Herbal supplements and heart medicines may not mix

Many herbal supplements interact with medications for cardiovascular disease. Some of these interactions can be life-threatening.

By Mayo Clinic Staff

Herbal supplements are natural, so they must be safe, right? Not necessarily.

Herbal supplements can have strong effects in the body. Some can interact with prescription medications used to treat heart and circulatory problems, such as high blood pressure and heart failure. Some of these interactions can even be dangerous.

Herbal supplements and prescription medications

About one-half of adults in the United States report having used at least one dietary supplement in the previous month. But research suggests that only about 34 percent of people taking an herbal supplement tell their doctors about this use — and most of those people also are taking a prescription medication.

Yet many herbal supplements may interact with medications for cardiovascular disease. For example, several popular herbal supplements interact with the blood thinner warfarin (Coumadin, Jantoven).

Here are just a few of the herbal supplements that can affect warfarin:

  • Danshen
  • Licorice
  • St. John's wort

There are several others. That's why it's so important to talk with your doctor before taking herbal supplements if you take prescription medications. Your doctor and pharmacist can help you avoid risky interactions.

Herbal supplements and drug interactions

Several popular herbal supplements interact with common heart medications. This list covers only some interactions. It's important to talk to your doctor before taking any herbal supplements if you take prescription medications.

Coenzyme Q-10

Taking coenzyme Q-10 can decrease:

  • The effectiveness of warfarin
  • Your blood pressure if you also take a calcium channel blocker, such as diltiazem (Cardizem, Dilacor XR, others)

Danshen

Danshen can interact strongly with certain heart medications, including:

  • Anticoagulants. Taking danshen significantly increases your risk of bleeding if you also take warfarin or another anticoagulant, such as clopidogrel (Plavix) or aspirin.
  • Calcium channel blockers. Taking danshen increases your risk of low blood pressure if you also take diltiazem or another calcium channel blocker.
  • Digoxin (Lanoxin). Taking danshen increases the effects of digoxin — which is used to treat a variety of heart conditions — and puts you at risk of irregular heartbeat (arrhythmia).

Evening primrose

Evening primrose may increase your risk of bleeding if you also take an anticoagulant, such as:

  • Aspirin
  • Clopidogrel
  • Warfarin

Garlic

Garlic increases your risk of bleeding if you also take an anticoagulant, such as:

  • Aspirin
  • Clopidogrel
  • Warfarin

Gingko biloba

Ginkgo biloba increases your risk of bleeding if you also take:

  • Aspirin
  • Clopidogrel
  • Warfarin

Ginseng

Taking ginseng with warfarin decreases warfarin's effectiveness.

Hawthorn

Hawthorn might interact with:

  • Beta blockers, such as atenolol (Tenormin), nadolol (Corgard) or propranolol (Inderal LA, Innopran XL)
  • Calcium channel blockers, such as diltiazem, nifedipine (Procardia) and verapamil (Calan, Verelan)
  • Nitrates, such as nitroglycerin (Nitrostat, Nitro-Dur, others) and isosorbide (Dilatrate-SR, Isordil)
  • Digoxin

Licorice

Licorice decreases levels of warfarin and can increase the effects of digoxin.

Saw palmetto

Saw palmetto increases your risk of bleeding if you also take:

  • Aspirin
  • Clopidogrel
  • Warfarin

St. John's wort

Taking St. John's wort reduces the effectiveness of:

  • Calcium channel blockers
  • Digoxin
  • Warfarin
  • Statins, such as atorvastatin (Lipitor), lovastatin (Altoprev) and simvastatin (Zocor)

Playing it safe with herbal supplements

If your doctor tells you it's OK to use an herbal supplement combined with a medication, make sure you follow dosing instructions carefully. Watch for any unusual signs or symptoms that you could be having a drug interaction, such as:

  • Rapid heartbeat
  • Changes in blood pressure
Sept. 16, 2017 See more In-depth

See also

  1. A Very Happy Brain
  2. Acupuncture for back pain?
  3. Alexander Technique
  4. Alternative cancer treatments: 10 options to consider
  5. Aromatherapy: Is it worthwhile?
  6. Candida cleanse diet
  7. CBD safety
  8. Chronic fatigue: Can a natural remedy boost my energy?
  9. Colloidal silver
  10. Colon cleansing
  11. Considering complementary therapy
  12. Cupping therapy: Can it relieve fibromyalgia pain?
  13. Detox foot pads
  14. Diabetes treatment: Can cinnamon lower blood sugar?
  15. Do infrared saunas have any health benefits?
  16. Scent-based weight-loss products
  17. Prickly pear cactus
  18. Ear candling
  19. Ear infection treatment: Do alternative therapies work?
  20. Echinacea: Is it effective for the common cold?
  21. Ginkgo biloba: Can it prevent memory loss?
  22. Herbal supplements: Not risk-free
  23. Herbal supplements: Safety first
  24. Huperzine A: Can it treat Alzheimer's?
  25. Integrative approaches to treating pain
  26. Integrative medicine: Different techniques, one goal
  27. Integrative medicine: Find out what works
  28. Kombucha tea
  29. Kratom: Unsafe and ineffective
  30. Kratom and pregnancy: Not a safe mix
  31. Kratom for opioid withdrawal
  32. Learn to reduce stress through mindful living
  33. Massage
  34. Medical marijuana
  35. Meditation 2.0: A new way to meditate
  36. Meditation Application
  37. Mindfulness exercises
  38. Mindfulness practice: Can it reduce symptoms of MS?
  39. Miracle cure or marketing scam?
  40. Natural aphrodisiacs
  41. Natural remedies for depression: Are they effective?
  42. Oil of oregano: Can it treat sinusitis?
  43. Pet therapy
  44. Probiotics and prebiotics
  45. Fish oil supplements
  46. Tai chi
  47. Tai Chi and Cardiac Rehab
  48. Valerian: A safe and effective herbal sleep aid?
  49. Tai chi
  50. Vitamin B-12 and Alzheimer's
  51. Alternative psoriasis treatments
  52. What is hot yoga?
  53. What is reflexology?
  54. Wheatgrass
  55. Why aromatherapy is showing up in hospital surgical units
  56. Yucca: Can it relieve arthritis pain?
  57. Do zinc supplements shorten colds?