Interactions with other drugs | ACE inhibitors

Interactions with other drugs

The blood pressure-lowering effect of ACE inhibitors can be enhanced by simultaneous treatment with other blood pressure medications. This can be very positive for the treatment of high blood pressure, as the combined administration of additional drugs can achieve an effective and lasting reduction in blood pressure. Potassium-sparing diureticsThe increased reabsorption of potassium, also by the ACE inhibitors in the kidney, can cause the potassium level in the blood to rise dangerously.

Insulin / oral antidiabeticsThe effect of antihypertensive drugs can be enhanced. Cytostatics, immunosuppressives, glucocorticoidsAre all drugs that influence or suppress the immune system and thus strongly alter the blood count; this blood-image-altering effect can be intensified in combination with ACE inhibitors. It is advised not to consume alcohol during treatment with ACE inhibitors.

The main reason for this is the unpredictable effects on blood pressure and their consequences. A distinction must be made between the short-term and long-term effects of alcohol on blood pressure. In the short term, alcohol can lead to a dilation of the blood vessels.

This may cause a drop in blood pressure. ACE inhibitors also lower blood pressure. When these blood pressure-lowering effects add up, this can lead to mild to severe circulatory problems.

Long-term alcohol consumption can contribute to an increase in blood pressure. Individual factors play a role in whether and to what extent this happens. If additional smoking or psychological stress and annoyance are present, the increase in blood pressure can be further intensified by alcohol consumption.

Often the blood pressure-increasing effects are permanently stronger than the blood pressure-lowering effects of alcohol. Thus, drinking alcohol would reduce the effects of ACE inhibitors or, if necessary, render them largely ineffective. This could have fatal consequences. The risk of diseases associated with high blood pressure would increase enormously. This means that the risk of diseases from which the ACE inhibitor is supposed to protect, such as strokes and heart attacks, would increase.


Pregnancy and lactation are contraindications for the use of ACE inhibitors. Contraindications are circumstances that prohibit the use of the drug. – Patients with a narrowing of the renal artery (renal artery stenosis)

  • Patients with only one kidney
  • Those with liver dysfunction or
  • A narrowing of the aorta (aortic stenosis) must not take ACE inhibitors. – Nor should this group of drugs be used if there is a reduced volume in the vascular system or an increase in potassium in the blood before starting treatment.


ACE inhibitors are used in the treatment of high blood pressure, cardiac dysfunction, after a heart attack and in diabetics with kidney disease (diabetic nephropathy) and here they reduce the mortality of patients. The regression of structural changes in the heart after an infarction and in diabetic nephropathy can be achieved by ACE inhibitors and thus improve the health prognosis of those affected. The procedure for discontinuing ACE inhibitors is controversially discussed.

Some authors report that, for example, ramipril, a substance from the group of ACE inhibitors, does not cause an increase in blood pressure when discontinued. They report that the so-called rebound phenomenon would not occur with this substance. Therefore, discontinuing the drug in consultation with the physician would be problem-free.

Gradual discontinuation would therefore not be necessary. Other authors strongly advise against abruptly discontinuing the ACE inhibitors. According to these voices, a change to another blood pressure-lowering drug could sometimes be useful.

But sudden discontinuation increases the risk of complications that could be fatal. Nevertheless, patients often discontinue the medication on their own. This is usually due to insufficient information and/or understanding.

Patients are often symptom-free before taking ACE inhibitors. If they then take the medication, this can lead to complaints such as dizziness. This has to do with the fact that the body has become accustomed to high blood pressure.

A (sudden) drop causes symptoms. It is therefore only natural that this stimulates the body to stop taking the medication. However, it should be noted that permanently high blood pressure levels increase the risk of diseases such as stroke and heart attack.

As a rule of thumb, it is stated that a blood pressure increase of 10 mmHg costs 10 years of life. This means that even a permanent increase in blood pressure without symptoms can shorten life. If a reduction in blood pressure can be achieved with ACE inhibitors, it does not mean that these values will remain the same when weaning.

In most cases, discontinuing the antihypertensive drugs would result in a return to high blood pressure. However, this also depends on the cause of the elevated blood pressure. It is advisable to consult the doctor in charge. In most cases, an individually targeted, adequately creeping and, if necessary, balancing therapy with ACE inhibitors seems to be effective.