Concerns With Taking Licorice With Metoprolol
In our latest question and answer, the pharmacist discusses the concern of taking licorice supplements with metoprolol.
I want to improve my problem with GERD. I had it for years but finally got off PPIs. It eventually returned as Silent Reflux, so I am on PPIs again. I'd like to take DGL licorice, Aloe Vera, and similar remedies, but I take Metoprolol for A-fib, and I’ve been advised not to take them together. I’ve had GERD for years and finally got off PPIs, but now I am back on them. I would like to treat it with DGL licorice, Aloe Vera, and similar remedies instead of PPIs, but I understand that Metoprolol for A-fib makes this difficult. Is there any way around this? Thank you.
Jul 02, 2024- Licorice supplements contain glycyrrhizin, which can raise blood pressure, lower potassium, and cause irregular heartbeats that are especially risky if you have atrial fibrillation.
- Deglycyrrhizinated licorice (DGL) has the harmful compound removed and is a safer alternative to regular licorice supplements.
- Talk with your doctor before taking any licorice product, even DGL, since they know your complete medical situation best.
Answer
Thank you for reaching out to us!
The concern you're hearing about is likely due to the potential interaction between metoprolol and licorice supplements. I'll disregard aloe from this conversation as there doesn't appear to be any evidence of a clinically significant interaction between it and metoprolol.
Licorice candy and supplements were a news item a number of years ago due to reports that they can worsen certain cardiovascular conditions, including increasing the risk of arrhythmia. You mentioned you had AFib in your question, and I imagine that is where your concern is coming from.
The FDA posted a warning back in 2017 about licorice (Consumer Updates > Black Licorice: Trick or Treat? (archive-it.org)) and they even posted a YouTube video about it (Black Licorice: Trick or Treat (youtube.com)). Additionally, news outlets also reported on its potential dangers (FDA Issues Warning About Black Licorice For Halloween (forbes.com)).
Why Licorice Is a Concern
Licorice contains a compound called glycyrrhizin, which can be problematic for the heart and blood pressure.
In large amounts, glycyrrhizin has been reported to cause serious issues like high blood pressure, low potassium levels, and irregular heartbeats. This happens because glycyrrhizin may increase the body's cortisol levels, which can lead to fluid retention and other complications.
People with atrial fibrillation (AFib), a condition where the heart beats irregularly, need to be especially careful with licorice. The effects of glycyrrhizin can worsen their condition, increasing the risk of severe heart problems.
Solutions
If you are set on using a licorice supplement, look for deglycyrrhizinated licorice (DGL) products, which have the glycyrrhizin removed and are safer for those with heart issues.
You mentioned DGL licorice in your question, so it seems you are already aware that it is the safer option versus licorice supplements that contain glycyrrhizin. DGL supplements may certainly be an option for you.
I highly recommend speaking with your doctor before taking any supplements, even DGL licorice. It is likely safer for you than other licorice supplements, but since your doctor knows your medical situation best, they are in the best position to provide appropriate advice to you.
Some other natural options (if your doctor doesn't want you to have licorice) include Indian Gooseberry (Efficacy and safety of Amla (Phyllanthus emblica L.) in non-erosive reflux disease: a double-blind, randomized, placebo-controlled clinical trial - PubMed (nih.gov)) and quince.
Final Words
I wanted to thank you again for reaching out. Please do so again anytime.
References & sources
Glossary — Terms in This Answer
- Metoprolol
- A medication that slows heart rate and reduces blood pressure, often prescribed for heart conditions and high blood pressure.
- Arrhythmia
- An irregular heartbeat where the heart beats too fast, too slow, or in an uneven pattern.
- AFib
- A type of irregular heartbeat called atrial fibrillation where the upper chambers of the heart beat chaotically.
- Glycyrrhizin
- The main active compound found in licorice that can affect heart function and blood pressure.
- Cortisol
- A hormone in the body that, when increased, can cause fluid retention and other health issues.
- Atrial fibrillation
- A heart condition where the upper chambers beat irregularly, increasing the risk of complications like stroke.
- Deglycyrrhizinated licorice
- A form of licorice supplement with the potentially harmful compound glycyrrhizin removed, making it safer for heart patients.
- DGL
- An abbreviation for deglycyrrhizinated licorice, a processed form of licorice without the harmful glycyrrhizin compound.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
More answers from Brian →