Health Information

Fosinopril

Drug Information

Fosinopril is an angiotensin-converting enzyme (ACE) inhibitor, a family of drugs used to treat Reference high blood pressure and some types of heart failure.

Common brand names:

Monopril

Summary of Interactions with Vitamins, Herbs, & Foods

Reference What Are Nutrient Interactions

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

Reference Zinc

In a study of 34 people with Reference hypertension, six months of Reference captopril or Reference enalapril (ACE inhibitors related to fosinopril) treatment led to decreased zinc levels in certain white blood cells,¹ 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 fosinopril long term to consider, as a precaution, taking a zinc supplement or a Reference 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 Reference 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

Reference 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

Reference 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 taking 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.
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.

Explanation Required

none

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].

Last Review: 11-07-2012

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The information presented in Aisle7 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 June 2013.

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