hypotension
14 interactions related to hypotension
losartan + hawthorn
Hawthorn produces modest blood pressure lowering (roughly 5 to 11 mmHg systolic in clinical trials) through vasodilation and mild ACE-like activity. Combined with losartan, the additive effect could occasionally cause hypotension or dizziness, particularly in people on multiple antihypertensives or those starting hawthorn at high doses.
metoprolol + hawthorn
Hawthorn (Crataegus) has mild vasodilatory and positive inotropic effects that can additively lower blood pressure and slow heart rate when combined with metoprolol, increasing the risk of hypotension, bradycardia, dizziness, or syncope. The interaction is pharmacodynamic, not metabolic, so spacing the doses does not prevent it.
beetroot + vardenafil
Vardenafil blocks PDE5 and prolongs nitric oxide signaling. Beetroot is a major dietary source of nitrate that the body converts to nitric oxide, so concentrated beetroot products can add to vardenafil's blood pressure lowering effect.
beetroot + nitroglycerin
Nitroglycerin releases nitric oxide to dilate blood vessels and relieve angina. Beetroot is the most concentrated dietary source of inorganic nitrate, which the body also converts to nitric oxide, so combining the two can cause additive vasodilation, low blood pressure, headache, and fainting.
alcohol + propranolol
Alcohol and propranolol can produce additive hypotension, dizziness, and sedation through combined vasodilation and central nervous system depression; propranolol also masks the warning symptoms of low blood sugar and rapid heart rate. Chronic heavy drinking induces hepatic enzymes and can reduce propranolol effectiveness.
alcohol + hydrochlorothiazide
Hydrochlorothiazide and alcohol both lower blood pressure and promote dehydration; combined use causes additive hypotension, dizziness, and orthostatic syncope, especially on standing or in hot weather. The combination also worsens electrolyte loss, particularly potassium and magnesium.
cbd + beta-blockers
CBD inhibits several CYP450 enzymes (notably CYP3A4, CYP2C19, CYP2C9, CYP1A2) and may modestly inhibit CYP2D6. Beta-blockers such as metoprolol, propranolol, and carvedilol are metabolized via CYP2D6 (and CYP1A2 for propranolol), so co-use can raise beta-blocker plasma levels, with additive blood-pressure lowering and bradycardia.
hibiscus tea + hydrochlorothiazide
Hibiscus (Hibiscus sabdariffa) has intrinsic diuretic and antihypertensive activity and animal studies show it increases serum levels of hydrochlorothiazide while reducing its clearance. The combination can produce additive blood pressure lowering and amplified electrolyte loss including hypokalemia.
dark chocolate + blood pressure medications
Dark chocolate flavanols improve nitric-oxide-dependent vasodilation and modestly lower systolic and diastolic blood pressure (typically 2–3 mmHg). Combined with antihypertensives, this can additively lower blood pressure, occasionally producing symptoms of hypotension such as dizziness in sensitive patients.
celery juice + blood pressure medications
Celery contains phthalides (including 3-n-butylphthalide), nitrate, and other constituents that relax vascular smooth muscle and have demonstrated blood pressure lowering effects in animal and small human studies. Large daily celery juice intake can add to the effect of antihypertensive drugs, including ACE inhibitors, calcium channel blockers, and diuretics.
beetroot + sildenafil
Beetroot is high in dietary inorganic nitrate that the body converts to nitric oxide, the same vasodilator pathway amplified by PDE5 inhibitors like sildenafil. While organic nitrate drugs (not dietary) are the formal contraindication, large doses of beetroot juice can meaningfully lower blood pressure and may add to sildenafil's vasodilatory effect.
beetroot + tadalafil
Tadalafil inhibits PDE5 for up to 36 hours, prolonging the vasodilatory effect of any nitric oxide pathway activation. Beetroot's dietary nitrate becomes nitric oxide in the body and can add to tadalafil's blood pressure lowering, particularly with concentrated beetroot shots or supplements.
pomegranate + ace inhibitors
Pomegranate polyphenols (pedunculagin, punicalin, gallagic acid) directly inhibit angiotensin-converting enzyme, and clinical trials show pomegranate juice lowers systolic and diastolic blood pressure on its own. Combined with prescription ACE inhibitors the effects can stack, potentially causing additive hypotension, dizziness, or hyperkalemia.
alcohol + nitroglycerin
Both nitroglycerin and alcohol are vasodilators; combined, they cause additive hypotension that can produce severe dizziness, fainting, or cardiovascular collapse, particularly with sublingual or fast-acting nitrate formulations. The classic interaction was first described in the New England Journal of Medicine in 1965.