Variant Angina Associated With Bitter Orange in a Dietary Supplement

Gange, Christopher A.; Madias, Christopher; Felix-Getzik, Erika; Weintraub, Andrew; Estes, N.A. Mark

doi:10.4065/81.4.545

Cited by 48 publications

(22 citation statements)

References 12 publications

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“…Users of commercial weight-loss products should be warned against the use of ephedrinebased products, but even bitter orange, advertised as being "ephedra-free," was reported to induce variant angina. 15 CAS is associated also with marijuana, alcohol, butane, amphetamine, and several over-the-counter, chemotherapy, antimigraine, and antibiotic medications. 16 Perioperative CAS is prevalent in elderly male patients with coronary risk factors; instability of the autonomic nervous system and vascular hyperactivity in these patients are supposed to be the underlying autogenic mechanism of the spasm.…”

Section: Coronary Spasm Under Special Circumstancesmentioning

confidence: 99%

Coronary Artery Spasm

2009

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Section: Coronary Spasm Under Special Circumstancesmentioning

confidence: 99%

Coronary Artery Spasm

2009

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“…Adverse events associated with bitter orange are increased blood pressure and heart rate (Bui, Nguyen, & Ambrose, 2006), myocardial infarction (Nykamp, Fackih, & Compton, 2004), angina (Gange, Madias, Felix-Getzik, Weintraub, & Estes, 2006), and ischemic colitis (Sultan, Spector, & Mitchell, 2006).…”

Section: Bitter Orangementioning

confidence: 99%

Dietary Supplements for Improving Body Composition and Reducing Body Weight: Where Is the Evidence?

Manore¹

2012

International Journal of Sport Nutrition and Exercise Metabolism

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Weight-loss supplements typically fall into 1 of 4 categories depending on their hypothesized mechanism of action: products that block the absorption of fat or carbohydrate, stimulants that increase thermogenesis, products that change metabolism and improve body composition, and products that suppress appetite or give a sense of fullness. Each category is reviewed, and an overview of the current science related to their effectiveness is presented. While some weight-loss supplements produce modest effects (<2 kg weight loss), many have either no or few randomized clinical trials examining their effectiveness. A number of factors confound research results associated with the efficacy of weight-loss supplements, such as small sample sizes, short intervention periods, little or no follow-up, and whether the supplement is given in combination with an energy-restricted diet or increased exercise expenditure. There is no strong research evidence indicating that a specific supplement will produce significant weight loss (>2 kg), especially in the long term. Some foods or supplements such as green tea, fiber, and calcium supplements or dairy products may complement a healthy lifestyle to produce small weight losses or prevent weight gain over time. Weight-loss supplements containing metabolic stimulants (e.g., caffeine, ephedra, synephrine) are most likely to produce adverse side effects and should be avoided.

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“…15 The reported cardiac side effects we identified included tachycardia, tachyarrhythmias, QT prolongation, variant angina, myocardial infarction, cardiac arrest, ventricular fibrillation, syncope, and death. [15][16][17][18][19][20] Most of these side effects occurred when bitter orange was taken with caffeine or ephedrine. Because bitter orange can inhibit the metabolism of drugs by cytochrome P450 3A4 (CYP3A4), taking bitter orange with CYP3A4-metabolized drugs can increase blood levels of those drugs and thus increase the risk of adverse effects.…”

Section: Figurementioning

confidence: 99%