Taking Heart Medications And Supplements Safely

Taking care of your heart involves several steps, including taking any medications your doctor prescribes.

Sometimes, patients with heart disease, high blood pressure or high cholesterol may faithfully take their medications. Still, they may also be taking supplements or other over-the-counter medications and supplements that can interfere with the effectiveness of their prescription drugs.

But being aware of possible side effects and interactions with supplements or over-the-counter medicines can be beneficial for your heart.

“It's one thing to have a sudden heart attack come on and treat that with medications. It's another one to have a drug-drug interaction put you in the hospital," said Joshua Rajkumar, PharmD, a cardiology clinical pharmacist working at Franciscan Health Indiana Heart Physicians in Indianapolis. "Those things are preventable. Talking with your doctor, talking with your pharmacist about not only the medications that you're taking, but also different herbal supplements, different foods that you're eating, and what your diet looks like as well, that can all affect medication concentrations. Having a good awareness of that is vital.”

Drug Interactions With Supplements

Drug interactions happen when one supplement medicine changes how another works.

"You may not be getting the best effect out of the medication, or you might be getting too much of an effect from the medication, which can lead to some pretty severe side effects that you may feel with that," Dr. Rajkumar said.

Here are a few ways this can happen:

• Increased or decreased medication effectiveness: Some medications or supplements can make the heart medications you're prescribed less effective or increase their side effects. Others, such as grapefruit supplements or juice, are known to increase the metabolizing of statins, meaning your body goes through the medication faster.
• Increased risk of side effects: Certain supplements can increase the risk of bleeding, especially when combined with blood thinners.
• Toxicity: In some cases, combining supplements with certain medications can lead to toxic levels of either substance in your body.

Supplements And Safety

"Supplements are something I see a lot of patients. They take them because on their labels, there are a lot of sayings like, 'Oh, this helps with coronary artery disease. This helps with your heart health. This helps reduce heart attacks and stuff," Dr. Rajkumar said. "The thing about supplements is they have a different regulation process than medications do. Medications are very strictly put under the microscope with regulation testing from the Federal Drug Administration, and different testing sets to make sure they're up to par before they go on the market.

"Dietary supplements has sort of an abridged process, but they can't say that their supplements can treat, cure or help with any specific condition. So, the labeling is very specific on those medications. It's not actually saying it's going to help, it is giving something that it'll help there, giving a little inkling there. They can say it, but not specific verbiage. That's because when you look at the dietary supplement studies that looked at these medications, there's not a lot out there, truly. There's not a lot of published literature there, and the published literature that is out there doesn't really show anything super promising for the medication."

3 Common Supplements For Heart Health

Dr. Rajkumar explained what you should know about three common heart supplements:

Fish oil

"Fish oil is one of those medications that doesn't really have a lot of benefit," he said. "Now, I'm not going to say it doesn't have any, You're not seeing like very big numbers there like with statins, I mean, you're reducing that cholesterol by 50%. With Zetia, maybe like 15%, right? When you come to fish oil, it's about 1-2%; at most, 3% in some cases. So, not a lot of efficacy there. Now in terms of risk then, let's balance that against the risk of taking that supplement.

"The big thing with that is this one does have a blood-thinning effect with the medication. There's a lot of patients that might be on fish oil with Eliquis or with Plavix, and there's actually an increased risk for bleeding while on fish oil while taking Eliquis or Xarelto medication. So, on its own, it's not going to cause any major or minor bleeds. But with other anticoagulant medications, it does. And so, when you're weighing the risks and benefits of that medication in terms of when you take it. And the thing I tell my patients as well, particularly with fish oil, is, 'If you're on an anticoagulant, the fish oil is coming off. There's very minimal benefit for you and a very high cost,' versus, if somebody is just taking it, help reduce their cholesterol, not any other blood thinners, generally, I'm like, 'It's okay. But it's not really helping as much as you may think.'"

Niacin

"Niacin medication was originally used like cholesterol medications. It's actually not really recommended for patients with abnormal cholesterol or dyslipidemia," he said. "The guidelines no longer advocate it and that's because, in the studies that looked at that medication as an add-on to statin therapy or as its own, a lot of the evidence shows it did not reduce the chance of passing away due to any cardiac conditions or non-cardiac conditions. It didn't prevent any future heart attacks or strokes for patients, but it was associated with a lot of side effects."

Those side effects include:

• Flushing
• Nausea
• Vomiting

CoQ10

"This is also a medication that is not recommended by the American College of Cardiology," Dr. Rajkumar said. "Now, coenzyme Q10 does have other like anti-inflammatory and antioxidant effects in diseases such as, diabetes or cancer or fertility. But I'll keep it kind of focused here on cardiology since that's my area of expertise. So for CoQ10, it is not recommended as a therapy according to the heart guidelines. It doesn't have a lot of data to show that it is effective at reducing your risk for cardiovascular disease. I think there are still patients that develop cardiovascular disease with being on coenzyme Q10. And so, it's not really shown to be a really good dietary supplement as well.

"In fact, when taken with statins, in particular statin medications, it can cause myalgias or muscle symptoms, or that muscle twinging that's very particularly known with statin medications, it would exacerbate that. So, not only is there really no benefit and it's not recommended by the American College of Cardiology, it also can cause significant side effects."

Talk to Your Doctor

It's crucial to talk to your doctor about all prescribed medications, over-the-counter medications, and supplements you are taking, including vitamins and herbs.

• Your doctor can:
• Help assess potential drug interactions.
• Recommend safe and effective supplements.
• Monitor for any side effects.