Other Common Names
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Angiotensin-Converting Enzyme Inhibitors such as: benazepril (Lotensin®), captopril (Capoten®, Apo-Capto,
Novo-Captopril, Nu-Capto, Syn-Captopril), enalapril (Vasotec®, Apo-Enalapril), fosinopril (Monopril®), lisinopril
(Prinivil®, Zestril®, Apo-Lisinopril), quinapril (Accupril®), ramipril (Altace®)
Uses
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Angiotensin converting enzyme inhibitors (ACE Inhibitors) are used in the treatment of high blood pressure and
congestive heart failure. ACE Inhibitors are also used to delay the deterioration of the kidneys in diabetics.
ACE is an enzyme which can increase blood pressure by changing Angiotensin I into the potent
vasoconstrictor, Angiotensin II. Enzyme inhibitors can reduce blood pressure by inhibiting the conversion.
Capoten is also used in the treatment of diabetes when kidney disease is present, to halt the advancement of
Depletions
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Zinc
Research has shown that Captopril and, to a lesser extent, enalapril increase secretion of zinc in the urine.
Captopril therapy can result in diminished red blood cell zinc (Pelton R, et al, Drug-Induced Nutrient Depletion
Handbook, 2nd Edition. Hudson, Ohio: Lexi-Comp, Inc., 2001, p433). The ACE inhibitors bind to zinc ions
located in the angiotensin-converting enzyme molecule. Thus, a zinc deficiency test is suggested, which may
indicate the need for zinc supplementation. Make sure the zinc supplement does not contain high amounts of
potassium. Caution: High amounts of zinc could imbalance the zinc to copper balance in the body. Zinc
supplementation in amounts greater than 150 mg/day can actually depress the immune system and cause a
Interactions
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Hawthorn berries, potassium, ginseng, guarana, glycyrrhizin, cayenne, ephedra, Chinese rhubarb, cola nitida,
bayberry, hawthorn, devil's claw, Vitex agnus castus, maté, St. John's wort, juniper, Arctostaphylos uva ursi,
licorice, wood betony, black cohosh, cat’s claw, dandelion, goldenseal, Irish moss, kelp, aspirin, addictive
substances
Hawthorn Berries
Hawthorn berries demonstrate some ability to inhibit ACE (angiotensin-converting enzyme) (Jpn J Pharmacol
1987;43:242-245). Hawthorn berries have been used in conjunction with other ACE inhibiting drugs, however
the combination should be determined by a physician. Angiotension converting enzyme converts a relatively
inactive form of angiotensin (angiotensin I) into an active, very powerful vasoconstrictor, angiotensin II. The
ability of the proanthocyanidins (in Hawthorn berries) to inhibit the converting enzyme is reported to rival that of
Captopril (Jpn J Pharmacol 1987;43:242-245).
Potassium
These medications may increase blood potassium levels in some individuals (JAMA 1995;274:538), which is
not a problem unless extra potassium is ingested. Problems could arise when ingesting
potassium-containing salt substitutes, supplements, or high potassium foods (i.e fruit (bananas), green leafy
vegetables, potatoes, etc.). Levels should be monitored by a physician.
Ginseng
The
ginsengs and Siberian ginseng (not considered a true ginseng because it belongs
to the same family but
not the same genus) are considered to be adaptogens. However, in large amounts, they can be
contraindicated in high blood pressure, as that is one of the side effects from excess use. Siberian ginseng is
tolerated better than the other “true” ginsengs as far as the upper limits causing side effects.
Guarana
Guarana is a plant which contains more caffeine by dry weight than coffee, and is not recommended by most
herbalists due to its stimulatory effect. It should not be combined with blood pressure medications.
Glycyrrhizin
Glycyrrhizin is an ingredient in licorice root which can increase glucocorticoid activity in significant amounts,
and is contraindicated in high blood pressure (it can also potentiate potassium loss).
Capsicum frutescens (cayenne)
The concurrent use of ACE inhibitors with topical capsaicin cream may predispose a patient to coughing
(Brinker F, Herb Contraindications and Drug Interactions. Sandy, Oregon: Eclectic Medical Publications, 2001.
Ephedra
Ephedra’s influence on blood pressure may antagonize the blood pressure lowering effects of ACE inhibitors.
Chinese rhubarb (Rheum palmatum)
This plant has been reported to improve the ability of captopril to reduce the progression of chronic renal failure
by lowering blood urea nitrogen, cholesterol, and triglycerides (Brinker, p169).
Hypertensive Botanicals
Plants containing constituents that increase blood pressure may antagonize ACE inhibitors. Examples include
Cola nitida and bayberry (Myrica cerifera).
Botanicals with Mineralocorticoid Effects
These plants contain constituents that mimic the effect of the hormone aldosterone by inducing kidney
retention of sodium (and water) in the body. This effect increases blood pressure and antagonizes the effect of
ACE inhibitors. Examples are licorice and bayberry.
Hypotensive Botanicals
Plants containing hypotensive constituents may enhance the effects of ACE inhibitors. Examples are hawthorn
(Crataegus species) and devil’s claw (Harpagophytum procumbens).
Botanicals with sympathomimetic effects or high amine levels
These plants may antagonize the effects of ACE inhibitors. Examples are Vitex agnus castus, black cohosh
(Cimicifuga racemosa), cola nitida, maté, and St. John's wort (Hypericum perforatum).
Diuretic herbs
These plants may increase the effect of ACE inhibitors. Examples are dandelion (Taraxacum officnale), juniper,
and Arctostaphylos uva ursi (Facts and Comparisons: The Review of Natural Products. St. Louis: Wolters
Kluwer Company, 2001).
Herbs
Wood betony, black cohosh, cat’s claw, dandelion, goldenseal, Irish moss, and kelp are all herbs which may
enhance the hypotensive effects when taken in combination with blood pressure drugs. Concomitant use
should be avoided or carefully monitored (Fetrow, C, PharmD, et. Al, Complementary & Alternative Medicines,
Springhouse
Corporation, Springhouse, PA).
Aspirin
Aspirin may
interfere with the drug’s effectiveness, but there is no substantiated
literature to support this claim.
The statements above have not been evaluated by the FDA. The nutritional suggestions and research provided are not intended to diagnose, treat, cure or prevent disease and should not be used as a substitute for sound medical advice. Please see your health care professional in all matters pertaining to your physical health. The Professional Description, Professional Notes, Patient Instructions, and items marked with an astrisk (*) are provided by the practitioner and are the sole responsibility of the practitioner.Copyright © 1998-2002 Standard in Natural Solutions, LLC.