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Thursday, February 4, 2010

Herbal Products to Avoid in Patients With Cardiovascular Diseases

Herbal Products to Avoid in Patients With Cardiovascular Diseases*
HerbPurported UseCardiac Adverse Effect of Interaction

AlfalfaArthritis, asthma, dyspepsia, hyperlipidemia, diabetesIncreases bleeding risk with warfarin
Aloe veraWounds (topical), diabetes (oral)Hypokalemia causing digitalis toxicity and arrhythmia
Angelica (dong quai)Appetite loss, dyspepsia, infectionIncreases bleeding risk with warfarin
BilberryCirculatory disorders, local inflammation, skin conditions, diarrhea, arthritisIncreases bleeding risk with warfarin
Butcher's broomCirculatory disorders, inflammation, leg crampsDecreases effects of alpha-blockers
CapsicumShingles, trigeminal and diabetic neuralgiaIncreases blood pressure (with MAOI)
FenugreekHigh cholesterolIncreases bleeding risk with warfarin, hypoglycemia
FumitoryInfection, edema, hypertension, constipationIncreases effects of beta-blockers, calcium-channel blockers, cardiac glycosides
GarlicHigh cholesterol, hypertension, heart diseaseIncreases bleeding risk with warfarin
GingerHigh cholesterol, motion sickness, indigestion, antioxidantIncreases bleeding risk with warfarin
GinkgoPoor circulation, cognitive disorderIncreases bleeding risk with warfarin, aspirin, or COX-2 inhibitors
Potential risk of seizures
GinsengAging, diminished immunity, improves mental and physical capacity and stress toleranceIncreases blood pressure
Decreases effects of warfarin
GossypolMale contraceptiveIncreases effects of diuretics
Grapefruit juiceWeight loss, to promote cardiovascular healthIncreases effects of statins, calcium-channel blockers, or cyclosporines
Green teaImprove cognitive performance, mental alertness, weight loss, diureticDecreases effects of warfarin (contains vitamin K)
HawthornCHF, hypertensionPotentiates action of cardiac glycosides and nitrates
Irish mossUlcers, gastritisIncreases effects of antihypertensives
KelpCancer, obesityIncreases effects of antihypertensive and anticoagulant agents
KhellaMuscle spasmsIncreases effects of anticoagulant agents and calcium-channel blockers
LicoriceUlcer, cirrhosis, cough, sore throat, infectionsIncreases blood pressure
May potentiate digoxin toxicity
Lily of the valleyCHFIncreases effects of beta-blockers, calcium-channel blockers, digitalis, quinidine, steroids
Ma-huang (ephedra)Obesity, coughIncreases heart rate and blood pressure
Night-blooming cereusCHFIncreases effects of angiotensin-converting enzyme inhibitors, antiarrhythmics, beta-blockers, calcium-channel blockers, cardiac glycosides
OleanderMuscle cramps, asthma, cancer, CHF, hepatitis, psoriasis, arthritis
Heart block
St. John's wortDepression
Increases heart rate and blood pressure (with MAOI)
Decreases digoxin concentration
StorphanthusCHFIncreases effects of cardiac glycosides
Increases heart rate
Increases or decreases blood pressure

* Only major indications, adverse effects, and interactions are listed; thus, the list is not all inclusive.

CHF = congestive heart failure; COX = cyclooxygenase; MAOI = monoamine oxidase inhibitor.

JACC online

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