Blood Pressure Lowering Medications
Angiotensin-Converting Enzyme (ACE) Inhibitors
Benazepril HCl (Lotensin)
Captopril (Capoten)
Enalapril (Vasotec)
Fosinopril Sodium (Monopril)
Lisinopril (Prinivil, Zestril)
Quinapril HCl (Accupril)
Ramipril (Altace)
Alpha-adrenergic Blocking Agents
Doxazosin (Cardura)
Prazosin (Minipress)
Rauwolfia (Reserpine, Serpasil)
Terazosin (Hytrin)
Beta-adrenergic Blocking Agents
Acebutolol (Sectral)
Atenolol (Tenormin)
Betapace (Sotalol)
Bisoprolol (Zebeta)
Esmolol (Brevibloc)
Metoprolol (Lopressor, Toprol XL)
Nadolol (Corgard)
Penbutolol (Levatol)
Pindolol (Visken)
Propranolol (Inderal)
Timolol Maleate (Blocadren)
Calcium Channel Blockers
Amlodipine (Norvasc)
Bepridil (Vascor)
Diltiazem (Cardizem, Cartia XT, Dilacor, Tiazac)
Felodipine (Plendil)
Isradipine (Dynacirc)
Minoxidil (Loniten)
Nicardipine (Cardene)
Nifedipine (Adalat, Procardia)
Nimodipine (Nimotop)
Nisoldipine (Sular)
Verapamil (Calan, Covera HS, Isoptin, Verelan)
Other Antihypertensives
Carvedilol (Coreg)
Diazoxide (Hyperstat IV)
Hydralazine (Apresazide, Apresoline)
Labetalol (Normodyne, Trandate)
Nutritional Considerations:
A low sodium and low calorie diet may be beneficial. (Pronsky 1999).
Avoid alcohol. (Allison 1971) (Facts and Comparisons 2000) (Pronsky 1999)
Avoid consuming excessive potassium in foods and supplements when taking ACE inhibitors. Ask your pharmacist for more information regarding electrolyte balance. (Burnakis 1984) (Good 1995)
Arginine, found in meat, fish, and dairy products, can also cause elevated potassium levels. Do not use with ACE inhibitors. (McKevoy 1998)
ACE inhibitors may contribute to zinc deficiency. Ask your pharmacist whether supplementation would be beneficial. (Golik 1990) (Golik 1998)
Long-term use of beta-blockers may cause deficiencies in chromium and magnesium. Discuss supplementation of these minerals with your pharmacist. (Roeback JR Jr 1991) (Rubio-Luengo MA 1995)
CoQ10 has blood pressure lowering properties. The dosage requirements of blood pressure medications may be changed if CoQ10 is supplemented. Consult your pharmacist before taking this supplement with the above-mentioned drugs. (Langsjoen 1994) (Singh 1999)
Calcium supplements may interfere with the absorption of beta-blockers. Consult your pharmacist before taking calcium supplements with beta-blocking agents. (Pronsky 1999)
Use caution in diabetics because beta-blockers can prolong or mask the symptoms of hypoglycemia. (Pronsky 1999)
Grapefruit juice may increase the effects of some calcium channel blockers and coreg, possibly causing an excessive lowering of blood pressure. Avoid within 2 hours of the drug. (Facts and Comparisons 2000) (Holt 1998) (Pronsky 1999)
Limit coffee and tea with calcium channel blockers. (Rachima-Maoz, 1998)
Herbal Considerations:
Topical capsicum may increase the cough associated with using ACE inhibitors. (Hakas 1990) (Stockley 1996)
Avoid natural licorice products with beta-blockers and calcium channel blockers. (Farese 1991) (Pronsky 1999) (Shintani 1992).
Avoid caffeine-containing herbs such as Cola, Guarana, and Mate while taking beta-blocking agents and calcium channel blockers. (Brinker 1998)
One of the side effects of beta-blockers is sleep disturbance. Melatonin may be able to help reverse sleep disturbance patterns and remedy this side effect when taken with beta- blockers. However, always consult a pharmacist before supplementation. (Attenburrow 1995) (Stoschitzky 1999) (Van den Huevel 1997)
Theoretically, salicylates contained in meadowsweet, poplar, and willow may decrease the activity of some beta-blockers. Do not take these herbs with beta-blockers, without consulting a pharmacist. (The Review of Natural Products 1999) (Facts and Comparisons 2000) (Newall 1996)
Consult your pharmacist before taking Guggal with Cardizem, it may lower the availability and effects of Cardizem. (Dalvi 1994)
St. John's Wort may interact with some calcium channel blockers due to the use of similar pathways to metabolize the drugs and herb. (Yue 2000) Consult your pharmacist before taking this herb with any calcium channel blockers.
References
Allison, R.D. et al: Effects of alcohol and nitroglycerin in vascular responses in man. Angiology, 1971, 22: 211-222.
Attenburrow ME, Dowling BA, Sargent PA, Sharpley AL, Cowen PJ. Melatonin phase advances circadian rhythm. Psychopharmacology (Berl). 1995 Oct; 121(4): 503-5.
Brinker, Francis, N.D. Herb Contraindications and Drug Interactions. 1998.
Burnakis TG & Mioduch HJ: Combined therapy with captopril and potassium supplementation. A potential for hyperkalemia. Arch Intern Med 1984; 144:2371-2372.
Dalvi SS, Nayak VK, Pohujani SM, et al. Effect of gugulipid on bioavailability of diltiazem and propranolol. J Assoc Physicians India, 1994;42(6):454-5.
Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 2000.
Facts and Comparisons, Review of Natural Products, Wolters Kluwer Company, 1999
Farese, RV et al., Licorice-induced hypermineralcorticoidism. NEJM. 1991, 325:1,1223-1,227.
Good CB, McDermott L, McCloskey B. Diet and serum potassium in patients on ACE inhibitors. JAMA 1995;274:538.
Golik A, Modai D, Averbukh Z, et al: Zinc metabolism in patients treated with captopril versus enalapril, Metabolism, 1990, 39(7): 665-7.
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(1): 75-8.
Hakas JF. Topical capsaicin induces cough in patient receiving ACE inhibitor. Ann Allergy 1990: 65:322
Holt GA. Food & Drug Interactions. Chicago: Precept Press,1998, 94.
Langsjoen P, Langsjoen P, Willis R, Folkers K. Treatment of essential hypertension with coenzyme Q10. Mol Aspects Med 1994; 15 Suppl: S265-72.
McKevoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.
Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996
Pronsky, Zaneta. Food Medication Interactions. 11th edition. 1999.
Rachima-Maoz C, Peleg E, Rosenthal T. The effect of caffeine on ambulatory blood pressure in hypertensive patients. Am J Hypertens 1998;11:1426-32.
Roeback JR Jr, Hla KM, Chambless LE, Fletcher RH. Effects of chromium supplimentation on serum high-density lipoprotein cholesterol levels in men taking beta-blockers. A randomized, controlled trial. Ann Intern Med. 1991 Dec 15; 115(12): 917-24.
Rubio-Luengo MA, Maldonado-Martin A, Gil-Extremera B, Gonzalez-Gomez L, Luna del Castillo, JD. Variations in Magnesium and Zinc in hypertensive patients receiving different treatments. Am J Hypertens. 1995 Jul;8(7): 689-95.
Shintani S, Murase H, Tsukagoshi H, Shiigai T. Glycyrrhizin (licorice)-induced hypokalemic myopathy. Report of two cases and review of the literature. Eur Neurol 1992;32:44-51.
Singh RB, Niaz MA, Rastogi SS, Shukla PK, Thakur AS. Effect of hydrosoluble coenzyme Q10 on blood pressures and insulin resistance in hypertensive patients with coronary artery disease. J Hum Hyertens 1999 Mar; 13(3): 203-8
Stockley. Drug Interactions, 4th Edition, 1996.
Stoschitzky K, Sakotnik A, Lercher P, et al. Influence of beta-blockers on melatonin release. Eur J Clin Pharmacol 1999;55(2):111-115
Van Den Heuvel CJ, Reid KJ, Dawson D. "Effect of atenolol on nocturnal sleep and temperature in young men: reversal by pharmacological doses of melatonin." Physiol Behav, Jun. 1997; 61(6):795-802.
Yue QY, Bergquist C, GerdÈn B. Safety of St John's wort (Hypericum perforatum). Lancet 2000;355(9203).
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