The short answer
Glycyrrhizin-containing licorice can raise blood pressure, retain fluid and lower potassium, so it can undermine the treatment goals of enalapril. Avoid self-starting medicinal licorice and discuss existing use with your clinician. Separating doses by a few hours is not an established solution.
What this answer covers
Oral glycyrrhizin-containing licorice root or root-and-rhizome products identified as Radix et Rhizoma Glycyrrhizae. The European assessment concerns roots and stolons of G. glabra, G. inflata or G. uralensis that contain glycyrrhizin. Species, processing, part and glycyrrhizin dose must still be checked. Deglycyrrhizinated licorice and topical preparations are excluded.
- Supplement or preparation
- licorice root (glycyrrhizin-containing)
- Medication ingredient
- enalapril
What does licorice do that matters here?
Glycyrrhizin-containing licorice can make the body retain sodium and water and lose potassium. The European assessment warns that it may counteract prescribed blood-pressure treatment. That concern applies to enalapril because of its treatment purpose, but there is no reliable estimate of how much a particular licorice product will change your blood pressure.
What happened in the published enalapril case?
A man taking enalapril developed worsening hypertension and severe potassium loss while using two remedies containing glycyrrhizin. Symptoms improved after the remedies were stopped and potassium was given. The authors suggested enalapril had delayed the problem. This case supports taking the licorice exposure seriously; it does not show that enalapril caused the potassium loss.
Could low potassium affect the heart rhythm?
Severe licorice-related potassium loss can cause changes in the heart tracing and dangerous rhythm problems. This is an effect of substantial licorice toxicity, not a proven special QT interaction with enalapril. Because enalapril can also raise potassium in other circumstances, do not try to balance the effects with potassium tablets or changes to your prescription dose.
Does a time gap or a different form solve the problem?
No spacing interval has been shown to prevent this interaction. The concern involves ongoing hormone-like effects on fluid and electrolytes, so a few hours between doses is not an established safeguard. Products with glycyrrhizin removed are different preparations; this article does not establish their safety or effectiveness with enalapril.
What information should I bring to a medication review?
Bring the labels for licorice teas, extracts and mixed herbal remedies, including the plant species and any glycyrrhizin amount. Long exposure, multiple licorice products, hypertension, heart disease, kidney disease and other medicines affecting potassium make review more important. Your clinician can decide whether blood pressure, kidney function or potassium needs checking.
Evidence and practical considerations
Side effects & toxicity
Glycyrrhizin-containing licorice may undermine enalapril treatment goals through hypertension, fluid retention and potassium loss.
- Exact scope
- Oral glycyrrhizin-containing licorice root or root-and-rhizome products identified as Radix et Rhizoma Glycyrrhizae. The European assessment concerns roots and stolons of G. glabra, G. inflata or G. uralensis that contain glycyrrhizin. Species, processing, part and glycyrrhizin dose must still be checked. Deglycyrrhizinated licorice and topical preparations are excluded. with Enalapril, exact RxCUI 3827, inventory name enalapril, TTY IN. The inspected enalapril maleate label explicitly identifies the maleate salt of enalapril and its hydrolysis to enalaprilat. This is the salt-to-IN bridge for oral tablets and solution. The solution label also includes tablet clinical data. Do not transfer these conclusions to injected enalaprilat, combination products, or other ACE inhibitors without a separate rationale.
- Medication form and route
- oral
- Timing or duration
- Higher doses and longer use are frequent in harm reports; no universal safe co-use duration.
What remains uncertain
- The case confirms enalapril exposure but involves two mixed remedies. Official antihypertensive guidance is applied through a stated physiologic rationale, not unqualified ACE-inhibitor class transfer. Enalapril is not shown to amplify licorice toxicity.
Factors that may matter: glycyrrhizin dose; long use; multiple licorice products; kidney or cardiovascular disease; other potassium-active medicines.
Read the supporting source summaries
Source 1: regulatory herbal assessment
ema.europa.eu · Source check Sep 10, 2026
Population: Human studies and adverse-event reports concerning licorice preparations; not an enalapril trial.
Recognizes blood-pressure elevation, sodium retention and potassium loss. Severe hypokalemia can produce QT changes and arrhythmias. Licorice may counteract prescribed antihypertensive action and is not recommended in hypertension, cardiovascular or kidney disease.
How this applies: Applies conditionally to Radix et Rhizoma Glycyrrhizae products containing glycyrrhizin from the named species. Uses shared constituent and oral systemic exposure as the explicit preparation bridge. Excludes deglycyrrhizinated licorice and isolated topical products.
Mixed preparations, doses and study designs; no universal safe threshold or enalapril-specific risk estimate. Root/stolon assessment cannot be treated as a complete trial of every root-and-rhizome preparation.
Source 2: primary human case report
link.springer.com · Source check Sep 10, 2026
Population: One 77-year-old man with hypertension and hyperuricemia.
Developed worsening hypertension, weakness, severe hypokalemia and metabolic alkalosis with urinary potassium loss. Stopping both herbal remedies and providing potassium improved symptoms and electrolytes. Authors suggested enalapril had delayed pseudoaldosteronism.
How this applies: Exact enalapril exposure is confirmed. Botanical applicability is limited to oral glycyrrhizin-containing remedies; the accessible abstract does not resolve all species, parts, product ingredients or doses.
One case involving two mixed remedies, changing enalapril dose and unreported constituent amounts in the accessible abstract. Does not show enalapril amplified toxicity or establish risk for a standardized single licorice product.
Source 3: regulatory prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients prescribed oral enalapril for hypertension, heart failure or asymptomatic left ventricular dysfunction.
Warns that volume or salt depletion can produce excessive hypotension and renal consequences. Serum potassium should be monitored. Potassium supplements can cause hyperkalemia. Describes the maleate salt and conversion to enalaprilat.
How this applies: Applies to oral enalapril through the explicit maleate-to-enalapril bridge. Physiologic susceptibility is relevant when a botanical causes fluid loss or opposes blood-pressure control; this is an explicit clinical inference.
No named botanical interaction is measured. These medication-specific warnings establish susceptibility and monitoring context, not the incidence or magnitude of any botanical interaction.
Research assessment: · Open full citations ↗
Timing & monitoring
Review or avoid glycyrrhizin-containing medicinal licorice during enalapril treatment; no evidence-based dose-separation interval was identified.
- Exact scope
- Oral glycyrrhizin-containing licorice root or root-and-rhizome products identified as Radix et Rhizoma Glycyrrhizae. The European assessment concerns roots and stolons of G. glabra, G. inflata or G. uralensis that contain glycyrrhizin. Species, processing, part and glycyrrhizin dose must still be checked. Deglycyrrhizinated licorice and topical preparations are excluded. with Enalapril, exact RxCUI 3827, inventory name enalapril, TTY IN. The inspected enalapril maleate label explicitly identifies the maleate salt of enalapril and its hydrolysis to enalaprilat. This is the salt-to-IN bridge for oral tablets and solution. The solution label also includes tablet clinical data. Do not transfer these conclusions to injected enalaprilat, combination products, or other ACE inhibitors without a separate rationale.
- Medication form and route
- oral
- Timing or duration
- Sustained systemic effects are the concern rather than simultaneous gastrointestinal contact.
What remains uncertain
- Avoidance is a preparation- and disease-based precaution. Clinical review is needed for the exact product. A time gap and enalapril-related potassium retention are not demonstrated protective strategies.
Factors that may matter: hypertension; heart failure; low potassium; unknown constituent dose.
Read the supporting source summaries
Source 1: regulatory herbal assessment
ema.europa.eu · Source check Sep 10, 2026
Population: Human studies and adverse-event reports concerning licorice preparations; not an enalapril trial.
Recognizes blood-pressure elevation, sodium retention and potassium loss. Severe hypokalemia can produce QT changes and arrhythmias. Licorice may counteract prescribed antihypertensive action and is not recommended in hypertension, cardiovascular or kidney disease.
How this applies: Applies conditionally to Radix et Rhizoma Glycyrrhizae products containing glycyrrhizin from the named species. Uses shared constituent and oral systemic exposure as the explicit preparation bridge. Excludes deglycyrrhizinated licorice and isolated topical products.
Mixed preparations, doses and study designs; no universal safe threshold or enalapril-specific risk estimate. Root/stolon assessment cannot be treated as a complete trial of every root-and-rhizome preparation.
Source 2: primary human case report
link.springer.com · Source check Sep 10, 2026
Population: One 77-year-old man with hypertension and hyperuricemia.
Developed worsening hypertension, weakness, severe hypokalemia and metabolic alkalosis with urinary potassium loss. Stopping both herbal remedies and providing potassium improved symptoms and electrolytes. Authors suggested enalapril had delayed pseudoaldosteronism.
How this applies: Exact enalapril exposure is confirmed. Botanical applicability is limited to oral glycyrrhizin-containing remedies; the accessible abstract does not resolve all species, parts, product ingredients or doses.
One case involving two mixed remedies, changing enalapril dose and unreported constituent amounts in the accessible abstract. Does not show enalapril amplified toxicity or establish risk for a standardized single licorice product.
Source 3: regulatory prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients prescribed oral enalapril for hypertension, heart failure or asymptomatic left ventricular dysfunction.
Warns that volume or salt depletion can produce excessive hypotension and renal consequences. Serum potassium should be monitored. Potassium supplements can cause hyperkalemia. Describes the maleate salt and conversion to enalaprilat.
How this applies: Applies to oral enalapril through the explicit maleate-to-enalapril bridge. Physiologic susceptibility is relevant when a botanical causes fluid loss or opposes blood-pressure control; this is an explicit clinical inference.
No named botanical interaction is measured. These medication-specific warnings establish susceptibility and monitoring context, not the incidence or magnitude of any botanical interaction.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Original evidence and current official source documents inspected. Article distinguishes measured findings, preparation limits and remaining uncertainty. | |
| Research summary published |
Article revision: 19982bd83408cebe
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.