Supplements and Enalapril maleate.
Enalapril maleate, sold under the brand name Innovace, is an ACE inhibitor: it lowers blood pressure by blocking the conversion of angiotensin I to angiotensin II.
Enalapril maleate is an ACE inhibitor. The class blocks the conversion of angiotensin I to angiotensin II, dropping blood pressure and reducing afterload on the heart. The defining side effect is a dry persistent cough from bradykinin accumulation. It affects around 10 to 15 percent of UK patients and is the most common reason for switching to an ARB. Renal function depends on renin-angiotensin signalling for glomerular filtration pressure, so annual U&E checks are standard. The most clinically important class interaction with supplements is with chronic NSAID use, which blunts the antihypertensive effect and adds renal stress in older patients. Additive BP supplements (beetroot extract, hibiscus, garlic, CoQ10 at the larger studied doses) stack on top, sometimes usefully. Liquorice opposes the BP effect through aldosterone-mediated sodium retention. It warrants caution at habitual intake.
Below are the 4 documented pairs we have explicitly assessed against Enalapril maleate in the Distil database: 1 red and 3 amber. The pairs cluster around 3 mechanisms: Additive hyperkalaemia (raised potassium), Reduced renal lithium clearance, and Renal zinc wasting (drug-induced). Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not on this list is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by supplement, and the missing-item form at the bottom of the page routes any uncatalogued supplement into our next curation pass.
Documented interactions
Additive hyperkalaemia (raised potassium)
Enalapril raises blood potassium by reducing how much the kidneys pass out. A potassium supplement adds more potassium on top. Together they can push potassium high enough to affect the heart rhythm, which can be dangerous. Do not take a potassium supplement alongside enalapril unless your GP has specifically advised it and is checking your blood potassium.
Reduced renal lithium clearance
ACE inhibitor blood pressure tablets such as enalapril can reduce how well the kidneys clear lithium, which raises the lithium level in the blood. With prescription lithium this is a recognised caution, especially in older people. At the small amount of lithium in a typical lithium orotate supplement (around 5 mg) the effect is expected to be very small; it matters more for higher-strength products (around 20 mg) and for anyone whose kidney function is reduced. If you take an ACE inhibitor, check with your pharmacist or GP before using a lithium supplement.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Renal zinc wasting (drug-induced)
Enalapril can make the kidneys pass out more zinc in the urine, so people on it long term can drift towards low zinc. This works the opposite way to most interactions: the medicine lowers your zinc rather than the supplement affecting the medicine, so taking zinc is generally a supportive response rather than a hazard. If you take enalapril long term it is worth letting your GP know you supplement zinc, and not taking very high doses without a reason, since too much zinc over time can lower copper.
Enalapril can make the kidneys pass out more zinc in the urine, so people on it long term can drift towards low zinc. This works the opposite way to most interactions: the medicine lowers your zinc rather than the supplement affecting the medicine, so taking zinc is generally a supportive response rather than a hazard. If you take enalapril long term it is worth letting your GP know you supplement zinc, and not taking very high doses without a reason, since too much zinc over time can lower copper.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope (food-supplement interactions only; for drug-drug interactions, the BNF is authoritative). Use the checker below to surface any supplement, and submit a missing item if you take something we have not catalogued.
How we grade severity, choose what's in scope, and what we exclude.
Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.
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