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Dietary supplement

Descend Ingredients & Drug Interactions

by Vaxxen Labs

Descend label
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Capsule Category: Other Combinations
Most serious interaction: Major
Clinical methodology reviewed by · Updated Sep 16, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Descend 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

The interaction bottom line Most serious interaction: Major

Descend is a dietary supplement by Vaxxen Labs with 11 active ingredients. Its ingredients are commonly taken for thinning mucus in lung conditions, acetaminophen (tylenol) overdose treatment, antioxidant and glutathione support.Based on those ingredients, 1,395 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Milk Thistle, Red Yeast Rice powder, Chrysin. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

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Check Your Meds Against Descend by Vaxxen Labs

Ask about any prescription or over-the-counter medication and we check it for interactions with Descend by Vaxxen Labs — and tell you which ingredient is responsible.

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Computed from our clinical databases

HelloPharmacist Scorecard of Descend by Vaxxen Labs

Four independent checks of what is known — a summary of the available information, not a grade of the product itself.

Evidence for Intended Use
By FDA rules, dietary supplements can’t claim to treat, cure, or prevent disease — so labels speak in careful marketing language. We discern each product’s intended use from its name, label claims, and label statements, then grade the clinical evidence for that use. How these ratings are computed
Not assessable

The stated purpose hasn't been mapped to our evidence data yet.

Why this rating?
  • We haven't mapped this product's purpose to our evidence data yet — it'll be graded on the next content refresh.
Ingredient Transparency
Full

Every active ingredient lists its own amount on the label.

Why this rating?
  • The label discloses an exact amount for 11 of its 11 active ingredients.
  • No proprietary blends here — you can verify the dose of every single component.
Known Interaction Concern
Major identified

At least one ingredient has a documented Major-severity interaction. Check your medications for a personalized result.

Why this rating?
  • 10 of the 11 matched ingredients can interact with medications — Tribulus, Milk Thistle, Stinging Nettle, Red Yeast Rice, Coenzyme Q10, among others.
  • The most serious interaction on file is rated Major.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; immunosuppressants / transplant drugs; diabetes medications; lithium; Parkinson's medications.
  • For scale: 1,396 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.
Safety Information
Well characterized

Adverse-effect, pregnancy, and general safety data are on file for most of these ingredients.

Why this rating?
  • We hold adverse-effect (side-effect) data for 8 of the 11 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 11 of 11.
  • General safety write-ups exist for 11 of 11.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

HelloPharmacist summaryFully disclosed formula with no assessable stated purpose. Major medication interactions have been identified, and safety information is well characterized.

Assessment coverage: 11 of 11 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Dec 22, 2019.

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

At a glance

General information

Key facts about Descend, straight from the product label.

Brand Vaxxen Labs
Net contents 90 Capsule(s)
Market status Off market
Date entered into DSLD Dec 22, 2019
DSLD ID 210061
Product type Other Combinations
Supplement form Capsule
Dietary claims / uses Structure/Function
Intended target group(s) Adult (18 - 50 Years)
From the label
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 Descend by Vaxxen Labs, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
3 Capsule(s)
Maximum serving Sizes:
3 Capsule(s)
Servings per container
30
IngredientAmount% DV
N-Acetyl-Cysteine600 mg--
Chrysin50 mg--
Stinging Nettle root powder300 mg--
Ubiquinol50 mg--
Mucuna pruriens50 mg--
Androsta-3,5-Diene-7,17-Dione75 mg--
Milk Thistle200 mg--
Saw Palmetto200 mg--
5a-Hydroxylaxogenin25 mg--
Tribulus terrestris400 mg--
Red Yeast Rice powder200 mg--

Other ingredients: Gelatin, Magnesium Stearate, Silicon Dioxide, FD&C Red #40, FD&C Yellow #5

Tap any ingredient to jump to its full detail below.

Label statements
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

Post Cycle Therapy

General Statements

30 Full dosage servings

FDA Statement of Identity

Dietary Supplement

Is this label outdated? Report a formula or label change and our pharmacy team will review it.

See for yourself

Descend by Vaxxen Labs label

The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.

Descend label

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)
What’s inside

The Ingredients in Descend by Vaxxen Labs

These are the 11 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.

N-Acetyl-Cysteine

Interacts with
294 drugs
600 mg per serving

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 & interactions

Chrysin

Interacts with
358 drugs
50 mg per serving

Chrysin is a plant flavonoid sold mainly as a bodybuilding supplement claimed to raise testosterone or block estrogen, but human studies have not show...

Chrysin monograph & interactions

Stinging Nettle root powder

Interacts with
164 drugs
300 mg per serving

Stinging nettle is a common plant used as food and in traditional medicine, most often for prostate symptoms, allergies, and joint pain. The evidence...

Stinging Nettle root powder monograph & interactions

Ubiquinol

Interacts with
198 drugs
50 mg per serving

CoQ10 is a vitamin-like substance your body makes naturally that helps cells produce energy and acts as an antioxidant. It is generally well tolerated...

Ubiquinol monograph & interactions

Mucuna pruriens

Interacts with
193 drugs
50 mg per serving Form: L-Dopa

Cowhage (Mucuna pruriens) is a tropical legume best known as a natural source of L-dopa, the compound the body turns into dopamine. It is most studied...

Mucuna pruriens monograph & interactions

Androsta-3,5-Diene-7,17-Dione

Interacts with
4 drugs
75 mg per serving

Arimistane (sometimes sold as Estrovade) is a synthetic aromatase inhibitor marketed as a dietary supplement to lower estrogen and raise testosterone,...

Androsta-3,5-Diene-7,17-Dione monograph & interactions

Milk Thistle

Interacts with
954 drugs
200 mg per serving Form: Silymarin

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 monograph & interactions

Saw Palmetto

Interacts with
174 drugs
200 mg per serving

Saw palmetto is a plant extract most often used for urinary symptoms linked to an enlarged prostate (BPH). The best research suggests it works no bett...

Saw Palmetto monograph & interactions

5a-Hydroxylaxogenin

No known
interactions
25 mg per serving

Laxogenin is a plant-based steroid-like compound marketed mostly to bodybuilders for muscle growth and recovery, but there is very little human resear...

5a-Hydroxylaxogenin monograph & interactions

Tribulus terrestris

Interacts with
259 drugs
400 mg per serving Form: Saponins

Tribulus is a plant supplement most often marketed to boost libido, testosterone, and athletic performance, but the human evidence behind these claims...

Tribulus terrestris monograph & interactions

Red Yeast Rice powder

Interacts with
477 drugs
200 mg per serving

Red yeast rice contains monacolin K, which is chemically identical to the prescription statin lovastatin, and it can lower LDL ('bad') cholesterol. Be...

Red Yeast Rice powder monograph & interactions

Other (inactive) ingredients: Gelatin, Magnesium Stearate, Silicon Dioxide, FD&C Red #40, FD&C Yellow #5. These complete the product’s ingredient list but are not active constituents.

Interaction report

Descend by Vaxxen Labs Drug Interactions

Descend contains 11 ingredients, and 10 of them have known drug interactions. Altogether they interact with 1,395 medications. Here’s the picture, then you can look up your own drug.

Want to check YOUR meds against Descend?

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 checker
1,395Drugs
18 Major 1,000 Moderate 377 Minor

Ingredients driving the most interactions

Milk Thistle 954
Red Yeast Rice powder 477
Chrysin 358
N-Acetyl-Cysteine 294
Tribulus terrestris 259

Individual Drug Interactions

The ingredients in Descend interact with 1,395 drugs. Click any drug to see the details.

10 of the 11 ingredients in Descend interact with drugs. Each result below shows which ingredient is responsible. Milk Thistle Red Yeast Rice powder Chrysin N-Acetyl-Cysteine Tribulus terrestris Ubiquinol Mucuna pruriens Saw Palmetto Stinging Nettle root powder Androsta-3,5-Diene-7,17-Dione

Each ingredient & the kinds of drugs it affects

For each ingredient in Descend 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.

Milk Thistle17 drug types · 954 drugs

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.

Likelihood Possible Evidence B
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence B
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Unlikely Evidence B
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.

Likelihood Unlikely Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Unlikely Evidence D
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.

Likelihood Unlikely Evidence B
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.

Likelihood Possible Evidence D
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.

Likelihood Unlikely Evidence B
Milk Thistle full monograph & interactions

Red Yeast Rice powder6 drug types · 477 drugs

Cyclosporine (Neoral, Sandimmune)

Theoretically, taking red yeast rice in combination with cyclosporine might increase the risk of myopathy.
Red yeast rice contains varying levels of the statin drug lovastatin. Cyclosporine has been reported to increase plasma levels of lovastatin by 5- to 20-fold, resulting in reports of myopathy and rhabdomyolysis.

Likelihood Probable Evidence D
Cytochrome P450 3A4 (Cyp3A4) Inhibitors

Theoretically, drugs that inhibit the CYP3A4 enzymes might increase levels of lovastatin from red yeast rice.
Red yeast rice contains varying levels of the statin drug lovastatin, which is metabolized by CYP3A4. Combining red yeast rice with CYP3A4 inhibitors might increase serum levels of lovastatin from red yeast rice.

Likelihood Possible Evidence D
Gemfibrozil (Lopid)

Theoretically, taking red yeast rice in combination with gemfibrozil might increase the risk of rhabdomyolysis.
Red yeast rice contains varying levels of the statin drug lovastatin. Gemfibrozil has been reported to increase the risk of rhabdomyolysis when used in combination with lovastatin.

Likelihood Probable Evidence D
Hepatotoxic Drugs

Theoretically, concomitant use might increase the risk of liver damage.
Red yeast rice contains varying levels of the drug lovastatin. Lovastatin can cause liver damage in some people. Some clinical research suggests that supplements containing red yeast rice might increase liver enzyme levels in some, but not all, participants. Cases of acute hepatitis have been associated with red yeast rice. Combining it with hepatotoxic drugs might further increase this risk.

Likelihood Possible Evidence D
Hmg-Coa Reductase Inhibitors ("Statins")

Theoretically, taking red yeast rice with other statins might increase the risk of potential adverse effects.
Red yeast rice contains varying levels of the statin drug lovastatin and might result in supratherapeutic levels when used with other statins. Based on evaluation of data from the US Food and Drug Administration's adverse event reporting system (FAERS), it is recommended that red yeast rice products be avoided in people taking prescription statins.

Likelihood Probable Evidence D
Niacin

Theoretically, taking red yeast rice in combination with high-dose niacin might increase the risk of rhabdomyolysis.
Red yeast rice contains varying levels of the statin drug lovastatin and has been linked to reports of myopathy. Niacin has been reported to increase the risk of rhabdomyolysis when used in combination with lovastatin.

Likelihood Probable Evidence D
Red Yeast Rice powder full monograph & interactions

Chrysin9 drug types · 358 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, chrysin might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.
In vitro evidence suggests that chrysin might inhibit platelet aggregation.

Likelihood Possible Evidence D
Aromatase Inhibitors

Theoretically, chrysin might increase the effects and adverse effects of aromatase inhibitors.
In vitro research suggests that chrysin might decrease estrogen synthesis by acting as an aromatase (estrogen synthetase) inhibitor..

Likelihood Possible Evidence D
Contraceptive Drugs

Theoretically, chrysin might reduce the efficacy of estrogen-containing contraceptive drugs.
In vitro research suggests that chrysin might have antiestrogenic activity.

Likelihood Possible Evidence D
Diclofenac (Voltaren, Others)

Theoretically, chrysin might increase the effects and adverse effects of diclofenac.
In vitro research suggests that chrysin and its sulfate conjugate inhibit diclofenac metabolism. It is speculated that chrysin and its sulfate conjugate reduce the metabolism of diclofenac by inhibiting cytochrome P450 2C9. This effect has not been reported in humans.

Likelihood Possible Evidence D
Estrogens

Theoretically, chrysin might decrease the effects of estrogen therapy.
In vitro research suggests that chrysin might have antiestrogenic activity.

Likelihood Possible Evidence D
Mephenytoin (Mesantoin)

Theoretically, chrysin might increase the effects and adverse effects of mephenytoin.
In vitro research suggests that chrysin and its sulfate and glucuronide conjugates inhibit S-mephenytoin metabolism. It is speculated that chrysin and its conjugates reduce the metabolism of S-mephenytoin by inhibiting cytochrome P450 2C19. This effect has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 1A2 (Cyp1A2) Substrates

Theoretically, chrysin might increase levels of drugs metabolized by CYP1A2.
In vitro research suggests that chrysin inhibits CYP1A2 isozymes. However, chrysin does not appear to inhibit CYP1A2-dependent caffeine metabolism in animals. Due to chrysin's low bioavailability and rapid metabolism to glucuronide and sulfate conjugates, this interaction is unlikely.

Likelihood Unlikely Evidence D
Glucuronidated Drugs

Theoretically, chrysin might increase the clearance of drugs that are UGT1A1 substrates, thereby reducing their effectiveness.
In vitro research suggests that chrysin might induce UDP-glucuronosyltransferase 1A1 (UGT1A1).

Likelihood Unlikely Evidence D
Testosterone

Theoretically, chrysin might increase the effects and adverse effects of testosterone.
In vitro research suggests that chrysin and its sulfate conjugate inhibit testosterone metabolism. It is speculated that chrysin and its sulfate conjugate reduce the metabolism of testosterone by inhibiting cytochrome P450 3A4. This effect has not been reported in humans.

Likelihood Possible Evidence D
Chrysin full monograph & interactions

N-Acetyl-Cysteine5 drug types · 294 drugs

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.

Likelihood Probable Evidence B
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
N-Acetyl-Cysteine full monograph & interactions

Tribulus terrestris3 drug types · 259 drugs

Antidiabetes Drugs

Taking tribulus with antidiabetes drugs might increase the risk of hypoglycemia.
Clinical research shows that Tribulus can lower blood glucose levels in adults with type 2 diabetes who are taking antidiabetes medications.

Likelihood Possible Evidence D
Antihypertensive Drugs

Theoretically, taking tribulus with antihypertensive drugs might increase the risk of hypotension.
Animal research shows that tribulus can lower blood pressure by inhibiting angiotensin-converting enzyme (ACE). Tribulus has also demonstrated hypotensive effects in pre-hypertensive adults.

Likelihood Possible Evidence D
Lithium

Theoretically, tribulus might increase the levels and clinical effects of lithium.
Tribulus is thought to have diuretic properties. Due to these potential diuretic effects, tribulus might reduce excretion and increase levels of lithium. The dose of lithium might need to be decreased.

Likelihood Probable Evidence D
Tribulus terrestris full monograph & interactions

Ubiquinol3 drug types · 198 drugs

Alkylating Agents

Coenzyme Q10 has antioxidant effects. Theoretically, this may reduce the activity of chemotherapy drugs that generate free radicals.
Theoretically, antioxidants such as coenzyme Q10 might protect tumor cells from chemotherapeutic agents that work by inducing oxidative stress, such as alkylating agents (e.g., cyclophosphamide) and radiation therapy. The clinical importance of this interaction is unknown.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Coenzyme Q10 is chemically similar to menaquinone and might have vitamin K-like procoagulant effects, which could decrease the effects of warfarin.
Concomitant use of coenzyme Q10 and warfarin might reduce the anticoagulant effects of warfarin. Four cases of decreased warfarin efficacy thought to be due to coenzyme Q10 have been reported. However, there is some preliminary clinical research that suggests coenzyme Q10 might not significantly decrease the effects of warfarin in patients who have a stable INR.

Likelihood Possible Evidence D
Antihypertensive Drugs

Theoretically, coenzyme Q10 might have additive effects with antihypertensive drugs.
Some clinical research shows that coenzyme Q10 can significantly lower blood pressure, although other studies have shown conflicting results.

Likelihood Possible Evidence B
Ubiquinol full monograph & interactions

Mucuna pruriens8 drug types · 193 drugs

Levodopa

Concomitant use can increase the risk of levodopa-related adverse effects.
Cowhage contains levodopa. Some cowhage products have been standardized to contain 75-400 mg of levodopa per dose.

Likelihood Likely Evidence D
Methyldopa (Aldomet)

Theoretically, concomitant use of cowhage and methyldopa might increase the risk of hypotension.
Cowhage contains levodopa. Use of levodopa with methyldopa might cause additive hypotension. In addition, methyldopa may inhibit peripheral decarboxylation of levodopa and increase levodopa levels in the central nervous system; avoid using.

Likelihood Probable Evidence D
Monoamine Oxidase Inhibitors (Maois)

Theoretically, concomitant use of cowhage and non-selective MAOIs might increase the risk of hypertensive crisis.
Cowhage contains levodopa. Use of levodopa with non-selective MAOIs might cause hypertensive crisis. However, this interaction has not been reported with MAO-B selective inhibitors such as selegiline.

Likelihood Probable Evidence D
Anesthesia

Theoretically, concomitant use of cowhage and anesthesia might increase the risk of arrhythmias.
Cowhage contains levodopa. Use of levodopa with cyclopropane or halogenated hydrocarbon anesthesia has led to arrhythmias. Other anesthetics have not been implicated. Use other anesthetics in patients taking cowhage or tell patients to stop taking cowhage at least 2 weeks before surgery.

Likelihood Possible Evidence D
Antidiabetes Drugs

Theoretically, concomitant use of cowhage and antidiabetes drugs might increase the risk of hypoglycemia.
Animal research shows that cowhage might have hypoglycemic effects.

Likelihood Possible Evidence D
Antipsychotic Drugs

Theoretically, use of cowhage might decrease the clinical effects of antipsychotic drugs.
Cowhage contains levodopa. Use of levodopa might counteract the antidopaminergic effects of antipsychotic medications.

Likelihood Possible Evidence D
Guanethidine (Ismelin)

Theoretically, concomitant use of cowhage and guanethidine might increase the risk of hypotension.
Cowhage contains levodopa. Use of levodopa with guanethidine might cause additive hypotension; avoid using.

Likelihood Probable Evidence D
Tricyclic Antidepressants (Tcas)

Theoretically, use of TCAs might reduce the levels and clinical effects of cowhage.
Cowhage contains levodopa. Use of TCAs might reduce the absorption of levodopa. Some case reports describe patients that developed hypertension and dyskinesia when taking both levodopa and TCAs.

Likelihood Possible Evidence D
Mucuna pruriens full monograph & interactions

Saw Palmetto3 drug types · 174 drugs

Anticoagulant/Antiplatelet Drugs

Saw palmetto might increase the risk of bleeding with anticoagulant or antiplatelet drugs.
Saw palmetto is reported to prolong bleeding time. Theoretically, it might increase the risk of bleeding when used concomitantly with anticoagulant or antiplatelet drugs.

Likelihood Possible Evidence D
Contraceptive Drugs

Saw palmetto might reduce the effectiveness of contraceptive drugs.
Saw palmetto might have antiestrogenic effects. Theoretically, it might interfere with contraceptive drugs taken concomitantly.

Likelihood Possible Evidence B
Estrogens

Saw palmetto might reduce the effectiveness of estrogens.
Saw palmetto might have antiestrogenic effects. Theoretically, it might interfere with estrogens taken concomitantly.

Likelihood Possible Evidence B
Saw Palmetto full monograph & interactions

Stinging Nettle root powder4 drug types · 164 drugs

Antidiabetes Drugs

Theoretically, stinging nettle might have additive effects with antidiabetes drugs.
Clinical research shows that stinging nettle might decrease blood glucose levels in patients with diabetes.

Likelihood Possible Evidence B
Diuretic Drugs

Theoretically, combining stinging nettle with diuretic drugs may have additive effects.
Animal research suggests that the above ground parts and roots of stinging nettle may have a diuretic effect.

Likelihood Possible Evidence D
Lithium

Theoretically, stinging nettle might reduce excretion and increase levels of lithium.
Animal research suggests that stinging nettle has diuretic and natriuretic properties, which could alter the excretion of lithium. The dose of lithium might need to be decreased.

Likelihood Possible Evidence D
Warfarin (Coumadin)

There is some concern that stinging nettle might decrease the effects of anticoagulant drugs such as warfarin.
Stinging nettle contains a significant amount of vitamin K. When taken in large quantities, this might interfere with the activity of warfarin.

Likelihood Possible Evidence D
Stinging Nettle root powder full monograph & interactions

Androsta-3,5-Diene-7,17-Dione1 drug type · 4 drugs

Aromatase Inhibitors

It is believed that Arimistane inhibits the aromatase enzyme, which may interact with other aromatase inhibitors. This interaction could potentially increase the risk of side effects associated with low estrogen levels or from additive side effects, such as an increased risk of liver toxicity. It is recommended to consult with a healthcare provider before combining Arimistane with other aromatase inhibitors to assess the potential risks and benefits.

Likelihood Probable Evidence C
Androsta-3,5-Diene-7,17-Dione full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Descend, from the product label.

Vaxxen Labs

See all Vaxxen Labs products
Name
Vaxxen Labs
Pharmacist Counseling Corner

Descend by Vaxxen Labs: Common Questions

Does Descend by Vaxxen Labs interact with any medications?
Yes. Based on its ingredients, Descend has a known interaction with 1,395 medications, including 18 rated major. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Descend contains 11 active ingredients, and an interaction can come from any of them. We check every ingredient, combine the results into one list per medication, and show which ingredient and mechanism is responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Not sure if Descend is safe with your meds?

Our pharmacists answer your medication & supplement questions — free.

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Label information is sourced from the NIH Dietary Supplement Label Database and reflects the product version on file; always read your actual product label. This page is for education only and is not a substitute for professional medical advice. Confirm with your pharmacist or doctor before combining supplements and medications.

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Go deeper

The Full Monographs Behind Descend’s Ingredients

Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.

Herb & supplement monograph

N-acetyl Cysteine (nac)

Interacts with 294 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 prescription uses for acetaminophen over...

Read the full N-acetyl Cysteine (nac) monograph → Herb & supplement monograph

Chrysin

Interacts with 358 drugs

Chrysin is a plant flavonoid sold mainly as a bodybuilding supplement claimed to raise testosterone or block estrogen, but human studies have not shown these benefits, largely because the bo...

Read the full Chrysin monograph → Herb & supplement monograph

Stinging Nettle

Interacts with 164 drugs

Stinging nettle is a common plant used as food and in traditional medicine, most often for prostate symptoms, allergies, and joint pain. The evidence is mixed and mostly preliminary, so it i...

Read the full Stinging Nettle monograph → Herb & supplement monograph

Coenzyme Q10

Interacts with 198 drugs

CoQ10 is a vitamin-like substance your body makes naturally that helps cells produce energy and acts as an antioxidant. It is generally well tolerated and is most studied for heart condition...

Read the full Coenzyme Q10 monograph → Herb & supplement monograph

Cowhage

Interacts with 193 drugs

Cowhage (Mucuna pruriens) is a tropical legume best known as a natural source of L-dopa, the compound the body turns into dopamine. It is most studied for Parkinson's disease symptoms and ma...

Read the full Cowhage monograph → Herb & supplement monograph

Arimistane

Interacts with 4 drugs

Arimistane (sometimes sold as Estrovade) is a synthetic aromatase inhibitor marketed as a dietary supplement to lower estrogen and raise testosterone, often during or after steroid or prohor...

Read the full Arimistane monograph → Herb & supplement monograph

Milk Thistle

Interacts with 954 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. While it is generally well tolerated, th...

Read the full Milk Thistle monograph → Herb & supplement monograph

Saw Palmetto

Interacts with 174 drugs

Saw palmetto is a plant extract most often used for urinary symptoms linked to an enlarged prostate (BPH). The best research suggests it works no better than a placebo for most men, though i...

Read the full Saw Palmetto monograph → Herb & supplement monograph

Laxogenin

Laxogenin is a plant-based steroid-like compound marketed mostly to bodybuilders for muscle growth and recovery, but there is very little human research to show it actually works. Because pr...

Read the full Laxogenin monograph → Herb & supplement monograph

Tribulus

Interacts with 259 drugs

Tribulus is a plant supplement most often marketed to boost libido, testosterone, and athletic performance, but the human evidence behind these claims is weak and inconsistent. It is general...

Read the full Tribulus monograph → Herb & supplement monograph

Red Yeast Rice

Interacts with 477 drugs

Red yeast rice contains monacolin K, which is chemically identical to the prescription statin lovastatin, and it can lower LDL ('bad') cholesterol. Because of this, it carries the same risks...

Read the full Red Yeast Rice monograph →
Sources

Sources & How We Checked

Descend'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.

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 339 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.

N-acetyl Cysteine (nac) 86 references
  1. Ellenhorn MJ, et al. Ellenhorn's Medical Toxicology: Diagnoses and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams & Wilkins, 1997.
  2. Jepsen S, Hansen AB. The influence of N-acetylcysteine on the measurement of prothrombin time and activated partial thromboplastin time in healthy subjects. Scand J Clin Lab Invest 1994;54:543-7. PubMed
  3. van Zandwijk N, Dalesio O, Pastorino U, et al. EUROSCAN, a randomized trial of vitamin A and N-acetylcysteine in patients with head and neck cancer or lung cancer. For the European Organization for Research and Treatment of Cancer Head and Neck and Lung C DOI
  4. Horowitz RS, Dart RC, Jarvie DR, et al. Placental transfer of N-acetylcysteine following human maternal acetaminophen toxicity. J Toxicol Clin Toxicol 1997;35:447-51.
  5. Bailey B, McGuigan MA. Management of anaphylactoid reactions to intravenous N-acetylcysteine. Ann Emerg Med 1998;31:710-5. PubMed
  6. Spiller HA, Krenzelok EP, Grande GA, et al. A prospective evaluation of the effect of activated charcoal before oral N-acetylcysteine in acetaminophen overdose. Ann Emerg Med 1994;23:519-23. PubMed
  7. Ardissino D, Merlini PA, Savonitto S, et al. Effect of transdermal nitroglycerin or N-acetylcysteine, or both, in the long-term treatment of unstable angina pectoris. J Am Coll Cardiol 1997;29:941-7. PubMed
  8. Horowitz JD, Henry CA, Syrjanen ML, et al. Nitroglycerine/N-acetylcysteine in the management of unstable angina pectoris. Eur Heart J 1988;9:95-100. PubMed
  9. Louwerse ES, Weverling GJ, Bossuyt PM, et al. Randomized, double-blind, controlled trial of acetylcysteine in amyotrophic lateral sclerosis. Arch Neurol 1995;52:559-64. PubMed
  10. Wiklund O, Fager G, Andersson A, et al. N-acetylcysteine treatment lowers plasma homocysteine but not serum lipoprotein(a) levels. Atherosclerosis 1996;119:99-106. PubMed
  11. De Flora S, Grassi C, Carati L. Attenuation of influenza-like symptomatology and improvement of cell-mediated immunity with long-term N-acetylcysteine treatment. Eur Respir J 1997;10:1535-41. PubMed
  12. Iversen HK. N-acetylcysteine enhances nitroglycerin-induced headache and cranial arterial responses. Clin Pharmacol Ther 1992;52:125-33. PubMed
  13. Behr J, Maier K, Degenkolb B, et al. Antioxidative and clinical effects of high-dose N-acetylcysteine in fibrosing alveolitis. Adjunctive therapy to maintenance immunosuppression. Am J Respir Crit Care Med 1997;156:1897-901.
  14. Tenenbein PK, Sitar DS, Tenenbein M. Interaction between N-acetylcysteine and activated charcoal: implications for the treatment of acetaminophen poisoning. Pharmacotherapy 2001;21:1331-6.
  15. Arstall MA, Yang J, Stafford I, et al. N-acetylcysteine in combination with nitroglycerin and streptokinase for the treatment of evolving acute myocardial infarction. Safety and biochemical effects. Circulation 1995;92:2855-62.
  16. Estensen RD, Levy M, Klopp SJ, et al. N-acetylcysteine suppression of the proliferative index in the colon of patients with previous adenomatous colonic polyps. Cancer Lett 1999;147:109-14. PubMed
  17. Pela R, Calcagni AM, Subiaco S, et al. N-acetylcysteine reduces the exacerbation rate in patients with moderate to severe COPD. Respiration 1999;66:495-500.. PubMed
  18. Oldemeyer JB, Biddle WP, Wurdeman RL, et al. Acetylcysteine in the prevention of contrast-induced nephropathy after coronary angiography. Am Heart J 2003;146:E23. . PubMed
  19. Ekins BR, Ford DC, Thompson MI, et al. The effect of activated charcoal on N-acetylcysteine absorption in normal subjects. Am J Emerg Med. 1987;5(6):483-7. PubMed
  20. Chamberlain JM, Gorman RL, Oderda GM, Klein-Schwartz W, Klein BL. Use of activated charcoal in a simulated poisoning with acetaminophen: a new loading dose for N-acetylcysteine? Ann Emerg Med. 1993;22(9):1398-402. PubMed
  21. Renzi FP, Donovan JW, Martin TG, Morgan L, Harrison EF. Concomitant use of activated charcoal and N-acetylcysteine. Ann Emerg Med. 1985;14(6):568-72. DOI
  22. North DS, Peterson RG, Krenzelok EP. Effect of activated charcoal administration on acetylcysteine serum levels in humans. Am J Hosp Pharm. 1981;38(7):1022-4. DOI
  23. Loscalzo J. N-Acetylcysteine potentiates inhibition of platelet aggregation by nitroglycerin. J Clin Invest. 1985;76(2):703-8. PubMed
  24. Ruiz FJ, Salom MG, Inglés AC, et al. N-acetyl-L-cysteine potentiates depressor response to captopril and enalaprilat in SHRs. Am J Physiol. 1994;267(3 Pt 2):R767-72. PubMed
  25. Deharo E, Barkan D, Krugliak M, Golenser J, Ginsburg H. Potentiation of the antimalarial action of chloroquine in rodent malaria by drugs known to reduce cellular glutathione levels. Biochem Pharmacol. 2003;66(5):809-17. PubMed
  26. Buckley, N. A., Whyte, I. M., O'Connell, D. L., and Dawson, A. H. Oral or intravenous N-acetylcysteine: which is the treatment of choice for acetaminophen (paracetamol) poisoning? J Toxicol.Clin Toxicol. 1999;37(6):759-767.
  27. Sunman, W., Hughes, A. D., and Sever, P. S. Anaphylactoid response to intravenous acetylcysteine. Lancet 5-16-1992;339(8803):1231-1232. PubMed
  28. Reynard, K., Riley, A., and Walker, B. E. Respiratory arrest after N-acetylcysteine for paracetamol overdose. Lancet 9-12-1992;340(8820):675. PubMed
  29. BERNSTEIN, I. L. and AUSDENMOORE, R. W. IATROGENIC BRONCHOSPASM OCCURRING DURING CLINICAL TRIALS OF A NEW MUCOLYTIC AGENT, ACETYLCYSTEINE. Dis.Chest 1964;46:469-473. PubMed
  30. REAS, H. W. THE USE OF N-ACETYLCYSTEINE IN THE TREATMENT OF CYSTIC FIBROSIS. J Pediatr 1964;65:542-557. PubMed
  31. Bibi, H., Seifert, B., Oullette, M., and Belik, J. Intratracheal N-acetylcysteine use in infants with chronic lung disease. Acta Paediatr. 1992;81(4):335-339. PubMed
  32. Jepsen, S., Herlevsen, P., Knudsen, P., Bud, M. I., and Klausen, N. O. Antioxidant treatment with N-acetylcysteine during adult respiratory distress syndrome: a prospective, randomized, placebo-controlled study. Crit Care Med 1992;20(7):918-923. PubMed
  33. Roes, E. M., Raijmakers, M. T., Boo, T. M., Zusterzeel, P. L., Merkus, H. M., Peters, W. H., and Steegers, E. A. Oral N-acetylcysteine administration does not stabilise the process of established severe preeclampsia. Eur.J Obstet.Gynecol.Reprod.Biol 2006
  34. Spiller, H. A., Winter, M. L., Klein-Schwartz, W., and Bangh, S. A. Efficacy of activated charcoal administered more than four hours after acetaminophen overdose. J Emerg.Med 2006;30(1):1-5. PubMed
  35. Tirouvanziam, R., Conrad, C. K., Bottiglieri, T., Herzenberg, L. A., Moss, R. B., and Herzenberg, L. A. High-dose oral N-acetylcysteine, a glutathione prodrug, modulates inflammation in cystic fibrosis. Proc Natl.Acad.Sci U.S.A 3-21-2006;103(12):4628-463
  36. Niemi, T. T., Munsterhjelm, E., Poyhia, R., Hynninen, M. S., and Salmenpera, M. T. The effect of N-acetylcysteine on blood coagulation and platelet function in patients undergoing open repair of abdominal aortic aneurysm. Blood Coagul.Fibrinolysis 2006;1 PubMed
  37. Komisarof, J. A., Gilkey, G. M., Peters, D. M., Koudelka, C. W., Meyer, M. M., and Smith, S. M. N-acetylcysteine for patients with prolonged hypotension as prophylaxis for acute renal failure (NEPHRON). Crit Care Med 2007;35(2):435-441. PubMed
  38. Grimble, G. K. Adverse gastrointestinal effects of arginine and related amino acids. J Nutr 2007;137(6 Suppl 2):1693S-1701S. PubMed
  39. Berk, M., Copolov, D. L., Dean, O., Lu, K., Jeavons, S., Schapkaitz, I., Anderson-Hunt, M., and Bush, A. I. N-acetyl cysteine for depressive symptoms in bipolar disorder--a double-blind randomized placebo-controlled trial. Biol Psychiatry 9-15-2008;64(6) PubMed
  40. Shahin, A. Y., Hassanin, I. M., Ismail, A. M., Kruessel, J. S., and Hirchenhain, J. Effect of oral N-acetyl cysteine on recurrent preterm labor following treatment for bacterial vaginosis. Int J Gynaecol.Obstet. 2009;104(1):44-48. PubMed
  41. Nigwekar, S. U. and Kandula, P. N-acetylcysteine in cardiovascular-surgery-associated renal failure: a meta-analysis. Ann Thorac.Surg 2009;87(1):139-147. PubMed
  42. Sandilands, E. A. and Bateman, D. N. Adverse reactions associated with acetylcysteine. Clin Toxicol.(Phila) 2009;47(2):81-88. PubMed
  43. Wijeysundera, D. N., Karkouti, K., Rao, V., Granton, J. T., Chan, C. T., Raban, R., Carroll, J., Poonawala, H., and Beattie, W. S. N-acetylcysteine is associated with increased blood loss and blood product utilization during cardiac surgery. Crit Care Me PubMed
  44. Holdiness, M. R. Clinical pharmacokinetics of N-acetylcysteine. Clin Pharmacokinet. 1991;20(2):123-134. PubMed
  45. Dawson, A. H., Henry, D. A., and McEwen, J. Adverse reactions to N-acetylcysteine during treatment for paracetamol poisoning. Med J Aust. 3-20-1989;150(6):329-331.
  46. Rasmussen, J. B. and Glennow, C. Reduction in days of illness after long-term treatment with N-acetylcysteine controlled-release tablets in patients with chronic bronchitis. Eur.Respir.J 1988;1(4):351-355. DOI
  47. Walters, M. T., Rubin, C. E., Keightley, S. J., Ward, C. D., and Cawley, M. I. A double-blind, cross-over, study of oral N-acetylcysteine in Sjogren's syndrome. Scand J Rheumatol.Suppl 1986;61:253-258.
  48. Cato, A., Goldstein, I., and Millman, M. A double-blind parallel study of acetylcysteine-isoproterenol and saline-isoproterenol in patients with chronic obstructive lung disease. J Int Med Res 1977;5(3):175-183. PubMed
  49. Parr, G. D. and Huitson, A. Oral Fabrol (oral N-acetyl-cysteine) in chronic bronchitis. Br.J.Dis.Chest 1987;81(4):341-348.
  50. Dano, G. Bronchospasm caused by acetylcysteine in children with bronchial asthma. Acta Allergol. 1971;26(3):181-190. DOI
  51. Howatt, W. F. and DeMuth, G. R. A double-blind study of the use of acetylcysteine in patients with cystic fibrosis. Univ Mich.Med Cent.J 1966;32(2):82-85.
  52. Millman, M. and Grundon, W. Use of acetylcysteine in bronchial asthma and emphysema. J Asthma Res 1969;6(4):199-209. PubMed
  53. Vale, J. A. and Wheeler, D. C. Anaphylactoid reaction to acetylcysteine. Lancet 10-30-1982;2(8305):988.
  54. Mant, T. G., Tempowski, J. H., Volans, G. N., and Talbot, J. C. Adverse reactions to acetylcysteine and effects of overdose. Br Med J (Clin Res Ed) 7-28-1984;289(6439):217-219. PubMed
  55. Myers, C., Bonow, R., Palmeri, S., Jenkins, J., Corden, B., Locker, G., Doroshow, J., and Epstein, S. A randomized controlled trial assessing the prevention of doxorubicin cardiomyopathy by N-acetylcysteine. Semin.Oncol 1983;10(1 Suppl 1):53-55.
  56. Miller, L. F. and Rumack, B. H. Clinical safety of high oral doses of acetylcysteine. Semin.Oncol 1983;10(1 Suppl 1):76-85.
  57. Boman, G., Backer, U., Larsson, S., Melander, B., and Wahlander, L. Oral acetylcysteine reduces exacerbation rate in chronic bronchitis: report of a trial organized by the Swedish Society for Pulmonary Diseases. Eur J Respir.Dis 1983;64(6):405-415.
  58. Tattersall, A. B., Bridgman, K. M., and Huitson, A. Irish general practice study of acetylcysteine (Fabrol) in chronic bronchitis. J Int Med Res 1984;12(2):96-101. PubMed
  59. Jackson, I. M., Barnes, J., and Cooksey, P. Efficacy and tolerability of oral acetylcysteine (Fabrol) in chronic bronchitis: a double-blind placebo controlled study. J Int Med Res 1984;12(3):198-206. PubMed
  60. Ho, S. W. and Beilin, L. J. Asthma associated with N-acetylcysteine infusion and paracetamol poisoning: report of two cases. Br Med J (Clin Res Ed) 9-24-1983;287(6396):876-877. PubMed
  61. Vale, J. A. and Buckley, B. M. Asthma associated with N-acetylcysteine infusion and paracetamol poisoning. Br Med J (Clin Res Ed) 10-22-1983;287(6400):1223. PubMed
  62. Bateman, D. N., Woodhouse, K. W., and Rawlins, M. D. Adverse reactions to N-acetylcysteine. Hum Toxicol. 1984;3(5):393-398. PubMed
  63. Gervais, S., Lussier-Labelle, F., and Beaudet, G. Anaphylactoid reaction to acetylcysteine. Clin Pharm 1984;3(6):586-587.
  64. Tattersall, A. B., Bridgman, K. M., and Huitson, A. Acetylcysteine (Fabrol) in chronic bronchitis--a study in general practice. J Int Med Res 1983;11(5):279-284. PubMed
  65. Casola, G. and vanSonnenberg, E. Skin damage from acetylcysteine leak during percutaneous abscess drainage. Radiology 1984;152(1):233. PubMed
  66. Aylward, M., Maddock, J., and Dewland, P. Clinical evaluation of acetylcysteine in the treatment of patients with chronic obstructive bronchitis: a balanced double-blind trial with placebo control. Eur.J Respir.Dis.Suppl 1980;111:81-89.
  67. Long-term oral acetylcysteine in chronic bronchitis. a double-blind controlled study. Eur.J Respir.Dis.Suppl 1980;111:93-108.
  68. Chan, T. Y. and Critchley, J. A. Adverse reactions to intravenous N-acetylcysteine in Chinese patients with paracetamol (acetaminophen) poisoning. Hum Exp.Toxicol. 1994;13(8):542-544. PubMed
  69. Hansen, N. C., Skriver, A., Brorsen-Riis, L., Balslov, S., Evald, T., Maltbaek, N., Gunnersen, G., Garsdal, P., Sander, P., Pedersen, J. Z., and . Orally administered N-acetylcysteine may improve general well-being in patients with mild chronic bronchiti
  70. Reid, M. B., Stokic, D. S., Koch, S. M., Khawli, F. A., and Leis, A. A. N-acetylcysteine inhibits muscle fatigue in humans. J Clin Invest 1994;94(6):2468-2474. PubMed
  71. Chirkov, Y. Y. and Horowitz, J. D. N-Acetylcysteine potentiates nitroglycerin-induced reversal of platelet aggregation. J Cardiovasc.Pharmacol 1996;28(3):375-380. PubMed
  72. Hershkovitz, E., Shorer, Z., Levitas, A., and Tal, A. Status epilepticus following intravenous N-acetylcysteine therapy. Isr.J Med Sci 1996;32(11):1102-1104.
  73. Stavem, K. [Anaphylactic reaction to N-acetylcysteine after poisoning with paracetamol]. Tidsskr.Nor Laegeforen. 5-30-1997;117(14):2038-2039.
  74. Walton, N. G., Mann, T. A., and Shaw, K. M. Anaphylactoid reaction to N-acetylcysteine. Lancet 12-15-1979;2(8155):1298. PubMed
  75. Perry, H. E. and Shannon, M. W. Efficacy of oral versus intravenous N-acetylcysteine in acetaminophen overdose: results of an open-label, clinical trial. J Pediatr 1998;132(1):149-152. PubMed
  76. Kory, R. C., Hirsch, S. R., and Giraldo, J. Nebulization of N-acetylcysteine combined with a bronchodilator in patients with chronic bronchitis. A controlled study. Chest 1968;54(6):504-509. PubMed
  77. Nahir, A. M., Scharf, J. M., and Szargel, R. Effects of oral N-acetylcysteine on both ocular and oral manifestations of Sjogren's Syndrome. Curr Ther Res 1989;46:187-192.
  78. Charley, G., Dean, B. S., and Krenzelok, E. P. Oral N-acetylcysteine-induced urticaria: a case report. Vet.Hum Toxicol. 1987;29:477.
  79. Jenkins DD, Wiest DB, Mulvihill DM, et al. Fetal and neonatal effects of N-acetylcysteine when used for neuroprotection in maternal chorioamnionitis. J Pediatr. 2016 Jan;168:67-76.e6. PubMed
  80. Costa DLC, Diniz JB, Requena G, et al. Randomized double-blind, placebo-controlled trial of N-acetylcysteine augmentation for treatment-resistant obsessive-compulsive disorder. J Clin Psychiatry. 2017 Jul;78(7):e799-e773.
  81. Kranzer K, Elamin WF, Cox H, Seddon JA, Ford N, Drobniewski F. A systematic review and meta-analysis of the efficacy and safety of N-acetylcysteine in preventing aminoglycoside-induced ototoxicity: implications for the treatment of multidrug-resistant TB.
  82. Wang W, Zhang Y, Liu Y, Xu L, Shi D. Severe chest pain due to N-acetylcysteine-induced esophagitis. Case Rep Med. 2019;2019:8057259.
  83. Li F, Welling MC, Johnson JA, et al. N-acetylcysteine for pediatric obsessive-compulsive disorder: A small pilot study. J Child Adolesc Psychopharmacol. 2020;30(1):32-37. PubMed
  84. Monti DA, Zabrecky G, Leist TP, et al. N-acetyl cysteine administration is associated with increased cerebral glucose metabolism in patients with multiple sclerosis: An exploratory study. Front Neurol. 2020;11:88. PubMed
  85. Gray KM, Carpenter MJ, Baker NL, et al. A double-blind randomized controlled trial of N-acetylcysteine in cannabis-dependent adolescents. Am J Psychiatry. 2012;169(8):805-12.
  86. Sarris J, Byrne G, Castle D, et al. N-acetyl cysteine (NAC) augmentation in the treatment of obsessive-compulsive disorder: A phase III, 20-week, double-blind, randomized, placebo-controlled trial. Prog Neuropsychopharmacol Biol Psychiatry 2022;117:110550 PubMed

See these in context on the N-acetyl Cysteine (nac) monograph →

Chrysin 23 references
  1. Galijatovic A, Otake Y, Walle UK, Walle T. Extensive metabolism of the flavonoid chrysin by human Caco-2 and Hep G2 cells. Xenobiotica 1999;29:1241-56. PubMed
  2. Lee H, Yeom H, Kim YG, et al. Structure-related inhibition of human hepatic caffeine N3-demethylation by naturally occurring flavonoids. Biochem Pharmacol 1998;55:1369-75. PubMed
  3. Galijatovic A, Walle UK, Walle T. Induction of UDP-glucuronosyltransferase by the flavonoids chrysin and quercetin in Caco-2 cells. Pharm Res 2000;17:21-6.
  4. Walle UK, Galijatovic A, Walle T. Transport of the flavonoid chrysin and its conjugated metabolites by the human intestinal cell line Caco-2. Biochem Pharmacol 1999;58:431-8. PubMed
  5. Kao YC, Zhou C, Sherman M, et al. Molecular basis of the inhibition of human aromatase (estrogen synthetase) by flavone and isoflavone phytoestrogens: A site-directed mutagenesis study. Environ Health Perspect 1998;106:85-92. PubMed
  6. Jeong HJ, Shin YG, Kim IH, Pezzuto JM. Inhibition of aromatase activity by flavonoids. Arch Pharm Res 1999;22:309-12. PubMed
  7. Walle T, Otake Y, Galijatovic A, et al. Induction of UDP-glucuronosyltransferase UGT1A1 by the flavonoid chrysin in the human hepatoma cell line hep G2. Drug Metab Dispos 2000;28:1077-82. DOI
  8. Walle T, Otake Y, Brubaker JA, et al. Disposition and metabolism of the flavonoid chrysin in normal volunteers. Br J Clin Pharmacol 2001;51:143-6. DOI
  9. Galijatovic A, Otake Y, Walle UK, Walle T. Induction of UDP-glucuronosyltransferase UGT1A1 by the flavonoid chrysin in Caco-2 cells--potential role in carcinogen bioinactivation. Pharm Res 2001;18:374-9. PubMed
  10. Lautraite S, Musonda AC, Doehmer J, et al. Flavonoids inhibit genetic toxicity produced by carcinogens in cells expressing CYP1A2 and CYP1A1. Mutagenesis 2002;17:45-53. PubMed
  11. Han, D. H., Denison, M. S., Tachibana, H., and Yamada, K. Relationship between estrogen receptor-binding and estrogenic activities of environmental estrogens and suppression by flavonoids. Biosci.Biotechnol.Biochem 2002;66(7):1479-1487. PubMed
  12. O'Leary, K. A., de Pascual-Tereasa, S., Needs, P. W., Bao, Y. P., O'Brien, N. M., and Williamson, G. Effect of flavonoids and vitamin E on cyclooxygenase-2 (COX-2) transcription. Mutat.Res 7-13-2004;551(1-2):245-254. PubMed
  13. Woodman, O. L. and Chan, E. C. Vascular and anti-oxidant actions of flavonols and flavones. Clin Exp Pharmacol Physiol 2004;31(11):786-790. PubMed
  14. Simons, A. L., Renouf, M., Hendrich, S., and Murphy, P. A. Human gut microbial degradation of flavonoids: structure-function relationships. J Agric.Food Chem 5-18-2005;53(10):4258-4263. PubMed
  15. Kim, H. J., Lee, S. B., Park, S. K., Kim, H. M., Park, Y. I., and Dong, M. S. Effects of hydroxyl group numbers on the B-ring of 5,7-dihydroxyflavones on the differential inhibition of human CYP 1A and CYP1B1 enzymes. Arch Pharm Res 2005;28(10):1114-1121 PubMed
  16. Moon, Y. J., Wang, X., and Morris, M. E. Dietary flavonoids: effects on xenobiotic and carcinogen metabolism. Toxicol In Vitro 2006;20(2):187-210. PubMed
  17. Landolfi, R., Mower, R. L., and Steiner, M. Modification of platelet function and arachidonic acid metabolism by bioflavonoids. Structure-activity relations. Biochem Pharmacol 5-1-1984;33(9):1525-1530. PubMed
  18. Tsyrlov, I. B., Mikhailenko, V. M., and Gelboin, H. V. Isozyme- and species-specific susceptibility of cDNA-expressed CYP1A P-450s to different flavonoids. Biochim.Biophys Acta 4-13-1994;1205(2):325-335. PubMed
  19. Collins, B. M., McLachlan, J. A., and Arnold, S. F. The estrogenic and antiestrogenic activities of phytochemicals with the human estrogen receptor expressed in yeast. Steroids 1997;62(4):365-372. PubMed
  20. Kuiper, G. G., Lemmen, J. G., Carlsson, B., Corton, J. C., Safe, S. H., van der Saag, P. T., van der Burg, B., and Gustafsson, J. A. Interaction of estrogenic chemicals and phytoestrogens with estrogen receptor beta. Endocrinology 1998;139(10):4252-4263. PubMed
  21. Liu G, Xie W, He AD, et al. Antiplatelet activity of chrysin via inhibiting platelet aIIbß3-mediated signaling pathway. Mol Nutr Food Res 2016;60(9):1984-93.
  22. Noh K, Oh do G, Nepal MR, et al. Pharmacokinetic interaction of chrysin with caffeine in rats. Biomol Ther (Seoul) 2016;24(4):446-52. PubMed
  23. Mohos V, Fliszár-Nyúl E, Ungvári O, et al. Effects of Chrysin and Its Major Conjugated Metabolites Chrysin-7-Sulfate and Chrysin-7-Glucuronide on Cytochrome P450 Enzymes and on OATP, P-gp, BCRP, and MRP2 Transporters. Drug Metab Dispos 2020;48(10):1064-10 PubMed

See these in context on the Chrysin monograph →

Stinging Nettle 23 references
  1. Monographs on the medicinal uses of plant drugs. Exeter, UK: European Scientific Co-op Phytother, 1997.
  2. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
  3. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
  4. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physician's Guide to Herbal Medicine. Terry C. Telger, transl. 3rd ed. Berlin, GER: Springer, 1998.
  5. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.
  6. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  7. Mittman P. Randomized, double-blind study of freeze-dried Urtica dioica in the treatment of allergic rhinitis. Planta Med 1990;56:44-7.
  8. Vontobel HP, Herzog R, Rutishauser G, Kres H. [Results of a double-blind study on the effectiveness of ERU (extractum radicis Urticae) capsules in conservative treatment of benign prostatic hyperplasia]. (Abstract). Urologe A 1985;24:49-51.
  9. Randall C, Randall H, Dobbs F, et al. Randomized controlled trial of nettle sting for treatment of base-of-thumb pain. J R Soc Med 2000;93:305-9. PubMed
  10. Caliskaner Z, Karaayvaz M, Ozturk S. Misuse of a herb: stinging nettle (Urtica urens) induced severe tongue oedema. Complement Ther Med 2004;12:57-8. PubMed
  11. Krzeski, T., Kazon, M., Borkowski, A., Witeska, A., and Kuczera, J. Combined extracts of Urtica dioica and Pygeum africanum in the treatment of benign prostatic hyperplasia: double-blind comparison of two doses. Clin Ther 1993;15(6):1011-1020.
  12. Randall, C., Meethan, K., Randall, H., and Dobbs, F. Nettle sting of Urtica dioica for joint pain--an exploratory study of this complementary therapy. Complement Ther Med 1999;7(3):126-131. PubMed
  13. Tahri, A., Yamani, S., Legssyer, A., Aziz, M., Mekhfi, H., Bnouham, M., and Ziyyat, A. Acute diuretic, natriuretic and hypotensive effects of a continuous perfusion of aqueous extract of Urtica dioica in the rat. J Ethnopharmacol 2000;73(1-2):95-100. PubMed
  14. Sahin, M., Yilmaz, H., Gursoy, A., Demirel, A. N., Tutuncu, N. B., and Guvener, N. D. Gynaecomastia in a man and hyperoestrogenism in a woman due to ingestion of nettle (Urtica dioica). N.Z.Med.J. 2007;120(1265):U2803.
  15. Randall, C., Dickens, A., White, A., Sanders, H., Fox, M., and Campbell, J. Nettle sting for chronic knee pain: a randomised controlled pilot study. Complement Ther.Med. 2008;16(2):66-72. PubMed
  16. Rayburn, K., Fleischbein, E., Song, J., Allen, B., Kundert, M., Leiter, C., and Bush, T. Stinging nettle cream for osteoarthritis. Altern.Ther.Health Med. 2009;15(4):60-61.
  17. Oliver, F., Amon, E. U., Breathnach, A., Francis, D. M., Sarathchandra, P., Black, A. K., and Greaves, M. W. Contact urticaria due to the common stinging nettle (Urtica dioica)-- histological, ultrastructural and pharmacological studies. Clin Exp Dermato PubMed
  18. Kulze, A. and Greaves, M. Contact urticaria caused by stinging nettles. Br.J Dermatol. 1988;119(2):269-270. PubMed
  19. Patten G. Medicinal plant review: Urtica. Aust J Med Herbalism 1993;5(1):5-13.
  20. Maor D, Little M. Skin contact with a stinging tree requiring intensive care unit admission. Contact Dermatitis. 2017 Nov;77(5):335-37. PubMed
  21. Easton L, Vaid S, Nagel AK, Venci JV, Fortuna RJ. Stinging Nettle (Urtica dioica): An Unusual Case of Galactorrhea. Am J Case Rep 2021;22:e933999. PubMed
  22. Niazi B, Ahmed K, Ahmed M, Ali S, Song K, Elias S. Drug-Induced Liver Injury from Herbal Liver Detoxification Tea. Case Rep Gastroenterol 2022;16(3):612-617. PubMed
  23. Nnamani I, Tolu-Akinnawo O, Dufera RR, Akintunde A, Maliakkal B. Tinospora cordifolia (Guduchi/Giloy)-Induced Liver Injury: A Case Review. Cureus 2023;15(5):e39793. PubMed

See these in context on the Stinging Nettle monograph →

Coenzyme Q10 40 references
  1. Kamikawa T, Kobayashi A, Yamashita T, et al. Effects of coenzyme Q10 on exercise tolerance in chronic stable angina pectoris. Am J Cardiol 1985;56:247-51. PubMed
  2. Langsjoen P, Willis R, Folkers K. Treatment of essential hypertension with coenzyme Q10. Mol Aspects Med 1994;S265-72. PubMed
  3. Spigset O. Reduced effect of warfarin caused by ubidecarenone. Lancet 1994;334:1372-3. PubMed
  4. Singh RB, Niaz MA, Rastogi SS, et al. Effect of hydrosoluble coenzyme Q10 on blood pressures and insulin resistance in hypertensive patients with coronary artery disease. J Hum Hypertens 1999;13:203-8. PubMed
  5. Portakal O, Ozkaya O, Erden Inal M, et al. Coenzyme Q10 concentrations and antioxidant status in tissues of breast cancer patients. Clin Biochem 2000;33:279-84. PubMed
  6. Lund EL, Quistorff B, Spang-Thomsen M, Kristjansen PE. Effect of radiation therapy on small-cell lung cancer is reduced by ubiquinone intake. Folia Microbiol (Praha) 1998;43:505-6. PubMed
  7. Langsjoen PH, Langsjoen PH, Folkers K. Long-term efficacy and safety of coenzyme Q10 therapy for idiopathic dilated cardiomyopathy. Am J Cardiol 1990;65:521-3. PubMed
  8. Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm 2000;57:1221-7. DOI
  9. Landbo C, Almdal TP. [Interaction between warfarin and coenzyme Q10]. Ugeskr Laeger 1998;160:3226-7.
  10. Baggio E, Gandini R, Plauncher AC, et al. Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunctive therapy in heart failure. CoQ10 Drug Surveillance Investigators. Mol Aspects Med 1994;15 Suppl:S287-94. PubMed
  11. Burke BE, Neuenschwander R, Olson RD. Randomized, double-blind, placebo-controlled trial of coenzyme Q10 in isolated systolic hypertension. South Med J 2001;94:1112-7. PubMed
  12. The Huntington Study Group. A randomized, placebo-controlled trial of coenzyme Q10 and remacemide in Huntington's disease. Neurology 2001;57:397-404.
  13. Hodgson JM, Watts GF, Playford DA, et al. Coenzyme Q10 improves blood pressure and glycaemic control: a controlled trial in subjects with type 2 diabetes. Eur J Clin Nutr 2002;56:1137-42. PubMed
  14. Singh RB, Neki NS, Kartikey K, et al. Effect of coenzyme Q10 on risk of atherosclerosis in patients with recent myocardial infarction. Mol Cell Biochem 2003;246:75-82. DOI
  15. Porterfield LM. Why did the response to warfarin change? RN 2000;63:107.
  16. Sandor PS, Di Clemente L, Coppola G, et al. Efficacy of coenzyme Q10 in migraine prophylaxis: A randomized controlled trial. Neurology 2005;64:713-5. PubMed
  17. Engelsen J, Nielsen JD, Winther K. Effect of coenzyme Q10 and Ginkgo biloba on warfarin dosage in stable, long-term warfarin treated outpatients. A randomised, double blind, placebo-crossover trial. Thromb Haemost 2002;87:1075-6. DOI
  18. Berman M, Erman A, Ben-Gal T, et al. Coenzyme Q10 in patients with end-stage heart failure awaiting cardiac transplantation: a randomized, placebo-controlled study. Clin Cardiol 2004;27:295–9. PubMed
  19. Storch A, Jost WH, Vieregge P, et al. Randomized, double-blind, placebo-controlled trial on symptomatic effects of coenzyme Q10 in Parkinson disease. Arch Neurol 2007;64:938-44. DOI
  20. Digiesi V, Cantini F, Oradei A, et al. Coenzyme Q10 in essential hypertension. Mol Aspects Med 1994;15 Suppl:s257-63. PubMed
  21. Yamagami T, Takagi M, Akagami H, et al. Effect of coenzyme Q10 on essential hypertension, a double blind controlled study. In: Folkers KA, Yamamura Y, eds. Biomedical and Clinical Aspects of Coenzyme Q, Vol. 5. Amsterdam: Elsevier Science Publications, 19
  22. Ho MJ, Bellusci A, Wright JM. Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension (review). Cochrane Database Syst Rev 2009;(4):CD007435. PubMed
  23. Rosenfeldt, F. L., Haas, S. J., Krum, H., Hadj, A., Ng, K., Leong, J. Y., and Watts, G. F. Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials. J Hum.Hypertens. 2007;21(4):297-306. PubMed
  24. Stamelou, M., Reuss, A., Pilatus, U., Magerkurth, J., Niklowitz, P., Eggert, K. M., Krisp, A., Menke, T., Schade-Brittinger, C., Oertel, W. H., and Hoglinger, G. U. Short-term effects of coenzyme Q10 in progressive supranuclear palsy: a randomized, place DOI
  25. Keogh A, Fenton S, Leslie C, et al. Randomised double-blind, placebo-controlled trial of coenzyme Q, therapy in class II and III systolic heart failure. Heart Lung Circ. 2003;12:135-41.
  26. Gane, E. J., Weilert, F., Orr, D. W., Keogh, G. F., Gibson, M., Lockhart, M. M., Frampton, C. M., Taylor, K. M., Smith, R. A., and Murphy, M. P. The mitochondria-targeted anti-oxidant mitoquinone decreases liver damage in a phase II study of hepatitis C
  27. Lynch, D. R., Perlman, S. L., and Meier, T. A phase 3, double-blind, placebo-controlled trial of idebenone in friedreich ataxia. Arch Neurol. 2010;67(8):941-947. PubMed
  28. Young, J. M., Florkowski, C. M., Molyneux, S. L., McEwan, R. G., Frampton, C. M., Nicholls, M. G., Scott, R. S., and George, P. M. A randomized, double-blind, placebo-controlled crossover study of coenzyme Q10 therapy in hypertensive patients with the me
  29. Ishiyama, T., Morita, Y., Toyama, S., Yamagami, T., and Tsukamoto, N. A clinical study of the effect of coenzyme Q on congestive heart failure. Jpn.Heart J 1976;17(1):32-42. PubMed
  30. Matthews, P. M., Ford, B., Dandurand, R. J., Eidelman, D. H., O'Connor, D., Sherwin, A., Karpati, G., Andermann, F., and Arnold, D. L. Coenzyme Q10 with multiple vitamins is generally ineffective in treatment of mitochondrial disease. Neurology 1993;43(5
  31. Malm, C., Svensson, M., Sjoberg, B., Ekblom, B., and Sjodin, B. Supplementation with ubiquinone-10 causes cellular damage during intense exercise. Acta Physiol Scand. 1996;157(4):511-512. PubMed
  32. Singh, R. B., Wander, G. S., Rastogi, A., Shukla, P. K., Mittal, A., Sharma, J. P., Mehrotra, S. K., Kapoor, R., and Chopra, R. K. Randomized, double-blind placebo-controlled trial of coenzyme Q10 in patients with acute myocardial infarction. Cardiovasc. PubMed
  33. Digiesi V, Cantini F, and Brodbeck B. Effect of coenzyme Q10 on essential arterial hypertension. Current Therapeutic Research 1990;47(5):841-845.
  34. Parkinson Study Group QE3 Investigators, Beal MF, Oakes D, et al. A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit. JAMA Neurol. 2014;71(5):543-52.
  35. Alehagen U, Johansson P, Bjornstedt M, et al. Cardiovascular mortality and N-terminal-proBNP reduced after combined selenium and coenzyme Q10 supplementation: A 5-year prospective randomized double-blind placebo-controlled trial among elderly Swedish citi
  36. Ho MJ, Li EC, Wright JM. Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane Database Syst Rev. 2016 Mar 3;3:CD007435. doi: 10.1002/14651858.CD007435.pub3. PubMed
  37. Tabrizi R, Akbari M, Sharifi N, Lankarani KB, Moosazadeh M, Kolahdooz F, et al. The effects of coenzyme Q10 supplementation on blood pressures among patients with metabolic diseases: a systematic review and meta-analysis of randomized controlled trials. PubMed
  38. Tsai IC, Hsu CW, Chang CH, Tseng PT, Chang KV. Effectiveness of coenzyme Q10 supplementation for reducing fatigue: A systematic review and meta-analysis of randomized controlled trials. Front Pharmacol 2022;13:883251. PubMed
  39. Yaghini O, Hoseini N, Ghazavi MR, et al. A comparative study on the efficacy of coenzyme Q10 and amitriptyline in the prophylactic treatment of migraine headaches in children: A randomized controlled trial. Adv Biomed Res 2022;11:43. PubMed
  40. Hansen KS, Mogensen TH, Agergaard J, et al. High-dose coenzyme Q10 therapy versus placebo in patients with post COVID-19 condition: A randomized, phase 2, crossover trial. Lancet Reg Health Eur 2022. PubMed

See these in context on the Coenzyme Q10 monograph →

Cowhage 12 references
  1. McEvoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.
  2. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  3. Anon. Epidemiological notes and reports: Mucuna pruriens-associated pruritus--New Jersey. MMWR Morb Mortal Wkly Rep 1985;34:732-3.
  4. HP-200 in Parkinson's Disease study group. An alternative medicine treatment for Parkinson's disease: Results of a multicenter clinical trial. J Alt Comp Med 1995;1:249-55. DOI
  5. Infante ME, Perez AM, Simao MR, et al. Outbreak of acute toxic psychosis attributed to Mucuna pruriens. Lancet 1990;336:1129. PubMed
  6. Vaidya AB, Rajagopalan TG, Mankodi NA, et al. Treatment of Parkinson's disease with the cowhage plant-Mucuna pruriens Bak. Neurol India 1978;26:171-6.
  7. Vadivel V, Janardhanan K. Nutritional and anti-nutritional composition of velvet bean: an under-utilized food legume in south India. Int J Food Sci Nutr 2000;51:279-87. PubMed
  8. Akhtar MS, Qureshi AQ, Iqbal J. Antidiabetic evaluation of Mucuna pruriens, Linn seeds. J Pak Med Assoc 1990;40:147-50.
  9. Prakash, D., Niranjan, A., and Tewari, S. K. Some nutritional properties of the seeds of three Mucuna species. Int.J.Food Sci.Nutr. 2001;52(1):79-82.
  10. Vadivel, V. and Janardhanan, K. Nutritional and antinutritional characteristics of seven South Indian wild legumes. Plant Foods Hum.Nutr 2005;60(2):69-75. PubMed
  11. Creapure (Creatine Monohydrate). Toxicological Datasheet. Degussa BioActives. Available at: https://www.fda.gov/ohrms/DOCKETS/.../95s-0316-rpt0154-54-Ref-50-vol112.pdf.
  12. Pulikkalpura H, Kurup R, Mathew PJ, Baby S. Levodopa in Mucuna pruriens and its degradation. Sci Rep 2015;5:11078. PubMed

See these in context on the Cowhage monograph →

Arimistane 1 reference
  1. Joseph JF, Parr MK. Synthetic androgens as designer supplements. Curr Neuropharmacol. 2015;13(1):89-100. PubMed

See these in context on the Arimistane monograph →

Milk Thistle 69 references
  1. Ferenci P, Dragosics B, Dittrich H, et al. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol 1989;9:105-13. PubMed
  2. Anon. Milk thistle: Effects on liver disease and cirrhosis and clinical adverse effects. Summary, Evidence Report/Technology Assessment: Number 21, September 2000. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.ahrq.g
  3. Beckmann-Knopp S, Rietbrock S, Weyhenmeyer R, et al. Inhibitory effects of silibinin on cytochrome P-450 enzymes in human liver microsomes. Pharmacol Toxicol 2000;86:250-6. PubMed
  4. Venkataramanan R, Ramachandran V, Komoroski BJ, et al. Milk thistle, a herbal supplement, decreases the activity of CYP3A4 and uridine diphosphoglucuronosyl transferase in human hepatocyte cultures. Drug Metab Dispos 2000;28:1270-3. DOI
  5. Kim DH, Jin YH, Park JB, Kobashi K. Silymarin and its components are inhibitors of beta-glucuronidase. Biol Pharm Bull 1994;17:443-5. PubMed
  6. Pares A, Planas R, Torres M, et al. Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial. J Hepatol 1998;28:615-21. PubMed
  7. Piscitelli SC, Formentini E, Burstein AH, et al. Effect of milk thistle on the pharmacokinetics of indinavir in healthy volunteers. Pharmacotherapy 2002;22:551-6. PubMed
  8. Boerth J, Strong KM. The clinical utility of milk thistle (Silybum marianum) in cirrhosis of the liver. J Herb Pharmacother 2002;2:11-7.
  9. Tanamly MD, Tadros F, Labeeb S, et al. Randomised double-blinded trial evaluating silymarin for chronic hepatitis C in an Egyptian village: study description and 12-month results. Dig Liver Dis 2004;36:752-9. PubMed
  10. Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo assessment of botanical supplementation on human cytochrome P450 phenotypes: Citrus aurantium, Echinacea purpurea, milk thistle, and saw palmetto. Clin Pharmacol Ther 2004;76:428-40. .
  11. Huseini HF, Larijani B, Heshmat R, et al. The efficacy of Silybum marianum (L.) Gaertn. (silymarin) in the treatment of type II diabetes: a randomized, double-blind, placebo-controlled, clinical trial. Phytother Res 2006;20;1036-9.
  12. Deng JW, Shon JH, Shin HJ, et al. Effect of silymarin supplement on the pharmacokinetics of rosuvastatin. Pharm Res 2008;25:1807-14. PubMed
  13. Kim CS, Choi SJ, Park CY, et al. Effects of silybinin on the pharmacokinetics of tamoxifen and its active metabolite, 4-hydroxytamoxifen in rats. Anticancer Res 2010;30:79-85.
  14. Sridar C, Goosen TC, Kent UM, et al. Silybin inactivates cytochromes P450 3A4 and 2C9 and inhibits major hepatic glucuronosyltransferases. Drug Metab Dispos 2004;32:587-94. PubMed
  15. van Erp NP, Baker SD, Zhao M, et al. Effect of milk thistle (Silybum marianum) on the pharmacokinetics of irinotecan. Clin Cancer Res 2005;11:7800-6.
  16. Budzinski JW, Trudeau VL, Drouin CE, et al. Modulation of human cytochrome P450 3A4 (CYP3A4) and P-glycoprotein (P-gp) in Caco-2 cell monolayers by selected commercial-source milk thistle and goldenseal products. Can J Physiol Pharmacol 2007;85:966-78.
  17. Doehmer J, Weiss G, McGregor GP, Appel K. Assessment of a dry extract from milk thistle (Silybum marianum) for interference with human liver cytochrome-P450 activities. Toxicol In Vitro 2011;25:21-7. PubMed
  18. Jiao Z, Shi XJ, Li ZD, et al. Population pharmacokinetics of sirolimus in de novo Chinese adult renal transplant patients. Br.J.Clin.Pharmacol. 2009;68(1):47-60.
  19. Gurley, B. J., Barone, G. W., Williams, D. K., Carrier, J., Breen, P., Yates, C. R., Song, P. F., Hubbard, M. A., Tong, Y., and Cheboyina, S. Effect of milk thistle (Silybum marianum) and black cohosh (Cimicifuga racemosa) supplementation on digoxin phar
  20. Allain, H., Schuck, S., Lebreton, S., Strenge-Hesse, A., Braun, W., Gandon, J. M., and Brissot, P. Aminotransferase levels and silymarin in de novo tacrine-treated patients with Alzheimer's disease. Dement.Geriatr.Cogn Disord. 1999;10(3):181-185. PubMed
  21. Angulo, P., Patel, T., Jorgensen, R. A., Therneau, T. M., and Lindor, K. D. Silymarin in the treatment of patients with primary biliary cirrhosis with a suboptimal response to ursodeoxycholic acid. Hepatology 2000;32(5):897-900. PubMed
  22. Bean, P. The use of alternative medicine in the treatment of hepatitis C. Am.Clin.Lab 2002;21(4):19-21.
  23. Hussain, S. A. Silymarin as an adjunct to glibenclamide therapy improves long-term and postprandial glycemic control and body mass index in type 2 diabetes. J.Med.Food 2007;10(3):543-547. PubMed
  24. El-Kamary, S. S., Shardell, M. D., Abdel-Hamid, M., Ismail, S., El-Ateek, M., Metwally, M., Mikhail, N., Hashem, M., Mousa, A., Aboul-Fotouh, A., El-Kassas, M., Esmat, G., and Strickland, G. T. A randomized controlled trial to assess the safety and effic
  25. Gharagozloo, M., Moayedi, B., Zakerinia, M., Hamidi, M., Karimi, M., Maracy, M., and Amirghofran, Z. Combined therapy of silymarin and desferrioxamine in patients with beta-thalassemia major: a randomized double-blind clinical trial. Fundam.Clin.Pharmaco
  26. Ladas, E. J., Kroll, D. J., Oberlies, N. H., Cheng, B., Ndao, D. H., Rheingold, S. R., and Kelly, K. M. A randomized, controlled, double-blind, pilot study of milk thistle for the treatment of hepatotoxicity in childhood acute lymphoblastic leukemia (ALL PubMed
  27. Sayyah, M., Boostani, H., Pakseresht, S., and Malayeri, A. Comparison of Silybum marianum (L.) Gaertn. with fluoxetine in the treatment of Obsessive-Compulsive Disorder. Prog.Neuropsychopharmacol.Biol.Psychiatry 3-17-2010;34(2):362-365. PubMed
  28. Flaig, T. W., Glode, M., Gustafson, D., van, Bokhoven A., Tao, Y., Wilson, S., Su, L. J., Li, Y., Harrison, G., Agarwal, R., Crawford, E. D., Lucia, M. S., and Pollak, M. A study of high-dose oral silybin-phytosome followed by prostatectomy in patients w
  29. Ramirez-Santos, A., Perez-Bustillo, A., Gonzalez-Sixto, B., Suarez-Amor, O., and Rodriguez-Prieto, M. A. [Acute generalized exanthematous pustulosis due to milk thistle (Silybum marianum) tea]. Actas Dermosifiliogr. 2011;102(9):744-745. DOI
  30. Loguercio C, Andreone P, Brisc C, et al. Silybin combined with phosphatidylcholine and vitamin E in patients with nonalcoholic fatty liver disease: a randomized controlled trial. Free Radic Biol Med 2012;52(9):1658-65. PubMed
  31. Yakoot, M. and Salem, A. Spirulina platensis versus silymarin in the treatment of chronic hepatitis C virus infection. A pilot randomized, comparative clinical trial. BMC.Gastroenterol. 2012;12:32. PubMed
  32. Fallahzadeh, M. K., Dormanesh, B., Sagheb, M. M., Roozbeh, J., Vessal, G., Pakfetrat, M., Daneshbod, Y., Kamali-Sarvestani, E., and Lankarani, K. B. Effect of addition of silymarin to renin-angiotensin system inhibitors on proteinuria in type 2 diabetic
  33. Fried, M. W., Navarro, V. J., Afdhal, N., Belle, S. H., Wahed, A. S., Hawke, R. L., Doo, E., Meyers, C. M., and Reddy, K. R. Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis C unsuccessfully treated with interferon t
  34. Fallah Huseini, H., Larijani, B., Fakhrzadeh, H., Rajabi Pour, B., Akhondzadeh, S., Toliat, T., and Heshmat, R. The clinical trial of Silybum Marianum seed extract (Silymarin) on type II diabetic patients with hyperlipidemia. Iran J.Diabetes Lipid Disord
  35. Mironets VI, Krasovskaia EA, and Polishchuk II. [A case of urticaria during Carsil treatment]. Vrach Delo 1990;7:86-87.
  36. Velussi M, Cernigoi AM, Viezzoli L, and et al. Silymarin reduces hyperinsulinemia, malondialdehyde levels, and daily insulin need in cirrhotic diabetic patients. Curr Ther Res 1993;53(5):533-545. DOI
  37. Marcelli R, Bizzoni P, Conte D, and et al. Randomized controlled study of the efficacy and tolerability of a short course of IdB 1016 in the treatment of chronic persistent hepatitis. Eur Bull Drug Res 1992;1(3):131-135.
  38. Vailati A, Aristia L, Sozze E, and et al. Randomized open study of the dose-effect relationship of a short course of IdB 1016 in patients with viral or alcoholic hepatitis. Fitoterapia 1993;64(3):219-228.
  39. Marena C and Lampertico M. Preliminary clinical development of silipide: a new complex of silybin in toxic liver disorders. Planta Med 1991;57(2):A124-A125. DOI
  40. Grungreiff K, Albrecht M, and Strenge-Hesse A. Benefit of medicinal liver therapy in general practice. Med Welt 1995;46:222-227.
  41. Frerick F, Kuhn U, and Strenge-Hesse A. Silymarin--ein Phytopharmakon zur Behandlung toxischen Leberschaden: Anwendungsbeobachtung bei 2169 Patienten. Kassenarzt 1990;33:36-41.
  42. Schuppan D, Strosser W, Burkard G, and et al. Influence of Legalon(TM) 140 on the metabolism of collagen in patients with chronic liver disease--Review by measurement of PIIINP-values. Zeitschrift fur Allgemeinmedizin 1998;74:577-584.
  43. Studlar M. Die Behandlung chronischer Leberkrankungen mit Silymarin und B-Vitaminen. Therapiewoche 1985;35:3375-3378.
  44. Anon. Adverse reaction: milk thistle-associated toxicity. Nurse Drug Alert 1999;23(7):51.
  45. Gufford BT, Chen G, Vergara AG, et al. Milk Thistle Constituents Inhibit Raloxifene Intestinal Glucuronidation: A Potential Clinically Relevant Natural Product-Drug Interaction. Drug Metab Dispos. 2015;43(9):1353-9. PubMed
  46. El-Shitany NA, Hegazy S, El-Desoky K. Evidences for antiosteoporotic and selective estrogen receptor modulator activity of silymarin compared with ethinylestradiol in ovariectomized rats. Phytomedicine. 2010;17(2):116-25. PubMed
  47. Seidlová-Wuttke D, Becker T, Christoffel V, Jarry H, Wuttke W. Silymarin is a selective estrogen receptor beta (ERbeta) agonist and has estrogenic effects in the metaphysis of the femur but no or antiestrogenic effects in the uterus of ovariectomized (ovx
  48. 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
  49. Derosa G, Romano D, D'Angelo A, Maffioli P. Berberis aristata/Silybum marianum fixed combination (Berberol(®)) effects on lipid profile in dyslipidemic patients intolerant to statins at high dosages: a randomized, placebo-controlled, clinical trial. Phyto PubMed
  50. Luangchosiri C, Thakkinstian A, Chitphuk S, Stitchantrakul W, Petraksa S, Sobhonslidsuk A. A double-blinded randomized controlled trial of silymarin for the prevention of antituberculosis drug-induced liver injury. BMC Complement Altern Med. 2015;15:334. PubMed
  51. Kawaguchi-Suzuki M, Frye RF, Zhu HJ, et al. The effects of milk thistle (Silybum marianum) on human cytochrome P450 activity. Drug Metab Dispos. 2014;42(10):1611-6. PubMed
  52. Rastegarpanah M, Malekzadeh R, Vahedi H, et al. A randomized, double blinded, placebo-controlled clinical trial of silymarin in ulcerative colitis. Chin J Integr Med. 2015;21(12):902-6. PubMed
  53. Di Pierro F, Bellone I, Rapacioli G, Putignano P. Clinical role of a fixed combination of standardized Berberis aristata and Silybum marianum extracts in diabetic and hypercholesterolemic patients intolerant to statins. Diabetes Metab Syndr Obes. 2015;8:8 PubMed
  54. Di Pierro F, Villanova N, Agostini F, Marzocchi R, Soverini V, Marchesini G. Pilot study on the additive effects of berberine and oral type 2 diabetes agents for patients with suboptimal glycemic control. Diabetes Metab Syndr Obes. 2012;5:213-7. PubMed
  55. Guarino G, Strollo F, Carbone L, et al. Bioimpedance analysis, metabolic effects and safety of the association Berberis aristata/Bilybum marianum: a 52-week double-blind, placebo-controlled study in obese patients with type 2 diabetes. J Biol Regul Homeos
  56. Ebrahimpour-Koujan S, Gargari BP, Mobasseri M, Valizadeh H, Asghari-Jafarabadi M. Lower glycemic indices and lipid profile among type 2 diabetes mellitus patients who received novel dose of Silybum marianum (L.) Gaertn. (silymarin) extract supplement: A T
  57. Lash DB, Ward S. CYP2C9-mediated warfarin and milk thistle interaction. J Clin Pharm Ther. 2019. PubMed
  58. Malekshah RE, Khaleghian A. Influence of Silybum marianum on morphine addicted rats, biochemical parameters and molecular simulation studies on µ-opioid receptor. Drug Res (Stuttg). 2019;69(11):630-638. PubMed
  59. Soleymani S, Ayati MH, Mansourzadeh MJ, Namazi N, Zargaran A. The effects of Silymarin on the features of cardiometabolic syndrome in adults: A systematic review and meta-analysis. Phytother Res. 2022 Jan 11. doi: 10.1002/ptr.7364. PubMed
  60. Gamissans M, Expósito-Serrano V, López-Llunell C, Valdivieso L, Garbayo-Salmons P. Bullous pemphigoid triggered by Silybum marianum: an unexpected side effect of an herbal remedy. Int J Dermatol. 2021 Aug 7. doi: 10.1111/ijd.15822. PubMed
  61. Aboras SI, Korany MA, El-Yazbi AF, Ragab MAA, Abdine HH. In-depth investigation of the Silymarin effect on the pharmacokinetic parameters of sofosbuvir, GS-331007 and ledipasvir in rat plasma using LC-MS. Biomed Chromatogr 2022;36(9):e5427. PubMed
  62. Wattanakrai P, Nimmannitya K. A Randomized, Double-Blind, Split-Face Study of Topical Silymarin vs 2% Hydroquinone Cream in Melasmas. J Drugs Dermatol 2022;21(12):1304-1310. PubMed
  63. Pochet S, Lechon AS, Lescrainier C, et al. Herb-anticancer drug interactions in real life based on VigiBase, the WHO global database. Sci Rep 2022;12(1):14178. PubMed
  64. Zhang W, Zhang Y, Wen C, Jiang X, Wang L. In vitro Assessment of the Effects of Silybin on CYP2B6-mediated Metabolism. Planta Med 2023. PubMed
  65. Bechtold BJ, Lynch KD, Oyanna VO, et al. Rifampin- and Silymarin-Mediated Pharmacokinetic Interactions of Exogenous and Endogenous Substrates in a Transgenic OATP1B Mouse Model. Mol Pharm 2024;21(5):2284-2297. PubMed
  66. Mohammadi S, Asbaghi O, Afrisham R, et al. Impacts of Supplementation with Silymarin on Cardiovascular Risk Factors: A Systematic Review and Dose-Response Meta-Analysis. Antioxidants (Basel) 2024;13(4):390. PubMed
  67. Rustamzadeh A, Sadigh N, Vahabi Z, et al. Effects silymarin and rosuvastatin on amyloid-carriers level in dyslipidemic Alzheimer's patients: A double-blind placebo-controlled randomized clinical trial. IBRO Neurosci Rep 2024;17:108-121. PubMed
  68. Fatemi Shandiz A, Karimi G, Dayyani M, Hosseini S, Elyasi S. Evaluation of oral silymarin formulation efficacy in prevention of doxorubicin induced hepatotoxicity in patients with non-metastatic breast cancer. J Oncol Pharm Pract 2024. PubMed
  69. Duan X, Bai W, Hu J, et al. Inhibitory effect of flavonoids on multidrug and toxin extrusion protein 1 function: Implications for food/herb-drug interaction and drug-induced kidney injury. J Appl Toxicol 2024;44(9):1388-1402. PubMed

See these in context on the Milk Thistle monograph →

Saw Palmetto 22 references
  1. Wilt TJ, Ishani A, Stark G, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. JAMA 1998;280:1604-9. PubMed
  2. Carraro JC, Raynaud JP, Koch G, et al. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate 1996;29:231-40. DOI
  3. Di Silverio F, D'Eramo G, Lubrano C, et al. Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertrophy patients. Eur Urol 1992;21:309-14. PubMed
  4. Stepanov VN, Siniakova LA, Sarrazin B, Raynaud JP. Efficacy and tolerability of the lipidosterolic extract of Serenoa repens (Permixon) in benign prostatic hyperplasia: a double-blind comparison of two dosage regimens. Adv Ther 1999;16:231-41.
  5. Cheema P, El-Mefty O, Jazieh AR. Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature. J Intern Med 2001;250:167-9. PubMed
  6. Jibrin I, Erinle A, Saidi A, Aliyu ZY. Saw palmetto-induced pancreatitis. South Med J 2006;99:611-2. PubMed
  7. Prager N, Bickett K, French N, Marcovici G. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. J Altern Complement Med 2002
  8. Avins AL, Bent S, Staccone S, et al. A detailed safety assessment of a saw palmetto extract. Complement Ther Med 2008;16:147-54. PubMed
  9. Morgia, G., Mucciardi, G., Gali, A., Madonia, M., Marchese, F., Di, Benedetto A., Romano, G., Bonvissuto, G., Castelli, T., Macchione, L., and Magno, C. Treatment of chronic prostatitis/chronic pelvic pain syndrome category IIIA with Serenoa repens plus
  10. Aliaev, IuG, Vinarov, A. Z., Lokshin, K. L., and Spivak, L. G. [Efficiency and safety of prostamol-Uno in patients with chronic abacterial prostatitis]. Urologiia. 2006;(1):47-50.
  11. Agbabiaka, T. B., Pittler, M. H., Wider, B., and Ernst, E. Serenoa repens (saw palmetto): a systematic review of adverse events. Drug Saf 2009;32(8):637-647. PubMed
  12. Wargo, K. A., Allman, E., and Ibrahim, F. A possible case of saw palmetto-induced pancreatitis. South.Med.J. 2010;103(7):683-685. PubMed
  13. Lapi, F., Gallo, E., Giocaliere, E., Vietri, M., Baronti, R., Pieraccini, G., Tafi, A., Menniti-Ippolito, F., Mugelli, A., Firenzuoli, F., and Vannacci, A. Acute liver damage due to Serenoa repens: a case report. Br.J.Clin.Pharmacol. 2010;69(5):558-560.
  14. Mantovani, F. Serenoa repens in benign prostatic hypertrophy: analysis of 2 Italian studies. Minerva Urol.Nefrol. 2010;62(4):335-340.
  15. Hanaka, M., Yoshii, C., Yatera, K., Ito, C., Chojin, Y., Nagata, S., Yamasaki, K., Nishida, C., Kawanami, T., Kawanami, Y., Ishimoto, H., and Mukae, H. [A case of rhabdomyolysis caused by saw palmetto of healthy foods]. J.UOEH. 6-1-2012;34(2):193-199. PubMed
  16. Miroddi, M., Carni, A., Mannucci, C., Moleti, M., Navarra, M., and Calapai, G. Hot flashes in a young girl: a wake-up call concerning Serenoa repens use in children. Pediatrics 2012;130(5):e1374-e1376.
  17. Braeckman J. The extract of Serenoa repens in the treatment of benign prostatic hyperplasia: a multicenter open study. Current Therapeutic Research 1994;55(7):776-785. DOI
  18. Jipescu D, Patel A, Bohra H, Pientka A. Rare case of saw palmetto induced heart block. JACC 2017;69(11) supplement:2310.
  19. Morabito P, Miroddi M, Giovinazzo S, Spina E, Calapai G. Serenoa repens as an endocrine disruptor in a 10-year-Old young girl: a new case report. Pharmacology. 2015;96(1-2):41-3. doi: 10.1159/000431327.
  20. Gammoudi R, Ameur K, Ouni B, et al. Fixed drug eruption to Serenoa repens: first case report and consideration of the use of herbal medicine. Dermatol Ther 2020 Aug 29:e14247.
  21. Paulis G, Paulis A, Perletti G. Serenoa repens and its effects on male sexual function. A systematic review and meta-analysis of clinical trials. Arch Ital Urol Androl 2021;93(4):475-480. PubMed
  22. Venkateswaran S, Declet-Bauzo R, Shodeinde M, Gilford P. Postoperative Retroperitoneal Hematoma: A Case of Saw Palmetto and the Importance of Primary Care Intervention. HCA Healthc J Med 2020;1(5):279-282. PubMed

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Laxogenin 3 references
  1. Dietary Supplements for Exercise and Athletic Performance — NIH Office of Dietary Supplements Source
  2. Dietary Supplements: What You Need to Know — NIH Office of Dietary Supplements Source
  3. Using Dietary Supplements Wisely — NIH NCCIH Source

See these in context on the Laxogenin monograph →

Tribulus 10 references
  1. Sharifi AM, Darabi R, Akbarloo N. Study of antihypertensive mechanism of Tribulus terrestris in 2K1C hypertensive rats: role of tissue ACE activity. Life Sci 2003;73:2963-71. PubMed
  2. Walker D, Bird A, Flora T, O'Sullivan B. Some effects of feeding Tribulus terrestris, Ipomoea lonchophylla and the seed of Abelmoschus ficulneus on fetal development and the outcome of pregnancy in sheep. Reprod Fertil Dev 1992;4:135-44. PubMed
  3. Al-Ali M, Wahbi S, Twaij H, Al-Badr A. Tribulus terrestris: preliminary study of its diuretic and contractile effects and comparison with Zea mays. J Ethnopharmacol 2003;85:257-60. PubMed
  4. Tabakova, P., Dimitrov, M., Ognyanov, K., and et al. Clinical study of Tribestan in females with endocrine sterility. Documentation for Registration (unpublished) 1999.
  5. Akhtari E, Raisi F, Keshavarz M, et al. Tribulus terrestris for treatment of sexual dysfunction in women: randomized double-blind placebo-controlled study. Daru 2014;22:40. PubMed
  6. Ryan M, Lazar I, Nadasdy GM, et al. Acute kidney injury and hyperbilirubinemia in a young male after ingestion of Tribulus terrestris. Clin Nephrol 2015;83(3):177-83. PubMed
  7. Postigo S, Lima SM, Yamada SS, et al. Assessment of the effects of Tribulus terrestris on sexual function of menopausal women. Rev Bras Ginecol Obstet 2016;38(3):140-6. PubMed
  8. Talasaz AH, Abbasi MR, Abkhiz S, Dashti-Khavidaki S. Tribulus terrestris-induced severe nephrotoxicity in a young healthy male. Nephrol Dial Tranplant 2010;25(11):3792-3. PubMed
  9. Samani NB, Jokar A, Soveid M, Heydari M, Mosavat SH. Efficacy of the hydroalcoholic extract of Tribulus terrestris on the serum glucose and lipid profile of women with diabetes mellitus: a double-blind randomized placebo-controlled clinical trial. J Evid
  10. Siddiqui MA, Itrat M, Mobeen A, Khan MI. Efficacy of khar-i-khasak (Tribulus terrestris Linn.) in prehypertension: a randomized, double-blind, placebo-controlled trial. J Complement Integr Med. 2021.

See these in context on the Tribulus monograph →

Red Yeast Rice 50 references
  1. Hebel SK, ed. Drug Facts and Comparisons. 52nd ed. St. Louis: Facts and Comparisons, 1998.
  2. Heber D, Yip I, Ashley JM, et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr 1999;69:231-6. PubMed
  3. Wang J, Lu A, Chi J. Multicenter clinical trial of the serum lipid-lowering effects of a monascus purpureus (red yeast) rice preparation from traditional Chinese medicine. Cur Ther Res 1997;58:964-78. DOI
  4. Wigger-Alberti W, Bauer A, Hipler UC, Elsner P. Anaphylaxis due to Monascus purpureus-fermented rice (red yeast rice). Allergy 1999;54:1330-1.
  5. Prasad GV, Wong T, Meliton G, Bhaloo S. Rhabdomyolysis due to red yeast rice (Monascus purpureus) in a renal transplant recipient. Transplantation 2002;74:1200-1. PubMed
  6. Heber D, Lembertas A, Lu QY, et al. An analysis of nine proprietary Chinese red yeast rice dietary supplements: implications of variability in chemical profile and contents. J Altern Complement Med 2001;7:133-9. PubMed
  7. Mueller PS. Symptomatic myopathy due to red yeast rice. Ann Intern Med 2006;145:474-5. PubMed
  8. Roselle H, Ekatan A, Tzeng J, et al. Symptomatic hepatitis associated with the use of herbal red yeast rice. Ann Intern Med 2008;149:516-7. PubMed
  9. Lapi F, Gallo E, Bernasconi S, et al. Myopathies associated with red yeast rice and liquorice: spontaneous reports from the Italian Surveillance System of Natural Health Products. Br J Clin Pharmacol 2008;66:572-74. PubMed
  10. Becker DJ, Gordon RY, Halbert SC, et al. Red yeast rice for dyslipidemia in statin-intolerant patients: A randomized trial. Ann Intern Med 2009;150:830-9. PubMed
  11. Halbert SC, French B, Gordon RY, et al. Tolerability of red yeast rice (2,400 mg twice daily) versus pravastatin (20 mg twice daily) in patients with previous statin intolerance. Am J Cardiol 2010;105:198-204. PubMed
  12. Gordon RY, Cooperman T, Obermeyer W, Becker DJ. Marked variability of monacolin levels in commercial red yeast rice products: buyer beware! Arch Intern Med 2010;170:1722-7. PubMed
  13. Karl M, Rubenstein M, Rudnick C, Brejda J. A multicenter study of nutraceutical drinks for cholesterol (evaluating effectiveness and tolerability). J Clin Lipidology 2012;6:150-158. PubMed
  14. Huang, J., Frohlich, J., and Ignaszewski, A. P. The impact of dietary changes and dietary supplements on lipid profile. Can J Cardiol 2011;27(4):488-505. PubMed
  15. Grieco, A., Miele, L., Pompili, M., Biolato, M., Vecchio, F. M., Grattagliano, I., and Gasbarrini, G. Acute hepatitis caused by a natural lipid-lowering product: when "alternative" medicine is no "alternative" at all. J Hepatol 2009;50(6):1273-1277. PubMed
  16. Smith, D. J. and Olive, K. E. Chinese red rice-induced myopathy. South.Med J 2003;96(12):1265-1267. PubMed
  17. Liu, B. H., Wu, T. S., Su, M. C., Chung, C. P., and Yu, F. Y. Evaluation of citrinin occurrence and cytotoxicity in Monascus fermentation products. J Agric.Food Chem. 1-12-2005;53(1):170-175.
  18. Lin, C. C., Li, T. C., and Lai, M. M. Efficacy and safety of Monascus purpureus Went rice in subjects with hyperlipidemia. Eur J Endocrinol 2005;153(5):679-686. PubMed
  19. Zhao, S. P., Lu, Z. L., Du, B. M., Chen, Z., Wu, Y. F., Yu, X. H., Zhao, Y. C., Liu, L., Ye, H. J., and Wu, Z. H. Xuezhikang, an extract of cholestin, reduces cardiovascular events in type 2 diabetes patients with coronary heart disease: subgroup analysis
  20. Lu, Z., Kou, W., Du, B., Wu, Y., Zhao, S., Brusco, O. A., Morgan, J. M., Capuzzi, D. M., and Li, S. Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction. Am J Cardiol PubMed
  21. Li, J. J., Lu, Z. L., Kou, W. R., Chen, Z., Wu, Y. F., Yu, X. H., and Zhao, Y. C. Beneficial impact of Xuezhikang on cardiovascular events and mortality in elderly hypertensive patients with previous myocardial infarction from the China Coronary Secondary
  22. Li, J. J., Lu, Z. L., Kou, W. R., Chen, Z., Wu, Y. F., Yu, X. H., and Zhao, Y. C. Impact of Xuezhikang on coronary events in hypertensive patients with previous myocardial infarction from the China Coronary Secondary Prevention Study (CCSPS). Ann Med 2010 PubMed
  23. Li, J. J., Lu, Z. L., Kou, W. R., Chen, Z., Wu, Y. F., Yu, X. H., and Zhao, Y. C. Long-term effects of Xuezhikang on blood pressure in hypertensive patients with previous myocardial infarction: data from the Chinese Coronary Secondary Prevention Study (CC
  24. Liu, Z. L., Liu, J. P., Zhang, A. L., Wu, Q., Ruan, Y., Lewith, G., and Visconte, D. Chinese herbal medicines for hypercholesterolemia. Cochrane Database Syst Rev 2011;(7):CD008305. PubMed
  25. Chagas, G. M., Kluppel, M. L., Campello, Ade P., Buchi, Dde F., and de Oliveira, M. B. Alterations induced by citrinin in cultured kidney cells. Cell Struct.Funct. 1994;19(2):103-108. PubMed
  26. Krejci, M. E., Bretz, N. S., and Koechel, D. A. Citrinin produces acute adverse changes in renal function and ultrastructure in pentobarbital-anesthetized dogs without concomitant reductions in [potassium] plasma. Toxicology 1-8-1996;106(1-3):167-177. PubMed
  27. Blanc PJ, Laussac JP, Le Bars J, et al. Characterization of monascidin A from Monascus as citrinin. Int J Food Microbiol. 1995;27(2-3):201-213. PubMed
  28. Lu, Z. L., Xu, S., and Kou, W. R. The clinical observation of treatment of hyperlipidemia with different dose of Xuezhikang. National Symposium of Clinical Therapies for Cardiovascular Diseases 1995;1997:53-57.
  29. Bonovich, K., Colfer, H., Petoskey, M. I., and et al. A multi-center, self-controlled study of cholestin in subjects with elevated cholesterol. Journal of Investigative Medicine 1999;47(2):54A.
  30. Pisciotta, L., Boscarini, M., and Corio, R. Studi clinici su Normolip5, integratore alimentare per il controllo del colesterolo. Medicina Naturale 2004;68-70.
  31. Barrat E, Zaïr Y, Sirvent P, et al. Effect on LDL-cholesterol of a large dose of a dietary supplement with plant extracts in subjects with untreated moderate hypercholesterolaemia: a randomised, double-blind, placebo-controlled study. Eur J Nutr. 2013;52( PubMed
  32. Kumari S, Sherriff JM, Spooner D, Beckett R. Peripheral neuropathy induced by red yeast rice in a patient with a known small bowel gastrointestinal tumour. BMJ Case Rep. 2013;2013. PubMed
  33. Mazzanti G, Moro PA, Raschi E, Da Cas R, Menniti-Ippolito F. Adverse reactions to dietary supplements containing red yeast rice: assessment of cases from the Italian surveillance system. Br J Clin Pharmacol 2017;83(4):894-908. PubMed
  34. Gerards MC, Terlou RJ, Yu H, Koks CH, Gerdes VE. Traditional Chinese lipid-lowering agent red yeast rice results in significant LDL reduction but safety is uncertain - a systematic review and meta-analysis. Atherosclerosis. 2015;240(2):415-23. doi: 10.101 PubMed
  35. Venhuis BJ, van Hunsel F, van de Koppel S, Keizers PH, Jeurissen SM, De Kaste D. Pharmacologically effective red yeast rice preparations marketed as dietary supplements illustrated by a case report. Drug Test Anal. 2016;8(3-4):315-8. doi: 10.1002/dta.1929 PubMed
  36. Raschi E, Girardi A, Poluzzi E, et al. Adverse events to food supplements containing red yeast rice: comparative analysis of FAERS and CAERS reporting systems. Drug Saf 2018;41(8):745-52. doi: 10.1007/s40264-018-0661-3. PubMed
  37. Mercurio V, Pucci G, Bosso G, et al. A nutraceutical combination reduces left ventricular mass in subjects with metabolic syndrome and left ventricular hypertrophy: A multicenter, randomized, double-blind, placebo-controlled trial. Clin Nutr. 2020;39(5):1 PubMed
  38. Prescribing Information. Mevacor (lovastatin). Whitehouse Station, NJ: Merck & Co., Inc., February 2012.
  39. Cicero AFG, Kennedy C, Knezevic T, et al. Efficacy and Safety of Armolipid Plus(®): An Updated PRISMA Compliant Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials. Nutrients 2021;13(2):638. PubMed
  40. Cicero AFG, Bove M, Cincione RI, Fogacci F, Veronesi M. Effect of combined lipid-lowering and antioxidant nutraceutical on plasma lipids, endothelial function, and estimated cardiovascular disease risk in moderately hypercholesterolemic patients: a double
  41. 7-20-21 FDA Drug Safety Communication. FDA requests removal of strongest warning against using cholesterol-lowering statins during pregnancy; still advises most pregnant patients should stop taking statins. Available at: https://www.fda.gov/drugs/drug-s
  42. García-García MD, Bellido Muñoz F, Cordero Ruiz P, Caunedo Álvarez Á. Drug-induced liver injury associated to red yeast rice. Rev Esp Enferm Dig 2023. PubMed
  43. Santos S, Gomes S, Carvalho I, Bonito I, Carmo C. Rhabdomyolysis Related to Red Yeast Rice Ingestion. Cureus 2023;15(1):e33532. PubMed
  44. Banach M, Norata GD. Rhabdomyolysis or severe acute hepatitis associated with the use of red yeast rice extracts: an update from the adverse event reporting systems. Curr Atheroscler Rep 2023;25(11):879-888. PubMed
  45. Wang YH, Zhang SS, Li HT, Zhi HW, Wu HY. Rhabdomyolysis-induced acute kidney injury after administration of a red yeast rice supplement: A case report. World J Clin Cases 2023;11(23):5547-5553. PubMed
  46. Norata GD, Banach M. The Impact of Red Yeast Rice Extract Use on the Occurrence of Muscle Symptoms and Liver Dysfunction: An Update from the Adverse Event Reporting Systems and Available Meta-Analyses. Nutrients 2024;16(3):444. PubMed
  47. Trogkanis E, Karalexi MA, Sergentanis TN, Kornarou E, Vassilakou T. Safety and Efficacy of the Consumption of the Nutraceutical "Red Yeast Rice Extract" for the Reduction of Hypercholesterolemia in Humans: A Systematic Review and Meta-Analysis. Nutrients PubMed
  48. Maiguma M, Kihara M, Hamaguchi M, et al. Successful treatment of acute tubulointerstitial nephritis probably due to Benikoji CholesteHelp(®), a supplement containing red yeast rice. CEN Case Rep 2024. PubMed
  49. Oda K, Murata T, Tanaka F, et al. A case of acute kidney injury and Fanconi syndrome while taking multiple supplements, including Red Yeast Rice Cholesterol Help(®). CEN Case Rep 2024. PubMed
  50. Miyazaki R, Takahashi Y, Kawamura T, Ueda H, Tsuboi N, Yokoo T. Acute kidney tubular injury after ingestion of red yeast rice supplement. Clin Kidney J 2024;17(6):sfae151. PubMed

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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.

© 2021 Therapeutic Research Center, LLC

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