Active substances and pharmaceuticals concerned
| Name of active substance | Trade name | Affected micronutrients |
| Lisinopril | Acemin®, Acetan® |
Lithium |
| Captopril | Captopril® | |
| Enalapril | Enac® | |
| Ramipril | Hypren® | |
| Fosinopril | Fositens® |
| Name of active substance | Trade name | Affected micronutrients |
| Lisinopril | Acemin®, Acetan® |
Lithium |
| Captopril | Captopril® | |
| Enalapril | Enac® | |
| Ramipril | Hypren® | |
| Fosinopril | Fositens® |
| Name of active substance | Trade name | Affected micronutrients |
| Captopril | Captopril® | |
| Enalapril | Enac® | Zinc, Folic acid |
| Mechanism of interaction | |
| Potassium | WARNING: Self-medication with potassium results in additive potassium retention. |
| Lithium | ACE inhibitors reduce renal lithium excretion. |
| Zinc | It results in increased renal excretion due to the complexing between the sulfhydryl (SH) group of captopril and the carboxyalkyl group (COOR) of enalapril. |
| Iron | The inhibition of angiotensin conversion enzyme leads to an accumulation of bradykinin in the bronchial mucosa. This leads to the well-known side effect of chesty cough. Iron interferes with the transcriptional expression of inducible NO synthase (iNOS) with ACE administration, thereby reducing chest irritation. |
| Folic acid | A combination of enalapril and folic acid can reduce the risk of stroke in hypertensive people with genetically and/or nutritionally low levels of serum folic acid. |
| Negative consequences of the interaction | Possible symptoms | |
| Potassium | Increase in potassium levels |
|
| Lithium | Increase in lithium levels |
|
| Zinc | Decrease in zinc level |
|
| Positive consequences of the interaction | Possible symptoms | |
| Iron | Inhibition of iNOS activation |
|
| Folic acid | Synergy with antihypertensives |
|
| Medical substance | Recommended supplementation | Dosage |
| ACE inhibitor | Iron (II) | 50-200 mg/d p.o. |
| First and foremost Captopril, Enalapril | Zinc | 20 mg/d p.o. |
| Instructions for use | ||
| Potassium | Self-medication with high-dose potassium preparations (> 600 mg/d) is not recommended. | |
| Zinc | Zinc supplementation is recommended for diabetics with high blood pressure. A time interval between ACE inhibitors and zinc intake is recommended. | |
| Iron | The supplementation should always be short-term and controlled. | |
| References |
| Bhalla P et al. Attenuation of angiotensin converting enzyme inhibitor induced cough by iron supplementation: role of nitric oxide. J Renin Angiotensin Aldosterone Syst. 2011 Dec;12(4):491-7. doi: 10.1177/1470320311399604. Epub 2011 Mar 18. Braun LA, Rosenfeldt F. Pharmaco-nutrient interactions - a systematic review of zinc and antihypertensive therapy. Int J Clin Pract. 2013 Aug;67(8):717-25. doi: 10.1111/ijcp.12040. Epub 2012 Dec 26. Cruz CS et al. Hyperkalaemia in congestive heart failure patients using ACE inhibitors and spironolactone. Nephrol Dial Transplant. 2003 Sep;18(9):1814-9. Golik A et al. Effects of captopril and enalapril on zinc metabolism in hypertensive patients. J Am Coll Nutr. 1998 Feb;17(1):75-8. Gröber U. Mikronährstoffe. Metabolic Tuning – Prävention – Therapie. 3. Auflage, 2011 Gröber U. Arzneimittel und Mikronährstoffe. Medikationsorientierte Supplementierung. 3. Akt. und erw. Auflage, 2014 Juurlink DN et al. Drug-induced lithium toxicity in the elderly: a population-based study. J Am Geriatr Soc. 2004 May;52(5):794-8 Lazarczyk MJ, Giannakopoulos P. Temporal association as a prerequisite factor of valsartan-induced lithium toxicity. Bipolar Disord. 2014 Sep;16(6):662-6. doi: 10.1111/bdi.12174. Epub 2013 Dec 23. Lee SC et al. Iron supplementation inhibits cough associated with ACE inhibitors.Hypertension. 2001 Aug;38(2):166-70. Stargrove Mitchell Bebel, Treasure Jonathan, McKee Dwight L.: Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies. 2008 |