Alternative Medicine
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High-potassium foods* Potassium supplements* Salt substitutes*
Side effect reduction/prevention
None known
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.
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 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.
In a study of 34 people with hypertension, six months of captopril or enalapril (ACE inhibitors related to lisinopril) 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 lisinopril, until more is known, it makes sense for people taking lisinopril 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.
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.
Sifton DW, ed. Physicians' Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1965-8.
Stoltz ML. Severe hyperkalemia during very-low-calorie diets and angiotensin converting enzyme use. JAMA 1990;264:2737-8 [letter].
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.
Mojaverian P, Rocci ML Jr, Vlasses PH, et al. Effect of food on the bioavailability of lisinopril, a nonsulfhydryl angiotensin-converting enzyme inhibitor. J Pharm Sci 1986;75:395-7.
The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires August 2007.
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