Zestril interactions: Alcohol, medications, and other factors

Zestril interactions with other medications  

Before you start treatment with Zestril, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Zestril interacts with supplements, herbs, or vitamins, see the “Zestril and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Zestril. Keep in mind that this table doesn’t include all drugs that may interact with Zestril. Some of these interactions are described in detail just below in “Drug interactions in depth.”

When to avoid Zestril

In some cases, factors or conditions could prevent your doctor from prescribing Zestril due to the risk of harm. These are known as contraindications. The contraindications of Zestril include:

Having a history of angioedema

Doctors typically will not prescribe Zestril for people with a history of the following:

• hereditary (genetic) angioedema
• angioedema that is idiopathic (due to an unknown cause)
• angioedema due to a type of drug called an angiotensin converting enzyme (ACE) inhibitor

Angioedema is sudden swelling, typically affecting the face, throat, or limbs. It’s usually caused by an allergic reaction. ACE inhibitor drugs, such as Zestril, can cause this type of allergic reaction.

People with a history of angioedema may have a higher risk of experiencing angioedema when taking Zestril.

If you have a history of angioedema, talk with your doctor before taking Zestril. They’ll likely prescribe an alternative treatment for your condition.

Taking a neprilysin inhibitor

Doctors typically will not prescribe Zestril in combination with a type of drug called a neprilysin inhibitor. An example is the heart failure drug sacubitril/valsartan (Entresto).

Taking Zestril with a neprilysin inhibitor can increase your risk of angioedema.

Before you start treatment with Zestril, it’s important to tell your doctor if you take a neprilysin inhibitor. They’ll likely have you stop taking the neprilysin inhibitor and wait at least 36 hours before starting treatment with Zestril.

Likewise, after you stop taking Zestril, your doctor will typically have you wait at least 36 hours before starting treatment with a neprilysin inhibitor.

Having diabetes and taking aliskiren

If you have diabetes, doctors typically will not prescribe Zestril in combination with a drug called aliskiren (Tekturna).

This is because people with diabetes have a higher risk of kidney problems, low blood pressure, and high potassium levels if they take Zestril with aliskiren. When potassium levels in your blood are too high, there’s an increased risk of certain heart problems, including arrhythmias (irregular heart rhythms) and heart attacks. (Zestril is prescribed for high blood pressure and certain heart conditions.)

If you have diabetes and take aliskiren, talk with your doctor before taking Zestril. They’ll likely prescribe a treatment other than Zestril for your condition. Or they may have you stop taking aliskiren before starting treatment with Zestril.

Are pregnant or may become pregnant

Doctors typically will not prescribe Zestril if you’re pregnant. They’re also unlikely to prescribe the drug if you’re able to become pregnant and are not using effective birth control.

This is because Zestril may not be safe to take during pregnancy. In fact, the drug has a boxed warning about the risk of fetal harm. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see the “Boxed warning” note at the beginning of this article.

Your doctor can recommend a different treatment for high blood pressure or a heart condition that’s safe for use in pregnancy. If you’re able to become pregnant, your doctor can advise you on birth control options to use while taking Zestril.

Having had an allergic reaction to Zestril or any of its ingredients

Your doctor will likely not prescribe Zestril if you have had a past allergic reaction to:

• Zestril
• any of the drug’s ingredients
• other drugs in the same class as Zestril (ACE inhibitors)

Taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Note: Before you start treatment with Zestril, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Zestril.

Zestril interaction with alcohol

There aren’t any known interactions between Zestril and alcohol. However, your doctor may advise you to avoid or limit alcohol consumption during Zestril treatment.

This is because drinking alcohol while taking the drug may worsen some of Zestril side effects. For example, you may experience:

• headache
• dizziness
• fatigue
• diarrhea
• blurry vision
• flushing

If you consume alcohol during Zestril treatment, these side effects may be more likely to occur.

Drinking large amounts of alcohol can also lead to dehydration, which can raise your risk of low blood pressure and kidney problems with Zestril.

If you have questions about drinking alcohol while taking Zestril, talk with your doctor.

Drug interactions in depth

Here’s a closer look at certain drug interactions of Zestril.

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and reduce inflammation (swelling). Some of these drugs are available over the counter without a prescription.

Interaction result: Taking Zestril with an NSAID can cause kidney problems. It can also make Zestril less effective.

Interaction explained: Zestril and NSAIDs can both cause kidney problems. Taking these drugs together can raise your risk of this side effect. NSAIDs can also increase your blood pressure. Zestril is prescribed to lower blood pressure, but it may be less effective if you take it with an NSAID.

Examples of NSAIDs: Here are some NSAIDs that may interact with Zestril:

• aspirin
• celecoxib (Celebrex)
• ibuprofen (Advil, Motrin)
• naproxen (Aleve, Naprosyn)

If you already have kidney problems or are older than 65 years, you may have a higher risk of kidney problems if you take Zestril with an NSAID. You may also have a higher risk if you become dehydrated when taking these drugs together.

Steps you or your doctor may take: While taking Zestril, you should avoid taking NSAIDs unless they have been recommended by your doctor.

If your doctor prescribes Zestril with an NSAID, they’ll likely monitor your kidney function and blood pressure closely. If you take these drugs together, be sure to drink enough nonalcoholic fluids to avoid becoming dehydrated. Talk with your doctor about how much water you should drink each day.

If you have questions about taking Zestril with an NSAID, talk with your doctor or pharmacist.

Diuretics

Diuretics are prescribed to treat high blood pressure, edema (fluid buildup), and heart failure. They are sometimes called water pills.

Interaction result: Taking Zestril with a diuretic can sometimes cause low blood pressure or kidney problems. Taking Zestril with a type of diuretic called a potassium-sparing diuretic can also cause high potassium levels.

Interaction explained: Zestril and diuretics both lower your blood pressure. So taking them together could lower your blood pressure too much. Diuretics can also lower the level of fluid in your blood, which can raise your risk of kidney problems with Zestril.

Potassium-sparing diuretics can also increase your potassium levels. Zestril can also cause this side effect. Taking Zestril with this type of diuretic can lead to high potassium levels, especially if you have kidney problems or are age 65 years or older.

Examples of diuretic drugs: Here are some diuretics that may interact with Zestril:

• furosemide (Lasix)
• hydrochlorothiazide

Here are some potassium-sparing diuretics that may interact with Zestril:

• amiloride (Midamor)
• eplerenone (Inspra)
• spironolactone (Aldactone)
• triamterene (Dyrenium)

Steps you or your doctor may take: If your doctor prescribes Zestril with a diuretic, they’ll closely monitor your blood pressure and kidney function. Tell your doctor if you feel dizzy or lightheaded while taking these medications together. This could be a sign that your blood pressure is too low. If you have low blood pressure, your doctor may lower your dosage of one or both medications.

If you take these drugs together, be sure to drink enough nonalcoholic fluids to avoid becoming dehydrated. Talk with your doctor about how much water you should drink each day.

If your doctor prescribes Zestril with a potassium-sparing diuretic, they’ll also closely monitor your potassium levels. If your potassium level gets too high, your doctor may lower your dosage of one or both medications.

If you have questions about taking Zestril with a diuretic, talk with your doctor or pharmacist. For information about typically recommended Zestril dosages, see this article.

Diabetes medications

Diabetes medications help manage blood sugar levels in people with diabetes.

Interaction result: Taking Zestril with diabetes medications may raise your risk of hypoglycemia (low blood sugar levels).

Interaction explained: Zestril can increase the blood sugar-lowering effect of diabetes medications.

Examples of diabetes medications: Here are some diabetes medications that may interact with Zestril:

• insulins, such as:
  • insulin aspart (Novolog)
  • insulin glargine (Lantus)
  • insulin lispro (Humalog)
• oral diabetes medications, such as:
  • glimepiride (Amaryl)
  • glipizide (Glucotrol XL)
  • metformin (Fortamet, Glumetza)

Steps you or your doctor may take: If your doctor prescribes Zestril with diabetes medications, they may want you to check your blood sugar levels more frequently. Talk with your doctor about how often your blood sugar should be checked. Also talk with them about how to recognize and treat the symptoms of hypoglycemia.

If you have questions about taking Zestril with diabetes medications, talk with your doctor or pharmacist.

Zestril and other interactions

Zestril may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Zestril.

Zestril interactions with supplements

Before you start treatment with Zestril, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

Taking Zestril with potassium supplements can cause high potassium levels. You should only take Zestril with potassium supplements if this is recommended by your doctor.

Taking Zestril with coenzyme Q10 (CoQ10) supplements can cause low blood pressure. Talk with your doctor before taking Zestril with CoQ10.

If you have questions about these or other supplement interactions that may affect you, ask your doctor or pharmacist.

Zestril and herbs

There are no specific reports of herbs interacting with Zestril. However, that doesn’t mean herbal interactions won’t occur or be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during Zestril treatment.

Zestril and vitamins

There are no specific reports of vitamins interacting with Zestril. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Zestril.

Zestril interactions with food

Zestril can interact with salt substitutes that contain potassium. Taking Zestril with these salt substitutes can cause high potassium levels.

You should avoid using potassium-containing salt substitutes while taking Zestril, unless they are recommended by your doctor.

If you have additional questions or want more information about eating certain foods during Zestril treatment, talk with your doctor. You can also read about foods that can help lower blood pressure.

Zestril and vaccines

There aren’t any known interactions between Zestril and vaccines. Talk to your doctor or pharmacist to see whether you’re due for any vaccines.

Zestril and lab tests

Zestril isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk to your doctor.

ZESTRIL INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Zestril. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Zestril. The impact of cannabis may affect how well you stick to your Zestril treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Zestril and health-related interactions

Certain medical conditions and other factors may increase the risk of interactions with Zestril. Before you take this drug, be sure to talk with your doctor about your health history. Zestril may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Zestril include:

• Kidney problems: Your kidneys clear Zestril from your system. If you have a kidney problem, the drug can build up in your body. This can raise your risk of side effects from the medication, especially low blood pressure and high potassium levels. Zestril could also worsen your kidney problem. Due to these risks, your doctor may prescribe a dosage of Zestril that’s lower than typically recommended.
• Dialysis: Zestril can cause angioedema in some people. If you’re receiving a certain type of dialysis, you may have a raised risk of this side effect. You may also have a raised risk of low blood pressure with Zestril. Talk with your doctor about whether the drug is safe for you.
• Immunotherapy with hymenoptera venom: If you’re receiving immunotherapy with venom from hymenoptera (a group of insects that includes bees and wasps), you may have a raised risk of angioedema with Zestril. (Immunotherapy is used to desensitize a person to a particular allergy). Talk with your doctor about whether Zestril is safe for you.
• Diabetes: Zestril can sometimes cause high potassium levels and kidney problems. If you have diabetes, you may have a higher risk of these side effects. As well, if you take diabetes medications, you may have a raised risk of hypoglycemia if you take Zestril with your diabetes medication. Your doctor will explain what monitoring you will need while taking Zestril. For more information, see “Diabetes medications” in the “Drug interactions in depth” section.
• Heart disease: If you have heart disease, you may have an increased risk of developing low blood pressure and kidney problems from Zestril treatment. Your doctor will likely monitor your blood pressure and kidney function closely after you start taking the drug and after any dose increases.
• Dehydration: Being dehydrated while taking Zestril can raise your risk of low blood pressure and kidney problems. Excessive sweating, diarrhea, and vomiting can lead to dehydration. If you experience these issues, be sure to drink enough fluids to prevent dehydration.
• Low sodium levels: If you have low sodium levels and take Zestril, you may have a raised risk of low blood pressure. Your doctor will likely monitor your blood pressure closely after you start taking Zestril and after any dose increases. They may also prescribe medication to increase your sodium levels.
• Allergic reaction: If you’ve had an allergic reaction to Zestril, any of its ingredients, or similar drugs (ACE inhibitors), your doctor will likely not prescribe Zestril. For more information, see the section “When to avoid Zestril.”
• Angioedema: If you have a history of hereditary or idiopathic angioedema, your doctor will likely not prescribe Zestril. For details, see the “When to avoid Zestril” section.
• Pregnancy: If you’re pregnant or planning a pregnancy, your doctor will likely not prescribe Zestril. The drug has a boxed warning about the risk of fetal harm if taken during pregnancy. For more information, see the boxed warning at the start of this article.
• Breastfeeding: It’s not known whether it’s safe to take Zestril while breastfeeding. There isn’t enough information to determine whether the drug passes into breast milk or what effects Zestril may have on a child who is breastfed. Your doctor will likely recommend that you do not breastfeed while taking Zestril. If you’re breastfeeding or planning to, talk with your doctor before taking Zestril. They can advise you about treatment options and ways to feed your child.
• Upcoming surgery: You may have a raised risk of low blood pressure during any surgery you have while receiving treatment with Zestril. Talk with your doctor about whether you should stop taking the drug before a planned surgery.

Preventing interactions

You can take certain steps to help prevent interactions with Zestril. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Zestril label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Zestril doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Zestril by taking it exactly as your doctor prescribes.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.