Be Hard Ingredients & Drug Interactions
What is this page for?
First and foremost: checking Be Hard 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
Be Hard is a dietary supplement by Become Nutrition with 13 active ingredients. Its ingredients are commonly taken for morning sickness in pregnancy, premenstrual syndrome (pms), preventing or treating b6 deficiency.Based on those ingredients, 1,577 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Ashwagandha extract, Black Pepper extract, Fenugreek Seeds Extract. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Be Hard by Become Nutrition
Ask about any prescription or over-the-counter medication and we check it for interactions with Be Hard by Become Nutrition — 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 Be Hard by Become Nutrition
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
Full disclosure
Be Hard contains 13 active ingredients. The first two are B vitamins: vitamin B6 and vitamin B12, which support nerve function and cellular metabolism.
Zinc is a mineral that supports immune function. Ashwagandha is a traditional herbal extract used in Ayurvedic medicine.
Magnesium is a mineral involved in over 300 enzyme reactions in the body. Damiana is a plant powder traditionally used in herbal preparations.
Black pepper extract contains piperine, a compound that may enhance absorption of other nutrients. Tribulus terrestris is a plant extract.
Fenugreek seeds extract is derived from a legume. Maca is a root powder from Peru.
Longjack (Eurycoma longifolia) is a Southeast Asian plant extract. DIM (diindolylmethane) is a compound found in cruciferous vegetables.
The product also contains two inactive ingredients: plant cellulose and magnesium stearate.
Does it work?
Leans against
The evidence for Be Hard's ingredients is mixed. Vitamin B6 is effective for sideroblastic anemia and B6 deficiency, and possibly effective for pregnancy-related nausea.
Vitamin B12 is effective for B12 deficiency. Magnesium is effective for constipation and dyspepsia, and effective for preventing pre-eclampsia in pregnancy.
Zinc is effective for zinc deficiency. Ashwagandha is possibly effective for insomnia, anxiety, and stress.
For the other ingredients — damiana, black pepper, tribulus, fenugreek, maca, longjack, and DIM — the evidence we hold does not establish their effectiveness for the purposes this product may be marketed for. Most show insufficient reliable evidence to rate.
How safe is it?
Well-documented data
Overall, these ingredients are generally well tolerated at recommended doses. Vitamin B6 is safe at normal amounts but can cause nerve damage (sensory neuropathy) at very high doses over time — doses above 1,000 mg daily carry the most risk.
Vitamin B12 is very safe with no established upper limit. Magnesium may cause diarrhea and gastrointestinal upset at higher doses.
Zinc is well tolerated below 40 mg daily; higher doses can lead to copper deficiency. Ashwagandha is generally well tolerated short-term but has rare cases of liver damage linked to it, and it's traditionally thought to risk miscarriage — safety data during pregnancy are limited.
Damiana, tribulus, fenugreek, maca, longjack, and DIM all have limited long-term human safety data. For pregnancy: vitamin B6 and vitamin B12 are likely safe; magnesium is likely safe with medical guidance; ashwagandha is advised against; damiana, maca, longjack, and DIM lack sufficient data — talk with your doctor.
For breastfeeding: B vitamins are safe; magnesium is acceptable with medical guidance; ashwagandha and several others are advised against due to insufficient data.
Meds to double-check
Major interaction found
Check these medication types before taking Be Hard: levodopa/carbidopa (Major severity interaction with magnesium), then antihypertensive drugs (blood pressure medications), diabetes medications, antidiabetics/diabetes drugs, sedatives and CNS depressants, benzodiazepines, blood thinners and anticoagulants, seizure medications (phenytoin, phenobarbital), thyroid hormones, antibiotics (quinolone, tetracycline, cephalexin), and HIV medications (protease inhibitors, integrase inhibitors). If you don't take any of these, no interactions are documented for the ingredients we could fully check.
The bottom line
Scorecard at a glanceFully disclosed formula with graded evidence leaning against its stated purpose. Major medication interactions have been identified, and safety information is well characterized.
Be Hard is designed with ingredients used traditionally for sexual performance and stamina. If you take medications for blood pressure, diabetes, Parkinson's disease, seizures, or heart rhythm — or if you take sedatives, blood thinners, or any HIV medications — you need to check your specific drugs with the tool below before starting.
Talk with your pharmacist about whether this product fits your health situation.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 12 of 13 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Jun 16, 2022.
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 Be Hard, straight from the product label.
| Brand | Become Nutrition |
|---|---|
| Barcode (UPC) | 728028460612 |
| Net contents | 120 Capsule(s) |
| Market status | On market |
| Date entered into DSLD | Jun 16, 2022 |
| DSLD ID | 267661 |
| Product type | Other Combinations |
| Supplement form | Capsule |
| Dietary claims / uses | All Other, Structure/Function |
| Intended target group(s) | Adult Male (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 Be Hard by Become Nutrition, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Vitamin B6 | 1 mg | 59% |
| Vitamin B12 | 4 mcg | 167% |
| Zinc | 5 mg | 33% |
| Ashwagandha extract | 500 mg | -- |
| Magnesium | 5 mg | 1% |
| Damiana powder | 250 mcg | -- |
| Black Pepper extract | 5 mg | -- |
| Tribulus terrestris extract | 800 mg | -- |
| Fenugreek Seeds Extract | 500 mg | -- |
| organic Maca powder | 250 mg | -- |
| Longjack extract | 100 mg | -- |
| DIM | 100 mg | -- |
| Dehydroabietic Acid | 100 mg | -- |
Other ingredients: Plant Cellulose, Magnesium Stearate
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.
General Statements
YouTube Facebook Instagram Twitter 30 servings
Formulation
Vegan Caps
Naturally supports increases in test Elevated performance Supports strength Increased lean body mass
FDA Statement of Identity
Dietary Supplement
FDA Disclaimer Statement
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Be Hard by Become Nutrition 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 Be Hard by Become Nutrition
These are the 13 active ingredients this product is made of. Select any to open its full monograph.
Serving size4 Capsule(s) Dosage formCapsule Servings per container30 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.
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 & 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 & interactionsZinc
Interacts with67 drugs
Zinc is an essential mineral that your body needs for immune function, wound healing, taste, and smell. Most people get enough from food, but suppleme...
Zinc monograph & interactionsAshwagandha extract
Interacts with1,372 drugs
Ashwagandha is an Ayurvedic herb most often taken to help with stress, anxiety, and sleep, and some small studies suggest it may help, though the evid...
Ashwagandha extract monograph & interactionsMagnesium
Interacts with295 drugs
Magnesium is an essential mineral your body needs for muscles, nerves, blood pressure, and many other functions, and supplements are useful for preven...
Magnesium monograph & interactionsDamiana powder
Interacts with86 drugs
Damiana is a traditional herb most famous as an aphrodisiac and mild mood-lifter, but solid human evidence for any of its uses is very limited. It is...
Damiana powder monograph & interactionsBlack Pepper extract
Interacts with1,019 drugs
Black pepper is a common kitchen spice that is generally safe in the amounts used in food. Its extract, piperine, is mostly added to supplements to he...
Black Pepper extract monograph & interactionsTribulus terrestris extract
Interacts with259 drugs
Tribulus is a plant supplement most often marketed to boost libido, testosterone, and athletic performance, but the human evidence behind these claims...
Tribulus terrestris extract monograph & interactionsFenugreek Seeds Extract
Interacts with389 drugs
Fenugreek is a common kitchen spice that is also taken as a supplement, mainly for blood sugar, cholesterol, and to support breast milk production. So...
Fenugreek Seeds Extract monograph & interactionsOrganic Maca powder
No knowninteractions
Maca is a nutrient-rich Andean root often used for energy, libido, and menopause symptoms. Early studies suggest it may modestly help sexual desire an...
Organic Maca powder monograph & interactionsLongjack extract
Interacts with248 drugs
Eurycoma longifolia (tongkat ali) is a Southeast Asian herb most popular for supporting testosterone, libido, and male fertility, with some small huma...
Longjack extract monograph & interactionsDIM
Interacts with269 drugs
Diindolylmethane (DIM) is a compound made when your body digests cruciferous vegetables, and it is sold as a supplement mainly for hormone balance and...
DIM monograph & interactionsDehydroabietic Acid
Other (inactive) ingredients: Plant Cellulose, Magnesium Stearate. These complete the product’s ingredient list but are not active constituents.
Be Hard by Become Nutrition Drug Interactions
HelloPharmacist Interaction Report
Be Hard by Become Nutrition contains 13 ingredients, several of which interact with medications.
The most serious interaction is with magnesium and levodopa/carbidopa (Sinemet) — a Major severity interaction. Magnesium reduces the absorption of levodopa by 35% and carbidopa by 81%, which could significantly weaken the medication's effects for Parkinson's disease.
Read the full breakdown — every affected drug type, severity by severity
Several ingredients affect blood pressure and diabetes medications. Vitamin B6, ashwagandha, tribulus, and fenugreek can all theoretically lower blood pressure (Moderate severity with antihypertensive drugs) or blood sugar (Moderate severity with antidiabetes drugs).
Ashwagandha also interacts with CNS depressants like sedatives and benzodiazepines (Moderate), and theoretically with thyroid hormone and immunosuppressants (both Moderate). Magnesium interacts with skeletal muscle relaxants, calcium channel blockers, quinolone and tetracycline antibiotics, bisphosphonates, and sulfonylureas — all Moderate severity.
Zinc affects quinolone and tetracycline antibiotics, cephalexin, penicillamine, HIV protease inhibitors, integrase inhibitors, and cisplatin — all Moderate. Black pepper, fenugreek, and longjack each affect multiple drug classes including anticoagulants, antiplatelet drugs, and antidepressants through metabolic interactions (mostly Moderate).
Vitamin B6 at high doses may reduce phenobarbital and phenytoin levels (Moderate) and theoretically increase photosensitivity with amiodarone (Moderate). Ashwagandha is linked to cases of liver damage (Moderate with hepatotoxic drugs).
DIM theoretically affects estrogens and diuretics (Moderate). We could not check dehydroabietic acid for interactions.
Altogether, these interactions span 1,554 individual medications. Run your exact medications through the checker below before starting this product.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Be Hard?
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 Be Hard interact with 1,577 drugs. Click any drug to see the details.
11 of the 13 ingredients in Be Hard interact with drugs. Each result below shows which ingredient is responsible. Ashwagandha extract Black Pepper extract Fenugreek Seeds Extract Magnesium DIM Tribulus terrestris extract Longjack extract Vitamin B6 Damiana powder Zinc Vitamin B12
6-mercaptopurinePurinethol
How 6-mercaptopurine interacts with Be Hard — through 1 ingredient. Tap an ingredient for the detail:
Ashwagandha ExtractHepatotoxic Drugs, Immunosuppressants Moderate
Interaction Summary
Theoretically, taking ashwagandha with hepatotoxic drugs might increase the risk of liver damage.
Read the full Ashwagandha Extract + 6-mercaptopurine interactionAdo-trastuzumab EmtansineKadcyla
How Ado-trastuzumab Emtansine interacts with Be Hard — through 2 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Black Pepper Extract + Ado-trastuzumab Emtansine interactionAshwagandha ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP3A4 substrates.
Read the full Ashwagandha Extract + Ado-trastuzumab Emtansine interactionAbacavir Sulfate, Dolutegravir, LamivudineTriumeq
How Abacavir Sulfate, Dolutegravir, Lamivudine interacts with Be Hard — through 1 ingredient. Tap an ingredient for the detail:
Ashwagandha ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking ashwagandha with hepatotoxic drugs might increase the risk of liver damage.
Read the full Ashwagandha Extract + Abacavir Sulfate, Dolutegravir, Lamivudine interactionAbacavir, LamivudineEpzicom
How Abacavir, Lamivudine interacts with Be Hard — through 1 ingredient. Tap an ingredient for the detail:
Ashwagandha ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking ashwagandha with hepatotoxic drugs might increase the risk of liver damage.
Read the full Ashwagandha Extract + Abacavir, Lamivudine interactionAbciximabReoPro
How Abciximab interacts with Be Hard — through 3 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, black pepper might increase the risk of bleeding when taken with antiplatelet or anticoagulant drugs.
Read the full Black Pepper Extract + Abciximab interactionFenugreek Seeds ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, fenugreek might have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Fenugreek Seeds Extract + Abciximab interactionMagnesiumAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium + Abciximab interactionAbemaciclibVerzenio
How Abemaciclib interacts with Be Hard — through 2 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Black Pepper Extract + Abemaciclib interactionAshwagandha ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP3A4 substrates.
Read the full Ashwagandha Extract + Abemaciclib interactionAbiraterone
How Abiraterone interacts with Be Hard — through 2 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Black Pepper Extract + Abiraterone interactionAshwagandha ExtractHepatotoxic Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, taking ashwagandha with hepatotoxic drugs might increase the risk of liver damage.
Read the full Ashwagandha Extract + Abiraterone interactionAbiraterone AcetateYonsa, Zytiga
How Abiraterone Acetate interacts with Be Hard — through 2 ingredients. Tap an ingredient for the detail:
Ashwagandha ExtractHepatotoxic Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, taking ashwagandha with hepatotoxic drugs might increase the risk of liver damage.
Read the full Ashwagandha Extract + Abiraterone Acetate interactionBlack Pepper ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Black Pepper Extract + Abiraterone Acetate interactionAbrocitinibCibinqo
How Abrocitinib interacts with Be Hard — through 5 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, black pepper might increase the risk of bleeding when taken with antiplatelet or anticoagulant drugs.
Read the full Black Pepper Extract + Abrocitinib interactionAshwagandha ExtractImmunosuppressants Moderate
Interaction Summary
Theoretically, taking ashwagandha might decrease the effects of immunosuppressants.
Read the full Ashwagandha Extract + Abrocitinib interactionFenugreek Seeds ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, fenugreek might have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Fenugreek Seeds Extract + Abrocitinib interactionLongjack ExtractCytochrome P450 2c19 (cyp2c19) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels of CYP2C19 substrates.
Read the full Longjack Extract + Abrocitinib interactionMagnesiumAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium + Abrocitinib interactionAcalabrutinibCalquence
How Acalabrutinib interacts with Be Hard — through 2 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of P-glycoprotein substrates.
Read the full Black Pepper Extract + Acalabrutinib interactionAshwagandha ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP3A4 substrates.
Read the full Ashwagandha Extract + Acalabrutinib interactionAcarboseGlucobay, Prandase, Precose
How Acarbose interacts with Be Hard — through 5 ingredients. Tap an ingredient for the detail:
Ashwagandha ExtractHepatotoxic Drugs, Antidiabetes Drugs Moderate
Interaction Summary
Theoretically, taking ashwagandha with hepatotoxic drugs might increase the risk of liver damage.
Read the full Ashwagandha Extract + Acarbose interactionBlack Pepper ExtractAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, black pepper might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Read the full Black Pepper Extract + Acarbose interactionFenugreek Seeds ExtractAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, fenugreek seed might have additive hypoglycemic effects when used with antidiabetes drugs.
Read the full Fenugreek Seeds Extract + Acarbose interactionTribulus Terrestris ExtractAntidiabetes Drugs Moderate
Interaction Summary
Taking tribulus with antidiabetes drugs might increase the risk of hypoglycemia.
Read the full Tribulus Terrestris Extract + Acarbose interactionDamiana PowderAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, taking damiana with antidiabetes drugs might increase the risk of hypoglycemia.
Read the full Damiana Powder + Acarbose interactionAcebutololRhotral, Sectral
How Acebutolol interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Tribulus Terrestris ExtractAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, taking tribulus with antihypertensive drugs might increase the risk of hypotension.
Read the full Tribulus Terrestris Extract + Acebutolol interactionAshwagandha ExtractAntihypertensive Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking ashwagandha with antihypertensive drugs might increase the risk of hypotension.
Read the full Ashwagandha Extract + Acebutolol interactionVitamin B6Antihypertensive Drugs Moderate
Interaction Summary
Theoretically, vitamin B6 may have additive effects when used with antihypertensive drugs.
Read the full Vitamin B6 + Acebutolol interactionFenugreek Seeds ExtractAntihypertensive Drugs Minor
Interaction Summary
Fenugreek may also have an additive effect on blood pressure-lowering medications.
Read the full Fenugreek Seeds Extract + Acebutolol interactionAcenocoumarolSintrom
How Acenocoumarol interacts with Be Hard — through 3 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, black pepper might increase the risk of bleeding when taken with antiplatelet or anticoagulant drugs.
Read the full Black Pepper Extract + Acenocoumarol interactionFenugreek Seeds ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, fenugreek might have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Fenugreek Seeds Extract + Acenocoumarol interactionMagnesiumAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium + Acenocoumarol interactionAcepromazineAtravet
How Acepromazine interacts with Be Hard — through 1 ingredient. Tap an ingredient for the detail:
Ashwagandha ExtractCns Depressants Moderate
Interaction Summary
Theoretically, taking ashwagandha might increase the sedative effects of CNS depressants.
Read the full Ashwagandha Extract + Acepromazine interactionAcetaminophenChildren's Tylenol, Children's Tylenol Meltaways, Tylenol, Tylenol Ex Strength
How Acetaminophen interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Ashwagandha ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Ashwagandha Extract + Acetaminophen interactionBlack Pepper ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, black pepper might decrease levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Black Pepper Extract + Acetaminophen interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen interactionAcetaminophen, AspirinGemnisyn
How Acetaminophen, Aspirin interacts with Be Hard — through 6 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractAnticoagulant/antiplatelet Drugs, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase the risk of bleeding when taken with antiplatelet or anticoagulant drugs.
Read the full Black Pepper Extract + Acetaminophen, Aspirin interactionFenugreek Seeds ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, fenugreek might have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Fenugreek Seeds Extract + Acetaminophen, Aspirin interactionAshwagandha ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Ashwagandha Extract + Acetaminophen, Aspirin interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Aspirin interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Aspirin interactionMagnesiumAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium + Acetaminophen, Aspirin interactionAcetaminophen, Aspirin, CaffeineExcedrin, Excedrin Extra Strength, Excedrin Migraine
How Acetaminophen, Aspirin, Caffeine interacts with Be Hard — through 6 ingredients. Tap an ingredient for the detail:
Ashwagandha ExtractHepatotoxic Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Moderate
Interaction Summary
Theoretically, taking ashwagandha with hepatotoxic drugs might increase the risk of liver damage.
Read the full Ashwagandha Extract + Acetaminophen, Aspirin, Caffeine interactionBlack Pepper ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Anticoagulant/antiplatelet Drugs +1 Moderate
Interaction Summary
Theoretically, black pepper might decrease levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Black Pepper Extract + Acetaminophen, Aspirin, Caffeine interactionFenugreek Seeds ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, fenugreek might have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Fenugreek Seeds Extract + Acetaminophen, Aspirin, Caffeine interactionMagnesiumAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium + Acetaminophen, Aspirin, Caffeine interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Aspirin, Caffeine interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Aspirin, Caffeine interactionAcetaminophen, Brompheniramine, PhenylpropanolamineDimetapp Cold and Flu
How Acetaminophen, Brompheniramine, Phenylpropanolamine interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Ashwagandha ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Ashwagandha Extract + Acetaminophen, Brompheniramine, Phenylpropanolamine interactionBlack Pepper ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, black pepper might decrease levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Black Pepper Extract + Acetaminophen, Brompheniramine, Phenylpropanolamine interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Brompheniramine, Phenylpropanolamine interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Brompheniramine, Phenylpropanolamine interactionAcetaminophen, ButalbitalAxocet, Bancap, Bucet, Butex Forte, Esgic CF, Orbivan CF +5 more
How Acetaminophen, Butalbital interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Ashwagandha ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Ashwagandha Extract + Acetaminophen, Butalbital interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Butalbital interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Butalbital interactionBlack Pepper ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, black pepper might decrease levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Black Pepper Extract + Acetaminophen, Butalbital interactionAcetaminophen, Butalbital, CaffeineEsgic, Esgic Plus, Fiogesic, Fioricet, Repan, Tecnal +1 more
How Acetaminophen, Butalbital, Caffeine interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Ashwagandha ExtractHepatotoxic Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Moderate
Interaction Summary
Theoretically, taking ashwagandha with hepatotoxic drugs might increase the risk of liver damage.
Read the full Ashwagandha Extract + Acetaminophen, Butalbital, Caffeine interactionBlack Pepper ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Black Pepper Extract + Acetaminophen, Butalbital, Caffeine interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Butalbital, Caffeine interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Butalbital, Caffeine interactionAcetaminophen, Butalbital, Caffeine, CodeineEsgic with Codeine, Fioricet w/ Codeine
How Acetaminophen, Butalbital, Caffeine, Codeine interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Moderate
Interaction Summary
Theoretically, black pepper might decrease levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Black Pepper Extract + Acetaminophen, Butalbital, Caffeine, Codeine interactionAshwagandha ExtractCns Depressants, Cytochrome P450 3a4 (cyp3a4) Substrates +2 Moderate
Interaction Summary
Theoretically, taking ashwagandha might increase the sedative effects of CNS depressants.
Read the full Ashwagandha Extract + Acetaminophen, Butalbital, Caffeine, Codeine interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Butalbital, Caffeine, Codeine interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Butalbital, Caffeine, Codeine interactionAcetaminophen, Butalbital, CodeineBancap w/ Codeine
How Acetaminophen, Butalbital, Codeine interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractCytochrome P450 2d6 (cyp2d6) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP2D6.
Read the full Black Pepper Extract + Acetaminophen, Butalbital, Codeine interactionAshwagandha ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cns Depressants +1 Moderate
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Ashwagandha Extract + Acetaminophen, Butalbital, Codeine interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Butalbital, Codeine interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Butalbital, Codeine interactionAcetaminophen, Butalbital, Codeine PhosphatePhrenilin #3
How Acetaminophen, Butalbital, Codeine Phosphate interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Ashwagandha ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Hepatotoxic Drugs +1 Moderate
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Ashwagandha Extract + Acetaminophen, Butalbital, Codeine Phosphate interactionBlack Pepper ExtractCytochrome P450 2d6 (cyp2d6) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP2D6.
Read the full Black Pepper Extract + Acetaminophen, Butalbital, Codeine Phosphate interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Butalbital, Codeine Phosphate interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Butalbital, Codeine Phosphate interactionAcetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, PhenylephrineHycomine Compound
How Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 2d6 (cyp2d6) Substrates +1 Moderate
Interaction Summary
Theoretically, black pepper might decrease levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Black Pepper Extract + Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine interactionAshwagandha ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cns Depressants +2 Moderate
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Ashwagandha Extract + Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine interactionAcetaminophen, Caffeine, CodeineGesic C15, Gesic C30, Gesic C8, Lenoltec 1, Lenoltec 2, Lenoltec 3 +1 more
How Acetaminophen, Caffeine, Codeine interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 2d6 (cyp2d6) Substrates +1 Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Black Pepper Extract + Acetaminophen, Caffeine, Codeine interactionAshwagandha ExtractCns Depressants, Cytochrome P450 1a2 (cyp1a2) Substrates +2 Moderate
Interaction Summary
Theoretically, taking ashwagandha might increase the sedative effects of CNS depressants.
Read the full Ashwagandha Extract + Acetaminophen, Caffeine, Codeine interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Caffeine, Codeine interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Caffeine, Codeine interactionAcetaminophen, Caffeine, Codeine, SalicylamideCodalan No.1, Codalan No.2, Codalan No.3
How Acetaminophen, Caffeine, Codeine, Salicylamide interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Ashwagandha ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Hepatotoxic Drugs +2 Moderate
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Ashwagandha Extract + Acetaminophen, Caffeine, Codeine, Salicylamide interactionBlack Pepper ExtractCytochrome P450 2d6 (cyp2d6) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP2D6.
Read the full Black Pepper Extract + Acetaminophen, Caffeine, Codeine, Salicylamide interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Caffeine, Codeine, Salicylamide interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Caffeine, Codeine, Salicylamide interactionAcetaminophen, Caffeine, DihydrocodeineDHC Plus, Panlor DC, Panlor SS
How Acetaminophen, Caffeine, Dihydrocodeine interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Moderate
Interaction Summary
Theoretically, black pepper might decrease levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Black Pepper Extract + Acetaminophen, Caffeine, Dihydrocodeine interactionAshwagandha ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cns Depressants +2 Moderate
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Ashwagandha Extract + Acetaminophen, Caffeine, Dihydrocodeine interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Caffeine, Dihydrocodeine interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Caffeine, Dihydrocodeine interactionAcetaminophen, Caffeine, IsomethepteneMigralam
How Acetaminophen, Caffeine, Isometheptene interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Black Pepper Extract + Acetaminophen, Caffeine, Isometheptene interactionAshwagandha ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Hepatotoxic Drugs +1 Moderate
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Ashwagandha Extract + Acetaminophen, Caffeine, Isometheptene interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Caffeine, Isometheptene interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Caffeine, Isometheptene interactionAcetaminophen, Caffeine, PyrilamineMidol Max Strength Menstrual
How Acetaminophen, Caffeine, Pyrilamine interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Ashwagandha ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Hepatotoxic Drugs +1 Moderate
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP3A4 substrates.
Read the full Ashwagandha Extract + Acetaminophen, Caffeine, Pyrilamine interactionDimDiuretic Drugs, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, diindolylmethane might increase the risk of hyponatremia if used with sodium-depleting diuretics.
Read the full Dim + Acetaminophen, Caffeine, Pyrilamine interactionBlack Pepper ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Black Pepper Extract + Acetaminophen, Caffeine, Pyrilamine interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Caffeine, Pyrilamine interactionAcetaminophen, Chlorpheniramine Maleate, Dextromethorphan HbrVicks Formula 44M Cough, Cold & Flu Relief
How Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan Hbr interacts with Be Hard — through 4 ingredients. Tap an ingredient for the detail:
Black Pepper ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 2d6 (cyp2d6) Substrates +1 Moderate
Interaction Summary
Theoretically, black pepper might decrease levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Black Pepper Extract + Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan Hbr interactionAshwagandha ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates +2 Moderate
Interaction Summary
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Ashwagandha Extract + Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan Hbr interactionLongjack ExtractCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
Read the full Longjack Extract + Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan Hbr interactionDimCytochrome P450 1a2 (cyp1a2) Substrates Minor
Interaction Summary
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
Read the full Dim + Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan Hbr interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Be Hard 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.
Ashwagandha extract
Antidiabetes Drugs
Theoretically, taking ashwagandha with antidiabetes drugs might increase the risk of hypoglycemia.
There is preliminary clinical evidence suggesting that ashwagandha might lower blood glucose levels. Theoretically, ashwagandha might have additive effects when used with antidiabetes drugs and increase the risk of hypoglycemia.
Antihypertensive Drugs
Theoretically, taking ashwagandha with antihypertensive drugs might increase the risk of hypotension.
Animal research suggests that ashwagandha might lower systolic and diastolic blood pressure. Theoretically, ashwagandha might have additive effects when used with antihypertensive drugs and increase the risk of hypotension.
Benzodiazepines
Theoretically, taking ashwagandha might increase the sedative effects of benzodiazepines.
There is preliminary evidence that ashwagandha might have an additive effect with diazepam (Valium) and clonazepam (Klonopin). This may also occur with other benzodiazepines.
Cns Depressants
Theoretically, taking ashwagandha might increase the sedative effects of CNS depressants.
Ashwagandha seems to have sedative effects. Theoretically, this may potentiate the effects of barbiturates, other sedatives, and anxiolytics.
Hepatotoxic Drugs
Theoretically, taking ashwagandha with hepatotoxic drugs might increase the risk of liver damage.
Ashwagandha has been linked to cases of acute hepatitis, liver failure, hepatic encephalopathy, autoimmune hepatitis, the need for liver transplantation, and death due to liver failure.
Immunosuppressants
Theoretically, taking ashwagandha might decrease the effects of immunosuppressants.
Ashwagandha has demonstrated immunostimulant effects in humans. Animal research has shown that ashwagandha can attenuate the immunosuppression caused by cyclophosphamide.
Thyroid Hormone
Ashwagandha might increase the effects and adverse effects of thyroid hormone.
Concomitant use of ashwagandha with thyroid hormones may cause additive therapeutic and adverse effects. Preliminary clinical research and animal studies suggest that ashwagandha boosts thyroid hormone synthesis and secretion. In one clinical study, ashwagandha increased triiodothyronine (T3) and thyroxine (T4) levels by 41.5% and 19.6%, respectively, and reduced serum TSH levels by 17.4% from baseline in adults with subclinical hypothyroidism.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP1A2 substrates.
In vitro research shows that ashwagandha extract induces CYP1A2 enzymes.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, ashwagandha might decrease the levels and clinical effects of CYP3A4 substrates.
In vitro research shows that ashwagandha extract induces CYP3A4 enzymes.
Serotonergic Drugs
Some animal studies have reported that ashwagandha can enhance serotonergic transmission by altering certain serotonin (5-HT) receptors. However, there is no evidence to suggest that ashwagandha increases the risk of serotonin-related effects, and there have been no published case reports of serotonin syndrome when combined with other serotonergic drugs. Nevertheless, due to the lack of extensive studies on the matter and the fact that ashwagandha appears to affect serotonergic pathways, it would be prudent to exercise caution when combining it with drugs that affect serotonin. [References: - Effects of Withania somnifera (Ashwaga ndha) on Stress and the Stress-Related Neuropsychiatric Disorders Anxiety, Depression, and Insomnia. Curr Neuropharmacol. 2021 Sep 14; 19: 1468–1495. - A Prospective, Randomized Double-Blind, Placebo-Controlled Study of Safety and Efficacy of a High-Concentration Full-Spectrum Extract of Ashwagandha Root in Reducing Stress and Anxiety in Adults. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573577/]
Black Pepper extract
Anticoagulant/Antiplatelet Drugs
Theoretically, black pepper might increase the risk of bleeding when taken with antiplatelet or anticoagulant drugs.
In vitro research shows that piperine, a constituent of black pepper, seems to inhibit platelet aggregation. This has not been reported in humans.
Antidiabetes Drugs
Theoretically, black pepper might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Animal research shows that piperine, a constituent of black pepper, can reduce blood glucose levels. Monitor blood glucose levels closely. Dose adjustments might be necessary.
Atorvastatin (Lipitor)
Theoretically, black pepper might increase blood levels of atorvastatin.
Animal research shows that taking piperine, a constituent of black pepper, 35 mg/kg can increase the maximum serum concentration of atorvastatin three-fold. This has not been reported in humans.
Cyclosporine (Neoral, Sandimmune)
Theoretically, black pepper might increase the effects and side effects of cyclosporine.
In vitro research shows that piperine, a constituent of black pepper, increases the bioavailability of cyclosporine. This has not been reported in humans.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Theoretically, black pepper might increase levels of drugs metabolized by CYP2D6.
In vitro research suggests that some constituents of black pepper inhibit CYP2D6. This has not been reported in humans.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
In vitro research and pharmacokinetic simulation data suggest that piperine, a constituent of black pepper, as well as the pepper fruit seem to inhibit CYP3A4. This has not been reported in humans.
Lithium
Theoretically, black pepper might increase blood levels of lithium due to its diuretic effects. The dose of lithium might need to be reduced.
Black pepper is thought to have diuretic properties.
Nevirapine (Viramune)
Black pepper might increase blood levels of nevirapine.
Clinical research shows that piperine, a constituent of black pepper, increases the plasma concentration of nevirapine. However, no adverse effects were observed in this study.
P-Glycoprotein Substrates
Theoretically, black pepper might increase levels of P-glycoprotein substrates.
In vitro research shows that piperine, a constituent of black pepper, seems to inhibit P-glycoprotein.
Pentobarbital (Nembutal)
Theoretically, black pepper might increase the sedative effects of pentobarbital.
Animal research shows that piperine, a constituent of black pepper, increases pentobarbital-induced sleeping time.
Phenytoin (Dilantin)
Black pepper might increase blood levels of phenytoin.
Clinical research shows that piperine, a constituent of black pepper, seems to increase absorption, slow elimination, and increase levels of phenytoin. Taking a single dose of black pepper 1 gram along with phenytoin seems to double the serum concentration of phenytoin. Consuming a soup with black pepper providing piperine 44 mg/200 mL of soup along with phenytoin also seems to increase phenytoin levels when compared with consuming the same soup without black pepper.
Propranolol (Inderal)
Black pepper might increase blood levels of propranolol.
Clinical research shows that piperine, a constituent of black pepper, seems to increase absorption and slow elimination of propranolol.
Rifampin (Rifadin)
Black pepper might increase blood levels of rifampin.
Clinical research shows that piperine, a constituent of black pepper, seems to increase absorption and serum levels of rifampin.
Theophylline
Black pepper might increase blood levels of theophylline.
Clinical research shows that piperine, a constituent of black pepper, seems to increase absorption and slow elimination of theophylline.
Amoxicillin (Amoxil, Trimox)
Theoretically, black pepper might increase the effects and side effects of amoxicillin.
Animal research shows that taking piperine, a constituent of black pepper, with amoxicillin increases plasma levels of amoxicillin. This has not been reported in humans.
Carbamazepine (Tegretol)
Theoretically, black pepper might increase blood levels of carbamazepine, potentially increasing the effects and side effects of carbamazepine.
One clinical study in patients taking carbamazepine 300 mg or 500 mg twice daily shows that taking a single 20 mg dose of purified piperine, a constituent of black pepper, increases carbamazepine levels. Piperine may increase carbamazepine absorption by increasing blood flow to the GI tract, increasing the surface area of the small intestine, or inhibiting cytochrome P450 3A4 (CYP3A4) in the gut wall. Absorption was significantly increased by 7-10 mcg/mL/hour. The time to eliminate carbamazepine was also increased by 4-8 hours. Although carbamazepine levels were increased, this did not appear to increase side effects. In vitro research also shows that piperine can increase carbamazepine levels by 11% in a time-dependent manner.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, black pepper might decrease levels and clinical effects of drugs metabolized by CYP1A2.
In vitro research suggests that black pepper induces CYP1A2. This has not been reported in humans.
Fenugreek Seeds Extract
Anticoagulant/Antiplatelet Drugs
Theoretically, fenugreek might have additive effects when used with anticoagulant or antiplatelet drugs.
Some of the constituents in fenugreek have antiplatelet effects in animal and in vitro research. However, common fenugreek products might not contain sufficient concentrations of these constituents for clinical effects. A clinical study in patients with coronary artery disease or diabetes shows that taking fenugreek seed powder 2.5 grams twice daily for 3 months does not affect platelet aggregation, fibrinolytic activity, or fibrinogen levels .
Antidiabetes Drugs
Theoretically, fenugreek seed might have additive hypoglycemic effects when used with antidiabetes drugs.
Clinical research shows that fenugreek seed can reduce fasting blood glucose and 2-hour postprandial glucose levels in adults with type 2 diabetes.
Clopidogrel (Plavix)
Theoretically, fenugreek seed might alter the clinical effects of clopidogrel by inhibiting its conversion to the active form.
Animal research shows that fenugreek seed 200 mg/kg daily for 14 days increases the maximum serum concentration of clopidogrel by 21%. It is unclear how this affects the pharmacokinetics of the active metabolite of clopidogrel; however, this study found that concomitant use of fenugreek seed and clopidogrel prolonged bleeding time by an additional 11%.
Metoprolol (Toprol)
Theoretically, fenugreek seed might have additive hypotensive effects when used with metoprolol.
Animal research shows that fenugreek seed 300 mg/kg daily for 2 weeks decreases systolic and diastolic blood pressure by 9% and 11%, respectively, when administered alone, and by 15% and 22%, respectively, when given with metoprolol 10 mg/kg.
Phenytoin (Dilantin)
Theoretically, fenugreek might decrease plasma levels of phenytoin.
Animal research shows that taking fenugreek seeds for 1 week decreases maximum concentrations and the area under the curve of a single dose of phenytoin by 44% and 72%, respectively. This seems to be related to increased clearance. So far, this interaction has not been reported in humans.
Sildenafil (Viagra)
Theoretically, concurrent use of sildenafil and fenugreek might reduce levels and therapeutic effects of sildenafil.
Animal research shows that taking fenugreek seeds for 1 week reduces maximum concentrations and the area under the curve of a single dose of sildenafil by 27% and 48%, respectively. So far, this interaction has not been reported in humans.
Theophylline
Theoretically, fenugreek may reduce the levels and clinical effects of theophylline.
Animal research shows that fenugreek 50 grams daily for 7 days reduces the maximum serum concentration (Cmax) of theophylline by 28% and the area under the plasma drug concentration-time curve (AUC) by 22%.
Warfarin (Coumadin)
Theoretically, fenugreek might have additive effects with warfarin and increase the international normalized ratio (INR).
Some fenugreek constituents have antiplatelet effects, although these might not be present in concentrations that are clinically significant. In one case report, a patient taking warfarin experienced an increased INR when starting to take fenugreek in combination with boldo.
Antihypertensive Drugs
Fenugreek may also have an additive effect on blood pressure-lowering medications. Studies on animals have shown that fenugreek seed can decrease both systolic and diastolic blood pressure by up to 22% when combined with metoprolol. Therefore, it is essential to monitor your blood pressure regularly if you are taking fenugreek and metoprolol together or any other antihypertensive drugs.
Magnesium
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.
DIM
Diuretic Drugs
Theoretically, diindolylmethane might increase the risk of hyponatremia if used with sodium-depleting diuretics.
Large doses of diindolylmethane (600 mg daily) have been associated with two cases of asymptomatic hyponatremia in clinical research.
Estrogens
Theoretically, diindolylmethane might increase or decrease the effects of estrogens.
Diindolylmethane might have mild estrogenic or antiestrogenic effects. Theoretically, large amounts of diindolylmethane might interfere with hormone replacement therapy.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, diindolylmethane might lower serum levels of CYP1A2 substrates.
In vitro evidence suggests that diindolylmethane can induce CYP1A2. Theoretically, it might increase metabolism of CYP1A2 substrates and lower serum concentrations. This interaction has not been reported in humans.
Tribulus terrestris extract
Antidiabetes Drugs
Taking tribulus with antidiabetes drugs might increase the risk of hypoglycemia.
Clinical research shows that Tribulus can lower blood glucose levels in adults with type 2 diabetes who are taking antidiabetes medications.
Antihypertensive Drugs
Theoretically, taking tribulus with antihypertensive drugs might increase the risk of hypotension.
Animal research shows that tribulus can lower blood pressure by inhibiting angiotensin-converting enzyme (ACE). Tribulus has also demonstrated hypotensive effects in pre-hypertensive adults.
Lithium
Theoretically, tribulus might increase the levels and clinical effects of lithium.
Tribulus is thought to have diuretic properties. Due to these potential diuretic effects, tribulus might reduce excretion and increase levels of lithium. The dose of lithium might need to be decreased.
Longjack extract
Propranolol (Inderal)
Eurycoma longifolia can reduce the levels and clinical effects of propranolol.
A small clinical study in healthy persons shows that taking a single dose of a water-based Eurycoma longifolia extract 200 mg, in combination with a single dose of propranolol 80 mg, reduces the propranolol area under the curve (AUC) by 29%, reduces the peak concentration by 42%, and increases time to peak concentration by 86% when compared with control. Since the elimination half-life of propranolol did not change, it seems that Eurycoma longifolia alters the kinetics of propranolol by decreasing its absorption in the gut, and not by altering its metabolism. It is not known if separating administration will prevent this interaction.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
In vitro research suggests that methanolic Eurycoma longifolia root extract weakly inhibits CYP1A2 enzymes. This effect has not been reported in humans.
Cytochrome P450 2A6 (Cyp2A6) Substrates
Theoretically, Eurycoma longifolia might increase levels of CYP2A6 substrates.
In vitro research suggests that methanolic Eurycoma longifolia root extract weakly inhibits CYP2A6 enzymes. This effect has not been reported in humans.
Cytochrome P450 2C19 (Cyp2C19) Substrates
Theoretically, Eurycoma longifolia might increase levels of CYP2C19 substrates.
In vitro research suggests that methanolic Eurycoma longifolia root extract weakly inhibits CYP2C19 enzymes. This effect has not been reported in humans.
Testosterone
Theoretically, Eurycoma longifolia may further increase levels of testosterone.
A clinical study in aging males with testosterone levels below 300 ng/dL shows that taking a specific water extract of Eurycoma longifolia roots (Physta; Biotropics Malaysia) 100-200 mg daily with breakfast for 12 weeks increases total testosterone levels by 8% to 11% when compared with placebo. It is unclear whether this increase would occur in individuals with normal testosterone levels.
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.
Damiana powder
Antidiabetes Drugs
Theoretically, taking damiana with antidiabetes drugs might increase the risk of hypoglycemia.
Animal research shows that taking damiana lowers blood glucose level.
Zinc
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)
Theoretically, zinc 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 zinc containing products.
Cephalexin (Keflex)
Zinc might decrease cephalexin levels by chelating with cephalexin in the gut and preventing its absorption.
A pharmacokinetic study shows that zinc sulfate 250 mg taken concomitantly with cephalexin 500 mg decreases peak levels of cephalexin by 31% and reduces the exposure to cephalexin by 27%. Also, taking zinc sulfate 3 hours before cephalexin decreases peak levels of cephalexin by 11% and reduces the exposure to cephalexin by 18%. By decreasing cephalexin levels, zinc might increase the risk of treatment failure. This effect does not occur when zinc is taken 3 hours after the cephalexin dose. To avoid an interaction, advise patients take zinc sulfate 3 hours after taking cephalexin.
Cisplatin (Platinol-Aq)
Theoretically, zinc might interfere with the therapeutic effects of cisplatin.
Animal research suggests that zinc stimulates tumor cell production of the protein metallothionein, which binds and inactivates cisplatin. It is not known whether zinc supplements or high dietary zinc intake can cause clinically significant interference with cisplatin therapy. Cisplatin might also increase zinc excretion.
Integrase Inhibitors
Theoretically, taking zinc along with integrase inhibitors might decrease the levels and clinical effects of these drugs.
Zinc is a divalent cation. Pharmacokinetic studies have shown that other divalent cations such as calcium and iron can decrease blood levels of the integrase inhibitor dolutegravir through chelation.
Penicillamine (Cuprimine, Depen)
Zinc might reduce the levels and clinical effects of penicillamine.
By forming an insoluble complex with penicillamine, zinc interferes with penicillamine absorption and activity. Zinc supplements reduce the efficacy of low-dose penicillamine (0.5-1 gram/day), but do not seem to affect higher doses (1-2.75 gram/day), provided dosing times are separated. Advise patients to take zinc and penicillamine at least 2 hours apart.
Quinolone Antibiotics
Zinc can decrease the levels and clinical effects of quinolones antibiotics.
Quinolones form complexes with zinc in the gastrointestinal tract, reducing absorption of both the quinolone and zinc if taken at the same time. Advise patients to take these drugs at least 2 hours before, or 4-6 hours after, zinc supplements.
Ritonavir (Norvir)
Zinc modestly reduces levels of ritonavir.
Clinical research shows that zinc might reduce serum ritonavir levels by chelating with ritonavir in the gut and preventing its absorption. In patients with HIV, ritonavir is taken with atazanavir to prevent the metabolism and increase the effects of atazanavir. A pharmacokinetic study shows that, in patients being treated with atazanavir/ritonavir, co-administration of zinc sulfate (Solvazinc tablets) 125 mg as a single dose or as multiple daily doses for 2 weeks reduces plasma levels of ritonavir by about 16%. However, atazanavir levels still remains high enough to prevent HIV virus replication. Therefore, the decrease in ritonavir levels is not likely to be clinically significant.
Tetracycline Antibiotics
Zinc might reduce levels of tetracycline antibiotics.
Tetracyclines form complexes with zinc in the gastrointestinal tract, which can reduce absorption of both the tetracycline and zinc when taken at the same time. Taking zinc sulfate 200 mg with tetracycline reduces absorption of the antibiotic by 30% to 40%. Demeclocycline and minocycline cause a similar interaction. However, doxycycline does not seem to interact significantly with zinc. Advise patients to take tetracyclines at least 2 hours before, or 4-6 hours after, zinc supplements to avoid any interactions.
Amiloride (Midamor)
Amiloride can modestly reduce zinc excretion and increase zinc levels.
Clinical research shows that amiloride can reduce urinary zinc excretion, especially at doses of 10 mg per day or more. This zinc-sparing effect can help to counteract zinc losses caused by thiazide diuretics, but it is unlikely to cause zinc toxicity at usual amiloride doses. The other potassium-sparing diuretics, spironolactone (Aldactone) and triamterene (Dyrenium), do not seem to have a zinc-sparing effect.
Atazanavir (Reyataz)
Zinc modestly reduces levels of atazanavir, although this effect does not seem to be clinically significant.
Clinical research shows that zinc might decrease serum atazanavir levels by chelating with atazanavir in the gut and preventing its absorption. Although a single dose of zinc sulfate (Solvazinc tablets) 125 mg orally does not affect atazanavir concentrations in patients being treated with atazanavir/ritonavir, co-administration of zinc sulfate 125 mg daily for 2 weeks reduces plasma levels of atazanavir by about 22% in these patients. However, despite this decrease, atazanavir levels still remain at high enough concentrations for the prevention of HIV virus replication.
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.
Brand information
Manufacturer and brand details for Be Hard, from the product label.
Become Nutrition
See all Become Nutrition products- Name
- Become Nutrition
- Street Address
- 110 Jensen Rd
- City
- Columbia Falls
- State
- MT
- ZipCode
- 59912
- Web Address
- www.becomenutrition.com
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The Full Monographs Behind Be Hard’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 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 monographZinc
Interacts with 67 drugsZinc is an essential mineral that your body needs for immune function, wound healing, taste, and smell. Most people get enough from food, but supplements can help correct or prevent a defici...
Read the full Zinc monograph → Herb & supplement monographAshwagandha
Interacts with 1,372 drugsAshwagandha is an Ayurvedic herb most often taken to help with stress, anxiety, and sleep, and some small studies suggest it may help, though the evidence is still limited. It is generally w...
Read the full Ashwagandha 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 monographDamiana
Interacts with 86 drugsDamiana is a traditional herb most famous as an aphrodisiac and mild mood-lifter, but solid human evidence for any of its uses is very limited. It is generally well tolerated in the small am...
Read the full Damiana monograph → Herb & supplement monographBlack Pepper
Interacts with 1,019 drugsBlack pepper is a common kitchen spice that is generally safe in the amounts used in food. Its extract, piperine, is mostly added to supplements to help the body absorb other ingredients (li...
Read the full Black Pepper monograph → Herb & supplement monographTribulus
Interacts with 259 drugsTribulus is a plant supplement most often marketed to boost libido, testosterone, and athletic performance, but the human evidence behind these claims is weak and inconsistent. It is general...
Read the full Tribulus monograph → Herb & supplement monographFenugreek
Interacts with 389 drugsFenugreek is a common kitchen spice that is also taken as a supplement, mainly for blood sugar, cholesterol, and to support breast milk production. Some early research is encouraging for blo...
Read the full Fenugreek monograph → Herb & supplement monographMaca
Maca is a nutrient-rich Andean root often used for energy, libido, and menopause symptoms. Early studies suggest it may modestly help sexual desire and some menopause symptoms, but the evide...
Read the full Maca monograph → Herb & supplement monographEurycoma Longifolia
Interacts with 248 drugsEurycoma longifolia (tongkat ali) is a Southeast Asian herb most popular for supporting testosterone, libido, and male fertility, with some small human studies suggesting possible benefits....
Read the full Eurycoma Longifolia monograph → Herb & supplement monographDiindolylmethane
Interacts with 269 drugsDiindolylmethane (DIM) is a compound made when your body digests cruciferous vegetables, and it is sold as a supplement mainly for hormone balance and cancer prevention. Although early lab s...
Read the full Diindolylmethane monograph →Sources & How We Checked
Be Hard'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 354 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.
Vitamin B6 32 references
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- 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
- Lauritzen CH, Reuter HD, Repges R, Bohnert K, and Schmidt U. Treatment of premenstrual tension syndrome with Vitex agnus castus. Controlled, double-blind study versus pyridoxine. Phytomed 1997;4(3):183-189. PubMed
- Fonseca VA, Lavery LA, Thethi TK, et al. Metanx in type 2 diabetes with peripheral neuropathy: A randomized trial. Am J Med 2013;126(2):141-9. PubMed
- Hankey GJ, Eikelboom JW, Yi Q, et al. Treatment with B vitamins and incidence of cancer in patients with previous stroke or transient ischemic attack: Results of a randomized placebo-controlled trial. Stroke 2012;43(6):1572-7. PubMed
- Hoyer-Kuhn H, Kohbrok S, Volland R, Franklin J, Hero B, Beck BB, Hoppe B. Vitamin B6 in primary hyperoxaluria I: first prospective trial after 40 years of practice. Clin J Am Soc Nephrol. 2014 Mar;9(3):468-77. PubMed
- Mahmoud A, Tabassum S, Al Enazi S, et al. Amelioration of levetiracetam-induced behavioral side effects by pyridoxine. A randomized double blind controlled study. Pediatr Neurol 2021;119:15-21. PubMed
- Gupta M, Gallante B, Bamberger JN, et al. Prospective randomized evaluation of idiopathic hyperoxaluria treatments. J Endourol 2021;35(12):1844-1851. PubMed
- Li H, Chen M, Liang S, et al. Excessive vitamin B6 during treatment is related to poor prognosis of patients with nasopharyngeal carcinoma: A U-shaped distribution suggests low dose supplement. Clin Nutr 2021;40(4):2293-2300. PubMed
- Tanigawa J, Nabatame S, Tominaga K, et al. High-dose pyridoxine treatment for inherited glycosylphosphatidylinositol deficiency. Brain Dev 2021;43(6):680-687. PubMed
- Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy. Obstet Gynecol. 2018;131(1):e15-e30. PubMed
Vitamin B12 30 references
- 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
- Hartman TJ, Woodson K, Stolzenberg-Solomon R, et al. Association of the B-vitamins pyridoxal 5'-phosphate (B6), B12, and folate with lung cancer risk in older men. Am J Epidemiol 2001;153:688-94.. 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..
- Lange H, Suryapranata H, De Luca G, et al. Folate therapy and in-stent restenosis after coronary stenting. N Engl J Med 2004;350:2673-81. PubMed
- Collin, S. M., Metcalfe, C., Refsum, H., Lewis, S. J., Zuccolo, L., Smith, G. D., Chen, L., Harris, R., Davis, M., Marsden, G., Johnston, C., Lane, J. A., Ebbing, M., Bonaa, K. H., Nygard, O., Ueland, P. M., Grau, M. V., Baron, J. A., Donovan, J. L., Nea
- Geissbuhler, P., Mermillod, B., and Rapin, C. H. Elevated serum vitamin B12 levels associated with CRP as a predictive factor of mortality in palliative care cancer patients: a prospective study over five years. J.Pain Symptom.Manage. 2000;20(2):93-103. PubMed
- Salles, N., Herrmann, F., Sakbani, K., Rapin, C. H., and Sieber, C. High vitamin B12 level: a strong predictor of mortality in elderly inpatients. J Am Geriatr.Soc 2005;53(5):917-918.
- Looker, H. C., Fagot-Campagna, A., Gunter, E. W., Pfeiffer, C. M., Sievers, M. L., Bennett, P. H., Nelson, R. G., Hanson, R. L., and Knowler, W. C. Homocysteine and vitamin B(12) concentrations and mortality rates in type 2 diabetes. Diabetes Metab Res R
- Uhl, W., Nolting, A., Golor, G., Rost, K. L., and Kovar, A. Safety of hydroxocobalamin in healthy volunteers in a randomized, placebo-controlled study. Clin Toxicol (Phila) 2006;44 Suppl 1:17-28. PubMed
- Borron, S. W., Baud, F. J., Barriot, P., Imbert, M., and Bismuth, C. Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation. Ann Emerg.Med 2007;49(6):794-801, 801. PubMed
- Borron, S. W., Baud, F. J., Megarbane, B., and Bismuth, C. Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation. Am J Emerg.Med 2007;25(5):551-558. PubMed
- Lewis, J. G. Gout, Steatorrhoea, and Megaloblastic Anaemia. Ann Rheum.Dis 1962;21(3):284-286. PubMed
- Tal, S., Shavit, Y., Stern, F., and Malnick, S. Association between vitamin B12 levels and mortality in hospitalized older adults. J Am Geriatr.Soc 2010;58(3):523-526. PubMed
- Baztan, J. J., Gavidia, J. J., Gomez-Pavon, J., Esteve, A., and Ruiperez, I. High vitamin B12 levels and in-hospital mortality. J Am Geriatr.Soc 2010;58(11):2237-2238. PubMed
- Omboni, E., Checchini, M., and Longoni, F. [Hypopotassemia and megaloblastic anemia. Presentation of a case]. Minerva Med 8-31-1987;78(16):1255-1257.
- Aalfs As, Scholvinck LH, Horvath B. Acneiform eruption in a 5-year old due to vitamin B12 supplementation. Eur J Dermatol 2013;23(5):726-7. PubMed
- Balta I, Ozuguz P. Vitamin B12-induced acneiform eruption. Cutan Ocul Toxicol 2014;33(2):94-5. PubMed
- Carman KB, Belgemen T, Yis U. Involuntary movements misdiagnosed as seizure during vitamin B12 treatment. Pediatr Emerg Care 2013;29(11):1223-4. PubMed
- Djuric V, Bogic M, Popadic AP, et al. Anaphylactic reaction to hydroxycobalamin with tolerance to cyanocobalamin. Ann Allergy Asthma Immunol 2012;108(3):207-8. PubMed
- Kartel O, Gulec M, Demirel F, et al. Vitamin B12 allergy and successful desensitization with cyanocobalamin: A case report. Allergol Immunopath (Madr) 2012;40(5):324-5.
- Patiroglu T, Unal E, Yildirim S. Infantile tremor syndrome associated with cobalamin therapy: A case report. Clin Neurol Neurosurg 2013;115(9):1903-5. PubMed
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