Drug & supplement interaction

Apple Cider Vinegar + Hydrochlorothiazide

Hydrochlorothiazide brand names: Esidrix, Hydro, Microzide, HydroDiuril, Hydro-D, and others.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Apple Cider Vinegar has a moderate interaction with Hydrochlorothiazide. Theoretically, concomitant use of apple cider vinegar with diuretic drugs might increase the risk of hypokalemia.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Apple Cider Vinegar and Hydrochlorothiazide

Here is the interaction we found between these two, with the evidence behind it.

Moderate

DIURETIC DRUGS

Why this applies to Hydrochlorothiazide

Hydrochlorothiazide falls under DIURETIC DRUGS — the group Apple Cider Vinegar interacts with.

Theoretically, concomitant use of apple cider vinegar with diuretic drugs might increase the risk of hypokalemia.
A case of hypokalemia related to chronic use of apple cider vinegar has been reported. There is some concern that people taking apple cider vinegar along with potassium depleting diuretics might have an increased risk for hypokalemia.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist: hydrochlorothiazide is a water pill that already lowers your potassium by flushing it out through your urine. Apple cider vinegar, taken in large or regular amounts, may also nudge potassium down. Stack the two and there's a chance your potassium dips lower than it should, which can show up as muscle cramps, weakness, tiredness, or an irregular heartbeat.

I want to be honest about the evidence here. This concern comes mostly from one reported case and theory, not strong studies, so it's a possible issue, not a guaranteed one. A splash of ACV on a salad is unlikely to matter. Daily concentrated shots or pills are where I'd pay attention. If you use ACV often, mention it to your doctor or pharmacist so your potassium can be checked.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Lhotta K, Hofle G, Gasser R, Finkenstedt G. Hypokalemia, hyperreninemia, and osteoporosis in a patient ingesting large amounts of cider vinegar. Nephron 1998;80:242-3. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Apple Cider Vinegar Also Interacts With Other Medications

Apple Cider Vinegar has 88 moderate, 73 minor known drug interactions in our database — the Hydrochlorothiazide one above is one of them. If you take anything else, check it against the full list below.

Moderate 88 Minor 73 No known interaction 2,669 (incl. Hydrochlorothiazide)
Taking anything else?

Check Another of Your Medications Against Apple Cider Vinegar

Covers the 2,830 medications we’ve checked against Apple Cider Vinegar. Pick one to open its full report.

From our Q&A

Questions About Apple Cider Vinegar or Hydrochlorothiazide

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Apple Cider Vinegar or Hydrochlorothiazide, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Hydrochlorothiazide

This page covers Apple Cider Vinegar only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Hydrochlorothiazide page lists 230 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), American Mistletoe (major), Asarabacca (major) and Dolomite (major).

By severity: 10 major · 195 moderate · 25 minor.

From our pharmacist’s overview on the Hydrochlorothiazide page

“Hydrochlorothiazide sits at the strong end of the caution scale for supplement interactions, and the small group of major-rated entries deserves a careful read before everything else on the page. Most of what appears here either adds to the pill's blood-pressure-lowering effect or piles onto its diuretic action, pushing fluid and potas…”

Reviewed by 2 · Jul 18, 2026

Open the Hydrochlorothiazide interaction page

One more smart check

Taking Apple Cider Vinegar as Part of a Dietary Supplement Product? Check It for Interactions

We hold 1,329 real supplement products containing Apple Cider Vinegar, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Apple Cider Vinegar. Your product may carry other ingredients that interact with Hydrochlorothiazide too, on top of Apple Cider Vinegar — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Apple Cider Vinegar and Hydrochlorothiazide Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Apple Cider Vinegar
Top 10%

#125 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Hydrochlorothiazide
Top 5%

#122 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Apple Cider Vinegar

What is Apple Cider Vinegar?

Apple Cider Vinegar
  • Blood sugar support
  • Weight management
  • Digestive upset
  • Appetite control
  • Skin and hair care

Apple cider vinegar is a fermented apple product that many people use hoping to help with blood sugar, weight, or digestion. The evidence for most of these uses is limited and mixed, and the modest effects seen in small studies are not a substitute for proven treatments. When diluted and used in small amounts it is generally safe for most people, but undiluted vinegar can harm teeth and the throat.

Read the full Apple Cider Vinegar monograph & all interactions
Medication

About Hydrochlorothiazide

What Is Hydrochlorothiazide Used For?

Brand names: Esidrix, Hydro, Microzide, HydroDiuril, Hydro-D, Oretic, Aquazide H, Aquazide, HCTZ

Hydrochlorothiazide treats high blood pressure (hypertension) in adults and children, either alone or combined with other blood pressure medicines. Lowering blood pressure reduces the risk of strokes and heart attacks.

It also treats edema (fluid buildup) linked to congestive heart failure, hepatic cirrhosis (liver scarring), and kidney conditions including nephrotic syndrome. Hydrochlorothiazide tablets are additionally indicated for edema caused by corticosteroid or estrogen therapy, and edema from acute glomerulonephritis or chronic renal failure. Inzirqo (the oral suspension) is specifically approved for both hypertension and edema in adult and pediatric patients.

See full Hydrochlorothiazide drug information
Keep checking

Other Drugs & Apple Cider Vinegar

Browse every other medication we’ve checked against Apple Cider Vinegar — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
88Moderate
73Minor
2,668No known interaction
88 Moderate 73 Minor 2,668 No interaction
Moderate

88 interactions

Showing 60 of 88 moderate interactions — see all 88 on the Apple Cider Vinegar page.

Minor

73 interactions

Showing 60 of 73 minor interactions — see all 73 on the Apple Cider Vinegar page.

No interaction 2,668 drugs checked — show the list

We also checked Apple Cider Vinegar against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,668 medications checked with no known interaction — see the full Apple Cider Vinegar list.

See the full Apple Cider Vinegar interactions page
See every supplement checked against Hydrochlorothiazide, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Apple Cider Vinegar monograph › Uses, safety, and every drug interaction in one place Hydrochlorothiazide supplement interactions › Every supplement checked against Hydrochlorothiazide, ranked by severity Hydrochlorothiazide drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Apple Cider Vinegar and Hydrochlorothiazide Together: Common Questions

Can you take Apple Cider Vinegar with Hydrochlorothiazide?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Apple Cider Vinegar and Hydrochlorothiazide interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Hydrochlorothiazide and Apple Cider Vinegar?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.