Epoprostenol and Bilberry: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Epoprostenol
Bilberry
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased risk of bleeding
Interaction Deep Dive
Theoretically, bilberry may potentiate the effects of antiplatelet agents. One case report describes a patient taking several herbal medicines including bilberry (Vaccinium myrtilis (VMA)) who developed substantial postoperative bleeding1. Oral doses of VMA (Myrtocyan(R)), inhibited platelet aggregation in humans 2. VMA inhibited platelet aggregation and prolonged bleeding time in rabbits 3. VMA increased production of prostaglandin I2-like substances in vascular tissues in rats, leading to enhanced anti-aggregatory mechanisms 4.
Why it happens (mechanism)
Additive antiplatelet effects
Literature reports
2 reports — tap to read
a) A 60-year-old female taking several undisclosed dietary supplements up to the day of surgery (left modified radical mastectomy with sentinel node biopsy and right breast reduction) experienced substantial postoperative bleeding. Herbal supplements included bilberry, ginkgo, huang qi (astragalus), and ginseng. Vitamin supplements included vitamin E, vitamin C, and vitamin B12. Prescription medications included montelukast, albuterol, salmeterol, fluticasone, quinine, and sertraline. Preoperative labs were normal except for a slightly prolonged prothrombin time of 15.6 seconds (reference range, 10.2 to 12.3 seconds), and INR 1.27 (normal 1). The patient and surgeons were informed of the possible increased risk of bleeding due to the herbal supplements and agreed to proceed with surgery. No medicines that could affect bleeding were given during surgery. Blood loss during the procedure was estimated at 250 milliliters (mL). In the postanesthesia unit both breasts and axilla were noted to have significant ecchymotic discoloration. Surgical drains collected 269 mL of grossly bloody fluid, Hgb and Hct were 10.1 g/dL and 26% respectively. The patient required emergency exploratory surgery with removal of a hematoma. The authors concluded that the combination of dietary supplements and prescription drugs may have resulted in an acquired coagulation disorder or vitamin K deficiency and increased loss of blood postoperatively in this patient 1.
b) Platelet aggregation induced by collagen or adenosine diphosphate (ADP) was reduced in patients receiving Myrtocyan(R) (Vaccinium myrtilis (VMA)). Thirty healthy subjects who had not used aspirin, nonsteroidal anti-inflammatory drugs, or corticosteroids received VMA 480 milligrams (mg), ascorbic acid 3 grams, or VMA 480 mg plus ascorbic acid 3 grams, daily in three divided doses. VMA decreased both collagen and ADP-induced platelet aggregation at 30 and 60 days of treatment. Addition of ascorbic acid further enhanced the decrease in platelet aggregation 2.
Common questions
Can I take Epoprostenol and Bilberry together?
Increased risk of bleeding Always confirm with your pharmacist or prescriber before making any change.
How serious is the Epoprostenol and Bilberry interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Epoprostenol or Bilberry need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (4)
- Norred CL & Finlayson CA: Hemorrhage after the preoperative use of complementary and alternative medicines. AANA J 2000; 68:217-220.
- Pulliero G, Montin S, Bettini V, et al: Ex vivo study of the inhibitory effects of Vaccinium myrtilis anthocyanosides on human platelet aggregation. Fitoterapia 1989; 60:69-75.
- Morazzoni P & Magistretti MJ: Activity of Myrtocyan(R), an anthocyanoside complex from Vaccinium myrtilis (VMA), on platelet aggregation and adhesiveness. Fitoterapia 1990; 61:13-21.
- Morazzoni P & Magistretti MJ: Effects of Vaccinium myrtilis anthocyanosides on prostacyclin-like activity in rat arterial tissue. Fitoterapia 1986; 57:11-14.
Keep reading about Epoprostenol
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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