Interactions on record — worth a quick check against your medications. Check your meds →
Dietary supplement

Epic Pro Ingredients & Drug Interactions

by Swanson

Epic Pro label
See full label image
Capsule Category: Other Combinations
Most serious interaction: Moderate
Clinical methodology reviewed by · Updated Sep 16, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Epic Pro 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

Epic Pro is a dietary supplement by Swanson with 2 active ingredients. Its ingredients are commonly taken for digestive health and balance, diarrhea (including antibiotic-related), vaginal yeast and bacterial infections.Based on those ingredients, 222 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are Probiotic Blend. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

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Check Your Meds Against Epic Pro by Swanson

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

Pharmacist-reviewed data Checks every ingredient Answer in seconds
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HelloPharmacist Scorecard of Epic Pro by Swanson

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 1 of its 26 active ingredients.
  • “Probiotic Blend” is a proprietary blend — the label gives one combined amount (175 mg) without saying how much of each component you get.

Epic Pro is a multi-strain probiotic capsule containing 26 active ingredients—primarily beneficial bacteria (Lactobacillus and Bifidobacterium species) and a live yeast (Saccharomyces boulardii). These are live microorganisms meant to support your gut flora.

The product also includes FOS (a prebiotic fiber that feeds beneficial bacteria). The capsule itself is made from inactive ingredients: hypromellose, gellan gum, microcrystalline cellulose, calcium palmitate, and silica.

Does it work?

Moderate 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
Moderate

Some clinical evidence supports this product's ingredients for its stated purpose, but it isn't conclusive.

Why this rating?
  • The label markets this product for: supports gastrointestinal balance and bowel regularity.
  • We looked for evidence on: Antibiotic-associated diarrhea, Clostridioides difficile infection, Constipation, Diarrhea, Dyspepsia, Abdominal pain — and 4 related terms.
  • The strongest evidence on file: Saccharomyces Boulardii is rated "Possibly Effective" for Antibiotic-associated diarrhea (Natural Medicines).
  • Also on file: Saccharomyces Boulardii is rated "Possibly Effective" for Rotaviral diarrhea, Travelers' diarrhea, Clostridioides difficile infection.
  • Also on file: Lactobacillus Acidophilus is rated "Possibly Effective" for Antibiotic-associated diarrhea, Irritable bowel syndrome (IBS).

The evidence for Epic Pro's individual strains is mixed. Saccharomyces boulardii shows the strongest data—it's possibly effective for travelers' diarrhea, antibiotic-associated diarrhea, rotaviral diarrhea, Clostridioides difficile infection (a serious diarrheal illness), Helicobacter pylori, and necrotizing enterocolitis.

Lactobacillus acidophilus is possibly effective for irritable bowel syndrome (IBS), antibiotic-associated diarrhea, Helicobacter pylori, and bacterial vaginosis. Bifidobacterium bifidum is possibly effective for IBS and respiratory tract infections.

For most of the other strains in this blend, the evidence isn't strong enough yet—the data we hold rates them as insufficient to say whether they work for the conditions that have been studied.

The evidence, ingredient by ingredient Lactobacillus Acidophilus Bifidobacterium Breve Bifidobacterium Longum Streptococcus Thermophilus Lactobacillus Delbrueckii Lactobacillus Helveticus Saccharomyces Boulardii Bifidobacterium Bifidum

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 9 of the 9 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 9 of 9.
  • General safety write-ups exist for 9 of 9.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

This product is generally well tolerated in healthy adults and children. However, if you're critically ill, immunocompromised, or have a weakened immune system, the safety data advise caution—in rare cases, the live organisms have caused serious infections (bacteremia or sepsis) in people in those situations, particularly those with indwelling catheters or in intensive care.

Gastrointestinal side effects like bloating, flatulence, abdominal discomfort, and diarrhea have been reported, though they're uncommon. The safety data for pregnancy and lactation are incomplete for most ingredients; for Lactobacillus acidophilus and Bifidobacterium bifidum, the rating is possibly safe, but for several others—including Bifidobacterium breve, Bifidobacterium longum, Lactobacillus bulgaricus, Lactobacillus helveticus, and Saccharomyces boulardii—there isn't enough data to know either way, so talk with your doctor or pharmacist for personalized advice if you're pregnant or nursing.

Side effects, ingredient by ingredient Lactobacillus Acidophilus Bifidobacterium Breve Bifidobacterium Longum Streptococcus Thermophilus Lactobacillus Delbrueckii Lactobacillus Helveticus Saccharomyces Boulardii Bifidobacterium Bifidum

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?
  • 8 of the 9 matched ingredients can interact with medications — Saccharomyces Boulardii, Lactobacillus Acidophilus, Bifidobacterium Breve, Bifidobacterium Bifidum, Bifidobacterium Longum, among others.
  • The most serious interaction on file is rated Moderate.
  • For scale: 222 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 you take Epic Pro, double-check with your doctor or pharmacist if you're on antibiotic drugs—they're the most serious interaction (Moderate severity), and you'll need to separate when you take them. If you use antifungal medications, that's a Minor interaction to flag as well.

No other medication interactions are documented for the ingredients we could check.

Check your own medication Run your meds through the checker above

The bottom line

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

Epic Pro is a multi-strain probiotic best suited for people in good general health who want digestive or immune support. If you're taking antibiotics or antifungals, timing matters—you'll need to space them out from this product.

Anyone who is seriously ill, immunocompromised, or pregnant should check with their doctor or pharmacist first before starting it.

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

Assessment coverage: 11 of 26 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Jun 16, 2022.

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 Epic Pro, straight from the product label.

Brand Swanson
Barcode (UPC) 087614190303
Net contents 30 Veggie DRcap(s)
Market status On market
Date entered into DSLD Jun 16, 2022
DSLD ID 265099
Product type Other Combinations
Supplement form Capsule
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Vegetarian, 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 Epic Pro by Swanson, 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:
1 Veggie Capsule(s)
Maximum serving Sizes:
1 Veggie Capsule(s)
Servings per container
30
UPC/BARCODE
087614190303
IngredientAmount% DV
Bifidobacterium breve Bb-030 NP--
Bifidobacterium infantis0 NP--
Bifidobacterium longum0 NP--
Lactobacillus casei0 NP--
Lactobacillus fermentum0 NP--
Streptococcus thermophilus0 NP--
Lactobacillus bulgaricus (Lb-87)0 NP--
Lactobacillus Helveticus0 NP--
Probiotic Blend175 mg--
Saccharomyces boulardii0 NP--
FOS100 mg--
Bifidobacterium animalis0 NP--
Lactobacillus rhamnosus (Lr-32)0 NP--
Lactobacillus reuteri0 NP--
Lactobacillus acidophilus (UALa-01)0 NP--
Lactobacillus acidophilus DDS0 NP--
Lactobacillus salivarius UALs-070 NP--
Bifidobacterium bifidum UABb-100 NP--
Lactobacillus brevis (Lbr-35)0 NP--
Bifidobacterium lactis Bi-070 NP--
Bifidobacterium lactis (UABLA-12)0 NP--
Lactobacillus helveticus (Rosell-52)0 NP--
Lactobacillus paracasei UALpc-040 NP--
Lactobacillus plantarum UALp-050 NP--
Lactococcus lactis (Ll-23)0 NP--
Lactobacillus gasseri (Lg-36)0 NP--
Lactobacillus fermentum LF-330 NP--

Other ingredients: Hypromellose, Gellan Gum, Microcrystalline Cellulose, Calcium Palmitate, Silica

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.
General Statements

swanson.com or call 1-800-437-4148

Science-Backed Quality Since 1969

Formulation

Helps maintain gastrointestinal balance Supports bowel regularity Supports digestion and micronutrient absorption

Vegetarian

Digestive Health

Suggested/Recommended/Usage/Directions

Suggested use: As a dietary supplement, take one veggie DRcaps capsule per day with water.

Brand IP Statement(s)

DRcaps & logo are trademarks of Lonza or its affiliates. DDS is a registered trademark of UAS Laboratories LLC and used under license.

Formula

Contains 30 billion CFU (colony forming units) when manufactured, and provides an effective level of bacteria until at least the "best by" date.

25-Strain Probiotic 30 Billion CFU

Precautions

Warning: For adults only.

Consult your physician before using this or any product if you are pregnant or nursing, taking medication, or if you have a medical condition.

Keep out of reach of children.

Do not use if seal is broken.

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.

FDA Statement of Identity

Dietary Supplement

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

See for yourself

Epic Pro by Swanson label

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

Epic Pro 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 Epic Pro by Swanson

These are the 2 active ingredients this product is made of. Select any to open its full monograph.

Serving size1 Veggie Capsule(s) Dosage formCapsule Servings per container30 Amounts shown are per serving.

Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.

Probiotic Blend

Interacts with
182 drugs
175 mg per serving

Lactobacillus acidophilus is a 'friendly' bacterium used as a probiotic to support gut and vaginal health. It is generally well tolerated in healthy p...

Probiotic Blend monograph & interactions

FOS

100 mg per serving

Other (inactive) ingredients: Hypromellose, Gellan Gum, Microcrystalline Cellulose, Calcium Palmitate, Silica. These complete the product’s ingredient list but are not active constituents.

Interaction report

Epic Pro by Swanson Drug Interactions

Want to check YOUR meds against Epic Pro?

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
222Drugs
182 Moderate 40 Minor

Ingredients driving the most interactions

Probiotic Blend 182

Individual Drug Interactions

The ingredients in Epic Pro interact with 222 drugs. Click any drug to see the details.

1 of the 2 ingredients in Epic Pro interact with drugs. Each result below shows which ingredient is responsible. Probiotic Blend

Each ingredient & the kinds of drugs it affects

For each ingredient in Epic Pro with known interactions, here are the types of medications it can affect. Open any type for the detail — or search your exact drug in the checker above.

Probiotic Blend1 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
Probiotic Blend full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Epic Pro, from the product label.

Swanson

See all Swanson products
Name
Swanson Health Products
City
Fargo
State
ND
ZipCode
58104
Phone Number
1-800-437-4148
Web Address
swanson.com
Pharmacist Counseling Corner

Epic Pro by Swanson: Common Questions

Does Epic Pro by Swanson interact with any medications?
Yes. Based on its ingredients, Epic Pro has a known interaction with 222 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Epic Pro contains 2 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.
Does this product actually work for digestive issues?
It depends on the issue. Saccharomyces boulardii in this blend has decent evidence for travelers' diarrhea, antibiotic-associated diarrhea, and other diarrheal conditions. Lactobacillus acidophilus and Bifidobacterium bifidum show promise for IBS and some infections. For other uses, the evidence isn't strong enough yet to say either way.
What are the inactive ingredients?
The capsule itself contains hypromellose, gellan gum, microcrystalline cellulose, calcium palmitate, and silica—these are binders, fillers, and capsule materials. The active part is the probiotic strains and FOS.
Can I take this if I'm on antibiotics?
Not at the same time. Since antibiotics kill bacteria, they'd wipe out the live organisms in this product. Talk with your doctor or pharmacist about timing—you may need to space doses several hours apart or wait until you finish antibiotics.
Is it safe if I'm immunocompromised?
The safety data advise caution. In rare cases, the live organisms have caused serious infections in people with weakened immune systems. Check with your doctor or pharmacist before starting this product if that applies to you.
Can I take this while pregnant or breastfeeding?
For some strains like Lactobacillus acidophilus and Bifidobacterium bifidum, the data suggest it's possibly safe, but for others, we don't have enough information. Talk with your doctor or pharmacist about whether it's right for you.
What side effects might I notice?
Mild GI side effects like bloating, gas, and abdominal discomfort have been reported, though they're uncommon. In rare cases, gastrointestinal complaints like nausea, vomiting, or decreased appetite have occurred. Most people tolerate it well.

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

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

Epic Pro label
Go deeper

The Full Monographs Behind Epic Pro’s Ingredients

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

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 Breve

Interacts with 182 drugs

Bifidobacterium breve is a 'friendly' gut bacterium taken as a probiotic, most often to support digestion and balance the gut microbiome. Some studies suggest possible benefits for certain d...

Read the full Bifidobacterium Breve 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

Streptococcus Thermophilus

Streptococcus thermophilus is a friendly bacterium used as a probiotic, often combined with other strains in yogurt and supplements. It is generally well tolerated in healthy people and may...

Read the full Streptococcus Thermophilus 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 Helveticus

Interacts with 182 drugs

Lactobacillus helveticus is a lactic acid bacterium used as a probiotic, often combined with other strains in mood, gut, and general wellness products. Early research is interesting—especial...

Read the full Lactobacillus Helveticus monograph → Herb & supplement monograph

Saccharomyces Boulardii

Interacts with 40 drugs

Saccharomyces boulardii is a beneficial yeast used as a probiotic, with the strongest evidence for preventing and treating certain types of diarrhea, including antibiotic-associated diarrhea...

Read the full Saccharomyces Boulardii 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

Lactobacillus Gasseri

Interacts with 182 drugs

Lactobacillus gasseri is a 'friendly' probiotic bacterium found naturally in the human gut, mouth, and vaginal tract, and in some fermented foods. Early research suggests it may help with di...

Read the full Lactobacillus Gasseri monograph →
Sources

Sources & How We Checked

Epic Pro'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 122 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.

Bifidobacterium Breve 9 references
  1. Pierce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: The Stonesong Press, 1999:19.
  2. 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
  3. 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.
  4. Ohishi A, Takahashi S, Ito Y, et al. Bifidobacterium septicemia associated with postoperative probiotic therapy in a neonate with omphalocele. J Pediatr. 2010;156(4):679-81. PubMed
  5. Sakurai Y, Watanabe T, Miura Y, et al. Clinical and bacteriologic characteristics of six cases of Bifidobacterium breve bacteremia due to probiotic administration in the neonatal intensive care unit. Pediatr Infect Dis J 2022;41(1):62-65. PubMed
  6. 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
  7. Wakabayashi Y, Nakayama S, Yamamoto A, et al. First case of necrotizing fasciitis and bacteremia caused by Bifidobacteriumbreve. Anaerobe 2022;76:102613.
  8. Takeda Y, Ota K, Kondo A, et al. A case of necrotizing fasciitis caused by Bifidobacterium breve. IDCases 2022;31:e01667. PubMed
  9. Suwantarat N, Romagnoli M, Wakefield T, Carroll KC. Ventriculoperitoneal shunt infection caused by Bifidobacterium breve. Anaerobe 2014;28:1-3. PubMed

See these in context on the Bifidobacterium Breve 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 →

Streptococcus Thermophilus 21 references
  1. Saxelin M, Chuang NH, Chassy B, et al. Lactobacilli and bacteremia in southern Finland 1989-1992. Clin Infect Dis 1996;22:564-6. PubMed
  2. Tynkkynen S, Singh KV, Varmanen P. Vancomycin resistance factor of Lactobacillus rhamnosus GG in relation to enterococcal vancomycin resistance (van) genes. Int J Food Microbiol 1998;41:195-204. PubMed
  3. Klein G, Zill E, Schindler R, et al. Peritonitis associated with vancomycin-resistant Lactobacillus rhamnosus in a continuous ambulatory peritoneal dialysis patient; organism identification, antibiotic therapy, and case report. J Clin Microbiol 1998;36:
  4. Kalima P, Masterton RG, Roddie PH, et al. Lactobacillus rhamnosus infection in a child following bone marrow transplant. J Infect 1996;32:165-7. PubMed
  5. Goldin BR. Health Benefits of probiotics. Br J Nutr 1998;80:S203-7. DOI
  6. Rautio M, Jousimies-Somer H, Kauma H, et al. Liver abscess due to Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG. Clin Infect Dis 1999;28:1159-60.
  7. MacGregor G, Smith AJ, Thakker B, Kinsella J. Yoghurt biotherapy: contraindicated in immunosuppressed patients? Postgrad Med J 2002;78:366-7. PubMed
  8. Land MH, Rouster-Stevens K, Woods CR, et al. Lactobacillus sepsis associated with probiotic therapy. Pediatrics 2005;115:178-81.
  9. De Groote MA, Frank DN, Dowell E, et al. Lactobacillus rhamnosus GG bacteremia associated with probiotic use in a child with short gut syndrome. Pediatr Infect Dis J 2005;24:278-80. PubMed
  10. Vahabnezhad E, Mochon AB, Wozniak LJ, Ziring DA. Lactobacillus bacteremia associated with probiotic use in a pediatric patient with ulcerative colitis. J Clin Gastroenterol. 2013;47(5):437-9. PubMed
  11. Dolatkhah N, Hajifaraji M, Abbasalizadeh F, Aghamohammadzadeh N, Mehrabi Y, Abbasi MM. Is there a value for probiotic supplements in gestational diabetes mellitus? A randomized clinical trial. J Health Popul Nutr. 2015;33:25. PubMed
  12. 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.
  13. Sendil S, Shrimanker I, Mansoora Q, Goldman J, Nookala VK. Lactobacillus rhamnosus bacteremia in an immunocompromised renal transplant patient. Cureus. 2020;12(2):e6887. PubMed
  14. Albarillo FS, Shah U, Joyce C, Slade D. Lactobacillus rhamnosus Infection: A single-center 4-year descriptive analysis. J Glob Infect Dis. 2020;12(3):119-123. PubMed
  15. Pasala S, Singer L, Arshad T, Roach K. Lactobacillus endocarditis in a healthy patient with probiotic use. IDCases. 2020;22:e00915. PubMed
  16. Agrawal S, Tuchman ES, Bruce MJ, Theodorou ME. Fatal Lactobacillus endocarditis in a patient with transcatheter aortic valve replacement. BMJ Case Rep. 2020;13(11):e236835.
  17. Antoun M, Hattab Y, Akhrass FA, Hamilton LD. Uncommon pathogen, Lactobacillus, causing infective endocarditis: Case report and review. Case Rep Infect Dis. 2020;2020:8833948. PubMed
  18. Rossi F, Amadoro C, Gasperi M, Colavita G. Lactobacilli infection case reports in the last three years and safety implications. Nutrients. 2022;14(6):1178. PubMed
  19. Franko B, Vaillant M, Recule C, Vautrin E, et al. Lactobacillus paracasei endocarditis in a consumer of probiotics. Med Mal Infect. 2013;43(4):171-3. PubMed
  20. Campbell RE, Miller A, Afroze A. Native valve endocarditis secondary to Lactobacillus paracasei bacteremia. Consultant. 2020;60(9):27-8. DOI
  21. Kato K, Funabashi N, Takaoka H, et al. Lactobacillus paracasei endocarditis in a consumer of probiotics with advanced and severe bicuspid aortic valve stenosis complicated with diffuse left ventricular mid-layer fibrosis. Int J Cardiol. 2016;224:157-161. PubMed

See these in context on the Streptococcus Thermophilus monograph →

Lactobacillus Delbrueckii 9 references
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  2. Rossi F, Amadoro C, Gasperi M, Colavita G. Lactobacilli infection case reports in the last three years and safety implications. Nutrients. 2022;14(6):1178. PubMed
  3. Ranchal P, Gupta R, Goldberg R, A Lobo S, Pascual A, El Khoury MY. Penicillin-sensitive Lactobacillus jensenii bacteremia. Am J Ther 2021;28(2):e250-e252. PubMed
  4. Grazioli-Gauthier L, Rigamonti E, Leo LA, Martinetti Lucchini G, Lo Priore E, Bernasconi E. Lactobacillus jensenii mitral valve endocarditis: Case report, literature review and new perspectives. IDCases 2022;27:e01401. PubMed
  5. Toprak NU, Bozan T, Yilmaz S, Buyukbayrak EE, Tigen ET. Polymicrobial bacteremia due to Lactobacillus jensenii and Veillonella montpellierensis in a pregnant patient; case report and review of literature. Anaerobe 2022;75:102576. PubMed
  6. Chazan B, Raz R, Shental Y, Sprecher H, Colodner R. Bacteremia and pyelonephritis caused by Lactobacillus jensenii in a patient with urolithiasis. Isr Med Assoc J 2008;10(2):164-5.
  7. Neonakis IK, Skamagkas I, Stafylaki D, Maraki S. Lactobacillus delbrueckii urinary tract infection in a male patient: a case report. Germs 2022;12(2):304-307. PubMed
  8. Maillet F, Passeron A, Podglajen I, Ranque B, Pouchot J. Lactobacillus delbrueckii urinary tract infection in a male patient. Med Mal Infect 2019;49(3):226-228. PubMed
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See these in context on the Lactobacillus Delbrueckii monograph →

Lactobacillus Helveticus 2 references
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  2. Rossi F, Amadoro C, Gasperi M, Colavita G. Lactobacilli infection case reports in the last three years and safety implications. Nutrients. 2022;14(6):1178. PubMed

See these in context on the Lactobacillus Helveticus monograph →

Lactobacillus Acidophilus 15 references
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  2. Begtrup LM, de Muckadell OB, Kjeldsen J, Christensen RD, Jarbøl DE. Long-term treatment with probiotics in primary care patients with irritable bowel syndrome--a randomised, double-blind, placebo controlled trial. Scand J Gastroenterol 2013;48(10):1127-35 PubMed
  3. Chatterjee S, Kar P, Das T, Ray S, Gangulyt S, Rajendiran C, Mitra M. Randomised placebo-controlled double blind multicentric trial on efficacy and safety of Lactobacillus acidophilus LA-5 and Bifidobacterium BB-12 for prevention of antibiotic-associated
  4. Shavakhi A, Tabesh E, Yaghoutkar A, Hashemi H, Tabesh F, Khodadoostan M,Minakari M, Shavakhi S, Gholamrezaei A. The effects of multistrain probiotic compound on bismuth-containing quadruple therapy for Helicobacter pylori infection: a randomized placebo-c
  5. Karamali M, Dadkhah F, Sadrkhanlou M, et al. Effects of probiotic supplementation on glycaemic control and lipid profiles in gestational diabetes: a randomized, double-blind, placebo-controlled trial. Diabetes Metab 2016;42(4):234-41. PubMed
  6. Badehnoosh B, Karamali M, Zarrati M, et al. The effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in gestational diabetes. J Matern Fetal Neonatal Med. 2018 May;31(9):1128-1136.
  7. Kumar S, Kumar R, Rohilla L, Jacob N, Yadav J, Sachdeva N. A high potency multi-strain probiotic improves glycemic control in children with new-onset type 1 diabetes mellitus: A randomized, double-blind, and placebo-controlled pilot study. Pediatr Diabete
  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. Xiao SD, Zhang DZ, Lu H, et al. Multicenter, randomized, controlled trial of heat-killed Lactobacillus acidophilus LB in patients with chronic diarrhea. Adv Ther. 2003;20(5):253-60.
  10. Rossi F, Amadoro C, Gasperi M, Colavita G. Lactobacilli infection case reports in the last three years and safety implications. Nutrients. 2022;14(6):1178. PubMed
  11. Ozer M, Goksu SY, Shahverdiani A, Mustafa M. Lactobacillus acidophilus-induced endocarditis and associated splenic abscess. Case Rep Infect Dis 2020;2020:1382709.
  12. Sadrin S, Sennoune S, Gout B, et al. A 2-strain mixture of Lactobacillus acidophilus in the treatment of irritable bowel syndrome: A placebo-controlled randomized clinical trial. Dig Liver Dis 2020;52(5):534-540. PubMed
  13. Stoffer JN, Slingsby TJ, Giuliari GP. Lactobacillus acidophilus endophthalmitis after intravitreal bevacizumab injection requiring intraocular lens explantation. Can J Ophthalmol 2022;57(1):e21-e22. PubMed
  14. Cukovic-Cavka S, Likic R, Francetic I, Rustemovic N, Opacic M, Vucelic B. Lactobacillus acidophilus as a cause of liver abscess in a NOD2/CARD15-positive patient with Crohn's disease. Digestion 2006;73(2-3):107-10.
  15. Hui J, Ren Y, Wang Y, Han Q. Lactobacillus acidophilus endophthalmitis postcataract operation: A case report with a literature review. Ocul Immunol Inflamm 2023.

See these in context on the Lactobacillus Acidophilus monograph →

Saccharomyces Boulardii 26 references
  1. Niault M, Thomas F, Prost J, et al. Fungemia due to Saccharomyces species in a patient treated with enteral Saccharomyces boulardii. Clin Infect Dis 1999;28:930.
  2. Pletinex M, Legein J, Vandenplas Y. Fungemia with Saccharomyces boulardii in a 1-year-old girl with protracted diarrhea. J Pediatr Gastroenterol Nutr 1995;21:113-5. DOI
  3. Fredenucci I, Chomarat M, Boucaud C, et al. Saccharomyces boulardii fungemia in a patient receiving ultra-levure therapy. Clin Infect Dis 1998;27:222-3.
  4. Elmer GW, McFarland LV, Surawicz CM, et al. Behaviour of Saccharomyces boulardii in recurrent Clostridium difficile disease patients. Aliment Pharmacol Ther 1999;13:1663-8.
  5. Lewis SJ, Freedman AR. Review article: the use of biotherapeutic agents in the prevention and treatment of gastrointestinal disease. Aliment Pharmacol Ther 1998;12:807-22. PubMed
  6. Cesaro S, Chinello P, Rossi L, Zanesco L. Saccharomyces cerevisiae fungemia in a neutropenic patient treated with Saccharomyces boulardii. Support Care Cancer 2000;8:504-5. PubMed
  7. Hennequin C, Thierry A, Richard GF, et al. Microsatellite typing as a new tool for identification of Saccharomyces cerevisiae strains. J Clin Microbiol 2001;39:551-9.
  8. Plein K, Hotz J. Therapeutic effects of Saccharomyces boulardii on mild residual symptoms in a stable phase of Crohn's disease with special respect to chronic diarrhea - a pilot study. Z Gastroenterol 1993;31:129-34.
  9. Borriello SP, Hammes WP, Holzapfel W, et al. Safety of probiotics that contain lactobacilli or bifidobacteria. Clin Infect Dis 2003;36:775-80. PubMed
  10. Marteau P, Seksik P. Tolerance of probiotics and prebiotics. J Clin Gastroenterol 2004;38:S67-9. PubMed
  11. Munoz P, Bouza E, Cuenca-Estrella M, et al. Saccharomyces cerevisiae fungemia: an emerging infectious disease. Clin Infect Dis 2005;40:1625-34. PubMed
  12. Lherm, T., Monet, C., Nougiere, B., Soulier, M., Larbi, D., Le Gall, C., Caen, D., and Malbrunot, C. Seven cases of fungemia with Saccharomyces boulardii in critically ill patients. Intensive Care Med 2002;28(6):797-801. PubMed
  13. Riquelme, A. J., Calvo, M. A., Guzman, A. M., Depix, M. S., Garcia, P., Perez, C., Arrese, M., and Labarca, J. A. Saccharomyces cerevisiae fungemia after Saccharomyces boulardii treatment in immunocompromised patients. J Clin.Gastroenterol. 2003;36(1):41- PubMed
  14. Cherifi, S., Robberecht, J., and Miendje, Y. Saccharomyces cerevisiae fungemia in an elderly patient with Clostridium difficile colitis. Acta Clin Belg. 2004;59(4):223-224. PubMed
  15. Ellouze O, Berthoud V, Mervant M, Parthiot JP, Girard C. Septic shock due to Sacccaromyces boulardii. Med Mal Infect. 2016;46(2):104-105.
  16. Appel-da-Silva MC, Narvaez GA, Perez LRR, Drehmer L, Lewgoy J. Saccharomyces cerevisiae var. boulardii fungemia following probiotic treatment. Med Mycol Case Rep. 2017;18:15-7. PubMed
  17. Atici S, Soysal A, Karadeniz Cerit K, et al. Catheter-related Saccharomyces cerevisiae Fungemia Following Saccharomyces boulardii Probiotic Treatment: In a child in intensive care unit and review of the literature. Med Mycol Case Rep. 2017;15:33-35. PubMed
  18. Martin IW, Tonner R, Trivedi J, et al. Saccharomyces boulardii probiotic-associated fungemia: questioning the safety of this preventive probiotic's use. Diagn Microbiol Infect Dis. 2017;87(3):286-8. PubMed
  19. Romanio MR, Coraine LA, Maielo VP, Abramczyc ML, Souza RL, Oliveira NF. Saccharomyces cerevisiae fungemia in a pediatric patient after treatment with probiotics. Rev Paul Pediatr 2017;35(3):361-4.
  20. Roy U, Jessani LG, Rudramurthy SM, et al. Seven cases of Saccharomyces fungaemia related to use of probiotics. Mycoses 2017;60(6):375-380.
  21. Romanio MR, Coraine LA, Maielo VP, Abramczyc ML, Souza RL, Oliveira NF. Saccharomyces cerevisiae fungemia in a pediatric patient after treatment with probiotics. Rev Paul Pediatr. 2017 Jul-Sep;35(3):361-364. doi: 10.1590/1984-0462/;2017;35;3;00014.
  22. Flatley EA, Wilde AM, Nailor MD. Saccharomyces boulardii for the prevention of hospital onset Clostridium difficile infection. J Gastrointestin Liver Dis. 2015;24(1):21-4. PubMed
  23. Ventoulis I, Sarmourli T, Amoiridou P, et al. Bloodstream infection by Saccharomyces cerevisiae in two COVID-19 patients after receiving supplementation of Saccharomyces in the ICU. J Fungi (Basel). 2020;6(3):98. PubMed
  24. Wombwell E, Bransteitter B, Gillen LR. Incidence of Saccharomyces cerevisiae fungemia in hospitalised patients administered Saccharomyces boulardii probiotic. Mycoses 2021;64(12):1521-1526.
  25. Rannikko J, Holmberg V, Karppelin M, et al. Fungemia and Other Fungal Infections Associated with Use of Saccharomyces boulardii Probiotic Supplements. Emerg Infect Dis 2021;27(8):2090-6.
  26. Awoyemi A, Mayerhofer C, Felix AS, et al. Rifaximin or Saccharomyces boulardii in heart failure with reduced ejection fraction: Results from the randomized GutHeart trial. EBioMedicine 2021;70:103511. PubMed

See these in context on the Saccharomyces Boulardii monograph →

Bifidobacterium Bifidum 7 references
  1. Pierce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: The Stonesong Press, 1999:19.
  2. 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
  3. Rerksuppaphol S, Rerksuppaphol L. Randomized controlled trial of probiotics to reduce common cold in schoolchildren. Pediatr Int. 2012;54(5):682-7. PubMed
  4. Karamali M, Dadkhah F, Sadrkhanlou M, et al. Effects of probiotic supplementation on glycaemic control and lipid profiles in gestational diabetes: a randomized, double-blind, placebo-controlled trial. Diabetes Metab 2016;42(4):234-41. PubMed
  5. Badehnoosh B, Karamali M, Zarrati M, et al. The effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in gestational diabetes. J Matern Fetal Neonatal Med. 2018 May;31(9):1128-1136.
  6. 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.
  7. 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

See these in context on the Bifidobacterium Bifidum monograph →

Lactobacillus Gasseri 12 references
  1. Pierce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: The Stonesong Press, 1999:19.
  2. Ramachandran L, Dontaraju VS, Patel K. Lactobacillus-associated spontaneous bacterial peritonitis in a liver cirrhosis patient on probiotics. Cureus. 2020;12(12):e11896. PubMed
  3. Rossi F, Amadoro C, Gasperi M, Colavita G. Lactobacilli infection case reports in the last three years and safety implications. Nutrients. 2022;14(6):1178. PubMed
  4. Ranchal P, Gupta R, Goldberg R, A Lobo S, Pascual A, El Khoury MY. Penicillin-sensitive Lactobacillus jensenii bacteremia. Am J Ther 2021;28(2):e250-e252. PubMed
  5. Grazioli-Gauthier L, Rigamonti E, Leo LA, Martinetti Lucchini G, Lo Priore E, Bernasconi E. Lactobacillus jensenii mitral valve endocarditis: Case report, literature review and new perspectives. IDCases 2022;27:e01401. PubMed
  6. Toprak NU, Bozan T, Yilmaz S, Buyukbayrak EE, Tigen ET. Polymicrobial bacteremia due to Lactobacillus jensenii and Veillonella montpellierensis in a pregnant patient; case report and review of literature. Anaerobe 2022;75:102576. PubMed
  7. Chazan B, Raz R, Shental Y, Sprecher H, Colodner R. Bacteremia and pyelonephritis caused by Lactobacillus jensenii in a patient with urolithiasis. Isr Med Assoc J 2008;10(2):164-5.
  8. Ramos-Coria D, Canto-Losa J, Carrillo-Vázquez D, Carbajal-Morelos L, Estrada-León R, Corona-Rodarte E. Lactobacillus gasseri liver abscess and bacteremia: a case report. BMC Infect Dis 2021;21(1):518. PubMed
  9. Elikowski W, Malek-Elikowska M, Lisiecka M, Bodora A, Wisniewska K, Oko-Sarnowska Z. Lactobacillus gasseri endocarditis on the aortic valve bioprosthesis - a case report. Pol Merkur Lekarski 2017;43(257):220-223.
  10. Esquibel A, Dababneh AS, Palraj BR. Lactobacillus gasseri causing bilateral empyema. Case Rep Infect Dis 2017;2017:4895619.
  11. Tleyjeh IM, Routh J, Qutub MO, Lischer G, Liang KV, Baddour LM. Lactobacillus gasseri causing Fournier's gangrene. Scand J Infect Dis 2004;36(6-7):501-3. PubMed
  12. Dickgiesser U, Weiss N, Fritsche D. Lactobacillus gasseri as the cause of septic urinary infection. Infection 1984;12(1):14-6. PubMed

See these in context on the Lactobacillus Gasseri monograph →

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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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