Angiotensin-Converting Enzyme (ACE) Inhibitors
Also indexed as: ACE Inhibitors, Aceon, Cilazapril, Fosinopril,
Mavik, Monopril, Perindopril, Trandolapril
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: 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
|
| Depletion or interference |
None known
|
| 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.
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 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
References: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.
5. Burnakis TG. Captopril and increased serum potassium levels.
JAMA 1984;252:1682–3 [letter].
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.