Decrease (-) Restore Default Increase (+)
Print    Email
Bookmark and Share

Health Information

Health Information

Health Information

Complementary and Alternative Medicine - Cam

Search Health Information    Enalapril

Topic Contents

Enalapril

Drug Information

Enalapril is a type of angiotensin-converting enzyme (ACE) inhibitor, a family of drugs used to treat high blood pressure and some types of heart failure . Enalapril is also used to slow the progression of kidney disease in people with diabetes .

Common brand names:

Vasotec

Summary of Interactions with Vitamins, Herbs, & Foods

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • 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.1

    It makes sense for people taking enalapril 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.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduce Side Effects

  • 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.2

Support Medicine

  • none

Reduces Effectiveness

  • none

Potential Negative Interaction

  • Potassium

    An uncommon yet potentially serious side effect of taking ACE inhibitors is increased blood potassium levels.3 , 4 , 5 This problem is more likely to occur in people with advanced kidney disease. Taking potassium supplements,6 potassium-containing salt substitutes (No Salt, Morton Salt Substitute, and others),7 , 8 , 9 or large amounts of high-potassium foods at the same time as ACE inhibitors could cause life-threatening problems.10 Therefore, people should consult their healthcare practitioner before supplementing additional potassium and should have their blood levels of potassium checked periodically while taking ACE inhibitors.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Salt Substitutes

    An uncommon yet potentially serious side effect of taking ACE inhibitors is increased blood potassium levels.11 , 12 , 13 This problem is more likely to occur in people with advanced kidney disease. Taking potassium supplements,14 potassium-containing salt substitutes (No Salt, Morton Salt Substitute, and others),15 , 16 , 17 or large amounts of high-potassium foods (such as bananas and other fruit) at the same time as taking ACE inhibitors could cause life-threatening problems.18 Therefore, people should consult their healthcare practitioner before supplementing additional potassium and should have their blood levels of potassium checked periodically while taking ACE inhibitors.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Explanation Required 

  • Sodium

    In a short-term study of nine overweight men, enalapril plus a low-salt diet reduced blood pressure more than a low-salt diet alone.19 Additionally, enalapril plus a low-salt diet resulted in better insulin response than the low-salt diet alone. The importance of this preliminary information for overweight people with high blood pressure is unclear.

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

References

1. 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.

2. Lee SC, Park SW, Kim DK, et al. Iron supplementation inhibits cough associated with ACE inhibitors. Hypertension 2001;38:166-70.

3. Good CB, McDermott L, McCloskey B. Diet and serum potassium in patients on ACE inhibitors. JAMA 1995;274:538.

4. Rush JE, Merrill DD. The Safety and tolerability of lisinopril in clinical trials. J Cardiovasc Pharmacol 1987;9(Suppl 3):S99-107.

5. Sifton DW, ed. Physicians' Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1965-8.

6. Burnakis TG, Mioduch HJ. Combined therapy with captopril and potassium supplementation. A potential for hyperkalemia. Arch Intern Med 1984;144:2371-2.

7. Burnakis TG. Captopril and increased serum potassium levels. JAMA 1984;252:1682-3 [letter].

8. 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.

9. Sifton DW, ed. Physicians' Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1965-8.

10. Stoltz ML. Severe hyperkalemia during very-low-calorie diets and angiotensin converting enzyme use. JAMA 1990;264:2737-8 [letter].

11. Good CB, McDermott L, McCloskey B. Diet and serum potassium in patients on ACE inhibitors. JAMA 1995;274:538.

12. Rush JE, Merrill DD. The Safety and tolerability of lisinopril in clinical trials. J Cardiovasc Pharmacol 1987;9(Suppl 3):S99-107.

13. Sifton DW, ed. Physicians' Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1965-8.

14. Burnakis TG, Mioduch HJ. Combined therapy with captopril and potassium supplementation. A potential for hyperkalemia. Arch Intern Med 1984;144:2371-2.

15. Burnakis TG. Captopril and increased serum potassium levels. JAMA 1984;252:1682-3 [letter].

16. 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.

17. Sifton DW, ed. Physicians' Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1965-8.

18. Stoltz ML. Severe hyperkalemia during very-low-calorie diets and angiotensin converting enzyme use. JAMA 1990;264:2737-8 [letter].

19. Egan BM, Stepniakowski K. Effects of enalapril on the hyperinsulinemic response to severe salt restriction in obese young men with mild systemic hypertension. Am J Cardiol 1993;72:53-7.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

© 2014 St. Mary's Health System   |  3700 Washington Avenue  |  Evansville, IN 47750  |  (812) 485-4000