What are the recommended copper and zinc intake levels with Prednisone, Entresto (sacubitril/valsartan), Coreg (carvedilol), and Spironolactone?

Copper and Zinc Supplementation with Your Current Medications

You do not need to increase copper or zinc supplementation based on your current medication regimen (prednisone, Entresto, Coreg, and spironolactone), as these medications do not create clinically significant deficiencies requiring routine supplementation in adults.

Medication-Specific Effects on Trace Minerals

Prednisone Impact

• Prednisone at 30 mg daily causes acute decreases in plasma zinc with increased urinary zinc and copper losses, but these changes are temporary and return to baseline within 2 days of dose reduction 1
• Long-term oral corticosteroid therapy (similar to your dose) causes modest further decreases in plasma zinc only in patients with moderate inflammation, and these changes are less intense than those caused by severe inflammation itself 1
• No routine supplementation is recommended for corticosteroid-induced zinc changes in the absence of documented deficiency 1

Entresto, Coreg, and Spironolactone

• No documented interactions exist between sacubitril/valsartan (Entresto), carvedilol (Coreg), or spironolactone and zinc or copper metabolism at therapeutic doses 2
• These cardiac medications do not increase trace mineral requirements in standard clinical practice 2

Standard Adult Requirements Without Deficiency

If you were to supplement (which is not indicated), the recommended ratio would be:

• 15 mg zinc with 2 mg copper daily maintains the optimal 7.5:1 to 8:1 ratio and prevents zinc-induced copper deficiency 2, 3
• This matches standard multivitamin formulations and represents adequate intake for elderly and younger adults 3

When Supplementation Would Be Indicated

You should only supplement if:

• Documented deficiency on laboratory testing (serum zinc <70 mcg/dL or serum copper <70 mcg/dL) 2
• Chronic kidney disease requiring dialysis, where zinc and copper losses are substantial (50 mg zinc and 3 mg copper daily may be needed) 4
• High gastrointestinal fluid losses from ileostomy, severe diarrhea, or malabsorption 4

Monitoring Recommendations

Check baseline levels if you develop:

• Unexplained anemia, leukopenia, or thrombocytopenia (copper deficiency signs) 2
• Poor wound healing, skin rash, or recurrent infections (zinc deficiency signs) 4
• Neurologic symptoms including peripheral neuropathy (copper deficiency) 2

If supplementing for any reason:

• Recheck zinc and copper levels after 3 months 2
• Maintain the 8:1 to 15:1 zinc-to-copper ratio to prevent induced deficiencies 2, 5
• Take supplements 30 minutes before meals for optimal absorption 2

Critical Caveat About Your Medication Combination

• One case report documented rhabdomyolysis when Entresto was combined with atorvastatin and similar cardiac medications (carvedilol, spironolactone) 6
• While this is unrelated to trace minerals, monitor for unexplained muscle pain or weakness and report immediately to your physician 6