Heart drugs and supplements a risky mix
November 15th, 2010
08:30 AM ET

Heart drugs and supplements a risky mix

Herbal and dietary supplements are found in the aisles of supermarkets and health-food stores rather than behind a pharmacy counter, and they can be  dangerous when mixed with the wrong drug.

A new survey suggests that a majority of heart patients taking the popular blood-thinning drug warfarin are risking potentially dangerous complications by combining it with supplements such as fish oil, glucosamine and chondroitin, coenzyme Q10, and multivitamins.

The survey, which included 100 heart patients in Utah, found that more than two-thirds were taking dietary supplements in addition to their prescribed blood thinner, in most cases unbeknownst to their doctor. Nearly half of the patients didn't view supplements as drugs.

Health.com: Heart trouble? 30 herbal remedies to avoid

"More and more patients are self-medicating with these supplements," says Jennifer Strohecker, a clinical pharmacist at Intermountain Medical Center, in Salt Lake City. "Many of us will Google something and then go out and try it, and our doctor would never know."

In a previous study, Strohecker and her colleagues found that nine of the 10 most commonly sold supplements had the potential to conflict with warfarin. The offenders included St. John's wort, melatonin, glucosamine and chondroitin, and fish oil.

"Even your multivitamin can interact with warfarin," says Strohecker, who presented her research Sunday at the American Heart Association's annual Scientific Sessions meeting in Chicago, Illinois.

Health.com: Supplements for cholesterol: what works?

Some supplements have the ability to either enhance or negate warfarin's effects, which could potentially trigger one of two dangerous complications: severe bleeding or a blood clot.

"People think that a supplement is always natural and safe," Strohecker says. "They don't realize that the body sees it as a chemical." (As she likes to tell her patients in an effort to set them straight, warfarin itself was originally derived from a plant called sweet clover.)

Perhaps the most alarming finding of the survey was the apparent communication gap between doctors and patients. Less than one-third of the survey respondents said that their doctors had specifically asked them about supplement use, though nearly all said they would discuss it if asked. (Patients who don't view supplements as drugs tend not to list them on standard doctor's office paperwork, Strohecker says.)

Health.com: How to use supplements safely

In addition to recommending that doctors ask patients about supplement use, Strohecker suggests that patients who choose to take supplements do so consistently.

"I also fully believe that there should be some cautionary statements or some labeling changes on the supplements themselves," Strohecker says. "It's a communication thing."

The Scientific Sessions meeting highlights the latest heart-related research and treatment advances. Unlike studies published in medical journals, the research presented at the meeting has not been vetted by independent experts in the field.

Copyright Health Magazine 2011

soundoff (207 Responses)
  1. anonymous

    Triglycerides =3,000? are you sure you are reading the report correctly?

    The Balloon Boy's dad claimed he was a scientist too. He actually had a little web cast called "the real scientists"claiming how smart and educated he was.In "REAL LIFE" Richard Heene flunked out of community college and was just a HAndyman doing odd jobs with dreams of becoming a T.V. star...Now Richard is a FELON.......People read a little blog/web and a little wikipedia and they are "experts" ON EVERYTHING...information without knowledge is just trivia

    November 16, 2010 at 12:55 | Report abuse | Reply

    Many of these comments are interesting and revealing of the ignorance of the public at large. It is unfortunate that many fall for the "lying with statistics" approach used by multi-million/billion dollar companies such as Big NutSupp (nutritional supplement) and Big EnDri (energy drink) companies who sole purpose is profit, and not the health of the public. The billions of dollars spent each year by Big Pharma every year on donating immunizations and vitamins to developing countries should be enough to convince one of motive. Do you think polio and smallpox went away because Big Pharma was making a profit immunizing billions of people in poor nations? And anecdotal evidence does not work: just because you happen to have done well with whatever magic powder du jour you have used doesn't mean the next person will. The population is on a bell curve, hence the scientific approach mentioned above by Roger and Smitty. No, I do not work for Big Pharma. Yes, I am a physician and scientist. Unfortunately, statistically, only one out of ten patients listen to their physician, and of those that listen, one out of ten follow their advice – which means one out of one hundred patients actually benefit from their interaction with their physician. It is a shame, and downright scary, to hear people like jjay and Doc Justice say that supplements are safe and that herbs used for centuries are safe. The principle of modern pharmacology, based on 5000 years of documented medical history, advancing knowledge and scientific technique, is to minimize the side effects of natural substances and maximize the beneficial therapeutic effects. After all, hemlock is all natural. So is arsenic. And mercury. Are they safe? Those of my great-grandfather's generation drank kerosene because they believed in its magical qualities. Only two generations ago we had cocaine toothache drops, heroin in a bottle, and paragoric consisting of alcohol and opium that would be given to week old infants. Wake up folks – you're being foolish to ignore 5000 years of scientific and medicinal advance.

    November 16, 2010 at 13:06 | Report abuse | Reply
    • retiredDOC

      Good well-thought out post.People need to remember that supplements are chemicals if they do have a "daily recommended requirement" on the nutritional section.If it is blank it is probably not a vitamin or a mineral that your body needs so use caution.A problem that needs to be addressed is that most of the manufacturing plants are now outside the United States.About 6 years ago there was a supplement that actually had viagra in it.

      Yes I remember cocaine 4% topical for nasal injuries,in my last of year of practice I did find paregoric for a nice lady because it was the only thing that helped her IBS but I don't remember heroin in a bottle?

      My best advice to patients is to find a health care professional you can TRUST and can meet FACE to FACE .The web is nice but it is filled with misinformation.There are still free nurses and pharmacists phone advice phone lines(disappearing fast) out there and by law they are suppose to identify who they are.Your health is a very very valuable asset and I would not trust a valuable asset to some one I know nothing about including a person with the handle retiredDOC.

      Find a healthcare professional you know and trust.I went into healthcare to HELP people not to become a millionaire.There are still doctors and healthcare professionals out there that still want to HELP PATIENTS lead better lives they may be harder to find but they do exist! Peace and HAPPINESS to ALL!

      November 16, 2010 at 15:07 | Report abuse |
  3. Tex

    Many herbs and supplements are suggestested By CAM Doctors at Columbia U Hospital ......go on PUB MED and Readfor yourself.......seek out a really good natural practioner certified in nutrion/herbology/ and bio chem have them work with your doctor and take a weekly blood chem to see how your platelets and other organs are doing and lastly some supplements and herbs go beyond the required regulations that some pharmeceutical co practice and are much more effective.......a good plce to start natural news .com or rain-tree.com. lifeextention.org ore cure zone.com

    November 17, 2010 at 08:34 | Report abuse | Reply
  4. Mackie Barch

    Why isn't anybody talking about Clotamin, the only multivitamin on the market for people on blood thinners? http://www.clotamin.com

    November 17, 2010 at 09:05 | Report abuse | Reply
  5. Geoff Horwitz

    An interesting but jaded view on why not to take supplements/multi-vitamins...if we just listened to the ridiculous commericals on TV and asked our doctors about the newest, greatest medications, we'd all live happily ever after, right? WTF? Does Ms. Peeples, of health.com believe this warped view? If so, you should find another contributor to this site, as her views are so one sided it makes me want to puke! I am an open heart patient, on coumadin/warfarin the rest of my life as I have an artificial valve in replacement of my defective aortic valve...I am also an avid believer in the benefits of many of the supplements on the "30 supplements to avoid list"....Someone on Warfarin needs an objective health care professional who can monitor their INR and adjust the warfarin per the patients needs...If the health care professional is to close minded to do so, find another one...and please don't believe the crap written here...be mindful of what goes into your body, but don't be afraid to help it by being scared to use some natrual herbal remedies....

    November 17, 2010 at 13:21 | Report abuse | Reply
  6. Sarah

    Jennifer Strohecker, is a total wack-job. I had her as a professor & she was the most pathetic excuse for a teacher I had ever experienced. She was completely ill-prepared and unprofessional. I wouldn't trust any of her research!

    November 20, 2010 at 23:27 | Report abuse | Reply
    • Addie

      Didn't have her as a teacher, but I know what you're talking about....she's the last person anyone should have comment on anything worthwhile.

      December 13, 2010 at 22:53 | Report abuse |
  7. Commentary

    I would just like to say that alternative medicine and herbal therapy are making a big comeback. Several years back I was on 2 blood pressure drugs and I came off both using alternative supplements. The alternative supplements worked better than the 2 prescriptions. The important thing is that you thoroughly research what you are about to take, including interactions with medications that you are already on. Prescription drugs have side effects; some that are serious. As you age you produce less CoQ10, and this is very significant-read about it. Statin drugs lower your cholesterol, but some also lower your CoQ10, a negative side effect. Vitamin D is another big issue. Read about how many disorders are related to a low level of Vitamin D? I had to ask my doctor to test me, and I was way below the minimum level, even with sunshine and daily milk and yogurt. Herbs and alternative medicine were used many years before prescription drugs existed, and they worked. Food choice is another issue. The US needs to ban all pesticides, artificial colors, additives and chemical preservatives in our food. Imagine a world with fewer behavioral disorders, less ADHD? Studies have shown the significant difference. Europe is light years ahead of us.

    November 21, 2010 at 11:12 | Report abuse | Reply
  8. usdoc1

    Alternative medicines have extreme limitations and some have significant side effects when taken in combination with other alternative medicines. I recently had a life threatening brain hemorrhage and had to undergo two emergency surgeries. I was on combination of Glucosamine+Chondroitin and fish oil pill along with two OTC Aleve. The bleeding was very difficult to control.I was trying to prevent a heart attack, but did damage to the brain. I have short time memory loss. To make matters I am a physician!

    November 22, 2010 at 16:36 | Report abuse | Reply
  9. Walter

    The study uncovers nothing! Everything we injest, taken to the extreme can kill us. Of course herbal supplements can interfere and interact with perscription medicines. Dr. Strohecker has unveiled something so obvious it required no confirmation. Yes, she is a questionable personality as well!

    November 26, 2010 at 22:18 | Report abuse | Reply
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