Drug & supplement interaction

L-arginine + Irbesartan

Irbesartan brand names: Avapro, Aprovel.

Moderate Interaction
The bottom line Moderate

Irbesartan falls into 2 drug categories that L-arginine can interact with; the most serious is rated moderate. Theoretically, concomitant use of L-arginine and antihypertensive drugs may increase the risk of hypotension.

Read the full interaction report
SeverityModerate
LikelihoodProbable
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

L-arginine and Irbesartan

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

L-arginine interacts with whole categories of medication. Irbesartan falls into 2 of those categories, so it can interact with L-arginine in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

ANTIHYPERTENSIVE DRUGS

1 of 2

Why this applies to Irbesartan

Irbesartan falls under ANTIHYPERTENSIVE DRUGS — the group L-arginine interacts with.

Theoretically, concomitant use of L-arginine and antihypertensive drugs may increase the risk of hypotension.
L-arginine increases nitric oxide, which causes vasodilation. Clinical evidence shows that L-arginine can reduce blood pressure in some individuals with hypertension. Furthermore, combining L-arginine with some antihypertensive drugs seems to have additive vasodilating and blood pressure-lowering effects.
Severity Moderate Likelihood Probable Evidence D

Interaction 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..

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

Here's the simple version: irbesartan already lowers your blood pressure by relaxing and widening your blood vessels. L-arginine works through a different route (your body turns it into nitric oxide, which also relaxes vessels), so the two can stack on top of each other. The concern is that your blood pressure could dip a bit lower than expected.

If that happens, you might feel lightheaded, dizzy, tired, or off-balance, especially when standing up quickly. I'll be honest, this is a theoretical concern based on how both work, not a strong proven danger, and many people do fine. Still, if you're considering an L-arginine supplement (not just normal protein in food), it's worth a quick chat with your pharmacist or doctor, and keep an eye on your blood pressure readings.

References
  1. Siani A, Pagano E, Iacone R, et al. Blood pressure and metabolic changes during dietary L-arginine supplementation in humans. Am J Hypertens 2000;13:547-51. PubMed
  2. Cheng JW, Balwin SN. L-arginine in the management of cardiovascular diseases. Ann Pharmacother 2001;35:755-64. PubMed
  3. Huynh NT, Tayek JA. Oral arginine reduces systemic blood pressure in type 2 diabetes: its potential role in nitric oxide generation. J Am Coll Nutr 2002;21:422-7.. PubMed
  4. Higashi Y, Oshima T, Sasaki S, et. al. Angiotensin-converting enzyme inhibition, but not calcium antagonism, improves a response of the renal vasculature to L-arginine in patients with essential hypertension. Hypertension. 1998 Jul;32(1):16-24.
  5. Komers, R., Komersova, K., Kazdova, L., Ruzickova, J., and Pelikanova, T. Effect of ACE inhibition and angiotensin AT1 receptor blockade on renal and blood pressure response to L-arginine in humans. J Hypertens. 2000;18(1):51-59. PubMed
  6. Nagaya, N., Uematsu, M., Oya, H., Sato, N., Sakamaki, F., Kyotani, S., Ueno, K., Nakanishi, N., Yamagishi, M., and Miyatake, K. Short-term oral administration of L-arginine improves hemodynamics and exercise capacity in patients with precapillary pulmona
  7. Stokes, G. S., Barin, E. S., Gilfillan, K. L., and Kaesemeyer, W. H. Interactions of L-arginine, isosorbide mononitrate, and angiotensin II inhibitors on arterial pulse wave. Am J Hypertens. 2003;16(9 Pt 1):719-724.
  8. Palloshi, A., Fragasso, G., Piatti, P., Monti, L. D., Setola, E., Valsecchi, G., Galluccio, E., Chierchia, S. L., and Margonato, A. Effect of oral L-arginine on blood pressure and symptoms and endothelial function in patients with systemic hypertension,
  9. Ast, J., Jablecka, A., Bogdanski, P., Smolarek, I., Krauss, H., and Chmara, E. Evaluation of the antihypertensive effect of L-arginine supplementation in patients with mild hypertension assessed with ambulatory blood pressure monitoring. Med.Sci.Monit. 2
  10. Dong, J. Y., Qin, L. Q., Zhang, Z., Zhao, Y., Wang, J., Arigoni, F., and Zhang, W. Effect of oral L-arginine supplementation on blood pressure: a meta-analysis of randomized, double-blind, placebo-controlled trials. Am.Heart J 2011;162(6):959-965. PubMed
  11. Dell'Omo, G., Catapano, G., Ebel, M., Gazzano, A., Ducci, M., Del, Chicca M., Clerico, A., and Pedrinelli, R. [Pressor, renal and endocrine effects of systemic infusion of L-arginine in hypertensive patients]. Ann.Ital Med.Int. 1995;10(2):107-112.
  12. Higashi, Y., Oshima, T., Ozono, R., Watanabe, M., Matsuura, H., and Kajiyama, G. Effects of L-arginine infusion on renal hemodynamics in patients with mild essential hypertension. Hypertension 1995;25(4 Pt 2):898-902.
  13. Li H, Liu Q, Zou Z, et al. L-arginine supplementation to mitigate cardiovascular effects of walking outside in the context of traffic-related air pollution in participants with elevated blood pressure: A randomized, double-blind, placebo-controlled trial. PubMed
  14. Shiraseb F, Asbaghi O, Bagheri R, Wong A, Figueroa A, Mirzaei K. The Effect of L-arginine Supplementation On Blood Pressure in Adults: A Systematic Review and Dose-response Meta-analysis of Randomized Clinical Trials. Adv Nutr 2021. PubMed
Moderate

ANGIOTENSIN RECEPTOR BLOCKERS (ARBs)

2 of 2

Irbesartan also falls under ANGIOTENSIN RECEPTOR BLOCKERS (ARBs).

Theoretically, concomitant use of L-arginine and ARBs may increase the risk of hypotension and hyperkalemia.
L-arginine increases nitric oxide, which causes vasodilation. Combining L-arginine with ARBs seems to increase L-arginine-induced vasodilation. Furthermore, ARBs can increase potassium levels. Use of L-arginine has been associated with hyperkalemia in some patients. Theoretically, concomitant use of ARBs with L-arginine may increases the risk of hyperkalemia.
Severity Moderate Likelihood Probable Evidence D

Interaction 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..

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

Here's the gist with irbesartan (Avapro) and L-arginine. Irbesartan already lowers blood pressure by relaxing your blood vessels. L-arginine works a little differently, turning into nitric oxide that also widens vessels. Stack the two and you could nudge your pressure down a bit more than expected, which might leave you feeling lightheaded, dizzy, or wobbly when you stand up quickly.

There's a second piece worth knowing. ARBs like irbesartan can raise potassium, and L-arginine has been tied to higher potassium in some people too. Together, that could push potassium up. To be honest, this is mostly a theoretical concern based on how each works, not solid proof. Still, if you want to add L-arginine, check with your pharmacist or doctor first, especially if you have kidney issues.

References
  1. Cheng JW, Balwin SN. L-arginine in the management of cardiovascular diseases. Ann Pharmacother 2001;35:755-64. PubMed
  2. Komers, R., Komersova, K., Kazdova, L., Ruzickova, J., and Pelikanova, T. Effect of ACE inhibition and angiotensin AT1 receptor blockade on renal and blood pressure response to L-arginine in humans. J Hypertens. 2000;18(1):51-59. PubMed
  3. Hertz, P. and Richardson, J. A. Arginine-induced hyperkalemia in renal failure patients. Arch.Intern.Med. 1972;130(5):778-780. DOI
  4. Bushinsky, D. A. and Gennari, F. J. Life-threatening hyperkalemia induced by arginine. Ann.Intern.Med. 1978;89(5 Pt 1):632-634. 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

L-arginine Also Interacts With Other Medications

L-arginine has 394 moderate, 8 minor known drug interactions in our database — the Irbesartan one above is among them. If you take anything else, check it against the full list below.

Taking anything else?

Check Another of Your Medications Against L-arginine

Covers the 2,830 medications we’ve checked against L-arginine. Pick one to open its full report.

From our Q&A

Questions About L-arginine or Irbesartan

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers L-arginine or Irbesartan, 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 Irbesartan

This page covers L-arginine only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Irbesartan page lists 182 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), Tyramine (major) and Adrafinil (moderate).

By severity: 4 major · 145 moderate · 33 minor.

Open the Irbesartan interaction page

One more smart check

Taking L-arginine as Part of a Dietary Supplement Product? Check It for Interactions

We hold 26 real supplement products containing L-arginine, each one broken down to its full ingredient list — and combination products often carry several ingredients besides L-arginine. Your product may carry other ingredients that interact with Irbesartan too, on top of L-arginine — 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 L-arginine and Irbesartan 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 L-arginine
Steady interest

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

29 days ago today
Medication Irbesartan
Top half

#1,374 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 L-arginine

What is L-arginine?

L-arginine
  • High blood pressure
  • Erectile dysfunction
  • Athletic performance
  • Chest pain (angina)
  • Improving blood flow

L-arginine is an amino acid that the body uses to make nitric oxide, a substance that helps blood vessels relax and widen. It is popularly used for blood pressure, erectile dysfunction, and exercise, but the evidence is mixed and stronger for some uses than others. It is generally well tolerated in healthy adults, but talk with a pharmacist or doctor before using it, especially if you have heart problems or take other medicines.

Read the full L-arginine monograph & all interactions
Medication

About Irbesartan

What Is Irbesartan Used For?

Brand names: Avapro, Aprovel

Irbesartan tablets — sold as Avapro and under the generic name Irbesartan — are used to treat high blood pressure (hypertension). Lowering blood pressure reduces the risk of serious cardiovascular events, including stroke and heart attack. The medication can be used alone or combined with other blood pressure medicines.

Irbesartan tablets are also used to treat diabetic nephropathy (kidney disease caused by diabetes) in adults who have type 2 diabetes, high blood pressure, elevated creatinine levels, and significant protein in the urine. In these patients, it slows the worsening of kidney disease.

See full Irbesartan drug information
Keep checking

Other Drugs & L-arginine

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

0Major
394Moderate
8Minor
2,427No known interaction
Moderate

394 interactions

Showing 60 of 394 moderate interactions — see all 394 on the L-arginine page.

Minor

8 interactions

No interaction 2,427 drugs checked — show the list
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

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Pharmacist Counseling Corner

Taking L-arginine and Irbesartan Together: Common Questions

Can you take L-arginine with Irbesartan?
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.
Why are there 2 interactions listed for L-arginine and Irbesartan?
Irbesartan belongs to more than one drug category, and L-arginine interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the L-arginine and Irbesartan 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 Irbesartan and L-arginine?

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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.