Angina Medications
Beta-adrenergic Blocking Agents - See also Blood Pressure Lowering Medications
Metoprolol (Lopressor, Toprol XL)
Propranolol (Inderal)
Calcium Channel Blockers-See also Blood Pressure Lowering Medications Amlodipine (Norvasc)
Diltiazem (Cardizem, Cartia XT, Dilacor, Tiazac)
Nifedipine (Adalat, Procardia)
Verapamil (Calan, Covera HS, Isoptin, Verelan)
Nitrate and nitrite derivatives
Erythrityl Tetranitrate (Cardilate)
Isosorbide Dinitrate (Isordil, Sorbitrate, Isonate, Dilatrate-SR)
Isosorbide Mononitrate (Imdur, ISMO)
Nitroglycerin (Nitrobid, Nitrostat, Nitro-Dur)
Pentaerythritol Tetranitrate (P.E.T.N., Mycardol, Pentylan, Peritrate)
Nutritional Considerations:
A low sodium and low calorie diet may be beneficial. (Pronsky 1999)
Avoid alcohol. (Allison 1971) (Andersson 1984) (Facts and Comparisons 2000)
Long-term use of beta-blockers may cause deficiencies in chromium, magnesium, and coenzyme Q10. Discuss supplementation of these minerals with your pharmacist. (Kishi 1975) (Roeback JR Jr 1991) (Rubio-Luengo MA 1995)
Grapefruit juice may increase the effects of some calcium channel blockers, possibly causing an excessive lowering of blood pressure. Avoid within 2 hours of the drug. (Facts and Comparisons 1999) (Holt 1998) (Pronsky 1999)
Vitamin C and vitamin E may be useful in preventing tolerence to nitroglycerin that may occur with long- term use. Ask your pharmacist about supplementation. (Bassenge 1998) (Watanabe 1998) (Watanabe 1997)
Herbal Considerations:
Avoid natural licorice products. (Pronsky 1999) (Farese 1991) (Shintani 1992).
These herbs may have cardioactive properties and should be avoided while using Nitrostat: Blue Cohosh, Butcher's Broom, Devil's Claw, Fenugreek, Ginseng, Goldenseal, Hawthorn, Horehound, Mate, Mistletoe, Motherwort, Pleurisy Root, Prickly Ash, Shepherd's Purse, and Wild Carrot. (Newall 1996)
Black Cohosh, Calamus, Celery Seed, Cornsilk, Fenugreek, Garlic Plant, Ginger, Horse radish, Onion plant, Parsley Plant, Sage, Wild Carrot, Carrot Seeds, and Yarrow all may lower blood pressure and may have additive effects with drugs that also affect blood pressure, like calcium channel blockers. (Blumenthal 1998) (Newall 1996)
Bayberry, Broom, Cohosh (Blue), Cola, Coltsfoot, Gentian, Ginger, Ginseng (Panax), Goldenseal, Licorice, Mate, and Vervain may increase blood pressure and may interfere with drug therapy. These herbs should be used with caution with the above-mentioned drugs. (Newall 1996)
References:
Allison, R.D. et al: Effects of alcohol and nitroglycerin in vascular responses in man. Angiology, 1971, 22: 211-222.
Andersson O: The use of diuretics in modern antihypertensive therapy, Acta Pharmacol Toxicol, 1984:54 (suppl. 1): 79-82
Bassenge E, et al. Dietary supplement with vitamin C prevents nitrate tolerance. J Clin Invest 31: 67-71, 1998.
Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.
Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 2000.
Farese, RV et al., Licorice-induced hypermineralcorticoidism. NEJM. 1991, 325:1,1223-1,227.
Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 274-75
Kishi H, Kishi T, Folkers K: Bioenergetics in clinical medicine III - inhibition of coenzyme Q10-enzymes by clinically used antihypertensive drugs, Res Commun Chem Pathol Pharmacol, 1975, 12(3):533-40.
Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996
Pronsky, Zaneta. Food Medication Interactions. 11th edition. 1999.
Roeback JR Jr, Hla KM, Chambless LE, Fletcher RH. Effects of chromium supplementation on serum high-density lipoprotein cholesterol levels in men taking beta-blockers. A randomized, controlled trial. Ann Intern Med. 1991 Dec 15; 115(12): 917-24.
Rubio-Luengo MA, Maldonado-Martin A, Gil-Extremera B, Gonzalez-Gomez L, Luna del Castillo, JD. Variations in Magnesium and Zinc in hypertensive patients receiving different treatments. Am J Hypertens. 1995 Jul;8(7): 689-95.
Shintani S, Murase H, Tsukagoshi H, Shiigai T. Glycyrrhizin (licorice)-induced hypokalemic myopathy. Report of two cases and review of the literature. Eur Neurol 1992; 32:44-51.
Watanabe H, et al. Randomized, double-blind, placebo-controlled study of the preventive effect of supplemental oral vitamin C on attenuation of development of nitrate tolerance. J Am Coll Cardiol 31(6) 1323-1329, 1998.
Watanabe H, Kakihana M, Ohtsuka S, Sugishita Y. Randomized, double-blind, placebo-controlled study of supplemental vitamin E on attenuation of the development of nitrate tolerance. Circulation 1997 Oct 21; 96(8): 2545-50
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