Examples of ACE inhibitors
Inhibitors of angiotensin-converting enzyme): benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec, Renitec), fosinopril (Monopril), lisinopril (Lisodur, Lopril, Novatec, Prinivil, Zestril), moexipril (Univasc), perindopril (Coversyl, Aceon), quinapril (Accupril), ramipril (Altace, Tritace, Ramace, Ramiwin), trandolapril (Mavik), zofenopril
Angiotensin antagonists: losartan potassium (Cozaar), candesartan cilexetil (Atacand), eprosartan mesylate (Teveten), irbesartan (Avapro), telmisartan (Micardis), valsartan (Diovan)
What Do They Do in the Body? ACE inhibitors lower blood pressure by blocking the production of a series of chemicals, especially one called angiotensin, that the body releases to raise blood pressure. When blood pressure drops, the kidneys release a hormone called renin, which in turn stimulates the production of angiotensin, which has its own potent actions, including constricting the arteries to raise blood pressure. Angiotensin also stimulates the release of the adrenal hormone aldosterone, which gives cells signals to hold on to sodium and release potassium, thus allowing fluid buildup, another way of raising blood pressure.
Thus taking an ACE inhibitor has a very powerful effect on an important blood-pressure control mechanism, which is good news when your blood pressure needs lowering in the moment. But this can be bad news when it needs to rise, because the mechanism that allows it to do so is suppressed.
ACE inhibitors are a classic example of suppressing a symptom to treat a disease. The danger, of course, is that the disease progresses underneath, and a whole new set of symptoms and risks are created by the drug.
What Are They Prescribed For? High blood pressure, especially in combination with thiazide diuretics. Some of the ACE inhibitors are prescribed for CHF and for heart attack patients after a myocardial infarction, and sometimes for diabetic nephropathy (kidney disease).
What Are the Possible Side Effects? The most common side effect of ACE inhibitors is an annoying, persistent, nagging cough. While this isn’t directly life threatening, it’s a big energy drain and it’s enough to create a loss of sleep. ACE inhibitors have probably gotten more people stuck on the drug treadmill than any other single drug. Why? They take an ACE inhibitor, get a cough, and then complain to their physician. Instead of taking them off the ACE inhibitor, the physician prescribes a cough suppressant, which causes insomnia, so the physician prescribes a sleeping pill, which is addictive, and so on.
The ACE inhibitor captopril (Capoten) can cause a large reduction of white blood cells (neutropenia), seriously compromising the immune system. This seems like an unacceptably severe side effect when there are so many alternatives. The risk of neutropenia is especially high for people with some kinds of kidney problems. There is some evidence that other ACE inhibitors could also cause neutropenia, although not as frequently. Captopril may also cause kidney damage.
ACE inhibitors can cause a serious allergy-type reaction (anaphylactic) that causes swelling, especially around the head and neck, which can be fatal when it obstructs airways.
Because ACE inhibitors block the release of the adrenal hormone aldosterone, which is an androgen, or male hormone, they have been known to cause symptoms of feminization in men such as breast enlargement. This same mechanism also blocks signals telling the body to release potassium, which can result in excessively high levels of potassium.
As with all drugs that lower blood pressure, there is always the risk that the blood pressure is lowered too much or that some other factor such as food, another drug, diarrhea, dehydration, exercise, or overheating will combine with the drug to lower blood pressure too far.
The ACE inhibitors ramipril (Altace) and fosinopril (Monopril) can aggravate existing liver disease. There have been cases where people taking ACE inhibitors suffered liver damage and liver failure (death), as well as kidney damage and kidney failure.
Other side effects of ACE inhibitors are dizziness (common with all drugs that lower blood pressure), headaches, irregular heartbeat, chest pain, diarrhea, nausea, fatigue, shortness of breath, rash, sexual dysfunction, vision disturbances, taste disturbances, and weakness.
There have been dozens of “adverse effects” reported by people taking ACE inhibitors, so don’t rule out a symptom as a side effect of this drug just because it’s not on this list. The latest to make the (unofficial) ACE inhibitor side effects list is sleep disturbances and nightmares, which apparently go away rapidly when the drug is stopped.
These types of drugs can cause injury and death to a developing fetus when taken in the second and third trimesters. Because of this, there doesn’t seem to be any reason whatsoever for a woman of child-bearing age to take them.
Think Twice About Taking These Drugs If . . .
Please think twice about taking an ACE inhibitor no matter what, especially captopril. They are especially risky for people with some types of kidney or liver disease, and the elderly, who tend to have decreased kidney function as a matter of aging. Don’t go near this drug if there is any possibility of pregnancy.
What Are the Interactions with Food? Capsaicin, or cayenne, used as a spice and as an alternative medicine treatment for a variety of ailments, may make an ACE-inhibitor-caused cough worse. Capsaicin is also used topically to treat herpes zoster (shingles). Levels of captopril may be significantly reduced if it is taken with food, so take it an hour before or after eating. Other ACE inhibitors may be reduced less significantly. (Enalapril, benazepril, and lisinopril do not seem to be affected by food.)
Prescription Alternatives: Hundreds of Free, Natural, Prescription-Free Remedies to Restore & Maintain Your Health, by Earl L. Mindell, R.Ph, Ph. D, & Virginia Hopkins, M.A. Published by McGraw-Hill.