Brain 4 Way Support System Ingredients & Drug Interactions
What is this page for?
First and foremost: checking Brain 4 Way Support System 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
Brain 4 Way Support System is a dietary supplement by Pure Essence Labs with 20 active ingredients. Its ingredients are commonly taken for mental focus and alertness, coping with stress, fatigue and sleep loss.Based on those ingredients, 1,675 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Ginkgo leaf, Eleuthero, Acorus root. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Brain 4 Way Support System by Pure Essence Labs
Ask about any prescription or over-the-counter medication and we check it for interactions with Brain 4 Way Support System by Pure Essence Labs — 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 Brain 4 Way Support System by Pure Essence Labs
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
Brain 4 Way Support System contains 20 ingredients total. The active ones you're taking this for are L-Tyrosine (an amino acid precursor to neurotransmitters), Phosphatidylcholine and Phosphatidylserine (compounds that support cell membranes and signaling in the brain), Spirulina (an algal source of nutrients), Ginkgo leaf (for circulation and cognition), Eleuthero and Schisandra (adaptogens from traditional medicine), Alpha-GPC (a choline compound), oat grass juice, Rehmannia root, Mucuna pruriens seed (which contains the drug-like compound levodopa), Asparagus and Acorus roots, Danshen (Salvia root), Goji fruit, and Black Pepper extract.
The product also includes inactive ingredients like cellulose, silicon dioxide, and stearic acid as fillers and binders.
Does it work?
Moderate evidence
The evidence for effectiveness is mixed and sparse across this product's ingredients. Oat grass juice is likely effective for cholesterol and heart health.
Ginkgo, phosphatidylserine, and alpha-GPC are possibly effective for age-related cognitive decline and dementia. L-Tyrosine is possibly effective for cognitive function and memory.
Most other ingredients — including Spirulina, Eleuthero, Schisandra, Rehmannia, Mucuna pruriens, Asparagus, Danshen, Goji, and Black Pepper — have insufficient reliable evidence to rate their effects on brain function, or their effectiveness ratings come tied to conditions this product doesn't claim to address. The bottom line: some ingredients have decent evidence for brain support, but many do not.
How safe is it?
Well-documented data
Most ingredients in this product are generally well tolerated at typical doses, but several come with caveats. Tyrosine, Phosphatidylcholine, and Ginkgo are generally well tolerated in healthy adults, though Ginkgo carries a real risk of bleeding.
Phosphatidylserine can cause insomnia, flatulence, headache, or nausea. Spirulina quality varies widely and some products are contaminated with heavy metals or toxins — a real concern.
Eleuthero, Schisandra, and Danshen are generally well tolerated short-term but long-term safety data are limited. Mucuna pruriens contains levodopa, an active pharmaceutical compound that should only be used under professional guidance.
Acorus root (calamus) is likely unsafe — it may contain beta-asarone, a possible carcinogen banned from food by the FDA. For pregnancy and breastfeeding: Phosphatidylserine safety data advise against use during pregnancy and breastfeeding.
Schisandra and Eleuthero are best avoided in pregnancy. Mucuna pruriens may lower milk supply because of its dopamine effects.
Ginkgo is possibly unsafe in pregnancy. Most others lack enough data to know either way — talk with your healthcare provider.
Meds to double-check
Major interaction found
Check with your pharmacist before taking this if you use blood thinners or antiplatelet drugs like warfarin (Major risk from Ginkgo, Danshen, and Goji). If you take methyldopa or any MAOI antidepressant, do not take this product — Mucuna pruriens poses a Major risk of dangerous blood pressure changes.
Watch for Moderate interactions if you're on heart medications (especially digoxin or tacrolimus), anti-seizure drugs, diabetes medications, any antidepressants, anxiety medications, cholesterol drugs, immunosuppressants, or medications metabolized by your liver. No interactions are documented for the three ingredients we could not check.
The bottom line
Scorecard at a glanceFully disclosed formula with some supporting evidence for its stated purpose. Major medication interactions have been identified, and safety information is well characterized.
This is a complex multi-ingredient brain supplement with mixed evidence. If you take any blood thinners, heart medications, diabetes drugs, antidepressants (especially MAOIs), anti-seizure medications, or immunosuppressants, you need to check with your pharmacist or doctor first — the interaction potential is real.
The contaminant risk with Spirulina and the safety questions around Acorus root are also worth considering. Talk to your pharmacist before starting, especially if you're on any regular medications.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 16 of 20 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Nov 25, 2011.
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 Brain 4 Way Support System, straight from the product label.
| Brand | Pure Essence Labs |
|---|---|
| Barcode (UPC) | 659670180507 |
| Net contents | 60 Tablet(s) |
| Market status | On market |
| Date entered into DSLD | Nov 25, 2011 |
| DSLD ID | 2204 |
| Product type | Other Combinations |
| Supplement form | Tablet Or Pill |
| Dietary claims / uses | 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 Brain 4 Way Support System by Pure Essence Labs, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| L-Leucine | 40 mg | -- |
| L-Tyrosine | 100 mg | -- |
| Phosphatidylcholine | 80 mg | -- |
| Phosphatidylserine | 80 mg | -- |
| organic Spirulina | 300 mg | -- |
| Eleuthero | 27 mg | -- |
| Schizandra fruit | 131 mg | -- |
| Glycerylphosphorylcholine | 80 mg | -- |
| 78 Ionic Trace Mineral Complex | 75 mg | -- |
| Organic oat grass juice | 60 mg | -- |
| Ginkgo leaf | 45 mg | -- |
| Rehmannia root | 45 mg | -- |
| Polygala tenuifolia root | 27 mg | -- |
| Mucuna pruriens seed | 27 mg | -- |
| Asparagus root | 27 mg | -- |
| Acorus root | 27 mg | -- |
| Salvia root | 27 mg | -- |
| Lycium fruit | 27 mg | -- |
| Platycodon root | 27 mg | -- |
| BioPerine Piper nigrum extract | 5 mg | -- |
Other ingredients: Cellulose, Silicon Dioxide, Croscarmellose Sodium, Maltodextrin, Stearic 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.
Suggested/Recommended/Usage/Directions
SUGGESTED USE: One tablet after breakfast, and another after lunch. When immediate mental enhancement is needed, take two tablets together.
Precautions
Please keep all supplements out of children's reach.
Caution: Not intended for use during pregnancy.
This product contains ginkgo biloba. Those on blood thinning medication should have their blood monitored while using it.
FDA Disclaimer Statement
*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
Storage
Storage: Keep tightly closed at room temperature.
General Statements
©2006 All Rights Reserved.
Estimated Whole Food/Herbal Value 11,000 mg
relieve nourish cleanse restore
General
V-030 309-040309
Brand IP Statement(s)
4 Way Brain Support System(TM)does not contain artificial colorings or flavorings, GMO’s, sugar, yeast, dairy, gluten or wheat.
About 4 Way Brain Support System(TM)
BioPerine(R) is a registered trademark of Sabinsa Corp.
Brain dysfunction stems from imbalances in the heart and kidney systems. 4 Way Brain Support System(TM)provides nutrients that directly improve brain function, while also nourishing, cleansing and restoring these systems to more normal function.*
Formulation
It is suitable for vegetarians, and is guaranteed to your complete satisfaction.
FDA Statement of Identity
DIETARY SUPPLEMENT
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Brain 4 Way Support System by Pure Essence Labs 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 Brain 4 Way Support System by Pure Essence Labs
These are the 20 active ingredients this product is made of. Select any to open its full monograph.
Serving size1 Tablet(s) Dosage formTablet Or Pill 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.
L-Leucine
L-Tyrosine
Interacts with21 drugs
L-tyrosine is an amino acid your body uses to make brain chemicals like dopamine and norepinephrine. Some studies suggest it may help mental performan...
L-Tyrosine monograph & interactionsPhosphatidylcholine
No knowninteractions
Phosphatidylcholine is a phospholipid that is part of every cell membrane and a source of choline. People take it for liver, brain, and gut health, bu...
Phosphatidylcholine monograph & interactionsPhosphatidylserine
Interacts with219 drugs
Phosphatidylserine is a natural fat-like compound found in cell membranes, especially in the brain, and it is sold mainly to support memory and thinki...
Phosphatidylserine monograph & interactionsOrganic Spirulina
Interacts with327 drugs
Blue-green algae are nutrient-rich aquatic microorganisms (such as spirulina and Klamath Lake algae) taken as a supplement for energy, nutrition, and...
Organic Spirulina monograph & interactionsEleuthero
Interacts with1,140 drugs
Eleuthero is an herb traditionally used as an 'adaptogen' to fight fatigue, boost energy, and help the body handle stress. The scientific evidence beh...
Eleuthero monograph & interactionsSchizandra fruit
Interacts with803 drugs
Schisandra is a traditional Chinese medicine berry used as an adaptogen for stress, fatigue, and liver support. Human evidence is limited and most cla...
Schizandra fruit monograph & interactionsGlycerylphosphorylcholine
Interacts with16 drugs
Alpha-GPC is a choline-containing compound used mainly for memory, brain health, and as a choline source. There is some evidence it may help cognition...
Glycerylphosphorylcholine monograph & interactions78 Ionic Trace Mineral Complex
Organic oat grass juice
Interacts with86 drugs
Oats are a well-studied whole grain whose soluble fiber (beta-glucan) can help lower cholesterol and support heart health when eaten regularly. As a f...
Organic oat grass juice monograph & interactionsGinkgo leaf
Interacts with1,266 drugs
Ginkgo is one of the world's most popular herbal supplements, mostly taken to support memory and circulation. The evidence for these uses is mixed and...
Ginkgo leaf monograph & interactionsRehmannia root
Interacts with258 drugs
Rehmannia is a root used for centuries in Traditional Chinese Medicine, often to 'tonify' the kidneys and support energy or blood health. Human eviden...
Rehmannia root monograph & interactionsPolygala tenuifolia root
Mucuna pruriens seed
Interacts with193 drugs
Cowhage (Mucuna pruriens) is a tropical legume best known as a natural source of L-dopa, the compound the body turns into dopamine. It is most studied...
Mucuna pruriens seed monograph & interactionsAsparagus root
Interacts with76 drugs
Asparagus is a nutritious vegetable that is safe and healthy to eat as part of a normal diet. Most of its claimed medicinal benefits, such as use as a...
Asparagus root monograph & interactionsAcorus root
Interacts with1,117 drugs
Calamus is a swamp plant with a long history in Ayurvedic and traditional Chinese medicine, mostly for digestive and nervous-system complaints. Howeve...
Acorus root monograph & interactionsSalvia root
Interacts with1,059 drugs
Danshen is a root used in traditional Chinese medicine, mainly for heart and circulation problems. Some early research is promising, but the evidence...
Salvia root monograph & interactionsLycium fruit
Interacts with1,000 drugs
Goji berries are a nutritious fruit rich in antioxidants, vitamins, and plant polysaccharides, and they are safe for most people as a food. While they...
Lycium fruit monograph & interactionsPlatycodon root
BioPerine Piper nigrum 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...
BioPerine Piper nigrum extract monograph & interactionsOther (inactive) ingredients: Cellulose, Silicon Dioxide, Croscarmellose Sodium, Maltodextrin, Stearic Acid. These complete the product’s ingredient list but are not active constituents.
Brain 4 Way Support System by Pure Essence Labs Drug Interactions
HelloPharmacist Interaction Report
Brain 4 Way Support System by Pure Essence Labs contains several ingredients that interact with medications.
The most serious concern is Mucuna pruriens seed, which contains levodopa and carries Major-severity interactions with methyldopa (a blood pressure medication) and monoamine oxidase inhibitors (MAOIs, a class of antidepressants) — both can cause dangerous blood pressure spikes or crashes. Levodopa also carries a Major interaction with other levodopa products themselves, risking overdose-like effects.
Read the full breakdown — every affected drug type, severity by severity
Several other ingredients interact at Moderate severity with common drug types. Ginkgo leaf increases bleeding risk with blood thinners like warfarin, and may reduce effectiveness of some anxiety medications and cholesterol drugs.
Schisandra fruit significantly affects how your liver metabolizes many medications, including the immunosuppressant tacrolimus and the sedative midazolam, potentially changing their blood levels. Salvia root (danshen) also increases bleeding risk with anticoagulants and may interact with heart medications.
Lycium fruit (goji) interacts with warfarin and several heart and diabetes drugs. Black pepper extract boosts absorption of multiple medications including anti-seizure and heart drugs.
Eleuthero affects liver metabolism of several drug types. Spirulina may interfere with blood thinners, diabetes drugs, and immunosuppressants.
Tyrosine may reduce levodopa effectiveness and add to thyroid hormone effects. Phosphatidylserine may decrease anticholinergic drug effectiveness.
Oat grass and Rehmannia may lower blood sugar or blood pressure additively.
Altoghether, these interactions span 1,655 individual medications. We could not check L-Leucine, the Ionic Trace Mineral Complex, or Polygala tenuifolia root — no data are on file for those.
Run your exact medications through the checker on this page before starting.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Brain 4 Way Support System?
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 Brain 4 Way Support System interact with 1,675 drugs. Click any drug to see the details.
15 of the 20 ingredients in Brain 4 Way Support System interact with drugs. Each result below shows which ingredient is responsible. Ginkgo leaf Eleuthero Acorus root Salvia root BioPerine Piper nigrum extract Lycium fruit Schizandra fruit organic Spirulina Rehmannia root Phosphatidylserine Mucuna pruriens seed Organic oat grass juice Asparagus root L-Tyrosine Glycerylphosphorylcholine
Alginic Acid, Aluminum HydroxideRafton
How Alginic Acid, Aluminum Hydroxide interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
Acorus RootAntacids Minor
Interaction Summary
Theoretically, taking calamus might reduce the effectiveness of antacids.
Read the full Acorus Root + Alginic Acid, Aluminum Hydroxide interactionAluminum HydroxideAlu-Cap, Amphojel, Gaviscon
How Aluminum Hydroxide interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
Acorus RootAntacids Minor
Interaction Summary
Theoretically, taking calamus might reduce the effectiveness of antacids.
Read the full Acorus Root + Aluminum Hydroxide interactionAluminum Hydroxide, Magnesium Hydroxide (otc Drug)Maalox, Mucogel
How Aluminum Hydroxide, Magnesium Hydroxide (otc Drug) interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
Acorus RootAntacids Minor
Interaction Summary
Theoretically, taking calamus might reduce the effectiveness of antacids.
Read the full Acorus Root + Aluminum Hydroxide, Magnesium Hydroxide (otc Drug) interactionAluminum Hydroxide, Magnesium Hydroxide, Simethicone (otc Drug)Mylanta
How Aluminum Hydroxide, Magnesium Hydroxide, Simethicone (otc Drug) interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
Acorus RootAntacids Minor
Interaction Summary
Theoretically, taking calamus might reduce the effectiveness of antacids.
Read the full Acorus Root + Aluminum Hydroxide, Magnesium Hydroxide, Simethicone (otc Drug) interactionAluminum, Magnesium (otc Drug)Almagel
How Aluminum, Magnesium (otc Drug) interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
Acorus RootAntacids Minor
Interaction Summary
Theoretically, taking calamus might reduce the effectiveness of antacids.
Read the full Acorus Root + Aluminum, Magnesium (otc Drug) interactionBismuth Subcarbonate, Calcium Carbonate, OpiumDiabismul
How Bismuth Subcarbonate, Calcium Carbonate, Opium interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
Acorus RootAntacids Minor
Interaction Summary
Theoretically, taking calamus might reduce the effectiveness of antacids.
Read the full Acorus Root + Bismuth Subcarbonate, Calcium Carbonate, Opium interactionBrincidofovirTembexa
How Brincidofovir interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
EleutheroOrganic Anion-transporting Polypeptide Substrates (oatp) Minor
Interaction Summary
Theoretically, eleuthero might decrease levels of drugs metabolized by OATP.
Read the full Eleuthero + Brincidofovir interactionCalcium CarbonateAdcal, Adcal-D3, Calcichew, Os-Cal, Tums
How Calcium Carbonate interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
Acorus RootAntacids Minor
Interaction Summary
Theoretically, taking calamus might reduce the effectiveness of antacids.
Read the full Acorus Root + Calcium Carbonate interactionCerivastatin SodiumBaycol
How Cerivastatin Sodium interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
EleutheroOrganic Anion-transporting Polypeptide Substrates (oatp) Minor
Interaction Summary
Theoretically, eleuthero might decrease levels of drugs metabolized by OATP.
Read the full Eleuthero + Cerivastatin Sodium interactionCinoxacinCinobac
How Cinoxacin interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
EleutheroOrganic Anion-transporting Polypeptide Substrates (oatp) Minor
Interaction Summary
Theoretically, eleuthero might decrease levels of drugs metabolized by OATP.
Read the full Eleuthero + Cinoxacin interactionCiprofloxacin, HydrocortisoneCipro HC Otic
How Ciprofloxacin, Hydrocortisone interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
EleutheroOrganic Anion-transporting Polypeptide Substrates (oatp) Minor
Interaction Summary
Theoretically, eleuthero might decrease levels of drugs metabolized by OATP.
Read the full Eleuthero + Ciprofloxacin, Hydrocortisone interactionDihydroxyaluminum Sodium CarbonateRolaids
How Dihydroxyaluminum Sodium Carbonate interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
Acorus RootAntacids Minor
Interaction Summary
Theoretically, taking calamus might reduce the effectiveness of antacids.
Read the full Acorus Root + Dihydroxyaluminum Sodium Carbonate interactionGatifloxacinTequin, Tequin Injection
How Gatifloxacin interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
EleutheroOrganic Anion-transporting Polypeptide Substrates (oatp) Minor
Interaction Summary
Theoretically, eleuthero might decrease levels of drugs metabolized by OATP.
Read the full Eleuthero + Gatifloxacin interactionGemifloxacinFactive
How Gemifloxacin interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
EleutheroOrganic Anion-transporting Polypeptide Substrates (oatp) Minor
Interaction Summary
Theoretically, eleuthero might decrease levels of drugs metabolized by OATP.
Read the full Eleuthero + Gemifloxacin interactionLevofloxacin (ophthalmic)Levofloxacin
How Levofloxacin (ophthalmic) interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
EleutheroOrganic Anion-transporting Polypeptide Substrates (oatp) Minor
Interaction Summary
Theoretically, eleuthero might decrease levels of drugs metabolized by OATP.
Read the full Eleuthero + Levofloxacin (ophthalmic) interactionMagaldrateRiopan
How Magaldrate interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
Acorus RootAntacids Minor
Interaction Summary
Theoretically, taking calamus might reduce the effectiveness of antacids.
Read the full Acorus Root + Magaldrate interactionNizatidineAxid, Axid Injection
How Nizatidine interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
Acorus RootH2-blockers Minor
Interaction Summary
Theoretically, taking calamus might reduce the effectiveness of H2-blockers.
Read the full Acorus Root + Nizatidine interactionNorfloxacinNorflox, Noroxin
How Norfloxacin interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
EleutheroOrganic Anion-transporting Polypeptide Substrates (oatp) Minor
Interaction Summary
Theoretically, eleuthero might decrease levels of drugs metabolized by OATP.
Read the full Eleuthero + Norfloxacin interactionPravastatin SodiumPravachol
How Pravastatin Sodium interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
EleutheroOrganic Anion-transporting Polypeptide Substrates (oatp) Minor
Interaction Summary
Theoretically, eleuthero might decrease levels of drugs metabolized by OATP.
Read the full Eleuthero + Pravastatin Sodium interactionSodium Bicarbonate (otc Drug)Sodium Bicarbonate
How Sodium Bicarbonate (otc Drug) interacts with Brain 4 Way Support System — through 1 ingredient. Tap an ingredient for the detail:
Acorus RootAntacids Minor
Interaction Summary
Theoretically, taking calamus might reduce the effectiveness of antacids.
Read the full Acorus Root + Sodium Bicarbonate (otc Drug) interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Brain 4 Way Support System 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.
Ginkgo leaf
Talinolol
Taking ginkgo with talinolol seems to increase blood levels of talinolol.
There is some evidence that using ginkgo leaf extract 120 mg orally three times daily for 14 days can increase levels of talinolol by 36% in healthy male individuals. However, single doses of ginkgo do not seem to affect talinolol pharmacokinetics.
Alprazolam (Xanax)
Theoretically, ginkgo might decrease the levels and clinical effects of alprazolam.
In clinical research, ginkgo extract (Ginkgold) 120 mg twice daily seems to decrease alprazolam levels by about 17%. However, ginkgo does not appear to decrease the elimination half-life of alprazolam. This suggests that ginkgo is more likely to decrease absorption of alprazolam rather than induce hepatic metabolism of alprazolam.
Anticoagulant/Antiplatelet Drugs
Ginkgo has been shown to increase the risk of bleeding in some people when taken with warfarin. Theoretically, ginkgo might increase the risk of bleeding if used with other anticoagulant or antiplatelet drugs.
Several pharmacodynamic studies suggest that ginkgo inhibits platelet aggregation. It is thought that the ginkgo constituent, ginkgolide B, displaces platelet-activating factor (PAF) from its binding sites, decreasing blood coagulation. Several case reports have documented serious bleeding events in patients taking ginkgo. However, population and clinical studies have produced mixed results. Some evidence shows that short-term use of ginkgo leaf does not significantly reduce platelet aggregation and blood clotting. A study in healthy males who took a specific ginkgo leaf extract (EGb 761) 160 mg twice daily for 7 days found no change in prothrombin time. An analysis of a large medical record database suggests that ginkgo increases the risk of a bleeding adverse event by 38% when taken concurrently with warfarin. It has been suggested that ginkgo has to be taken for at least 2-3 weeks to have a significant effect on platelet aggregation. However, a meta-analysis of 18 studies using standardized ginkgo extracts, 80-480 mg daily for up to 32 weeks, did not find a significant effect on platelet aggregation, fibrinogen concentration, or PT/aPTT. In addition, a single dose of ginkgo plus clopidogrel or ticlopidine does not seem to significantly increase bleeding time or platelet aggregation. Also, taking ginkgo leaf extract daily for 8 days in conjunction with rivaroxaban does not affect anti-factor Xa activity; however, this study did not evaluate bleeding time.
Anticonvulsants
Theoretically, ginkgo might reduce the effectiveness of anticonvulsants.
Ginkgo seeds contain ginkgotoxin. Large amounts of ginkgotoxin can cause neurotoxicity and seizure. Ginkgotoxin is present in much larger amounts in ginkgo seeds than leaves. Ginkgo leaf extract contains trace amounts of ginkgotoxin. The amount of ginkgotoxin in ginkgo leaf and leaf extract seems unlikely to cause toxicity. However, there are anecdotal reports of seizure occurring after use of ginkgo leaf both in patients without a history of seizure disorder and in those with previously well-controlled epilepsy.
Antidiabetes Drugs
Theoretically, taking ginkgo with antidiabetes drugs might alter the response to antidiabetes drugs.
Ginkgo leaf extract seems to alter insulin secretion and metabolism, and might affect blood glucose levels in people with type 2 diabetes. The effect of ginkgo seems to differ depending on the insulin and treatment status of the patient. In diet-controlled diabetes patients with hyperinsulinemia, taking ginkgo does not seem to significantly affect insulin or blood glucose levels. In patients with hyperinsulinemia who are treated with oral hypoglycemic agents, taking ginkgo seems to decrease insulin levels and increase blood glucose following an oral glucose tolerance test. Researchers speculate that this could be due to ginkgo-enhanced hepatic metabolism of insulin. In patients with pancreatic exhaustion, taking ginkgo seems to stimulate pancreatic beta-cells, resulting in increased insulin and C-peptide levels, but with no significant change in blood glucose levels in response to an oral glucose tolerance test.
Atorvastatin (Lipitor)
Theoretically, ginkgo might decrease the levels and clinical effects of atorvastatin.
In humans, intake of ginkgo extract appears to increase atorvastatin clearance, reducing the area under the curve of atorvastatin by 10% to 14% and the maximum concentration by 29%. However, this interaction does not appear to affect cholesterol synthesis and absorption. Further, a model in rats with hyperlipidemia suggests that administering ginkgo extract does not impact blood levels of atorvastatin and leads to lower total cholesterol, low-density lipoprotein cholesterol, and triglycerides when compared with rats given atorvastatin alone.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, ginkgo might increase levels of drugs metabolized by CYP1A2.
Laboratory research suggests that ginkgo leaf extract can mildly inhibit CYP1A2 enzymes. However, clinical research suggests ginkgo might not affect CYP1A2. Until more is known, use ginkgo cautiously in patients taking drugs metabolized by these enzymes.
Cytochrome P450 2C19 (Cyp2C19) Substrates
Theoretically, ginkgo might decrease levels of drugs metabolized by CYP2C19.
Some clinical research shows that a specific ginkgo leaf extract (Remembrance, Herbs Product LTD) 140 mg twice daily can induce CYP2C19 enzymes and potentially decrease levels of drugs metabolized by these enzymes. However, other clinical research shows that taking ginkgo 120 mg twice daily for 12 days has no effect on levels of drugs metabolized by CYP2C19.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, ginkgo might increase levels of drugs metabolized by CYP2C9.
In vitro, a specific standardized extract of ginkgo leaf (EGb 761) inhibits CYP2C9 activity . The terpenoid (ginkgolides) and flavonoid (quercetin, kaempferol, etc.) constituents seem to be responsible for this effect. Most ginkgo extracts contain some amount of these constituents. Therefore, other ginkgo leaf extracts might also inhibit the CYP2C9 enzyme. However, clinical research suggests that ginkgo might not have a significant effect on CYP2C9 in humans. Ginkgo does not seem to significantly affect the pharmacokinetics of CYP2C9 substrates diclofenac or tolbutamide.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, ginkgo might decrease levels of drugs metabolized by CYP3A4.
There is conflicting evidence about whether ginkgo induces or inhibits CYP3A4. Ginkgo does not appear to affect hepatic CYP3A4. However, it is not known if ginkgo affects intestinal CYP3A4. Preliminary clinical research suggests that taking ginkgo does not significantly affect levels of donepezil, lopinavir, or ritonavir, which are all CYP3A4 substrates. Other clinical research also suggests ginkgo does not significantly affect CYP3A4 activity. However, there are two case reports of decreased efavirenz concentrations and increased viral load in patients taking ginkgo. It is suspected that terpenoids from the ginkgo extract reduced drug levels by inducing cytochrome P450 3A4 (CYP3A4).
Efavirenz (Sustiva)
Theoretically, ginkgo might decrease the levels and clinical effects of efavirenz.
There are two case reports of decreased efavirenz concentrations and increased viral load in patients taking ginkgo. In one case, an HIV-positive male experienced over a 50% decrease in efavirenz levels over the course of 14 months while taking ginkgo extract. HIV-1 RNA copies also increased substantially, from less than 50 to more than 1500. It is suspected that terpenoids from the ginkgo extract reduced drug levels by inducing cytochrome P450 3A4 (CYP3A4). In another case report, a patient stable on antiviral therapy including efavirenz for 10 years, had an increase in viral load from <50 copies/mL to 1350 copies/mL after 2 months of taking a combination of supplements including ginkgo. After stopping ginkgo, the viral load was again controlled with the same antiviral therapy regimen.
Ibuprofen (Advil, Others)
Theoretically, ginkgo might increase the risk of bleeding when used with ibuprofen.
Ginkgo might have antiplatelet effects and has been associated with several case reports of spontaneous bleeding. In one case, a 71-year-old male had taken a specific ginkgo extract (Gingium, Biocur) 40 mg twice daily for 2.5 years. About 4 weeks after starting ibuprofen 600 mg daily he experienced a fatal intracerebral hemorrhage. However, the antiplatelet effects of ginkgo have been questioned. A meta-analysis and other studies have not found a significant antiplatelet effect with standardized ginkgo extracts, 80 mg to 480 mg taken daily for up to 32 weeks.
P-Glycoprotein Substrates
Theoretically, taking ginkgo with P-glycoprotein substrates might increase the levels and adverse effects of these substrates.
A small clinical study in healthy volunteers shows that using ginkgo leaf extract 120 mg orally three times daily for 14 days can increase levels of the P-glycoprotein substrate, talinolol, by 36% in healthy male individuals. However, single doses of ginkgo do not have the same effect.
Risperidone (Risperdal)
Theoretically, taking ginkgo with risperidone might increase the levels and adverse effects of risperidone.
A single case of priapism has been reported for a 26-year-old male with schizophrenia who used risperidone 3 mg daily along with ginkgo extract 160 mg daily. Risperidone is metabolized by cytochrome P450 (CYP) 2D6 and CYP3A4. CYP3A4 activity might be affected by ginkgo. Theoretically, ginkgo may inhibit the metabolism of risperidone and increase the risk of adverse effects.
Rosiglitazone (Avandia)
Theoretically, ginkgo might decrease the levels and clinical effects of rosiglitazone.
Animal research shows that ginkgo leaf extract orally 100 or 200 mg/kg daily for 10 days alters the pharmacodynamics of rosiglitazone in a dose-dependent manner. The 100 mg/kg and 200 mg/kg doses reduce the area under the concentration time curve (AUC) of rosiglitazone by 39% and 52%, respectively, and the half-life by 28% and 39%, respectively. It is hypothesized that these changes may be due to induction of cytochrome P450 2C8 by ginkgo.
Seizure Threshold Lowering Drugs
Theoretically, taking ginkgo with drugs that lower the seizure threshold might increase the risk for convulsions.
Ginkgo seeds contain ginkgotoxin. Large amounts of ginkgotoxin can cause neurotoxicity and seizure. Ginkgotoxin is present in much larger amounts in ginkgo seeds than leaves. Ginkgo leaf extract contains trace amounts of ginkgotoxin. The amount of ginkgotoxin in ginkgo leaf and leaf extract seems unlikely to cause toxicity. However, there are anecdotal reports of seizure occurring after use of ginkgo leaf both in patients without a history of seizure disorder and in those with previously well-controlled epilepsy.
Simvastatin (Zocor)
Theoretically, ginkgo might decrease the levels and clinical effects of simvastatin.
Clinical research shows that taking ginkgo extract can reduce the area under the curve and maximum concentration of simvastatin by 32% to 39%. However, ginkgo extract does not seem to affect the cholesterol-lowering ability of simvastatin.
Sofosbuvir (Sovaldi)
Theoretically, ginkgo might increase the levels and clinical effects of sofosbuvir.
Animal research in rats shows that giving a ginkgo extract 25 mg/kg orally daily for 14 days increases the area under the concentration time curve (AUC) after a single sofosbuvir dose of 40 mg/kg by 11%, increases the half-life by 60%, and increases the plasma concentration at 4 hours by 38%. This interaction appears to be related to the inhibition of intestinal P-glycoprotein by ginkgo.
Tacrolimus (Prograf)
Theoretically, ginkgo might increase the blood levels of tacrolimus.
In vitro evidence suggests that certain biflavonoids in ginkgo leaves (i.e. amentoflavone, ginkgetin, bilobetin) may inhibit the metabolism of tacrolimus by up to 50%. This interaction appears to be time-dependent and due to inhibition of cytochrome P450 (CYP) 3A4 by these bioflavonoids. In rats given tacrolimus 1 mg/kg orally, amentoflavone was shown to increase the area under the concentration time curve (AUC) of tacrolimus by 3.8-fold.
Trazodone (Desyrel)
Theoretically, ginkgo might increase the levels and clinical effects of trazodone.
In a case report, an Alzheimer patient taking trazodone 20 mg twice daily and ginkgo leaf extract 80 mg twice daily for four doses became comatose. The coma was reversed by administration of flumazenil (Romazicon). Coma might have been induced by excessive GABA-ergic activity. Ginkgo flavonoids are thought to have GABA-ergic activity and act directly on benzodiazepine receptors. Ginkgo might also increase metabolism of trazodone to active GABA-ergic metabolites, possibly by inducing cytochrome P450 3A4 (CYP3A4) metabolism.
Warfarin (Coumadin)
Ginkgo has been shown to increase the risk of bleeding in some people when taken with warfarin.
Several pharmacodynamic studies suggest that ginkgo inhibits platelet aggregation. It is thought that the ginkgo constituent, ginkgolide B, displaces platelet-activating factor (PAF) from its binding sites, decreasing blood coagulation. Several case reports have documented serious bleeding events in patients taking ginkgo. Information from a medical database suggests that when taken concurrently with warfarin, ginkgo increases the risk of a bleeding adverse event by 38%. There is also some evidence that ginkgo leaf extract can inhibit cytochrome P450 2C9, an enzyme that metabolizes warfarin. This could result in increased warfarin levels. However, population and clinical research has produced mixed results. Clinical research in healthy people suggests that ginkgo has no effect on INR, or the pharmacokinetics or pharmacodynamics of warfarin. A meta-analysis of 18 studies using standardized ginkgo extracts, 80 mg to 480 mg daily for up to 32 weeks, did not find a significant effect on platelet aggregation, fibrinogen concentration, or PT/aPTT. There is also some preliminary clinical research that suggests ginkgo might not significantly increase the effects of warfarin in patients that have a stable INR.
Nifedipine (Procardia)
Theoretically, taking ginkgo with oral, but not intravenous, nifedipine might increase levels and adverse effects of nifedipine.
Animal research and some clinical evidence suggests that taking ginkgo leaf extract orally in combination with oral nifedipine might increase nifedipine levels and cause increased side effects, such as headaches, dizziness, and hot flushes. However, taking ginkgo orally does not seem to affect the pharmacokinetics of intravenous nifedipine.
Omeprazole (Prilosec)
Theoretically, taking ginkgo with omeprazole might decrease the levels and clinical effects of omeprazole.
Clinical research shows that a specific ginkgo leaf extract (Remembrance, Herbs Product LTD) 140 mg twice daily can induce cytochrome P450 (CYP) 2C19 enzymes and decrease levels of omeprazole by about 27% to 42%.
Eleuthero
Anticoagulant/Antiplatelet Drugs
Theoretically, eleuthero may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
In vitro and animal research shows that a constituent of eleuthero, dihydroxybenzoic acid, appears to inhibit platelet aggregation. Concomitant use with anticoagulant or antiplatelet drugs might increase the risk of bleeding. This effect has not been reported in humans.
Antidiabetes Drugs
Theoretically, eleuthero might have additive effects when used with antidiabetes drugs.
Animal research suggests that certain constituents of eleuthero have hypoglycemic activity in both healthy and diabetic animals. A small study in adults with type 2 diabetes also shows that taking eleuthero for 3 months can lower blood glucose levels. However, one very small study in healthy individuals shows that taking powdered eleuthero 3 grams, 40 minutes prior to a 75-gram oral glucose tolerance test, significantly increases postprandial blood glucose levels when compared with placebo. These contradictory findings might be due to patient-specific variability and variability in active ingredient ratios.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, eleuthero might increase levels of drugs metabolized by CYP1A2.
In vitro and animal research suggest that standardized extracts of eleuthero inhibit CYP1A2. This effect has not been reported in humans.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, eleuthero might increase levels of drugs metabolized by CYP2C9.
In vitro and animal research suggest that standardized extracts of eleuthero might inhibit CYP2C9. This effect has not been reported in humans.
Digoxin (Lanoxin)
Eleuthero might increase serum digoxin levels and increase the risk of side effects.
In one case report, a 74-year-old male who was stabilized on digoxin presented with an elevated serum digoxin level after starting an eleuthero supplement, without symptoms of toxicity. After stopping the supplement, serum digoxin levels returned to normal. It is not clear whether this was due to a pharmacokinetic interaction or to interference with the digoxin assay. Although the product was found to be free of digoxin and digitoxin, it was not tested for other contaminants.
Immunosuppressants
Theoretically, eleuthero might interfere with immunosuppressive drugs because of its immunostimulant activity.
Animal and in vitro research shows that eleuthero extracts have immunomodulatory effects, including increasing cellular and humoral activity.
P-Glycoprotein Substrates
Theoretically, eleuthero might increase levels of P-glycoprotein substrates.
In vitro research suggests that eleuthero can inhibit the multi-drug transporter protein, P-glycoprotein. However, it is too soon to tell if this is clinically important. This interaction has not been reported in humans.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Theoretically, eleuthero might increase levels of drugs metabolized by CYP2D6.
In vitro and animal research suggest that standardized extracts of eleuthero might inhibit CYP2D6. However, research in healthy human volunteers has found that taking eleuthero 485 mg twice daily for 14 days does not inhibit CYP2D6 drug metabolism.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, eleuthero might increase levels of drugs metabolized by CYP3A4.
In vitro and animal research suggest that standardized extracts of eleuthero might inhibit CYP3A4. However, research in healthy human volunteers has found that taking eleuthero 485 mg twice daily for 14 days does not inhibit CYP3A4 drug metabolism.
Organic Anion-Transporting Polypeptide Substrates (Oatp)
Theoretically, eleuthero might decrease levels of drugs metabolized by OATP.
In vitro research suggests that eleuthero inhibits OATP2B1, which might reduce the bioavailability of oral drugs that are substrates of OATP2B1. Due to the weak inhibitory effect identified in this study, this interaction is not likely to be clinically significant.
Acorus root
Anticholinergic Drugs
Theoretically, concurrent use of anticholinergic drugs and calamus might decrease the effectiveness of the anticholinergic drug.
In vitro evidence shows that calamus can inhibit acetylcholinesterase (AChE).
Antihypertensive Drugs
Theoretically, taking calamus with other antihypertensive medications might increase the risk of hypotension.
Animal research shows that calamus decreases the rate and strength of the heartbeat, which might lower blood pressure. use with caution.
Cholinergic Drugs
Theoretically, concurrent use of cholinergic drugs and calamus might have an additive effect and increase the risk of cholinergic effects.
In vitro evidence shows that calamus can inhibit acetylcholinesterase (AChE).
Cns Depressants
Theoretically, concurrent use of CNS depressants and calamus might have an additive effect and increase the risk of sedative effects.
Animal research shows that calamus is a CNS depressant and increases gamma-aminobutyric acid levels.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Theoretically, taking calamus with drugs metabolized by CYP2D6 might increase drug levels and potentially increase the risk of adverse effects.
In vitro research shows that calamus extract inhibits CYP2D6 enzyme.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, taking calamus with drugs metabolized by CYP3A4 might increase drug levels and potentially increase the risk of adverse effects.
In vitro research shows that calamus extract inhibits CYP3A4 enzyme.
Monoamine Oxidase Inhibitors (Maois)
Theoretically, calamus might potentiate the effects and adverse effects of MAOIs.
Some reports suggest that calamus increases the effects of MAOIs.
Antacids
Theoretically, taking calamus might reduce the effectiveness of antacids.
Some research suggests that calamus lowers gastric pH.
H2-Blockers
Theoretically, taking calamus might reduce the effectiveness of H2-blockers.
Some research suggests that calamus lowers gastric pH.
Proton Pump Inhibitors (Ppis)
Theoretically, taking calamus might reduce the effectiveness of PPIs.
Some research suggests that calamus lowers gastric pH.
Salvia root
Anticoagulant/Antiplatelet Drugs
Theoretically, danshen may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Danshen has been reported to have antithrombotic effects. Animal research also suggests that taking a danshen combination formula with clopidogrel exhibits a synergistic increase in antiplatelet aggregation and prolongation of coagulation time when compared with either taken alone.
Digoxin (Lanoxin)
Theoretically, using danshen with digoxin might increase the risk of adverse effects.
Danshen has structural and pharmacological similarities to cardiac glycosides.
Amlodipine (Norvasc)
Theoretically, taking danshen in combination with amlodipine may decrease the clinical effects of amlodipine.
In animal research, taking danshen orally in combination with amlodipine reduced blood levels of amlodipine by about 52%. This may have been due to induction of cytochrome P450 3A4 (CYP3A4) by danshen, which has been demonstrated in vitro. So far, this interaction has not been reported in humans.
Antihypertensive Drugs
Theoretically, taking danshen with antihypertensive drugs might increase the risk of hypotension.
Animal research suggests that danshen can produce dose-dependent hypotensive effects. Furthermore, concomitant use with captopril appears to potentiate this effect.
Aspirin
Theoretically, danshen may increase the levels of aspirin and the risk of bleeding.
Research in healthy adult males shows that taking a combination of danshen and kudzu with aspirin increases plasma aspirin area under the curve by approximately 3.4-fold. Animal research also shows that taking a combination of danshen and kudzu (danshen-gegen formula) with aspirin increases maximal blood levels of aspirin and salicylic acid by approximately 4-fold and 3.7-fold, respectively, without impacting blood loss. Taking danshen increases the antiplatelet activity of aspirin and might increase the side effects of aspirin.
Clopidogrel (Plavix)
Theoretically, danshen may increase the risk of bleeding if taken with clopidogrel.
Clopidogrel is an antiplatelet prodrug that is metabolized by carboxyl esterase 1 (CES1) to an inactive metabolite. Animal research shows that a danshen combination formula decreases the activity of CES1, decreasing levels of the inactive metabolite in the blood and possibly increasing levels of the active metabolite. Animal research also suggests that taking a danshen combination formula with clopidogrel exhibits a synergistic increase in antiplatelet aggregation and prolongation of coagulation time when compared with either taken alone.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, danshen may increase the levels and clinical effects of drugs metabolized by CYP1A2.
In vitro research shows that danshen tincture and various constituents of danshen inhibit the activity of CYP1A2. However, this activity has not been shown in humans when theophylline, a CYP1A2 substrate, was used as a target drug.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, danshen may increase the levels and clinical effects of drugs metabolized by CYP2C9.
In vitro research shows that various constituents of danshen inhibit the activity of CYP2C9. So far, this interaction has not been reported in humans.
Cytochrome P450 2E1 (Cyp2E1) Substrates
Theoretically, danshen may increase the levels and clinical effects of drugs metabolized by CYP2E1.
In vitro research shows that various constituents of danshen inhibit the activity of CYP2E1. So far, this interaction has not been reported in humans.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Danshen might alter the levels and clinical effects of drugs metabolized by CYP3A4.
Preliminary clinical research in healthy males shows that the administration of danshen for 10-14 days induces intestinal CYP3A4 and increases the clearance of midazolam, a CYP3A4 substrate. The maximum concentration of midazolam was decreased by 31% to 67%, and drug levels were decreased by 27% to 80%. However, a single dose of danshen has the opposite effect, increasing maximum concentrations of midazolam by 87%.
Fexofenadine (Allegra)
Danshen might increase the levels and clinical effects of fexofenadine.
Pharmacokinetic research in healthy volunteers shows that taking danshen extract 1 gram three times daily for 10 days prior to receiving fexofenadine 60 mg increases peak levels of fexofenadine, a p-glycoprotein substrate, by 27.4% and area under the curve (AUC) by 37.2%.
Glucuronidated Drugs
Theoretically, danshen might affect the levels and clinical effects of drugs requiring glucuronidation.
In vitro research shows that danshen induces the expression of glucuronosyltransferases. However, it also inhibits the activity of glucuronosyltransferases, including various members of the 1A and 2B families. The extent of inhibition of a specific glucuronosyltransferase seems to be dependent on whether or not the danshen is processed via 'sweating'. This type of processing may affect the levels of constituents in danshen that alter glucuronosyltransferase activity. So far, this interaction has not been reported in humans.
Midazolam (Versed)
Danshen might alter the levels and clinical effects of midazolam.
Preliminary clinical research in healthy males shows that the administration of danshen for 10-14 days induces intestinal CYP3A4 and increases midazolam clearance. The maximum concentration was decreased by 31% to 67%, and drug levels were decreased by 27% to 80%. However, a single dose of danshen has the opposite effect, increasing maximum concentrations of midazolam by 87%.
P-Glycoprotein Substrates
Danshen might alter the levels of drugs cleared by p-glycoprotein.
Pharmacokinetic research in healthy volunteers suggests that danshen might affect p-glycoprotein activity. Taking danshen extract 1 gram three times daily for 10 days prior to receiving fexofenadine 60 mg increases peak levels of fexofenadine, a p-glycoprotein substrate, by 27.4% and area under the curve (AUC) by 37.2%.
Rosuvastatin (Crestor)
Theoretically, danshen might increase the levels and clinical effects of rosuvastatin.
Animal research shows that a single dose of danshen increases levels of rosuvastatin at least 2-fold, possibly by increasing absorption and/or decreasing elimination. So far, this interaction has not been reported in humans.
Warfarin (Coumadin)
Theoretically, danshen may increase the risk of bleeding if used with warfarin.
There have been several case reports of increased international normalized ratio (INR) after concomitant use of danshen and warfarin. Elevations in INR have occurred as early as 3-5 days after start of danshen. However, a clinical trial in adults taking warfarin with stable INR found that the addition of compound danshen dripping pills, containing danshen extract, Panax notoginseng, and borneol, 270 mg three times daily for 4 weeks did not alter INR levels or the average required warfarin dose when compared to baseline. These findings are consistent with animal research, which found no change in warfarin pharmacokinetics with the use of danshen. Other research in healthy adult males also shows that taking a combination of danshen and kudzu with warfarin does not increases plasma warfarin area under the curve, but may reduce plasma soluble thrombomodulin levels. However, other research shows that danshen might increase the rate of absorption and decrease the elimination rate of warfarin. Also, research in healthy adult males shows that taking a combination of danshen and kudzu with warfarin increases plasma area under the curve of danshensu, a constituent of danshen, by approximately 29.5-fold. Danshen should be used cautiously in patients taking warfarin.
BioPerine Piper nigrum 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.
Lycium fruit
Warfarin (Coumadin)
Goji can increase the effects of warfarin and possibly increase the risk of bleeding.
There are at least 5 case reports of increased international normalized ratio (INR) in patients stabilized on warfarin who began drinking goji juice, concentrated goji tea, or goji wine. Goji may inhibit the metabolism of warfarin by cytochrome P450 2C9 (CYP2C9).
Antihypertensive Drugs
Theoretically, concomitant use of goji root bark, but not goji fruit, with antihypertensive drugs might have additive effects.
Animal and in vitro research suggest that goji root bark has hypotensive effects. However, goji fruit juice does not appear to reduce systolic or diastolic blood pressure in humans.
Cytochrome P450 2C19 (Cyp2C19) Substrates
Theoretically, goji berry might inhibit CYP2C19 and reduce metabolism of CYP2C19 substrates.
In vitro research shows that goji berry tincture and juice inhibit CYP2C19 enzymes. Concomitant use with goji may decrease metabolism and increase levels of CYP2C19 substrates. However, this has not been reported in humans.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, goji berry might inhibit CYP2C9 and reduce metabolism of CYP2C9 substrates.
In vitro research shows that goji berry tincture and juice inhibit CYP2C9 enzymes. Additionally, multiple case reports suggest that goji berry concentrated tea and juice inhibit the metabolism of warfarin, a CYP2C9 substrate. Concomitant use with goji may decrease metabolism and increase levels of CYP2C9 substrates.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Theoretically, goji berry might inhibit CYP2D6 and reduce metabolism of CYP2D6 substrates.
In vitro research shows that goji berry juice inhibits CYP2D6 enzymes. Concomitant use with goji may decrease metabolism and increase levels of CYP2D6 substrates. However, this has not been reported in humans.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, goji berry might inhibit CYP3A4 and reduce metabolism of CYP3A4 substrates.
In vitro research shows that goji berry juice inhibits CYP3A4 enzymes. Concomitant use with goji may decrease metabolism and increase levels of CYP3A4 substrates. However, this has not been reported in humans.
Flecainide (Tambocor)
Theoretically, goji berry might increase the levels and clinical effects of flecainide.
In one case report, a 75-year-old patient stable on flecainide and warfarin presented to the emergency room with fainting and pleomorphic arrhythmia caused by flecainide toxicity. Flecainide toxicity was attributed to drinking 1-2 glasses of concentrated goji tea daily for 2 weeks. Theoretically, goji may have inhibited the cytochrome P450 2D6 (CYP2D6) metabolism of flecainide.
Antidiabetes Drugs
Theoretically, concomitant use of goji fruit polysaccharides or goji root bark with antidiabetes drugs might have additive effects.
Animal and in vitro research show that goji root bark and fruit polysaccharides might have hypoglycemic effects. However, clinical research has only shown that taking goji fruit polysaccharides with or without antidiabetes drugs modestly reduces postprandial glucose when compared with control, with no reports of hypoglycemia.
Schizandra fruit
Cyclophosphamide
Theoretically, schisandra might increase the levels and clinical effects of cyclophosphamide.
In vitro research shows that schisandra increases the concentration of cyclophosphamide, likely through inhibition of cytochrome P450 3A4. After multiple doses of the schisandra constituents schisandrin A and schisantherin A, the maximum concentration of cyclophosphamide was increased by 7% and 75%, respectively, while the overall exposure to cyclophosphamide was increased by 29% and 301%, respectively.
Cyclosporine (Neoral, Sandimmune)
Schisandra can increase the levels and clinical effects of cyclosporine.
A small observational study in children with aplastic anemia found that taking schisandra with cyclosporine increased cyclosporine trough levels by 93% without increasing the risk of adverse events. However, the dose of cyclosporine was reduced in 9% of children to maintain appropriate cyclosporine blood concentrations.
Cytochrome P450 2C19 (Cyp2C19) Substrates
Theoretically, schisandra might increase the levels and clinical effects of CYP2C19 substrates.
In vitro research shows that schisandra inhibits CYP2C19, and animal research shows that schisandra increases the concentration of voriconazole, a CYP2C19 substrate. Theoretically, schisandra may also inhibit the metabolism of other CYP2C19 substrates. This effect has not been reported in humans.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, schisandra might decrease the levels and clinical effects of CYP2C9 substrates.
In vitro and animal research suggests that schisandra induces CYP2C9 enzymes. This effect has not been reported in humans.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Schisandra can increase the levels and clinical effects of drugs metabolized by CYP3A4.
Most clinical and laboratory research shows that schisandra, administered either as a single dose or up to twice daily for 14 days, inhibits CYP3A4 and increases the concentration of CYP3A4 substrates such as cyclophosphamide, midazolam, tacrolimus, and talinolol. Although one in vitro and animal study shows that schisandra may induce CYP3A4 metabolism, this effect appears to be overpowered by schisandra's CYP3A4 inhibitory activity and has not been reported in humans.
Midazolam (Versed)
Schisandra can increase the levels and clinical effects of midazolam.
A small pharmacokinetic study in healthy adults shows that taking schisandra extract (Hezheng Pharmaceutical Co.) containing deoxyschizandrin 33.75 mg twice daily for 8 days and a single dose of midazolam 15 mg on day 8 increases the overall exposure to midazolam by about 119%, increases the peak plasma level of midazolam by 86%, and decreases midazolam clearance by about 52%. This effect has been attributed to inhibition of CYP3A4 by schisandra.
P-Glycoprotein Substrates
Schisandra might increase the levels and clinical effects of P-glycoprotein substrates.
In vitro research shows that schisandra extracts and constituents such as schisandrin B inhibit P-glycoprotein mediated efflux in intestinal cells and in P-glycoprotein over-expressing cell lines. Additionally, a small clinical study shows that schisandra increases the peak concentration and overall exposure to talinolol, a P-glycoprotein probe substrate. Theoretically, schisandra might inhibit the efflux of other P-glycoprotein substrates.
Sirolimus (Rapamune)
Schisandra can increase the levels and clinical effects of sirolimus.
A small pharmacokinetic study in healthy volunteers shows that taking 3 capsules of schisandra (Hezheng Pharmaceutical Company) containing a total of 33.75 mg deoxyschizandrin twice daily for 13 days and then taking a single dose of sirolimus 2 mg increases the overall exposure and peak level of sirolimus by two-fold. This effect is thought to be due to inhibition of cytochrome P450 3A4 by schisandra, as well as possible inhibition of the P-glycoprotein drug transporter.
Tacrolimus (Prograf)
Schisandra can increase the levels and clinical effects of tacrolimus.
Clinical research in healthy children and adults, transplant patients, and patients with nephrotic syndrome and various rheumatic immunologic disorders shows that taking schisandra with tacrolimus increases tacrolimus peak levels by 183% to 268%, prolongs or delays time to peak tacrolimus concentrations, increases overall exposure to tacrolimus by 126% to 343%, and decreases tacrolimus clearance by 19% to 73%. This effect is thought to be due to inhibition of P-glycoprotein drug transporter and CYP3A4 and CYP3A5 by schisandra. Some clinical and observational studies suggest that schisandra increases tacrolimus levels similarly in both expressors and non-expressors of CYP3A5, while other studies suggest it does so to a greater degree in CYP3A5 expressors than non-expressors. Animal research suggests that the greatest increase in tacrolimus levels occurs when schisandra is taken either concomitantly or up to 2 hours before tacrolimus, and clinical and observational research in humans suggests that schisandra may increase whole blood levels of tacrolimus and decrease clearance of tacrolimus in a dose-dependent manner.
Talinolol
Schisandra can increase the levels and clinical effects of talinolol.
A small pharmacokinetic study in healthy volunteers shows that taking schisandra extract 300 mg twice daily for 14 days with a single dose of talinolol 100 mg on day 14 increases the peak talinolol level by 51% and the overall exposure to talinolol by 47%. This effect is thought to be due to the possible inhibition of cytochrome P450 3A4 and P-glycoprotein by schisandra.
tly.
Voriconazole (Vfend)
Theoretically, schisandra might increase the levels and clinical effects of voriconazole.
Animal research shows that oral schisandra given daily for 1 or 14 days increases levels of intravenously administered voriconazole, a cytochrome P450 (CYP) 2C19 substrate. This effect is thought to be due to inhibition of CYP2C19 by schisandra. However, this interaction has not been reported in humans.
Warfarin (Coumadin)
Theoretically, schisandra might decrease the levels and clinical effects of warfarin.
Animal research suggests that oral schisandra extract, given daily for 6 days, reduces levels of intravenously administered warfarin. This effect might be due to the induction of cytochrome P450 (CYP) 2C9 metabolism by schisandra. However, this interaction has not been reported in humans.
organic Spirulina
Anticoagulant/Antiplatelet Drugs
Theoretically, spirulina blue-green algae might increase the risk of bleeding if used with other anticoagulant or antiplatelet drugs. However, this is unlikely.
Spirulina blue-green algae have shown antiplatelet and anticoagulant effects in vitro. However, one preliminary study in 24 patients receiving spirulina blue-green algae 2.3 grams daily for 2 weeks showed no effect on platelet activation or measures of clotting time.
Antidiabetes Drugs
Theoretically, taking blue-green algae with antidiabetes drugs might increase the risk of hypoglycemia.
Human research shows that spirulina blue-green algae can have hypoglycemic effects in patients with diabetes, at least some of whom were using antidiabetes drugs. However, blue-green algae does not seem to improve glycated hemoglobin (HbA1c) levels in patients with diabetes. A meta-analysis of animal studies also suggests that spirulina blue-green algae have hypoglycemic effects.
Immunosuppressants
Theoretically, concurrent use of blue-green algae might interfere with immunosuppressive therapy.
Blue-green algae have been shown to stimulate the immune system.
Rehmannia root
Antidiabetes Drugs
Theoretically, rehmannia might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Animal research shows that rehmannia may have hypoglycemic effects.
Antihypertensive Drugs
Theoretically, rehmannia might increase the risk of hypotension when taken with antihypertensive drugs.
Animal research shows that rehmannia may have hypotensive effects. Laboratory research shows that formulations of dried and processed rehmannia root inhibit angiotensin-converting enzyme (ACE).
Phosphatidylserine
Anticholinergic Drugs
Theoretically, phosphatidylserine might decrease the effectiveness anticholinergic drugs.
Phosphatidylserine is thought to increase acetylcholine levels, which could theoretically interfere with the activity of anticholinergic agents.
Cholinergic Drugs
Theoretically, phosphatidylserine might have additive effects with cholinergic drugs.
Phosphatidylserine is thought to increase acetylcholine levels, which could theoretically lead to additive cholinergic effects when used with cholinergic drugs.
Mucuna pruriens seed
Levodopa
Concomitant use can increase the risk of levodopa-related adverse effects.
Cowhage contains levodopa. Some cowhage products have been standardized to contain 75-400 mg of levodopa per dose.
Methyldopa (Aldomet)
Theoretically, concomitant use of cowhage and methyldopa might increase the risk of hypotension.
Cowhage contains levodopa. Use of levodopa with methyldopa might cause additive hypotension. In addition, methyldopa may inhibit peripheral decarboxylation of levodopa and increase levodopa levels in the central nervous system; avoid using.
Monoamine Oxidase Inhibitors (Maois)
Theoretically, concomitant use of cowhage and non-selective MAOIs might increase the risk of hypertensive crisis.
Cowhage contains levodopa. Use of levodopa with non-selective MAOIs might cause hypertensive crisis. However, this interaction has not been reported with MAO-B selective inhibitors such as selegiline.
Anesthesia
Theoretically, concomitant use of cowhage and anesthesia might increase the risk of arrhythmias.
Cowhage contains levodopa. Use of levodopa with cyclopropane or halogenated hydrocarbon anesthesia has led to arrhythmias. Other anesthetics have not been implicated. Use other anesthetics in patients taking cowhage or tell patients to stop taking cowhage at least 2 weeks before surgery.
Antidiabetes Drugs
Theoretically, concomitant use of cowhage and antidiabetes drugs might increase the risk of hypoglycemia.
Animal research shows that cowhage might have hypoglycemic effects.
Antipsychotic Drugs
Theoretically, use of cowhage might decrease the clinical effects of antipsychotic drugs.
Cowhage contains levodopa. Use of levodopa might counteract the antidopaminergic effects of antipsychotic medications.
Guanethidine (Ismelin)
Theoretically, concomitant use of cowhage and guanethidine might increase the risk of hypotension.
Cowhage contains levodopa. Use of levodopa with guanethidine might cause additive hypotension; avoid using.
Tricyclic Antidepressants (Tcas)
Theoretically, use of TCAs might reduce the levels and clinical effects of cowhage.
Cowhage contains levodopa. Use of TCAs might reduce the absorption of levodopa. Some case reports describe patients that developed hypertension and dyskinesia when taking both levodopa and TCAs.
Organic oat grass juice
Antidiabetes Drugs
Theoretically, oats may have additive effects with antidiabetic agents and might increase the risk of hypoglycemia.
Consuming oats can decrease blood glucose in patients with diabetes. In those who require insulin, taking oats 100 grams daily for 2 days reduces the insulin dose required to achieve metabolic control.
Insulin
Concomitant use of oats and insulin might increase the risk of hypoglycemia.
In patients with insulin-dependent type 2 diabetes, taking oats 100 grams daily for 2 days reduces the insulin dose required to achieve metabolic control.
Asparagus root
Diuretic Drugs
Theoretically, asparagus root might increase diuresis and electrolyte loss when used with diuretic drugs.
Animal studies show that asparagus root extracts have diuretic effects. This effect has not been reported in humans.
Lithium
Theoretically, asparagus root might cause diuresis, reducing lithium clearance.
Animal studies show that asparagus root extracts have diuretic effects. Theoretically, this might reduce excretion and increase levels of lithium. The dose of lithium might need to be decreased.
L-Tyrosine
Levodopa
Theoretically, tyrosine might decrease the effectiveness of levodopa.
Tyrosine and levodopa compete for absorption in the proximal duodenum by the large neutral amino acid (LNAA) transport system. Advise patients to separate doses of tyrosine and levodopa by at least 2 hours.
Thyroid Hormone
Theoretically, tyrosine might have additive effects with thyroid hormone medications.
Tyrosine is a precursor to thyroxine and might increase levels of thyroid hormones.
Glycerylphosphorylcholine
Scopolamine (Transderm Scop)
Theoretically, alpha-GPC might decrease the effects of scopolamine.
A small clinical study shows that alpha-GPC can partially counteract the attention and memory impairment effects caused by scopolamine given intramuscularly. Whether alpha-GPC can decrease the beneficial anti-motion sickness effects of the scopolamine patch (Transderm Scop) is unclear.
Brand information
Manufacturer and brand details for Brain 4 Way Support System, from the product label.
Pure Essence Labs
See all Pure Essence Labs products- Name
- Pure Essence Laboratories, Inc.
- Street Address
- P.O. Box 95397
- City
- Las Vegas
- State
- NV
- ZipCode
- 89193
- Web Address
- www.pureessencelabs.com
Brain 4 Way Support System by Pure Essence Labs: Common Questions
Does Brain 4 Way Support System by Pure Essence Labs interact with any medications?
How can one product interact with so many drugs?
Where does this information come from?
Does this product have levodopa in it? I'm on a Parkinson's medication.
Is this safe while I'm on warfarin?
What does phosphatidylserine do, and why does it cause insomnia for some people?
Can I take this while breastfeeding?
Is the Spirulina in this safe? I've heard about contamination.
How does Black Pepper extract in here help the product work?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
Not sure if Brain 4 Way Support System is safe with your meds?
Our pharmacists answer your medication & supplement questions — free.
Label information is sourced from the NIH Dietary Supplement Label Database and reflects the product version on file; always read your actual product label. This page is for education only and is not a substitute for professional medical advice. Confirm with your pharmacist or doctor before combining supplements and medications.
The Full Monographs Behind Brain 4 Way Support System’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Tyrosine
Interacts with 21 drugsL-tyrosine is an amino acid your body uses to make brain chemicals like dopamine and norepinephrine. Some studies suggest it may help mental performance during short-term stress, sleep loss,...
Read the full Tyrosine monograph → Herb & supplement monographPhosphatidylcholine
Phosphatidylcholine is a phospholipid that is part of every cell membrane and a source of choline. People take it for liver, brain, and gut health, but solid human evidence is limited for mo...
Read the full Phosphatidylcholine monograph → Herb & supplement monographPhosphatidylserine
Interacts with 219 drugsPhosphatidylserine is a natural fat-like compound found in cell membranes, especially in the brain, and it is sold mainly to support memory and thinking. Some research suggests possible bene...
Read the full Phosphatidylserine monograph → Herb & supplement monographBlue-green Algae
Interacts with 327 drugsBlue-green algae are nutrient-rich aquatic microorganisms (such as spirulina and Klamath Lake algae) taken as a supplement for energy, nutrition, and general wellness. Evidence for most heal...
Read the full Blue-green Algae monograph → Herb & supplement monographEleuthero
Interacts with 1,140 drugsEleuthero is an herb traditionally used as an 'adaptogen' to fight fatigue, boost energy, and help the body handle stress. The scientific evidence behind these uses is limited and mixed, so...
Read the full Eleuthero monograph → Herb & supplement monographSchisandra
Interacts with 803 drugsSchisandra is a traditional Chinese medicine berry used as an adaptogen for stress, fatigue, and liver support. Human evidence is limited and most claims are not well proven, but it appears...
Read the full Schisandra monograph → Herb & supplement monographAlpha-gpc
Interacts with 16 drugsAlpha-GPC is a choline-containing compound used mainly for memory, brain health, and as a choline source. There is some evidence it may help cognition in people with dementia, but evidence i...
Read the full Alpha-gpc monograph → Herb & supplement monographOats
Interacts with 86 drugsOats are a well-studied whole grain whose soluble fiber (beta-glucan) can help lower cholesterol and support heart health when eaten regularly. As a food, oats are safe for most people, and...
Read the full Oats monograph → Herb & supplement monographGinkgo
Interacts with 1,266 drugsGinkgo is one of the world's most popular herbal supplements, mostly taken to support memory and circulation. The evidence for these uses is mixed and generally weak, and it is not proven to...
Read the full Ginkgo monograph → Herb & supplement monographRehmannia
Interacts with 258 drugsRehmannia is a root used for centuries in Traditional Chinese Medicine, often to 'tonify' the kidneys and support energy or blood health. Human evidence for most modern uses is limited, so i...
Read the full Rehmannia monograph → Herb & supplement monographCowhage
Interacts with 193 drugsCowhage (Mucuna pruriens) is a tropical legume best known as a natural source of L-dopa, the compound the body turns into dopamine. It is most studied for Parkinson's disease symptoms and ma...
Read the full Cowhage monograph → Herb & supplement monographAsparagus
Interacts with 76 drugsAsparagus is a nutritious vegetable that is safe and healthy to eat as part of a normal diet. Most of its claimed medicinal benefits, such as use as a diuretic or for urinary health, come fr...
Read the full Asparagus monograph → Herb & supplement monographCalamus
Interacts with 1,117 drugsCalamus is a swamp plant with a long history in Ayurvedic and traditional Chinese medicine, mostly for digestive and nervous-system complaints. However, it contains beta-asarone, a compound...
Read the full Calamus monograph → Herb & supplement monographDanshen
Interacts with 1,059 drugsDanshen is a root used in traditional Chinese medicine, mainly for heart and circulation problems. Some early research is promising, but the evidence is not strong enough to confirm it works...
Read the full Danshen monograph → Herb & supplement monographGoji
Interacts with 1,000 drugsGoji berries are a nutritious fruit rich in antioxidants, vitamins, and plant polysaccharides, and they are safe for most people as a food. While they are popular for eye health, immune supp...
Read the full Goji 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 →Sources & How We Checked
Brain 4 Way Support System'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 327 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.
Tyrosine 4 references
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- van Spronsen FJ, van Rijn M, Bekhof J. Phenylketonuria: tyrosine supplementation in phenylalanine-restricted diets. Am J Clin Nutr 2001;73:153-7. PubMed
Phosphatidylcholine 15 references
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- Aronson PJ, Lorincz AL. Promotion of palmar sweating with oral phosphatidylcholine. Acta Derm Venereol 1985;65:19-24. DOI
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- Loguercio C, Andreone P, Brisc C, et al. Silybin combined with phosphatidylcholine and vitamin E in patients with nonalcoholic fatty liver disease: a randomized controlled trial. Free Radic Biol Med 2012;52(9):1658-65. PubMed
- Panos, J. M., Palson, R., Johnson, R., Portmann, B., and Williams, R. Polyunsaturated phosphatidylcholine for acute alcoholic hepatitis: a double blind randomized placebo controlled trial. Eur.J.Gastroenterol 1990;2:351-355.
- Stremmel W, Braun A, Hanemann A, Ehehalt R, Autschbach F, Karner M. Delayed release phosphatidylcholine in chronic-active ulcerative colitis: a randomized, double-blinded, dose finding study. J Clin Gastroenterol 2010;44(5):e101-7. PubMed
- Stremmel W, Ehehalt R, Autschbach F, Karner M. Phosphatidylcholine for steroid-refractory chronic ulcerative colitis: a randomized trial. Ann Intern Med. 2007;147(9):603-10. PubMed
- Stremmel W, Vural H, Evliyaoglu O, Weiskirchen R. Delayed Release Phosphatidylcholine is Effective for Treatment of Ulcerative Colitis: A Meta-Analysis. Dig Dis 2021;39(5):508-515. PubMed
Phosphatidylserine 9 references
- Crook T, Petrie W, Wells C, Massari DC. Effects of phosphatidylserine in Alzheimer's disease. Psychopharmacol Bull 1992;28:61-6.
- Pepping J. Phosphatidylserine. Am J Health-Syst Pharm 1999;56:2038,2043-4.
- Kidd PM. Phosphatidylserine; Membrane nutrient for memory. A clinical and mechanistic assessment. Altern Med Rev 1996;1:70-84.
- Kim HY, Akbar M, Lau A, et al. Inhibition of neuronal apoptosis by docosahexaenoic acid (22:6n-3). Role of phosphatidylserine in antiapoptotic effect. J Biol Chem 2000;275:35215-23.. PubMed
- Zanotti A, Valzelli L, Toffano G. Chronic phosphatidylserine treatment improves spatial memory and passive avoidance in aged rats. Psychopharmacology (Berl) 1989;99:316-21.. PubMed
- Schreiber S, Kampf-Sherf O, Gorfine M, et al. An open trial of plant-source derived phosphatydilserine for treatment of age-related cognitive decline. Isr J Psychiatry Relat Sci 2000;37:302-7.
- Pepping, J. Phosphatidylserine. Am J Health Syst.Pharm. 10-15-1999;56(20):2038, 2043-2038, 2044.
- Monteverde, A., Gnemmi, P., Rossi, F., Monteverde, A., and Finali, G. C. Selegiline in the treatment of mild to moderate Alzheimer-type dementia. Clin.Ther 1990;12(4):315-322.
- Vakhapova V, Cohen T, Richter Y, Herzog Y, Kam Y, Korczyn AD. Phosphatidylserine containing omega-3 Fatty acids may improve memory abilities in nondemented elderly individuals with memory complaints: results from an open-label extension study. Dement Geri PubMed
Blue-green Algae 22 references
- Jensen GS, Ginsberg DJ, Huerta P, et al. Consumption of Aphanizomenon flos-aquae has rapid effects on the circulation and function of immune cells in humans. A novel approach to nutritional mobilization of the immune system. JANA 2000;2:50-6.
- Iwasa M, Yamamoto M, Tanaka Y, et al. Spirulina-associated hepatotoxicity. Am J Gastroenterol 2002;97:3212-13. PubMed
- Hayashi O, Katoh T, Okuwaki Y. Enhancement of antibody production in mice by dietary Spirulina platensis. J Nutr Sci Vitaminol (Tokyo) 1994;40:431-41.. PubMed
- Vitale S, Miller NR, Mejico LJ, et al. A randomized, placebo-controlled, crossover clinical trial of super blue-green algae in patients with essential blepharospasm or Meige syndrome. Am J Ophthalmol 2004;138:18-32. PubMed
- Mani UV, Desai S, Iyer U. Studies on the long-term effect of spirulina supplementation on serum lipid profile and glycated proteins in NIDDM patients. J Nutraceut 2000;2(3):25-32. DOI
- Chiu HF, Yang SP, Kuo YL, et al. Mechanisms involved in the antiplatelet effect of C-phycocyanin. Br J Nutr 2006;95:435-40. PubMed
- Hsiao G, Chou PH, Shen MY, et al. C-phycocyanin, a very potent and novel platelet aggregation inhibitor from Spirulina platensis. J Agric Food Chem 2005;53:7734-40.
- Katz M, Levine AA, Kol-Degani H, Kav-Venaki L. A compound herbal preparation (CHP) in the treatment of children with ADHD: a randomized controlled trial. J Atten Disord 2010;14:281-91. PubMed
- Madhyastha, H. K., Radha, K. S., Sugiki, M., Omura, S., and Maruyama, M. Purification of c-phycocyanin from Spirulina fusiformis and its effect on the induction of urokinase-type plasminogen activator from calf pulmonary endothelial cells. Phytomedicine PubMed
- Mazokopakis, E. E., Karefilakis, C. M., Tsartsalis, A. N., Milkas, A. N., and Ganotakis, E. S. Acute rhabdomyolysis caused by Spirulina (Arthrospira platensis). Phytomedicine. 2008;15(6-7):525-527. PubMed
- Halidou, Doudou M., Degbey, H., Daouda, H., Leveque, A., Donnen, P., Hennart, P., and Dramaix-Wilmet, M. [The effect of spiruline during nutritional rehabilitation: systematic review]. Rev.Epidemiol.Sante Publique 2008;56(6):425-431.
- Konno, T., Umeda, Y., Umeda, M., Kawachi, I., Oyake, M., and Fujita, N. [A case of inflammatory myopathy with widely skin rash following use of supplements containing Spirulina]. Rinsho Shinkeigaku 2011;51(5):330-333. PubMed
- Le TM, Knulst AC, Röckmann H. Anaphylaxis to Spirulina confirmed by skin prick test with ingredients of Spirulina tablets. Food Chem Toxicol 2014;74:309-10. PubMed
- Rzymski P, Niedzielski P, Kaczmarek N, Jurczak T, Klimaszyk P. The multidisciplinary approach to safety and toxicity assessment of microalgae-based food supplements following clinical cases of poisoning. Harmful Algae 2015;46:34-42. DOI
- Petrus M, Culerrier R, Campistron M, et al. First case report of anaphylaxis to spirulin: identification of phycocyanin as responsible allergen. Allergy 2010;65(7):924-5. PubMed
- Marles RJ, Barrett ML, Barnes J, et al. United States Pharmacopeia safety evaluation of spirulina. Crit Rev Food Sci Nutr 2011;51(7):593-604. PubMed
- Majdoub H, Ben Mansour M, Chaubet F, et al. Anticoagulant activity of a sulfated polysaccharide from the green alga Arthrospira platensis. Biochim Biophys Acta 2009;1790(10):1377-81. PubMed
- Cha BG, Kwak HW, Park AR, et al. Structural characteristics and biological performance of silk fibroin nanofiber containing microalgae spirulina extract. Biopolymers 2014;101(4):307-18. PubMed
- Jensen GS, Drapeau C, Lenninger M, Benson KF. Clinical safety of a high dose of phycocyanin-enriched aqueous extract from Arthrospira (Spirulina) platensis: results from a randomized, double-Blind, placebo-controlled study with a focus on anticoagulant ac
- Hamedifard Z, Milajerdi A, Reiner Z, Taghizadeh M, Kolahdooz F, Asemi Z. The effects of spirulina on glycemic control and serum lipoproteins in patients with metabolic syndrome and related disorders: A systematic review and meta-analysis of randomized con
- Moradi S, Zobeiri M, Feizi A, Clark CCT, Entezari MH. The effects of spirulina (Arthrospira platensis) supplementation on anthropometric indices, blood pressure, sleep quality, mental health, fatigue status and quality of life in patients with ulcerative
- Ghanbari F, Amerizadeh A, Behshood P, Moradi S, Asgary S. Effect of microalgae arthrospira on biomarkers of glycemic control and glucose metabolism: a systematic Review and meta-analysis. Curr Probl Cardiol 2022;47(10):100942. PubMed
Eleuthero 24 references
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- McRae S. Elevated serum digoxin levels in a patient taking digoxin and Siberian ginseng. CMAJ 1996;155:293-5.
- Awang DVC. Siberian ginseng toxicity may be case of mistaken identity (letter). CMAJ 1996;155:1237.
- Mills S, Bone K. Principles and Practice of Phytotherapy. London: Churchill Livingstone, 2000.
- Harkey MR, Henderson GL, Zhou L, et al. Effects of Siberian ginseng (Eleutherococcus senticosus) on c-DNA-expressed P450 drug metabolizing enzymes. Alt Ther 2001;7:S14.
- Hikino H, Takahashi M, Otake K, Konno C. Isolation and hypoglycemic activity of eleutherans A, B, C, D, E, F, and G: glycans of Eleutherococcus senticosus roots. J Nat Prod 1986;49:293-7. PubMed
- Yun-Choi HS, Kim JH, Lee JR. Potential inhibitors of platelet aggregation from plant sources, III. J Nat Prod 1987;50:1059-64. PubMed
- Donovan JL, DeVane CL, Chavin KD, et al. Siberian Ginseng (Eleutheroccus senticosus) Effects on CYP2D6 and CYP3A4 Activity in Normal Volunteers. Drug Metab Dispos 2003;31:519-22.. PubMed
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- Sievenpiper JL, Arnason JT, Leiter LA, Vuksan V. Decreasing, null and increasing effects of eight popular types of ginseng on acute postprandial glycemic indices in healthy humans: the role of ginsenosides. J Am Coll Nutr 2004;23:248-58. PubMed
- Dasgupta A, Wu S, Actor J, et al. Effect of Asian and Siberian ginseng on serum digoxin measurement by five digoxin immunoassays. Significant variation in digoxin-like immunoreactivity among commercial ginsengs. Am J Clin Pathol 2003;119:298-303. DOI
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- Molokovskii, D. S., Davydov, V. V., and Tiulenev, V. V. [The action of adaptogenic plant preparations in experimental alloxan diabetes]. Probl.Endokrinol.(Mosk) 1989;35(6):82-87.
- Schmolz, M. W., Sacher, F., and Aicher, B. The synthesis of Rantes, G-CSF, IL-4, IL-5, IL-6, IL-12 and IL-13 in human whole-blood cultures is modulated by an extract from Eleutherococcus senticosus L. roots. Phytother.Res 2001;15(3):268-270.
- Huang, D. B., Ran, R. Z., and Yu, Z. F. [Effect of Acanthopanax senticosus injection on the activities of human tumor necrosis factor and natural killer cell in blood in the patients with lung cancer]. Zhongguo Zhong.Yao Za Zhi. 2005;30(8):621-624.
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DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
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