hypotension
14 interactions related to hypotension
losartan + hawthorn
Hawthorn modestly lowers blood pressure through vasodilation and endothelial effects. Taken with losartan, an angiotensin II receptor blocker, the two can add up and occasionally cause dizziness or lightheadedness, mainly in people who already run low or who take more than one blood pressure medication.
metoprolol + hawthorn
Hawthorn (Crataegus) has mild vasodilatory and heart-supporting effects that can add to the blood-pressure and heart-rate lowering of metoprolol, modestly increasing the chance of low blood pressure, a slow pulse, dizziness, or fainting. The interaction is pharmacodynamic (it happens at the receptor and tissue level), not metabolic, so taking the doses at different times 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 works by releasing nitric oxide to widen blood vessels and relieve angina. Beetroot is a concentrated dietary source of inorganic nitrate, which the body also converts to nitric oxide. Combining concentrated beetroot products with nitroglycerin is mechanistically likely to add to nitroglycerin's blood-pressure-lowering and dizziness, although no clinical cases of this specific pairing have been documented. Whole-food beet portions are not a meaningful concern.
alcohol + propranolol
Alcohol and propranolol can produce additive drops in blood pressure with dizziness, lightheadedness, and fainting through combined vasodilation and a blunted heart-rate response. Propranolol can also mask the racing-heart and shakiness warning signs of low blood sugar, and alcohol can raise propranolol levels in the body.
alcohol + hydrochlorothiazide
Hydrochlorothiazide and alcohol both lower blood pressure and increase fluid loss, so taking them together can cause additive dizziness, lightheadedness on standing, and fainting. Both can also worsen loss of potassium and magnesium. The interaction is usually manageable at light drinking levels but becomes more significant in older adults, in hot weather, and during illness.
cbd + beta-blockers
CBD weakly inhibits CYP2D6, the liver enzyme that clears beta-blockers such as metoprolol, propranolol, and carvedilol, so in theory it could nudge their plasma levels up. CBD also has a mild blood-pressure-lowering effect of its own. Both actions point in the same direction as the beta-blocker, but the CYP2D6 effect is weak and its real-world clinical significance has not been demonstrated in humans.
hibiscus tea + hydrochlorothiazide
Hibiscus tea and hydrochlorothiazide both lower blood pressure and act as mild diuretics, so together the effect can be additive on blood pressure and on potassium loss. Animal data also suggest hibiscus may raise hydrochlorothiazide blood levels by reducing its renal clearance, though this has not been confirmed in humans.
dark chocolate + blood pressure medications
Cocoa flavanols in dark chocolate boost nitric-oxide-dependent vasodilation and modestly lower blood pressure. On top of antihypertensive medication the effect is additive and usually helpful, but in sensitive people it can occasionally nudge readings low enough to cause light-headedness.
celery juice + blood pressure medications
Celery contains phthalides (including 3-n-butylphthalide), nitrate, and potassium that relax blood vessels and have a mild blood-pressure-lowering effect demonstrated in a human trial of celery seed extract. Drinking celery juice regularly can add to the effect of antihypertensive drugs such as ACE inhibitors, ARBs, calcium channel blockers, and diuretics, potentially pushing blood pressure lower than intended.
beetroot + sildenafil
Beetroot is rich in dietary inorganic nitrate, which the body converts to nitric oxide, the same blood-vessel-relaxing pathway that sildenafil (a PDE5 inhibitor) amplifies. The formal contraindication on sildenafil is for organic nitrate drugs, not food, but concentrated beetroot juice and nitrate supplements can lower blood pressure enough that combining them with sildenafil may add to its blood-pressure-lowering effect. This is a mechanism-based caution rather than a documented danger.
beetroot + tadalafil
Beetroot's dietary nitrate is converted in the body to nitric oxide, which relaxes blood vessels and modestly lowers blood pressure. Tadalafil is a long-acting PDE5 inhibitor that prolongs the same nitric-oxide signal. Concentrated beetroot products taken alongside tadalafil can add to its blood-pressure-lowering effect. Whole-food amounts of beets are generally not a concern.
pomegranate + ace inhibitors
Pomegranate juice modestly lowers blood pressure on its own and can add to the blood-pressure-lowering effect of ACE inhibitors; it also contributes dietary potassium, which may compound the potassium-retaining effect of these drugs.
alcohol + nitroglycerin
Both nitroglycerin and alcohol widen blood vessels, so taking them together can lower blood pressure more than either does alone. This additive drop can cause dizziness, fainting, or worsened chest pain, and it is most pronounced with fast-acting sublingual tablets or spray. The combination has been recognized since an early case report in the New England Journal of Medicine in 1965.