DermeXX Ingredients & Drug Interactions
What is this page for?
First and foremost: checking DermeXX 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
DermeXX is a dietary supplement by Viatrexx Bio Incorporated with 8 active ingredients. Its ingredients are commonly taken for bone health and osteoporosis prevention, dietary calcium deficiency, heartburn relief (calcium carbonate antacids).Based on those ingredients, 704 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Centella asiatica, Calcium. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against DermeXX by Viatrexx Bio Incorporated
Ask about any prescription or over-the-counter medication and we check it for interactions with DermeXX by Viatrexx Bio Incorporated — 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 DermeXX by Viatrexx Bio Incorporated
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
DermeXX is a liquid supplement with 8 active ingredients. The main one is calcium, a mineral essential for bone health and many body functions.
The product also contains gotu kola (Centella asiatica), a plant used traditionally for skin and circulation. Several other ingredients — bovine placenta, porcine and bovine skin, porcine collagen, porcine placenta, and hyaluronidase — are included in a proprietary blend.
The inactive ingredients are alcohol and water.
Does it work?
Moderate evidence
Calcium in this product is effective for kidney failure, heartburn and stomach upset (dyspepsia), low blood calcium (hypocalcemia), high potassium (hyperkalemia), and likely effective for osteoporosis. Gotu kola has possibly effective evidence for venous insufficiency — poor blood flow in the legs — and burns, but possibly ineffective for radiation skin damage and cognitive function.
The evidence for gotu kola in Alzheimer disease and anxiety is insufficient to rate. We don't have effectiveness data on file for the other ingredients.
How safe is it?
Well-documented data
Calcium is generally well tolerated at recommended doses, though high amounts can cause problems. Common side effects from taking it by mouth include belching, constipation, diarrhea, bloating, and stomach upset.
Rare serious concerns include kidney stones and a condition called calciphylaxis. There's also some concern that very high doses — over 1500–2000 mg daily — might increase risk of advanced prostate cancer and cardiovascular disease, though research on this is mixed.
Adequate calcium is important in pregnancy and breastfeeding; stick to recommended amounts and talk with your doctor if you're unsure. Gotu kola is generally well tolerated short-term, but quality safety data is limited.
The most common side effect is gastric irritation and nausea when taken by mouth; topically it can occasionally cause eczema or allergic contact dermatitis. There's concern about liver toxicity — we have at least four case reports, though the exact cause wasn't confirmed in all of them.
A trial using 120 mg daily for 6 months didn't show liver problems. Gotu kola should be avoided in pregnancy due to lack of safety data, and it's best avoided while breastfeeding as well.
Meds to double-check
Major interaction found
If you take HIV integrase inhibitors (dolutegravir or elvitegravir), check before starting — calcium significantly lowers their levels. Also double-check if you're on thyroid hormone (levothyroxine), heart medications (diltiazem, sotalol), the HIV drug raltegravir, calcipotriene cream for psoriasis, or if you receive IV ceftriaxone antibiotics.
If you take sedating medications or drugs that stress the liver, gotu kola may add to those effects. Check your exact drugs with the tool below.
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.
DermeXX is primarily a calcium and gotu kola supplement in liquid form. If you take HIV medications (dolutegravir, elvitegravir, raltegravir), thyroid medication, heart drugs, or any IV antibiotics, you need to check with your pharmacist before using this — the calcium can significantly interfere with how they work.
Pregnant or breastfeeding people should talk to their doctor, especially about the gotu kola component. Everyone should run their medications through the interaction checker on this page.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 2 of 8 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Jun 20, 2024.
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 DermeXX, straight from the product label.
| Brand | Viatrexx Bio Incorporated |
|---|---|
| Barcode (UPC) | 041910105508 |
| Net contents | 1.7 Ounce(s); 50 mL |
| Market status | On market |
| Date entered into DSLD | Jun 20, 2024 |
| DSLD ID | 309867 |
| Product type | Other Combinations |
| Supplement form | Liquid |
| Dietary claims / uses | All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years), Gluten Free, Dairy Free, Sugar Free |
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 DermeXX by Viatrexx Bio Incorporated, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Calcium | 0 NP | -- |
| Proprietary Micro Blend of Trace and Essences | 0 NP | -- |
| Bovine Placenta | 0 NP | -- |
| Centella asiatica | 0 NP | -- |
| Sus scrofa Collagen | 0 NP | -- |
| Sus scrofa Skin | 0 NP | -- |
| Bovine Skin | 0 NP | -- |
| Sus scrofa Placenta | 0 NP | -- |
| Hyaluronidase | 0 NP | -- |
Other ingredients: Alcohol, Water
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.
Formulation
DermeXX for the temporary relief of symptoms associated to skin challenges.
Organic alcohol used/Certified organic or wildcrafted sources used whenever possible.
Free of: Gluten, wheat, yeast, corn, dairy, soy, sugar & artificial colors/flavours.
Suggested/Recommended/Usage/Directions
Suggested use: As a dietary supplement, hold nozzle 1" from mouth: 1-5 spray(s) - 1-3 time(s) a day or as recommended by your healthcare practitioner.
Precautions
Caution: Do not exceed recommended dose. Do not use if safety seal is damaged or missing.
Pregnant or nursing mothers, children under the age of 18, and individuals with a known medical condition should consult with a healthcare practitioner before taking this or any dietary supplement.
Pregnant or nursing mothers, children under the age of 18, and individuals with a known medical condition should consult with a healthcare practitioner before taking this or any dietary supplement. Keep out of reach of children.
Storage
Store in a cool, dry place.
FDA Disclaimer Statement
These statements have not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
FDA Statement of Identity
Dietary Supplement
General Statements
For more information visit: Viatrexx.com
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
DermeXX by Viatrexx Bio Incorporated 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 DermeXX by Viatrexx Bio Incorporated
These are the 8 active ingredients this product is made of. Select any to open its full monograph.
Serving size1 Spray(s) Dosage formLiquid Servings per container300 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.
Proprietary Micro Blend of Trace and Essences
- › Calcium
- › Bovine Placenta
- › Centella asiatica
- › Sus scrofa Collagen
- › Sus scrofa Skin
- › Bovine Skin
- › Sus scrofa Placenta
- › Hyaluronidase
Other (inactive) ingredients: Alcohol, Water. These complete the product’s ingredient list but are not active constituents.
DermeXX by Viatrexx Bio Incorporated Drug Interactions
HelloPharmacist Interaction Report
DermeXX by Viatrexx Bio Incorporated contains calcium, which interacts with a number of medications.
The most serious concern is with HIV integrase inhibitors — dolutegravir (Tivicay) and elvitegravir (Vitekta) — where calcium can reduce drug levels by a significant amount. If you take either of these, you'll need to separate doses by at least 2 hours before or 6 hours after calcium.
Calcium also has a major interaction with the antibiotic ceftriaxone (Rocephin) when given intravenously; the two can form a dangerous precipitate in the lungs and kidneys, so avoid IV calcium within 48 hours of IV ceftriaxone.
Read the full breakdown — every affected drug type, severity by severity
Calcium has moderate interactions with several other medications. It may reduce levels of raltegravir (Isentress), another HIV medication, though not enough to require a dose change.
It can also interfere with absorption of levothyroxine (Synthroid), a thyroid hormone — separate these by at least 4 hours. Calcium may reduce how well sotalol (Betapace), a heart rhythm medication, is absorbed; space them 2 hours before or 4–6 hours after.
Taking calcium with calcipotriene (Dovonex), a vitamin D cream for psoriasis, might raise calcium levels too high. It may also theoretically reduce the effectiveness of diltiazem (Cardizem), a heart medication.
The product also contains gotu kola (Centella asiatica), which has moderate interactions with CNS depressants — sedating medications like benzodiazepines or opioids — and theoretically with drugs that are hard on the liver. We could not check several other ingredients in this product: bovine placenta, porcine collagen, porcine and bovine skin, porcine placenta, and hyaluronidase.
Altogether, these interactions span 688 individual medications. Run your exact medications through the checker below before you start.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against DermeXX?
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 DermeXX interact with 704 drugs. Click any drug to see the details.
2 of the 8 ingredients in DermeXX interact with drugs. Each result below shows which ingredient is responsible. Centella asiatica Calcium
CeftriaxoneRocephin
How Ceftriaxone interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
CalciumCeftriaxone (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 + Ceftriaxone interactionCobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide FumarateGenvoya
How Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interacts with DermeXX — through 2 ingredients. Tap an ingredient for the detail:
CalciumElvitegravir (vitekta), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionCentella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionDolutegravirTivicay
How Dolutegravir interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
CalciumDolutegravir (tivicay) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium + Dolutegravir interactionDolutegravir, Emtricitabine, Tenofovir AlafenamideDolutegravir, Emtricitabine, Tenofovir Alafenamide
How Dolutegravir, Emtricitabine, Tenofovir Alafenamide interacts with DermeXX — through 2 ingredients. Tap an ingredient for the detail:
CalciumDolutegravir (tivicay), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionCentella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionDolutegravir, RilpivirineJuluca
How Dolutegravir, Rilpivirine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
CalciumDolutegravir (tivicay) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium + Dolutegravir, Rilpivirine interactionElvitegravirVitekta
How Elvitegravir interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
CalciumElvitegravir (vitekta) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium + Elvitegravir interactionElvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil FumarateStribild
How Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interacts with DermeXX — through 2 ingredients. Tap an ingredient for the detail:
CalciumElvitegravir (vitekta), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionCentella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interaction6-mercaptopurinePurinethol
How 6-mercaptopurine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + 6-mercaptopurine interactionAbacavir Sulfate, Dolutegravir, LamivudineTriumeq
How Abacavir Sulfate, Dolutegravir, Lamivudine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Abacavir Sulfate, Dolutegravir, Lamivudine interactionAbacavir, LamivudineEpzicom
How Abacavir, Lamivudine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Abacavir, Lamivudine interactionAbiraterone
How Abiraterone interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Abiraterone interactionAbiraterone AcetateYonsa, Zytiga
How Abiraterone Acetate interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Abiraterone Acetate interactionAcarboseGlucobay, Prandase, Precose
How Acarbose interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acarbose interactionAcebutololRhotral, Sectral
How Acebutolol interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acebutolol interactionAcepromazineAtravet
How Acepromazine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaCns Depressants Moderate
Interaction Summary
Theoretically, taking gotu kola might increase the sedative effects of CNS depressants.
Read the full Centella Asiatica + Acepromazine interactionAcetaminophenChildren's Tylenol, Children's Tylenol Meltaways, Tylenol, Tylenol Ex Strength
How Acetaminophen interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acetaminophen interactionAcetaminophen, AspirinGemnisyn
How Acetaminophen, Aspirin interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acetaminophen, Aspirin interactionAcetaminophen, Aspirin, CaffeineExcedrin, Excedrin Extra Strength, Excedrin Migraine
How Acetaminophen, Aspirin, Caffeine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acetaminophen, Aspirin, Caffeine interactionAcetaminophen, Brompheniramine, PhenylpropanolamineDimetapp Cold and Flu
How Acetaminophen, Brompheniramine, Phenylpropanolamine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acetaminophen, Brompheniramine, Phenylpropanolamine interactionAcetaminophen, ButalbitalAxocet, Bancap, Bucet, Butex Forte, Esgic CF, Orbivan CF +5 more
How Acetaminophen, Butalbital interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acetaminophen, Butalbital interactionAcetaminophen, Butalbital, CaffeineEsgic, Esgic Plus, Fiogesic, Fioricet, Repan, Tecnal +1 more
How Acetaminophen, Butalbital, Caffeine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acetaminophen, Butalbital, Caffeine interactionAcetaminophen, Butalbital, Caffeine, CodeineEsgic with Codeine, Fioricet w/ Codeine
How Acetaminophen, Butalbital, Caffeine, Codeine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs, Cns Depressants Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acetaminophen, Butalbital, Caffeine, Codeine interactionAcetaminophen, Butalbital, CodeineBancap w/ Codeine
How Acetaminophen, Butalbital, Codeine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaCns Depressants, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola might increase the sedative effects of CNS depressants.
Read the full Centella Asiatica + Acetaminophen, Butalbital, Codeine interactionAcetaminophen, Butalbital, Codeine PhosphatePhrenilin #3
How Acetaminophen, Butalbital, Codeine Phosphate interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs, Cns Depressants Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acetaminophen, Butalbital, Codeine Phosphate interactionAcetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, PhenylephrineHycomine Compound
How Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaCns Depressants, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola might increase the sedative effects of CNS depressants.
Read the full Centella Asiatica + Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine interactionAcetaminophen, Caffeine, CodeineGesic C15, Gesic C30, Gesic C8, Lenoltec 1, Lenoltec 2, Lenoltec 3 +1 more
How Acetaminophen, Caffeine, Codeine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs, Cns Depressants Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acetaminophen, Caffeine, Codeine interactionAcetaminophen, Caffeine, Codeine, SalicylamideCodalan No.1, Codalan No.2, Codalan No.3
How Acetaminophen, Caffeine, Codeine, Salicylamide interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaCns Depressants, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola might increase the sedative effects of CNS depressants.
Read the full Centella Asiatica + Acetaminophen, Caffeine, Codeine, Salicylamide interactionAcetaminophen, Caffeine, DihydrocodeineDHC Plus, Panlor DC, Panlor SS
How Acetaminophen, Caffeine, Dihydrocodeine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs, Cns Depressants Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acetaminophen, Caffeine, Dihydrocodeine interactionAcetaminophen, Caffeine, IsomethepteneMigralam
How Acetaminophen, Caffeine, Isometheptene interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acetaminophen, Caffeine, Isometheptene interactionAcetaminophen, Caffeine, PyrilamineMidol Max Strength Menstrual
How Acetaminophen, Caffeine, Pyrilamine interacts with DermeXX — through 1 ingredient. Tap an ingredient for the detail:
Centella AsiaticaHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
Read the full Centella Asiatica + Acetaminophen, Caffeine, Pyrilamine interactionEach ingredient & the kinds of drugs it affects
For each ingredient in DermeXX 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.
Centella asiatica
Cns Depressants
Theoretically, taking gotu kola might increase the sedative effects of CNS depressants.
In vitro research suggests that gotu kola may have sedative effects via binding of GABA receptors.
Hepatotoxic Drugs
Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
There are at least four case reports of hepatotoxicity associated with the use of gotu kola. However, more information is needed to determine if gotu kola was the causative factor in these cases.
Calcium
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.
Brand information
Manufacturer and brand details for DermeXX, from the product label.
Viatrexx Bio Incorporated
See all Viatrexx Bio Incorporated products- Name
- Viatrexx Bio Incorporated
- City
- Newark
- State
- DE
- ZipCode
- 19713
- Phone Number
- 1.888.743.6652
- Web Address
- Viatrexx.com
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The Full Monographs Behind DermeXX’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Calcium
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 monographGotu Kola
Interacts with 579 drugsGotu kola is a traditional Ayurvedic and Asian herb that people use for wound healing, circulation, skin problems, and as a calming or memory-supporting herb. Some early studies suggest poss...
Read the full Gotu Kola monograph →Sources & How We Checked
DermeXX'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 80 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.
Calcium 62 references
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- Maton PN, Burton ME. Antacids revisited: a review of their clinical pharmacology and recommended therapeutic use. Drugs 1999;57:855-70.
- Clemens JD, Feinstein AR. Calcium carbonate and constipation: a historical review of medical mythopoeia. Gastroenterology 1977;72:957-61. DOI
- Saunders D, Sillery J, Chapman R. Effect of calcium carbonate and aluminum hydroxide on human intestinal function. Dig Dis Sci 1988;33:409-13. PubMed
- Friedman PA, Bushinsky DA. Diuretic effects on calcium metabolism. Semin Nephrol 1999;19:551-6.
- Koo WK, Walters JC, Esterlitz J, et al. Maternal calcium supplementation and fetal bone mineralization. Obstet Gynecol 1999;94:577-82. DOI
- Raman L, Rajalakshmi K, Krishnamachari KAVR, et al. Effect of calcium supplementation to undernourished mothers during pregnancy on the bone density of the neonates. Am J Clin Nutr 1978; 31:466-9. DOI
- Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
- Chan JM, Giovannucci E, Andersson SO, et al. Dairy products, calcium, phosphorous, vitamin D, and risk of prostate cancer. Cancer Causes Control 1998;9:559-66.
- Butner LE, Fulco PP, Feldman G, et al. Calcium carbonate-induced hypothyroidism. Ann Intern Med 2000:132:595. PubMed
- Schneyer CR. Calcium carbonate and reduction of levothyroxine efficacy. JAMA 1998;279:750. PubMed
- Moser LR, Smythe MA, Tisdale JE. The use of calcium salts in the prevention and management of verapamil-induced hypotension. Ann Pharmacother 2000;34:622-9. PubMed
- Singh N, Singh PN, Hershman JM. Effect of calcium carbonate on the absorption of levothyroxine. JAMA 2000;283:2822-5. PubMed
- Kahela P, Anttila M, Tikkanen R, Sundquist H. Effect of food, food constituents and fluid volume on the bioavailability of sotalol. Acta Pharmacol Toxicol (Copenh) 1979;44:7-12.. PubMed
- Pletz MW, Petzold P, Allen A, et al. Effect of calcium carbonate on bioavailability of orally administered gemifloxacin. Antimicrob Agents Chemother 2003;47:2158-60.. PubMed
- Bar-Or D, Yoel G. Calcium and calciferol antagonize effect of verapamil in atrial fibrillation. Br Med J 1981;282:1585-6.
- Decktor DL, Robinson M, Maton PN, et al. Effects of aluminum/magnesium hydroxide and calcium carbonate on esophageal and gastric pH in subjects with heartburn. Am J Ther 1995;2:546-52. PubMed
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- Peters ML, Leonard M, Licata AA. Role of alendronate and risedronate in preventing and treating osteoporosis. Cleve Clin J Med 2001;68:945-51. PubMed
- Bourke JF, Mumford R, Whittaker P, et al. The effects of topical calcipotriol on systemic calcium homeostasis in patients with chronic plaque psoriasis. J Am Acad Dermatol 1997;37:929-34.
- Gueguen L, Pointillart A. The bioavailability of dietary calcium. J Am Coll Nutr 2000;19:119s-136s. PubMed
- Vella A, Gerber TC, Hayes DL, Reeder GS. Digoxin, hypercalcaemia, and cardiac conduction. Postgrad Med J 1999;75:554-6. PubMed
- Bania TC, Blaufeux B, Hughes S, et al. Calcium and digoxin vs. calcium alone for severe verapamil toxicity. Acad Emerg Med 2000;7:1089-96. PubMed
- Tseng M, Breslow RA, Graubard BI, Ziegler RG. Dairy, calcium, and vitamin D intakes and prostate cancer risk in the National Health and Nutrition Examination Epidemiologic Follow-up Study cohort. Am J Clin Nutr 2005;81:1147-54. PubMed
- Weingarten MA, Zalmanovici A, Yaphe J. Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. Cochrane Database Syst Rev 2004;(1):CD003548. PubMed
- Tavani A, Bertuccio P, Bosetti C, et al. Dietary intake of calcium, vitamin D, phosphorus and the risk of prostate cancer. Eur Urol 2005;48:27-33. PubMed
- Giovannucci E, Liu Y, Stampfer MJ, Willett WC. A prospective study of calcium intake and incident and fatal prostate cancer. Cancer Epidemiol Biomarkers Prev 2006;15:203-10. PubMed
- Rocephin (ceftriaxone) and calcium interaction. Pharmacist's Letter / Prescriber's Letter 2007;23(10):231005.
- Bolland MJ, Barber PA, Doughty RN, et al. Vascular events in healthy older women receiving calcium supplementation: randomised control trial. BMJ 2008;336:262-6.
- Bolland MJ, Avenell A, Baron JA, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010;341:c3691. PubMed
- Calcium supplementation and vascular events. Pharmacist's Letter / Prescriber's Letter 2008;24(3):240306.
- Dietary reference intakes for calcium and vitamin D. Institute of Medicine, November 30, 2010. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Vitamin%20D%20and%20Calcium%202010%20Repo
- Coburn JW, Mischel MG, Goodman WG, et al. Calcium citrate markedly enhances aluminum absorption from aluminum hydroxide. Am J Kidney Dis. 1991;17(6):708-11. PubMed
- Bradley JS, Wassel RT, Lee L, et al. Intravenous ceftriaxone and calcium in the neonate: assessing the risk for cardiopulmonary adverse events. Pediatrics. 2009;123(4):e609-13. PubMed
- Kays MB, Overholser BR, Mueller BA, et al. Effects of sevelamer hydrochloride and calcium acetate on the oral bioavailability of ciprofloxacin. Am J Kidney Dis. 2003;42(6):1253-9. PubMed
- Neuhofel, A. L., Wilton, J. H., Victory, J. M., Hejmanowsk, L. G., and Amsden, G. W. Lack of bioequivalence of ciprofloxacin when administered with calcium-fortified orange juice: a new twist on an old interaction. J Clin Pharmacol. 2002;42(4):461-466. DOI
- Dickinson, H. O., Nicolson, D. J., Cook, J. V., Campbell, F., Beyer, F. R., Ford, G. A., and Mason, J. Calcium supplementation for the management of primary hypertension in adults. Cochrane.Database.Syst.Rev. 2006;(2):CD004639. PubMed
- Jones, B. J. and Twomey, P. J. Requesting patterns for serum calcium concentration in patients on long-term lithium therapy. Int J Clin Pract. 2009;63(1):170-172. PubMed
- Levine, M., Nikkanen, H., and Pallin, D. J. The effects of intravenous calcium in patients with digoxin toxicity. J Emerg.Med. 2011;40(1):41-46. PubMed
- Castelo-Branco, C., Ciria-Recasens, M., Cancelo-Hidalgo, M. J., Palacios, S., Haya-Palazuelos, J., Carbonell-Abello, J., Blanch-Rubio, J., Martinez-Zapata, M. J., Manasanch, J., and Perez-Edo, L. Efficacy of ossein-hydroxyapatite complex compared with ca
- Li K, Kaaks R, Linseisen J, Rohrmann S. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation i
- Chung M, Tang AM, Fu Z. Calcium Intake and Cardiovascular Disease Risk: An Updated Systematic Review and Meta-analysis. Ann Intern Med. 2016 Oct 25. PubMed
- Nolan CR, Califano JR, Butzin CA. Influence of calcium acetate or calcium citrate on intestinal aluminum absorption. Kidney Int. 1990;38(5):937-41. PubMed
- Lewis JR, Radavelli-Bagatini S, Rejnmark L, et al. The effects of calcium supplementation on verified coronary heart disease hospitalization and death in postmenopausal women: a collaborative meta-analysis of randomized controlled trials. J Bone Miner Res PubMed
- Jalloh MA, Gregory PJ, Hein D, et al. Dietary supplement interactions with antiretrovirals: a systematic review. Int J STD AIDS. 2017 Jan;28(1):4-15. PubMed
- Lappe J, Watson P, Travers-Gustafson D, Recker R, Garland C, Gorham E, Baggerly K, McDonnell SL. Effect of Vitamin D and Calcium Supplementation on Cancer Incidence in Older Women: A Randomized Clinical Trial. JAMA. 2017 Mar 28;317(12):1234-1243. PubMed
- Grove ML, Cook D. Calcium and heart attacks. Doesn't apply to most calcium prescriptions. BMJ. 2010;341:c5003. PubMed
- Insentress [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp.; 2014.
- Roberts JL, Kiser JJ, Hindman JT, Meditz AL. Virologic failure with a raltegravir-containing antiretroviral regimen and concomitant calcium administration. Pharmacotherapy 2011;31(10):298e-302e. DOI
- Vitekta [package insert]. Foster City, CA: Gilead Sciences, Inc.; 2014.
- Storan ER, O'Gorman SM, Murphy A, Laing M. Case Report of Calciphylaxis Secondary to Calcium and Vitamin D<sub>3</sub> Supplementation. J Cutan Med Surg. 2017;21(2):162-163. DOI
- Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental vitamins and minerals for CVD prevention and treatment. J Am Coll Cardiol 2018;71(22):2570-84. PubMed
- Borkenhagen JF, Connor EL, Stafstrom CE. Neonatal hypocalcemic seizures due to excessive maternal calcium ingestion. Pediatr Neurol 2013;48(6):469-71. PubMed
- WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016 (http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/ anc-positive-pregnancy-experience/en/).
- Aune D, Navarro Rosenblatt DA, Chan DS, et al. Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. Am J Clin Nutr. 2015;101(1):87-117. PubMed
- Lan T, Park Y, Colditz GA, et al. Adolescent dairy product and calcium intake in relation to later prostate cancer risk and mortality in the NIH-AARP Diet and Health Study. Cancer Causes Control. 2020;31(10):891-904. PubMed
- Zhang Y, Li Y, Liu J, et al. Association of Vitamin D or Calcium Supplementation with Cardiovascular Outcomes and Mortality: A Meta-Analysis with Trial Sequential Analysis. J Nutr Health Aging 2021;25(2):263-270. PubMed
- Myung SK, Kim HB, Lee YJ, Choi YJ, Oh SW. Calcium Supplements and Risk of Cardiovascular Disease: A Meta-Analysis of Clinical Trials. Nutrients 2021;13(2):368. PubMed
- Hetaimish B. Neonatal Calcinosis Cutis After Treatment of Hypocalcemia with Calcium Gluconate: A Report of 2 Cases. Am J Case Rep 2024;25:e943397. PubMed
- US Food and Drug Administration (FDA). Biktarvy Prescribing Information. October 2024. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/210251Orig1s020lbl.pdf. Accessed July 16, 2025.
Gotu Kola 18 references
- Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
- Pointel JP, Boccalon H, Cloarec M, et al. Titrated extract of Centella asiatica (TECA) in the treatment of venous insufficiency of the lower limbs. Angiol 1987;38:46-50. PubMed
- Brinkhaus B, Lindner M, Schuppan D, Hahn EG. Chemical, pharmacological and clinical profile of the east Asian medical plant Centella asiatica. Phytomedicine 2000;7:427-48.
- Eun HC, Lee AY. Contact dermatitis due to madecassol. Contact Dermatitis 1985;13:310-3.. PubMed
- Hausen BM. Centella asiatica (Indian pennywort), an effective therapeutic but a weak sensitizer. Contact Dermatitis 1993;29:175-9..
- Bilbao I, Aguirre A, Zabala R, et al. Allergic contact dermatitis from butoxyethyl nicotinic acid and Centella asiatica extract. Contact Dermatitis 1995;33:435-6.
- Cesarone MR, Incandela L, De Sanctis MT, et al. Evaluation of treatment of diabetic microangiopathy with total triterpenic fraction of Centella asiatica: a clinical prospective randomized trial with a microcirculatory model. Angiology 2001;52 Suppl 2 DOI
- Bradwejn J, Zhou Y, Koszycki D, Shlik J. A double-blind, placebo-controlled study on the effects of Gotu Kola (Centella asiatica) on acoustic startle response in healthy subjects. J Clin Psychopharmacol 2000;20:680-4. PubMed
- Young GL, Jewell D. Creams for preventing stretch marks in pregnancy. Cochrane Database Syst Rev 2000;(2):CD000066. PubMed
- Jorge OA, Jorge AD. Hepatotoxicity associated with the ingestion of Centella asiatica. Rev Esp Enferm Dig 2005;97:115-24. PubMed
- Mallol J, Belda MA, Costa D, et al. Prophylaxis of striae gravidarum with a topical formulation. A double blind trial. Int J Cosmet Sci 1991;3:51-7.
- Izu, R., Aguirre, A., Gil, N., and Diaz-Perez, J. L. Allergic contact dermatitis from a cream containing Centella asiatica extract. Contact Dermatitis 1992;26(3):192-193.
- Santucci, B., Picardo, M., and Cristaudo, A. Contact dermatitis due to Centelase. Contact Dermatitis 1985;13(1):39. PubMed
- Vena, G. A. and Angelini, G. Contact allergy to Centelase. Contact Dermatitis 1986;15(2):108-109. PubMed
- Marastoni, F., Baldo, A., Redaelli, G., and Ghiringhelli, L. [Centella asiatica extract in venous pathology of the lower limbs and its evaluation as compared with tribenoside]. Minerva Cardioangiol. 1982;30(4):201-207.
- Danese, P., Carnevali, C., and Bertazzoni, M. G. Allergic contact dermatitis due to Centella asiatica extract. Contact Dermatitis 1994;31(3):201.
- Bilbao, I., Aguirre, A., Zabala, R., Gonzalez, R., Raton, J., and Diaz Perez, J. L. Allergic contact dermatitis from butoxyethyl nicotinic acid and Centella asiatica extract. Contact Dermatitis 1995;33(6):435-436.
- Dantuluri S, North-lewis P, Karthik SV. Gotu Kola induced hepatotoxicity in a child - need for caution with alternative remedies. Dig Liver Dis. 2011;43(6):500. PubMed
Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
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