NutriStack
Enalapril and Zinc, a caution.
Enalapril increases urinary zinc excretion and lowers intracellular zinc in monocytes over months of use. In a 6-month controlled study of hypertensive patients on captopril or enalapril, intramonocyte zinc fell significantly in both groups, supporting a class effect on zinc status. Symptoms of zinc deficiency include altered taste, slow wound healing, hair loss, and reduced immune function.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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What the row says.
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At a glance
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. Enalapril increases urinary zinc excretion and lowers intracellular zinc in monocytes over months of use. In a 6-month controlled study of hypertensive patients on captopril or enalapril, intramonocyte zinc fell significantly in both groups, supporting a class effect on zinc status. Symptoms of zinc deficiency include altered taste, slow wound healing, hair loss, and reduced immune function.
Mechanism. ACE inhibitors with sulfhydryl-related chelating capacity form complexes with zinc that increase its urinary excretion. Chronic use depletes intracellular zinc pools even when serum zinc looks normal.
Recommendation. If you take enalapril long term, consider a modest zinc supplement (15-30 mg/day) or a multivitamin containing zinc, especially if you notice loss of taste or recurrent infections. Take zinc with food to limit GI upset, and have your prescriber check zinc status if you suspect deficiency.
Sources (2)
- Golik A, Zaidenstein R, Dishi V, Blatt A, Cohen N, Cotter G, Berman S, Weissgarten J. Effects of captopril and enalapril on zinc metabolism in hypertensive patients. J Am Coll Nutr. 1998;17(1):75-8. PMID 9477394
- Braun LA, Rosenfeldt F. Pharmaco-nutrient interactions - a systematic review of zinc and antihypertensive therapy. Int J Clin Pract. 2013;67(8):717-25. PMID 23279674
Stack Score
How this pair moves the number.
Effect on the composite score
If both Enalapril and Zinc are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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