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
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