Depletions

The use of captopril, fosinopril, or ramipril may cause depletion of sodium. Trandolapril may deplete sodium and calcium.

Calcium

Calcium, along with vitamin D, keeps your bones strong and healthy.

Low levels of calcium may cause:

• Muscle cramps
• Numbness or tingling in toes and feet
• Irregular heartbeat
• Depression
• Bone pain
• Spinal problems
• Seizures

Sodium deficiency is rare because it is widely available in dietary sources. When it does occur, low levels have been associated with:

• Weakness
• Nausea and vomiting
• Headache
• Confusion
• Memory impairment
• Reduced attention
• Muscle cramps
• Strong, rapid or irregular heartbeat
• Lack of energy
• Restlessness

Severe cases can cause seizures, loss of consciousness, and possibly coma. The development of symptoms depends on how fast you lose sodium.

Editorial Note

The information presented here covers some of the nutrients that may be affected when you take certain medicines. If you have any of these signs and symptoms, it does not always mean you have low levels of these nutrients.

Factors that affect the level of nutrients are:

• Your medical history
• Diet
• Lifestyle
• How long you have been taking the medicine

Please talk to your health care provider. They can best address your health care needs and see if you are at risk for low levels of any nutrients.

Supporting Research

Braun LA, Rosenfeldt F. Pharmaco-nutrient interactions - a systemic review of zinc and antihypertensive therapy. Int J Clin Pract. 2013;67(8):717-725. PMID: 23279674 www.ncbi.nlm.nih.gov/pubmed/23279674.

Dineen R, Hannon MJ, Thompson CJ. Hyponatremia and hypernatremia. In: Jameson JL, De Groot LJ, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 112.

Gold Standard Drug Database. Drug Monograph: Captopril; Hydrochlorothiazide, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-939. Accessed July 13, 2016.

Gold Standard Drug Database. Drug Monograph: Enalapril; Hydrochlorothiazide, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-1030. Accessed July 13, 2016.

Gold Standard Drug Database. Drug Monograph: Hydrochlorothiazide; Lisinopril, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-1079. Accessed July 13, 2016.

Gold Standard Drug Database. Drug Monograph: Hydrochlorothiazide; Moexipril, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-2264. Accessed July 13, 2016.

Gold Standard Drug Database. Drug Monograph: Hydrochlorothiazide; Quinapril, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-2501. Accessed July 13, 2016.

Pfennig CL, Slovis CM. Electrolyte disorders. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 125.

Smogorzewski MJ, Stubbs JR, Yu ASL. Disorders of calcium, magnesium, and phosphate balance. In: Skorecki K, Chertow GM, Marsden PA, Yu ASL, Taal MW, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier; 2016:chap 19.

van Orten-Luiten AC, Janse A, Dhonukshe-Rutten RA, Witkamp RF. The association between drugs frequently used by the elderly and vitamin D blood levels: a review of observational and experimental studies. Drugs Aging. 2014;31(2):111-123. PMID: 24385337 www.ncbi.nlm.nih.gov/pubmed/24385337.

Weir MR, Hanes DS, Klassen DK, Wasser WG. Antihypertensive therapy. In: Skorecki K, Chertow GM, Marsden PA, Yu ASL, Taal MW, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier; 2016:chap 50.