Drug & supplement interaction

Malic Acid + Ramipril

Ramipril brand name: Altace.

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

Malic Acid has a moderate interaction with Ramipril. Theoretically, malic acid might increase the risk of hypotension when taken with antihypertensive drugs.

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

Malic Acid and Ramipril

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

Moderate

ANTIHYPERTENSIVE DRUGS

Why this applies to Ramipril

Ramipril falls under ANTIHYPERTENSIVE DRUGS — the group Malic Acid interacts with.

Theoretically, malic acid might increase the risk of hypotension when taken with antihypertensive drugs.
Animal research shows that malic acid isolated from tagetes roots can reduce mean arterial blood pressure.
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 for ramipril (Altace). Your blood pressure medicine already works to relax your blood vessels and lower your pressure. The concern on file is that malic acid might also nudge blood pressure down a little, so stacking the two together could, in theory, push it lower than you want.

I want to be honest about how soft this evidence is. It comes only from animal research using malic acid pulled from a plant root, not from people taking supplements. The malic acid in apples and food is very unlikely to matter at all. Concentrated supplement doses are a bigger question mark. If you ever feel dizzy, lightheaded, or faint, especially when standing up, mention it to your pharmacist or doctor before changing anything.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Saleem R, Ahmad M, Naz A, et al. Hypotensive and toxicological study of citric acid and other constituents from Tagetes patula roots. Arch Pharm Res 2004;27(10):1037-42.

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

Malic Acid Also Interacts With Other Medications

Malic Acid has 171 moderate known drug interactions in our database — the Ramipril one above is one of them. If you take anything else, check it against the full list below.

Moderate 171 No known interaction 2,659 (incl. Ramipril)
Taking anything else?

Check Another of Your Medications Against Malic Acid

Covers the 2,830 medications we’ve checked against Malic Acid. Pick one to open its full report.

From our Q&A

Questions About Malic Acid or Ramipril

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Malic Acid or Ramipril, 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 Ramipril

This page covers Malic Acid only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ramipril page lists 149 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 Siberian Cocklebur (major).

By severity: 6 major · 119 moderate · 24 minor.

From our pharmacist’s overview on the Ramipril page

“Ramipril (Altace) is an ACE inhibitor for high blood pressure and heart protection, and its supplement list is one I would treat with real seriousness. Most interacting ingredients either deepen its pressure-lowering effect or push back against it, so readings can drift too low or creep back up.”

Reviewed by 2 · Jul 18, 2026

Open the Ramipril interaction page

One more smart check

Taking Malic Acid as Part of a Dietary Supplement Product? Check It for Interactions

We hold 678 real supplement products containing Malic Acid, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Malic Acid. Your product may carry other ingredients that interact with Ramipril too, on top of Malic Acid — 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 Malic Acid and Ramipril 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 Malic Acid
Top 25%

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

29 days ago today
Medication Ramipril
Top half

#1,108 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 Malic Acid

What is Malic Acid?

Malic Acid
  • Fibromyalgia symptoms
  • Muscle pain and fatigue
  • Dry mouth (used in some lozenges)
  • Skin exfoliation (topical)
  • Flavoring and food additive

Malic acid is a natural acid found in apples and other fruits, often combined with magnesium in supplements marketed for fibromyalgia and muscle pain. The evidence for its health benefits is weak and limited, and it is mostly used as a food flavoring. It is generally well tolerated in food amounts, but talk to your pharmacist or doctor before using supplement doses.

Read the full Malic Acid monograph & all interactions
Medication

About Ramipril

What Is Ramipril Used For?

Brand name: Altace

Ramipril capsules are used to treat high blood pressure (hypertension), either alone or combined with a thiazide diuretic (water pill). Lowering blood pressure reduces the risk of heart attack and stroke.

In adults 55 and older at high cardiovascular risk, ramipril capsules are used to reduce the risk of heart attack, stroke, or death from cardiovascular causes. Ramipril capsules are also used in stable patients who develop signs of heart failure within the first days after a heart attack, to lower the risk of death and hospitalization related to heart failure.

See full Ramipril drug information
Keep checking

Other Drugs & Malic Acid

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

0Major
171Moderate
0Minor
2,658No known interaction
171 Moderate 2,658 No interaction
Moderate

171 interactions

Showing 60 of 171 moderate interactions — see all 171 on the Malic Acid page.

No interaction 2,658 drugs checked — show the list

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

Showing the 60 most looked-up of 2,658 medications checked with no known interaction — see the full Malic Acid list.

See the full Malic Acid interactions page
See every supplement checked against Ramipril, 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
Malic Acid monograph › Uses, safety, and every drug interaction in one place Ramipril supplement interactions › Every supplement checked against Ramipril, ranked by severity Ramipril 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 Malic Acid and Ramipril Together: Common Questions

Can you take Malic Acid with Ramipril?
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 Malic Acid and Ramipril 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 Ramipril and Malic Acid?

Our pharmacists answer your medication & supplement questions — free.

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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.