If you take lisinopril, ramipril, or enalapril for high blood pressure, a handful of everyday foods can nudge your blood potassium into a range that unsettles the heart. Drugs in this family, called ACE inhibitors, are among the most prescribed medicines in the country, and part of how they work makes it harder for the kidneys to flush extra potassium away.
Lisinopril alone was the fifth most prescribed drug in the United States in 2024, filling roughly 66.7 million prescriptions for about 16.9 million patients, according to the ClinCalc DrugStats Database.
Why potassium matters on these pills
ACE inhibitors block the renin-angiotensin-aldosterone hormone system. Because aldosterone normally tells the kidneys to swap sodium for potassium, dampening it means potassium builds up more easily, the StatPearls clinical reference from the National Library of Medicine explains. In someone with healthy kidneys and a normal diet, the effect is small. Add extra potassium at every meal and levels can rise into a range that disturbs the heart's rhythm, a condition doctors call hyperkalemia.
Foods and products to watch
The single biggest hazard sits on the shelf next to the salt. Most salt substitutes labeled "lite salt," "no salt," or "heart salt" swap sodium for potassium chloride, and a single teaspoon can hold well over 2,000 milligrams of potassium, more than half of what many adults need in a whole day.
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Everyday high-potassium foods matter too. The usual list includes bananas, oranges, potatoes, tomato sauce, spinach, avocados, beans, and dried fruit like apricots and raisins. For most people on an ACE inhibitor with normal kidney function, these foods are fine in ordinary servings, but the load adds up quickly if several sit on the same plate.
A review in the Cleveland Clinic Journal of Medicine warns that risk climbs sharply when ACE inhibitors are combined with potassium-sparing diuretics such as spironolactone, with potassium supplements, or with common painkillers in the NSAID family like ibuprofen and naproxen.
The special problem with black licorice
Black licorice looks like a candy question but the FDA treats it as a heart question. The agency states that "if you're 40 or older, eating 2 ounces of black licorice a day for at least two weeks could land you in the hospital with an irregular heart rhythm or arrhythmia," as reported in the FDA consumer update on the candy.
The culprit is glycyrrhizin, a sweet compound in licorice root that mimics the hormone aldosterone. It raises blood pressure, working against the very drug you take to lower it, and it can drop potassium in ways that trigger palpitations. Cleveland Clinic dietitian Katherine Patton tells readers to "stop eating it if you think you notice any type of irregular heartbeats." Anise-flavored candy that only tastes like licorice does not contain glycyrrhizin and is not the same concern.
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Who needs to be extra careful
Risk is highest for people with reduced kidney function, diabetes, or heart failure, and for anyone taking more than one medication that affects potassium. The Cleveland Clinic Journal of Medicine review notes that older adults are more vulnerable because kidney function tends to slip with age, and it recommends checking blood potassium one to two weeks after starting an ACE inhibitor and then a few times a year.
Symptoms of high potassium are easy to miss. Muscle weakness, a slow or fluttering pulse, tingling in the hands or lips, and mental fog can all be signs, and severe cases can cause dangerous heart rhythms.
Do not stop your medication or overhaul your diet on your own. Talk to your prescriber before switching to a salt substitute, adding a potassium supplement, or making a big change to how much fruit, produce, or licorice ends up on your plate.
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This article is made and published by Jesper Bengtson, who may have used AI in the preparation.