From the Research
Angiotensin-Converting Enzyme inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs) can potentially reduce zinc levels in the body, and patients on long-term therapy with these medications should consider monitoring their zinc status and may benefit from a zinc supplement of 15-30 mg elemental zinc daily. The medications in the ACEi class, such as lisinopril, enalapril, and ramipril, and common ARBs, including losartan, valsartan, and olmesartan, may lead to increased urinary zinc excretion and decreased serum zinc concentrations over time 1, 2. The zinc-depleting effect of ACEi occurs because ACE is a zinc-dependent enzyme, and ACEi drugs can bind to zinc ions and increase their elimination 3. For ARBs, the mechanism may be related to their effects on renal function and mineral handling 1. Some studies suggest that treating heart failure patients with ACE inhibitors may result in zinc deficiency, with higher urine zinc levels and lower concentrations of zinc in serum in heart failure patients compared to matched controls 2. Additionally, zinc deficiency caused by chronic ACE inhibitor usage may exacerbate the pathogenicity of COVID-19 in susceptible patients 4. It is essential for patients on long-term therapy with these medications to be aware of the potential for zinc deficiency and to discuss zinc supplementation with their healthcare provider to avoid potential interactions or excessive supplementation. Key points to consider include:
- Monitoring zinc status in patients on long-term ACEi or ARB therapy
- Considering zinc supplementation of 15-30 mg elemental zinc daily
- Being aware of the potential for zinc deficiency in patients with heart failure or COVID-19
- Discussing zinc supplementation with a healthcare provider to avoid potential interactions or excessive supplementation 1, 4, 2, 3.