Moexipril

Summary of Interactions with Vitamins, Herbs, and Foods
(for details about the summarized interactions, read the full article)

May be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.	Lithium (prescription) Potassium
May be Beneficial: Side effect reduction/prevention—Taking these supplements may help reduce the likelihood and/or severity of a potential side effect caused by the medication.	Iron
Avoid: Reduced drug absorption/bioavailability—Avoid these supplements when taking this medication since the supplement may decrease the absorption and/or activity of the medication in the body.	Food
Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.	High-potassium foods* Lithium (supplements) Low-salt diet Potassium supplements* Salt substitutes*
Supportive interaction	None known

Interactions with Dietary Supplements

Potassium
An uncommon yet potentially serious side effect of taking ACE inhibitors is increased blood potassium levels.¹ ² ³ This problem is more likely to occur in people with advanced kidney disease. Taking potassium supplements,⁴ potassium-containing salt substitutes (No Salt®, Morton Salt Substitute®, and others),⁵ ⁶ ⁷ or large amounts of high-potassium foods (such as bananas and other fruit) at the same time as taking ACE inhibitors could cause life-threatening problems.⁸ 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.

Lithium
Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders, such as bipolar disorder. Taking lithium at the same time as ACE inhibitors may increase blood levels of the mineral.⁹ Controlled studies are needed to determine whether taking moexipril together with the tiny amounts of lithium present in some supplements might produce similar side effects. People taking moexipril should exercise caution when supplementing with lithium until more information is available.

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.¹⁰

Interactions with Foods and Other Compounds

Food
Taking moexipril with food dramatically reduces the absorption of the drug, especially when taken with a high-fat meal.¹¹ Therefore, moexipril should be taken an hour before or two hours after a meal.

Low-salt diet
Taking moexipril while on a low-salt diet might cause excessively low blood pressure.¹² Therefore, people taking moexipril should notify their healthcare practitioner before starting a low-salt diet.

References

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

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

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

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

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

6. 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.

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

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

9. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2871–3.

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

11. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2871–3.

12. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2871–3.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires July 2004.