Herbal Products to Avoid in Patients With Cardiovascular Diseases

Herbal Products to Avoid in Patients With Cardiovascular Diseases^_*

Herb Purported Use Cardiac Adverse Effect of Interaction Alfalfa Arthritis, asthma, dyspepsia, hyperlipidemia, diabetes Increases bleeding risk with warfarin Aloe vera Wounds (topical), diabetes (oral) Hypokalemia causing digitalis toxicity and arrhythmia Angelica (dong quai) Appetite loss, dyspepsia, infection Increases bleeding risk with warfarin Bilberry Circulatory disorders, local inflammation, skin conditions, diarrhea, arthritis Increases bleeding risk with warfarin Butcher's broom Circulatory disorders, inflammation, leg cramps Decreases effects of alpha-blockers Capsicum Shingles, trigeminal and diabetic neuralgia Increases blood pressure (with MAOI) Fenugreek High cholesterol Increases bleeding risk with warfarin, hypoglycemia Fumitory Infection, edema, hypertension, constipation Increases effects of beta-blockers, calcium-channel blockers, cardiac glycosides Garlic High cholesterol, hypertension, heart disease Increases bleeding risk with warfarin Ginger High cholesterol, motion sickness, indigestion, antioxidant Increases bleeding risk with warfarin Ginkgo Poor circulation, cognitive disorder Increases bleeding risk with warfarin, aspirin, or COX-2 inhibitors Potential risk of seizures Ginseng Aging, diminished immunity, improves mental and physical capacity and stress tolerance Increases blood pressure Decreases effects of warfarin Hypoglycemia Gossypol Male contraceptive Increases effects of diuretics Hypokalemia Grapefruit juice Weight loss, to promote cardiovascular health Increases effects of statins, calcium-channel blockers, or cyclosporines Green tea Improve cognitive performance, mental alertness, weight loss, diuretic Decreases effects of warfarin (contains vitamin K) Hawthorn CHF, hypertension Potentiates action of cardiac glycosides and nitrates Irish moss Ulcers, gastritis Increases effects of antihypertensives Kelp Cancer, obesity Increases effects of antihypertensive and anticoagulant agents Khella Muscle spasms Increases effects of anticoagulant agents and calcium-channel blockers Licorice Ulcer, cirrhosis, cough, sore throat, infections Increases blood pressure Hypokalemia May potentiate digoxin toxicity Lily of the valley CHF Increases effects of beta-blockers, calcium-channel blockers, digitalis, quinidine, steroids Ma-huang (ephedra) Obesity, cough Increases heart rate and blood pressure Night-blooming cereus CHF Increases effects of angiotensin-converting enzyme inhibitors, antiarrhythmics, beta-blockers, calcium-channel blockers, cardiac glycosides Oleander Muscle cramps, asthma, cancer, CHF, hepatitis, psoriasis, arthritis Heart block Hyperkalemia Arrhythmia Death St. John's wort Depression Increases heart rate and blood pressure (with MAOI) Decreases digoxin concentration Storphanthus CHF Increases effects of cardiac glycosides Yohimbine Impotence 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.

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