Angiotensin-converting enzyme (ACE) inhibitors constitute a family of drugs used to treat
high blood pressure and heart failure, as well as to improve survival
following a heart attack. ACE inhibitors are
also used to slow the progression of kidney disease in people with diabetes.
Summary of
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
interactions.
May Be Beneficial:Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them.
Zinc*
May Be Beneficial:Side effect
reduction/prevention—Taking these supplements may help reduce the likelihood and/or
severity of a potential side effect caused by the medication.
Iron
Avoid:Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results.
High-potassium foods
Potassium supplements
Salt substitutes
Supportive interaction
None known
Reduced drug
absorption/bioavailability
None known
Interactions common to many, if not all, ACE
Inhibitors are described in this article. Interactions reported for only one or several drugs
in this class may not be listed in this article. Some drugs listed in this article are linked
to articles specific to that respective drug; please refer to those individual drug articles.
The information in this article may not necessarily apply to drugs in this class for which no
separate article exists. If you are taking an ACE Inhibitor for which no separate article
exists, talk with your doctor or pharmacist.
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
evidence.
Interactions that are common to all ACE inhibitors are described below. For interactions
involving specific ACE inhibitors, refer to the highlighted drugs listed below.
Potassium
An uncommon yet potentially serious side effect of taking ACE inhibitors is increased blood
potassium levels.123 Taking potassium
supplements,4 potassium-containing salt substitutes (No Salt, Morton Salt
Substitute, and others),567 or large amounts of
high-potassium foods at the same time as ACE inhibitors could cause life-threatening
problems.8 Therefore, individuals should consult their healthcare practitioner
before supplementing additional potassium and should have their blood levels of potassium
checked periodically while taking ACE inhibitors.
Iron
In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor,
supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks
reduced the severity of the cough by a statistically significant 45%, compared with a
nonsignificant 8% improvement in the placebo group.9
Zinc
In a study of 34 people with hypertension, six
months of captopril or enalapril treatment led to decreased zinc levels in certain white blood
cells,10 raising concerns about possible ACE inhibitor–induced zinc
depletion.
While zinc depletion has not been reported with all ACE inhibitors, until more is known, it
makes sense for people taking one of these drugs long term to consider, as a precaution,
taking a zinc supplement or a multimineral tablet containing zinc. (Such multiminerals usually
contain no more than 99 mg of potassium, probably not enough to trigger the above-mentioned
interaction.) Supplements containing zinc should also contain copper, to protect against a
zinc-induced copper deficiency.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
1. Good CB, McDermott L, McCloskey B. Diet and serum potassium in
patients on ACE inhibitors. JAMA 1995;274:538.
2. Rush JE, Merrill DD. The Safety and tolerability of lisinopril in
clinical trials. J Cardiovasc Pharmacol 1987;9(Suppl 3):S99–107.
3. Sifton DW, ed. Physicians’ Desk Reference. Montvale,
NJ: Medical Economics Company, Inc., 2000, 1965–8.
4. Burnakis TG, Mioduch HJ. Combined therapy with captopril and potassium
supplementation. A potential for hyperkalemia. Arch Intern Med
1984;144:2371–2.
6. Ray K, Dorman S, Watson R. Severe hyperkalemia due to the concomitant
use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening
interaction. J Hum Hypertens 1999;13:717–20.
7. Sifton DW, ed. Physicians’ Desk Reference. Montvale,
NJ: Medical Economics Company, Inc., 2000, 1965–8.
8. Stoltz ML. Severe hyperkalemia during very-low-calorie diets and
angiotensin converting enzyme use. JAMA 1990;264:2737–8 [letter].
9. Lee SC, Park SW, Kim DK, et al. Iron supplementation inhibits cough
associated with ACE inhibitors. Hypertension 2001;38:166–70.
10. Golik A, Zaidenstein R, Dishi V, et al. Effects of captopril and
enalapril on zinc metabolism in hypertensive patients. J Am Coll Nutr
1998;17:75–8.
The information presented in Healthnotes is for informational purposes
only. It is based on scientific studies (human, animal, or in vitro), clinical
experience, or traditional usage as cited in each article. The results reported may not
necessarily occur in all individuals. For many of the conditions discussed, treatment with
prescription or over the counter medication is also available. Consult your doctor,
practitioner, and/or pharmacist for any health problem and before using any supplements or
before making any changes in prescribed medications. Information expires June 2009.
