By Brandon Blood, DC and Todd Mexico, DC
"Medications, both prescription and over-the-counter, can affect how the body uses nutrients."1 Stop and think about this statement by Janice Hermann, PhD, from Oklahoma State University. How many patients who present to your clinic are currently consuming either prescription or OTC medications? Statistically, nearly 50 percent of Americans are currently taking prescription medications2 – that's one out of every two patients who walks into your office.
For some of us, this does not necessarily affect our day-to-day patient care. But for those of us who feel that our patients should leave our office with a bottle of magnesium, fish oil or any other nutritional supplement, knowing this information becomes vital. Many of us need to do a better job understanding that drug-nutrient interactions do actually exist and can be detrimental to us and our patients if not appropriately considered.
As we continue our educational series on the importance of understanding drug-nutrient interactions, let's look at the medication lisinopril [brand names: Prinivil, Zestril]. According to Forbes.com, lisinopril, an ACE-inhibitor prescribed for the treatment of hypertension, was the third most prescribed medication in 2010, prescribed over 81 million times.3 So, being that half of our patients are walking into our clinics on medication, the likelihood of them being on this particular medication is high.
Potential Supplement Interactions With Lisinopril
Here are a few of the more common positive and negative drug-nutrient interactions involving lisinopril:
Negative
Positive
- Zinc: Consuming zinc while on lisinopril may help combat drug-induced depletion of this mineral.10-11
- Iron: Iron supplementation concurrent with lisinopril use may help alleviate the undesired side effect of a dry cough. (Iron should be taken with caution, as it may also decrease drug absorption.)12-13
The findings above are not inclusive of the potential drug-nutrient interactions involving lisinopril; they are just a sample of the information that has been researched. It is important for doctors of chiropractic to analyze all of the medications and nutritional supplements their patients are taking to assess the possible beneficial and negative interactions. It is perhaps equally important to document these results in a manner that exhibits due diligence on the part of the observing DC from a medical-legal standpoint. By understanding this research and applying your nutritional knowledge in practice, you will likely also see an increase in patient confidence in you and the care you provide.
References
- Hermann J. "Drug-Nutrient Interactions." Oklahoma State University, Oklahoma Cooperative Extension Service. http://pods.dasnr.okstate.edu/docushare/dsweb/Get/Document-2458/T-3120web.pdf
- Fast Facts: Therapeutic Drug Use. Centers for Disease Control and Prevention. www.cdc.gov/nchs/FASTATS/drugs.htm
- In Pictures: The Most Popular Prescription Drugs. No. 3: Lisinopril. Forbes.com.
- Good CB, McDermott L, McCloskey B. Diet and serum potassium in patients on ACE inhibitors [letter]. JAMA, 1995;274:538.
- Warren SE, O'Connor DT. Hyperkalemia resulting from captopril administration. JAMA, 1980;244:2551-2552.
- Grossman A, Eckland D, Price P, et al. Captopril: reversible renal failure with severe hyperkalaemia [letter]. Lancet, 1980;1:712.
- Burnakis TG, Mioduch HJ. Combined therapy with captopril and potassium supplementation. A potential for hyperkalemia. Arch Intern Med, 1984;144:2371-2372.
- Stoltz ML, Andrews CE Jr. Severe hyperkalemia during very-low-calorie diets and angiotensin converting enzyme use. JAMA, 1990;264:2737-2738.
- AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 2000:2306-2307.
- Golik A, Modai D, Averbukh Z, et al. Zinc metabolism in patients treated with captopril versus enalapril. Metabolism, 1990;39:665-667.
- Golik A, Zaidenstein R, Dishi V, et al. Effects of captopril and enalapril on zinc metabolism in hypertensive patients. J Am Coll Nutr, 1998;17:75-80.
- Campbell NR, Hasinoff BB. Iron supplements: a common cause of drug interactions. Br J Clin Pharmacol, 1991;31:251-255.
- Lee SC, Park SW, Kim DK, et al. Iron supplementation inhibits cough associated with ACE inhibitors. Hypertension, 2001;38:166-170.
Drs. Todd Mexico and Brandon Blood, who are both 2006 graduates of Palmer College of Chiropractic Florida, are the president and vice president, respectively, of eMedFx.com. Dr. Mexico practices in Baldwinville, Mass., while Dr. Blood maintains a practice in Canton, Ohio.