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| Cardiovascular Medications |
| Angiotensin-Converting Enzyme (ACE) Inhibitors |
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| Depletions |
| Zinc |
| Mechanism |
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The ACE inhibitors benazepril, captopril, and enalapril significantly reduce serum zinc levels and increase urinary zinc excretion (Golik et al. 1998; Peczkowska. 1996). The effect is more pronounced with captopril; depletion of zinc from red blood cells occurs after three months of use (Golik et al. 1990). Hypertensive patients treated with captopril or enalapril may be at risk for zinc deficiency (Golik et al. 1998). Although it has not yet been reported, zinc loss could theoretically occur with fosinopril, lisinopril, quinapril, and ramipril. |
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| Significance of Depletion |
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Clinically, signs and symptoms of zinc deficiency include alopecia, dermatitis, diarrhea, growth retardation, increased susceptibility to infection, and loss of appetite or sense of taste (Ames 2000; Falchuk 1998). Severe zinc deficiency further impacts dermatologic, gastrointestinal, immune, nervous, reproductive, respiratory, and skeletal systems (Ames 2000; Hambidge 2000). |
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| Replacement Therapy |
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Doses of zinc up to 50 mg/day may be recommended (Hambidge 2000). This upper limit includes an adult's total daily intake, which may be higher than anticipated because of the increasing trend to fortify foods with zinc. It is important to be mindful of this limit, even if decisions are deliberately made to temporarily exceed this level for anticipated pharmacological benefits. |
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| Editorial Note |
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This information is intended to serve as a concise reference for healthcare professionals to identify substances that may be depleted by many commonly prescribed medications. Depletion of these substances depends upon a number of factors including medical history, lifestyle, dietary habits, and duration of treatment with a particular medication. The signs and symptoms associated with deficiency may be nonspecific and could be indicative of clinical conditions other than deficiency. The material presented in these monographs should not in any event be construed as specific instructions for individual patients. |
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| References |
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Ames BN. Micronutrient deficiencies: A major cause of DNA damage. Ann NY Acad Sci. 2000;889:87-106. Falchuk KH. Disturbances in Trace Elements. In: Fauci A, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill Companies Health Professional Division; 1998:490-491. Hambidge M. Human zinc deficiency. J Nutr. 2000;130(5S Suppl):1344S-1349S. Golik A, Modai D, Averbukh Z, et al. Zinc metabolism in patients treated with captopril versus enalapril. Metab. 1990;39(7):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(1):75-78. Peczkowska M. [Influence of angiotensin I converting enzyme inhibitors on selected parameters of zinc metabolism]. Pol Arch Med Wewn. 1996;96(1):32-38. |
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Copyright © 2000 Integrative Medicine Communications This publication contains information relating to general principles of medical care that should not in any event be construed as specific instructions for individual patients. The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. The reader is advised to check product information (including package inserts) for changes and new information regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein. |
