Enalapril

Also indexed as: Ednyt, Enacard, Enalaprilat, Innovace, Pralenal, Vasotec

Combination drugs: Innozide, Vaseretic

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.

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*
Check: Other—Before taking any of these supplements or eating any of these foods with your medication, read this article in full for details.	Sodium
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 ACE inhibitors could cause life-threatening problems.⁸ Therefore, people should consult their doctor before supplementing additional potassium and should have their blood levels of potassium checked periodically while taking ACE inhibitors.

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.⁹ 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.

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 sulphate 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

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.¹¹

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.

Interactions with Foods and Other Compounds

Food
Enalapril may be taken with or without food.¹²

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. 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.

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

11. 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.

12. 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, 165o–5p.

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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 chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

2007-09-01

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Interactions with Dietary Supplements

Interactions with Foods and Other Compounds

References