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Share your herbal supplement use with your doctor: research shows that some popular supplements may be dangerous for people with cardiovascular diseases.

A recent study published in the Feb. 1 issue of the Journal of the American College of Cardiology found that about 15 million Americans may be taking herbal remedies and/or vitamins that could be interacting with their heart medications. Researchers found that popular herbal supplements, such as St. John's wort, ginkgo biloba, and garlic, can be dangerous if combined with medications for heart disease like digoxin, warfarin, and aspirin.

So, which supplements should you avoid? "It depends on what condition the patient has," says Leslie Cho, MD, FACC, Editor-in-Chief of Cleveland Clinic's Heart Advisor. "In general, doctors don't like patients taking red yeast rice because it can increase liver dysfunction if they are on statins or other medications like amiodarone that can also cause liver dysfunction. Also, patients who are on Coumadin should avoid products that contain vitamin K."

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She goes on to say that patients who have renal dysfunction should avoid taking potassium and magnesium supplements, unless they clear it with their doctors first. "Diet medications and weight loss supplements often contain substances that can increase heart rate and blood pressure and can be very dangerous for some of our cardiac patients," adds Dr. Cho.

Herbal remedies can interact with prescription heart medications by either reducing their effectiveness or increasing their potency. In addition, some herbs and food products can cause cardiovascular side effects, which can be especially dangerous for people who already have been diagnosed with heart problems.

Herbal supplements are often seen as safe because they are marketed as "natural" remedies. But they aren't regulated the way prescription medications are and their potential side effects do not always appear on their labels.

The herbs and foods you should avoid really depend on your condition and themedications you take. "The bottom line is to clear it with your doctor first," Dr. Cho says.
COMMON HERB-DRUG INTERACTIONS

HERB          DRUG OR DRUG CLASS               INTERACTION

COMFREY       Phenobarbital              Increases metabolism and can
                                         lead to severe
                                         hepatotoxicity

DANSHEN       Anticoagulant or           Increases bleeding due to
              antiplatelet agents        additive effects

              Digoxin                    Increases side effects of
                                         digoxin

ECHINACEA     Amiodarone or ibutilide    Increases QT interval

              Statins, fibrates, niacin  Increases risk of hepatotoxic
                                         effects

EVENING       Phenobarbital              Decreases seizure threshold
PRIMROSE OIL

GARLIC        Aspirin, clopidogrel,      Increases bleeding risk
              warfarin, or heparinoid

              Antidiabetes drugs         Increases hypoglycemia

GINKGO        Aspirin                    Increases bleeding
BILOBA

              Warfarin                   Inhibits platelet-activating
                                         factor (PTF) hemorrhage

GINSENG       Antidiabetes drugs         Increases hypoglycemia

              Digoxin                    Interferes with digoxin
                                         assay, leading to falsely
                                         increased levels

              Warfarin                   Decreases effectiveness of
                                         warfarin

              Phenelzine sulfate         Headache, Irritability,
                                         Insomnia

HAWTHORN      Digoxin                    Increases effects of digoxin

              Calcium-channel blockers   Increases vasodilatory
              or nitrates                effects

KAVA          Alprazolam                 Increases central nervous
                                         system (CNS) depression.
                                         Increases effects of alcohol

LICORICE      Spironolactone             Increases effects of
                                         spironolactone

SAW PALMETTO  Anticoagulant or           Increases bleeding
              antiplatelet agents

SOY MILK      Warfarin                   Decreases effectiveness of
                                         warfarin

              Digoxin                    Decreases serum digoxin
                                         concentration

              Clopidogrel                Increases activity of
                                         clopidogrel. Increases
                                         bleeding

              Warfarin                   Decreases warfarin
                                         bioavailability and
                                         effectiveness

              Simvastatin                Decreases effectiveness of
                                         simvastatin

ST. JOHN'S    Paroxetine                 Nausea, Lethargy,
WORT                                     Incoherence

              Class IA and III           Decreases effectiveness
              antiarrhythmic agents      (precipitating arrhythmias)

              Cyclosporine               Decreases cyclosporine
                                         concentration due to
                                         increased clearance
                                         (transplant rejection)

              Theophylline               Decreases serum
                                         concentration

YOHIMBINE     Clonidine, Guanabenz       Decreases blood pressure
                                         reduction effect of centrally
                                         active agents

              CNS stimulants (e.g.,      Risk of hypertensive crisis
              amphetamines)              due to its monoamine oxidase
                                         inhibitor activity

              ACE inhibitors             Decreases effectiveness of
                                         ACE inhibitors. Hypertension

              Beta-blockers              Decreases effectiveness of
                                         beta-blockers. Hypertension.
                                         Increases heart rate

HERBAL PRODUCTS TO AVOID IN PATIENTS WITH CARDIOVASCULAR DISEASES

HERB             PURPORTED USE          CARDIAC ADVERSE EFFECT OF
                                             INTERACTION

ALOE VERA   Wounds (topical), diabetes  Hypokalemia (low
            (oral)                      potassium) causing
                                        digitalis toxicity and
                                        arrhythmia.

FENUGREEK   High cholesterol            Increases bleeding risk
                                        with warfarin,
                                        hypoglycemia (low blood
                                        sugar).

GINKGO      Poor circulation,           Potential risk of
            cognitive disorder          seizures.

GINSENG     Aging, diminished           Increases blood pressure.
            immunity, improves mental   Hypoglycemia.
            and physical capacity and
            stress tolerance

GOSSYPOL    Male contraceptive          Increases effects of
                                        diuretics. Hypokalemia.

GRAPEFRUIT  Weight loss, to promote     Increases effects of
JUICE       cardiovascular health       statins, calcium-channel
                                        blockers, and
                                        cyclosporines.

GREEN TEA   Improve cognitive           Decreases effects of
            performance, mental         warfarin (contains vitamin
            alertness, weight loss,     K).
            diuretic

LICORICE    Ulcer, cirrhosis, cough,    Increases blood pressure.
            sore throat, infections     Hypokalemia. May
                                        potentiate digoxin
                                        toxicity.

MA-HUANG    Obesity, cough              Increases heart rate and
(EPHEDRA)                               blood pressure.

OLEANDER    Muscle cramps, asthma,      Heart block. Hyperkalemia.
            cancer, congestive heart    Arrhythmia. Death.
            failure, hepatitis,
            psoriasis, arthritis

YOHIMBINE   Impotence                   Increases heart rate.
                                        Increases or decreases
                                        blood pressure.
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Title Annotation:WARNINGS
Publication:Heart Advisor
Geographic Code:1USA
Date:Apr 1, 2010
Words:720
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