice because it treats both the blood pressure and the underlying cardiac condition at once. Dual-agent combination therapy is now recommended for most patients with hypertension, and the beta-blocker/ACE inhibitor pairing is one of several established options.¹

Side Effects to Watch For

Each drug has its own side-effect profile, and taking both means you can experience effects from either one. The issues that matter most with this combination are the ones where both drugs push your body in the same direction.

Low Blood Pressure

Both lisinopril and metoprolol lower blood pressure by design. When you take them together, the combined effect can occasionally drop your pressure too far, especially when you first start treatment, after a dose increase, or if you become dehydrated. The classic warning signs are dizziness when standing up, lightheadedness, and feeling faint. Standing up slowly from a seated or lying position is a simple habit that helps. If you notice these symptoms regularly, your doctor may adjust one or both doses rather than stop a medication entirely.

Slow Heart Rate

Metoprolol directly slows your heart rate. Lisinopril does not have that as a primary effect, but any drug that lowers blood pressure can slightly alter heart rate as the body compensates. In practice, a slow heart rate from this combination is driven almost entirely by the metoprolol dose. If your resting pulse drops below about 50 beats per minute and you feel tired, dizzy, or short of breath, that is worth reporting. Many people, particularly those who are physically fit, have resting heart rates in the low 50s without any problems, so the number alone is not the issue; it is the number plus symptoms that matters.

Fatigue and Cold Extremities

Beta-blockers like metoprolol are well known for causing tiredness, particularly in the first few weeks. Some people also notice that their hands and feet feel colder than usual, because beta-blockers reduce the heart’s output and can slightly decrease blood flow to the extremities. Lisinopril can contribute to fatigue as well, though less commonly. These side effects tend to improve as the body adjusts, but they are worth mentioning to your doctor if they persist or affect your daily life.

The ACE Inhibitor Cough

Lisinopril, like all ACE inhibitors, causes a dry, persistent cough in a meaningful minority of people. Estimates vary, but roughly one in ten users develops this cough. It is not dangerous, but it can be annoying enough to make people want to switch medications. If you develop a nagging dry cough after starting lisinopril, your doctor can switch you to an angiotensin receptor blocker (ARB), which works on a similar pathway without the cough problem. The metoprolol does not need to change in that scenario.

Potassium Levels and Kidney Function

One of the less obvious concerns with lisinopril is its effect on potassium. ACE inhibitors reduce the amount of potassium the kidneys excrete, which can push blood potassium levels above the normal range. This matters because high potassium, known as hyperkalemia, can cause dangerous heart rhythm problems at extreme levels.

In a study of over 5,000 patients with chronic kidney disease who started lisinopril, about 2.8% developed hyperkalemia within 90 days. The risk was higher in people who were older, had diabetes, had heart failure, were taking potassium supplements, or were on a high dose of lisinopril.⁵ For people with normal kidney function, the risk is considerably lower, but routine blood work is still standard practice when you are on an ACE inhibitor. Your doctor will typically check your potassium and kidney function within a couple of weeks of starting lisinopril or increasing the dose, and periodically after that.

Metoprolol itself does not have a major direct effect on potassium, but it is worth knowing that the combination of an ACE inhibitor with certain other medications, like potassium-sparing diuretics or nonsteroidal anti-inflammatory drugs (NSAIDs), can amplify the potassium-raising effect. If you take over-the-counter ibuprofen or naproxen regularly, mention it to your doctor, because those drugs can interfere with kidney function and compound the issue.

How Monitoring Works in Practice

If you are on both medications, your doctor is watching a few key numbers. Blood pressure and heart rate are the most immediate. You may be asked to check these at home, especially during the first few months or after a dose change. A home blood pressure cuff that also displays heart rate is a worthwhile investment if you are managing a heart condition.

Blood tests for potassium, creatinine, and kidney function (usually reported as eGFR) are the lab side of monitoring. These are typically drawn within one to two weeks after starting the ACE inhibitor, after any dose increase, and then every few months once things stabilize. The testing schedule ramps up if you have chronic kidney disease, diabetes, or other risk factors for hyperkalemia, as the study on lisinopril in kidney disease patients makes clear.⁵

There is no single “correct” blood pressure target for everyone on this combination. Guidelines generally aim for below 130/80 in most adults with cardiovascular disease, but your doctor may accept slightly different numbers depending on your age, symptoms, and other conditions. What matters more than hitting an exact number is avoiding both extremes: blood pressure that stays too high despite both medications, and pressure that drops so low it causes symptoms.

Starting Both Drugs at Once Versus Adding One Later

Doctors handle the introduction of these two medications differently depending on the clinical situation. After a heart attack, both drugs are often started during the hospital stay, sometimes within hours of each other. In that setting, the patient is being monitored continuously, so any excessive drop in blood pressure or heart rate is caught immediately.

For outpatient management of hypertension or stable heart failure, it is more common to start one drug first, get the dose to a comfortable level, and then add the second. This makes it easier to tell which drug is causing any side effects and to adjust doses independently. If you were already on lisinopril for blood pressure and then your doctor adds metoprolol for a new diagnosis, expect to start at a low dose of metoprolol and increase gradually over a few weeks. The same applies in reverse.

The gradual-titration approach is especially important with metoprolol in heart failure. Beta-blockers can actually worsen heart failure symptoms temporarily when first introduced, even though they improve outcomes over the long term. Starting low and going slow is the standard strategy, and your doctor may tell you to expect a brief period of feeling slightly worse before you feel better.

When the Combination Needs Extra Caution

While the pairing is broadly safe, a few populations and situations call for closer attention.

Severe kidney disease: Lisinopril is cleared by the kidneys, so reduced kidney function means the drug sticks around longer and the risk of potassium problems rises. Dose reductions and more frequent lab work are standard in this group.
Asthma or severe COPD: Beta-blockers like metoprolol, even cardioselective ones, can trigger bronchospasm in people with reactive airway disease. If you have asthma, your doctor may prefer a different beta-blocker or avoid the class altogether.
Diabetes: Beta-blockers can mask the symptoms of low blood sugar, particularly the trembling and rapid heartbeat that usually alert you to a hypoglycemic episode. If you have diabetes and take insulin or sulfonylureas, you need to be aware that a low blood sugar event might feel different on metoprolol. Sweating, the other major symptom, is usually preserved.
Older adults: The combination’s blood-pressure-lowering effect can increase the risk of falls in older people, especially those who already have balance issues or orthostatic hypotension. Lower starting doses and slower titration help mitigate this.
Pregnancy: Both drugs are contraindicated in pregnancy. ACE inhibitors can cause serious harm to a developing fetus, especially in the second and third trimesters. If you are planning a pregnancy or discover you are pregnant, contact your doctor immediately to switch to safer alternatives.

Can You Stop One or Both Abruptly?

This is one area where the two drugs differ sharply in how they should be handled. Lisinopril can be stopped relatively quickly if needed, though your blood pressure will rise back to its previous level and your doctor will want to substitute another medication. Metoprolol, on the other hand, should never be stopped suddenly. Abruptly withdrawing a beta-blocker can cause a rebound surge in heart rate and blood pressure, and in people with coronary artery disease, it can trigger chest pain or even a heart attack. If your doctor decides you should stop metoprolol, the dose will be tapered down over a week or two.

This is worth remembering if you run out of refills or are tempted to skip doses because of side effects. Running out of metoprolol for a few days is riskier than running out of lisinopril for a few days, though neither situation is ideal. Keep both prescriptions filled, and if cost is an issue, both drugs are available as inexpensive generics.

Timing and Dosing Logistics

A common question from people taking both drugs is whether they should take them at the same time or spread them apart. There is no strict pharmacological requirement to separate the doses. Most people take both medications in the morning, and that works well for the majority of cases. If you are on the extended-release version of metoprolol (metoprolol succinate), it is taken once daily. If you are on the shorter-acting version (metoprolol tartrate), it is usually taken twice a day, morning and evening. Lisinopril is a once-daily drug regardless.

Some people find that taking metoprolol in the evening reduces daytime fatigue, which is the most commonly bothersome side effect. If your doctor agrees, shifting the timing is a reasonable experiment. Research on evening versus morning dosing for blood pressure medications in general has been mixed; a large study on the related drug valsartan found no advantage to evening dosing for nighttime or early-morning blood pressure control.⁶ This suggests that for most people, convenience and consistency matter more than the exact hour you swallow the pill.

Taking the medications with food is optional for both. Metoprolol tartrate is absorbed better with food, and some people find that taking it with a meal reduces stomach discomfort. Lisinopril absorption is not affected by food. The most important factor for both drugs is consistency: take them at roughly the same time every day so blood levels stay steady.

Fixed-Dose Combination Pills

For drug pairs that are frequently prescribed together, pharmaceutical companies sometimes package both into a single tablet, called a fixed-dose single-pill combination. This approach reduces the number of pills a patient has to take each day, which can improve adherence. Fixed-dose combinations of beta-blockers and ACE inhibitors do exist for some pairings and are recommended where available.¹ However, a lisinopril-plus-metoprolol combination pill is not widely available; the existing single-pill options in this class tend to use bisoprolol with ramipril or similar pairings. If you find managing two separate pills burdensome, ask your pharmacist about pill organizers or synchronized refill schedules. In practice, two pills a day is a light regimen compared to what many heart failure patients manage.

Alcohol and Lifestyle Interactions

Alcohol lowers blood pressure on its own, and combining it with two blood-pressure-lowering drugs amplifies that effect. A glass of wine is unlikely to cause problems for most people, but heavier drinking on any given occasion raises the risk of a significant blood pressure drop, dizziness, and fainting. If you drink, keep it moderate and pay attention to how you feel, particularly when standing up.

Exercise is encouraged and beneficial for people on both medications, but the metoprolol component will limit how high your heart rate can go during a workout. If you use heart rate zones for training, your usual targets will not apply. A better approach is to gauge exercise intensity by how hard you feel you are working (perceived exertion) rather than by heart rate number. This is a practical adjustment, not a reason to avoid exercise. Staying active actually improves the underlying conditions that these drugs are treating.

Salt intake interacts mainly with the lisinopril side of the equation. A high-sodium diet works against the blood-pressure-lowering effect of ACE inhibitors, which means your doctor may need to prescribe higher doses to achieve the same result. Reducing sodium intake to a reasonable level makes both drugs work more effectively and reduces the overall pill burden you might otherwise need.

1
Cardiovascular Therapeutics / Hindawi / John Wiley & Sons Ltd. Combination Therapy With Beta-Blockers and Angiotensin-Converting Enzyme Inhibitors for Cardiovascular Diseases: Focus on Bisoprolol/Ramipril
2
Europe PMC. Comparative Efficacy and Long-Term Outcomes of Beta-Blockers Alone or in Combination With Angiotensin-Converting Enzyme (ACE) Inhibitors in Chronic Heart Failure: A Systematic Review
3
Pro Research Analysis. Combined Use of Lisinopril and Metoprolol in Treating Chronic Congestive Heart Failure
4
CrossRef. Comparative effectiveness of pharmacologic agents for heart failure prevention in post-myocardial infarction patients: A comprehensive Bayesian network meta-analysis
5
PubMed Central. Predicting the risk of hyperkalemia in patients with chronic kidney disease starting lisinopril
6
Lippincott Williams & Wilkins. Time of administration important? Morning versus evening dosing of valsartan