AT1 antagonists (Sartans)

Active substances and pharmaceuticals concernedSpecially affected active substances and pharmaceuticalsMechanism of interactionConsequences and possible symptoms of the interactionRecommended SupplementationSpecial instructions for useReferences

Active substances and pharmaceuticals concerned

Name of active substance	Trade name	Affected micronutrients
Losartan	Cosaar®,Fortzaar®	Potassium Lithium
Candesartan	Blopress®, Atacand®
Olmesartan	Olmetec®
Valsartan	Diovan®

Specially affected active substances and pharmaceuticals

Name of active substance	Trade name	Affected micronutrients
Losartan	Cosaar®	Zinc

Mechanism of interaction

Mechanism of interaction
Potassium	WARNING: Self-medication with potassium results in additive potassium retention.
Lithium	ACE inhibitors reduce renal lithium excretion.
Zinc	The administration of 50 mg losartan in combination with HCT leads to increased renal zinc loss.

Consequences and possible symptoms of the interaction

Negative consequences of the interaction		Possible symptoms
Potassium	Increase in potassium levels	Hyperkalemia Bradycardia Arrythmias Muscle weakness
Lithium	Increase in lithium levels	Neurotoxic effect (tremor) Cardiotoxic effect (arrhythmias)
Zinc	Decrease in zinc levels	Wound healing disorders, hair loss, brittle, white spotted nails Increased susceptibility to infections Concentration disorders, hyperactivity, depression

Recommended Supplementation

Medical substance	Recommended supplementation	Dosage
Losartan	Zinc	15 mg/d p.o.

Special instructions for use

Instructions for use
Potassium	Self-medication of high-dose potassium preparations (> 600 mg/d) is not recommended.

References

Braun LA et al. Pharmaco-nutrient interactions - a systematic review of zinc and antihypertensive therapy.Int J Clin Pract. 2013 Aug;67(8):717-25. doi: 10.1111/ijcp.12040. Epub 2012 Dec 26
Gröber U. Mikronährstoffe. Metabolic Tuning – Prävention – Therapie. 3. Auflage, 2011
Gröber U. Arzneimittel und Mikronährstoffe. Medikationsorientierte Supplementierung. 3. Akt. und erw. Auflage, 2014
Koren-Michowitz M et al. The effect of losartan and losartan/hydrochlorothiazide fixed-combination on magnesium, zinc, and nitric oxide metabolism in hypertensive patients: a prospective open-label study. Am J Hypertens. 2005 Mar;18(3):358-63.
Lazarczyk MJ, Giannakopoulos P. Temporal association as a prerequisite factor of valsartan-induced lithium toxicity. Bipolar Disord. 2014 Sep;16(6):662-6. doi: 10.1111/bdi.12174. Epub 2013 Dec 23.
Miyahara Y et al. A case of intraoperative hyperkalemia induced with administration of an angiotensin II receptor antagonist (AIIA) and intake of dried persimmons. Masui. 2004 May;53(5):543-6.
Saito M et al. Serum concentration of potassium in chronic heart failure patients administered spironolactone plus furosemide and either enalapril maleate, losartan potassium or candesartan cilexetil. J Clin Pharm Ther. 2005 Dec;30(6):603-10
Stargrove Mitchell Bebel, Treasure Jonathan, McKee Dwight L.: Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies. 2008