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ACE inhibitors and ARBs: what to be careful with
These medicines relax blood vessels by blocking the renin-angiotensin system, and are used for high blood pressure, heart failure and kidney protection.
General information only, and not exhaustive. This is not medical advice, not a full list of interactions, and not a reason to start, stop or change a medicine. Interactions depend on the exact drug, the dose, your other medicines and your own health — a pharmacist or doctor is the one who decides. Always read the leaflet that came with your medicine, and ask your pharmacist before adding anything, including supplements.
Group, not a brandATC C09
Examples in this group: ramipril, enalapril, lisinopril, perindopril; losartan, valsartan, candesartan. Interactions usually belong to the whole group, but your own leaflet is brand-specific — always the final word.
Food and drink to be careful with
- Potassium-based salt substitutes. The most-missed one. "Low sodium" salt is usually potassium chloride, and this whole group of medicines already raises potassium. Combining them can push potassium higher than intended, which matters for heart rhythm.
- Potassium supplements and high-dose potassium. Same mechanism. Bananas and vegetables in normal amounts are not the issue; supplements and substitutes are.
- Liquorice. Real liquorice root, in quantity, raises blood pressure and lowers potassium, working against the medicine. Most sweets contain flavouring rather than enough of the root to matter, but liquorice tea and traditional preparations can.
- Grapefruit. Little effect on this group specifically, but people on blood-pressure treatment often take other medicines where it matters more.
Timing around meals
Once a day is usual. The first dose can cause dizziness, so it is often taken at bedtime. Food is not generally required, although some products in the group are absorbed slightly differently with a meal.
Alcohol
Alcohol lowers blood pressure acutely and adds to dizziness and light-headedness, particularly when standing up. Over the longer run, regular heavy drinking raises blood pressure and works against the treatment.
Other things to watch
- A dry, persistent cough is a well-known effect of ACE inhibitors and a common reason for switching to an ARB.
- NSAIDs blunt the blood-pressure effect and, together with a diuretic, strain the kidneys during dehydration.
- These medicines are not used in pregnancy, which is a conversation to have in advance.
If anything here does not match what you were told, or you notice a new symptom after starting a medicine, contact your pharmacist or doctor — do not just stop taking it. Stopping some medicines suddenly is more dangerous than any food interaction.
Source: The product's own Summary of Product Characteristics and patient information leaflet, published per medicine by the licensing authority. The potassium warning appears in ACE inhibitor and ARB product information. · checked 2026-09-02
Frequently asked questions
What should I avoid with ace inhibitors and arbs?
Potassium-based salt substitutes is the one people ask about most: The most-missed one. "Low sodium" salt is usually potassium chloride, and this whole group of medicines already raises potassium. Combining them can push potassium higher than intended, which matters for heart rhythm. This is general information — your leaflet and pharmacist have the specifics.
Can I drink alcohol with ace inhibitors and arbs?
Alcohol lowers blood pressure acutely and adds to dizziness and light-headedness, particularly when standing up. Over the longer run, regular heavy drinking raises blood pressure and works against the treatment.
Should ace inhibitors and arbs be taken with food?
Once a day is usual. The first dose can cause dizziness, so it is often taken at bedtime. Food is not generally required, although some products in the group are absorbed slightly differently with a meal.
Other medicine groups
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Metformin
Metformin lowers blood glucose mainly by reducing the amount of glucose the liver releases, and is usually the first medicine used in type 2 diabetes.
Levothyroxine
Levothyroxine replaces the thyroid hormone the body is not making enough of, in an underactive thyroid.
Warfarin
Warfarin thins the blood by blocking the vitamin K-dependent clotting factors, and is used to prevent and treat blood clots.
DOACs (direct oral anticoagulants)
DOACs thin the blood by directly blocking a single clotting factor, and are used to prevent stroke in atrial fibrillation and to treat and prevent venous clots.
SSRIs and SNRIs
These antidepressants raise the availability of serotonin (and for SNRIs also noradrenaline) in the brain, and are used for depression and several anxiety conditions.
All medicine groups · Alcohol units and clearance · Blood test reference ranges
Track meals and symptoms alongside your medicines
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