Can You Take Enalapril with Vitamin C?
Yes, adults with normal renal function can safely take enalapril together with vitamin C supplements without significant concern for drug interactions or adverse effects.
Evidence for Safety
The available medical literature does not identify any clinically significant drug interaction between enalapril (or other ACE inhibitors) and vitamin C supplementation 1, 2, 3.
No documented pharmacokinetic interactions: Studies examining enalapril's drug interaction profile have not identified vitamin C as causing alterations in enalapril absorption, metabolism, or elimination 1, 3.
No contraindication in guidelines: Major cardiovascular guidelines from the ACC/AHA and ESC/ESH that extensively discuss ACE inhibitor therapy do not list vitamin C as a contraindication or problematic combination 4.
Potential Beneficial Interaction
Interestingly, one clinical study suggests vitamin C may actually have a complementary effect when combined with enalapril:
Enhanced diuretic response: In patients with moderate heart failure treated with enalapril, vitamin C augmented the natriuretic effect of furosemide by counteracting oxidative stress through the renal kinin-nitric oxide pathway 5.
This suggests vitamin C does not interfere with ACE inhibitor mechanisms and may provide additive benefits in certain clinical contexts 5.
Important Caveats for Vitamin C Use
While the combination is safe, patients should be aware of general vitamin C precautions:
Kidney stone risk: Individuals with a history of kidney stone formation should exercise caution with supplemental vitamin C, as it may increase oxalate excretion 6.
Iron overload conditions: Patients with hemochromatosis or other iron overload disorders should use vitamin C cautiously, as it enhances iron absorption 6.
Gastrointestinal effects: High-dose vitamin C may occasionally cause diarrhea or mild nausea, though this is unrelated to enalapril interaction 6.
Documented ACE Inhibitor Interactions to Actually Avoid
For context, the clinically significant drug interactions with enalapril that do require attention include:
NSAIDs (ibuprofen, naproxen, indomethacin): These can attenuate the antihypertensive effects of ACE inhibitors and increase risk of renal dysfunction 4, 3.
Potassium supplements or potassium-sparing diuretics: Combining these with ACE inhibitors increases hyperkalemia risk 4, 7.
Dual RAS blockade: Simultaneous use of ACE inhibitors with ARBs or renin inhibitors is potentially harmful and not recommended 4, 7.