Interactions on record — worth a quick check against your medications. Based on 25 of 42 ingredients. Check your meds →
Dietary supplement

Digestive Enzymes Ingredients & Drug Interactions

by Purely Optimal

Digestive Enzymes label
See full label image
Capsule Category: Other Combinations
Most serious interaction: Moderate
Clinical methodology reviewed by · Updated Sep 9, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Digestive Enzymes 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: Moderate

Digestive Enzymes is a dietary supplement by Purely Optimal with 42 active ingredients. Its ingredients are commonly taken for digestive support for protein digestion, wound cleaning (debridement of dead tissue), sore throat and inflammation.Based on those ingredients, 1,517 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are organic Turmeric, Ginger, Bladderwrack Algae. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

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Check Your Meds Against Digestive Enzymes by Purely Optimal

Ask about any prescription or over-the-counter medication and we check it for interactions with Digestive Enzymes by Purely Optimal — and tell you which ingredient is responsible.

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HelloPharmacist Scorecard of Digestive Enzymes by Purely Optimal

Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.

From our pharmacy team — supplement deep dive

Generated from HelloPharmacist’s pharmacist-curated databases and editorial rules · Last generated Jul 23, 2026

What’s inside

Low disclosure
Ingredient Transparency · database check
Low

Most active ingredients don't disclose an individual amount — you can't tell how much of each you're getting.

Why this rating?
  • The label discloses an exact amount for 0 of its 42 active ingredients.
  • “Digestive Enzyme Complex” is a proprietary blend — the label gives one combined amount (450 mg) without saying how much of each component you get.
  • “organic Prebiotic Complex” is a proprietary blend — the label gives one combined amount (50 mg) without saying how much of each component you get.
  • “Multi Strain Probiotic Complex” is a proprietary blend — the label doesn't break down how much of each component you get.

Purely Optimal Digestive Enzymes contains 42 ingredients, including 14 active ones. The core digestive enzymes are amylase (breaks down carbohydrates), lipase (breaks down fats), protease (breaks down proteins), and bromelain and papain (additional protein-digesting enzymes).

It also contains cellulase, hemicellulase, invertase, glucoamylase, and alpha-galactosidase — enzymes that break down plant fibers and complex sugars. The product includes several live probiotic bacteria (Bifidobacterium longum, Lactobacillus species, and Lactobacillus bulgaricus) to support gut flora, as well as lactase for dairy digestion.

Plant ingredients include ginger, peppermint, and organic turmeric — all included for their digestive support properties. The inactive ingredients are vegetable cellulose (capsule material), magnesium stearate, silicon dioxide, and microcrystalline cellulose (fillers and flow agents).

Does it work?

Strong evidence
Evidence for Intended Use · database check
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
Strong

Clinical evidence supports at least one of this product's ingredients for its stated purpose.

Why this rating?
  • The label markets this product for: digestive enzyme support with prebiotics and probiotics.
  • We looked for evidence on: indigestion, bloating, maldigestion, lactose intolerance.
  • The strongest evidence on file: Lactase is rated "Effective" for Lactose intolerance (Natural Medicines).
  • Also on file: Lactobacillus Acidophilus is rated "Insufficient Reliable Evidence To Rate" for Lactose intolerance.
  • Also on file: Bifidobacterium Longum is rated "Insufficient Reliable Evidence To Rate" for Lactose intolerance.

Evidence for this product's ingredients is mixed. Peppermint is likely effective for irritable bowel syndrome (IBS) and possibly effective for indigestion and nausea; ginger is possibly effective for pregnancy-related nausea, period cramps, and arthritis pain; and turmeric is possibly effective for depression, high cholesterol, and indigestion.

Lactobacillus acidophilus is possibly effective for IBS, Helicobacter pylori, antibiotic-related diarrhea, and bacterial vaginosis. Lactase is effective for lactose intolerance.

However, many of the other enzyme and probiotic ingredients carry insufficient reliable evidence to rate their effectiveness. The product as a whole has not been studied as a formulation, so its overall benefit for digestive health is not established in our data.

The evidence, ingredient by ingredient Papain Bromelain Proteolytic Enzymes (proteases) Lipase Lactase Agave Bifidobacterium Longum Lactobacillus Delbrueckii

How safe is it?

Well-documented data
Safety Information · database check
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 23 of the 25 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 25 of 25.
  • General safety write-ups exist for 25 of 25.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Most ingredients are generally well tolerated short-term at appropriate doses. Papain may cause allergic reactions (itchy eyes, runny nose, sneezing, abdominal cramps, diarrhea) in sensitive individuals, and high doses may cause esophageal perforation or severe stomach inflammation — rare but serious.

Bromelain commonly causes diarrhea, gas, stomach upset, and headache; it may also trigger allergic reactions in sensitive people. Peppermint, ginger, and turmeric can cause mild gastrointestinal side effects (abdominal discomfort, diarrhea, nausea, heartburn).

High-dose ginger (above 5 grams daily) increases side-effect risk. Turmeric has been linked to rare liver damage with long-term supplement use.

The live probiotics are generally safe but carry rare risk of infection in critically ill or severely immunocompromised people. For pregnancy, ginger is likely safe and peppermint is likely safe, but papain is possibly unsafe (concentrated forms and unripe papaya should be avoided), and bromelain is best avoided — data are insufficient for turmeric (the facts list it as both likely safe and likely unsafe, so check with your doctor).

For breastfeeding, limited data exist for most ingredients; talk with your healthcare provider before regular use. Lactase is likely safe in pregnancy and lactation.

Side effects, ingredient by ingredient Papain Bromelain Proteolytic Enzymes (proteases) Lipase Lactase Agave Bifidobacterium Longum Lactobacillus Delbrueckii

Meds to double-check

Moderate interaction found
Known Interaction Concern · database check
Moderate identified

The most serious documented interaction for these ingredients is Moderate. Check your medications for a personalized result.

Why this rating?
  • 20 of the 25 matched ingredients can interact with medications — Papain, Asparagus, Beet, Fennel, Spinach, among others.
  • The most serious interaction on file is rated Moderate.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; immunosuppressants / transplant drugs; cancer treatments; diabetes medications; lithium; Parkinson's medications.
  • For scale: 1,518 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.

Before taking this product, check your medications against these drug types: blood thinners and antiplatelet drugs (warfarin, aspirin, clopidogrel) — papain, bromelain, ginger, and peppermint all pose Moderate risk; antibiotic drugs — the three Lactobacillus species and Bifidobacterium longum pose Moderate risk (separate doses by at least 2 hours); diabetes drugs — ginger poses Moderate risk; blood-pressure drugs, especially losartan and nifedipine — ginger poses Moderate risk; drugs that go through liver enzymes CYP2C19, CYP2C9, and CYP3A4 — peppermint and ginger pose Moderate risk; chemotherapy agents, especially camptothecin-type drugs and doxorubicin — turmeric poses Moderate risk; immunosuppressants like tacrolimus and sulfasalazine — turmeric poses Moderate risk. Bromelain also carries Minor risk with tetracycline antibiotics.

If you take any of these, use the medication checker on this page and confirm findings with your own doctor or pharmacist.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFormula with limited ingredient disclosure with clinical evidence supporting its stated purpose. Moderate medication interactions have been identified, and safety information is well characterized.

If you have IBS, indigestion, or lactose intolerance, some ingredients here have reasonable evidence of benefit — especially peppermint and lactase. However, if you take blood thinners (like warfarin), diabetes drugs, blood-pressure medications, antibiotics, chemotherapy, or drugs processed by your liver, you need to check your specific medications against this product before starting it.

The live probiotics require dose separation from antibiotics. Talk with your own doctor or pharmacist to see whether this blend is right for your situation.

Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI

Assessment coverage: 26 of 42 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Feb 25, 2021.

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 Digestive Enzymes, straight from the product label.

Brand Purely Optimal
Barcode (UPC) X002HNPRHZ
Net contents 180 Capsule(s)
Market status On market
Date entered into DSLD Feb 25, 2021
DSLD ID 243947
Product type Other Combinations
Supplement form Capsule
Dietary claims / uses All Other, 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 Digestive Enzymes by Purely Optimal, 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:
2 Capsule(s)
Maximum serving Sizes:
2 Capsule(s)
Servings per container
90
UPC/BARCODE
X002HNPRHZ
IngredientAmount% DV
Amylase0 NP--
Papain0 NP--
Bromelain0 NP--
Protease0 NP--
Lipase0 NP--
Lactase0 NP--
Bifidobacterium longum Bl-050 NP--
Lactobacillus salivarius Ls-330 NP--
Cellulase0 NP--
Invertase0 NP--
Peppermint0 NP--
Bifidobacterium animalis lactis0 NP--
Glucoamylase0 NP--
Alpha-Galactosidase0 NP--
Lactobacillus rhamnosus0 NP--
Ginger0 NP--
Lactobacillus bulgaricus (Lb-87)0 NP--
Hemicellulase0 NP--
organic Jerusalem Artichoke0 NP--
Digestive Enzyme Complex450 mg--
Lactobacillus casei (Lc-11)0 NP--
Lactobacillus paracasei Lpc-370 NP--
organic Turmeric0 NP--
Lactobacillus plantarum (Lp-115)0 NP--
Lactobacillus acidophilus (La-14)0 NP--
Fennel0 NP--
Asparagus0 NP--
Beet0 NP--
Banana0 NP--
Spinach0 NP--
Pineapple0 NP--
Bifidobacterium bifidum (Bb-02)0 NP--
Kale0 NP--
Wakame Algae0 NP--
Pepsin, Fungal0 NP--
organic Prebiotic Complex50 mg--
organic Blue Agave heart extract0 NP--
Multi Strain Probiotic Complex0 NP--
Natural Sea Vegetable Digestive Complex25 mg--
Nori Algae0 NP--
Bladderwrack Algae0 NP--
Wholefoods Enzyme Complex250 mg--
Cran d'Or ProCran0 NP--
Brussels Sprout0 NP--
Broccoli0 NP--
Papaya0 NP--
Cauliflower0 NP--

Other ingredients: Vegetable Cellulose, Magnesium Stearate, Silicon Dioxide, Microcrystalline Cellulose

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.
Suggested/Recommended/Usage/Directions

Suggested Use: As a dietary supplement, take two (2) capsules once a day or as directed by your health care professional. Should be taken 30 minutes before a meal.

Precautions

Caution: Do not exceed recommended dose.

Pregnant or nursing mothers, children under the age of 18, and individuals with a known medical condition should consult a physician before using this or any dietary supplement.

Pregnant or nursing mothers, children under the age of 18, and individuals with a known medical condition should consult a physician before using this or any dietary supplement. Keep out of reach of children.

Do not use if safety seal is damaged or missing.

Storage

Store in a cool, dry place.

FDA Disclaimer Statement

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Formula

With prebiotics & probiotics Wholefoods enzyme complex

FDA Statement of Identity

Dietary Supplement

Formulation

Supports better digestion Strengthens immune system Promotes healthy gut flora Enhances nutrient absorption

Made with Non GMO ingredients

Professional grade

Seals/Symbols

cGMP Facility Good Manufacturing Practice Certification Made in the USA Lab Tested 3rd Party Certified for Purity & Potency

Brand IP Statement(s)

Cran d'Or is a registered trademark in USA.

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

See for yourself

Digestive Enzymes by Purely Optimal label

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

Digestive Enzymes 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 Digestive Enzymes by Purely Optimal

These are the 42 active ingredients this product is made of. Select any to open its full monograph.

Serving size2 Capsule(s) Dosage formCapsule Servings per container90 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.

Digestive Enzyme Complex

450 mg per serving

Organic Prebiotic Complex

50 mg per serving

Multi Strain Probiotic Complex

0 NP per serving

Natural Sea Vegetable Digestive Complex

25 mg per serving

Wholefoods Enzyme Complex

250 mg per serving

Other (inactive) ingredients: Vegetable Cellulose, Magnesium Stearate, Silicon Dioxide, Microcrystalline Cellulose. These complete the product’s ingredient list but are not active constituents.

Interaction report

Digestive Enzymes by Purely Optimal Drug Interactions

Want to check YOUR meds against Digestive Enzymes?

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
1,517Drugs
1,385 Moderate 132 Minor

Ingredients driving the most interactions

organic Turmeric 1,133
Ginger 1,007
Bladderwrack Algae 891
Beet 861
Peppermint 796

Individual Drug Interactions

The ingredients in Digestive Enzymes interact with 1,517 drugs. Click any drug to see the details.

20 of the 42 ingredients in Digestive Enzymes interact with drugs. Each result below shows which ingredient is responsible. organic Turmeric Ginger Bladderwrack Algae Beet Peppermint Fennel Cran d'Or ProCran Brussels Sprout Broccoli Cauliflower Bifidobacterium longum Bl-05 Lactobacillus bulgaricus (Lb-87) Lactobacillus acidophilus (La-14) Bifidobacterium bifidum (Bb-02) Bromelain Papaya Spinach Asparagus Banana Papain

Each ingredient & the kinds of drugs it affects

For each ingredient in Digestive Enzymes 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.

organic Turmeric24 drug types · 1,133 drugs

Alkylating Agents

Turmeric has antioxidant effects. Theoretically, this may reduce the activity of chemotherapy drugs that generate free radicals. However, research is conflicting.
In vitro research suggests that curcumin, a constituent of turmeric, inhibits mechlorethamine-induced apoptosis of breast cancer cells by up to 70%. Also, animal research shows that curcumin inhibits cyclophosphamide-induced tumor regression. However, some in vitro research shows that curcumin does not affect the apoptosis capacity of etoposide. Also, other laboratory research suggests that curcumin might augment the cytotoxic effects of alkylating agents. Reasons for the discrepancies may relate to the dose of curcumin and the specific chemotherapeutic agent. Lower doses of curcumin might have antioxidant effects while higher doses might have pro-oxidant effects. More evidence is needed to determine what effect, if any, turmeric might have on alkylating agents.

Likelihood Possible Evidence D
Amlodipine (Norvasc)

Taking turmeric with amlodipine may increase levels of amlodipine.
Animal research shows that giving amlodipine 1 mg/kg as a single dose following the use of turmeric extract 200 mg/kg daily for 2 weeks increases the maximum concentration and area under the curve by 53% and 56%, respectively, when compared with amlodipine alone. Additional animal research shows that taking amlodipine 1 mg/kg with a curcumin 2 mg/kg pretreatment for 10 days increases the maximum concentration and area under the curve by about 2-fold when compared with amlodipine alone.

Likelihood Possible Evidence D
Anticoagulant/Antiplatelet Drugs

Turmeric may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs. However, research is conflicting.
Curcumin, a constituent of turmeric, has demonstrated antiplatelet effects in vitro. Furthermore, two case reports have found that taking turmeric along with warfarin or fluindione was associated with an increased international normalized ratio (INR). However, one clinical study in healthy volunteers shows that taking curcumin 500 mg daily for 3 weeks, alone or with aspirin 100 mg, does not increase antiplatelet effects or bleeding risk. It is possible that the dose of turmeric used in this study was too low to produce a notable effect.

Likelihood Possible Evidence B
Antidiabetes Drugs

Theoretically, taking turmeric with antidiabetes drugs might increase the risk of hypoglycemia.
Animal research and case reports suggest that curcumin, a turmeric constituent, can reduce blood glucose levels in patients with diabetes. Furthermore, clinical research in adults with type 2 diabetes shows that taking curcumin 475 mg daily for 10 days prior to taking glyburide 5 mg decreased postprandial glucose levels for up to 24 hours when compared with glyburide alone, despite the lack of a significant pharmacokinetic interaction. Other clinical studies in patients with diabetes show that taking curcumin daily can reduce blood glucose levels when compared with placebo.

Likelihood Possible Evidence B
Antitumor Antibiotics

Turmeric has antioxidant effects. Theoretically, this may reduce the activity of chemotherapy drugs that generate free radicals. However, research is conflicting.
In vitro and animal research shows that curcumin, a constituent of turmeric, inhibits doxorubicin-induced apoptosis of breast cancer cells by up to 65%. However, curcumin does not seem to affect the apoptosis capacity of daunorubicin. In fact, some research shows that curcumin might augment the cytotoxic effects of antitumor antibiotics, increasing their effectiveness. Reasons for the discrepancies may relate to the dose of curcumin and the chemotherapeutic agent. Lower doses of curcumin might have antioxidant effects while higher doses might have pro-oxidant effects. More evidence is needed to determine what effects, if any, antioxidants such as turmeric have on antitumor antibiotics.

Likelihood Possible Evidence D
Cytochrome P450 3A4 (Cyp3A4) Substrates

Turmeric might increase or decrease levels of drugs metabolized by CYP3A4.
In vitro and animal research show that turmeric and its constituents curcumin and curcuminoids inhibit CYP3A4. Also, 8 case reports from the World Health Organization (WHO) adverse drug reaction database describe increased toxicity in patients taking turmeric and cancer medications that are CYP3A4 substrates, including everolimus, ruxolitinib, ibrutinib, and palbociclib, and bortezomib. In another case report, a transplant patient presented with acute nephrotoxicity and elevated tacrolimus levels after consuming turmeric powder at a dose of 15 or more spoonfuls daily for ten days prior. It was thought that turmeric increased levels of tacrolimus due to CYP3A4 inhibition.
Conversely, other in vitro research suggests that turmeric induces CYP3A4 activity, leading to reduced levels of CYP3A4 substrates. An animal model suggests that induction of CYP3A4 occurs after daily curcumin use for 1 week. However, the induction of CYP3A4 by turmeric has not been reported in humans.

Likelihood Possible Evidence D
Hepatotoxic Drugs

Theoretically, turmeric might increase the risk of liver damage when taken with hepatotoxic drugs.
There is concern that turmeric might cause hepatotoxicity, especially when highly bioavailable formulations are used in high doses.

Likelihood Possible Evidence D
Methotrexate (Trexall, Others)

Theoretically, turmeric might have additive effects when used with hepatotoxic drugs such as methotrexate.
In one case report, a 39-year-old female taking methotrexate, turmeric, and linseed oil developed hepatotoxicity.

Likelihood Possible Evidence D
Organic Anion-Transporting Polypeptide Substrates (Oatp)

Theoretically, turmeric might increase blood levels of OATP4C1 substrates.
In vitro research shows that the turmeric constituent curcumin competitively inhibits OATP4C1 transport. This transporter is expressed in the kidney and facilitates the renal excretion of certain drugs. Theoretically, taking turmeric might decrease renal excretion of OATP substrates.

Likelihood Possible Evidence D
Sulfasalazine (Azulfidine)

Turmeric might increase the effects and adverse effects of sulfasalazine.
Clinical research shows that taking the turmeric constituent, curcumin, can increase blood levels of sulfasalazine by 3.2-fold.

Likelihood Probable Evidence B
Tacrolimus (Prograf)

Turmeric might increase the effects and adverse effects of tacrolimus.
In one case report, a transplant patient presented with acute nephrotoxicity and elevated tacrolimus levels of 29 ng/mL. The patient previously had tacrolimus levels within the therapeutic range at 9.7 ng/mL. Ten days prior to presenting at the emergency room the patient started consumption of turmeric powder at a dose of 15 or more spoonfuls daily. It was thought that turmeric increased levels of tacrolimus due to cytochrome P450 3A4 (CYP3A4) inhibition. In vitro and animal research show that turmeric and its constituent curcumin inhibit CYP3A4.

Likelihood Possible Evidence D
Talinolol

Turmeric may reduce the absorption of talinolol in some situations.
Clinical research shows that taking curcumin for 6 days decreases the bioavailability of talinolol when taken together on the seventh day. The clinical significance of this effect is unclear.

Likelihood Probable Evidence B
Tamoxifen (Nolvadex)

Theoretically, turmeric might reduce the levels and clinical effects of tamoxifen.
In a small clinical trial in patients with breast cancer taking tamoxifen 20-30 mg daily, adding curcumin 1200 mg plus piperine 10 mg three times daily reduces the 24-hour area under the curve of tamoxifen and the active metabolite endoxifen by 12.8% and 12.4%, respectively, as well as the maximum concentrations of tamoxifen, when compared with tamoxifen alone. However, in the absence of piperine, the area under the curve for endoxifen and the maximum concentration of tamoxifen were not significantly reduced. Effects were most pronounced in patients who were extensive cytochrome P450 (CYP) 2D6 metabolizers.

Likelihood Possible Evidence B
Topoisomerase I Inhibitors

Turmeric has antioxidant effects. There is some concern that this may reduce the activity of chemotherapy drugs that generate free radicals. However, research is conflicting.
In vitro research shows that curcumin, a constituent of turmeric, inhibits camptothecin-induced apoptosis of breast cancer cells by up to 71%. However, other in vitro research shows that curcumin augments the cytotoxic effects of camptothecin. Reasons for the discrepancies may relate to the dose of curcumin and the chemotherapeutic agents. Lower doses of curcumin might have antioxidant effects while higher doses might have pro-oxidant effects. More evidence is needed to determine what effect, if any, turmeric might have.

Likelihood Possible Evidence D
Tramadol (Ultram)

Theoretically, turmeric might increase or decrease levels of tramadol.
Animal research suggests that a single dose of curcumin, a constituent of turmeric, may increase tramadol's maximum concentration (Cmax) by inhibiting metabolism, while continued daily use for 7 days may reduce the area under the curve (AUC) due to the induction of drug-metabolizing enzymes such as cytochrome P450 3A4 (CYP3A4). However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Turmeric might increase the risk of bleeding with warfarin.
One case of increased international normalized ratio (INR) has been reported for a patient taking warfarin who began taking turmeric. Prior to taking turmeric, the patient had stable INR measurements. Within a few weeks of starting turmeric supplementation, the patient's INR increased to 10. Additionally, curcumin, the active constituent in turmeric, has demonstrated antiplatelet effects in vitro, which may produce additive effects when taken with warfarin.

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

Theoretically, turmeric might increase levels of drugs metabolized by CYP1A2. However, research is conflicting.
In vitro and animal research show that the turmeric constituent, curcumin, inhibits CYP1A2. However, other in vitro research suggests that curcumin does not significantly affect CYP1A2.

Likelihood Possible Evidence D
Docetaxel (Taxotere)

Theoretically, turmeric might increase blood levels of oral docetaxel.
Animal research suggests that the turmeric constituent, curcumin, enhances the oral bioavailability of docetaxel. However, the significance of this interaction is unclear, as this drug is typically administered intravenously in clinical settings.

Likelihood Possible Evidence D
Estrogens

Theoretically, large amounts of turmeric might interfere with hormone replacement therapy through competition for estrogen receptors.
In vitro research shows that curcumin, a constituent of turmeric, displaces the binding of estrogen to its receptors.

Likelihood Possible Evidence D
Glyburide (Diabeta, Others)

Theoretically, taking turmeric and glyburide in combination might increase the risk of hypoglycemia.
Clinical research shows that taking curcumin 475 mg daily for 10 days prior to taking glyburide 5 mg increases blood levels of glyburide by 12% at 2 hours after the dose in patients with type 2 diabetes. While maximal blood concentrations of glyburide were not affected, turmeric modestly decreased postprandial glucose levels for up to 24 hours when compared to glyburide alone, possibly due to the hypoglycemic effect of turmeric demonstrated in animal research.

Likelihood Possible Evidence B
Losartan (Cozaar)

Theoretically, turmeric might increase the effects of losartan.
Research in hypertensive rats shows that taking turmeric can increase the hypotensive effects of losartan.

Likelihood Possible Evidence D
Norfloxacin (Noroxin)

Theoretically, turmeric might increase the effects and adverse effects of norfloxacin.
Animal research shows that taking curcumin, a turmeric constituent, can increase blood levels of orally administered norfloxacin.

Likelihood Possible Evidence D
P-Glycoprotein Substrates

Theoretically, turmeric might increase the absorption of P-glycoprotein substrates.
In vitro and animal research shows that curcuminoids and other constituents found in turmeric can inhibit P-glycoprotein expression and activity.

Likelihood Possible Evidence D
Paclitaxel (Abraxane, Onxol)

Theoretically, turmeric might alter blood levels of paclitaxel, although any effect may not be clinically relevant.
Clinical research in adults with breast cancer receiving intravenous paclitaxel suggests that taking turmeric may modestly alter paclitaxel pharmacokinetics. Patients received paclitaxel on day 1, followed by either no treatment or turmeric 2 grams daily from days 2-22. Pharmacokinetic modeling suggests that turmeric reduces the maximum concentration and area under the curve of paclitaxel by 12.1% and 7.7%, respectively. However, these changes are not likely to be considered clinically relevant. Conversely, animal research suggests that curcumin, a constituent of turmeric, enhances the oral bioavailability of paclitaxel. However, the significance of this interaction is unclear, as this drug is typically administered intravenously in clinical settings.

Likelihood Possible Evidence D
organic Turmeric full monograph & interactions

Ginger14 drug types · 1,007 drugs

Anticoagulant/Antiplatelet Drugs

Ginger may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs. However, research is conflicting.
Laboratory research suggests that ginger inhibits thromboxane synthetase and decreases platelet aggregation. However, this has not been demonstrated unequivocally in humans, with mixed results from clinical trials. Theoretically, excessive amounts of ginger might increase the risk of bleeding when used with anticoagulant/antiplatelet drugs.

Likelihood Possible Evidence B
Antidiabetes Drugs

Theoretically, taking ginger with antidiabetes drugs might increase the risk of hypoglycemia.
Animal and human research suggests that ginger might increase insulin levels and/or decrease blood glucose levels.

Likelihood Possible Evidence D
Cytochrome P450 3A4 (Cyp3A4) Substrates

Ginger might increase or decrease the levels of CYP3A4 substrates.
In vitro research and some case reports suggest that ginger inhibits CYP3A4 activity. Three case reports from the World Health Organization (WHO) adverse drug reaction database describe increased toxicity in patients taking ginger and cancer medications that are CYP3A4 substrates (imatinib, dabrafenib, and crizotinib). However, the causality of this interaction is unclear due to the presence of multiple interacting drugs and routes of administration.
Conversely, other in vitro research suggests that ginger induces CYP3A4 activity, leading to reduced levels of CYP3A4 substrates. However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Losartan (Cozaar)

Theoretically, ginger might increase levels of losartan and the risk of hypotension.
In animal research, ginger increased the levels and hypotensive effects of a single dose of losartan. It is not clear if ginger alters the concentration or effects of losartan when taken continuously. Additionally, this interaction has not been shown in humans.

Likelihood Possible Evidence D
Nifedipine (Procardia)

Ginger may have antiplatelet effects and increase the risk of bleeding if used with nifedipine.
Clinical research shows that combined treatment with ginger 1 gram plus nifedipine 10 mg significantly inhibits platelet aggregation when compared to nifedipine or ginger alone.

Likelihood Possible Evidence B
P-Glycoprotein Substrates

Ginger might increase the absorption and blood levels of P-glycoprotein (P-gp) substrates.
In vitro research and case reports suggest that ginger inhibits drug efflux by P-gp, potentially increasing absorption and serum levels of P-gp substrates. Two case reports from the World Health Organization (WHO) adverse drug reaction database describe increased toxicity in patients taking ginger and cancer medications that are P-gp substrates (trametinib, crizotinib). However, the causality of this interaction is unclear due to the presence of multiple interacting drugs and routes of administration.

Likelihood Possible Evidence D
Phenprocoumon (Marcoumar, Others)

Ginger might increase the risk of bleeding with phenprocoumon.
Phenprocoumon, a warfarin-related anticoagulant, might increase the international normalized ratio (INR) when taken with ginger. There is one case report of a 76-year-old woman with a stable INR on phenprocoumon that increased to greater than 10 when she began consuming dried ginger and ginger tea.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Ginger might increase the risk of bleeding with warfarin.
Laboratory research suggests that ginger might inhibit thromboxane synthetase and decrease platelet aggregation. In one case report, ginger increased the INR when taken with phenprocoumon, which has similar pharmacological effects as warfarin. In another case report, ginger increased the INR when taken with a combination of warfarin, hydrochlorothiazide, and acetaminophen. A longitudinal analysis suggests that taking ginger increases the risk of bleeding in patients taking warfarin for at least 4 months. However, research in healthy people suggests that ginger has no effect on INR, or the pharmacokinetics or pharmacodynamics of warfarin. Until more is known, monitor INRs closely in patients taking large amounts of ginger.

Likelihood Possible Evidence B
Calcium Channel Blockers

Theoretically, taking ginger with calcium channel blockers might increase the risk of hypotension.
Some animal and in vitro research suggests that ginger has hypotensive and calcium channel-blocking effects. Another animal study shows that concomitant administration of ginger and the calcium channel blocker amlodipine leads to greater reductions in blood pressure when compared with amlodipine alone.

Likelihood Unlikely Evidence D
Cyclosporine (Neoral, Sandimmune)

Theoretically, when taken prior to cyclosporine, ginger might decrease cyclosporine levels.
In an animal model, ginger juice taken 2 hours prior to cyclosporine administration reduced the maximum concentration and area under the curve of cyclosporine by 51% and 40%, respectively. This effect was not observed when ginger juice and cyclosporine were administered at the same time.

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

Theoretically, ginger might increase the levels of CYP1A2 substrates.
In vitro research shows that ginger inhibits CYP1A2 activity. However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2B6 (Cyp2B6) Substrates

Theoretically, ginger might increase the levels of CYP2B6 substrates.
In vitro research shows that ginger inhibits CYP2B6 activity. However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2C9 (Cyp2C9) Substrates

Theoretically, ginger might increase the levels of CYP2C9 substrates.
In vitro research shows that ginger inhibits CYP2C9 activity. However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Metronidazole (Flagyl)

Theoretically, ginger might increase levels of metronidazole.
In an animal model, ginger increased the absorption and plasma half-life of metronidazole. In addition, the elimination rate and clearance of metronidazole was significantly reduced.

Likelihood Possible Evidence D
Ginger full monograph & interactions

Bladderwrack Algae9 drug types · 891 drugs

Amiodarone (Cordarone)

Theoretically, combining Fucus vesiculosus with amiodarone might cause excessively high iodine levels.
Fucus vesiculosus contains high concentrations of iodine. Amiodarone contains 37.3% iodine and can increase iodine levels. Concomitant use might increase the risk of having excessive iodine levels and adversely affecting thyroid function. Monitor thyroid function.

Likelihood Probable Evidence D
Antithyroid Drugs

Due to its iodine content, Fucus vesiculosus might alter the effects of antithyroid drugs.
Fucus vesiculosus contains high concentrations of iodine. Iodine in high doses has been reported to cause both hyperthyroidism and hypothyroidism, depending on the individual's past medical history. Taking Fucus vesiculosus while using antithyroid drugs could alter the effects of the antithyroid drugs.

Likelihood Possible Evidence D
Lithium

Concomitant use of Fucus vesiculosus and lithium has resulted in hyperthyroidism.
There is a case of hyperthyroidism occurring in a patient taking Fucus vesiculosus and lithium. Monitor thyroid hormones closely in patients taking lithium and Fucus vesiculosus concomitantly.

Likelihood Possible Evidence D
Thyroid Hormone

Due to its iodine content, Fucus vesiculosus might alter the effects of thyroid hormone.
Fucus vesiculosus contains high concentrations of iodine. Iodine in high doses has been reported to cause both hyperthyroidism and hypothyroidism, depending on the individual's past medical history. Taking Fucus vesiculosus while using thyroid hormone could alter the effects of thyroid hormone.

Likelihood Possible Evidence D
Anticoagulant/Antiplatelet Drugs

Theoretically, taking Fucus vesiculosus with antiplatelet or anticoagulant drugs might increase the risk of bruising and bleeding.
In vitro evidence suggests that a constituent of Fucus vesiculosus, known as fucoidan, has anticoagulant effects. However, in clinical research, fucoidan does not seem to have significant anticoagulant activity when taken orally, possibly due to poor absorption.

Likelihood Unlikely Evidence D
Cytochrome P450 2C8 (Cyp2C8) Substrates

Theoretically, concomitant use of Fucus vesiculosus with CYP2C8 substrates might increase the risk for adverse effects.
In vitro research shows that fucoidan, a constituent of Fucus vesiculosus, inhibits CYP2C8. This interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2C9 (Cyp2C9) Substrates

Theoretically, concomitant use of Fucus vesiculosus with CYP2C9 substrates might increase the risk for adverse effects.
In vitro research shows that fucoidan, a constituent of Fucus vesiculosus, inhibits CYP2C9. This interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2D6 (Cyp2D6) Substrates

Theoretically, concomitant use of Fucus vesiculosus with CYP2D6 substrates might alter the effects of these substrates.
In vitro research shows that fucoidan, a constituent of Fucus vesiculosus, both inhibits and induces CYP2D6. This interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, concomitant use of Fucus vesiculosus with CYP3A4 substrates might increase the risk for adverse effects.
In vitro research shows that fucoidan, a constituent of Fucus vesiculosus, inhibits CYP3A4. This interaction has not been reported in humans.

Likelihood Possible Evidence D
Bladderwrack Algae full monograph & interactions

Beet3 drug types · 861 drugs

Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, beet might increase the levels of CYP3A4 substrates.
In vitro research suggests that betanin, the major pigment in beet, competitively inhibits CYP3A4 in a dose-dependent manner similarly to strong CYP3A4 inhibitor ketoconazole.

Likelihood Possible Evidence D
Antihypertensive Drugs

Beet and beetroot contain nitrates, which can cause vasodilation, potentially leading to lower blood pressure. However, a study published in the European Journal of Clinical Nutrition using concentrated beetroot juice found no significant impact on blood pressure or heart rate in different age groups. Other small clinical studies suggest that while beet consumption might transiently lower blood pressure due to vessel dilation, there's no consistent evidence of a lasting effect. Overall, the theoretical risk of reduced blood pressure due to beet's nitrate content exists, but studies generally indicate a low and temporary impact rather than a sustained decrease.

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

Theoretically, beet might decrease the levels and clinical effects of CYP1A2 substrates.
In vitro research suggests that beet induces CYP1A2 enzymes.

Likelihood Possible Evidence D
Beet full monograph & interactions

Peppermint5 drug types · 796 drugs

Cyclosporine (Neoral, Sandimmune)

Theoretically, peppermint oil might increase the levels and adverse effects of cyclosporine.
In animal research, peppermint oil inhibits cyclosporine metabolism and increases cyclosporine levels. Inhibition of cytochrome P450 3A4 (CYP3A4) may be partially responsible for this interaction. An interaction between peppermint oil and cyclosporine has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2C19 (Cyp2C19) Substrates

Theoretically, peppermint might increase the levels of CYP2C19 substrates.
In vitro research shows that peppermint oil inhibits CYP2C19. So far, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2C9 (Cyp2C9) Substrates

Theoretically, peppermint might increase the levels of CYP2C9 substrates.
In vitro research shows that peppermint oil inhibits CYP2C9. So far, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, peppermint might increase the levels of CYP3A4 substrates.
Clinical research in healthy volunteers shows that a single dose of peppermint oil 600 mg inhibits CYP3A4 enzymes and increases the AUC of felodipine, a CYP3A4 substrate. However, in vitro research suggests that peppermint oil only inhibits CYP3A4 at very high concentrations.

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

Theoretically, peppermint might increase the levels of CYP1A2 substrates.
In vitro and animal research shows that peppermint oil and peppermint leaf inhibit CYP1A2. However, in clinical research, peppermint tea did not significantly affect the metabolism of caffeine, a CYP1A2 substrate. It is possible that the 6-day duration of treatment may have been too short to identify a difference.

Likelihood Possible Evidence B
Peppermint full monograph & interactions

Fennel6 drug types · 740 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, fennel might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.

Animal research suggests that fennel oil has antithrombotic and antiplatelet effects.

Likelihood Possible Evidence D
Ciprofloxacin (Cipro)

Theoretically, fennel might decrease the levels and clinical effects of ciprofloxacin.

Animal research shows that fennel reduces ciprofloxacin bioavailability by nearly 50%, possibly due to the metal cations such as calcium, iron, and magnesium contained in fennel. This study also found that fennel increased tissue distribution and slowed elimination of ciprofloxacin.

Likelihood Probable Evidence D
Contraceptive Drugs

Theoretically, taking large amounts of fennel might decrease the effects of contraceptive drugs due to competition for estrogen receptors.

Some constituents of fennel have estrogenic activity.

Likelihood Possible Evidence D
Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, fennel might increase levels of drugs metabolized by CYP3A4.

In vitro research suggests that fennel inhibits CYP3A4 enzyme activity. This effect has not been reported in humans.

Likelihood Possible Evidence D
Estrogens

Theoretically, taking large amounts of fennel might interfere with hormone replacement therapy due to competition for estrogen receptors.

Some constituents of fennel have estrogenic activity.

Likelihood Possible Evidence D
Tamoxifen (Nolvadex)

Theoretically, taking large amounts of fennel might decrease the antiestrogenic effect of tamoxifen.

Some constituents of fennel have estrogenic activity, which may interfere with the antiestrogenic activity of tamoxifen.

Likelihood Possible Evidence D
Fennel full monograph & interactions

Cran d'Or ProCran6 drug types · 712 drugs

Atorvastatin (Lipitor)

Theoretically, cranberry might increase levels and adverse effects of atorvastatin.
In one case report, a patient taking atorvastatin experienced upper back pain, rhabdomyolysis, and abnormal liver function after drinking cranberry juice 16 ounces daily for 2 weeks. Theoretically, this may have been caused by inhibition of cytochrome P450 3A4 (CYP3A4) enzymes by cranberry juice, as atorvastatin is a CYP3A4 substrate. Creatinine kinase and liver enzymes normalized within 2 weeks of stopping cranberry juice. Patients taking atorvastatin should avoid large quantities of cranberry juice.

Likelihood Possible Evidence D
Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, cranberry might increase the levels and adverse effects of CYP3A4 substrates.
A case of upper back pain, rhabdomyolysis, and abnormal liver function has been reported for a patient taking atorvastatin, a CYP3A4 substrate, in combination with cranberry juice 16 ounces daily for 2 weeks. Creatinine kinase and liver enzymes normalized within 2 weeks of stopping cranberry juice. Also, animal research suggests that cranberry juice, administered intraduodenally 30 minutes prior to nifedipine, a CYP3A4 substrate, inhibits nifedipine metabolism and increases the area under the concentration-time curve by 1.6-fold compared to control.

Likelihood Possible Evidence D
Nifedipine (Procardia)

Theoretically, cranberry might increase the levels and adverse effects of nifedipine.
Animal research suggests that cranberry juice, administered intraduodenally 30 minutes prior to nifedipine treatment, inhibits nifedipine metabolism and increases the area under the concentration-time curve by 1.6-fold compared to control. This interaction has not been reported in humans.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, cranberry might increase the levels and adverse effects of warfarin. However, research is conflicting.
There is contradictory evidence about the effect of cranberry juice on warfarin. Case reports have linked cranberry juice consumption to increases in the international normalized ratio (INR) in patients taking warfarin, resulting in severe spontaneous bleeding and excessive postoperative bleeding. Daily consumption of cranberry sauce for one week has also been linked to an increase in INR in one case report. In a small study in healthy young males, taking a high dose of 3 grams of cranberry juice concentrate capsules, equivalent to 57 grams of fruit daily, for 2 weeks produced a 30% increase in the area under the INR-time curve after a single 25-mg dose of warfarin. However, 3 very small clinical studies in patients stabilized on warfarin reported that cranberry juice 250 mL once or twice daily for 7 days (27% cranberry juice or pure cranberry juice) or 240 mL once daily for 14 days does not significantly increase INR or affect plasma warfarin levels. The reasons for these discrepant findings are unclear. It is possible that the form and dose of cranberry may play a role, as cranberry extracts and juices contain different constituents. Additionally, an in vitro study evaluating 5 different cranberry juices found varying effects, with only a cranberry concentrate, and not diluted cranberry juices, inhibiting CYP2C9. However, this concentrate did not inhibit CYP2C9 activity in humans.

Likelihood Possible Evidence B
Cytochrome P450 2C9 (Cyp2C9) Substrates

Theoretically, cranberry might increase the levels and adverse effects of CYP2C9 substrates. However, research is conflicting.
There is contradictory evidence about the effect of cranberry on CYP2C9 enzymes. In vitro evidence suggests that flavonoids in cranberry inhibit CYP2C9 enzymes. However, clinical research shows that cranberry juice does not significantly affect the levels, metabolism, or elimination of the CYP2C9 substrates flurbiprofen or diclofenac. Also, in patients stabilized on warfarin, drinking cranberry juice 250 mL daily for 7 days does not significantly increase the anticoagulant activity of warfarin, a CYP2C9 substrate. Additional pharmacokinetic research shows that cranberry juice does not increase peak plasma concentrations or area under the concentration-time curve of warfarin.

Likelihood Unlikely Evidence B
Diclofenac (Voltaren, Others)

Theoretically, cranberry might modestly increase the levels and adverse effects of diclofenac.
In vitro evidence suggests that cranberry juice inhibits diclofenac metabolism by human liver microsomes. However, drinking cranberry juice does not seem to affect diclofenac metabolism in humans.

Likelihood Unlikely Evidence B
Cran d'Or ProCran full monograph & interactions

Brussels Sprout5 drug types · 241 drugs

Acetaminophen (Tylenol, Others)

A cabbage and Brussels sprout-containing diet can increase metabolism and decrease levels of acetaminophen. In clinical research, a diet that includes daily consumption of cabbage and Brussels sprout decreases acetaminophen levels by as much as 16%. This appears to occur due to a boost of elimination through glucuronide conjugation.

Likelihood Probable Evidence B
Cytochrome P450 1A2 (Cyp1A2) Substrates

Animal research suggests that Brussels sprout can induce cytochrome P450 1A2 (CYP1A2) activity. Theoretically, Brussels sprout might increase the clearance and decrease the effects of drugs metabolized by CYP1A2. Some drugs metabolized by CYP1A2 include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others.

Likelihood Possible Evidence D
Glucuronidated Drugs

A cabbage and Brussels sprout-containing diet seems to boost elimination through glucuronide conjugation. Theoretically, these foods might also lower levels of other drugs that are metabolized through glucuronide conjugation, including acetaminophen (Tylenol, others) and oxazepam (Serax), haloperidol (Haldol), lamotrigine (Lamictal), morphine (MS Contin, Roxanol), zidovudine (AZT, Retrovir), and others.

Likelihood Probable Evidence B
Oxazepam (Serax)

A diet that includes daily consumption of cabbage and Brussels sprout decreases oxazepam levels by as much as 17%. This appears to occur due to a boost of elimination through glucuronide conjugation. Theoretically, Brussels sprout might also lower levels of other drugs that are metabolized through glucuronide conjugation including acetaminophen (Tylenol, others), haloperidol (Haldol), lamotrigine (Lamictal), morphine (MS Contin, Roxanol), zidovudine (AZT, Retrovir), and others.

Likelihood Probable Evidence B
Warfarin (Coumadin)

Preliminary clinical research shows that increasing Brussels sprout consumption by 400 grams daily can increase warfarin clearance rate by 27% and decrease plasma concentrations of warfarin by 16%. Theoretically, consuming Brussels sprout while taking warfarin might decrease the effects of warfarin and increase the risk of blood clots in some people.

Likelihood Possible Evidence B
Brussels Sprout full monograph & interactions

Broccoli2 drug types · 187 drugs

Cytochrome P450 1A2 (Cyp1A2) Substrates

Theoretically, broccoli might reduce the levels and effects of drugs metabolized by CYP1A2.
Pharmacokinetic research in humans shows that eating 500 grams of fresh broccoli daily for 6-12 days can increase CYP1A2 activity by 10% to 200%. Induction of CYP1A2 activity by broccoli is attributed to its glucosinolate constituents.

Likelihood Possible Evidence B
Cytochrome P450 2A6 (Cyp2A6) Substrates

Theoretically, broccoli might reduce the levels and effects of drugs metabolized by CYP2A6.
Pharmacokinetic research in humans shows that eating 500 grams of broccoli daily for 6 days increases CYP2A6 activity by 135% to 550%. Induction of CYP2A6 activity is attributed to its glucosinolate constituents.

Likelihood Possible Evidence B
Broccoli full monograph & interactions

Cauliflower1 drug type · 186 drugs

Cytochrome P450 1A2 (Cyp1A2) Substrates

Preliminary clinical evidence suggests that eating cruciferous vegetables, including broccoli, cauliflower, daikon radish sprouts, and cabbage, can increase cytochrome P450 1A2 (CYP1A2) activity by 14% to 27%. Theoretically, cauliflower might increase the clearance and decrease the effects of drugs metabolized by CYP1A2. Some drugs metabolized by CYP1A2 include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others.

Likelihood Possible Evidence B
Cauliflower full monograph & interactions

Bifidobacterium longum Bl-051 drug type · 182 drugs

Antibiotic Drugs

Theoretically, taking Bifidobacterium longum with antibiotic drugs might decrease the effectiveness of B. longum.
Since B. longum preparations usually contain live and active organisms, simultaneously taking antibiotics might kill a significant number of the organisms. Tell patients to separate administration of antibiotics and B. longum preparations by at least 2 hours.

Likelihood Probable Evidence D
Bifidobacterium longum Bl-05 full monograph & interactions

Lactobacillus bulgaricus (Lb-87)1 drug type · 182 drugs

Antibiotic Drugs

Theoretically, taking Lactobacillus delbrueckii with antibiotic drugs might decrease the effectiveness of L. delbrueckii.
Lactobacillus delbrueckii preparations usually contain live and active organisms. Therefore, simultaneously taking antibiotics might kill a significant number of the organisms. Tell patients to separate administration of antibiotics and L. delbrueckii preparations by at least two hours.

Likelihood Probable Evidence D
Lactobacillus bulgaricus (Lb-87) full monograph & interactions

Lactobacillus acidophilus (La-14)1 drug type · 182 drugs

Antibiotic Drugs

Theoretically, taking Lactobacillus acidophilus with antibiotic drugs might decrease the effectiveness of L. acidophilus.
L. acidophilus preparations usually contain live and active organisms. Therefore, simultaneously taking antibiotics might kill a significant number of the organisms. Tell patients to separate administration of antibiotics and L. acidophilus preparations by at least two hours.

Likelihood Probable Evidence D
Lactobacillus acidophilus (La-14) full monograph & interactions

Bifidobacterium bifidum (Bb-02)1 drug type · 182 drugs

Antibiotic Drugs

Theoretically, taking Bifidobacterium. bifidum with antibiotic drugs might decrease the effectiveness of B. bifidum.
Since B. bifidum preparations usually contain live and active organisms, simultaneously taking antibiotics might kill a significant number of the organisms. Tell patients to separate administration of antibiotics and B. bifidum preparations by at least 2 hours.

Likelihood Probable Evidence D
Bifidobacterium bifidum (Bb-02) full monograph & interactions

Bromelain2 drug types · 141 drugs

Anticoagulant/Antiplatelet Drugs

Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
There is one case report of a patient experiencing minor bruising while taking bromelain with naproxen. Bromelain is thought to have antiplatelet activity. Whether this interaction is of concern with topical bromelain is unclear. Interference with coagulation of burn wounds has been reported in a patient receiving bromelain-based enzymatic debridement. However, observational research has found that topical bromelain debridement is not associated with increases or decreases in laboratory markers of coagulation when compared with surgical debridement.

Likelihood Possible Evidence D
Tetracycline Antibiotics

Theoretically, bromelain might increase levels of tetracycline antibiotics.
Laboratory research suggests that bromelain might increase the absorption of tetracycline antibiotics. However, a study in healthy adults reported no difference in tetracycline plasma levels when a 500 mg dose was taken with or without bromelain 80 mg.

Likelihood Possible Evidence B
Bromelain full monograph & interactions

Papaya4 drug types · 92 drugs

Amiodarone (Cordarone)

Theoretically, papaya extract may increase the levels and clinical effects of amiodarone.
Animal research in rats shows that a single oral dose of papaya extract, as well as multiple doses of papaya extract daily over 14 days, prior to a single dose of amiodarone delays the time to maximum amiodarone concentration. However, only the 14-day papaya extract regimen increases systemic amiodarone exposure by 60% to 70%. This interaction has not been reported in humans.

Likelihood Probable Evidence D
Antidiabetes Drugs

Concomitant use of antidiabetic drugs with fermented papaya can produce additive effects. It is unclear if other forms of papaya have the same effect.
A small low-quality clinical study in patients with type 2 diabetes who are taking glibenclamide shows that taking a fermented papaya preparation 3 grams daily for 2 months decreases fasting and postprandial blood glucose levels when compared to baseline. Additionally, of the 25 patients in the study, 9 required a reduction in glibenclamide dose.

Likelihood Probable Evidence B
Levothyroxine (Synthroid, Others)

Theoretically, consuming large quantities of papaya fruit can reduce the clinical effects of levothyroxine.
In one case-report, a 37-year-old male with a history of thyroidectomy who was stabilized on levothyroxine for 5 years presented with hypothyroidism after consuming 5-6 papaya fruits daily for 14 days during vacation. In a controlled re-challenge test involving 5-6 papayas daily, the patient remained euthyroid for 7 days, but developed mild hypothyroidism after 14 days. Both times, thyroid levels normalized 40-45 days after discontinuing papaya.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, concomitant use of warfarin with papain-containing papaya extract might increase the effects and side effects of warfarin.
In one case report, a patient previously stable on warfarin was found to have an international normalization ratio (INR) of 7.4, which was attributed to ingestion of a supplement containing papain from papaya extract.

Likelihood Possible Evidence D
Papaya full monograph & interactions

Spinach2 drug types · 88 drugs

Antidiabetes Drugs

There are claims that spinach leaves have hypoglycemic effects. Evidence from clinical research suggests that consumption of a spinach-rich meal reduces post-meal blood glucose levels. Theoretically, spinach might have additive effects with antidiabetes drugs and increase the risk of hypoglycemia. Monitor blood glucose levels closely. Dose adjustments might be necessary. Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Spinach contains vitamin K, which can interfere with the activity of warfarin.
In human research, although eating spinach with one meal does not result in coagulation test results outside the therapeutic range, daily consumption for one week necessitates dose adjustment of warfarin. Individuals using anticoagulants should consume a consistent daily amount of spinach to maintain the effect of anticoagulant therapy.

Likelihood Possible Evidence D
Spinach full monograph & interactions

Asparagus2 drug types · 76 drugs

Diuretic Drugs

Theoretically, asparagus root might increase diuresis and electrolyte loss when used with diuretic drugs.
Animal studies show that asparagus root extracts have diuretic effects. This effect has not been reported in humans.

Likelihood Possible Evidence D
Lithium

Theoretically, asparagus root might cause diuresis, reducing lithium clearance.
Animal studies show that asparagus root extracts have diuretic effects. Theoretically, this might reduce excretion and increase levels of lithium. The dose of lithium might need to be decreased.

Likelihood Probable Evidence D
Asparagus full monograph & interactions

Banana1 drug type · 5 drugs

Levodopa

Taking banana may reduce the effectiveness of levodopa.
A case report describes apparent wearing off in a patient with Parkinson disease after eating a banana every day. The wearing off subsided after removing dietary bananas.

Likelihood Possible Evidence D
Banana full monograph & interactions

Papain1 drug type · 2 drugs

Warfarin (Coumadin)

Theoretically, papain might increase the effects and side effects of warfarin.
In one case report, a patient previously stable on warfarin was found to have an international normalization ratio (INR) of 7.4, which was attributed to ingestion of a supplement containing papain from papaya extract.

Likelihood Possible Evidence D
Papain full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Digestive Enzymes, from the product label.

Purely Optimal

See all Purely Optimal products
Name
Purely Optimal Nutrition Inc.
City
San Jose
State
CA
ZipCode
95132
Phone Number
1-800-738-6018
Web Address
www.purelyoptimal.com
Pharmacist Counseling Corner

Digestive Enzymes by Purely Optimal: Common Questions

Does Digestive Enzymes by Purely Optimal interact with any medications?
Yes. Based on its ingredients, Digestive Enzymes has a known interaction with 1,517 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Digestive Enzymes contains 42 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.
Can I take this if I'm on warfarin?
Not without checking first. Papain in this product may increase warfarin's effects and your bleeding risk — one case report documents elevated lab values. Ginger and turmeric also pose bleeding risk with warfarin. Talk to your own doctor or pharmacist about your specific dose and how to monitor safely.
Can I take this if I'm on antibiotics?
The live probiotic organisms (three Lactobacillus species and Bifidobacterium longum) may be killed by antibiotics, defeating their purpose. Separate this product and antibiotics by at least 2 hours if you want to maintain the probiotics' benefit. Bromelain also has a minor interaction with tetracycline antibiotics, so mention this product to your pharmacist.
Will this help my IBS?
Peppermint in this product is likely effective for IBS, and Lactobacillus acidophilus is possibly effective. However, the product as a whole has not been tested, so benefit depends on your individual situation and which ingredients matter most to you. Your doctor or pharmacist can help you decide if it's worth trying.
Is this safe during pregnancy?
Peppermint and ginger are likely safe in pregnancy — ginger is even used for morning sickness — but papain is possibly unsafe (concentrated forms and unripe papaya should be avoided) and bromelain should be avoided. The safety data for turmeric in pregnancy conflict, so check with your doctor before using any supplement.
What does papain do?
Papain is a protein-digesting enzyme from papaya that helps break down proteins during digestion. However, its effectiveness for any specific condition lacks reliable evidence in our data. It's included for digestive support, but talk with your pharmacist if you have any concerns about it.
Does this have fillers?
Yes. Beyond the 14 active ingredients, the capsule contains vegetable cellulose, magnesium stearate, silicon dioxide, and microcrystalline cellulose — these are inactive ingredients used to hold the product together and fill the capsule.

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

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Digestive Enzymes label
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The Full Monographs Behind Digestive Enzymes’s Ingredients

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

Herb & supplement monograph

Papain

Interacts with 2 drugs

Papain is a protein-digesting enzyme from the papaya plant that is used in digestive supplements and some topical products. While it has clear food and laboratory uses, strong human evidence...

Read the full Papain monograph → Herb & supplement monograph

Bromelain

Interacts with 141 drugs

Bromelain is a group of protein-digesting enzymes from pineapple that people take mainly for inflammation, swelling, and sinus problems. Some early studies are promising, but the overall evi...

Read the full Bromelain monograph → Herb & supplement monograph

Proteolytic Enzymes (proteases)

Proteolytic enzymes are proteins that help break down other proteins, and common examples include bromelain (from pineapple), papain (from papaya), trypsin, chymotrypsin, and pancreatin. Peo...

Read the full Proteolytic Enzymes (proteases) monograph → Herb & supplement monograph

Lipase

Lipase is a digestive enzyme that helps your body break down dietary fats. It is well established as part of prescription pancreatic enzyme therapy for people who cannot make enough of their...

Read the full Lipase monograph → Herb & supplement monograph

Lactase

Lactase is a digestive enzyme supplement that helps people who lack enough natural lactase break down lactose, the sugar in milk and dairy. It can reduce gas, bloating, cramping, and diarrhe...

Read the full Lactase monograph → Herb & supplement monograph

Agave

Agave is a succulent plant best known as the source of agave nectar, a popular sweetener, and the base for tequila and mezcal. While it has a long history of folk use for digestion, skin car...

Read the full Agave monograph → Herb & supplement monograph

Bifidobacterium Longum

Interacts with 182 drugs

Bifidobacterium longum is a 'friendly' bacterium found naturally in the human gut and used as a probiotic. It is generally well tolerated and is most studied for digestive issues, though evi...

Read the full Bifidobacterium Longum monograph → Herb & supplement monograph

Lactobacillus Delbrueckii

Interacts with 182 drugs

Lactobacillus delbrueckii is a 'friendly' bacterium used in food fermentation and sold as a probiotic, often as part of multi-strain products. It is generally considered safe for healthy peo...

Read the full Lactobacillus Delbrueckii monograph → Herb & supplement monograph

Lactobacillus Acidophilus

Interacts with 182 drugs

Lactobacillus acidophilus is a 'friendly' bacterium used as a probiotic to support gut and vaginal health. It is generally well tolerated in healthy people, and there is reasonable evidence...

Read the full Lactobacillus Acidophilus monograph → Herb & supplement monograph

Bifidobacterium Bifidum

Interacts with 182 drugs

Bifidobacterium bifidum is a 'friendly' bacteria (probiotic) that naturally lives in the human gut and is taken to support digestion and gut balance. Some evidence suggests probiotics may he...

Read the full Bifidobacterium Bifidum monograph → Herb & supplement monograph

Fucus Vesiculosus

Interacts with 891 drugs

Fucus vesiculosus (bladderwrack) is a brown seaweed rich in iodine that has been used traditionally for thyroid concerns, weight, and skin. There is little solid human evidence to support mo...

Read the full Fucus Vesiculosus monograph → Herb & supplement monograph

Peppermint

Interacts with 796 drugs

Peppermint is a popular herb with the best evidence supporting enteric-coated peppermint oil for easing IBS symptoms. It is generally well tolerated for most adults, but it can cause heartbu...

Read the full Peppermint monograph → Herb & supplement monograph

Ginger

Interacts with 1,007 drugs

Ginger is a widely used culinary spice with a long history in traditional medicine, and it has the strongest evidence for helping with nausea and vomiting, including from motion sickness, pr...

Read the full Ginger monograph → Herb & supplement monograph

Turmeric

Interacts with 1,133 drugs

Turmeric is a popular spice whose main active compounds, curcuminoids, are studied mostly for inflammation and joint pain. Some research is promising, but quality is mixed and curcumin is po...

Read the full Turmeric monograph → Herb & supplement monograph

Fennel

Interacts with 740 drugs

Fennel is a Mediterranean herb widely used as a food and spice, and traditionally taken for digestive complaints, colic, and menstrual cramps. Some small studies suggest possible benefit for...

Read the full Fennel monograph → Herb & supplement monograph

Asparagus

Interacts with 76 drugs

Asparagus is a nutritious vegetable that is safe and healthy to eat as part of a normal diet. Most of its claimed medicinal benefits, such as use as a diuretic or for urinary health, come fr...

Read the full Asparagus monograph → Herb & supplement monograph

Beet

Interacts with 861 drugs

Beet, especially beetroot juice, is a nitrate-rich food that may modestly lower blood pressure and slightly improve exercise performance in some people. It is generally safe as a food, but s...

Read the full Beet monograph → Herb & supplement monograph

Banana

Interacts with 5 drugs

Bananas are a nutritious, widely eaten fruit that provide potassium, fiber, vitamin B6, and quick energy, and they are part of a healthy diet. While some traditional uses (like easing diarrh...

Read the full Banana monograph → Herb & supplement monograph

Spinach

Interacts with 88 drugs

Spinach is a nutrient-dense leafy green that is a healthy part of a balanced diet, providing vitamins, minerals, fiber, and antioxidants. While it is very safe as a food, concentrated supple...

Read the full Spinach monograph → Herb & supplement monograph

Kale

Kale is a nutrient-dense leafy green vegetable that is rich in vitamins, minerals, fiber, and antioxidants. Eaten as a normal food it is very healthy for most people, but it is a whole food...

Read the full Kale monograph → Herb & supplement monograph

Cranberry

Interacts with 712 drugs

Cranberry is best known for helping to prevent repeated urinary tract infections (UTIs) in some people, and the evidence here is moderate but mixed. It is not a reliable treatment for an act...

Read the full Cranberry monograph → Herb & supplement monograph

Brussels Sprout

Interacts with 241 drugs

Brussels sprouts are a nutritious cruciferous vegetable rich in fiber, vitamin C, vitamin K, and plant compounds called glucosinolates. Eating them as part of a balanced diet is healthy and...

Read the full Brussels Sprout monograph → Herb & supplement monograph

Broccoli

Interacts with 187 drugs

Broccoli is a nutritious cruciferous vegetable rich in fiber, vitamins, and plant compounds like sulforaphane that have drawn scientific interest for health benefits. Eating broccoli as food...

Read the full Broccoli monograph → Herb & supplement monograph

Papaya

Interacts with 92 drugs

Papaya is a tropical fruit that is nutritious and generally safe to eat as food, and it contains an enzyme called papain used as a digestive aid and meat tenderizer. Papaya leaf extract is b...

Read the full Papaya monograph → Herb & supplement monograph

Cauliflower

Interacts with 186 drugs

Cauliflower is a nutritious cruciferous vegetable that provides vitamin C, fiber, and plant compounds called glucosinolates. As a food it is healthy and safe for most people, but there is no...

Read the full Cauliflower monograph →
Sources

Sources & How We Checked

Digestive Enzymes'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 461 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.

Papain 11 references
  1. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
  2. Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Saf 1997;17:342-56.
  3. Shuttleworth D, Hill S, Marks R, Connelly DM. Relief of experimentally induced pruritus with a novel eutectic mixture of local anaesthetic agents. Br J Dermatol 1988;119:535-40.
  4. Mansfield LE, Ting S, Haverly RW, Yoo TJ. The incidence and clinical implications of hypersensitivity to papain in an allergic population, confirmed by blinded oral challenge. Ann Allergy 1985;55:541-3.
  5. Martin, T., Uhder, K., Kurek, R., Roeddiger, S., Schneider, L., Vogt, H. G., Heyd, R., and Zamboglou, N. Does prophylactic treatment with proteolytic enzymes reduce acute toxicity of adjuvant pelvic irradiation? Results of a double-blind randomized trial PubMed
  6. Walker-Renard, P. Update on the medicinal management of phytobezoars. Am J Gastroenterol. 1993;88(10):1663-1666.
  7. Tymoszuk D, Wiszniewska M, Walusiak-Skorupa J. Papain-induced occupational rhinoconjunctivitis and asthma - A case report. Med Pr 2016;67(1):109-12. PubMed
  8. Soto-Mera MT, López-Rico MR, Filgueira JF, et al. Occupational allergy to papain. Allergy 2000;55(10):983-4. PubMed
  9. Tarlo SM, Shaikh W, Bell B, et al. Papain-induced allergic reactions. Clin Allergy 1978;8(3):207-15. PubMed
  10. Baur X, König G, Bencze K, Fruhmann G. Clinical symptoms and results of skin test, RAST and bronchial provocation test in thirty-three papain workers: Evidence for strong immunogenic potency and clinically relevant proteolytic e?ects of airborne papain. C
  11. Novey HS, Keenan WJ, Fairshter RD, Wells ID, Wilson AF, Culver BD. Pulmonary disease in workers exposed to papain: clinico-physiological and immunological studies. Clin Allergy 1980;10(6):721-31. PubMed

See these in context on the Papain monograph →

Bromelain 19 references
  1. Nettis E, Napoli G, Ferrannini A, Tursi A. IgE-mediated allergy to bromelain. Allergy 2001;56:257-8. PubMed
  2. Taussig SJ, Batkin S. Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application. An update. J Ethnopharmacol 1988;22:191-203.. PubMed
  3. Bradbrook ID, Morrison PJ, Rogers HJ. The effect of bromelain on the absorption of orally administered tetracycline. Br J Clin Pharmacol 1978;6:552-4. PubMed
  4. Bush TM, Rayburn KS, Holloway SW, et al. Adverse interactions between herbal and dietary substances and prescription medications: a clinical survey. Altern Ther Health Med 2007;13:30-5.
  5. Brien S, Lewith G, Walker AF, et al. Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study. QJM 2006;99:841-50. PubMed
  6. Mori S, Ojima Y, Hirose T, et al. The clinical effect of proteolytic enzyme containing bromelain and trypsin on urinary tract infection evaluated by double blind method. Acta Obstet Gynaecol Jpn 1972;19:147-53.
  7. Glaser D, Hilberg T. The influence of bromelain on platelet count and platelet activity in vitro. Platelets 2006;17:37-41. PubMed
  8. Heinicke R M, van der Wal L, Yokoyama M. Effect of bromelain (Ananase) on human platelet aggregation. Experientia 1972;28:844-5. PubMed
  9. Gailhofer, G., Wilders-Truschnig, M., Smolle, J., and Ludvan, M. Asthma caused by bromelain: an occupational allergy. Clin Allergy 1988;18(5):445-450. PubMed
  10. Mattei, O., Fabri, G., and Farina, G. [Occupational health experience regarding four cases of asthma due to bromelain (author's transl)]. Medicina del Lavoro 1979;70(5):404-409.
  11. Galleguillos, F. and Rodriguez, J. C. Asthma caused by bromelin inhalation. Clin Allergy 1978;8(1):21-24. PubMed
  12. Perez-Camo I, Quirce S, Duran MA, and et al. Latex allergy: evidence of cross-reactivity with papain and bromelain [abstract]. Allergy 1996;51(suppl 31):48.
  13. Martin GJ, Ehrenreich J, and Asbell N. Bromelain: pineapple proteases with anti-edema activity. Exp Med Surg 1962;20:227-247.
  14. Kasemsuk T, Saengpetch N, Sibmooh N, Unchern S. Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis. Clin Rheumatol. 2016 Oct;35(10):2531-40. PubMed
  15. Kutlu Ö, DemirbaS A, Elmas ÖF, Güvenç U, Metin A. Fixed drug eruption: a new side effect of bromelain. Contact Dermatitis 2020. Online ahead of print. PubMed
  16. Shoham Y, Shapira E, Haik J, et al. Bromelain-based enzymatic debridement of chronic wounds: Results of a multicentre randomized controlled trial. Wound Repair Regen 2021;29(6):899-907. PubMed
  17. Pfister P, Garcia Wendel PD, Kim BS, et al. Coagulation side effects of enzymatic debridement in burned patients. Burns 2022. PubMed
  18. Hasham S, Riyat H, Fletcher A, O'Boyle CP, Alexander S. To bleed or not to bleed? Case series and discussion of haemorrhage risk with enzymatic debridement in burn injuries. Scars Burn Heal 2023;9:20595131231168333. PubMed
  19. Leelakanok N, Petchsomrit A, Janurai T, Saechan C, Sunsandee N. Efficacy and safety of bromelain: A systematic review and meta-analysis. Nutr Health 2023. PubMed

See these in context on the Bromelain monograph →

Proteolytic Enzymes (proteases) 3 references
  1. Weeks JA, Harper RA, Simon RA, Burdick JD. Assessment of sensitization risk of a laundry pre-spotter containing protease. Cutan Ocul Toxicol. 2011;30(4):272-9. PubMed
  2. Marquès LI, Lara S, Abós T, Bartolomé B. Occupational rhinitis due to pepsin. J Investig Allergol Clin Immunol. 2006;16(2):136-7. DOI
  3. Cartier A, Malo JL, Pineau L, Dolovich J. Occupational asthma due to pepsin. J Allergy Clin Immunol. 1984;73(5 Pt 1):574-7. PubMed

See these in context on the Proteolytic Enzymes (proteases) monograph →

Lipase 1 reference
  1. Casper C, Hascoet JM, Ertl T, et al. Recombinant bile salt-stimulated lipase in preterm infant feeding: A randomized phase 3 study. PLoS One. 2016;11(5):e0156071. PubMed

See these in context on the Lipase monograph →

Lactase 1 reference
  1. Laukkanen A, Ruoppi P, Remes S, Koistinen T, Mäkinen-Kiljunen S. Lactase-induced occupational protein contact dermatitis and allergic rhinoconjunctivitis. Contact Dermatitis. 2007;57(2):89-93. PubMed

See these in context on the Lactase monograph →

Bifidobacterium Longum 21 references
  1. Ha GY, Yang CH, Kim H, Chong Y. Case of sepsis caused by Bifidobacterium longum. J Clin Microbiol 1999;37:1227-8.
  2. Pierce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: The Stonesong Press, 1999:19.
  3. Xiao JZ, Takahashi S, Odamaki T, et al. Antibiotic susceptibility of bifidobacterial strains distributed in the Japanese market. Biosci Biotechnol Biochem. 2010;74(2):336-42. PubMed
  4. Rautava S, Kainonen E, Salminen S, Isolauri E. Maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of eczema in the infant. J Allergy Clin Immunol. 2012;130(6):1355-60. PubMed
  5. Pruccoli G, Silvestro E, Pace Napoleone C, Aidala E, Garazzino S, Scolfaro C. Are probiotics safe? Bifidobacterium bacteremia in a child with severe heart failure. Infez Med. 2019;27(2):175-178.
  6. Pellonperä O, Vahlberg T, Mokkala K, et al. Weight gain and body composition during pregnancy: a randomised pilot trial with probiotics and/or fish oil. Br J Nutr. 2020 Nov 4:1-11. PubMed
  7. Pellonperä O, Mokkala K, Houttu N, et al. Efficacy of fish oil and/or probiotic intervention on the incidence of gestational diabetes mellitus in an at-risk group of overweight and obese women: A randomized, placebo-controlled, double-blind clinical trial PubMed
  8. Shahriari A, Karimi E, Shahriari M, Aslani N, Khooshideh M, Arab A. The effect of probiotic supplementation on the risk of gestational diabetes mellitus among high-risk pregnant women: A parallel double-blind, randomized, placebo-controlled clinical trial PubMed
  9. Esaiassen E, Hjerde E, Cavanagh JP, Simonsen GS, Klingenberg C; Norwegian Study Group on Invasive Bifidobacterial Infections. Bifidobacterium bacteremia: Clinical characteristics and a genomic approach to assess pathogenicity. J Clin Microbiol. 2017;55(7) PubMed
  10. Enomoto T, Sowa M, Nishimori K, et al. Effects of bifidobacterial supplementation to pregnant women and infants in the prevention of allergy development in infants and on fecal microbiota. Allergol Int 2014;63(4):575-85. PubMed
  11. US Food and Drug Administration (FDA). Dear Healthcare Provider Letter: Warning Regarding Use of Probiotics in Preterm Infants. September 2023. Available at: https://www.fda.gov/media/172606/download?attachment. Accessed November 1, 2023.
  12. Pillai A, Tan J, Paquette V, Panczuk J. Does probiotic bacteremia in premature infants impact clinically relevant outcomes? A case report and updated review of literature. Clin Nutr ESPEN. 2020;39:255-259. PubMed
  13. Sabaté JM, Iglicki F. Effect of Bifidobacterium longum 35624 on disease severity and quality of life in patients with irritable bowel syndrome. World J Gastroenterol 2022;28(7):732-744.
  14. Malaguarnera M, Greco F, Barone G, Gargante MP, Malaguarnera M, Toscano MA. Bifidobacterium longum with fructo-oligosaccharide (FOS) treatment in minimal hepatic encephalopathy: a randomized, double-blind, placebo-controlled study. Dig Dis Sci 2007;52(11) PubMed
  15. Zbinden A, Zbinden R, Berger C, Arlettaz R. Case series of Bifidobacterium longum bacteremia in three preterm infants on probiotic therapy. Neonatology 2015;107(1):56-9.
  16. Tamaki H, Nakase H, Inoue S, et al. Efficacy of probiotic treatment with Bifidobacterium longum 536 for induction of remission in active ulcerative colitis: A randomized, double-blinded, placebo-controlled multicenter trial. Dig Endosc 2016;28(1):67-74.
  17. Bertelli C, Pillonel T, Torregrossa A, et al. Bifidobacterium longum bacteremia in preterm infants receiving probiotics. Clin Infect Dis 2015;60(6):924-7. PubMed
  18. Esaiassen E, Cavanagh P, Hjerde E, Simonsen GS, Støen R, Klingenberg C. Bifidobacterium longum subspecies infantis bacteremia in 3 extremely preterm infants receiving probiotics. Emerg Infect Dis 2016;22(9):1664-6.
  19. Tena D, Losa C, Medina MJ, Sáez-Nieto JA. Peritonitis caused by Bifidobacterium longum: case report and literature review. Anaerobe 2014;27:27-30. PubMed
  20. Sangkanjanavanich S, Pradubpongsa P, Mitthamsiri W, Sangasapaviliya A, Boonpiyathad T. Bifidobacterium infantis 35624 efficacy in patients with uncontrolled asthma: A randomized placebo-controlled trial. Ann Allergy Asthma Immunol 2022;129(6):790-792. PubMed
  21. Wilson HL, Ong CW. Bifidobacterium longum vertebrodiscitis in a patient with cirrhosis and prostate cancer. Anaerobe 2017;47:47-50. PubMed

See these in context on the Bifidobacterium Longum monograph →

Peppermint 41 references
  1. Liu JH, Chen GH, Yeh HZ, et al. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol 1997;32:765-8. PubMed
  2. Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis. Am J Gastroenterol 1998;93:1131-5. PubMed
  3. Kline RM, Kline JJ, Di Palma J, Barbero GJ. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr 2001;138:125-8. PubMed
  4. Madisch A, Heydenreich CJ, Wieland V, et al. Treatment of functional dyspepsia with a fixed peppermint oil and caraway oil combination preparation as compared to cisapride. A multicenter, reference-controlled, double-blind equivalence study. Arzneimittel
  5. May B, Kuntz HD, Kieser M, Kohler S. Efficacy of a fixed peppermint oil/caraway oil combination in non-ulcer dyspepsia. Arzneimittelforschung 1996;46:1149-53.
  6. Micklefield GH, Greving I, May B. Effects of peppermint oil and caraway oil on gastroduodenal motility. Phytother Res 2000;14:20-3. DOI
  7. Morton CA, Garioch J, Todd P, et al. Contact sensitivity to menthol and peppermint in patients with intra-oral symptoms. Contact Dermatitis 1995;32:281-4. PubMed
  8. May B, Kohler S, Schneider B. Efficacy and tolerability of a fixed combination of peppermint oil and caraway oil in patients suffering from functional dyspepsia. Aliment Pharmacol Ther 2000;14:1671-7. PubMed
  9. Nash P, Gould SR, Bernardo DE. Peppermint oil does not relieve the pain of irritable bowel syndrome. Br J Clin Pract 1986;40:292-3. DOI
  10. Rees WD, Evans BK, Rhodes J. Treating irritable bowel syndrome with peppermint oil. Br Med J 1979;2:835-6. PubMed
  11. Davies SJ, Harding LM, Baranowski AP. A novel treatment of postherpetic neuralgia using peppermint oil. Clin J Pain 2002;18:200-2. PubMed
  12. Weston CF. Anal burning and peppermint oil. Postgrad Med J 1987;63:717. PubMed
  13. Dresser GK, Wacher V, Wong S, et al. Evaluation of peppermint oil and ascorbyl palmitate as inhibitors of cytochrome P4503A4 activity in vitro and in vivo. Clin Pharmacol Ther 2002;72:247-55. PubMed
  14. Wacher VJ, Wong S, Wong HT. Peppermint oil enhances cyclosporine oral bioavailability in rats: comparison with D-alpha-tocopheryl poly(ethylene glycol 1000) succinate (TPGS) and ketoconazole. J Pharm Sci 2002;91:77-90.
  15. Lawson MJ, Knight RE, Tran K, et al. Failure of enteric-coated peppermint oil in the irritable bowel syndrome: a randomized double-blind crossover study. J Gastroenterol Hepatol 1988;3:235-8. DOI
  16. Unger M, Frank A. Simultaneous determination of the inhibitory potency of herbal extracts on the activity of six major cytochrome P450 enzymes using liquid chromatography/mass spectrometry and automated online extraction. Rapid Commun Mass Spectrom 2004;1 PubMed
  17. Maliakal PP, Wanwimolruk S. Effect of herbal teas on hepatic drug metabolizing enzymes in rats. J Pharm Pharmacol 2001;53:1323-9. PubMed
  18. Rogers SN, Pahor AL. A form of stomatitis induced by excessive peppermint consumption. Dent Update 1995;22:36-7.
  19. Cappello G, Spezzaferro M, Grossi L, et al. Peppermint oil (Mintoil) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial. Dig Liver Dis 2007;39:530-6. PubMed
  20. Moghadam BK, Gier R, and Thurlow T. Extensive oral mucosal ulcerations caused by misuse of a commercial mouthwash. Cutis 1999;64:131-134.
  21. Andersen, K. E. Contact allergy to toothpaste flavors. Contact Dermatitis 1978;4(4):195-198. PubMed
  22. Barnard, D. R. Repellency of essential oils to mosquitoes (Diptera: Culicidae). J Med Entomol. 1999;36(5):625-629. PubMed
  23. Tamir, S., Davidovich, Z., Attal, P., and Eliashar, R. Peppermint oil chemical burn. Otolaryngol.Head Neck Surg. 2005;133(5):801-802. PubMed
  24. Kalavala, M., Hughes, T. M., Goodwin, R. G., Anstey, A. V., and Stone, N. M. Allergic contact dermatitis to peppermint foot spray. Contact Dermatitis 2007;57(1):57-58. PubMed
  25. Vermaat, H., van Meurs, T., Rustemeyer, T., Bruynzeel, D. P., and Kirtschig, G. Vulval allergic contact dermatitis due to peppermint oil in herbal tea. Contact Dermatitis 2008;58(6):364-365. PubMed
  26. Merat, S., Khalili, S., Mostajabi, P., Ghorbani, A., Ansari, R., and Malekzadeh, R. The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome. Dig.Dis.Sci. 2010;55(5):1385-1390. PubMed
  27. Tran, A., Pratt, M., and DeKoven, J. Acute allergic contact dermatitis of the lips from peppermint oil in a lip balm. Dermatitis 2010;21(2):111-115. DOI
  28. Hitz, Lindenmuller, I and Lambrecht, J. T. Oral care. Curr Probl.Dermatol 2011;40:107-115.
  29. Shavakhi, A., Ardestani, S. K., Taki, M., Goli, M., and Keshteli, A. H. Premedication with peppermint oil capsules in colonoscopy: a double blind placebo-controlled randomized trial study. Acta Gastroenterol Belg 2012;75(3):349-353.
  30. Lech, Y., Olesen, K. M., Hey, H., Rask-Pedersen, E., Vilien, M., and Ostergaard, O. [Treatment of irritable bowel syndrome with peppermint oil. A double- blind study with a placebo]. Ugeskr.Laeger 10-3-1988;150(40):2388-2389.
  31. Parys, B. T. Chemical burns resulting from contact with peppermint oil mar: a case report. Burns Incl.Therm.Inj. 1983;9(5):374-375. PubMed
  32. Bayat R, Borici-Mazi R. A case of anaphylaxis to peppermint. Allergy Asthma Clin Immunol. 2014;10(1):6. PubMed
  33. Rich G, Shah A, Koloski N, et al. A randomized placebo-controlled trial on the effects of Menthacarin, a proprietary peppermint- and caraway-oil-preparation, on symptoms and quality of life in patients with functional dyspepsia. Neurogastroenterol Motil 2 PubMed
  34. Douros A, Bronder E, Andersohn F, et al. Herb-Induced Liver Injury in the Berlin Case-Control Surveillance Study. Int J Mol Sci 2016;17(1). PubMed
  35. Begas E, Tsioutsiouliti A, Kouvaras E, et al. Effects of peppermint tea consumption on the activities of CYP1A2, CYP2A6, Xanthine Oxidase, N-acetyltranferase-2 and UDP-glucuronosyltransferases-1A1/1A6 in healthy volunteers. Food Chem Toxicol 2017;100:80-9 PubMed
  36. Cash BD, Epstein MS, Shah SM. A Novel Delivery System of Peppermint Oil Is an Effective Therapy for Irritable Bowel Syndrome Symptoms. Dig Dis Sci 2016;61(2):560-71. PubMed
  37. Elsaie LT, El Mohsen AM, Ibrahim IM, Mohey-Eddin MH, Elsaie ML. Effectiveness of topical peppermint oil on symptomatic treatment of chronic pruritus. Clin Cosmet Investig Dermatol 2016;9:333-8. PubMed
  38. Wu J, Xu R, Zhan R, et al. Effective symptomatic treatment for severe and intractable pruritus associated with severe burn-induced hypertrophic scars: A prospective, multicenter, controlled trial. Burns 2016;42(5):1059-66. PubMed
  39. Weerts ZZRM, Masclee AAM, Witteman BJM, et al. Efficacy and safety of peppermint oil in a randomized, double-blind trial of patients with irritable bowel syndrome. Gastroenterology. 2020;158(1):123-136. PubMed
  40. Nee J, Ballou S, Kelley JM, et al. Peppermint Oil Treatment for Irritable Bowel Syndrome: A Randomized Placebo-Controlled Trial. Am J Gastroenterol 2021;116(11):2279-2285. PubMed
  41. Ingrosso MR, Ianiro G, Nee J, et al. Systematic review and meta-analysis: efficacy of peppermint oil in irritable bowel syndrome. Aliment Pharmacol Ther 2022;56(6):932-41. PubMed

See these in context on the Peppermint monograph →

Ginger 64 references
  1. Fischer-Rasmussen W, Kjaer SK, Dahl C, Asping U. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 1991;38:19-24. PubMed
  2. Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev 2000;(2):CD000145. PubMed
  3. Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol 2001;97:577-82. DOI
  4. Backon J. Ginger in preventing nausea and vomiting of pregnancy; a caveat due to its thromboxane synthetase activity and effect on testosterone binding. Eur J Obstet Gynecol Reprod Biol 1991;42:163-4. PubMed
  5. Srivastava KC. Effect of onion and ginger consumption on platelet thromboxane production in humans. Prostaglandins Leukot Essent Fatty Acids 1989;35:183-5. PubMed
  6. Stewart JJ, Wood MJ, Wood CD, Mims ME. Effects of ginger on motion sickness susceptibility and gastric function. Pharmacology 1991;42:111-20. PubMed
  7. Smith C, Crowther C, Willson K, et al. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet Gynecol 2004;103:639-45. PubMed
  8. Portnoi G, Chng LA, Karimi-Tabesh L, et al. Prospective comparative study of the safety and effectiveness of ginger for the treatment of nausea and vomiting in pregnancy. Am J Obstet Gynecol 2003;189:1374-7.. PubMed
  9. Wigler I, Grotto I, Caspi D, Yaron M. The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Osteoarthritis Cartilage 2003;11:783-9. PubMed
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Lactobacillus Acidophilus 15 references
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Fennel 17 references
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Asparagus 14 references
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Beet 14 references
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Banana 11 references
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Spinach 6 references
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Bifidobacterium Bifidum 7 references
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Kale 2 references
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  2. Lutein and Zeaxanthin — NIH Office of Dietary Supplements Source

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Agave 8 references
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  2. Brenner S, Landau M, Goldberg I. Contact dermatitis with systemic symptoms from Agave americana. Dermatology 1998;196(4):408-411.
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  5. Ricks MR, Vogel PS, Elston DM, et al. Purpuric agave dermatitis. J Am Acad Dermatol 1999;40(2 Pt 2):356-358. PubMed
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  8. Cherpelis BS, Fenske NA. Purpuric irritant contact dermatitis induced by Agave americana. Cutis 2000;66(4):287-8.

See these in context on the Agave monograph →

Fucus Vesiculosus 15 references
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  2. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
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  11. Cumashi, A., Ushakova, N. A., Preobrazhenskaya, M. E., D'Incecco, A., Piccoli, A., Totani, L., Tinari, N., Morozevich, G. E., Berman, A. E., Bilan, M. I., Usov, A. I., Ustyuzhanina, N. E., Grachev, A. A., Sanderson, C. J., Kelly, M., Rabinovich, G. A., I
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  13. Arbaizar, B. and Llorca, J. [Fucus vesiculosus induced hyperthyroidism in a patient undergoing concomitant treatment with lithium]. Actas Esp.Psiquiatr. 2011;39(6):401-403.
  14. Church FC, Meade JB, Treanor RE, and et al. Antithrombin activity of fucoidan. The interaction of fucoidan with heparin cofactor II, antithrombin III, and thrombin. J Biol Chem 2-25-1989;264(6):3618-3623. DOI
  15. Mathew L, Burney M, Gaikwad A, et al. Preclinical evaluation of safety of fucoidan extracts from Undaria pinnatifida and Fucus vesiculosus for use in cancer treatment. Integr Cancer Ther 2017;16(4):572-84.

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Cranberry 33 references
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  7. Lilja JJ, Backman JT, Neuvonen PJ. Effects of daily ingestion of cranberry juice on the pharmacokinetics of warfarin, tizanidine, and midazolam - probes of CYP2C9, CYP1A2 and CYP3A4. Clin Pharmacol The 2007:81:833-9. PubMed
  8. Wing DA, Rumney PJ, Preslicka CW, Chung JH. Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study. J Urol 2008;180:1367-72. PubMed
  9. Mohammed Abdul MI, Jiang X, Williams KM, et al. Pharmacodynamic interaction of warfarin with cranberry but not with garlic in healthy subjects. Br J Pharmacol 2008;154:1691-700. PubMed
  10. McMurdo MET, Argo I, Phillips G, et al. Cranberry or trimethoprim for the prevention of recurrently urinary tract infections? A randomized controlled trial in older women. J Antimicrob Chemother 2009;63:389-95.
  11. Mergenhagen KA, Sherman O. Elevated International Normalized Ratio after concurrent ingestion of cranberry sauce and warfarin. Am J Health-Syst Pharm 2008;65:2113-6. PubMed
  12. Ansell J, McDonough M, Zhao Y, et al. The absence of an interaction between warfarin and cranberry juice: a randomized, double-blind trial. J Clin Pharmacol 2009;49:824-30. PubMed
  13. Haber SL, Cauthon KA, Raney EC. Cranberry and warfarin interaction: a case report and review of the literature. Consult Pharm 2012;27:58-65. PubMed
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  16. Garcia-Calatayud, S., Larreina Cordoba, J. J., and Lozano De La Torre MJ. [Severe cranberry juice poisoning]. An.Esp.Pediatr. 2002;56(1):72-73.
  17. Patel, D. A., Gillespie, B., Sobel, J. D., Leaman, D., Nyirjesy, P., Weitz, M. V., and Foxman, B. Risk factors for recurrent vulvovaginal candidiasis in women receiving maintenance antifungal therapy: results of a prospective cohort study. Am J Obstet.Gy PubMed
  18. Isele, H. [Fatal bleeding under warfarin plus cranberry juice. Is it due to salicylic acid?]. MMW.Fortschr.Med 3-11-2004;146(11):13.
  19. Linsenmeyer, T. A., Harrison, B., Oakley, A., Kirshblum, S., Stock, J. A., and Millis, S. R. Evaluation of cranberry supplement for reduction of urinary tract infections in individuals with neurogenic bladders secondary to spinal cord injury. A prospecti
  20. McMurdo, M. E., Bissett, L. Y., Price, R. J., Phillips, G., and Crombie, I. K. Does ingestion of cranberry juice reduce symptomatic urinary tract infections in older people in hospital? A double-blind, placebo-controlled trial. Age Ageing 2005;34(3):256- PubMed
  21. Sylvan, L. and Justice, N. P. Possible interaction between warfarin and cranberry juice. Am Fam.Physician 9-15-2005;72(6):1000.
  22. Niklasson, A. and Andren, L. [Interaction between Waran and cranberry juice]. Lakartidningen 3-15-2006;103(11):853-854.
  23. Rindone, J. P. and Murphy, T. W. Warfarin-cranberry juice interaction resulting in profound hypoprothrombinemia and bleeding. Am J Ther 2006;13(3):283-284. PubMed
  24. Uesawa, Y. and Mohri, K. Effects of cranberry juice on nifedipine pharmacokinetics in rats. J Pharm Pharmacol 2006;58(8):1067-1072. PubMed
  25. Valentova, K., Stejskal, D., Bednar, P., Vostalova, J., Cihalik, C., Vecerova, R., Koukalova, D., Kolar, M., Reichenbach, R., Sknouril, L., Ulrichova, J., and Simanek, V. Biosafety, antioxidant status, and metabolites in urine after consumption of dried
  26. Royer, D. J., George, J. N., and Terrell, D. R. Thrombocytopenia as an adverse effect of complementary and alternative medicines, herbal remedies, nutritional supplements, foods, and beverages. Eur J Haematol 2010;84(5):421-429. PubMed
  27. Stapleton, A. E., Dziura, J., Hooton, T. M., Cox, M. E., Yarova-Yarovaya, Y., Chen, S., and Gupta, K. Recurrent urinary tract infection and urinary Escherichia coli in women ingesting cranberry juice daily: a randomized controlled trial. Mayo.Clin.Proc. PubMed
  28. Doad GJ, Kabange W. Cranberry juice, atorvastatin and back pain. J Med Assoc Ga 2014;103(1):14.
  29. Griffiths AP, Beddall A, Pegler S. Fatal haemopericardium and gastrointestinal haemorrhage due to possible interaction of cranberry juice with warfarin. J R Soc Promot Health 2008;128(6):324-6. PubMed
  30. Mellen CK, Ford M, Rindone JP. Effect of high-dose cranberry juice on the pharmacodynamics of warfarin in patients. Br J Clin Pharmacol 2010;70(1):139-42. PubMed
  31. Ushijima K, Tsuruoka S, Tsuda H, Hasegawa G, Obi Y, Kaneda T, Takahashi M, Maekawa T, Sasaki T, Koshimizu TA, Fujimura A. Cranberry juice suppressed the diclofenac metabolism by human liver microsomes, but not in healthy human subjects. Br J Clin Pharmaco PubMed
  32. Ngo N, Brantley SJ, Carrizosa DR, et al. The warfarin-cranberry juice interaction revisited: A systematic in vitro-in vivo evaluation. J Exp Pharmacol. 2010;2010(2):83-91.
  33. Williams G, Stothart CI, Hahn D, Stephens JH, Craig JC, Hodson EM. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 2023;11(11):CD001321. PubMed

See these in context on the Cranberry monograph →

Brussels Sprout 19 references
  1. Pantuck EJ, Pantuck CB, Anderson KE, et al. Effect of brussels sprouts and cabbage on drug conjugation. Clin Pharmacol Ther 1984;35:161-9. PubMed
  2. Joshipura KJ, Ascherio A, Manson JE, et al. Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 1999;282:1233-39. PubMed
  3. Zhao H, Lin J, Grossman HB, et al. Dietary isothiocyanates, GSTM1, GSTT1, NAT2 polymorphisms and bladder cancer risk. Int J Cancer 2007;120:2208-13.
  4. Cohen, J. H., Kristal, A. R., and Stanford, J. L. Fruit and vegetable intakes and prostate cancer risk. J Natl.Cancer Inst. 1-5-2000;92(1):61-68. PubMed
  5. Kolonel, L. N., Hankin, J. H., Whittemore, A. S., Wu, A. H., Gallagher, R. P., Wilkens, L. R., John, E. M., Howe, G. R., Dreon, D. M., West, D. W., and Paffenbarger, R. S., Jr. Vegetables, fruits, legumes and prostate cancer: a multiethnic case-control st
  6. Kissel JT, Scott CB, Reyna SP, Crawford TO, Simard LR, Krosschell KJ, Acsadi G, Elsheik B, Schroth MK, D'Anjou G, LaSalle B, Prior TW, Sorenson S, Maczulski JA, Bromberg MB, Chan GM, Swoboda KJ; Project Cure Spinal Muscular Atrophy Investigators' Network.
  7. Ovesen L, Lyduch S, Idorn ML. The effect of a diet rich in Brussels sprouts on warfarin pharmacokinetics. Eur J Clin Pharmacol 1998;34(5):521-523. PubMed
  8. Wortelboer HM, de Kruif CA, van Iersel AAJ, et al. Effects of cooked Brussels sprouts on cytochrome P-450 profile and phase II enzymes in liver and small intestinal mucosa of the rat. Food Chem Toxicol 1992;30(1):17-27. PubMed
  9. Michaud DS, Spiegelman D, Clinton SK, et al. Fruit and vegetable intake and incidence of bladder cancer in a male prospective cohort. J Natl Cancer Inst 1999;91(7):605-13. PubMed
  10. Chang ET, Smedby KE, Zhang SM, et al. Dietary factors and risk of non-Hodgkin lymphoma in men and women. Cancer Epidemiol Biomarkers Prev 2005;14(2):512-20. PubMed
  11. Liu S, Serdula M, Janket SJ, et al. A prospective study of fruit and vegetable intake and the risk of type 2 diabetes in women. Diabetes Care 2004;27(12):2993-6. PubMed
  12. Gaudet MM, Britton JA, Kabat GC, et al. Fruits, vegetables, and micronutrients in relation to breast cancer modified by menopause and hormone receptor status. Cancer Epidemiol Biomarkers Prev 2004;13(9):1485-94. DOI
  13. Smith-Warner SA, Spiegelman D, Yaun SS, et al. Intake of fruits and vegetables and risk of breast cancer: a pooled analysis of cohort studies. JAMA 2001;285(6):769-76.
  14. Rohrmann S, Giovannucci E, Willett WC, Platz EA. Fruit and vegetable consumption, intake of micronutrients, and benign prostatic hyperplasia in US men. Am J Clin Nutr 2007;85(2):523-9. PubMed
  15. Brennan P, Hsu CC, Moullan N, et al. Effect of cruciferous vegetables on lung cancer in patients stratified by genetic status: a mendelian randomisation approach. Lancet 2005;366(9496):1558-60. PubMed
  16. Allaby RG, Peterson GW, Merriwether DA, Fu YB. Evidence of the domestication history of flax (Linum usitatissimum L.) from genetic diversity of the sad2 locus. Theor Appl Genet. 2005 Dec;112(1):58-65. PubMed
  17. Davis SJ, Arscott SA, Goltz S, Muir C, Binkley N, Tanumihardjo SA. Urinary 2- to 16a-hydroxyestrone ratio did not change with cruciferous vegetable intake in premenopausal women. Int J Vitam Nutr Res. 2023 Jun 19. doi: 10.1024/0300-9831/a000785.
  18. Madsen H, Sen A, Aune D. Fruit and vegetable consumption and the risk of hypertension: a systematic review and meta-analysis of prospective studies. Eur J Nutr. 2023 Aug;62(5):1941-1955. PubMed
  19. Halvorsen RE, Elvestad M, Molin M, Aune D. Fruit and vegetable consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of prospective studies. BMJ Nutr Prev Health. 2021 Jul 2;4(2):519-531. PubMed

See these in context on the Brussels Sprout monograph →

Broccoli 5 references
  1. Kristal AR, Lampe JW. Brassica vegetables and prostate cancer risk: a review of the epidemiological evidence. Nutr Cancer 2002;42:1-9. PubMed
  2. Chakrabarti A, Prais L, Foulds IS. Allergic contact dermatitis to broccoli. Br J Dermatol 2003;148:172-3. PubMed
  3. Hakooz, N. and Hamdan, I. Effects of dietary broccoli on human in vivo caffeine metabolism: a pilot study on a group of Jordanian volunteers. Curr Drug Metab 2007;8(1):9-15. PubMed
  4. Kall MA, Vang O, Clausen J. Effects of dietary broccoli on human drug metabolising activity. Cancer Lett. 1997;114(1-2):169-70. PubMed
  5. Bauman JE, Hsu CH, Centuori S, et al. Randomized Crossover Trial Evaluating Detoxification of Tobacco Carcinogens by Broccoli Seed and Sprout Extract in Current Smokers. Cancers (Basel). 2022;14(9):2129. Published 2022 Apr 24. PubMed

See these in context on the Broccoli monograph →

Papaya 14 references
  1. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
  2. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.
  3. Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Saf 1997;17:342-56.
  4. Mansfield LE, Ting S, Haverly RW, Yoo TJ. The incidence and clinical implications of hypersensitivity to papain in an allergic population, confirmed by blinded oral challenge. Ann Allergy 1985;55:541-3.
  5. Blanco C, Diaz-Perales A, Collada C, et al. Class I chitinases as potential panallergens involved in the latex-fruit syndrome. J Allergy Clin Immunol 1999;103(3 Pt 1):507-13. PubMed
  6. Diaz-Perales A, Collada C, Blanco C, et al. Cross-reactions in the latex-fruit syndrome: A relevant role of chitinases but not of complex asparagine-linked glycans. J Allergy Clin Immunol 1999;104:681-7. PubMed
  7. Castillo, R., Delgado, J., Quiralte, J., Blanco, C., and Carrillo, T. Food hypersensitivity among adult patients: epidemiological and clinical aspects. Allergol.Immunopathol.(Madr.) 1996;24(3):93-97.
  8. Oderinde, O., Noronha, C., Oremosu, A., Kusemiju, T., and Okanlawon, O. A. Abortifacient properties of aqueous extract of Carica papaya (Linn) seeds on female Sprague-Dawley rats. Niger.Postgrad.Med J 2002;9(2):95-98. DOI
  9. Danese, C., Esposito, D., D'Alfonso, V., Cirene, M., Ambrosino, M., and Colotto, M. Plasma glucose level decreases as collateral effect of fermented papaya preparation use. Clin Ter. 2006;157(3):195-198.
  10. Iliev, D. and Elsner, P. Generalized drug reaction due to papaya juice in throat lozenges. Dermatology 1997;194(4):364-366. PubMed
  11. Andersen HA, Bernatz PE, Grindlay JH. Perforation of the esophagus after use of a digestant agent: report of case and experimental study. Ann Otol Rhinol Laryngol 1959;68:890-6. PubMed
  12. Deiana L, Marini S, Mariotti S. Ingestion of large amounts of papaya fruit and impaired effectiveness of levothyroxine therapy. Endocr Pract 2012;18(1):98-100. PubMed
  13. Rodrigues M, Alves G, Francisco J, Fortuna A, Falcão A. Herb-drug pharmacokinetic interaction between Carica papaya extract and amiodarone in rats. J Pharm Pharm Sci 2014;17(3):302-15. PubMed
  14. Rajapakse S, de Silva NL, Weeratunga P, Rodrigo C, Sigera C, Fernando SD. Carica papaya extract in dengue: a systematic review and meta-analysis. BMC Complement Altern Med. 2019;19(1):265. PubMed

See these in context on the Papaya monograph →

Cauliflower 9 references
  1. Joshipura KJ, Ascherio A, Manson JE, et al. Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 1999;282:1233-39. PubMed
  2. Zhao H, Lin J, Grossman HB, et al. Dietary isothiocyanates, GSTM1, GSTT1, NAT2 polymorphisms and bladder cancer risk. Int J Cancer 2007;120:2208-13.
  3. Cohen, J. H., Kristal, A. R., and Stanford, J. L. Fruit and vegetable intakes and prostate cancer risk. J Natl.Cancer Inst. 1-5-2000;92(1):61-68. PubMed
  4. Michaud DS, Spiegelman D, Clinton SK, et al. Fruit and vegetable intake and incidence of bladder cancer in a male prospective cohort. J Natl Cancer Inst 1999;91(7):605-13. PubMed
  5. Feskanich D, Ziegler RG, Michaud DS, et al. Prospective study of fruit and vegetable consumption and risk of lung cancer among men and women. J Natl Cancer Inst 2000;92(22):1812-23. PubMed
  6. Chang ET, Smedby KE, Zhang SM, et al. Dietary factors and risk of non-Hodgkin lymphoma in men and women. Cancer Epidemiol Biomarkers Prev 2005;14(2):512-20. PubMed
  7. Liu S, Serdula M, Janket SJ, et al. A prospective study of fruit and vegetable intake and the risk of type 2 diabetes in women. Diabetes Care 2004;27(12):2993-6. PubMed
  8. Gaudet MM, Britton JA, Kabat GC, et al. Fruits, vegetables, and micronutrients in relation to breast cancer modified by menopause and hormone receptor status. Cancer Epidemiol Biomarkers Prev 2004;13(9):1485-94. DOI
  9. Peterson S, Schwarz Y, Li SS, et al. CYP1A2, GSTM1, and GSTT1 polymorphisms and diet effects on CYP1A2 activity in a crossover feeding trial. Cancer Epidemiol Biomarkers Prev 2009;18(11):3118-25.

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DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

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