Clinically Significant Cardiovascular Drug-Drug Interactions With OTC Supplements and Herbal Products Angiotensin-Converting Enzyme Inhibitors (ACEIs) • Night-blooming cereus - Increases effects of ACEIs, leading to hypotension • Green tea, Yohimbine - Decreases effectiveness of ACEIs, leading to hypertension Alpha-Blockers • Butcher’s Broom, Yohimbine - Decreases effects of alpha-blockers, leading to hypertension Antiplatelets • Danshen, Garlic, Ginkgo biloba, Saw palmetto - Increases bleeding risk • St. John’s wort - Increases activity of clopidogrel, leading to increased bleed risk Beta-Blockers • Fumitory, Lily of the valley, Night-blooming cereus - Increases effects of betablockers, leading to hypotension and bradycardia • Green tea, Ma-huang (ephedra), Yohimbine - Decreases effects of beta-blockers, leading to hypertension and tachycardia Calcium Channel Blockers (CCBs) • Fumitory, Grapefruit juice, Hawthorn, Khella, Lily of the valley, Nightblooming cereus - Increases effects of CCBs, leading to vasodilation, hypotension, and bradycardia • St. John’s wort - Decreases the effects of CCBs, leading to hypertension and tachycardia Digoxin • Aloe vera, Licorice - Causes hypokalemia, increasing risk of digoxin toxicity • Danshen, Fumitory, Hawthorn, Lily of the valley, Night-blooming cereus, Strophanthus - Potentiates action of digoxin, increasing risk for toxicity • St. John’s wort - Decreases digoxin concentration • Chan Su, Danshen, Ginseng, Uzara root - Interacts with digoxin assay Nitrates • Hawthorn - Potentiates action of nitrates, leading to vasodilation and hypotension Monoamine Oxidase Inhibitors • Capsicum, Ma-huang (ephedra), St. John’s wort - Increases blood pressure Spironolactone • Licorice - Increases effects of spironolactone Warfarin • Alfalfa, Bilberry, Danshen, Dong quai, Fenugreek, Garlic, Ginger, Ginkgo biloba, Grapefruit juice, Khella, Saw palmetto - Increases bleeding risk • Ginseng, Green tea, Soy milk, St. John’s wort - Decreases effects of warfarin Amiodarone • Echinacea, St. John’s wort - Increases QT interval • Grapefruit juice, St. John’s wort - Decreases effects of amiodarone, leading to potential arrhythmias Class I Antiarrhythmic Drugs • Echinacea, Ma-huang (ephedra), St. John’s wort - Increases QT interval • Lily of the valley - Increases effects of quinidine • St. John’s wort - Decreases effectiveness, leading to arrhythmias Statins • Grapefruit juice - Increases effects of statins and risk of myalgias • Echinacea - Increases risk of hepatotoxic effects #DrugDrug #Interactions #OTC #supplementals #herbal #pharmacology #DDI #table #cardiology
