Calm Nature Ingredients & Drug Interactions
What is this page for?
First and foremost: checking Calm Nature 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
Calm Nature is a dietary supplement by HoltraCeuticals with 28 active ingredients. Its ingredients are commonly taken for mental focus and alertness, coping with stress, fatigue and sleep loss.Based on those ingredients, 1,697 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are fo-ti extract, Chamomile flower extract, milk thistle seed extract. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Calm Nature by HoltraCeuticals
Ask about any prescription or over-the-counter medication and we check it for interactions with Calm Nature by HoltraCeuticals — 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 Calm Nature by HoltraCeuticals
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
Low disclosure
Calm Nature contains 28 active and inactive ingredients. The active ingredients include amino acids (L-tyrosine and L-taurine), a B vitamin (thiamine), antioxidants and digestive enzymes (N-acetyl cysteine, bromelain, and papain), minerals (calcium, magnesium, and potassium), and botanical extracts (mimosa tree, fo-ti, dong quai, poria mushroom, codonopsis, European peony, milk thistle seed, biota, bupleurum, and ligusticum).
The formulation also includes plant enzymes and dwarf morning glory root extract, along with inactive ingredients rice bran and gelatin capsules.
Does it work?
Moderate evidence
The evidence for Calm Nature is mixed because its ingredients target different purposes and have varying levels of research support. L-tyrosine is effective for phenylketonuria (PKU) and possibly effective for cognitive function and memory, though it's rated possibly ineffective for athletic performance.
Thiamine is effective for thiamine deficiency and Wernicke-Korsakoff syndrome and possibly effective for dysmenorrhea. Calcium is effective for bone health (osteoporosis) and several other conditions.
Magnesium is effective for several uses including constipation and pre-eclampsia. Taurine is possibly effective for heart failure and hepatitis.
However, most of the botanical ingredients—papain, bromelain, fo-ti, dong quai, poria, codonopsis, peony, milk thistle, biota, and bupleurum—have insufficient reliable evidence for the conditions they're traditionally used for. We hold no effectiveness data for jujube fruit extract, dwarf morning glory root extract, plant enzymes, lily turf, or ligusticum extract.
How safe is it?
Well-documented data
Most individual ingredients in this product are generally well tolerated at typical doses, but there are some cautions. L-tyrosine, thiamine, calcium, magnesium, and taurine are generally safe for healthy adults when taken at recommended amounts.
N-acetyl cysteine is well tolerated orally at normal doses, though doses above 9 grams or sustained use above 30 grams daily carries more risk. Papain and bromelain are usually well tolerated short-term but may cause gastrointestinal upset or allergic reactions in sensitive people.
Fo-ti has been linked to cases of liver damage (hepatitis) in both processed and unprocessed forms—around 450 cases have been documented in the medical literature. Dong quai can cause skin sensitivity to sunlight and may increase bleeding.
Several ingredients lack sufficient safety data for pregnancy or breastfeeding: papain is possibly unsafe in pregnancy; bromelain, poria, codonopsis, peony, biota, and bupleurum should be avoided during pregnancy due to insufficient data; and the same caution applies during breastfeeding for most botanical ingredients. L-tyrosine and N-acetyl cysteine have insufficient data on safety in pregnancy and lactation—talk with your doctor before using during pregnancy or while breastfeeding.
Meds to double-check
Major interaction found
Before you take Calm Nature, double-check with your pharmacist or doctor if you use any of these medication types: blood thinners or antiplatelet drugs (warfarin, aspirin, clopidogrel, and others), HIV integrase inhibitors (dolutegravir, elvitegravir), blood pressure medications, heart medications including nitroglycerin patches, Parkinson's medications (levodopa/carbidopa), thyroid hormones, antidiabetes drugs, antibiotics (especially tetracyclines and quinolones), psychiatric medications, or lithium. The most serious concerns are with nitroglycerin (NAC), HIV antivirals (calcium), levodopa (magnesium), and warfarin (dong quai, fo-ti, papain, peony, milk thistle).
The bottom line
Scorecard at a glanceFormula with limited ingredient disclosure with some supporting evidence for its stated purpose. Major medication interactions have been identified, and safety information is well characterized.
If you take medications—especially blood thinners, heart drugs, HIV antivirals, blood pressure medications, or thyroid medication—you need to check this product against your specific drugs before starting it; the interaction list is extensive. This product is best discussed with your pharmacist or doctor, particularly if you're pregnant, breastfeeding, have liver disease, or take any regular medications.
The evidence for effectiveness is strongest for individual nutrients like thiamine and calcium rather than the botanical blend as a whole.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 23 of 28 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Mar 25, 2013.
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 Calm Nature, straight from the product label.
| Brand | HoltraCeuticals |
|---|---|
| Net contents | 90 Capsule(s) |
| Market status | On market |
| Date entered into DSLD | Mar 25, 2013 |
| DSLD ID | 19335 |
| Product type | Other Combinations |
| Supplement form | Capsule |
| Dietary claims / uses | All Other |
| 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 Calm Nature by HoltraCeuticals, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| L-Tyrosine | 0 NP | -- |
| Thiamine | 16 mg | 1077% |
| Papain | 40000 FCC | -- |
| Bromelain | 2000 GDU | -- |
| L-Taurine | 0 NP | -- |
| N-Acetyl Cysteine | 0 NP | -- |
| Mimosa Tree | 0 NP | -- |
| Calcium Amino Acid Chelate | 0 NP | -- |
| Jujube fruit extract | 0 NP | -- |
| Magnesium | 16 mg | 4% |
| fo-ti extract | 0 NP | -- |
| Calm Nature | 1462 mg | -- |
| Calm Nature: | 0 NP | -- |
| Dong quai | 0 NP | -- |
| poria | 0 NP | -- |
| codonopsis | 0 NP | -- |
| European Peony | 0 NP | -- |
| milk thistle seed extract | 0 NP | -- |
| biota | 0 NP | -- |
| dwarf morning glory root extract | 0 NP | -- |
| plant enzymes | 0 NP | -- |
| bupleurum extract | 0 NP | -- |
| lily turf | 0 NP | -- |
| ligusticum extract | 0 NP | -- |
| potassium aspartate | 0 NP | -- |
| Passion Flower extract | 0 NP | -- |
| Chinese peony flower extract | 0 NP | -- |
| Chamomile flower extract | 0 NP | -- |
Other ingredients: Rice Bran, Gelatin
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.
Storage
Store in a cool, dry place protected from light.
General Statements
*Promotes Relaxation and Emotional Balance
Suggested/Recommended/Usage/Directions
Suggested Use: 3 capsules per day or as directed by your physician.
Precautions
Keep out of reach of children.
If you are under medical supervision seek the advice of your qualified healthcare provider prior to use of this product.
Pregnant or lactating women should consult their qualified healthcare provider prior to use.
FDA Statement of Identity
Dietary Supplement
Brand IP Statement(s)
HOLTORF MEDICAL GROUP(R) CENTERS FOR HORMONE IMBALANCE, HYPOTHYROIDISM AND FATIGUE
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Calm Nature by HoltraCeuticals 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 Calm Nature by HoltraCeuticals
These are the 28 active ingredients this product is made of. Select any to open its full monograph.
Serving size3 Capsule(s) Dosage formCapsule Servings per container30 Amounts shown are per serving.
Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.
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 & interactionsThiamine
Interacts with3 drugs
Thiamine (vitamin B1) is an essential nutrient your body needs to turn food into energy and to keep your nerves and heart healthy. Most people get eno...
Thiamine monograph & interactionsPapain
Interacts with2 drugs
Papain is a protein-digesting enzyme from the papaya plant that is used in digestive supplements and some topical products. While it has clear food an...
Papain monograph & interactionsBromelain
Interacts with141 drugs
Bromelain is a group of protein-digesting enzymes from pineapple that people take mainly for inflammation, swelling, and sinus problems. Some early st...
Bromelain monograph & interactionsL-Taurine
Interacts with173 drugs
Taurine is an amino acid your body makes naturally and that you also get from animal foods. It is widely used in energy drinks and sports supplements,...
L-Taurine monograph & interactionsN-Acetyl Cysteine
Interacts with294 drugs
N-acetyl cysteine (NAC) is a supplement form of the amino acid cysteine and a building block for the antioxidant glutathione. It has well-established...
N-Acetyl Cysteine monograph & interactionsMimosa Tree
Interacts with248 drugs
Albizia julibrissin (Persian silk tree, He Huan) is a plant used in traditional Chinese medicine, mainly the flower and bark, for calming the mind, li...
Mimosa Tree monograph & interactionsCalcium Amino Acid Chelate
Interacts with168 drugs
Calcium is an essential mineral your body needs for strong bones, nerve signaling, and muscle function, and supplements can help fill gaps when diet f...
Calcium Amino Acid Chelate monograph & interactionsJujube fruit extract
Interacts with469 drugs
Zizyphus (jujube) is an edible fruit and traditional remedy used mainly for sleep, anxiety, and digestion. The fruit is a nutritious food, but human e...
Jujube fruit extract monograph & interactionsMagnesium
Interacts with295 drugs
Magnesium is an essential mineral your body needs for muscles, nerves, blood pressure, and many other functions, and supplements are useful for preven...
Magnesium monograph & interactionsFo-ti extract
Interacts with1,257 drugs
Fo-ti (He Shou Wu) is a root used in traditional Chinese medicine, often promoted for healthy aging and hair. High-quality human evidence for these be...
Fo-ti extract monograph & interactionsCalm Nature
Calm Nature:
Dong quai
Interacts with163 drugs
Dong Quai is a traditional Chinese herb often called "female ginseng" and is mostly used for menstrual and menopausal complaints. High-quality scienti...
Dong quai monograph & interactionsPoria
Interacts with417 drugs
Poria mushroom (Fu Ling) is a fungus long used in Traditional Chinese Medicine, mainly as a mild diuretic and digestive and calming aid. Modern scient...
Poria monograph & interactionsCodonopsis
Interacts with211 drugs
Codonopsis (often called 'dang shen') is a root long used in Traditional Chinese Medicine as a gentle energy and digestive tonic, frequently as a mild...
Codonopsis monograph & interactionsEuropean Peony
Interacts with811 drugs
Peony root is a traditional Chinese medicine herb often used for menstrual problems, cramps, and inflammation, frequently as part of combination formu...
European Peony monograph & interactionsMilk thistle seed extract
Interacts with954 drugs
Milk thistle is a popular herbal supplement most often used for liver health, and its main active component is a group of compounds called silymarin....
Milk thistle seed extract monograph & interactionsBiota
No knowninteractions
Oriental Arborvitae is an evergreen conifer used in Traditional Chinese Medicine, where the seeds (Bai Zi Ren) are taken to calm the mind and ease con...
Biota monograph & interactionsDwarf morning glory root extract
Plant enzymes
Bupleurum extract
Interacts with327 drugs
Bupleurum (Chai Hu) is a root used in traditional Chinese medicine, usually as part of multi-herb formulas, for liver, digestive, and fever-related co...
Bupleurum extract monograph & interactionsLily turf
Interacts with157 drugs
Lily-of-the-valley is a poisonous plant that contains powerful heart-affecting compounds called cardiac glycosides, similar to the drug digoxin. While...
Lily turf monograph & interactionsLigusticum extract
Potassium aspartate
Interacts with62 drugs
Potassium is an essential mineral your body needs for nerve signals, muscle function, and a steady heartbeat, and most people get enough from a balanc...
Potassium aspartate monograph & interactionsPassion Flower extract
Interacts with836 drugs
Passion flower is a traditional calming herb that many people use for anxiety and sleep. Early studies hint it may help with mild anxiety and restless...
Passion Flower extract monograph & interactionsChinese peony flower extract
Interacts with811 drugs
Peony root is a traditional Chinese medicine herb often used for menstrual problems, cramps, and inflammation, frequently as part of combination formu...
Chinese peony flower extract monograph & interactionsChamomile flower extract
Interacts with960 drugs
German chamomile is a widely used herbal remedy taken mainly as a tea for calming, sleep, and digestive complaints. Early research suggests possible b...
Chamomile flower extract monograph & interactionsOther (inactive) ingredients: Rice Bran, Gelatin. These complete the product’s ingredient list but are not active constituents.
Calm Nature by HoltraCeuticals Drug Interactions
HelloPharmacist Interaction Report
Calm Nature by HoltraCeuticals is a 28-ingredient capsule supplement with documented interactions affecting a large number of medications.
The most serious interaction involves N-acetyl cysteine (NAC) with intravenous or transdermal nitroglycerin—a Major severity interaction that can cause severe low blood pressure and severe headaches; if you take nitroglycerol patches or IV nitro, this product is not for you without talking to your doctor first.
Read the full breakdown — every affected drug type, severity by severity
Several other ingredients carry Major interactions: calcium can significantly reduce levels of two HIV integrase inhibitors (dolutegravir and elvitegravir), making them less effective, and it can also cause dangerous precipitation when given intravenously alongside the antibiotic ceftriaxone; magnesium can reduce the effectiveness of levodopa (a Parkinson's medication) by as much as 35%; and dong quai can increase bleeding risk with warfarin. Additionally, you'll find Moderate severity interactions with blood thinners and antiplatelet drugs (from bromelain, papain, fo-ti, peony, codonopsis, and bupleurum), heart and blood pressure medications (from tyrosine, taurine, NAC, calcium, and magnesium), thyroid hormones (from tyrosine), and several other drug categories including antidiabetes medications, psychiatric drugs, and antimalarial medications.
Alongside these, there are Moderate interactions with quinolone antibiotics (magnesium), tetracycline antibiotics (bromelain), and drugs metabolized by liver enzymes (fo-ti, peony, and milk thistle). Minor interactions are documented with trimethoprim (from thiamine) and tetracyclines (from bromelain).
Altogether, these interactions span 1,670 individual medications.
Several ingredients we could not check for interactions: jujube fruit extract, dwarf morning glory root extract, plant enzymes, lily turf, and ligusticum extract—we hold no data for these. To see whether your specific medications are affected, use the checker below.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Calm Nature?
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 Calm Nature interact with 1,697 drugs. Click any drug to see the details.
21 of the 28 ingredients in Calm Nature interact with drugs. Each result below shows which ingredient is responsible. fo-ti extract Chamomile flower extract milk thistle seed extract Passion Flower extract European Peony Jujube fruit extract poria bupleurum extract Magnesium N-Acetyl Cysteine Mimosa Tree codonopsis L-Taurine Calcium Amino Acid Chelate Dong quai lily turf Bromelain potassium aspartate L-Tyrosine Thiamine Papain
Azelastine Hydrochloride, Fluticasone PropionateDymista
How Azelastine Hydrochloride, Fluticasone Propionate interacts with Calm Nature — through 6 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Azelastine Hydrochloride, Fluticasone Propionate interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Azelastine Hydrochloride, Fluticasone Propionate interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Azelastine Hydrochloride, Fluticasone Propionate interactionFo-ti ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti Extract + Azelastine Hydrochloride, Fluticasone Propionate interactionMilk Thistle Seed ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
It is unclear if milk thistle inhibits CYP3A4; research is conflicting.
Read the full Milk Thistle Seed Extract + Azelastine Hydrochloride, Fluticasone Propionate interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Azelastine Hydrochloride, Fluticasone Propionate interactionBeclometasone DipropionateBecotide
How Beclometasone Dipropionate interacts with Calm Nature — through 7 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Beclometasone Dipropionate interactionBupleurum ExtractImmunosuppressants Moderate
Interaction Summary
Theoretically, bupleurum might decrease the effects of immunosuppressants.
Read the full Bupleurum Extract + Beclometasone Dipropionate interactionFo-ti ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti Extract + Beclometasone Dipropionate interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Beclometasone Dipropionate interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Beclometasone Dipropionate interactionMilk Thistle Seed ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates.
Read the full Milk Thistle Seed Extract + Beclometasone Dipropionate interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Beclometasone Dipropionate interactionBeclomethasoneBeclovent, Vanceril
How Beclomethasone interacts with Calm Nature — through 7 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Beclomethasone interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Beclomethasone interactionBupleurum ExtractImmunosuppressants Moderate
Interaction Summary
Theoretically, bupleurum might decrease the effects of immunosuppressants.
Read the full Bupleurum Extract + Beclomethasone interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Beclomethasone interactionFo-ti ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti Extract + Beclomethasone interactionMilk Thistle Seed ExtractCytochrome P450 3a4 (cyp3a4) Substrates, P-glycoprotein Substrates Minor
Interaction Summary
It is unclear if milk thistle inhibits CYP3A4; research is conflicting.
Read the full Milk Thistle Seed Extract + Beclomethasone interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Beclomethasone interactionBeclomethasone DipropionateQNASL, Qvar
How Beclomethasone Dipropionate interacts with Calm Nature — through 7 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Beclomethasone Dipropionate interactionFo-ti ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti Extract + Beclomethasone Dipropionate interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Beclomethasone Dipropionate interactionBupleurum ExtractImmunosuppressants Moderate
Interaction Summary
Theoretically, bupleurum might decrease the effects of immunosuppressants.
Read the full Bupleurum Extract + Beclomethasone Dipropionate interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Beclomethasone Dipropionate interactionMilk Thistle Seed ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates.
Read the full Milk Thistle Seed Extract + Beclomethasone Dipropionate interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Beclomethasone Dipropionate interactionBenserazide, LevodopaMadopar, Prolopa
How Benserazide, Levodopa interacts with Calm Nature — through 2 ingredients. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Benserazide, Levodopa interactionL-tyrosineLevodopa Moderate
Interaction Summary
Theoretically, tyrosine might decrease the effectiveness of levodopa.
Read the full L-tyrosine + Benserazide, Levodopa interactionBetamethasoneCelestone, Diprolene AF, Diprosone
How Betamethasone interacts with Calm Nature — through 3 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Betamethasone interactionBupleurum ExtractImmunosuppressants Moderate
Interaction Summary
Theoretically, bupleurum might decrease the effects of immunosuppressants.
Read the full Bupleurum Extract + Betamethasone interactionMilk Thistle Seed ExtractP-glycoprotein Substrates Minor
Interaction Summary
Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates.
Read the full Milk Thistle Seed Extract + Betamethasone interactionBetamethasone DipropionateSernivo
How Betamethasone Dipropionate interacts with Calm Nature — through 3 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Betamethasone Dipropionate interactionBupleurum ExtractImmunosuppressants Moderate
Interaction Summary
Theoretically, bupleurum might decrease the effects of immunosuppressants.
Read the full Bupleurum Extract + Betamethasone Dipropionate interactionMilk Thistle Seed ExtractP-glycoprotein Substrates Minor
Interaction Summary
Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates.
Read the full Milk Thistle Seed Extract + Betamethasone Dipropionate interactionBetamethasone Dipropionate, CalcipotrieneEnstilar, Wynzora
How Betamethasone Dipropionate, Calcipotriene interacts with Calm Nature — through 4 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Betamethasone Dipropionate, Calcipotriene interactionBupleurum ExtractImmunosuppressants Moderate
Interaction Summary
Theoretically, bupleurum might decrease the effects of immunosuppressants.
Read the full Bupleurum Extract + Betamethasone Dipropionate, Calcipotriene interactionCalcium Amino Acid ChelateCalcipotriene (dovonex) Moderate
Interaction Summary
Taking calcipotriene with calcium might increase the risk for hypercalcemia.
Read the full Calcium Amino Acid Chelate + Betamethasone Dipropionate, Calcipotriene interactionMilk Thistle Seed ExtractP-glycoprotein Substrates Minor
Interaction Summary
Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates.
Read the full Milk Thistle Seed Extract + Betamethasone Dipropionate, Calcipotriene interactionBetamethasone ValerateLuxiq
How Betamethasone Valerate interacts with Calm Nature — through 3 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Betamethasone Valerate interactionBupleurum ExtractImmunosuppressants Moderate
Interaction Summary
Theoretically, bupleurum might decrease the effects of immunosuppressants.
Read the full Bupleurum Extract + Betamethasone Valerate interactionMilk Thistle Seed ExtractP-glycoprotein Substrates Minor
Interaction Summary
Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates.
Read the full Milk Thistle Seed Extract + Betamethasone Valerate interactionBudesonideEntocort EC, Eohilia, Pulmicort, Tarpeyo, Uceris
How Budesonide interacts with Calm Nature — through 6 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Budesonide interactionFo-ti ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti Extract + Budesonide interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Budesonide interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Budesonide interactionMilk Thistle Seed ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
It is unclear if milk thistle inhibits CYP3A4; research is conflicting.
Read the full Milk Thistle Seed Extract + Budesonide interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Budesonide interactionCarbidopaLodosyn
How Carbidopa interacts with Calm Nature — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Carbidopa interactionCarbidopa, LevodopaDhivy, Rytary, Sinemet, Sinemet CR
How Carbidopa, Levodopa interacts with Calm Nature — through 2 ingredients. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Carbidopa, Levodopa interactionL-tyrosineLevodopa Moderate
Interaction Summary
Theoretically, tyrosine might decrease the effectiveness of levodopa.
Read the full L-tyrosine + Carbidopa, Levodopa interactionCarbidopa, Levodopa, EntacaponeStalevo
How Carbidopa, Levodopa, Entacapone interacts with Calm Nature — through 3 ingredients. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Carbidopa, Levodopa, Entacapone interactionL-tyrosineLevodopa Moderate
Interaction Summary
Theoretically, tyrosine might decrease the effectiveness of levodopa.
Read the full L-tyrosine + Carbidopa, Levodopa, Entacapone interactionMilk Thistle Seed ExtractGlucuronidated Drugs Moderate
Interaction Summary
Theoretically, milk thistle might affect the clearance of drugs that undergo glucuronidation.
Read the full Milk Thistle Seed Extract + Carbidopa, Levodopa, Entacapone interactionCeftriaxoneRocephin
How Ceftriaxone interacts with Calm Nature — through 1 ingredient. Tap an ingredient for the detail:
Calcium Amino Acid ChelateCeftriaxone (rocephin) Major
Interaction Summary
Co-administration of intravenous calcium and ceftriaxone can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys.
Read the full Calcium Amino Acid Chelate + Ceftriaxone interactionClobetasolClobex, Temovate
How Clobetasol interacts with Calm Nature — through 2 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Clobetasol interactionMilk Thistle Seed ExtractP-glycoprotein Substrates Minor
Interaction Summary
Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates.
Read the full Milk Thistle Seed Extract + Clobetasol interactionCobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide FumarateGenvoya
How Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interacts with Calm Nature — through 7 ingredients. Tap an ingredient for the detail:
Calcium Amino Acid ChelateElvitegravir (vitekta), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium Amino Acid Chelate + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionMagnesiumBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Magnesium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Read the full Magnesium + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionFo-ti ExtractHepatotoxic Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Read the full Fo-ti Extract + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionMilk Thistle Seed ExtractCytochrome P450 3a4 (cyp3a4) Substrates, P-glycoprotein Substrates Minor
Interaction Summary
It is unclear if milk thistle inhibits CYP3A4; research is conflicting.
Read the full Milk Thistle Seed Extract + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionCortisone AcetateCortisone Tablets, Cortone
How Cortisone Acetate interacts with Calm Nature — through 3 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Cortisone Acetate interactionBupleurum ExtractImmunosuppressants Moderate
Interaction Summary
Theoretically, bupleurum might decrease the effects of immunosuppressants.
Read the full Bupleurum Extract + Cortisone Acetate interactionMilk Thistle Seed ExtractP-glycoprotein Substrates Minor
Interaction Summary
Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates.
Read the full Milk Thistle Seed Extract + Cortisone Acetate interactionDexamethasoneDecadron, Dexone, Dextenza, Dexycu, Hemady, Hexadrol +1 more
How Dexamethasone interacts with Calm Nature — through 7 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Dexamethasone interactionMilk Thistle Seed ExtractCytochrome P450 2b6 (cyp2b6) Substrates, P-glycoprotein Substrates +1 Moderate
Interaction Summary
Theoretically, milk thistle might inhibit CYP2B6.
Read the full Milk Thistle Seed Extract + Dexamethasone interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Dexamethasone interactionBupleurum ExtractImmunosuppressants Moderate
Interaction Summary
Theoretically, bupleurum might decrease the effects of immunosuppressants.
Read the full Bupleurum Extract + Dexamethasone interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Dexamethasone interactionFo-ti ExtractCytochrome P450 2b6 (cyp2b6) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP2B6.
Read the full Fo-ti Extract + Dexamethasone interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Dexamethasone interactionDigoxinDigitek, Lanoxicaps, Lanoxin
How Digoxin interacts with Calm Nature — through 5 ingredients. Tap an ingredient for the detail:
Lily TurfDigoxin (lanoxin) Major
Interaction Summary
Using lily-of-the-valley with digoxin can cause cardiac glycoside toxicity.
Read the full Lily Turf + Digoxin interactionCalcium Amino Acid ChelateDigoxin (lanoxin) Moderate
Interaction Summary
Using intravenous calcium with digoxin might increase the risk of fatal cardiac arrhythmias.
Read the full Calcium Amino Acid Chelate + Digoxin interactionFo-ti ExtractDigoxin (lanoxin) Moderate
Interaction Summary
Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of hypokalemia and cardiotoxicity when taken with digoxin.
Read the full Fo-ti Extract + Digoxin interactionMilk Thistle Seed ExtractGlucuronidated Drugs, P-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, milk thistle might affect the clearance of drugs that undergo glucuronidation.
Read the full Milk Thistle Seed Extract + Digoxin interactionMagnesiumDigoxin Moderate
Interaction Summary
Magnesium salts may reduce absorption of digoxin.
Read the full Magnesium + Digoxin interactionDolutegravirTivicay
How Dolutegravir interacts with Calm Nature — through 2 ingredients. Tap an ingredient for the detail:
Calcium Amino Acid ChelateDolutegravir (tivicay) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium Amino Acid Chelate + Dolutegravir interactionMilk Thistle Seed ExtractP-glycoprotein Substrates, Glucuronidated Drugs Moderate
Interaction Summary
Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates.
Read the full Milk Thistle Seed Extract + Dolutegravir interactionDolutegravir, Emtricitabine, Tenofovir AlafenamideDolutegravir, Emtricitabine, Tenofovir Alafenamide
How Dolutegravir, Emtricitabine, Tenofovir Alafenamide interacts with Calm Nature — through 4 ingredients. Tap an ingredient for the detail:
Calcium Amino Acid ChelateDolutegravir (tivicay), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium Amino Acid Chelate + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionMilk Thistle Seed ExtractGlucuronidated Drugs, P-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, milk thistle might affect the clearance of drugs that undergo glucuronidation.
Read the full Milk Thistle Seed Extract + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionFo-ti ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Read the full Fo-ti Extract + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionMagnesiumBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Magnesium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Read the full Magnesium + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionDolutegravir, RilpivirineJuluca
How Dolutegravir, Rilpivirine interacts with Calm Nature — through 6 ingredients. Tap an ingredient for the detail:
Calcium Amino Acid ChelateDolutegravir (tivicay) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium Amino Acid Chelate + Dolutegravir, Rilpivirine interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Dolutegravir, Rilpivirine interactionFo-ti ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti Extract + Dolutegravir, Rilpivirine interactionMilk Thistle Seed ExtractP-glycoprotein Substrates, Glucuronidated Drugs +1 Moderate
Interaction Summary
Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates.
Read the full Milk Thistle Seed Extract + Dolutegravir, Rilpivirine interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Dolutegravir, Rilpivirine interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Dolutegravir, Rilpivirine interactionElvitegravirVitekta
How Elvitegravir interacts with Calm Nature — through 6 ingredients. Tap an ingredient for the detail:
Calcium Amino Acid ChelateElvitegravir (vitekta) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium Amino Acid Chelate + Elvitegravir interactionFo-ti ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti Extract + Elvitegravir interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Elvitegravir interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Elvitegravir interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Elvitegravir interactionMilk Thistle Seed ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
It is unclear if milk thistle inhibits CYP3A4; research is conflicting.
Read the full Milk Thistle Seed Extract + Elvitegravir interactionElvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil FumarateStribild
How Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interacts with Calm Nature — through 7 ingredients. Tap an ingredient for the detail:
Calcium Amino Acid ChelateElvitegravir (vitekta), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium Amino Acid Chelate + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionFo-ti ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti Extract + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionMagnesiumBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Magnesium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Read the full Magnesium + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionMilk Thistle Seed ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
It is unclear if milk thistle inhibits CYP3A4; research is conflicting.
Read the full Milk Thistle Seed Extract + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionFludrocortisoneFlorinef Acetate
How Fludrocortisone interacts with Calm Nature — through 3 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Fludrocortisone interactionBupleurum ExtractImmunosuppressants Moderate
Interaction Summary
Theoretically, bupleurum might decrease the effects of immunosuppressants.
Read the full Bupleurum Extract + Fludrocortisone interactionMilk Thistle Seed ExtractP-glycoprotein Substrates Minor
Interaction Summary
Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates.
Read the full Milk Thistle Seed Extract + Fludrocortisone interactionFluticasoneFlixotide, Flonase, Flovent, Seretide, Veramyst
How Fluticasone interacts with Calm Nature — through 6 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Fluticasone interactionFo-ti ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti Extract + Fluticasone interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Fluticasone interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Fluticasone interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Fluticasone interactionMilk Thistle Seed ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
It is unclear if milk thistle inhibits CYP3A4; research is conflicting.
Read the full Milk Thistle Seed Extract + Fluticasone interactionFluticasone Furoate, Umeclidinium, VilanterolTrelegy Ellipta
How Fluticasone Furoate, Umeclidinium, Vilanterol interacts with Calm Nature — through 7 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Fluticasone Furoate, Umeclidinium, Vilanterol interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Fluticasone Furoate, Umeclidinium, Vilanterol interactionPoriaAnticholinergic Drugs Moderate
Interaction Summary
Theoretically, poria mushroom might decrease the clinical effects of anticholinergic drugs.
Read the full Poria + Fluticasone Furoate, Umeclidinium, Vilanterol interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Fluticasone Furoate, Umeclidinium, Vilanterol interactionFo-ti ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti Extract + Fluticasone Furoate, Umeclidinium, Vilanterol interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Fluticasone Furoate, Umeclidinium, Vilanterol interactionMilk Thistle Seed ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
It is unclear if milk thistle inhibits CYP3A4; research is conflicting.
Read the full Milk Thistle Seed Extract + Fluticasone Furoate, Umeclidinium, Vilanterol interactionFluticasone Furoate, Vilanterol TrifenatateBreo Ellipta
How Fluticasone Furoate, Vilanterol Trifenatate interacts with Calm Nature — through 6 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Fluticasone Furoate, Vilanterol Trifenatate interactionFo-ti ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti Extract + Fluticasone Furoate, Vilanterol Trifenatate interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Fluticasone Furoate, Vilanterol Trifenatate interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Fluticasone Furoate, Vilanterol Trifenatate interactionMilk Thistle Seed ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
It is unclear if milk thistle inhibits CYP3A4; research is conflicting.
Read the full Milk Thistle Seed Extract + Fluticasone Furoate, Vilanterol Trifenatate interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Fluticasone Furoate, Vilanterol Trifenatate interactionHydrocortisoneAlkindi Sprinkle, Alphaderm, Calmurid HC, Carmol HC cream, Cortef, Dioderm +8 more
How Hydrocortisone interacts with Calm Nature — through 7 ingredients. Tap an ingredient for the detail:
Lily TurfCorticosteroids Major
Interaction Summary
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Read the full Lily Turf + Hydrocortisone interactionChinese Peony Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Chinese Peony Flower Extract + Hydrocortisone interactionChamomile Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
Read the full Chamomile Flower Extract + Hydrocortisone interactionFo-ti ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti Extract + Hydrocortisone interactionBupleurum ExtractImmunosuppressants Moderate
Interaction Summary
Theoretically, bupleurum might decrease the effects of immunosuppressants.
Read the full Bupleurum Extract + Hydrocortisone interactionPassion Flower ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
Read the full Passion Flower Extract + Hydrocortisone interactionMilk Thistle Seed ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates.
Read the full Milk Thistle Seed Extract + Hydrocortisone interactionLevodopaInbrija, Larodopa
How Levodopa interacts with Calm Nature — through 2 ingredients. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Levodopa interactionL-tyrosineLevodopa Moderate
Interaction Summary
Theoretically, tyrosine might decrease the effectiveness of levodopa.
Read the full L-tyrosine + Levodopa interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Calm Nature 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.
fo-ti extract
Anticoagulant/Antiplatelet Drugs
Fo-ti has been linked to cases of acute liver failure which can decrease clotting factor production and increase the effects of anticoagulants. In one case, a patient who had been stable on warfarin presented with acute hepatitis and an INR elevated to 14.98. The patient had been taking fo-ti for 90 days prior to admission. Discontinuation of warfarin and fo-ti lead to a decrease in the INR and full recovery. Theoretically, concomitant use of fo-ti with anticoagulant or antiplatelet drugs may increase the risk of bleeding in some patients. Until more is known, monitor patients taking fo-ti and drugs that affect bleeding.
Some of these drugs include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), dipyridamole (Persantine), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), and others.
Antidiabetes Drugs
Theoretically, fo-ti might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Fo-ti reportedly has hypoglycemic effects.
Contraceptive Drugs
Theoretically, taking large amounts of fo-ti might interfere with contraceptive drugs due to competition for estrogen receptors.
In vitro research suggests that fo-ti extract has estrogenic activity.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, fo-ti might increase or decrease the levels and clinical effects of drugs metabolized by CYP1A2.
In vitro research suggests that fo-ti might inhibit CYP1A2. Additionally, in vitro research suggests that the degree of CYP1A2 inhibition depends on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, in an animal study, an aqueous extract of fo-ti inhibited CYP1A2 while an alcoholic extract of fo-ti induced CYP1A2. Induction or inhibition of CYP1A2 by fo-ti has not been reported in humans.
Cytochrome P450 2B6 (Cyp2B6) Substrates
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP2B6.
Animal research suggests that fo-ti might inhibit CYP2B6. One in vitro study suggests that the degree of CYP2B6 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this interaction has not been reported in humans.
Cytochrome P450 2C19 (Cyp2C19) Substrates
Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2C19.
Animal and in vitro research suggests that fo-ti may inhibit CYP2C19. An in vitro study suggests that the degree of CYP2C19 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this interaction has not been reported in humans.
Cytochrome P450 2C8 (Cyp2C8) Substrates
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP2C8.
In vitro research suggests that fo-ti might inhibit CYP2C8. However, this interaction has not been reported in humans.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2C9.
Animal and in vitro research suggests that fo-ti may inhibit CYP2C9. However, this interaction has not been reported in humans.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2D6.
Animal research suggests that fo-ti might inhibit CYP2D6. Additionally, an in vitro study suggests that the degree of CYP2D6 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this interaction has not been reported in humans.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
In vitro research suggests that fo-ti might inhibit CYP3A4. One in vitro study suggests that the degree of CYP3A4 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this evidence conflicts with animal research suggesting that fo-ti does not inhibit CYP3A4. This interaction has not been reported in humans.
Digoxin (Lanoxin)
Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of hypokalemia and cardiotoxicity when taken with digoxin.
Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects. In vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root.
Diuretic Drugs
Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of hypokalemia when taken with diuretic drugs.
Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects and compound diuretic-induced potassium loss. In vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root.
Estrogens
Theoretically, taking large amounts of fo-ti might interfere with hormone replacement therapy through competition for estrogen receptors.
In vitro research suggests that fo-ti extract has estrogenic activity.
Hepatotoxic Drugs
Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Fo-ti has been linked to liver damage in many reports.
Stimulant Laxatives
Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of fluid and electrolyte depletion when taken with stimulant laxatives.
Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects. However, in vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root.
Sulindac (Clinoril)
Theoretically, fo-ti might increase or decrease the levels and clinical effects of sulindac.
Animal research suggests that the type of fo-ti extract might affect the levels of sulindac differently; the raw plant may increase levels, but processed parts may decrease levels. Induction or inhibition of CYP1A2 by fo-ti has not been reported in humans.
Warfarin (Coumadin)
Theoretically, fo-ti might increase the effects and adverse effects of warfarin.
Fo-ti may have stimulant laxative effects and cause diarrhea, especially when the raw or unprocessed fo-ti root is used. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. Also, fo-ti has been linked to cases of acute liver failure which can decrease clotting factor production and increase the effects of warfarin. In one case, a patient who had been stable on warfarin presented with acute hepatitis and an INR elevated to 14.98. The patient had been taking fo-ti for 90 days prior to admission. Discontinuation of warfarin and fo-ti lead to a decrease in the INR and full recovery.
Chamomile flower extract
Cns Depressants
Theoretically, German chamomile might have additive effects when used with CNS depressants.
German chamomile has mild sedative effects. Theoretically, concomitant use with drugs with sedative properties can cause additive effects and side effects.
Contraceptive Drugs
Theoretically, large amounts of German chamomile might reduce the effectiveness of oral contraceptives.
In vitro, German chamomile has demonstrated antiestrogenic activity. Theoretically, concomitant use of large amounts of German chamomile might interfere with contraceptive drugs through competition for estrogen receptors.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, German chamomile might inhibit CYP2C9 and increase levels of drugs metabolized by these enzymes.
In vitro evidence shows that German chamomile might inhibit CYP2C9. So far, this interaction has not been reported in humans. However, there might be an increase in the levels of drugs metabolized by CYP2C9 in patients taking German chamomile.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Theoretically, German chamomile might inhibit CYP2D6 and increase levels of drugs metabolized by these enzymes.
In vitro evidence shows that German chamomile might inhibit CYP2D6. So far, this interaction has not been reported in humans. However, there might be an increase in the levels of drugs metabolized by CYP2D6 in patients taking German chamomile.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, German chamomile might inhibit CYP3A4 and increase levels of drugs metabolized by these enzymes.
In vitro evidence shows that German chamomile might inhibit CYP3A4. So far, this interaction has not been reported in humans. However, there might be an increase in the levels of drugs metabolized by CYP3A4 in patients taking German chamomile.
Estrogens
Theoretically, large amounts of German chamomile might reduce the effectiveness of estrogens.
In vitro, German chamomile has demonstrated antiestrogenic activity. Theoretically, large amounts of German chamomile might interfere with hormone replacement therapy through competition for estrogen receptors.
Tamoxifen (Nolvadex)
Theoretically, large amounts of German chamomile might interfere with the activity of tamoxifen.
In vitro, German chamomile has demonstrated antiestrogenic activity.
Warfarin (Coumadin)
German chamomile might increase the effects of warfarin and increase the risk of bleeding.
In one case, a 70-year-old female taking warfarin developed retroperitoneal hematoma and bilateral recti muscle bleeding along with an INR of 7.9 following ingestion of German chamomile tea 4-5 cups daily and use of a topical chamomile-based lotion applied 4-5 times daily.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, German chamomile might inhibit CYP1A2 and increase levels of drugs metabolized by these enzymes.
In vitro and animal research shows that German chamomile might inhibit CYP1A2. So far, this interaction has not been reported in humans. However, there might be an increase in the levels of drugs metabolized by CYP1A2 in patients taking German chamomile.
milk thistle seed extract
Antidiabetes Drugs
Taking milk thistle with antidiabetes drugs may increase the risk of hypoglycemia.
Clinical research shows that milk thistle extract, alone or along with tree turmeric extract, can lower blood glucose levels and glycated hemoglobin (HbA1c) in patients with type 2 diabetes, including those already taking antidiabetes drugs. Additionally, animal research shows that milk thistle extract increases the metformin maximum plasma concentration and area under the curve and decreases the renal clearance of metformin, due to inhibition of the multi-drug and toxin extrusion protein 1 (MATE1) renal tubular transport protein.
Cytochrome P450 2B6 (Cyp2B6) Substrates
Theoretically, milk thistle might inhibit CYP2B6.
An in vitro study shows that silybin, a constituent of milk thistle, binds to and noncompetitively inhibits CYP2B6. Additionally, silybin might downregulate the expression of CYP2B6 by decreasing mRNA and protein levels.
Glucuronidated Drugs
Theoretically, milk thistle might affect the clearance of drugs that undergo glucuronidation.
Laboratory research shows that milk thistle constituents inhibit uridine diphosphoglucuronosyl transferase (UGT), the major phase 2 enzyme that is responsible for glucuronidation. Theoretically, this could decrease the clearance and increase levels of glucuronidated drugs. Other laboratory research suggests that a milk thistle extract of silymarin might inhibit beta-glucuronidase, although the significance of this effect is unclear.
Ledipasvir
Theoretically, milk thistle might increase the levels and clinical effects of ledipasvir.
Animal research in rats shows that milk thistle increases the area under the curve (AUC) for ledipasvir and slows its elimination.
Morphine
Theoretically, concomitant use of milk thistle with morphine might affect serum levels of morphine and either increase or decrease its effects.
Animal research shows that milk thistle reduces serum levels of morphine by up to 66%. In contrast, laboratory research shows that milk thistle constituents inhibit uridine diphosphoglucuronosyl transferase (UGT), the major phase 2 enzyme that is responsible for glucuronidation. Theoretically, this could decrease the clearance and increase morphine levels. The effect of taking milk thistle on morphine metabolism in humans is not known.
Raloxifene (Evista)
Theoretically, milk thistle might decrease the clearance and increase levels of raloxifene.
Laboratory research suggests that the milk thistle constituents silibinin and silymarin inhibit the glucuronidation of raloxifene in the intestines.
Sirolimus (Rapamune)
Milk thistle might decrease the clearance of sirolimus.
Pharmacokinetic research shows that a milk thistle extract of silymarin decreases the apparent clearance of sirolimus in hepatically impaired renal transplant patients. It is unclear if this interaction occurs in patients without hepatic impairment.
Sofosbuvir (Solvaldi)
Theoretically, milk thistle might decrease the levels and clinical effects of sofosbuvir.
Animal research in rats shows that milk thistle reduces the metabolism of sofosbuvir, as well as the hepatic uptake of its active metabolite.
Tamoxifen (Nolvadex)
Theoretically, the milk thistle constituent silibinin might increase tamoxifen levels and interfere with its conversion to an active metabolite.
Animal research suggests that the milk thistle constituent silibinin might increase plasma levels of tamoxifen and alter its conversion to an active metabolite. The mechanism appears to involve inhibition of pre-systemic metabolism of tamoxifen by cytochrome P450 (CYP) 2C9 and CYP3A4, and inhibition of P-glycoprotein-mediated efflux of tamoxifen into the intestine for excretion. Whether this interaction occurs in humans is not known.
Warfarin (Coumadin)
Theoretically, milk thistle might increase the effects of warfarin.
In one case report, a man stabilized on warfarin experienced an increase in INR from 2.64 to 4.12 after taking a combination product containing milk thistle 200 mg daily, as well as dandelion, wild yam, niacinamide, and vitamin B12. Levels returned to normal after stopping the supplement. Although a direct correlation between milk thistle and the change in INR cannot be confirmed, some in vitro research suggests that milk thistle might inhibit cytochrome P450 2C9 (CYP2C9), an enzyme involved in the metabolism of various drugs, including warfarin.
Cytochrome P450 2C9 (Cyp2C9) Substrates
It is unclear if milk thistle inhibits CYP2C9; research is conflicting.
In vitro research suggests that milk thistle might inhibit CYP2C9. Additionally, 3 case reports from the World Health Organization (WHO) adverse drug reaction database describe increased toxicity in patients taking milk thistle and cancer medications that are CYP2C9 substrates, including imatinib and capecitabine. However, contradictory clinical research shows that milk thistle extract does not inhibit CYP2C9 or significantly affect levels of the CYP2C9 substrate tolbutamide. Differences in results could be due to differences in dosages or formulations utilized.
Cytochrome P450 3A4 (Cyp3A4) Substrates
It is unclear if milk thistle inhibits CYP3A4; research is conflicting.
While laboratory research shows conflicting results, pharmacokinetic research shows that taking milk thistle extract 420-1350 mg daily does not significantly affect the metabolism of the CYP3A4 substrates irinotecan, midazolam, or indinavir. However, 8 case reports from the World Health Organization (WHO) adverse drug reaction database describe increased toxicity in patients taking milk thistle and cancer medications that are CYP3A4 substrates, including gefitinib, sorafenib, doxorubicin, and vincristine.
Estrogens
Theoretically, milk thistle might interfere with estrogen therapy through competition for estrogen receptors.
Animal research suggests that a milk thistle extract of silymarin binds to estrogen receptor beta.
Hmg-Coa Reductase Inhibitors ("Statins")
Theoretically, milk thistle might interfere with statin therapy by decreasing the activity of organic anion transporting polypeptide 1B1 (OATB1B1) and inhibiting breast cancer resistance protein (BCRP).
Preliminary evidence suggests that a milk thistle extract of silymarin can decrease the activity of the OATP1B1, which transports HMG-CoA reductase inhibitors into the liver to their site of action, and animal research shows this increases the maximum plasma concentration of pitavastatin and pravastatin. The silibinin component also inhibits BCRP, which transports statins from the liver into the bile for excretion. However, in a preliminary study in healthy males, silymarin 140 mg three times daily had no effect on the pharmacokinetics of a single 10 mg dose of rosuvastatin.
Indinavir (Crixivan)
Theoretically, milk thistle may induce cytochrome P450 3A4 (CYP3A4) enzymes and increase the metabolism of indinavir; however, results are conflicting.
One pharmacokinetic study shows that taking milk thistle (Standardized Milk Thistle, General Nutrition Corp.) 175 mg three times daily in combination with multiple doses of indinavir 800 mg every 8 hours decreases the mean trough levels of indinavir by 25%. However, results from the same pharmacokinetic study show that milk thistle does not affect the overall exposure to indinavir. Furthermore, two other pharmacokinetic studies show that taking specific milk thistle extract (Legalon, Rottapharm Madaus; Thisilyn, Nature's Way) 160-450 mg every 8 hours in combination with multiple doses of indinavir 800 mg every 8 hours does not reduce levels of indinavir.
Organic Anion-Transporting Polypeptide Substrates (Oatp)
Milk thistle may inhibit one form of OATP, OATP-B1, which could reduce the bioavailability and clinical effects of OATP-B1 substrates.
In vitro research shows that milk thistle inhibits OATP-B1. Two case reports from the World Health Organization (WHO) adverse drug reaction database describe increased toxicity in patients taking milk thistle and cancer medications that are OATP substrates, including sorafenib and methotrexate. OATPs are expressed in the small intestine and liver and are responsible for the uptake of drugs and other compounds into the body. Inhibition of OATP may reduce the bioavailability of oral drugs that are substrates of OATP.
P-Glycoprotein Substrates
Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates. However, this effect does not seem to be clinically significant.
In vitro research shows that milk thistle can inhibit P-glycoprotein activity and 1 case report from the World Health Organization (WHO) adverse drug reaction database describes increased abdominal pain in a patient taking milk thistle and the cancer medication vincristine, a P-glycoprotein substrate, though this patient was also taking methotrexate. However, a small pharmacokinetic study in healthy volunteers shows that taking milk thistle (Enzymatic Therapy Inc.) 900 mg, standardized to 80% silymarin, in 3 divided doses daily for 14 days does not affect absorption of digoxin, a P-glycoprotein substrate.
Passion Flower extract
Cns Depressants
Concomitant use of passion flower with sedative drugs might cause additive effects and side effects.
Research in animals and humans shows that passion flower has sedative effects which can be additive when used with sedative medications like lorazepam.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, passion flower might decrease the effects of CYP3A4 substrates.
In vitro research suggests that passion flower can induce CYP3A4 enzymes, albeit to a much lower degree than rifampin, a known CYP3A4 inducer.
Organic Anion-Transporting Polypeptide Substrates (Oatp)
Theoretically, passion flower might reduce the bioavailability of OATP2B1 and OATP1A2 substrates.
In vitro research shows that the passion flower constituents apigenin and vitexin inhibit OATP2B1 and OATP1A2. This inhibition may be dose-dependent. One specific high-flavonoid passion flower extract (Valverde) seems to inhibit OATP2B1 and OATP1A2, while another extract with a lower flavonoid concentration (Arkocaps) shows less potent inhibition. OATPs are responsible for the uptake of drugs and other compounds into the body; however, the specific activities of OATP2B1 and OATP1A2 are not well characterized.
European Peony
Anticoagulant/Antiplatelet Drugs
Theoretically, combining peony with anticoagulant or antiplatelet drugs might increase the risk of bleeding.
In vitro research suggests that peony might have antiplatelet, anticoagulant, and antithrombotic effects.
Clozapine (Clozaril)
Theoretically, peony might increase the levels and clinical effects of clozapine.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on cytochromes P450 (CYP) 1A2 and CYP3A4. This effect has not been reported in humans.
Contraceptive Drugs
Theoretically, peony might interfere with contraceptive drugs due to competition for estrogen receptors.
In vitro and animal research shows that peony extract has estrogenic activity. Concomitant use might also increase the risk for estrogen-related adverse effects.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. This effect has not been reported in humans.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. This effect has not been reported in humans.
Estrogens
Theoretically, concomitant use of large amounts of peony might interfere with hormone replacement therapy and/or increase the risk for estrogen-related adverse effects.
In vitro and animal research shows that peony extract has estrogenic activity. Theoretically, peony might compete for estrogen receptors and/or cause additive estrogenic effects.
Phenytoin (Dilantin)
Theoretically, peony might reduce the levels and clinical effects of phenytoin.
Animal research shows that taking peony root reduces levels of phenytoin. Some researchers suggest that peony root might affect cytochrome P450 (CYP) 2C9, which metabolizes phenytoin. However, preliminary research in humans shows that peony root does not alter levels of losartan (Cozaar), which is also metabolized by CYP2C9.
Jujube fruit extract
Antidiabetes Drugs
Theoretically, zizyphus might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Animal research shows that zizyphus has hypoglycemic activity. However, a small clinical study shows that zizyphus fruit powder does not reduce fasting blood glucose levels in patients with type 2 diabetes.
Cns Depressants
Theoretically, zizyphus might cause additive sedative effects when taken with CNS depressants.
Some animal research has found that various parts of zizyphus have sedative effects. However, other animal research shows that zizyphus plant extract does not alter sleep parameters when used in combination with pentobarbital.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, zizyphus might decrease the levels and clinical effects of drugs metabolized by CYP1A2.
Animal research shows that zizyphus induces CYP1A2 enzymes. However, this effect has not been reported in humans.
poria
Anticholinergic Drugs
Theoretically, poria mushroom might decrease the clinical effects of anticholinergic drugs.
In animal research, poria mushroom essential oil reduces acetylcholinesterase activity. This interaction has not been shown in humans.
Cholinergic Drugs
Theoretically, poria mushroom might have additive effects when used with cholinergic drugs.
In animal research, poria mushroom essential oil reduces acetylcholinesterase activity. This interaction has not been shown in humans.
Cns Depressants
Theoretically, taking poria mushroom extract may enhance the therapeutic and adverse effects of sedatives.
Animal research shows that poria mushroom extract has sedative properties. This interaction has not been shown in humans.
bupleurum extract
Anticoagulant/Antiplatelet Drugs
Theoretically, bupleurum might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.
In vitro research suggests that saikosaponins, constituents of bupleurum, can inhibit platelet aggregation.
Antidiabetes Drugs
Theoretically, bupleurum might decrease the effects of antidiabetes drugs.
Animal research suggests that saikosaponins, constituents of bupleurum, can increase blood glucose.
Immunosuppressants
Theoretically, bupleurum might decrease the effects of immunosuppressants.
In vitro and animal research suggests that bupleurum might stimulate immune function.
Magnesium
Levodopa/Carbidopa (Sinemet)
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Clinical research in healthy volunteers shows that taking magnesium oxide 1000 mg with levodopa 100 mg/carbidopa 10 mg reduces the area under the curve (AUC) of levodopa by 35% and of carbidopa by 81%. In vitro and animal research shows that magnesium produces an alkaline environment in the digestive tract, which might lead to degradation and reduced bioavailability of levodopa/carbidopa.
Aminoglycoside Antibiotics
Concomitant use of aminoglycoside antibiotics and magnesium can increase the risk for neuromuscular weakness.
Both aminoglycosides and magnesium reduce presynaptic acetylcholine release, which can lead to neuromuscular blockade and possible paralysis. This is most likely to occur with high doses of magnesium given intravenously.
Antacids
Use of acid reducers may reduce the laxative effect of magnesium oxide.
A retrospective analysis shows that, in the presence of H2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs), a higher dose of magnesium oxide is needed for a laxative effect. This may also occur with antacids. Under acidic conditions, magnesium oxide is converted to magnesium chloride and then to magnesium bicarbonate, which has an osmotic laxative effect. By reducing acidity, antacids may reduce the conversion of magnesium oxide to the active bicarbonate salt.
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)
Magnesium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Advise patients that bictegravir/emtricitabine/tenofovir alafenamide should be taken at least 2 hours before or 6 hours after magnesium containing products.
Bisphosphonates
Magnesium can decrease absorption of bisphosphonates.
Cations, including magnesium, can decrease bisphosphonate absorption. Advise patients to separate doses of magnesium and these drugs by at least 2 hours.
Calcium Channel Blockers
Magnesium can have additive effects with calcium channel blockers, although evidence is conflicting.
Magnesium inhibits calcium entry into smooth muscle cells and may therefore have additive effects with calcium channel blockers. Severe hypotension and neuromuscular blockades may occur when nifedipine is used with intravenous magnesium, although some contradictory evidence suggests that concurrent use of magnesium with nifedipine does not increase the risk of neuromuscular weakness. High doses of magnesium could theoretically have additive effects with other calcium channel blockers.
Digoxin
Magnesium salts may reduce absorption of digoxin.
Clinical evidence suggests that treatment with oral magnesium hydroxide or magnesium trisilicate reduces absorption of digoxin from the intestines. This may reduce the blood levels of digoxin and decrease its therapeutic effects.
Potassium-Sparing Diuretics
Potassium-sparing diuretics decrease excretion of magnesium, possibly increasing magnesium levels.
Potassium-sparing diuretics also have magnesium-sparing properties, which can counteract the magnesium losses associated with loop and thiazide diuretics. Theoretically, increased magnesium levels could result from concomitant use of potassium-sparing diuretics and magnesium supplements.
Quinolone Antibiotics
Magnesium decreases absorption of quinolones.
Magnesium can form insoluble complexes with quinolones and decrease their absorption. Advise patients to take these drugs at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Skeletal Muscle Relaxants
Parenteral magnesium alters the pharmacokinetics of skeletal muscle relaxants, increasing their effects and accelerating the onset of effect.
Parenteral magnesium shortens the time to onset of skeletal muscle relaxants by about 1 minute and prolongs the duration of action by about 2 minutes. Magnesium potentiates the effects of skeletal muscle relaxants by decreasing calcium-mediated release of acetylcholine from presynaptic nerve terminals, reducing postsynaptic sensitivity to acetylcholine, and having a direct effect on the membrane potential of myocytes. Magnesium also has vasodilatory actions and increases cardiac output, allowing a greater amount of muscle relaxant to reach the motor end plate. A clinical study found that low-dose rocuronium (0.45 mg/kg), when given after administration of magnesium 30 mg/kg over 10 minutes, has an accelerated onset of effect, which matches the onset of effect seen with a full-dose rocuronium regimen (0.6 mg/kg). In another clinical study, onset times for rocuronium doses of 0.3, 0.6, and 1.2 mg/kg were 86, 76, and 50 seconds, respectively, when given alone, but were reduced to 66, 44, and 38 seconds, respectively, when the doses were given after a 15-minute infusion of magnesium sulfate 60 mg/kg. Giving intraoperative intravenous magnesium sulfate, 50 mg/kg loading dose followed by 15 mg/kg/hour, reduces the onset time of rocuronium, enhances its clinical effects, reduces the dose of intraoperative opiates, and prolongs the spontaneous recovery time. It does not affect the activity of subsequently administered neostigmine.
Sulfonylureas
Magnesium increases the systemic absorption of sulfonylureas, increasing their effects and side effects.
Clinical research shows that administration of magnesium hydroxide with glyburide increases glyburide absorption, increases maximal insulin response by 35-fold, and increases the risk of hypoglycemia, when compared with glyburide alone. A similar interaction occurs between magnesium hydroxide and glipizide. The mechanism of this effect appears to be related to the elevation of gastrointestinal pH by magnesium-based antacids, increasing solubility and enhancing absorption of sulfonylureas.
Tetracycline Antibiotics
Magnesium decreases absorption of tetracyclines.
Magnesium can form insoluble complexes with tetracyclines in the gut and decrease their absorption and antibacterial activity. Advise patients to take these drugs 1 hour before or 2 hours after magnesium supplements.
Anticoagulant/Antiplatelet Drugs
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
In vitro evidence shows that magnesium sulfate inhibits platelet aggregation, even at low concentrations. Some preliminary clinical evidence shows that infusion of magnesium sulfate increases bleeding time by 48% and reduces platelet activity. However, other clinical research shows that magnesium does not affect platelet aggregation, although inhibition of platelet-dependent thrombosis can occur.
Gabapentin (Neurontin)
Gabapentin absorption can be decreased by magnesium.
Clinical research shows that giving magnesium oxide orally along with gabapentin decreases the maximum plasma concentration of gabapentin by 33%, time to maximum concentration by 36%, and area under the curve by 43%. Advise patients to take gabapentin at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Sevelamer (Renagel, Renvela)
Sevelamer may increase serum magnesium levels.
In patients on hemodialysis, sevelamer use was associated with a 0.28 mg/dL increase in serum magnesium. The mechanism of this interaction remains unclear.
N-Acetyl Cysteine
Nitroglycerin
N-acetyl cysteine can increase the risk for hypotension and headaches when taken with intravenous or transdermal nitroglycerin.
Clinical research shows that concomitant administration of N-acetyl cysteine and intravenous or transdermal nitroglycerin can cause severe hypotension and intolerable headaches. Furthermore, in vitro research suggests that N-acetyl cysteine increases the anticoagulant activity of nitroglycerin.
Activated Charcoal
N-acetyl cysteine might reduce the effects of activated charcoal, while activated charcoal might reduce the absorption of N-acetyl cysteine.
N-acetyl cysteine appears to reduce the capacity of activated charcoal to adsorb acetaminophen and salicylic acid. Conversely, although clinical research suggests that although activated charcoal can reduce the absorption of N-acetyl cysteine by up to 40%, it does not seem to reduce its clinical effects. Other clinical evidence suggests that activated charcoal does not affect the absorption of N-acetyl cysteine.
Anticoagulant/Antiplatelet Drugs
Theoretically, N-acetyl cysteine might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.
Clinical research suggests that intravenous N-acetyl cysteine decreases prothrombin time, prolongs coagulation time, decreases platelet aggregation, and increases blood loss in surgical patients. Furthermore, in vitro research suggests that N-acetyl cysteine increases the anticoagulant activity of nitroglycerin.
Antihypertensive Drugs
Theoretically, N-acetyl cysteine might increase the risk of hypotension when taken with antihypertensive drugs.
Animal research suggests that N-acetyl cysteine potentiates the hypotensive effects of the angiotensin-converting enzyme inhibitors (ACEIs) captopril and enalaprilat. Theoretically, combining N-acetyl cysteine with other antihypertensive drugs might increase the risk of hypotension.
Chloroquine (Aralen)
Theoretically, N-acetyl cysteine might interfere with the antimalarial effects of chloroquine.
Animal research suggests that N-acetyl cysteine might reduce the antimalarial effects of chloroquine by increasing cellular levels of glutathione.
Mimosa Tree
Cns Depressants
Animal research suggests that certain constituents from Albizia julibrissin flowers can potentiate pentobarbital-induced sleeping time in mice. Theoretically, Albizia julibrissin might enhance the therapeutic and adverse effects of CNS depressants.
Some CNS depressants include pentobarbital (Nembutal), phenobarbital (Luminal), secobarbital (Seconal), clonazepam (Klonopin), lorazepam (Ativan), zolpidem (Ambien), and others.
codonopsis
Abiraterone (Zytiga)
Theoretically, taking codonopsis root with abiraterone might reduce the levels and therapeutic effects of abiraterone.
Animal research in rats shows that intragastric administration of codonopsis root along with abiraterone every 2 days for 2 weeks seems to increase the clearance of abiraterone and reduce the overall exposure and time to maximum concentration. This interaction has not been reported in humans.
Anticoagulant/Antiplatelet Drugs
Theoretically, codonopsis liquor might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
A small clinical study in adults with coronary heart disease shows that consuming Codonopsis pilosula liquor for 4 weeks inhibits platelet aggregation but does not affect tissue-type plasminogen activator (t-PA) or plasminogen activator inhibitor (PAI).
Antidiabetes Drugs
Theoretically, codonopsis might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Laboratory and animal research suggest that codonopsis has antidiabetic effects.
L-Taurine
Antihypertensive Drugs
Theoretically, taurine might increase the risk of hypotension when taken with antihypertensive drugs.
Some clinical evidence suggests that taurine can reduce both systolic and diastolic blood pressure.
Lithium
Theoretically, taurine might reduce excretion and increase plasma levels of lithium.
Taurine is thought to have diuretic properties, which might reduce the excretion of lithium.
Calcium Amino Acid Chelate
Ceftriaxone (Rocephin)
Co-administration of intravenous calcium and ceftriaxone can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys.
Avoid administering intravenous calcium in any form, such as parenteral nutrition or Lactated Ringers, within 48 hours of intravenous ceftriaxone. Case reports in neonates show that administering intravenous ceftriaxone and calcium can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys. In several cases, neonates have died as a result of this interaction. So far there are no reports in adults; however, there is still concern that this interaction might occur in adults.
Dolutegravir (Tivicay)
Calcium seems to reduce levels of dolutegravir.
Advise patients to take dolutegravir either 2 hours before or 6 hours after taking calcium supplements. Pharmacokinetic research suggests that taking calcium carbonate 1200 mg concomitantly with dolutegravir 50 mg reduces plasma levels of dolutegravir by almost 40%. Calcium appears to decrease levels of dolutegravir through chelation.
Elvitegravir (Vitekta)
Calcium seems to reduce levels of elvitegravir.
Advise patients to take elvitegravir either 2 hours before or 2 hours after taking calcium supplements. Pharmacokinetic research suggests that taking calcium along with elvitegravir can reduce blood levels of elvitegravir through chelation.
Aluminum
Calcium citrate might increase aluminum absorption and toxicity. Other types of calcium do not increase aluminum absorption.
Calcium citrate can increase the absorption of aluminum when taken with aluminum hydroxide. The increase in aluminum levels may become toxic, particularly in individuals with kidney disease. However, the effect of calcium citrate on aluminum absorption is due to the citrate anion rather than calcium cation. Calcium acetate does not appear to increase aluminum absorption.
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)
Calcium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption when taken in a fasting state.
Advise patients that bictegravir/emtricitabine/tenofovir alafenamide and calcium can be taken together if taken with food. However, if taken on an empty stomach, bictegravir/emtricitabine/tenofovir alafenamide should not be taken with, or 2 hours after, calcium containing products.
Bisphosphonates
Calcium reduces the absorption of bisphosphonates.
Advise patients to take bisphosphonates at least 30 minutes before calcium, but preferably at a different time of day. Calcium supplements decrease absorption of bisphosphonates.
Calcipotriene (Dovonex)
Taking calcipotriene with calcium might increase the risk for hypercalcemia.
Calcipotriene is a vitamin D analog used topically for psoriasis. It can be absorbed in sufficient amounts to cause systemic effects, including hypercalcemia. Theoretically, combining calcipotriene with calcium supplements might increase the risk of hypercalcemia.
Digoxin (Lanoxin)
Using intravenous calcium with digoxin might increase the risk of fatal cardiac arrhythmias.
Hypercalcemia increases the risk of fatal cardiac arrhythmias with digoxin. However, one retrospective analysis of clinical data suggests that intravenous calcium does not increase the risk of dysrhythmias or mortality in patients receiving digoxin.
Diltiazem (Cardizem, Others)
Theoretically, calcium may reduce the therapeutic effects of diltiazem.
Hypercalcemia can reduce the effectiveness of verapamil in atrial fibrillation. Theoretically, calcium might increase this risk of hypercalcemia and reduce the effectiveness of diltiazem.
Levothyroxine (Synthroid, Others)
Calcium seems to reduce the absorption and effectiveness of levothyroxine.
Advise patients to take levothyroxine and calcium supplements at least 4 hours apart. Calcium reduces levothyroxine absorption, probably by forming insoluble complexes. Calcium carbonate supplements reduce effectiveness of levothyroxine in patients with hypothyroidism.
Lithium
Theoretically, concomitant use of calcium and lithium may increase this risk of hypercalcemia.
Clinical research suggests that long-term use of lithium may cause hypercalcemia in 10% to 60% of patients. Theoretically, concomitant use of lithium and calcium supplements may further increase this risk.
Quinolone Antibiotics
Calcium seems to reduce the absorption of quinolone antibiotics.
Advise patients to take oral quinolones at least 2 hours before or 4-6 hours after calcium supplements or calcium-fortified foods. Taking calcium at the same time as oral quinolones can reduce quinolone absorption. Calcium binds to quinolones in the gut.
Raltegravir (Isentress)
Calcium may reduce levels of raltegravir.
Pharmacokinetic research shows that taking a single dose of calcium carbonate 3000 mg along with raltegravir 400 mg twice daily modestly decreases the mean area under the curve of raltegravir, but the decrease does not necessitate a dose adjustment of raltegravir. However, a case of elevated HIV-1 RNA levels and documented resistance to raltegravir has been reported for a patient taking calcium carbonate 1 gram three times daily plus vitamin D3 (cholecalciferol) 400 IU three times daily in combination with raltegravir 400 mg twice daily for 11 months. It is thought that calcium reduced raltegravir levels by chelation, leading to treatment failure.
Sotalol (Betapace)
Calcium seems to reduce the absorption of sotalol.
Advise patients to separate doses by at least 2 hours before or 4-6 hours after calcium. Calcium appears to reduce the absorption of sotalol, probably by forming insoluble complexes.
Tetracycline Antibiotics
Calcium seems to reduce the absorption of tetracycline antibiotics.
Advise patients to take oral tetracyclines at least 2 hours before, or 4-6 hours after calcium supplements. Taking calcium at the same time as oral tetracyclines can reduce tetracycline absorption. Calcium binds to tetracyclines in the gut.
Thiazide Diuretics
Taking calcium along with thiazides might increase the risk of hypercalcemia and renal failure.
Thiazides reduce calcium excretion by the kidneys. Using thiazides along with moderately large amounts of calcium carbonate increases the risk of milk-alkali syndrome (hypercalcemia, metabolic alkalosis, renal failure). Patients may need to have their serum calcium levels and/or parathyroid function monitored regularly.
Verapamil (Calan, Others)
Theoretically, calcium may reduce the therapeutic effects of verapamil.
Hypercalcemia can reduce the effectiveness of verapamil in atrial fibrillation. Theoretically, use of calcium supplements may increase this risk of hypercalcemia and reduce the effectiveness of verapamil.
Calcium Channel Blockers
Intravenous calcium may decrease the effects of calcium channel blockers; oral calcium is unlikely to have this effect.
Intravenous calcium is used to decrease the effects of calcium channel blockers in the management of overdose. Intravenous calcium gluconate has been used before intravenous verapamil (Isoptin) to prevent or reduce the hypotensive effects without affecting the antiarrhythmic effects. But there is no evidence that dietary or supplemental calcium when taken orally interacts with calcium channel blockers.
Dong quai
Warfarin (Coumadin)
Dong quai may increase the risk of bleeding when used with warfarin.
Case reports suggest that concomitant use of dong quai with warfarin can increase the anticoagulant effects of warfarin and increase the risk of bleeding. In one case, after 4 weeks of taking dong quai 565 mg once or twice daily, the international normalized ratio (INR) increased to 4.9. The INR normalized 4 weeks after discontinuation of dong quai.
Anticoagulant/Antiplatelet Drugs
Theoretically, dong quai may increase the risk of bleeding when used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Animal studies suggest that dong quai has antithrombin activity and inhibits platelet aggregation due to its coumarin components. Additionally, some case reports in humans suggest that dong quai can increase the anticoagulant effects of warfarin. However, clinical research in healthy adults shows that taking 1 gram of dong quai root daily for 3 weeks does not significantly inhibit platelet aggregation or cause bleeding. Until more is known, use dong quai with caution in patients taking antiplatelet/anticoagulant drugs.
Estrogens
Theoretically, dong quai may reduce the effects of estrogens.
Dong quai has estrogenic effects. Theoretically, concomitant use of large amounts of dong quai might interfere with hormone replacement therapy due to competition for estrogen receptors.
lily turf
Corticosteroids
Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Lily-of-the-valley contains cardiac glycosides. Concomitant, long-term corticosteroid use can increase the risk of cardiac glycoside toxicity due to potassium depletion and electrolyte imbalance.
Digoxin (Lanoxin)
Using lily-of-the-valley with digoxin can cause cardiac glycoside toxicity.
Lily-of-the-valley contains cardiac glycosides. Use of the cardiac glycoside digoxin and lily-of-the-valley concomitantly increases the risk of cardiac glycoside toxicity.
Quinine
Theoretically, using lily-of-the-valley with quinine can increase the risk of cardiac glycoside toxicity.
Quinine may reduce the clearance of oral digoxin. Theoretically, concomitant use of quinine with lily-of-the-valley might reduce the clearance of cardiac glycosides found in lily-of-the-valley and increase the risk of toxicity.
Diuretic Drugs
Theoretically, using lily-of-the-valley with diuretics can increase the risk of cardiac glycoside toxicity.
Lily-of-the-valley contains cardiac glycosides. Concomitant use of potassium depleting diuretics and lily-of-the-valley can increase the risk of cardiac glycoside toxicity due to potassium depletion and electrolyte imbalance.
Lithium
Theoretically, lily-of-the-valley can increase levels of lithium and increase toxicity.
Lily-of-the-valley is thought to have diuretic properties. Theoretically, due to these potential diuretic effects, lily-of-the-valley might reduce excretion and increase levels of lithium. The dose of lithium might need to be decreased.
Macrolide Antibiotics
Theoretically, using lily-of-the-valley with macrolide antibiotics can increase the risk of cardiac glycoside toxicity.
Macrolide antibiotics appear to increase the gastrointestinal absorption of oral digoxin. Theoretically, concomitant use of macrolide antibiotics might increase the absorption of the cardiac glycosides found in lily-of-the-valley.
Stimulant Laxatives
Theoretically, using lily-of-the-valley with stimulant laxatives can increase the risk of cardiac glycoside toxicity.
Lily-of-the-valley contains cardiac glycosides. The overuse of stimulant laxatives can increase the risk of cardiac glycoside toxicity with lily-of-the-valley due to potassium depletion.
Tetracycline Antibiotics
Theoretically, using lily-of-the-valley with tetracycline antibiotics might increase the risk of cardiac glycoside toxicity.
Tetracycline antibiotics appear to increase the gastrointestinal absorption of oral digoxin, a cardiac glycoside. Theoretically, concomitant use of tetracycline antibiotics might increase the absorption of the cardiac glycosides found in lily-of-the-valley.
Bromelain
Anticoagulant/Antiplatelet Drugs
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
There is one case report of a patient experiencing minor bruising while taking bromelain with naproxen. Bromelain is thought to have antiplatelet activity. Whether this interaction is of concern with topical bromelain is unclear. Interference with coagulation of burn wounds has been reported in a patient receiving bromelain-based enzymatic debridement. However, observational research has found that topical bromelain debridement is not associated with increases or decreases in laboratory markers of coagulation when compared with surgical debridement.
Tetracycline Antibiotics
Theoretically, bromelain might increase levels of tetracycline antibiotics.
Laboratory research suggests that bromelain might increase the absorption of tetracycline antibiotics. However, a study in healthy adults reported no difference in tetracycline plasma levels when a 500 mg dose was taken with or without bromelain 80 mg.
potassium aspartate
Ace Inhibitors (Aceis)
Using ACEIs with high doses of potassium increases the risk of hyperkalemia.
ACEIs block the actions of the renin-angiotensin-aldosterone system and reduce potassium excretion. Concomitant use of these drugs with potassium supplements increases the risk of hyperkalemia. However, concomitant use of these drugs with moderate dietary potassium intake (about 3775-5200 mg daily) does not increase serum potassium levels.
Angiotensin Receptor Blockers (Arbs)
Using ARBs with high doses of potassium increases the risk of hyperkalemia.
ARBs block the actions of the renin-angiotensin-aldosterone system and reduce potassium excretion. Concomitant use of these drugs with potassium supplements increases the risk of hyperkalemia. However, concomitant use of these drugs with moderate dietary potassium intake (about 3775-5200 mg daily) does not increase serum potassium levels.
Potassium-Sparing Diuretics
Concomitant use increases the risk of hyperkalemia.
Using potassium-sparing diuretics with potassium supplements increases the risk of hyperkalemia.
L-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.
Thiamine
Trimethoprim (Proloprim)
Trimethoprim might increase blood levels of thiamine.
In vitro, animal, and clinical research suggest that trimethoprim inhibits intestinal thiamine transporter ThTR-2, hepatic transporter OCT1, and renal transporters OCT2, MATE1, and MATE2, resulting in paradoxically increased thiamine plasma concentrations.
Papain
Warfarin (Coumadin)
Theoretically, papain might increase the effects and side effects of warfarin.
In one case report, a patient previously stable on warfarin was found to have an international normalization ratio (INR) of 7.4, which was attributed to ingestion of a supplement containing papain from papaya extract.
Brand information
Manufacturer and brand details for Calm Nature, from the product label.
HoltraCeuticals
See all HoltraCeuticals products- Name
- Kent Holtorf, MD and the Holtorf Medical Group, Inc.
- City
- Torrance
- State
- CA
- Phone Number
- (310) 375-2705
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Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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The Full Monographs Behind Calm Nature’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 monographThiamine
Interacts with 3 drugsThiamine (vitamin B1) is an essential nutrient your body needs to turn food into energy and to keep your nerves and heart healthy. Most people get enough from food, but supplements are clear...
Read the full Thiamine monograph → Herb & supplement monographPapain
Interacts with 2 drugsPapain is a protein-digesting enzyme from the papaya plant that is used in digestive supplements and some topical products. While it has clear food and laboratory uses, strong human evidence...
Read the full Papain monograph → Herb & supplement monographBromelain
Interacts with 141 drugsBromelain is a group of protein-digesting enzymes from pineapple that people take mainly for inflammation, swelling, and sinus problems. Some early studies are promising, but the overall evi...
Read the full Bromelain monograph → Herb & supplement monographTaurine
Interacts with 173 drugsTaurine is an amino acid your body makes naturally and that you also get from animal foods. It is widely used in energy drinks and sports supplements, and short-term use appears generally sa...
Read the full Taurine monograph → Herb & supplement monographN-acetyl Cysteine (nac)
Interacts with 294 drugsN-acetyl cysteine (NAC) is a supplement form of the amino acid cysteine and a building block for the antioxidant glutathione. It has well-established prescription uses for acetaminophen over...
Read the full N-acetyl Cysteine (nac) monograph → Herb & supplement monographAlbizia Julibrissin
Interacts with 248 drugsAlbizia julibrissin (Persian silk tree, He Huan) is a plant used in traditional Chinese medicine, mainly the flower and bark, for calming the mind, lifting mood, and easing sleep problems. H...
Read the full Albizia Julibrissin monograph → Herb & supplement monographCalcium
Interacts with 168 drugsCalcium is an essential mineral your body needs for strong bones, nerve signaling, and muscle function, and supplements can help fill gaps when diet falls short. Most people do best getting...
Read the full Calcium monograph → Herb & supplement monographZizyphus
Interacts with 469 drugsZizyphus (jujube) is an edible fruit and traditional remedy used mainly for sleep, anxiety, and digestion. The fruit is a nutritious food, but human evidence for its medicinal benefits is li...
Read the full Zizyphus monograph → Herb & supplement monographMagnesium
Interacts with 295 drugsMagnesium is an essential mineral your body needs for muscles, nerves, blood pressure, and many other functions, and supplements are useful for preventing or correcting deficiency. Some othe...
Read the full Magnesium monograph → Herb & supplement monographFo-ti
Interacts with 1,257 drugsFo-ti (He Shou Wu) is a root used in traditional Chinese medicine, often promoted for healthy aging and hair. High-quality human evidence for these benefits is limited, and processed Fo-ti h...
Read the full Fo-ti monograph → Herb & supplement monographDong Quai
Interacts with 163 drugsDong Quai is a traditional Chinese herb often called "female ginseng" and is mostly used for menstrual and menopausal complaints. High-quality scientific evidence that it works for these use...
Read the full Dong Quai monograph → Herb & supplement monographPoria Mushroom
Interacts with 417 drugsPoria mushroom (Fu Ling) is a fungus long used in Traditional Chinese Medicine, mainly as a mild diuretic and digestive and calming aid. Modern scientific evidence in humans is very limited,...
Read the full Poria Mushroom monograph → Herb & supplement monographCodonopsis
Interacts with 211 drugsCodonopsis (often called 'dang shen') is a root long used in Traditional Chinese Medicine as a gentle energy and digestive tonic, frequently as a milder substitute for ginseng. Human researc...
Read the full Codonopsis monograph → Herb & supplement monographPeony
Interacts with 811 drugsPeony root is a traditional Chinese medicine herb often used for menstrual problems, cramps, and inflammation, frequently as part of combination formulas. Human evidence for most uses is lim...
Read the full Peony monograph → Herb & supplement monographMilk Thistle
Interacts with 954 drugsMilk thistle is a popular herbal supplement most often used for liver health, and its main active component is a group of compounds called silymarin. While it is generally well tolerated, th...
Read the full Milk Thistle monograph → Herb & supplement monographOriental Arborvitae
Oriental Arborvitae is an evergreen conifer used in Traditional Chinese Medicine, where the seeds (Bai Zi Ren) are taken to calm the mind and ease constipation, and the leaves (Ce Bai Ye) ar...
Read the full Oriental Arborvitae monograph → Herb & supplement monographBupleurum
Interacts with 327 drugsBupleurum (Chai Hu) is a root used in traditional Chinese medicine, usually as part of multi-herb formulas, for liver, digestive, and fever-related complaints. High-quality human evidence fo...
Read the full Bupleurum monograph → Herb & supplement monographLily-of-the-valley
Interacts with 157 drugsLily-of-the-valley is a poisonous plant that contains powerful heart-affecting compounds called cardiac glycosides, similar to the drug digoxin. While it was used historically for heart cond...
Read the full Lily-of-the-valley monograph → Herb & supplement monographPotassium
Interacts with 62 drugsPotassium is an essential mineral your body needs for nerve signals, muscle function, and a steady heartbeat, and most people get enough from a balanced diet rich in fruits and vegetables. P...
Read the full Potassium monograph → Herb & supplement monographPassion Flower
Interacts with 836 drugsPassion flower is a traditional calming herb that many people use for anxiety and sleep. Early studies hint it may help with mild anxiety and restlessness, but the evidence is limited and mo...
Read the full Passion Flower monograph → Herb & supplement monographGerman Chamomile
Interacts with 960 drugsGerman chamomile is a widely used herbal remedy taken mainly as a tea for calming, sleep, and digestive complaints. Early research suggests possible benefits for mild anxiety and some skin o...
Read the full German Chamomile monograph →Sources & How We Checked
Calm Nature'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 519 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
- Meyer JS, Welch KM, Deshmukh VD, et al. Neurotransmitter precursor amino acids in the treatment of multi-infarct dementia and Alzheimer's disease. J Amer Geriat Soc 1977;25:289-98.
- DiPiro JT, Talbert RL, Yee GC, et al; eds. Pharmacotherapy: A pathophysiologic approach. 4th ed. Stamford, CT: Appleton & Lange, 1999.
- Wood DR, Reimherr FW, Wender PH. Amino acid precursors for the treatment of attention deficit disorder, residual type. Psychopharmacol Bull 1985;21:146-9.
- van Spronsen FJ, van Rijn M, Bekhof J. Phenylketonuria: tyrosine supplementation in phenylalanine-restricted diets. Am J Clin Nutr 2001;73:153-7. PubMed
Thiamine 7 references
- McEvoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.
- Yates AA, Schlicker SA, Suitor CW. Dietary reference intakes: The new basis for recommendations for calcium and related nutrients, B vitamins, and choline. J Am Diet Assoc 1998;98:699-706. PubMed
- Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (2000). Washington, DC: National Academy Press, 2000. Available at: http://b
- Rogovik, A. L., Vohra, S., and Goldman, R. D. Safety considerations and potential interactions of vitamins: should vitamins be considered drugs? Ann.Pharmacother. 2010;44(2):311-324. PubMed
- Arruti N, Bernedo N, Audicana MT, Villarreal O, Uriel O, Muñoz D. Systemic allergic dermatitis caused by thiamine after iontophoresis. Contact Dermatitis. 2013 Dec;69(6):375-6. PubMed
- Thiamine hydrochloride injection package insert. Lake Zurich, IL: Fresenius Kabi, LLC; September 2019.
- Vora B, Wen A, Yee SW, et al. The Effect of Trimethoprim on Thiamine Absorption: A Transporter-Mediated Drug-Nutrient Interaction. Clin Pharmacol Ther 2023;114(2):381-392.
Papain 11 references
- The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
- Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Saf 1997;17:342-56.
- Shuttleworth D, Hill S, Marks R, Connelly DM. Relief of experimentally induced pruritus with a novel eutectic mixture of local anaesthetic agents. Br J Dermatol 1988;119:535-40.
- Mansfield LE, Ting S, Haverly RW, Yoo TJ. The incidence and clinical implications of hypersensitivity to papain in an allergic population, confirmed by blinded oral challenge. Ann Allergy 1985;55:541-3.
- Martin, T., Uhder, K., Kurek, R., Roeddiger, S., Schneider, L., Vogt, H. G., Heyd, R., and Zamboglou, N. Does prophylactic treatment with proteolytic enzymes reduce acute toxicity of adjuvant pelvic irradiation? Results of a double-blind randomized trial PubMed
- Walker-Renard, P. Update on the medicinal management of phytobezoars. Am J Gastroenterol. 1993;88(10):1663-1666.
- Tymoszuk D, Wiszniewska M, Walusiak-Skorupa J. Papain-induced occupational rhinoconjunctivitis and asthma - A case report. Med Pr 2016;67(1):109-12. PubMed
- Soto-Mera MT, López-Rico MR, Filgueira JF, et al. Occupational allergy to papain. Allergy 2000;55(10):983-4. PubMed
- Tarlo SM, Shaikh W, Bell B, et al. Papain-induced allergic reactions. Clin Allergy 1978;8(3):207-15. PubMed
- Baur X, König G, Bencze K, Fruhmann G. Clinical symptoms and results of skin test, RAST and bronchial provocation test in thirty-three papain workers: Evidence for strong immunogenic potency and clinically relevant proteolytic e?ects of airborne papain. C
- Novey HS, Keenan WJ, Fairshter RD, Wells ID, Wilson AF, Culver BD. Pulmonary disease in workers exposed to papain: clinico-physiological and immunological studies. Clin Allergy 1980;10(6):721-31. PubMed
Bromelain 19 references
- Nettis E, Napoli G, Ferrannini A, Tursi A. IgE-mediated allergy to bromelain. Allergy 2001;56:257-8. PubMed
- Taussig SJ, Batkin S. Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application. An update. J Ethnopharmacol 1988;22:191-203.. PubMed
- Bradbrook ID, Morrison PJ, Rogers HJ. The effect of bromelain on the absorption of orally administered tetracycline. Br J Clin Pharmacol 1978;6:552-4. PubMed
- Bush TM, Rayburn KS, Holloway SW, et al. Adverse interactions between herbal and dietary substances and prescription medications: a clinical survey. Altern Ther Health Med 2007;13:30-5.
- Brien S, Lewith G, Walker AF, et al. Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study. QJM 2006;99:841-50. PubMed
- Mori S, Ojima Y, Hirose T, et al. The clinical effect of proteolytic enzyme containing bromelain and trypsin on urinary tract infection evaluated by double blind method. Acta Obstet Gynaecol Jpn 1972;19:147-53.
- Glaser D, Hilberg T. The influence of bromelain on platelet count and platelet activity in vitro. Platelets 2006;17:37-41. PubMed
- Heinicke R M, van der Wal L, Yokoyama M. Effect of bromelain (Ananase) on human platelet aggregation. Experientia 1972;28:844-5. PubMed
- Gailhofer, G., Wilders-Truschnig, M., Smolle, J., and Ludvan, M. Asthma caused by bromelain: an occupational allergy. Clin Allergy 1988;18(5):445-450. PubMed
- Mattei, O., Fabri, G., and Farina, G. [Occupational health experience regarding four cases of asthma due to bromelain (author's transl)]. Medicina del Lavoro 1979;70(5):404-409.
- Galleguillos, F. and Rodriguez, J. C. Asthma caused by bromelin inhalation. Clin Allergy 1978;8(1):21-24. PubMed
- Perez-Camo I, Quirce S, Duran MA, and et al. Latex allergy: evidence of cross-reactivity with papain and bromelain [abstract]. Allergy 1996;51(suppl 31):48.
- Martin GJ, Ehrenreich J, and Asbell N. Bromelain: pineapple proteases with anti-edema activity. Exp Med Surg 1962;20:227-247.
- Kasemsuk T, Saengpetch N, Sibmooh N, Unchern S. Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis. Clin Rheumatol. 2016 Oct;35(10):2531-40. PubMed
- Kutlu Ö, DemirbaS A, Elmas ÖF, Güvenç U, Metin A. Fixed drug eruption: a new side effect of bromelain. Contact Dermatitis 2020. Online ahead of print. PubMed
- Shoham Y, Shapira E, Haik J, et al. Bromelain-based enzymatic debridement of chronic wounds: Results of a multicentre randomized controlled trial. Wound Repair Regen 2021;29(6):899-907. PubMed
- Pfister P, Garcia Wendel PD, Kim BS, et al. Coagulation side effects of enzymatic debridement in burned patients. Burns 2022. PubMed
- Hasham S, Riyat H, Fletcher A, O'Boyle CP, Alexander S. To bleed or not to bleed? Case series and discussion of haemorrhage risk with enzymatic debridement in burn injuries. Scars Burn Heal 2023;9:20595131231168333. PubMed
- Leelakanok N, Petchsomrit A, Janurai T, Saechan C, Sunsandee N. Efficacy and safety of bromelain: A systematic review and meta-analysis. Nutr Health 2023. PubMed
Taurine 21 references
- Ahmad S, Robertson HT, Golper TA, et al. Multicenter trial of L-carnitine in maintenance hemodialysis patients. II. Clinical and biochemical effects. Kidney Int 1990;38:912-8. PubMed
- Machado-Vieira R, Viale CI, Kapczinski F. Mania associated with an energy drink: the possible role of caffeine, taurine, and inositol. Can J Psychiatry 2001;46:454-5. PubMed
- Obermann M, Schorn CF, Mummel P, et al. Taurine induced toxic encephalopathy? Clin Neurol Neurosurg 2006;108:812-3. PubMed
- Bichler, A., Swenson, A., and Harris, M. A. A combination of caffeine and taurine has no effect on short term memory but induces changes in heart rate and mean arterial blood pressure. Amino Acids 2006;31(4):471-476. PubMed
- Iyadurai, S. J. and Chung, S. S. New-onset seizures in adults: possible association with consumption of popular energy drinks. Epilepsy Behav 2007;10(3):504-508. PubMed
- Berger, A. J. and Alford, K. Cardiac arrest in a young man following excess consumption of caffeinated "energy drinks". Med J Aust. 1-5-2009;190(1):41-43. PubMed
- Worthley, M. I., Prabhu, A., De, Sciscio P., Schultz, C., Sanders, P., and Willoughby, S. R. Detrimental effects of energy drink consumption on platelet and endothelial function. Am J Med 2010;123(2):184-187. PubMed
- Morchon, Simon D. and Perez Castrillon, J. L. [Hypoglycemia by intake of taurine]. Rev.Clin Esp. 2010;210(1):49.
- Livshits, Z., Hoffman, R. S., Hymes, K. B., and Nelson, L. S. If vitamins could kill: massive hemolysis following naturopathic vitamin infusion. J Med Toxicol. 2011;7(3):224-226. PubMed
- Schoffl, I., Kothmann, J. F., Schoffl, V., Rupprecht, H. D., and Rupprecht, T. "Vodka energy": too much for the adolescent nephron? Pediatrics 2011;128(1):e227-e231. PubMed
- Calabro, R. S., Italiano, D., Gervasi, G., and Bramanti, P. Single tonic-clonic seizure after energy drink abuse. Epilepsy Behav 2012;23(3):384-385. PubMed
- Fujita, T., Ando, K., Noda, H., Ito, Y., and Sato, Y. Effects of increased adrenomedullary activity and taurine in young patients with borderline hypertension. Circulation 1987;75(3):525-532. PubMed
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See these in context on the N-acetyl Cysteine (nac) monograph →
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