AfterShock Orange Avalanche Ingredients & Drug Interactions
by MYOGENIX
What is this page for?
First and foremost: checking AfterShock Orange Avalanche against your medications. The heart of this page is the interaction checker and the full interaction report — how this product’s ingredients may interact with prescription and over-the-counter medicines you may be taking.
Around that, we add a pharmacist’s high-level view of the product as a whole — what’s inside, the evidence for its stated use, how transparent the label is, and what safety data exists — so you can see the full picture in one place. It’s educational information from our licensed clinical databases and the clinical staff at HelloPharmacist — not medical advice — and we don’t sell or endorse products. Our editorial policy
AfterShock Orange Avalanche is a dietary supplement by MYOGENIX with 19 active ingredients. Its ingredients are commonly taken for morning sickness in pregnancy, premenstrual syndrome (pms), preventing or treating b6 deficiency.Based on those ingredients, 1,584 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Joint Support Blend {Combination}, Vitamin E, Niacin. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against AfterShock Orange Avalanche by MYOGENIX
Ask about any prescription or over-the-counter medication and we check it for interactions with AfterShock Orange Avalanche by MYOGENIX — and tell you which ingredient is responsible.
AI summaries are generated from our interaction database for education only — always confirm with your pharmacist. How we use AI
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HelloPharmacist Scorecard of AfterShock Orange Avalanche by MYOGENIX
Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.
What’s inside
Partial disclosure
AfterShock Orange Avalanche contains 19 ingredients total. The active components include L-Glutamine (an amino acid), multiple B vitamins (B6, B12, thiamine, riboflavin, niacin, and pantothenic acid), Vitamin C, Vitamin E, Vitamin A, Potassium, Sodium, Magnesium (as Magnesium Glycyl Glutamine Chelate and MagnaPower Magnesium Creatine Chelate), Glucosamine Sulfate, and Chondroitin Sulfate for joint support.
The product also includes an amino acid blend and a magnesium creatine chelate formulation. Three ingredients—Folate, L-Norvaline, and MSM—couldn't be checked against our interaction database.
The inactive ingredients are listed separately and include the protein blend, glycogen support, cane sugar, flavoring, citric acid, citrate salts, beta-carotene, spray-dried orange, sucralose, and alpha lipoic acid.
Does it work?
Not established
The evidence for effectiveness varies by ingredient and use. L-Glutamine is rated effective for sickle cell disease and possibly effective for HIV/AIDS-related wasting, postoperative recovery, and critical illness.
Vitamin B6 is effective for sideroblastic anemia and vitamin B6 deficiency, and possibly effective for pregnancy-induced nausea and vomiting. Vitamin B12 is effective for B12 deficiency and Imerslund-Grasbeck disease.
Vitamin C is effective for vitamin C deficiency and possibly effective for atrial fibrillation and cataracts. Vitamin E is effective for vitamin E deficiency and AVED, and possibly effective for Alzheimer disease and beta-thalassemia.
Vitamin A is effective for vitamin A deficiency and possibly effective for oral leukoplakia, aging skin, and measles. Glucosamine Sulfate is rated likely effective for osteoarthritis.
Niacin is likely effective for pellagra and possibly effective for HIV/AIDS-related dyslipidemia. Magnesium is effective for dyspepsia, constipation, and hypomagnesemia.
Thiamine is effective for thiamine deficiency and Wernicke-Korsakoff syndrome. Chondroitin is possibly effective for osteoarthritis and cataracts.
Pantothenic acid is effective for pantothenic acid deficiency. Riboflavin, Potassium, Sodium, and Chondroitin have no effectiveness ratings on file for us.
How safe is it?
Well-documented data
Most ingredients are generally well tolerated at recommended amounts. However, several carry important cautions.
L-Glutamine is rated likely safe in pregnancy and lactation, though those with kidney or liver disease should use it only under medical supervision. Vitamin B6 at high doses over time can harm nerves (sensory neuropathy), and its pregnancy/lactation rating is mixed—likely safe in pregnancy but possibly unsafe.
Vitamin C is likely safe in pregnancy and lactation at normal amounts, though possibly unsafe at very high doses. Vitamin E is possibly safe in pregnancy and likely safe in lactation.
Vitamin A is possibly unsafe in pregnancy at high doses (especially as retinol, which can cause birth defects) and possibly unsafe in lactation. Potassium is likely safe in pregnancy and lactation from dietary sources, but supplements require medical guidance.
Sodium is likely safe in pregnancy and lactation at normal intake but possibly unsafe at high intake. Niacin is likely safe in pregnancy and lactation.
Magnesium is likely safe in pregnancy and lactation. Riboflavin, Thiamine, and Pantothenic Acid are rated likely safe in pregnancy and lactation.
Chondroitin has insufficient safety data and is advised against in pregnancy and lactation. Glucosamine also has insufficient safety data and is advised against in pregnancy and lactation.
Common adverse effects from the active ingredients include gastrointestinal symptoms (nausea, vomiting, diarrhea, constipation, bloating, heartburn), headache, and nausea. At high doses, some ingredients carry more serious risks: Vitamin B6 can cause sensory neuropathy; Vitamin E can increase bleeding risk and may raise hemorrhagic stroke risk in some populations; Vitamin A can cause liver toxicity, pseudotumor cerebri, and birth defects; and Niacin can cause hepatotoxicity at high doses.
Meds to double-check
Major interaction found
If you take any of the following medication types, check with your pharmacist or doctor before using this product. Most critical: warfarin or other blood thinners (Major risk with Glucosamine and Vitamin E).
Also important: levodopa/carbidopa, quinolone antibiotics, bisphosphonates, skeletal muscle relaxants, anticonvulsants, antihypertensive drugs, lithium, potassium-sparing diuretics, ACE inhibitors, ARBs, metformin, tetracycline antibiotics, estrogen-containing birth control or hormone therapy, niacin-interacting drugs (statins, hepatotoxic drugs, antidiabetes drugs, uricosuric agents), and chemotherapy drugs. No interactions are documented in our data for Folate, L-Norvaline, or MSM.
The bottom line
Scorecard at a glancePartially disclosed formula with no established evidence rating for its marketed use. Major medication interactions have been identified, and safety information is well characterized.
This supplement is a multivitamin and joint-support formula with ingredients used in sports recovery and post-workout nutrition. If you take warfarin or any blood thinner, do not use this product without talking to your pharmacist or doctor first—the Glucosamine Sulfate poses a Major interaction risk.
Anyone on levodopa/carbidopa for Parkinson's disease, taking quinolone antibiotics or bisphosphonates, using skeletal muscle relaxants, on anticonvulsants, or managing blood pressure, blood sugar, or mood disorders should double-check their specific medications before starting. Pregnant people should discuss this product with their doctor, especially if considering high doses of vitamin A or other fat-soluble vitamins.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 15 of 19 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Jul 24, 2015.
This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed
General information
Key facts about AfterShock Orange Avalanche, straight from the product label.
| Brand | MYOGENIX |
|---|---|
| Barcode (UPC) | 680269119516 |
| Net contents | 2.64 lbs |
| Market status | On market |
| Date entered into DSLD | Jul 24, 2015 |
| DSLD ID | 47904 |
| Product type | Other Combinations |
| Supplement form | Powder |
| Dietary claims / uses | Nutrient, All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years) |
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.
Supplement Facts
The label details for AfterShock Orange Avalanche by MYOGENIX, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Calories | 290 {Calories} | -- |
| Total Carbohydrates | 35 Gram(s) | 12% |
| L-Glutamine | 0 NP | -- |
| Sugar | 17 Gram(s) | -- |
| Calories from Fat | 10 {Calories} | -- |
| Vitamin B6 | 4 mg | 200% |
| Protein | 34 Gram(s) | -- |
| Saturated Fat | 0.5 Gram(s) | 3% |
| Sodium | 70 mg | 3% |
| Vitamin B12 | 12 mcg | 200% |
| Potassium | 250 mg | 7% |
| Cholesterol | 35 mg | 12% |
| Riboflavin | 3.4 mg | 200% |
| Total Fat | 1.5 Gram(s) | 2% |
| Thiamine | 3 mg | 200% |
| Vitamin C | 1000 mg | 1670% |
| Pantothenic Acid | 20 mg | 200% |
| Niacin | 40 mg | 200% |
| Chondroitin Sulfate | 0 NP | -- |
| Vitamin E | 60 IU | 200% |
| Glucosamine Sulfate | 0 NP | -- |
| Folate | 800 mcg | 200% |
| L-Norvaline | 0 NP | -- |
| MSM | 0 NP | -- |
| Vitamin A | 1000 IU | 20% |
| AMINO STACK | 8 Gram(s) | -- |
| MagnaPower Magnesium Creatine Chelate | 0 NP | -- |
| Magnesium Glycyl Glutamine Chelate | 0 NP | -- |
| Joint Support Blend {Combination} | 1.5 Gram(s) | -- |
Other ingredients: AfterShock(TM) Fast Absorption Protein Blend, Glycogenx(TM), Cane, Natural & Artificial flavors, Citric Acid, Potassium Citrate, Sodium Citrate, Beta-Carotene, spray dried Orange, Sucralose, Alpha Lipoic Acid
Tap any ingredient to jump to its full detail below.
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
Formula
Each serving of AfterShock(TM) contains: 34 grams Anabolic Whey Protein (Lactose Free, Fast Digesting Proteins With Di & Tri Peptides) 35 grams MassBuilding Carbohydrates (Rapid Absorption, Glycogen Replenishing Carbohydrates) 14 grams Amino Stack(TM) – Creatine & Glutamine Plus BCAAs (With High Absorption, Patented MagnaPower(R) (Magnesium Creatine Chelate), Magnesium Glycyl Glutamine, Leucine, Isoleucine, Valine, & Arginine) 1500 mg Joint Support Formula (Glucosamine, Chondroitin & MSM) Strong Antioxidant Blend (Alpha Lipoic Acid, Vitamin C & B-Vitamins)
34 grams LACTOSE FREE PROTEIN with 35 grams MASSBUILDING CARBOHYDRATES 14 grams Amino Stack PATENTED MAGNAPOWER(R) CREATINE & GLUTAMINE Plus BCAAs
ALLERGEN STATEMENT: THIS PRODUCT CONTAINS INGREDIENTS DERIVED FROM MILK, SOY, AND CRUSTACEANS.
Brand IP Statement(s)
Take AfterShock(TM) and Surge Past Genetic Limitations!
(C) All Rights Reserved.
ANABOLIC WINDOW THE KEY TO UNLIMITED MUSCLE GROWTH The anabolic window is a 30 minute period of time, immediately post exercise, when your body is primed for muscle growth, if given the proper nutrients. AfterShock(TM) contains these vital nutrients, absolutely critical for muscle growth, glycogen replenishment, and recovery.
FDA Disclaimer Statement
These statements have not been approved by the FDA. This product is not intended to diagnose, treat, cure, or prevent any diseases.
General Statements
Anabolic Window Muscle Activator Technology of Muscle
Tactical Post-Workout Catalyst
Muscularity Strength Recovery Endurance
Made in the USA
FDA Statement of Identity
Dietary Supplement
Suggested/Recommended/Usage/Directions
DIRECTIONS: Mix one serving of AfterShock(TM) (80 grams) with 12 to 16 oz of water and consume immediately after exercising. For Total Body Transformation(TM) use Hyper Shock(R) Rage pre-workout, and MyoLean Evolution(TM).
Precautions
Warning: Consult your healthcare professional prior to use if you have or suspect a medical condition, are taking prescription drugs, are pregnant or lactating, or have an allergy to shellfish.
Warning: Consult your healthcare professional prior to use if you have or suspect a medical condition, are taking prescription drugs, are pregnant or lactating, or have an allergy to shellfish.
ALLERGEN STATEMENT: THIS PRODUCT CONTAINS INGREDIENTS DERIVED FROM MILK, SOY, AND CRUSTACEANS. MANUFACTURED IN A FACILITY THAT PROCESSES MILK, SOY, EGGS, AND WHEAT.
Storage
Store in a cool, dry place, away from sunlight.
General
Item 11951 Rev. 1 10/2013
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
AfterShock Orange Avalanche by MYOGENIX label
The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.
Label images are published by the NIH Dietary Supplement Label Database for the version of this product on file. Always read your actual product label.
View the full label (PDF)The Ingredients in AfterShock Orange Avalanche by MYOGENIX
These are the 19 active ingredients this product is made of. Select any to open its full monograph.
Serving size80 Gram(s) Dosage formPowder Servings per container15 Amounts shown are per serving.
Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.
Sugar
Vitamin B6
Interacts with210 drugs
Vitamin B6 (pyridoxine) is an essential water-soluble vitamin that your body needs for metabolism, brain function, and making red blood cells. It is b...
Vitamin B6 monograph & interactionsProtein
Sodium
Interacts with205 drugs
Sodium is an essential mineral and electrolyte your body needs to balance fluids, support nerves, and help muscles work. Most people in modern diets g...
Sodium monograph & interactionsVitamin B12
Interacts with20 drugs
Vitamin B12 (cobalamin) is an essential nutrient your body needs to make red blood cells, keep nerves healthy, and support DNA. Supplements are very h...
Vitamin B12 monograph & interactionsPotassium
Interacts with62 drugs
Potassium is an essential mineral your body needs for nerve signals, muscle function, and a steady heartbeat, and most people get enough from a balanc...
Potassium monograph & interactionsRiboflavin
Interacts with20 drugs
Riboflavin (vitamin B2) is an essential nutrient your body needs to turn food into energy and to keep skin, eyes, and nerves healthy. It is generally...
Riboflavin monograph & interactionsThiamine
Interacts with3 drugs
Thiamine (vitamin B1) is an essential nutrient your body needs to turn food into energy and to keep your nerves and heart healthy. Most people get eno...
Thiamine monograph & interactionsVitamin C
Interacts with207 drugs
Vitamin C (ascorbic acid) is an essential nutrient your body needs but cannot make, so you must get it from food or supplements. It's important for im...
Vitamin C monograph & interactionsPantothenic Acid
No knowninteractions
Pantothenic acid is vitamin B5, an essential nutrient your body uses to turn food into energy. True deficiency is very rare because it is found in nea...
Pantothenic Acid monograph & interactionsNiacin
Interacts with727 drugs
Niacin (vitamin B3) is an essential nutrient your body needs for energy and metabolism, and deficiency is uncommon in most developed countries. Prescr...
Niacin monograph & interactionsVitamin E
Interacts with764 drugs
Vitamin E is an essential fat-soluble vitamin and antioxidant that most people get in adequate amounts from a normal diet. Supplements can help correc...
Vitamin E monograph & interactionsFolate
Vitamin A
Interacts with387 drugs
Vitamin A is an essential nutrient important for vision, skin, immune function, and growth. Most people get enough from a balanced diet, and supplemen...
Vitamin A monograph & interactionsAMINO STACK
- › L-Glutamine
- › L-Norvaline
- › MagnaPower Magnesium Creatine Chelate
- › Magnesium Glycyl Glutamine Chelate
Joint Support Blend {Combination}
Interacts with1,136 drugs
Cannabis contains many active compounds, mainly THC (which causes a 'high') and CBD (which does not). Some uses, such as chemotherapy-related nausea,...
Joint Support Blend {Combination} monograph & interactions- › Chondroitin Sulfate
- › Glucosamine Sulfate
- › MSM
Other (inactive) ingredients: AfterShock(TM) Fast Absorption Protein Blend, Glycogenx(TM), Cane, Natural & Artificial flavors, Citric Acid, Potassium Citrate, Sodium Citrate, Beta-Carotene, Spray dried Orange, Sucralose, Alpha Lipoic Acid. These complete the product’s ingredient list but are not active constituents.
AfterShock Orange Avalanche by MYOGENIX Drug Interactions
HelloPharmacist Interaction Report
AfterShock Orange Avalanche by MYOGENIX contains several ingredients with documented interactions with medications.
The most serious concern involves Glucosamine Sulfate, which carries a Major-severity interaction with warfarin (a blood thinner). Glucosamine may increase warfarin's anticoagulant effects and raise the risk of bruising and bleeding; two case reports document significant increases in INR (a measure of blood thinning) when glucosamine/chondroitin combinations were added to warfarin therapy.
Read the full breakdown — every affected drug type, severity by severity
Moderate-severity interactions span multiple drug categories. Magnesium can significantly reduce levodopa/carbidopa absorption (used for Parkinson's disease), lower quinolone antibiotic absorption, decrease bisphosphonate absorption, and potentiate skeletal muscle relaxants.
Vitamin A at high doses poses risks with retinoids, hepatotoxic drugs, warfarin, and tetracycline antibiotics. Vitamin C interacts with estrogens, chemotherapy drugs, aluminum-containing compounds, warfarin, and several others.
Vitamin E may increase bleeding risk with anticoagulants and antiplatelet drugs, and with warfarin at doses above 400 IU daily. Niacin interacts with antihypertensive drugs, hepatotoxic drugs, anticoagulants, antidiabetes drugs, and statins, among others.
L-Glutamine theoretically may antagonize anticonvulsants. Vitamin B6 at high doses can reduce phenobarbital and phenytoin levels, and may increase photosensitivity with amiodarone.
Potassium poses hyperkalemia risk with potassium-sparing diuretics, ACE inhibitors, and ARBs. Sodium can reduce antihypertensive drug effectiveness and interact with lithium, corticosteroids, and sodium-containing medications.
Chondroitin may potentiate warfarin's effects. Vitamin B12 has a minor interaction with metformin.
Additionally, we could not check three ingredients—Folate, L-Norvaline, and MSM—because we hold no interaction data for them. To confirm your exact medications are safe with this product, use the medication checker tool on this page.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against AfterShock Orange Avalanche?
Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.
Go to the checkerIngredients driving the most interactions
Individual Drug Interactions
The ingredients in AfterShock Orange Avalanche interact with 1,584 drugs. Click any drug to see the details.
13 of the 19 ingredients in AfterShock Orange Avalanche interact with drugs. Each result below shows which ingredient is responsible. Joint Support Blend {Combination} Vitamin E Niacin Vitamin A Magnesium Glycyl Glutamine Chelate Vitamin B6 Vitamin C Sodium Potassium L-Glutamine Vitamin B12 Riboflavin Thiamine
AcitretinSoriatane
How Acitretin interacts with AfterShock Orange Avalanche — through 2 ingredients. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Acitretin interactionJoint Support Blend {combination}Cytochrome P450 3a4 (cyp3a4) Inhibitors Moderate
Interaction Summary
Theoretically, CYP3A4 inhibitors might increase the levels and adverse effects of cannabis.
Read the full Joint Support Blend {combination} + Acitretin interactionAlitretinoinPanretin
How Alitretinoin interacts with AfterShock Orange Avalanche — through 1 ingredient. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Alitretinoin interactionBenserazide, LevodopaMadopar, Prolopa
How Benserazide, Levodopa interacts with AfterShock Orange Avalanche — through 2 ingredients. Tap an ingredient for the detail:
Magnesium Glycyl Glutamine ChelateLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium Glycyl Glutamine Chelate + Benserazide, Levodopa interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Benserazide, Levodopa interactionBexaroteneTargretin
How Bexarotene interacts with AfterShock Orange Avalanche — through 3 ingredients. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Bexarotene interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Bexarotene interactionJoint Support Blend {combination}Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, cannabis may increase the levels and adverse effects of CYP3A4 substrates.
Read the full Joint Support Blend {combination} + Bexarotene interactionCarbidopaLodosyn
How Carbidopa interacts with AfterShock Orange Avalanche — through 1 ingredient. Tap an ingredient for the detail:
Magnesium Glycyl Glutamine ChelateLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium Glycyl Glutamine Chelate + Carbidopa interactionCarbidopa, LevodopaDhivy, Rytary, Sinemet, Sinemet CR
How Carbidopa, Levodopa interacts with AfterShock Orange Avalanche — through 2 ingredients. Tap an ingredient for the detail:
Magnesium Glycyl Glutamine ChelateLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium Glycyl Glutamine Chelate + Carbidopa, Levodopa interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Carbidopa, Levodopa interactionCarbidopa, Levodopa, EntacaponeStalevo
How Carbidopa, Levodopa, Entacapone interacts with AfterShock Orange Avalanche — through 2 ingredients. Tap an ingredient for the detail:
Magnesium Glycyl Glutamine ChelateLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium Glycyl Glutamine Chelate + Carbidopa, Levodopa, Entacapone interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Carbidopa, Levodopa, Entacapone interactionHalobetasol Propionate,tazaroteneDuobrii
How Halobetasol Propionate,tazarotene interacts with AfterShock Orange Avalanche — through 1 ingredient. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Halobetasol Propionate,tazarotene interactionIsotretinoinAbsorica, Accutane, Amnesteem, Claravis, Roaccutane, Sotret
How Isotretinoin interacts with AfterShock Orange Avalanche — through 1 ingredient. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Isotretinoin interactionLevodopaInbrija, Larodopa
How Levodopa interacts with AfterShock Orange Avalanche — through 2 ingredients. Tap an ingredient for the detail:
Magnesium Glycyl Glutamine ChelateLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium Glycyl Glutamine Chelate + Levodopa interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Levodopa interactionLevodopa, CarbidopaDuodopa
How Levodopa, Carbidopa interacts with AfterShock Orange Avalanche — through 2 ingredients. Tap an ingredient for the detail:
Magnesium Glycyl Glutamine ChelateLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium Glycyl Glutamine Chelate + Levodopa, Carbidopa interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Levodopa, Carbidopa interactionTazaroteneArazlo, Avage, Fabior, Tazorotene, Zorac
How Tazarotene interacts with AfterShock Orange Avalanche — through 1 ingredient. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Tazarotene interactionTretinoinAltreno, Renova, Retin-A, Vesanoid
How Tretinoin interacts with AfterShock Orange Avalanche — through 1 ingredient. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Tretinoin interactionTretinoin, Benzoyl PeroxideTwyneo
How Tretinoin, Benzoyl Peroxide interacts with AfterShock Orange Avalanche — through 1 ingredient. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Tretinoin, Benzoyl Peroxide interactionWarfarinWarfarin
How Warfarin interacts with AfterShock Orange Avalanche — through 8 ingredients. Tap an ingredient for the detail:
Joint Support Blend {combination}Cytochrome P450 2c9 (cyp2c9) Substrates, Anticoagulant/antiplatelet Drugs +3 Major
Interaction Summary
Theoretically, cannabis might increase the levels and adverse effects of CYP2C9 substrates.
Read the full Joint Support Blend {combination} + Warfarin interactionGlucosamine SulfateWarfarin (coumadin) Major
Interaction Summary
Glucosamine might increase the anticoagulant effects of warfarin and increase the risk of bruising and bleeding.
Read the full Glucosamine Sulfate + Warfarin interactionNiacinAnticoagulant/antiplatelet Drugs, Warfarin (coumadin) Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Warfarin interactionChondroitin SulfateWarfarin (coumadin) Moderate
Interaction Summary
Taking chondroitin in combination with glucosamine might increase the anticoagulant effects of warfarin.
Read the full Chondroitin Sulfate + Warfarin interactionVitamin EAnticoagulant/antiplatelet Drugs, Warfarin (coumadin) +1 Moderate
Interaction Summary
Concomitant use of vitamin E and anticoagulant or antiplatelet agents might increase the risk of bleeding.
Read the full Vitamin E + Warfarin interactionVitamin AWarfarin (coumadin) Moderate
Interaction Summary
Theoretically, high doses of vitamin A could increase the risk of bleeding with warfarin.
Read the full Vitamin A + Warfarin interactionVitamin CWarfarin (coumadin) Moderate
Interaction Summary
High-dose vitamin C might reduce the levels and effectiveness of warfarin.
Read the full Vitamin C + Warfarin interactionMagnesium Glycyl Glutamine ChelateAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium Glycyl Glutamine Chelate + Warfarin interactionWarfarin SodiumCoumadin, Panwarfin, Sofarin
How Warfarin Sodium interacts with AfterShock Orange Avalanche — through 8 ingredients. Tap an ingredient for the detail:
Joint Support Blend {combination}Cytochrome P450 2c19 (cyp2c19) Substrates, Anticoagulant/antiplatelet Drugs +3 Major
Interaction Summary
Cannabis may increase levels of drugs metabolized by CYP2C19.
Read the full Joint Support Blend {combination} + Warfarin Sodium interactionGlucosamine SulfateWarfarin (coumadin) Major
Interaction Summary
Glucosamine might increase the anticoagulant effects of warfarin and increase the risk of bruising and bleeding.
Read the full Glucosamine Sulfate + Warfarin Sodium interactionVitamin AWarfarin (coumadin) Moderate
Interaction Summary
Theoretically, high doses of vitamin A could increase the risk of bleeding with warfarin.
Read the full Vitamin A + Warfarin Sodium interactionVitamin EAnticoagulant/antiplatelet Drugs, Warfarin (coumadin) +1 Moderate
Interaction Summary
Concomitant use of vitamin E and anticoagulant or antiplatelet agents might increase the risk of bleeding.
Read the full Vitamin E + Warfarin Sodium interactionVitamin CWarfarin (coumadin) Moderate
Interaction Summary
High-dose vitamin C might reduce the levels and effectiveness of warfarin.
Read the full Vitamin C + Warfarin Sodium interactionChondroitin SulfateWarfarin (coumadin) Moderate
Interaction Summary
Taking chondroitin in combination with glucosamine might increase the anticoagulant effects of warfarin.
Read the full Chondroitin Sulfate + Warfarin Sodium interactionNiacinAnticoagulant/antiplatelet Drugs, Warfarin (coumadin) Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Warfarin Sodium interactionMagnesium Glycyl Glutamine ChelateAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium Glycyl Glutamine Chelate + Warfarin Sodium interactionEtretinateTegison
How Etretinate interacts with AfterShock Orange Avalanche — through 1 ingredient. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Etretinate interaction6-mercaptopurinePurinethol
How 6-mercaptopurine interacts with AfterShock Orange Avalanche — through 2 ingredients. Tap an ingredient for the detail:
Vitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + 6-mercaptopurine interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + 6-mercaptopurine interactionAdo-trastuzumab EmtansineKadcyla
How Ado-trastuzumab Emtansine interacts with AfterShock Orange Avalanche — through 2 ingredients. Tap an ingredient for the detail:
Vitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Ado-trastuzumab Emtansine interactionJoint Support Blend {combination}Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, cannabis may increase the levels and adverse effects of CYP3A4 substrates.
Read the full Joint Support Blend {combination} + Ado-trastuzumab Emtansine interactionAbacavir Sulfate, Dolutegravir, LamivudineTriumeq
How Abacavir Sulfate, Dolutegravir, Lamivudine interacts with AfterShock Orange Avalanche — through 2 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abacavir Sulfate, Dolutegravir, Lamivudine interactionVitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + Abacavir Sulfate, Dolutegravir, Lamivudine interactionAbacavir, LamivudineEpzicom
How Abacavir, Lamivudine interacts with AfterShock Orange Avalanche — through 2 ingredients. Tap an ingredient for the detail:
Vitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + Abacavir, Lamivudine interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abacavir, Lamivudine interactionAbametapirXeglyze
How Abametapir interacts with AfterShock Orange Avalanche — through 1 ingredient. Tap an ingredient for the detail:
Joint Support Blend {combination}Cytochrome P450 3a4 (cyp3a4) Inhibitors Moderate
Interaction Summary
Theoretically, CYP3A4 inhibitors might increase the levels and adverse effects of cannabis.
Read the full Joint Support Blend {combination} + Abametapir interactionAbciximabReoPro
How Abciximab interacts with AfterShock Orange Avalanche — through 4 ingredients. Tap an ingredient for the detail:
Joint Support Blend {combination}Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, cannabis might increase the risk of bleeding when used concomitantly with anticoagulant/antiplatelet drugs.
Read the full Joint Support Blend {combination} + Abciximab interactionNiacinAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Abciximab interactionVitamin EAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Concomitant use of vitamin E and anticoagulant or antiplatelet agents might increase the risk of bleeding.
Read the full Vitamin E + Abciximab interactionMagnesium Glycyl Glutamine ChelateAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium Glycyl Glutamine Chelate + Abciximab interactionAbemaciclibVerzenio
How Abemaciclib interacts with AfterShock Orange Avalanche — through 2 ingredients. Tap an ingredient for the detail:
Vitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Abemaciclib interactionJoint Support Blend {combination}Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, cannabis may increase the levels and adverse effects of CYP3A4 substrates.
Read the full Joint Support Blend {combination} + Abemaciclib interactionAbiraterone
How Abiraterone interacts with AfterShock Orange Avalanche — through 4 ingredients. Tap an ingredient for the detail:
Joint Support Blend {combination}Cytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 2c9 (cyp2c9) Inhibitors +1 Moderate
Interaction Summary
Theoretically, cannabis may increase the levels and adverse effects of CYP3A4 substrates.
Read the full Joint Support Blend {combination} + Abiraterone interactionVitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + Abiraterone interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Abiraterone interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abiraterone interactionAbiraterone AcetateYonsa, Zytiga
How Abiraterone Acetate interacts with AfterShock Orange Avalanche — through 4 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abiraterone Acetate interactionJoint Support Blend {combination}Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, cannabis may increase the levels and adverse effects of CYP3A4 substrates.
Read the full Joint Support Blend {combination} + Abiraterone Acetate interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Abiraterone Acetate interactionVitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + Abiraterone Acetate interactionAbrocitinibCibinqo
How Abrocitinib interacts with AfterShock Orange Avalanche — through 4 ingredients. Tap an ingredient for the detail:
Joint Support Blend {combination}Cytochrome P450 2c19 (cyp2c19) Substrates, Cytochrome P450 2c9 (cyp2c9) Substrates +1 Moderate
Interaction Summary
Cannabis may increase levels of drugs metabolized by CYP2C19.
Read the full Joint Support Blend {combination} + Abrocitinib interactionVitamin EAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Concomitant use of vitamin E and anticoagulant or antiplatelet agents might increase the risk of bleeding.
Read the full Vitamin E + Abrocitinib interactionNiacinAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Abrocitinib interactionMagnesium Glycyl Glutamine ChelateAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium Glycyl Glutamine Chelate + Abrocitinib interactionAcalabrutinibCalquence
How Acalabrutinib interacts with AfterShock Orange Avalanche — through 2 ingredients. Tap an ingredient for the detail:
Joint Support Blend {combination}P-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, cannabis might alter levels of drugs that are substrates of P-glycoprotein (P-gp).
Read the full Joint Support Blend {combination} + Acalabrutinib interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Acalabrutinib interactionAcarboseGlucobay, Prandase, Precose
How Acarbose interacts with AfterShock Orange Avalanche — through 3 ingredients. Tap an ingredient for the detail:
Vitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + Acarbose interactionNiacinAntidiabetes Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Niacin can increase blood glucose levels and may diminish the effects of antidiabetes drugs.
Read the full Niacin + Acarbose interactionGlucosamine SulfateAntidiabetes Drugs Minor
Interaction Summary
Despite initial concerns, it is unlikely that glucosamine will interfere with the effects of antidiabetes drugs.
Read the full Glucosamine Sulfate + Acarbose interactionAcebutololRhotral, Sectral
How Acebutolol interacts with AfterShock Orange Avalanche — through 4 ingredients. Tap an ingredient for the detail:
Vitamin B6Antihypertensive Drugs Moderate
Interaction Summary
Theoretically, vitamin B6 may have additive effects when used with antihypertensive drugs.
Read the full Vitamin B6 + Acebutolol interactionNiacinAntihypertensive Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, niacin may increase the risk of hypotension when used with antihypertensive drugs.
Read the full Niacin + Acebutolol interactionVitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + Acebutolol interactionSodiumAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, a high intake of dietary sodium might reduce the effectiveness of antihypertensive drugs.
Read the full Sodium + Acebutolol interactionEach ingredient & the kinds of drugs it affects
For each ingredient in AfterShock Orange Avalanche with known interactions, here are the types of medications they can affect. Open any type for the detail — or search your exact drug in the checker above.
Joint Support Blend {Combination}
Warfarin (Coumadin)
Concomitant use with cannabis seems to increase the levels and clinical effects of warfarin.
In vitro research shows that the cannabis constituents delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabinol inhibit the cytochrome P450 2C9 (CYP2C9)-mediated 7-hydroxylation of S-warfarin in a concentration-dependent manner.
Additionally, there are multiple case reports of patients chronically taking warfarin that developed a spike in international normalized ratio (INR) after using cannabis in various forms, including smoking cannabis, taking medical cannabis orally, or drinking water infused with cannabis flower. One patient smoked 2-2.5 grams in one week and another patient had doubled the amount of THC consumed from 7.5 mg to 14.7 mg daily for one week.
Alcohol (Ethanol)
Theoretically, cannabis might have additive effects when used with alcohol.
Cannabis can have CNS depressant effects, similar to synthetic delta-9-tetrahydrocannabinol (THC). Theoretically, concomitant use of alcohol with cannabis can have additive effects including psychomotor impairment, sedation, and changes in mood and behavior.
Anesthesia
Cannabis use might alter the safety and clinical effects of various forms of anesthesia.
A small clinical study shows that higher doses of propofol may be needed to achieve relaxation and loss of consciousness in chronic cannabis users compared with nonusers. Another small clinical study shows that use of cannabis within 72 hours prior to undergoing surgery requiring atropine anesthesia may increase the risk of sustained postoperative tachycardia. The exact mechanisms of these interactions are unclear. Obtain a patient's history of cannabis use preoperatively and advise patients to discontinue cannabis use for at least 2 weeks prior to undergoing surgery.
Anticoagulant/Antiplatelet Drugs
Theoretically, cannabis might increase the risk of bleeding when used concomitantly with anticoagulant/antiplatelet drugs.
In vitro research shows that the cannabis constituents delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) inhibit platelet aggregation.
Barbiturates
Theoretically, cannabis might increase the levels and adverse effects of barbiturates.
Some research shows that synthetic delta-9-tetrahydrocannabinol (THC) increases the elimination half-life of pentobarbital by 4 hours when dosed concomitantly.
Cns Depressants
Theoretically, cannabis might have additive effects if used with other CNS depressants.
Cannabis can have CNS depressant effects. Combining cannabis with other CNS depressants might result in additive or synergistic effects. A small clinical trial in healthy adults shows that inhaling a high-grade cannabis (Bedrocan International B.V., Veendam, The Netherlands) 100 mg, containing delta-9-tetrahydrocannabinol 21.8% and cannabinol 0.1%, modestly increases subjective feelings of sedation when compared with cannabis alone.
Cytochrome P450 2C19 (Cyp2C19) Substrates
Cannabis may increase levels of drugs metabolized by CYP2C19.
Research shows that cannabidiol (CBD), a constituent of cannabis, inhibits CYP2C19. In clinical studies and case reports, cannabidiol use resulted in significant increases in the serum levels of topiramate, methadone, citalopram, omeprazole, and N-desmethylclobazam, the primary active metabolite of clobazam. These chemicals are metabolized by CYP2C19. Concomitant use of cannabis with CYP2C19 substrates may increase the risk for adverse effects from these substrates.
Cytochrome P450 2C9 (Cyp2C9) Inducers
Theoretically, drugs that are CYP2C9 inducers might decrease the effects of cannabis.
Delta-9-tetrahydrocannabinol (THC), an active constituent of cannabis, is a substrate of CYP2C9 enzymes.
Cytochrome P450 2C9 (Cyp2C9) Inhibitors
Theoretically, drugs that are CYP2C9 inhibitors might increase the adverse effects of cannabis.
Delta-9-tetrahydrocannabinol (THC), an active constituent of cannabis, is a substrate of CYP2C9 enzymes.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, cannabis might increase the levels and adverse effects of CYP2C9 substrates.
In vitro research shows that the cannabis constituents delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabinol moderately inhibit the CYP2C9-mediated 7-hydroxylation of S-warfarin in a concentration-dependent manner. In vitro research also shows that cannabis extracts modestly inhibit the CYP2C9 metabolism of tolbutamide; extracts providing the specific cannabinoids CBD and cannabigerol (CBG) had stronger inhibitory effects than extracts containing THC and CBD.
Cytochrome P450 2E1 (Cyp2E1) Substrates
Theoretically, cannabis might decrease the levels and clinical effects of CYP2E1 substrates.
In vitro research shows that cannabis can induce the activity of CYP2E1, which might increase the metabolism of CYP2E1 substrates.
Cytochrome P450 3A4 (Cyp3A4) Inducers
Theoretically, CYP3A4 inducers might reduce the levels and clinical effects of cannabis.
Delta-9-tetrahydrocannabinol (THC), an active constituent of cannabis, is a substrate of CYP3A4 enzymes.
Cytochrome P450 3A4 (Cyp3A4) Inhibitors
Theoretically, CYP3A4 inhibitors might increase the levels and adverse effects of cannabis.
Delta-9-tetrahydrocannabinol (THC), an active constituent of cannabis, is a substrate of CYP3A4 enzymes.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, cannabis may increase the levels and adverse effects of CYP3A4 substrates.
In vitro research shows that cannabis can inhibit the activity of CYP3A4 enzymes, which might decrease the metabolism of CYP3A4 substrates. In vitro research also shows that cannabis extracts modestly inhibit the CYP3A4 metabolism of testosterone; extracts providing the specific cannabinoids CBD and cannabigerol (CBG) had stronger inhibitory effects than extracts containing THC and CBD.
P-Glycoprotein Substrates
Theoretically, cannabis might alter levels of drugs that are substrates of P-glycoprotein (P-gp).
Most in vitro research suggests that constituents of cannabis, including cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC), can inhibit P-gp and increase the accumulation of probe compounds by reducing P-gp mediated drug efflux. In vitro studies in kidney cell lines show that a 1-hour exposure to CBD and THC inhibits P-gp. Cannabis may also alter the expression of P-gp, although this effect appears to vary based on duration of exposure. Some in vitro research in lymphoblastoid leukemia cell lines indicates that a 1-hour exposure to cannabinoids does not affect P-gp expression, while a prolonged 72-hour exposure decreases P-gp expression. Other in vitro research in these cell lines shows that a 4-hour exposure to THC and CBD induces P-gp gene expression, while exposure for longer than 4 hours and up to 48 hours does not induce P-gp gene expression.
Theophylline
Smoking cannabis while taking theophylline might reduce the levels and clinical effects of theophylline.
Similar to smoking tobacco, smoking cannabis seems to increase the metabolism of theophylline.
Thrombolytic Drugs
Cannabis might augment the effects of thrombolytic drugs and increase the risk of severe bleeding.
A case of cerebral hemorrhage has been reported for a 51-year-old female and chronic cannabis user who had consumed a large amount of cannabis prior to receiving recombinant tissue plasminogen activator (rtPA) for ischemic stroke. Hemorrhage had been ruled out prior to providing the rtPA. The exact mechanism of this interaction is unclear.
Antipsychotic Drugs
Cannabis does not seem to affect blood levels or effects of some antipsychotic drugs.
Human research shows that cannabis use does not affect blood levels or clinical effects of amisulpride, aripiprazole, or olanzapine in patients with schizophrenia and related disorders.
Vitamin E
Alkylating Agents
Theoretically, antioxidant effects of vitamin E might reduce the effectiveness of alkylating agents.
There's concern that antioxidants could reduce the activity of chemotherapy drugs which generate free radicals, such as cyclophosphamide, chlorambucil, carmustine, busulfan, and thiotepa. However, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that might interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin E have on chemotherapy. Advise patients to consult their oncologist before using vitamin E supplements, especially in high doses.
Anticoagulant/Antiplatelet Drugs
Concomitant use of vitamin E and anticoagulant or antiplatelet agents might increase the risk of bleeding.
Vitamin E seems to inhibit of platelet aggregation and antagonize the effects of vitamin K-dependent clotting factors. These effects appear to be dose-dependent, and are probably only likely to be clinically significant with doses of at least 800 units daily. Mixed tocopherols, such as those found in food, might have a greater antiplatelet effect than alpha-tocopherol. RRR alpha-tocopherol (natural vitamin E) 1000 IU daily antagonizes vitamin K-dependent clotting factors. Advise patients to avoid high doses of vitamin E, especially in people with low vitamin K intake or other risk factors for bleeding.
Antitumor Antibiotics
Theoretically, antioxidant effects of vitamin E might reduce the effectiveness of antitumor antibiotics.
There's concern that antioxidants could reduce the activity of antitumor antibiotic drugs such as doxorubicin, which generate free radicals. However, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that might interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin E have on chemotherapy involving antitumor antibiotics. Advise patients to consult their oncologist before using vitamin E supplements, especially in high doses.
Cyclosporine (Neoral, Sandimmune)
A specific form of vitamin E might increase absorption and levels of cyclosporine.
There is some evidence that one specific formulation of vitamin E (D-alpha-tocopheryl-polyethylene glycol-1000 succinate, TPGS, tocophersolan, Liqui-E) might increase absorption of cyclosporine. This vitamin E formulation forms micelles which seems to increase absorption of cyclosporine by 40% to 72% in some patients. However, this interaction is unlikely to occur with the usual forms of vitamin E.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Vitamin E appears to bind with the nuclear receptor, pregnane X receptor (PXR), which results in increased expression of CYP3A4. Although the clinical significance of this is not known, use caution when considering concomitant use of vitamin E and other drugs affected by these enzymes.
Selumetinib (Koselugo)
Taking selumetinib with vitamin E can result in a total daily dose of vitamin E that exceeds safe limits and therefore might increase the risk of bleeding.
Selumetinib contains 48-54 IU vitamin E per capsule. The increased risk of bleeding with vitamin E appears to be dose-dependent. Be cautious when using selumetinib in combination with supplemental vitamin E, especially in patients at higher risk of bleed, such as those with chronic conditions and those taking antiplatelet drugs.
Warfarin (Coumadin)
Using vitamin E with warfarin might increase the risk of bleeding.
Due to interference with production of vitamin K-dependent clotting factors, use of more than 400 IU of vitamin E daily with warfarin might increase prothrombin time (PT), INR, and the risk of bleeding,. At a dose of 1000 IU per day, vitamin E can antagonize vitamin K-dependent clotting factors even in people not taking warfarin. Limited clinical evidence suggests that doses up to 1200 IU daily may be used safely by patients taking warfarin, but this may not be applicable in all patient populations.
Niacin
Vitamin E might decrease the beneficial effects of niacin on high-density lipoprotein (HDL) cholesterol levels.
A combination of niacin and simvastatin (Zocor) effectively raises high-density lipoprotein (HDL) cholesterol levels in people with coronary disease and low HDL levels. Clinical research shows that taking a combination of antioxidants (vitamin C, vitamin E, beta-carotene, and selenium) along with niacin and simvastatin (Zocor) attenuates this rise in HDL, specifically the HDL-2 and apolipoprotein A1 fractions, by more than 50%. Vitamin E alone combined with a statin does not seem to decrease HDL levels. It is not known whether the adverse effect on HDL is due to one of the other antioxidants or to the combination. It also is not known whether it will occur in other patient populations.
Niacin
Alcohol (Ethanol)
Concomitant use of alcohol and niacin might increase the risk of flushing and hepatotoxicity.
Alcohol can exacerbate the flushing and pruritus associated with niacin. Large doses of niacin might also exacerbate liver dysfunction associated with chronic alcohol use. A case report describes delirium and lactic acidosis in a patient taking niacin 3 grams daily who ingested 1 liter of wine. Advise patients to avoid large amounts of alcohol while taking niacin.
Allopurinol (Zyloprim)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as allopurinol.
Large doses of niacin can reduce urinary excretion of uric acid, potentially resulting in hyperuricemia. Doses of uricosurics such as allopurinol might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Anticoagulant/Antiplatelet Drugs
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Several cases of clotting factor synthesis deficiency and coagulopathy have been reported in patients taking sustained-release niacin. Also, thrombocytopenia has been reported in patients treated with niacin or niacin plus lovastatin.
Antidiabetes Drugs
Niacin can increase blood glucose levels and may diminish the effects of antidiabetes drugs.
Niacin impairs glucose tolerance in a dose-dependent manner, probably by causing or aggravating insulin resistance and increasing hepatic production of glucose. In diabetes patients, niacin 4.5 grams daily for 5 weeks can increase plasma glucose by an average of 16% and glycated hemoglobin (HbA1c) by 21%. However, lower doses of 1.5 grams daily or less appear to have minimal effects on blood glucose. In some patients, glucose levels increase when niacin is started, but then return to baseline when a stable dose is reached. Up to 35% of patients with diabetes may need adjustments in hypoglycemic therapy when niacin is added.
Antihypertensive Drugs
Theoretically, niacin may increase the risk of hypotension when used with antihypertensive drugs.
The vasodilating effects of niacin can cause hypotension. Furthermore, some clinical evidence suggests that a one-hour infusion of niacin can reduce systolic, diastolic, and mean blood pressure in hypertensive patients. This effect is not observed in normotensive patients.
Bile Acid Sequestrants
Bile acid sequestrants can bind niacin and decrease absorption. Separate administration by 4-6 hours to avoid an interaction.
In vitro studies show that colestipol (Colestid) binds about 98% of available niacin and cholestyramine (Questran) binds 10% to 30%.
Gemfibrozil (Lopid)
Theoretically, concomitant use of niacin and gemfibrozil might increase the risk of myopathy in some patients.
A case of myopathy from concomitant use of niacin and gemfibrozil has been reported. Niacin alone has also been associated with cases of myopathy. Using gemfibrozil with niacin might further increase the risk of developing myopathy.
Hepatotoxic Drugs
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Niacin has been associated with cases of liver toxicity, especially when used in pharmacologic doses. Sustained-release niacin preparations appear to be associated with a higher risk of hepatotoxicity than immediate-release niacin.
Hmg-Coa Reductase Inhibitors ("Statins")
Theoretically, concomitant use of niacin and statins might increase the risk of myopathy and rhabdomyolysis in some patients.
Some case reports have raised concerns that niacin might increase the risk of myopathy and rhabdomyolysis when combined with statins. However, a significantly increased risk of myopathy has not been demonstrated in clinical trials, including those using an FDA-approved combination of lovastatin and niacin (Advicor).
Probenecid (Benemid)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as probenecid.
Large doses of niacin reduce urinary excretion of uric acid, potentially causing hyperuricemia. Doses of uricosurics such as probenecid might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Sulfinpyrazone (Anturane)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as sulfinpyrazone.
Large doses of niacin reduce urinary excretion of uric acid, potentially causing hyperuricemia. Doses of uricosurics such as sulfinpyrazone might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Thyroid Hormone
Theoretically, niacin might antagonize the therapeutic effects of thyroid hormones.
Clinical research and case reports suggests that taking niacin can reduce serum levels of thyroxine-binding globulin by up to 25% and moderately reduce levels of thyroxine (T4). Patients taking thyroid hormone for hypothyroidism might need dose adjustments when using niacin.
Transdermal Nicotine (Nicoderm)
Theoretically, concomitant use of niacin and transdermal nicotine might increase the risk of flushing and dizziness.
Niacin and nicotine can both cause flushing and dizziness.
Warfarin (Coumadin)
There is limited evidence that niacin may increase the anticoagulant effects of warfarin.
In a case report, a patient on warfarin developed an elevated international normalized ratio (INR) of 3.9 after taking niacin for two weeks. The patient's INR was previously stable, ranging between 2 and 3 in recent months, and no other medication changes were identified. The elevated INR returned to therapeutic range within 4 days following the discontinuation of niacin.
Aspirin
Large doses of aspirin might alter the clearance of niacin.
Aspirin is often used with niacin to reduce niacin-induced flushing. Doses of 80-975 mg aspirin have been used, but 325 mg appears to be optimal. Aspirin also seems to reduce the clearance of niacin by competing for glycine conjugation. Taking aspirin 1 gram seems to reduce niacin clearance by 45%. This is probably a dose-related effect and not clinically significant with the more common aspirin dose of 325 mg.
Vitamin A
Retinoids
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Retinoids, which are vitamin A derivatives, could have additive toxic effects when taken with vitamin A supplements.
Hepatotoxic Drugs
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
The tolerable upper intake level (UL) is the highest level of intake that is likely to pose no risk of adverse effects. Doses of vitamin A above the UL can cause hepatotoxicity, ranging from elevated liver enzymes to liver failure.
Tetracycline Antibiotics
Theoretically, taking tetracycline antibiotics with high doses of vitamin A can increase the risk of pseudotumor cerebri.
Benign intracranial hypertension (pseudotumor cerebri) can occur with tetracyclines and with acute or chronic vitamin A toxicity. Case reports suggest that taking tetracyclines and vitamin A concurrently can increase the risk of this condition. Avoid high doses of vitamin A in people taking tetracyclines chronically.
Warfarin (Coumadin)
Theoretically, high doses of vitamin A could increase the risk of bleeding with warfarin.
Vitamin A toxicity is associated with hemorrhage and hypoprothrombinemia, possibly due to vitamin K antagonism. Advise patients taking warfarin to avoid doses of vitamin A above the tolerable upper intake level of 10,000 IU/day for adults.
Magnesium Glycyl Glutamine Chelate
Levodopa/Carbidopa (Sinemet)
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Clinical research in healthy volunteers shows that taking magnesium oxide 1000 mg with levodopa 100 mg/carbidopa 10 mg reduces the area under the curve (AUC) of levodopa by 35% and of carbidopa by 81%. In vitro and animal research shows that magnesium produces an alkaline environment in the digestive tract, which might lead to degradation and reduced bioavailability of levodopa/carbidopa.
Aminoglycoside Antibiotics
Concomitant use of aminoglycoside antibiotics and magnesium can increase the risk for neuromuscular weakness.
Both aminoglycosides and magnesium reduce presynaptic acetylcholine release, which can lead to neuromuscular blockade and possible paralysis. This is most likely to occur with high doses of magnesium given intravenously.
Antacids
Use of acid reducers may reduce the laxative effect of magnesium oxide.
A retrospective analysis shows that, in the presence of H2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs), a higher dose of magnesium oxide is needed for a laxative effect. This may also occur with antacids. Under acidic conditions, magnesium oxide is converted to magnesium chloride and then to magnesium bicarbonate, which has an osmotic laxative effect. By reducing acidity, antacids may reduce the conversion of magnesium oxide to the active bicarbonate salt.
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)
Magnesium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Advise patients that bictegravir/emtricitabine/tenofovir alafenamide should be taken at least 2 hours before or 6 hours after magnesium containing products.
Bisphosphonates
Magnesium can decrease absorption of bisphosphonates.
Cations, including magnesium, can decrease bisphosphonate absorption. Advise patients to separate doses of magnesium and these drugs by at least 2 hours.
Calcium Channel Blockers
Magnesium can have additive effects with calcium channel blockers, although evidence is conflicting.
Magnesium inhibits calcium entry into smooth muscle cells and may therefore have additive effects with calcium channel blockers. Severe hypotension and neuromuscular blockades may occur when nifedipine is used with intravenous magnesium, although some contradictory evidence suggests that concurrent use of magnesium with nifedipine does not increase the risk of neuromuscular weakness. High doses of magnesium could theoretically have additive effects with other calcium channel blockers.
Digoxin
Magnesium salts may reduce absorption of digoxin.
Clinical evidence suggests that treatment with oral magnesium hydroxide or magnesium trisilicate reduces absorption of digoxin from the intestines. This may reduce the blood levels of digoxin and decrease its therapeutic effects.
Potassium-Sparing Diuretics
Potassium-sparing diuretics decrease excretion of magnesium, possibly increasing magnesium levels.
Potassium-sparing diuretics also have magnesium-sparing properties, which can counteract the magnesium losses associated with loop and thiazide diuretics. Theoretically, increased magnesium levels could result from concomitant use of potassium-sparing diuretics and magnesium supplements.
Quinolone Antibiotics
Magnesium decreases absorption of quinolones.
Magnesium can form insoluble complexes with quinolones and decrease their absorption. Advise patients to take these drugs at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Skeletal Muscle Relaxants
Parenteral magnesium alters the pharmacokinetics of skeletal muscle relaxants, increasing their effects and accelerating the onset of effect.
Parenteral magnesium shortens the time to onset of skeletal muscle relaxants by about 1 minute and prolongs the duration of action by about 2 minutes. Magnesium potentiates the effects of skeletal muscle relaxants by decreasing calcium-mediated release of acetylcholine from presynaptic nerve terminals, reducing postsynaptic sensitivity to acetylcholine, and having a direct effect on the membrane potential of myocytes. Magnesium also has vasodilatory actions and increases cardiac output, allowing a greater amount of muscle relaxant to reach the motor end plate. A clinical study found that low-dose rocuronium (0.45 mg/kg), when given after administration of magnesium 30 mg/kg over 10 minutes, has an accelerated onset of effect, which matches the onset of effect seen with a full-dose rocuronium regimen (0.6 mg/kg). In another clinical study, onset times for rocuronium doses of 0.3, 0.6, and 1.2 mg/kg were 86, 76, and 50 seconds, respectively, when given alone, but were reduced to 66, 44, and 38 seconds, respectively, when the doses were given after a 15-minute infusion of magnesium sulfate 60 mg/kg. Giving intraoperative intravenous magnesium sulfate, 50 mg/kg loading dose followed by 15 mg/kg/hour, reduces the onset time of rocuronium, enhances its clinical effects, reduces the dose of intraoperative opiates, and prolongs the spontaneous recovery time. It does not affect the activity of subsequently administered neostigmine.
Sulfonylureas
Magnesium increases the systemic absorption of sulfonylureas, increasing their effects and side effects.
Clinical research shows that administration of magnesium hydroxide with glyburide increases glyburide absorption, increases maximal insulin response by 35-fold, and increases the risk of hypoglycemia, when compared with glyburide alone. A similar interaction occurs between magnesium hydroxide and glipizide. The mechanism of this effect appears to be related to the elevation of gastrointestinal pH by magnesium-based antacids, increasing solubility and enhancing absorption of sulfonylureas.
Tetracycline Antibiotics
Magnesium decreases absorption of tetracyclines.
Magnesium can form insoluble complexes with tetracyclines in the gut and decrease their absorption and antibacterial activity. Advise patients to take these drugs 1 hour before or 2 hours after magnesium supplements.
Anticoagulant/Antiplatelet Drugs
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
In vitro evidence shows that magnesium sulfate inhibits platelet aggregation, even at low concentrations. Some preliminary clinical evidence shows that infusion of magnesium sulfate increases bleeding time by 48% and reduces platelet activity. However, other clinical research shows that magnesium does not affect platelet aggregation, although inhibition of platelet-dependent thrombosis can occur.
Gabapentin (Neurontin)
Gabapentin absorption can be decreased by magnesium.
Clinical research shows that giving magnesium oxide orally along with gabapentin decreases the maximum plasma concentration of gabapentin by 33%, time to maximum concentration by 36%, and area under the curve by 43%. Advise patients to take gabapentin at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Sevelamer (Renagel, Renvela)
Sevelamer may increase serum magnesium levels.
In patients on hemodialysis, sevelamer use was associated with a 0.28 mg/dL increase in serum magnesium. The mechanism of this interaction remains unclear.
Vitamin B6
Amiodarone (Cordarone)
Theoretically, vitamin B6 might increase the photosensitivity caused by amiodarone.
Despite initial case reports suggesting that pyridoxine may have a protective effect against amiodarone-induced photosensitivity, preliminary clinical research suggests that pyridoxine may actually exacerbate this adverse effect.
Antihypertensive Drugs
Theoretically, vitamin B6 may have additive effects when used with antihypertensive drugs.
Research in hypertensive rats shows that vitamin B6 can decrease systolic blood pressure. Similarly, clinical research in patients with hypertension shows that taking high doses of vitamin B6 may reduce systolic and diastolic blood pressure, possibly by reducing plasma levels of epinephrine and norepinephrine.
Phenobarbital (Luminal)
High doses of vitamin B6 may reduce the levels and clinical effects of phenobarbital.
Preliminary clinical evidence suggests that vitamin B6 200 mg daily can reduce plasma levels of phenobarbital, possibly by increasing metabolism. It is not known whether lower doses have any effect. Advise people taking phenobarbital to avoid high doses of vitamin B6.
Phenytoin (Dilantin)
High doses of vitamin B6 may reduce the levels and clinical effects of phenytoin.
Preliminary clinical evidence suggests that vitamin B6 200 mg daily can reduce plasma levels of phenytoin, possibly by increasing metabolism. It is not known whether lower doses have any effect. Advise people taking phenytoin to avoid high doses of vitamin B6.
Levodopa
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Vitamin B6 (pyridoxine) enhances the metabolism of levodopa, reducing its clinical effects. However, this interaction does not occur when carbidopa is used concurrently with levodopa (Sinemet). Therefore, it is not likely to be a problem in most people.
Vitamin C
Alkylating Agents
Theoretically, antioxidant effects of vitamin C might reduce the effectiveness of alkylating agents.
The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs that generate free radicals, such as cyclophosphamide, chlorambucil, carmustine, busulfan, and thiotepa. In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin C have on chemotherapy.
Aluminum
Vitamin C can increase the amount of aluminum absorbed from aluminum compounds.
Research in animals and humans shows that vitamin C increases aluminum absorption, theoretically by chelating aluminum and keeping it in solution where it is available for absorption. In people with normal renal function, urinary excretion of aluminum will likely increase, making aluminum retention and toxicity unlikely. Patients with renal failure who take aluminum-containing compounds such as phosphate binders should avoid vitamin C supplements in doses above the recommended dietary allowances.
Antitumor Antibiotics
Theoretically, the antioxidant effects of vitamin C might reduce the effectiveness of antitumor antibiotics.
The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs which generate free radicals, such as doxorubicin. In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effects, if any, antioxidants such as vitamin C have on chemotherapy.
Estrogens
Vitamin C might increase blood levels of estrogens.
Increases in plasma estrogen levels of up to 55% occur under some circumstances when vitamin C is taken concurrently with oral contraceptives or hormone replacement therapy, including topical products. It is suggested that vitamin C prevents oxidation of estrogen in the tissues, regenerates oxidized estrogen, and reduces sulfate conjugation of estrogen in the gut wall. When tissue levels of vitamin C are high, these processes are already maximized and supplemental vitamin C does not have any effect on estrogen levels. Increases in plasma estrogen levels may occur when patients who are deficient in vitamin C take supplements. Monitor these patients for estrogen-related side effects.
Fluphenazine (Prolixin)
Theoretically, vitamin C might decrease levels of fluphenazine.
In one patient there was a clinically significant decrease in fluphenazine levels when vitamin C (500 mg twice daily) was started. The mechanism is not known, and there is no further data to confirm this interaction.
Indinavir (Crixivan)
Vitamin C can modestly reduce indinavir levels.
One pharmacokinetic study shows that taking vitamin C 1 gram orally once daily along with indinavir 800 mg orally three times daily reduces the area under the concentration-time curve of indinavir by 14%. The mechanism of this interaction is unknown, but it is unlikely to be clinically significant in most patients. The effect of higher doses of vitamin C on indinavir levels is unknown.
Levothyroxine (Synthroid, Others)
Vitamin C can increase levothyroxine absorption.
Two clinical studies in adults with poorly controlled hypothyroidism show that swallowing levothyroxine with a glass of water containing vitamin C 500-1000 mg in solution reduces thyroid stimulating hormone (TSH) levels and increases thyroxine (T4) levels when compared with taking levothyroxine alone. This suggests that vitamin C increases the oral absorption of levothyroxine, possibly due to a reduction in pH.
Warfarin (Coumadin)
High-dose vitamin C might reduce the levels and effectiveness of warfarin.
Vitamin C in high doses may cause diarrhea and possibly reduce warfarin absorption. There are reports of two people who took up to 16 grams daily of vitamin C and had a reduction in prothrombin time. Lower doses of 5-10 grams daily can also reduce warfarin absorption. In many cases, this does not seem to be clinically significant. However, a case of warfarin resistance has been reported for a patient who took vitamin C 500 mg twice daily. Cessation of vitamin C supplementation resulted in a rapid increase in international normalized ratio (INR). Tell patients taking warfarin to avoid taking vitamin C in excessively high doses (greater than 10 grams daily). Lower doses may be safe, but the anticoagulation activity of warfarin should be monitored. Patients who are stabilized on warfarin while taking vitamin C should avoid adjusting vitamin C dosage to prevent the possibility of warfarin resistance.
Acetaminophen (Tylenol, Others)
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
A small pharmacokinetic study in healthy volunteers shows that taking high-dose vitamin C (3 grams) 1.5 hours after taking acetaminophen 1 gram slightly increases the apparent half-life of acetaminophen from around 2.3 hours to 3.1 hours. Ascorbic acid competitively inhibits sulfate conjugation of acetaminophen. However, to compensate, elimination of acetaminophen glucuronide and unconjugated acetaminophen increases. This effect is not likely to be clinically significant.
Aspirin
Acidification of the urine by vitamin C might increase aspirin levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction is not clinically significant.
Choline Magnesium Trisalicylate (Trilisate)
Acidification of the urine by vitamin C might increase choline magnesium trisalicylate levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction probably is not clinically significant.
Niacin
Vitamin C might decrease the beneficial effects of niacin on high-density lipoprotein (HDL) cholesterol levels.
A combination of niacin and simvastatin (Zocor) effectively raises HDL cholesterol levels in patients with coronary disease and low HDL levels. Clinical research shows that taking a combination of antioxidants (vitamin C, vitamin E, beta-carotene, and selenium) along with niacin and simvastatin (Zocor) attenuates this rise in HDL, specifically the HDL-2 and apolipoprotein A1 fractions, by more than 50% in patients with coronary disease. It is not known whether this adverse effect is due to a single antioxidant such as vitamin C, or to the combination. It also is not known whether it will occur in other patient populations.
Salsalate (Disalcid)
Acidification of the urine by vitamin C might increase salsalate levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams/day vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction probably is not clinically significant.
Sodium
Antihypertensive Drugs
Theoretically, a high intake of dietary sodium might reduce the effectiveness of antihypertensive drugs.
High intake of dietary sodium can increase systolic and diastolic blood pressure. Also, high intake of sodium may necessitate increased use of antihypertensive medications to achieve blood pressure control in some patients, such as those with chronic kidney disease.
Corticosteroids
Concomitant use of mineralocorticoids and some glucocorticoids with sodium supplements might increase the risk of hypernatremia.
Mineralocorticoids and some glucocorticoids (corticosteroids) cause sodium retention. This effect is dose-related and depends on mineralocorticoid potency. It is most common with hydrocortisone, cortisone, and fludrocortisone, followed by prednisone and prednisolone.
Didanosine (Videx)
Concomitant use of didanosine with additional sodium from dietary or supplemental sources may increase the risk of hypernatremia.
Didanosine formulations contain a significant amount of sodium.
Lithium
Altering dietary intake of sodium might alter the levels and clinical effects of lithium.
High sodium intake can reduce plasma concentrations of lithium by increasing lithium excretion. Reducing sodium intake can significantly increase plasma concentrations of lithium and cause lithium toxicity in patients being treated with lithium carbonate. Stabilizing sodium intake is shown to reduce the percentage of patients with lithium level fluctuations above 0.8 mEq/L. Patients taking lithium should avoid significant alterations in their dietary intake of sodium.
Sodium Phosphates
Theoretically, concomitant use of sodium phosphate with sodium supplements might increase the risk of hypernatremia.
Use of high doses (> 45 mL in 24 hours) of sodium phosphate, such as those used for bowel cleansing before surgery, can lead to serious electrolyte disturbances, including hypernatremia. The risk of hypernatremia is highest in the elderly and people with other risk factors for electrolyte disturbances.
Sodium-Containing Drugs
Concomitant use of sodium-containing drugs with additional sodium from dietary or supplemental sources may increase the risk of hypernatremia and long-term sodium-related complications.
The Chronic Disease Risk Reduction (CDRR) intake level of 2.3 grams of sodium daily indicates the intake at which it is believed that chronic disease risk increases for the apparently healthy population. Some medications contain high quantities of sodium. When used in conjunction with sodium supplements or high-sodium diets, the CDRR may be exceeded. Additionally, concomitant use may increase the risk for hypernatremia; this risk is highest in the elderly and people with other risk factors for electrolyte disturbances.
Tolvaptan (Samsca)
Theoretically, concomitant use of tolvaptan with sodium might increase the risk of hypernatremia.
Tolvaptan is a vasopressin receptor 2 antagonist that is used to increase sodium levels in patients with hyponatremia. Patients taking tolvaptan should use caution with the use of sodium salts such as sodium chloride.
Potassium
Ace Inhibitors (Aceis)
Using ACEIs with high doses of potassium increases the risk of hyperkalemia.
ACEIs block the actions of the renin-angiotensin-aldosterone system and reduce potassium excretion. Concomitant use of these drugs with potassium supplements increases the risk of hyperkalemia. However, concomitant use of these drugs with moderate dietary potassium intake (about 3775-5200 mg daily) does not increase serum potassium levels.
Angiotensin Receptor Blockers (Arbs)
Using ARBs with high doses of potassium increases the risk of hyperkalemia.
ARBs block the actions of the renin-angiotensin-aldosterone system and reduce potassium excretion. Concomitant use of these drugs with potassium supplements increases the risk of hyperkalemia. However, concomitant use of these drugs with moderate dietary potassium intake (about 3775-5200 mg daily) does not increase serum potassium levels.
Potassium-Sparing Diuretics
Concomitant use increases the risk of hyperkalemia.
Using potassium-sparing diuretics with potassium supplements increases the risk of hyperkalemia.
L-Glutamine
Anticonvulsants
Theoretically, glutamine might antagonize the effects of anticonvulsant medications.
Glutamine is metabolized to the excitatory neurotransmitter glutamate. Glutamate might have antagonistic effects with anticonvulsant drugs. However, this interaction has not yet been reported in humans.
Vitamin B12
Metformin (Glucophage)
Metformin, a common medication used to manage type 2 diabetes, has been associated with lower vitamin B12 levels in some individuals. Prolonged use of metformin can interfere with the absorption of B12 in the digestive system, potentially leading to a deficiency in this essential vitamin.
Riboflavin
Tetracycline Antibiotics
Theoretically, taking riboflavin with tetracycline antibiotics may decrease the potency of these antibiotics.
In vitro research suggests that riboflavin may inhibit the potency of tetracycline antibiotics. It is not clear if this effect is clinically significant, as this interaction has not been reported in humans.
Thiamine
Trimethoprim (Proloprim)
Trimethoprim might increase blood levels of thiamine.
In vitro, animal, and clinical research suggest that trimethoprim inhibits intestinal thiamine transporter ThTR-2, hepatic transporter OCT1, and renal transporters OCT2, MATE1, and MATE2, resulting in paradoxically increased thiamine plasma concentrations.
Brand information
Manufacturer and brand details for AfterShock Orange Avalanche, from the product label.
MYOGENIX
See all MYOGENIX products- Name
- MYOGENIX(R) Inc.
- Street Address
- 2309 A St.
- City
- Santa Maria
- State
- CA
- ZipCode
- 93445
- Phone Number
- 800-950-0348
- Web Address
- www.myogenix.com
AfterShock Orange Avalanche by MYOGENIX: Common Questions
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Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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The Full Monographs Behind AfterShock Orange Avalanche’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Vitamin B6
Interacts with 210 drugsVitamin B6 (pyridoxine) is an essential water-soluble vitamin that your body needs for metabolism, brain function, and making red blood cells. It is best known for helping with pregnancy-rel...
Read the full Vitamin B6 monograph → Herb & supplement monographSodium
Interacts with 205 drugsSodium is an essential mineral and electrolyte your body needs to balance fluids, support nerves, and help muscles work. Most people in modern diets get more than enough—often too much—from...
Read the full Sodium monograph → Herb & supplement monographVitamin B12
Interacts with 20 drugsVitamin B12 (cobalamin) is an essential nutrient your body needs to make red blood cells, keep nerves healthy, and support DNA. Supplements are very helpful for people who are deficient — su...
Read the full Vitamin B12 monograph → Herb & supplement monographPotassium
Interacts with 62 drugsPotassium is an essential mineral your body needs for nerve signals, muscle function, and a steady heartbeat, and most people get enough from a balanced diet rich in fruits and vegetables. P...
Read the full Potassium monograph → Herb & supplement monographRiboflavin
Interacts with 20 drugsRiboflavin (vitamin B2) is an essential nutrient your body needs to turn food into energy and to keep skin, eyes, and nerves healthy. It is generally very safe at typical doses, and the stro...
Read the full Riboflavin monograph → Herb & supplement monographThiamine
Interacts with 3 drugsThiamine (vitamin B1) is an essential nutrient your body needs to turn food into energy and to keep your nerves and heart healthy. Most people get enough from food, but supplements are clear...
Read the full Thiamine monograph → Herb & supplement monographVitamin C
Interacts with 207 drugsVitamin C (ascorbic acid) is an essential nutrient your body needs but cannot make, so you must get it from food or supplements. It's important for immune function, collagen, and acts as an...
Read the full Vitamin C monograph → Herb & supplement monographPantothenic Acid
Pantothenic acid is vitamin B5, an essential nutrient your body uses to turn food into energy. True deficiency is very rare because it is found in nearly all foods, and most people meet thei...
Read the full Pantothenic Acid monograph → Herb & supplement monographNiacin
Interacts with 727 drugsNiacin (vitamin B3) is an essential nutrient your body needs for energy and metabolism, and deficiency is uncommon in most developed countries. Prescription-strength niacin has been used to...
Read the full Niacin monograph → Herb & supplement monographVitamin E
Interacts with 764 drugsVitamin E is an essential fat-soluble vitamin and antioxidant that most people get in adequate amounts from a normal diet. Supplements can help correct a true deficiency, but high-dose vitam...
Read the full Vitamin E monograph → Herb & supplement monographVitamin A
Interacts with 387 drugsVitamin A is an essential nutrient important for vision, skin, immune function, and growth. Most people get enough from a balanced diet, and supplements are mainly useful for correcting a tr...
Read the full Vitamin A monograph → Herb & supplement monographGlutamine
Interacts with 50 drugsGlutamine is the most abundant amino acid in the body and is usually made in your muscles. A prescription form is FDA-approved to help reduce sickle cell disease complications, but for most...
Read the full Glutamine monograph → Herb & supplement monographMagnesium
Interacts with 295 drugsMagnesium is an essential mineral your body needs for muscles, nerves, blood pressure, and many other functions, and supplements are useful for preventing or correcting deficiency. Some othe...
Read the full Magnesium monograph → Herb & supplement monographCannabis
Interacts with 1,136 drugsCannabis contains many active compounds, mainly THC (which causes a 'high') and CBD (which does not). Some uses, such as chemotherapy-related nausea, certain seizure disorders, and muscle sp...
Read the full Cannabis monograph → Herb & supplement monographChondroitin Sulfate
Interacts with 2 drugsChondroitin sulfate is a naturally occurring building block of cartilage that is widely taken, often with glucosamine, for osteoarthritis joint pain. The evidence is mixed—some people report...
Read the full Chondroitin Sulfate monograph → Herb & supplement monographGlucosamine
Interacts with 170 drugsGlucosamine is a natural compound found in cartilage and joint fluid, and it is one of the most popular supplements for osteoarthritis, especially of the knee. The evidence is mixed, with so...
Read the full Glucosamine monograph →Sources & How We Checked
AfterShock Orange Avalanche's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.
- NIH Dietary Supplement Label Database (DSLD) — The official product label on file for this supplement.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference behind the ingredient interaction data.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.
The 781 references behind this product’s interaction data
Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.
Glutamine 11 references
- Miller AL. Therapeutic considerations of L-glutamine: a review of the literature. Altern Med Rev 1999;4:239-48..
- Bozzetti F, Biganzoli L, Gavazzi C, et al. Glutamine supplementation in cancer patients receiving chemotherapy: a double-blind randomized study. Nutrition 1997;13:748-51.. PubMed
- Mebane AH. L-Glutamine and mania. Am J Psychiatry 984;141:1302-3.
- Meldrum BS. Glutamate as a neurotransmitter in the brain: review of physiology and pathology. J Nutr 2000;130:1007S-15S.. PubMed
- Garlick PJ. Assessment of the safety of glutamine and other amino acids. J Nutr 2001;131:2556S-61S.. PubMed
- Chapman AG. Glutamate and epilepsy. J Nutr 2000;130:1043S-5S.. PubMed
- Ziegler TR. Glutamine supplementation in cancer patients receiving bone marrow transplantation and high dose chemotherapy. J Nutr 2001;131:2578S-84S.. PubMed
- Laviano A, Molfino A, Lacaria MT, Canelli A, De Leo S, Preziosa I, Rossi Fanelli F. Glutamine supplementation favors weight loss in nondieting obese female patients. A pilot study. Eur J Clin Nutr. 2014 Nov;68(11):1264-6. PubMed
- Endari (l-glutamine) [package insert]. Torrance, CA: Emmaus Medical,Inc; 2017.
- Niihara Y, Miller ST, Kanter J, et al. A Phase 3 Trial of l-Glutamine in Sickle Cell Disease. N Engl J Med 2018;379(3):226-35. doi: 10.1056/NEJMoa1715971.
- Ogden HB, Child RB, Fallowfield JL, et al. Gastrointestinal Tolerance of Low, Medium and High Dose Acute Oral l-Glutamine Supplementation in Healthy Adults: A Pilot Study. Nutrients. 2020;12(10):2953. PubMed
Vitamin B6 32 references
- Hansten PD, Horn JR. Drug Interactions Analysis and Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.
- Yates AA, Schlicker SA, Suitor CW. Dietary reference intakes: The new basis for recommendations for calcium and related nutrients, B vitamins, and choline. J Am Diet Assoc 1998;98:699-706. PubMed
- Geerling BJ, Dagnelie PC, Badart-Smook A, et al. Diet as a risk factor for the development of ulcerative colitis. Am J Gastroenterol 2000;95:1008-13. PubMed
- South M. Neonatal seizures after pyridoxine use -- reply. Lancet 1999;354:2083. PubMed
- Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (2000). Washington, DC: National Academy Press, 2000. Available at: http://b
- Baxter P, Aicardi J. Neonatal seizures after pyridoxine use. Lancet 1999;354:2082-3. PubMed
- Bendich A, Cohen M. Vitamin B6 safety issues. Ann N Y Acad Sci 1990;585:321-30.
- Schaumburg H, Kaplan J, Windebank A. Sensory neuropathy from pyridoxine abuse. A new megavitamin syndrome. N Engl J Med 1983;309:445-8. PubMed
- Gordon N. Pyridoxine dependency: an update. Dev Med Child Neurol 1997;39:63-5. PubMed
- Lewis PJ. Pain in the hand and wrist. Pyridoxine supplements may help patients with carpal tunnel syndrome. BMJ 1995;310:1534. PubMed
- Kaufman G. Pyridoxine against amiodarone-induced photosensitivity (letter). Lancet 1984;1:51-2. PubMed
- Mulrow JP, Mulrow CD, McKenna WJ. Pyridoxine and amiodarone-induced photosensitivity. Ann Intern Med 1985;103:68-9. PubMed
- Kawada A, Kashima A, Shiraishi H, et al. Pyridoxine-induced photosensitivity and hypophosphatasia. Dermatology 2000;201:356-60.. PubMed
- Vasile A, Goldberg R, Kornberg B. Pyridoxine toxicity: report of a case. J Am Osteopath Assoc 1984;83:790-1. DOI
- Hansson O, Sillanpaa M. Pyridoxine and serum concentration of phenytoin and phenobarbitone. Lancet 1976;1:256. DOI
- Jansen T, Romiti R, Kreuter A, Altmeyer P. Rosacea fulminans triggered by high-dose vitamins B6 and B12. J Eur Acad Dermatol Venereol 2001;15:484-5..
- Chittumma P, Kaewkiattikun K, Wiriyasiriwach B. Comparison of the effectiveness of ginger and vitamin B6 for treatment of nausea and vomiting in early pregnancy: a randomized double-blind controlled trial. J Med Assoc Thai 2007;90:15-20.
- Hatzitolios, A., Iliadis, F., Katsiki, N., and Baltatzi, M. Is the anti-hypertensive effect of dietary supplements via aldehydes reduction evidence based? A systematic review. Clin Exp.Hypertens. 2008;30(7):628-639. PubMed
- Vasdev, S., Ford, C. A., Parai, S., Longerich, L., and Gadag, V. Dietary vitamin B6 supplementation attenuates hypertension in spontaneously hypertensive rats. Mol.Cell Biochem. 1999;200(1-2):155-162.
- de, Vogel S., Dindore, V., van, Engeland M., Goldbohm, R. A., van den Brandt, P. A., and Weijenberg, M. P. Dietary folate, methionine, riboflavin, and vitamin B-6 and risk of sporadic colorectal cancer. J Nutr 2008;138(12):2372-2378. PubMed
- Hagen, I., Nesheim, B. I., and Tuntland, T. No effect of vitamin B-6 against premenstrual tension. A controlled clinical study. Acta Obstet.Gynecol.Scand. 1985;64(8):667-670. PubMed
- Aybak, M., Sermet, A., Ayyildiz, M. O., and Karakilcik, A. Z. Effect of oral pyridoxine hydrochloride supplementation on arterial blood pressure in patients with essential hypertension. Arzneimittelforschung. 1995;45(12):1271-1273.
- Lal, K. J., Dakshinamurti, K., and Thliveris, J. The effect of vitamin B6 on the systolic blood pressure of rats in various animal models of hypertension. J Hypertens. 1996;14(3):355-363. PubMed
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