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
|
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 with Dietary Supplements
Potassium
An uncommon yet potentially serious side effect of taking ACE inhibitors is increased blood
potassium levels.1 2 3 This problem is more likely to occur
in people with advanced kidney disease. 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 taking ACE inhibitors could cause life-threatening problems.8
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.
Zinc
In a study of 34 people with hypertension, six
months of captopril or enalapril (ACE inhibitors related to ramipril)
treatment led to decreased zinc levels in certain white blood cells,9 raising
concerns about possible ACE inhibitor–induced zinc depletion.
While zinc depletion has not been reported with ramipril, until more is known, it makes
sense for people taking ramipril 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.
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.10
Interactions with Foods and Other Compounds
Food
Food slows the rate of ramipril absorption but not the total amount of drug
absorbed.11
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. 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.
10. Lee SC, Park SW, Kim DK, et al. Iron supplementation inhibits cough
associated with ACE inhibitors. Hypertension 2001;38:166–70.
11. Threlkeld DS, ed. Diuretics and Cardiovasculars, Antihypertensives,
Angiotensin Converting Enzyme Inhibitors. In Facts and Comparisons Drug Information.
St. Louis, MO: Facts and Comparisons, Apr 1998, 165j.