Vitamins, supplements, herbal medicines, and arrhythmias.
Nutritional and herbal supplements may have harmful or beneficial effects on arrhythmias. Potential supplements that may have antiarrhythmic activity include omega-3 polyunsaturated fatty acids (N-3 PUFA), coenzyme Q10, and carnitine. Clinical studies show that N-3 PUFA or fish oil supplementation appears to reduce mortality and sudden death. Coenzyme Q10, used in treatment of heart failure, and carnitine and its derivatives may have beneficial effects on arrhythmias, although clinical studies have been limited. Antioxidant supplements may be beneficial, but large studies with vitamin E have been disappointing in that it does not reduce mortality. Correction of electrolyte disturbances has been long advised and magnesium supplementation has been beneficial in the treatment of torsades de pointes and in some studies after cardiac surgery. However, routine electrolyte supplementation with empiric potassium or magnesium in non-deficient patients has not been convincingly beneficial. Several herbal supplements have also been promoted to have antiarrhythmic activity. However, clinical studies are lacking to support routine use of these herbal medications. In addition, some herbal supplements may cause serious proarrhythmia, and many supplements significantly interact with warfarin and digoxin.
Chung
Mina K
MK
Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. chungm@ccf.org
D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000517:prevention & control*; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D002331:Carnitine / Q000008:administration & dosage; D003067:Coenzymes; D019587:Dietary Supplements / Q000009:adverse effects; D004077:Digoxin / Q000008:administration & dosage; D004573:Electrolytes / Q000008:administration & dosage* / Q000009:adverse effects; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D016166:Free Radical Scavengers / Q000008:administration & dosage; D006027:Glycosides / Q000008:administration & dosage / Q000009:adverse effects; D041743:Herb-Drug Interactions; D029001:Herbal Medicine; D006801:Humans; D014451:Ubiquinone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014815:Vitamins / Q000008:administration & dosage*
D002121:Calcium Channel Blockers; D003067:Coenzymes; D004573:Electrolytes; D015525:Fatty Acids, Omega-3; D016166:Free Radical Scavengers; D006027:Glycosides; D014815:Vitamins; D014451:Ubiquinone; D004077:Digoxin; C024989:coenzyme Q10; D002331:Carnitine