ACE inhibitors (ramipril, perindopril, lisinopril)
Altace, Tritace, Coversyl, Aceon, Zestril, Prinivil, Prestarium, Coversum
Forms: Other ACE inhibitors (enalapril, captopril and others) share the same risks. Also sold combined with diuretics (banned by WADA) or amlodipine. Never combined with sacubitril/valsartan (Entresto): risk of angioedema.
Angiotensin-converting enzyme inhibitors for high blood pressure, heart failure, heart-attack prevention and kidney disease. Prescription drugs — only under a doctor's supervision.
Legal status: Prescription medicines in most countries; not on the WADA Prohibited List (combinations with a diuretic are). Status varies by country.
What it gives
What people use it for and what the sources report. Strength is a general category from the literature: mild, clear or strong.
Purpose
A doctor may consider one when readings show high blood pressure, or when tests show heart damage linked to steroids; seized in doping cases, with users admitting self-treatment. Medical use: hypertension, heart failure, coronary disease, kidney disease.
What people seek and what studies show
Used to lower blood pressure and treat heart failure. In 9,297 high-risk patients, ramipril cut heart attacks, strokes and cardiovascular deaths from 17.8% to 14.0%; in stable coronary disease perindopril cut cardiovascular death, heart attack and cardiac arrest by 20%. In case reports, steroid users with heart failure improved after stopping steroids and starting standard therapy (in one case including lisinopril).
Effects
Evidence: Approved medicine — studied in people for its medical use
Sought effects by goal (as reported)
Possible side effects
Possible does not mean certain: whether they appear depends on dose, duration, individual response and monitoring. Below — what to watch for and how to notice it early.
1 possible side effect
level · how often it is reportedWhat the levels mean
Level: general category from the literature, not your personal risk
How often
- common
- reported often
- possible
- reported in some people
- rare
- reported occasionally
How to lower the risks
For 1 of 1 possible side effect there are specific ways to lower the chance: everyday measures, supplements and options a doctor may consider. No measure removes a risk completely.
Limit caffeine and other stimulants; with palpitations, stop the suspected drug and get an ECG. Don't add potassium on your own (supplements, Asparkam/Panangin, salt substitutes): it is dangerous with spironolactone, ARBs/ACE inhibitors or kidney problems; a blood test shows the level.
How each option helps (1)
- Heart screening: ECG and echocardiogram — An ECG reveals arrhythmias, conduction problems and QT changes — important with stimulants, clenbuterol, thyroid hormone or diuretics.
Check-ups and blood tests
Which tests and check-ups to do and when. This is a guide — agree the exact schedule with your doctor.
Which doctors can help
Get medical help at once if
- Racing or irregular heartbeat that does not settle at rest, dizziness, fainting, chest pain — call emergency services.
In an emergency, call your local emergency number.
For women
Contraindicated in pregnancy: they can injure and kill the developing fetus. Women who could become pregnant need reliable contraception and a doctor's oversight; not advised while breastfeeding.
Myth & fact
“ACE inhibitors like perindopril help build muscle and performance.”
In a randomized trial in 145 older people with low muscle mass, perindopril improved neither physical performance nor muscle mass; a meta-analysis of similar trials found no benefit either.
Combinations
Tadalafil lowers blood pressure a little, and so do these drugs; the effects add up. With dehydration, heat or alcohol this can mean dizziness or fainting, especially when standing up quickly.
TadalafilFurosemideHydrochlorothiazideSpironolactoneTelmisartanNebivololLosartan / valsartan (angiotensin receptor blockers)AmlodipineBisoprololCarvedilolSpironolactone keeps potassium in the body, and ACE inhibitors and sartans do so too. Together, especially with dehydration, NSAID painkillers or weaker kidneys, potassium can climb high enough to stop the heart, usually without symptoms until a blood test shows it. Spironolactone also removes water, and when the body is short of fluid these drugs can lower kidney filtering, up to acute kidney injury.
SpironolactoneLosartan / valsartan (angiotensin receptor blockers)ACE inhibitors and sartans raise blood potassium a little. With healthy kidneys this is rarely a problem, but potassium from electrolyte mixes or salt substitutes adds to it, more so with dehydration or NSAIDs; a potassium test shows where it stands.
Electrolyte mix (sodium, potassium, magnesium)Losartan / valsartan (angiotensin receptor blockers)Sources
Possible side effects by body system, combinations, how to lower the risks and which tests to do — free.
Open the stack check