Angiotensin-Converting Enzyme (ACE) Inhibitors

Also indexed as: ACE Inhibitors, Aceon, Cilazapril, Coversyl, Fosinopril, Gopten, Imidapril, Mavik, Monopril, Odrik, Perindopril, Staril, Tanatril, Trandolapril, Vascace

Illustration

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, a 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.

Beneficial 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*
Beneficial 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 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 a few 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 chemist.
Top

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Top

Interactions that are common to all ACE inhibitors are described below. For interactions involving specific ACE inhibitors, refer to the highlighted drugs listed below.

Top
Top

Interactions with Dietary Supplements

Potassium
An uncommon yet potentially serious side effect of taking ACE inhibitors is increased blood potassium levels.1 2 3 Taking potassium supplements,4 potassium-containing salt substitutes (No Salt, Morton Salt Substitute, and others),5 6 7 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 doctor 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 sulphate 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.

Top
References
(To view, roll mouse over the "References" heading; to hide, click on the heading)