Enhances effects of propranolol, may increase bleeding.

• A. Ginseng
• B. Omega-3 fish oil
• C. Kava-kava
• D. Black cohosh

Answer: (B)

Herb–drug interactions and bleeding risk are important considerations in older adults. Omega-3 fatty acids have antiplatelet effects that can increase bleeding tendency, especially when combined with other agents that affect coagulation. When paired with propranolol, the cardiovascular effects can be additive, potentially lowering blood pressure or heart rate further, which makes this combination particularly noteworthy for safety. That combination is especially relevant because it links both an increased bleeding risk and possible enhanced (hypotensive/bradycardic) effects of the prescription medication.

Ginseng, while it can interact with anticoagulants and affect blood pressure or glucose, isn’t as consistently linked to increased bleeding risk with propranolol. Kava-kava and black cohosh carry other safety concerns (CNS/hepatic effects and interactions with antihypertensives), but they don’t present the same clear bleeding risk when combined with a beta-blocker.