Drug & supplement interaction

Cola Nut + Gabapentin

Gabapentin brand names: Neurontin, Gralise.

No Known Interaction
The bottom line No known interaction

We found no known interaction between Cola Nut and Gabapentin in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

Know someone taking this? Share
Interaction report

Cola Nut and Gabapentin

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Gabapentin and Cola Nut in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Cola Nut safety at a glance

Cola Nut overall Use caution Generally tolerated in food amounts but contains caffeine, which can cause stimulant-related effects.
Pregnancy Possibly Safe When used orally in amounts found in foods. Due to the caffeine content of cola nut, pregnant patients should closely monitor their intake to ensure moderate co... Read the full pregnancy detail
Breastfeeding Possibly Safe When used orally in amounts found in foods. Due to the caffeine content of cola nut, caffeine intake should be closely monitored while nursing. Breast milk conc... Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center) — the full detail is in the Special populations card below. Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Gabapentin and Cola Nut? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Gabapentin

Interactions in our licensed database are recorded against drug classes, not just single drug names. Gabapentin is filed under 4 classifications — including anticonvulsants, cns depressants, oral drugs. Cola Nut has documented interactions with 41 drug classes — the most serious being adenosine (adenocard) (moderate), alcohol (ethanol) (moderate) and anticoagulant/antiplatelet drugs (moderate) — and none of Gabapentin’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Cola Nut Does Interact With Other Medications

Cola Nut has 547 moderate, 108 minor known drug interactions in our database — Gabapentin isn’t one of them. If you take anything else, check it against the full list below.

Taking anything else?

Check Another of Your Medications Against Cola Nut

Covers the 2,830 medications we’ve checked against Cola Nut. Pick one to open its full report.

What to actually watch for

No Interaction Found — But Data Suggests Cola Nut and Gabapentin May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do. 4 of them are worth acting on rather than waiting out — marked below.

  • Dependence or withdrawal symptoms / Confusion / Low mood Worth acting on Additional detail

    Cola Nut

    “Cola nut contains caffeine. Caffeine may lead to habituation and physical dependence with amounts as low as 100 mg daily. Higher doses of caffeine have caused nervousness, agitation, anxiety, irritability, delirium, depression, sleep disturbances, impaired attention, psychosis, and panic attacks.”

    Cola Nut · Natural Medicines adverse-effect record, reported in anxiety.

    6 sources cited
    1. 36353. Satoh, E., Ishii, T., Shimizu, Y., Sawamura, S., and Nishimura, M. Black tea extract, thearubigin fraction, counteract the effects of botulinum neurotoxins in mice. Br.J Pharmacol. 2001;132(4):797-798.
    2. 36355. Griffiths, R. R. and Chausmer, A. L. Caffeine as a model drug of dependence: recent developments in understanding caffeine withdrawal, the caffeine dependence syndrome, and caffeine negative reinforcement. Nihon Shinkei Seishin Yakurigaku Zasshi 2000;20(
    3. 36505. Stillner, V., Popkin, M. K., and Pierce, C. M. Caffeine-induced delirium during prolonged competitive stress. Am.J.Psychiatry 1978;135(7):855-856. PubMed
    4. 37717. Whalen, D. J., Silk, J. S., Semel, M., Forbes, E. E., Ryan, N. D., Axelson, D. A., Birmaher, B., and Dahl, R. E. Caffeine consumption, sleep, and affect in the natural environments of depressed youth and healthy controls. J Pediatr.Psychol. 2008;33(4):35 PubMed
    5. 37818. Natale, F., Cirillo, C., Di Marco, G. M., di Vetta, L. S., Aronne, L., Siciliano, A., Mocerino, R., Tedesco, M. A., Golino, P., and Calabro, R. When chewing gum is more than just a bad habit. Lancet 5-30-2009;373(9678):1918. PubMed
    6. 37839. Luebbe, A. M. and Bell, D. J. Mountain Dew or mountain don't?: a pilot investigation of caffeine use parameters and relations to depression and anxiety symptoms in 5th- and 10th-grade students. J Sch Health 2009;79(8):380-387.

    Gabapentin

    Listed in the ADVERSE REACTIONS section of the FDA label for Gabapentin. Read the label on DailyMed ›

  • A severe allergic reaction Worth acting on Additional detail

    Cola Nut

    “Cola nut contains caffeine. Caffeine can cause anaphylaxis in sensitive individuals, although true IgE-mediated caffeine allergy seems to be relatively rare.”

    Cola Nut · Natural Medicines adverse-effect record, reported in allergic rhinitis (hay fever).

    1 source cited
    1. 11315. Infante S, Baeza ML, Calvo M, et al. Anaphylaxis due to caffeine. Allergy 2003;58:681-2. PubMed

    Gabapentin

    Listed in the ADVERSE REACTIONS section of the FDA label for Gabapentin. Read the label on DailyMed ›

  • Mood changes or irritability / Drowsiness / Tiredness reported in 6.9% of FDA reports for Gabapentin Additional detail

    Cola Nut

    Recorded for Cola Nut in the same Natural Medicines adverse-effect record shown under Dependence or withdrawal symptoms / Confusion / Low mood above.

    Gabapentin

    Listed in the ADVERSE REACTIONS section of the FDA label for Gabapentin, and in voluntary FDA adverse-event reports. Read the label on DailyMed ›

  • Anxiety or restlessness / Trouble sleeping Additional detail

    Cola Nut

    “Orally, cola nut may prolong sleep latencies and suppress REM and 3rd and 4th stages of sleep. Cola nut has also been reported to cause insomnia in children and may exacerbate sleep disturbances in patients with acquired immunodeficiency syndrome (AIDS). Caffeine, a constituent of cola nut, can cause headaches, anxiety, jitteriness, restlessness, and nervousness.”

    Cola Nut · Natural Medicines adverse-effect record, reported in anxiety.

    6 sources cited
    1. 57697. Ogunremi OO and Mamora AO. Cola acuminata (Kolanut) and coffee: Acute effects on sleep of Nigerians. Psychopathologie Africaine 1980;16(1):69-75.
    2. 10755. Schechter MD, Timmons GD. Objectively measured hyperactivity--II. Caffeine and amphetamine effects. J Clin Pharmacol 1985;25:276-80.. PubMed
    3. 10204. Dreher HM. The effect of caffeine reduction on sleep quality and well-being in persons with HIV. J Psychosom Res 2003;54:191-8.. PubMed
    4. 36466. Wrenn, K. D. and Oschner, I. Rhabdomyolysis induced by a caffeine overdose. Ann.Emerg.Med. 1989;18(1):94-97. PubMed
    5. 37694. Doan, B. K., Hickey, P. A., Lieberman, H. R., and Fischer, J. R. Caffeinated tube food effect on pilot performance during a 9-hour, simulated nighttime U-2 mission. Aviat.Space Environ Med 2006;77(10):1034-1040.
    6. 37755. Killgore, W. D., Rupp, T. L., Grugle, N. L., Reichardt, R. M., Lipizzi, E. L., and Balkin, T. J. Effects of dextroamphetamine, caffeine and modafinil on psychomotor vigilance test performance after 44 h of continuous wakefulness. J Sleep Res 2008;17(3):3 PubMed

    Gabapentin

    Listed in the ADVERSE REACTIONS section of the FDA label for Gabapentin. Read the label on DailyMed ›

  • Stomach upset Additional detail

    Cola Nut

    “Orally, cola nut may induce gastric acid secretion and cause dyspepsia and peptic ulceration. The caffeine found in cola nut may cause feeding intolerance and gastrointestinal irritation in infants.”

    Cola Nut · Natural Medicines adverse-effect record, reported in dyspepsia.

    4 sources cited
    1. 57672. Holcombe, C., Omotara, B. A., Padonu, M. K., and Bassi, A. P. The prevalence of symptoms of dyspepsia in north eastern Nigeria. A random community based survey. Trop.Geogr.Med 1991;43(1-2):209-214.
    2. 57674. Holcombe, C., Kaluba, J., and Lucas, S. B. Non-ulcer dyspepsia in Nigeria: a case-control study. Trans.R.Soc Trop.Med Hyg. 1991;85(4):553-555. PubMed
    3. 57683. Ibu, J. O., Iyama, A. C., Ijije, C. T., Ishmael, D., Ibeshi, M., and Nwokediuko, S. The effect of cola acuminata and cola nitida on gastric acid secretion. Scand J Gastroenterol Suppl 1986;124:39-45. PubMed
    4. 6023. Tobias JD. Caffeine in the treatment of apnea associated with respiratory syncytial virus infection in neonates and infants. South Med J 2000;93:297-304. DOI

    Gabapentin

    Listed in the ADVERSE REACTIONS section of the FDA label for Gabapentin. Read the label on DailyMed ›

Showing the 10 most notable of 12 shared effects — ranked by how unusual each one is, not just whether both lists mention it.

Reported for Cola Nut but not commonly for Gabapentin: trouble concentrating, raised blood pressure, an irregular heartbeat and bone thinning.

Effects for Gabapentin come from the ADVERSE REACTIONS section of its FDA label; effects for Cola Nut come from the Natural Medicines adverse-effect record, quoted above. Where a percentage is shown, it is the share of 361,481 voluntary FDA FAERS reports for Gabapentin that mention that effect — a reporting proportion, not an incidence rate and not evidence the drug caused it. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

Special populations

Cola Nut in Pregnancy & Breastfeeding

Pregnancy Possibly Safe

When used orally in amounts found in foods. Due to the caffeine content of cola nut, pregnant patients should closely monitor their intake to ensure moderate consumption. Fetal blood concentrations of caffeine approximate maternal concentrations. The use of caffeine during pregnancy is controversial; however, moderate consumption has not been associated with clinically important adverse fetal effects. In some studies, consuming amounts over 200 mg daily is associated with a significantly increased risk of miscarriage. This increased risk may be most likely to occur in those with genotypes that confer a slow rate of caffeine metabolism. According to a review by Health Canada, and a subsequent large meta-analysis conducted in the US, most healthy pregnant patients can safely consume caffeine in doses up to 300 mg daily without an increased risk of spontaneous abortion, stillbirth, preterm birth, fetal growth retardation, or congenital malformations. Advise keeping caffeine consumption below 300 mg daily. This is similar to the amount of caffeine in about 3 cups of coffee or tea. Keep in mind that only the amount of ADDED caffeine must be stated on product labels. The amount of caffeine found in ingredients such as cola nut, which naturally contains caffeine, does not need to be provided. This can make it difficult to determine the total amount of caffeine in a given product.

Pregnancy Possibly Unsafe

When caffeine, a constituent of cola nut, is used orally in amounts over 300 mg daily. Caffeine crosses the placenta, producing fetal blood concentrations similar to maternal levels. Advise keeping caffeine consumption from all sources below 300 mg daily. High doses of caffeine throughout pregnancy have resulted in symptoms of caffeine withdrawal in newborn infants. High doses of caffeine have also been associated with spontaneous abortion, premature delivery, and low birth weight. Keep in mind that only the amount of added caffeine must be stated on product labels. The amount of caffeine found in ingredients such as cola nut, which naturally contains caffeine, does not need to be provided. This can make it difficult to determine the total amount of caffeine in a given product. In a study that included 2 large cohorts of mother/infant pairs, the first cohort with a median maternal plasma caffeine level of 168.5 ng/mL (range 29.5-650.5 ng/mL) during pregnancy, suggests birth weights and lengths were lower in the 4th quartile of caffeine intake compared with the 1st. By age 7, heights and weights were lower by 1.5 cm and 1.1 kg, respectively. In the second cohort of mother/infant pairs with higher maternal pregnancy plasma caffeine levels, median 625.5 ng/mL (range 86.2 to 1994.7 ng/mL), heights at age 8 were 2.2 cm lower, but there was no difference in weights.

Lactation Possibly Safe

When used orally in amounts found in foods. Due to the caffeine content of cola nut, caffeine intake should be closely monitored while nursing. Breast milk concentrations of caffeine are thought to be approximately 50% of maternal serum concentrations. Minimal consumption would likely result in limited exposure to a nursing infant.

Lactation Possibly Unsafe

When used orally in large amounts. Consumption of cola nut might cause sleep disturbances, irritability, and increased bowel activity in nursing infants due to its caffeine content. Large doses or excessive intake of cola nut should be avoided during lactation. It is unknown whether potentially carcinogenic constituents of cola nut are transferred via breast milk.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.© 2026 Therapeutic Research Center

From our Q&A

Questions About Cola Nut or Gabapentin

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Cola Nut or Gabapentin, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Gabapentin

This page covers Cola Nut only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Gabapentin page lists 106 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: 1,4-butanediol (major), Activated Charcoal (major), Beer (major), Gamma-hydroxybutyrate (ghb) (major) and Kava (major).

By severity: 7 major · 82 moderate · 17 minor.

From our pharmacist’s overview on the Gabapentin page

“Gabapentin (Neurontin, Gralise) calms overactive nerves, which means it already slows your nervous system down, and that is exactly what 78 of the 106 supplements on this list also do. So the dominant risk here is sedation stacked on sedation, extra drowsiness at best and dangerously slowed breathing at worst, and with seven entries ra…”

Reviewed by 2 · Jul 18, 2026

Open the Gabapentin interaction page

One more smart check

Taking Cola Nut as Part of a Dietary Supplement Product? Check It for Interactions

We hold 2 real supplement products containing Cola Nut, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Cola Nut. Even though Cola Nut itself has no known interaction with Gabapentin, another ingredient on your label might. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Cola Nut and Gabapentin Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Cola Nut
Steady interest

#1,048 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Gabapentin
Top 5%

#42 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Cola Nut reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 13, 2026. The Cola Nut and Gabapentin records this page draws on were last updated July 11, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
Supplement

About Cola Nut

What is Cola Nut?

Cola Nut
  • Energy and alertness
  • Mental focus
  • Physical performance
  • Weight loss support
  • Traditional digestive aid

Cola nut is a caffeine-containing seed from West Africa used mainly as a natural stimulant for energy and alertness. Most of its effects come from caffeine, and strong human evidence for specific health benefits is limited. Because of its caffeine content, people sensitive to stimulants and those who are pregnant or have heart conditions should be cautious.

Cola acuminata · Malvaceae · Seeds (nuts) · Capsules, powders, extracts, teas, energy drinks, and weight-loss products

An interaction check asks whether these two react with each other — it does not ask whether Cola Nut is a good idea for someone in your situation. Here is what our Cola Nut record says about it on its own.

Cola Nut: dosing

There is no well-established standardized dose for cola nut supplements. The amount of caffeine in products can vary widely depending on the form and brand.If you choose to use a cola nut product, follow the directions on the label and do not exceed the recommended amount. Keep in mind your total daily caffeine from all sources, including coffee, tea, and energy drinks.

From our Cola Nut monograph — the full record covers uses, side effects and every documented interaction.

Read the full Cola Nut monograph & all interactions
Medication

About Gabapentin

What Is Gabapentin Used For?

Brand names: Neurontin, Gralise

Gabapentin (brands include Neurontin, Relgaabi, Gabarone, Gralise, and Horizant) is primarily used to manage postherpetic neuralgia (PHN) — the nerve pain that lingers after a shingles outbreak — in adults. Neurontin, Relgaabi, Gabarone, and gabapentin capsules, tablets, and oral solution are also used as add-on therapy for partial onset seizures (a type of epilepsy) in adults and children aged 3 and older.

Horizant (gabapentin enacarbil extended-release tablet) has two specific approvals: treatment of moderate-to-severe primary restless legs syndrome (RLS) in adults, and management of postherpetic neuralgia in adults. Horizant is not recommended for people who need to sleep during the day and stay awake at night. Gralise is approved only for postherpetic neuralgia and cannot be substituted for other gabapentin products due to its different release profile.

Most-Reported Side Effects for Gabapentin

From FAERS, the FDA’s public side-effect reporting system (361,481 reports, all brands). Reports are voluntary and are not proof the drug caused the effect.

Fatigue 24,972 reports
Nausea 22,728 reports
Diarrhea 18,114 reports
Headache 17,897 reports
Dizziness 16,238 reports
See full Gabapentin drug information
Keep checking

Other Drugs & Cola Nut

Browse every other medication we’ve checked against Cola Nut — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
547Moderate
108Minor
2,174No known interaction
Moderate

547 interactions

Showing 60 of 547 moderate interactions — see all 547 on the Cola Nut page.

Minor

108 interactions

Showing 60 of 108 minor interactions — see all 108 on the Cola Nut page.

No interaction 2,174 drugs checked — show the list
Evidence & sources

Cola Nut References

The 157 references that drive our Cola Nut monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. McEvoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.
  2. Harder S, Fuhr U, Staib AH, Wolff T. Ciprofloxacin-caffeine: a drug interaction established using in vivo and in vitro investigations. Am J Med 1989;87:89S-91S. PubMed
  3. Carbo M, Segura J, De la Torre R, et al. Effect of quinolones on caffeine disposition. Clin Pharmacol Ther 1989;45:234-40. PubMed
  4. Healy DP, Polk RE, Kanawati L, et al. Interaction between oral ciprofloxacin and caffeine in normal volunteers. Antimicrob Agents Chemother 1989;33:474-8. PubMed
  5. Mester R, Toren P, Mizrachi I, et al. Caffeine withdrawal increases lithium blood levels. Biol Psychiatry 1995;37:348-50. PubMed
  6. Jefferson JW. Lithium tremor and caffeine intake: two cases of drinking less and shaking more. J Clin Psychiatry 1988;49:72-3.
  7. Joeres R, Klinker H, Heusler H, et al. Influence of mexiletine on caffeine elimination. Pharmacol Ther 1987;33:163-9. PubMed
  8. Vahedi K, Domingo V, Amarenco P, Bousser MG. Ischemic stroke in a sportsman who consumed MaHuang extract and creatine monohydrate for bodybuilding. J Neurol Neurosurg Psychiatr 2000;68:112-3.
  9. Wakabayashi K, Kono S, Shinchi K, et al. Habitual coffee consumption and blood pressure: A study of self-defense officials in Japan. Eur J Epidemiol 1998;14:669-73. PubMed
  10. Hodgson JM, Puddey IB, Burke V, et al. Effects on blood pressure of drinking green and black tea. J Hypertens 1999;17:457-63. PubMed
  11. Rapuri PB, Gallagher JC, Kinyamu HK, Ryschon KL. Caffeine intake increases the rate of bone loss in elderly women and interacts with vitamin D receptor genotypes. Am J Clin Nutr 2001;74:694-700. PubMed
  12. The National Toxicology Program (NTP). Caffeine. Center for the Evaluation of Risks to Human Reproduction (CERHR). Available at: http://cerhr.niehs.nih.gov/common/caffeine.html.
  13. Klebanoff MA, Levine RJ, DerSimonian R, et al. Maternal serum paraxanthine, a caffeine metabolite, and the risk of spontaneous abortion. N Engl J Med 1999;341:1639-44. PubMed
  14. Eskenazi B. Caffeine—filtering the facts. N Engl J Med 1999;341:1688-9. PubMed
  15. Fernandes O, Sabharwal M, Smiley T, et al. Moderate to heavy caffeine consumption during pregnancy and relationship to spontaneous abortion and abnormal fetal growth: a meta-analysis. Reprod Toxicol 1998;12:435-44. PubMed

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking Cola Nut and Gabapentin Together: Common Questions

Is it safe to take Cola Nut with Gabapentin?
We do not list a known interaction between Cola Nut and Gabapentin. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
Do Cola Nut and Gabapentin have any of the same side effects?
Yes — our sources link each of them separately to 10 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.
How was the Cola Nut and Gabapentin combination checked?
Interactions in our licensed database are recorded against drug classes. Gabapentin is filed under 4 classifications, and Cola Nut has documented interactions with 41 drug classes — none of Gabapentin's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does Cola Nut interact with any other medications?
Yes. Cola Nut has 655 documented drug interactions in our database — Gabapentin is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Gabapentin interact with any supplements?
Yes. Gabapentin has documented interactions with 106 supplements in our database — Cola Nut is not one of them. The Gabapentin interaction page linked on this page lists every one, ranked by severity.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Gabapentin and Cola Nut?

Our pharmacists answer your medication & supplement questions — free.

Ask a pharmacist

This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.