Lotrel

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Lotrel

Dos & Don'ts

Lotrel

This drug combines two primary active ingredients: amlodipine and benazepril.

Amlodipine is a calcium channel blocker used to treat angina and high blood pressure.

Benazepril is an angiotensin-converting enzyme (ACE) inhibitor drug used to treat high blood pressure.

Do…
  • Keep up the zinc While benazepril has not been shown to deplete zinc, other ACE inhibitors have, so it may be prudent to supplement with 20 to 50 mg daily to maintain adequate levels of this mineral in your body. (Those taking zinc supplements should also add 2 to 3 mg per day of copper to avoid deficiency.)
  • Try an iron supplement if you develop an ACE-inhibitor-induced cough 250 mg of ferrous sulfate per day for four weeks may reduce the severity of a cough caused by this drug.
Don't…
  • Consume nutrients that this drug helps your body retain Ask your doctor to check your blood levels of potassium and DHEA, and avoid high-potassium foods and salt substitutes to prevent an unhealthy build-up of the nutrient in the blood.

Interaction

Summary of Interactions with Vitamins, Herbs, & Foods

dnicon_Beneficial May Be Beneficial: Depletion or interference—This medication may deplete these substances from the body or interfere with how they work; extra intake may help replenish them.

Zinc*
dnicon_Beneficial May Be Beneficial: Side effect reduction and/or prevention—These substances may help reduce the likelihood and/or severity of a potential side effect caused by the medication.

Iron
dnicon_Beneficial May Be Beneficial: Supportive interaction—These substances may help this medication work better.

none

dnicon_Avoid Avoid: Reduces drug effectiveness—When taking this medication, avoid these substances as they may decrease the medication's absorption and/or activity in the body.

High-Potassium Diet*
dnicon_Avoid Avoid: Adverse interaction—When taking this medication, avoid these substances, as the combination may cause undesirable or dangerous interactions.

Pleurisy Root*

Potassium*

Salt Substitutes*
dnicon_Check Check: Explanation needed—When taking this medication, read the article details and discuss them with your doctor or pharmacist before taking these substances.

DHEA

Grapefruit

Pomegranate*

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 Details

Interactions with Vitamins

Dehydroepiandrosterone (DHEA)

Amlodipine has been shown to raise blood levels of DHEA-sulfate in insulin-resistant, obese men with high blood pressure.1

Potassium

An uncommon yet potentially serious side effect of taking ACE inhibitors is increased blood potassium levels.2 , 3 , 4 This problem is more likely to occur in people with advanced kidney disease. Taking potassium supplements,5 potassium-containing salt substitutes (No Salt, Morton Salt Substitute, and others),6 , 7 , 8 or large amounts of high-potassium foods at the same time as ACE inhibitors could cause life-threatening problems.9 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.

Zinc

In a study of 34 people with hypertension, six months of captopril or enalapril (ACE inhibitors related to benazepril) treatment led to decreased zinc levels in certain white blood cells,10 raising concerns about possible ACE inhibitor–induced zinc depletion.

While zinc depletion has not been reported with benazepril, until more is known, it makes sense for people taking benazepril 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.

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.11

Interactions with Herbs

Pleurisy root

As pleurisy root and other plants in the Aesclepius genus contain cardiac glycosides, it is best to avoid use of pleurisy root with heart medications such as calcium channel blockers.12

Interactions with Foods & Other Compounds

Grapefruit juice

Ingestion of grapefruit juice has been shown to increase the absorption of felodipine (a drug similar in structure and action to that of amlodipine) and to increase the adverse effects of the medication in patients with hypertension. Until more is known, it seems that grapefruit juice should not be ingested by people taking amlodipine or similar drugs.13 The same effects might be seen from eating grapefruit as from drinking its juice.

Pomegranate juice

Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice.14 , 15 The degree of inhibition is about the same for each of these juices. Therefore, it would be reasonable to expect that pomegranate juice might interact with lotrel in the same way that grapefruit juice does.

Food

Lotrel may be taken without food, as its ingredients amlodipine and benazepril may be taken without food.16 , 17

Brands

Common brand names:

Lotrel

References

1. Beer NA, Jakubowicz DJ, Beer RM, Nestler JE. The calcium channel blocker amlodipine raises serum dehydroepiandrosterone sulfate and androstenedione, but lowers serum cortisol, in insulin-resistant obese and hypertensive men. J Clin Endocrinol Metab 1993;76:1464–9.

2. Good CB, McDermott L, McCloskey B. Diet and serum potassium in patients on ACE inhibitors. JAMA 1995;274:538.

3. Rush JE, Merrill DD. The Safety and tolerability of lisinopril in clinical trials. J Cardiovasc Pharmacol 1987;9(Suppl 3):S99–107.

4. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1965–8.

5. Burnakis TG, Mioduch HJ. Combined therapy with captopril and potassium supplementation. A potential for hyperkalemia. Arch Intern Med 1984;144:2371–2.

6. Burnakis TG. Captopril and increased serum potassium levels. JAMA 1984;252:1682–3 [letter].

7. 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.

8. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1965–8.

9. Stoltz ML. Severe hyperkalemia during very-low-calorie diets and angiotensin converting enzyme use. JAMA 1990;264:2737–8 [letter].

10. 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.

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

12. Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-Care Professionals. London: Pharmaceutical Press, 1996, 213–4.

13. Bailey DG, Arnold MO, Strong HA, Munoz C, Spence JD, et al. Effect of grapefruit juice and naringin on nisoldipine pharmacokinetics. Clin Pharmacol Ther 1993;54:589–94.

14. Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. Am J Cardiol 2006;98:705–6.

15. Summers KM. Potential drug-food interactions with pomegranate juice. Ann Pharmacother 2006;40:1472–3.

16. Faulkner JK, Hayden ML, Chasseaud LF, Taylor T. Absorption of amlodipine unaffected by food. Solid dose equivalent to solution dose. Arzneimittelforschung 1989;39:799–801.

17. Gengo FM, Brady E. The pharmacokinetics of benazepril relative to other ACE inhibitors. Clin Cardiol 1991;14(8 suppl 4):IV44–50 [review].

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