Three common herbal supplements are reported to be associated with clinically significant hypokalemia: aloe vera, gossypol (used as a male contraceptive), and licorice.
Another popular herbal supplement is reported to be associated with clinically significant hyperkalemia: oleander.
Always ask your cardiac patients (especially those on digoxin) if they are taking any of these herbal supplements!
[Tachjian A, Maria V, Jahangir A. Use of herbal products and potential interactions in patients with cardiovascular diseases. J Am Coll Cardiol 2010;55:515-525.]
