The short answer
Not known. We found no study designed to isolate an interaction between arjuna and a nitrate. In a 2002 trial, 58 men with stable angina took arjuna bark extract, isosorbide mononitrate or a placebo, one week each. During the arjuna week they had fewer angina attacks and needed about a third as much rescue nitrate as on placebo.
So the men did use a rescue nitrate in the arjuna week. But the trial compared arjuna with the mononitrate rather than giving them together, and it included only men. Whether the two together lower blood pressure more than expected is an untested idea. If you take a nitrate for angina, tell your prescribing doctor before you start arjuna, and report any new dizziness or change in your chest pain.
Nitrates sold in India include Monotrate (isosorbide mononitrate) and Nitrocontin (nitroglycerin).
At a glance
| What was seen | How it may work | Direction | Evidence |
|---|---|---|---|
| Fewer angina attacks and less rescue nitrate needed in arjuna weeks[1] | Not established | Indirect: the mononitrate was a comparator; rescue dinitrate was used during arjuna weeks | RCT |
| Long-term arjuna use alongside heart medicines that included nitrates[2] | Not studied | Gastritis in two people and constipation in one; no nitrate-specific results | Observational |
No listing is not a clearance. A missing interaction here never means a combination is safe.
The evidence, study by study
Crossover trial in stable angina, 2002 RCT
Fifty-eight men with stable angina took arjuna bark extract (IPC-53, 500 mg every eight hours), isosorbide mononitrate (40 mg a day) or a placebo. Each treatment lasted a week, with at least three days off in between. In the arjuna week they had fewer angina attacks and used 5.7 mg of rescue isosorbide dinitrate a week, against 18.2 mg on placebo. Treadmill results improved about as much as with the mononitrate. The study included no women, the treatment periods were a week long, and arjuna was never given together with the mononitrate.[1]
Long-term study in coronary artery disease, New Delhi, 2019 Observational
Thirty-five heart patients took arjuna bark extract (500 mg three times a day) with their usual medicines, which included nitrates, for nine months to almost five years. Another 35 took the usual medicines alone. Two people on arjuna reported gastritis and one constipation. The study was small and did not look at the nitrate's effect or at blood pressure drops.[2]
What your doctor may watch for
- How often you get angina and how often you need your rescue tablet. Chest pain that is new, worse or not settling needs a doctor straight away.[1]
- Dizziness or light-headedness, especially on standing up.
What to tell your prescribing doctor
You can read this out, or show them this page:
“I am taking, or planning to take, arjuna (name of product, for example Arjunarishta, and how much) along with my nitrate for angina. Arjuna has been studied in people who also used nitrates, but no study I know of was designed to check how the two interact. Should I keep a record of my angina and my rescue tablets, and is there anything else to watch for?”
Withheld until review
Questions people ask
Can arjuna replace my angina medicine?
No study supports that. In the one trial, arjuna was compared with isosorbide mononitrate for a week at a time, in men only. Any change to angina medicine is for your doctor to decide.[1]
Do heart patients take arjuna along with their usual medicines?
Some do. In a New Delhi study, 35 heart patients took arjuna extract with their usual medicines, nitrates among them, for up to almost five years, and three reported stomach complaints. The study was small and was not designed to find interactions.[2]
Related
Arjunarishta
A fermented arjuna bark liquid used for the heart. It contains alcohol from fermentation, and the only study of it we found was in rats.
InteractionArjuna and blood pressure medicines
Arjuna capsules lowered blood pressure further in people taking telmisartan, in one small 28-day trial. Other BP drugs are untested.
InteractionArjuna and statins for cholesterol
In the lab, arjuna bark extract blocked CYP3A4, an enzyme that clears atorvastatin. Nobody has measured statin levels with arjuna.
InteractionArjuna and digoxin
No study has looked at people taking arjuna with digoxin. In the lab, arjuna made one digoxin blood test read slightly low.
Sources
- Bharani A, Ganguli A, Mathur LK, Jamra Y, Raman PG. Efficacy of Terminalia arjuna in chronic stable angina: a double-blind, placebo-controlled, crossover study comparing Terminalia arjuna with isosorbide mononitrate. Indian Heart J. 2002;54(2):170-175. PMID 12086380.
- Dwivedi S, Chopra D, Bhandari B. Role of Terminalia arjuna Wight and Arn. in the treatment of chronic coronary artery disease from pharmacovigilance point of view. AYU. 2019;40(2):104-108. PMID 32398910.
Updated 4 November 2026
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