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patients may elect to use omega-3 dietary supplements due to their convenience or the inability to consume enough omega-3 fatty acids through diet alone. The AHA recommends the consumption of omega- 3 fatty acids from fish and plant sources at least twice a week for all individuals because of the role these fatty acids play in cardiovascular protection. 8 Commonly used omega-3 dietary supplements con- tain fish oil (which provides eicosapen- taenoic acid and docosahexaenoic acid [DHA]) or flaxseed oil (which provides alpha-linolenic acid). Algae oils are a vegetarian source of DHA. 9 Patients with an allergy or a hypersensitivity to any of these products should avoid using them. Common adverse effects (AEs) asso- ciated with the use of omega-3 supple- ments include acid reflux, indigestion, nausea, diarrhea, and increased burp- ing. 7,9 Gastrointestinal (GI) AEs can be minimized if fish oil is taken with meals and if doses are started at a low level and gradually increased. 7 The most common drugs and supplements that interact with omega-3 supplements include aspirin, anticoagulants, antiplatelet agents, and some herbal supplements. 6,7 In addition, caution should be exercised by patients with diabetes because omega-3 fatty acid supplements may slightly decrease blood glucose. Remind patients who ingest more than 3 g of omega-3 fatty acids in supplement form that they should do so only under a physician's care, since high intakes may result in excessive bleeding or worsen heart rhythm in individuals with arrthymias. 6 Coenzyme Q10 CoQ10 is found in every human cell, pri- marily with the greatest concentrations in the mitochondria of the heart, liver, pancreas, and kidneys. 6 This supplement has been used to treat cardiovascular conditions, including congestive heart failure, cardiomyopathy, and hyperten- sion, and has been popular for managing AEs of statin drugs, such as myopa- thy. 6,10-12 More research is needed to conclude whether CoQ10 is useful for treating statin myopathy; currently, there is no research regarding the effective- ness of CoQ10 supplementation for the prevention of statin myopathy. 6,10-12 The most common AEs include insomnia, nausea, GI distress, anorexia, headache, heartburn, sensitivity to light, dizziness, rashes, and irritability. 10,12 Patients who are taking warfarin should discuss the use of CoQ10 prior to use since potential vitamin K-like procoagulant effects may occur. 6,10,12 Patients should have their international normalized ratios moni- tored more frequently until the effects of CoQ10 can be determined. 6,10,12 Garlic Garlic supplements have been used to treat conditions such as hyperlipidemia, hypertension, and type 2 diabetes and to prevent various cancers. 6,13,14 Garlic sup- plements are manufactured from dried or fresh bulbs of the Allium sativum plant. 6 Results from animal studies and in vitro studies show that garlic has hypotensive, hypolipidemic, antiplatelet, and antiin- fective properties. 6 The most common AEs include nausea, vomiting, and heart- burn, all of which typically occur with megadoses. 6,13,14 Due to the antithrom- botic effects of these supplements, they should be discontinued at least 10 to 14 days before any surgical procedure. 6 To avoid complications, patients should be reminded to discuss this issue with their PHCP. 6 In addition, due to potential bleeding risks, patients taking warfarin or other platelet-active agents should be advised to consult their PHCP prior to using garlic supplements. 6 Study results have shown that the use of garlic supple- ments may also decrease concentrations of the drug saquinavir by an estimated 50%; therefore, the use of garlic supple- ments and agents for treating HIV should typically be avoided. 6 Red Yeast Rice Red yeast rice, also known as Monascus purpureus, is yeast that grows on fer- mented rice and is often used in Chinese medicine. 6,15,16 Red yeast rice supple- ments are often used to lower lipid con- centrations. 6,15,16 They contain multiple components, one of which is mona- colin K, a naturally occurring lovas- tatin analogue. 6,15,16 Because this yeast contains a chemical comparable to the prescription drug lovastatin, its use may cause similar AEs, such as liver damage, severe muscle pain, and muscle dam- age. 15,16 The FDA has determined that red yeast rice products containing more than trace amounts of monacolin K are unapproved new drugs and cannot be sold legally as dietary supplements. 15 The most common AEs associated with this supplement include allergic reac- tions, headache, bloating, heartburn, and flatulence. 6 In addition, rhabdomyolysis and increases in liver function test results have been observed in patients who take red yeast supplements; therefore, liver function should be regularly evaluated in these patients. 6 Resveratrol Resveratrol is classified as a polyphenol and is found in grapes, wine, blue- berries, and pistachios. 6 Several clini- cal studies have investigated the link between resveratrol and its cardioprotec- tive effects. According to the National Institute of Diabetes and Digestive and Kidney Diseases, resveratrol has been proposed as a treatment for hyperlipid- emia and to prevent fatty liver, diabetes, atherosclerosis, and aging; its use has not been associated with serum enzyme elevations or with clinically apparent liver injury. 17 High dietary intake of resveratrol is linked to lower lipid levels, blood pressure, glucose levels, and heart rates. 6 There is no conclusive evidence regarding the benefits of using resvera- trol supplements. 17 The most common AEs include minor GI upset, nausea, headache, and fatigue; possible supple- ment–drug interactions include estrogens and anticoagulants. 17 For references, a table, and conclusion go to PharmacyTimes .com/publications/issue. MORE @ PHARMACY TIMES.COM In the 2015 Survey of Pharmacists' OTC Recommendations, your col - leagues recommend: Cholesterol Management Metamucil ................................43% Slo-Niacin ..................................37% Nature Made Cholestoff .........14% One a Day Cholesterol Plus ......3% Natrol Cholesterol Balance .......2% Other ..........................................2% Go to www.OTCGuide.net for other product recommendations . What Does the OTC GUIDE Say? 2015 -2016 OTC FOCUS A PHARMACIST'S GUIDE TO OTC THERAPY 24 PharmacyTimes.com December 2015 What supplements do you recommend for heart health? Tweet them @Pharmacy_ Times