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Avoid these with heart medications

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Interactions with common foods, beverages, vitamins, and supplements can change how your medicine works.

If you have heart disease or are at risk for it, you probably take two or more prescription drugs. It’s in your best interest to make sure these drugs work as well as they should. That’s why you need to know about foods, beverages, vitamins, dietary supplements, over-the-counter drugs, or other prescription medications that could interact with your medications. An interaction may cause the drug to become more powerful or less effective. If either happens to you, your heart disease could progress, or you might be at increased risk for a heart attack or fatal arrhythmia.

Although interactions don’t always occur, there is no way to know who will experience a problem and who will not. “To be on the safe side, we counsel everyone to avoid products that may interact with their medication,” says cardiologist Dr. Richard Lee, co-editor in chief of the Harvard Heart Letter.

Medication safety tips

Use the list on page 5 to locate the medications you take. Check the box next to the products you need to avoid, and save the list in a safe place. From this point on:

  • Tell your doctor about any vitamins or dietary supplements you are taking.

  • Whenever you are given a new prescription for any reason, ask your doctor if there are any foods, beverages, vitamins, dietary supplements, or other medications that may react with it. Write them down and post the list on your refrigerator door.

  • Obtain all your prescriptions from the same pharmacy.

  • Read the information that comes with prescription drugs and over-the–counter medications, as well as the “drug facts” printed on bottle labels.

“When it comes to your drugs, there’s no such thing as a silly question. If you are even remotely concerned about a medication, ask your doctor or pharmacist,” says Dr. Lee.

Products known to interact with heart medications. If you take…

An ACE inhibitor, such as lisinopril (Prinivil, Zestril), enalapril (Vasotec), or ramipril (Altace)

Spironolactone (Aldactone)

  • Avoid: Because ACE inhibitors cause increased blood potassium levels, be sure your doctor checks those levels periodically if you take over-the counter salt substitutes (which contain potassium) or if you eat many high-potassium foods (bananas, oranges, green leafy vegetables)

  • Why: High blood potassium levels can cause dangerous heart rhythms

  • Avoid: High-potassium foods, such as bananas, oranges, green leafy vegetables, salt substitutes, potassium supplements, diuretics

  • Why: May raise blood potassium levels and cause dangerous heart rhythms

The anti-arrhythmic drug amiodarone (Cordarone, Pacerone)

A nitrate, such as nitroglycerin (Nitrostat) or isosorbide mononitrate (Imdur)

  • Avoid: The statin drugs atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor)

  • Why: These statins increase risk of a severe muscle injury that can lead to kidney failure or death

  • Avoid: Alcohol

  • Why: May cause dangerously low blood pressure

Aspirin

  • Avoid: Hawthorn

  • Why: May lower blood pressure

  • Avoid: Fish oil, vitamin E, ginkgo, garlic, ginger, feverfew, ginseng, policosanol, and tamarind

  • Why: These supplements increase the risk of bleeding

A statin, such as atorvastatin (Lipitor) or simvastatin (Zocor)

A beta blocker, such as atenolol (Tenormin), metoprolol (Toprol), or propranolol (Inderal)

  • Avoid: Grapefruit and grapefruit juice, limes, Seville oranges, pomelos

  • Why: May make the statin more potent, increasing the risk of side effects

  • Avoid: Black licorice, alcohol (a problem with propranolol only)

  • Why: May lower blood pressure excessively

  • Avoid: St. John’s wort

  • Why: May render the statin less effective

Avoid: Hawthorn

Why: The interaction may increase blood pressure and heart rate

Warfarin (Coumadin, Jantoven)

A calcium-channel blocker, such as amlodipine (Norvasc) or felodipine (Plendil)

  • Avoid: Varying from one day to the next your intake of foods high in vitamin K (broccoli, cabbage, collard greens, spinach, kale, turnip greens, beet greens, Brussels sprouts, canola oil, soybean oil. It’s important to get some vitamin K each day, and ideally the same amount

  • Why: Vitamin K makes warfarin less effective, increasing the risk of blood clots

  • Avoid: Grapefruit and its juice

  • Why: Makes the drug more powerful

  • Avoid: Herbal teas, green tea, and many herbal medicines, including St. John’s wort, coenzyme Q10, feverfew, evening primrose oil, dong quai, danshen

  • Why: Can make warfarin more or less effective

  • Avoid: Hawthorn

  • Why: May lower blood pressure

  • Avoid: Cranberries, cranberry juice

  • Why: Increases the risk of bleeding

  • Avoid: Hawthorn

  • Why: May lower blood pressure

  • Avoid: Ginseng

  • Why: Decreases the effectiveness of warfarin

Clopidogrel (Plavix)

  • Avoid: Garlic, ginkgo, vitamin E

  • Why: Increases the risk of bleeding

  • Avoid: Fish oil, vitamin E, ginkgo, garlic, ginger, feverfew, ginseng, policosanol, and tamarind

  • Why: These supplements increase the risk of bleeding

  • Avoid: Ginger supplements, glucosamine

  • Why: Reduces warfarin’s effectiveness

  • Avoid: St. John’s wort

  • Why: This supplement makes clopidogrel less effective

  • Avoid: More than three alcoholic drinks per day

  • Why: Enhances bloodthinning

Digoxin (Lanoxin)

  • Avoid: Certain antibiotics. If you need to take an antibiotic, make sure the clinician prescribing it knows you take warfarin so he or she can choose an antibiotic that doesn’t interact with warfarin or, if it will, your doctor can temporarily change your warfarin dose

  • Why: Increases risk of internal bleeding

  • Avoid: High-fiber foods, such as bran

  • Why: May weaken the effect of digoxin

  • Avoid: St. John’s wort, senna

  • Why: These supplements make digoxin less effective

  • Avoid: Black licorice and other foods containing glycyrrhizin

  • Why: May cause irregular heartbeat or heart attack

Avoid: Hawthorn

Why: May increase blood pressure and heart rate

Posted by: Dr.Health

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