Interactions on record — worth a quick check against your medications. Based on 9 of 14 ingredients. Check your meds →
Dietary supplement

Fortitude Ingredients & Drug Interactions

by ANS Performance

Fortitude 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 Fortitude 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

Fortitude is a dietary supplement by ANS Performance with 14 active ingredients. Its ingredients are commonly taken for general antioxidant support, skin and hair care, heart health.Based on those ingredients, 1,187 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are Bee propolis extract, Japanese knotweed extract, Vitamin E. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

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Check Your Meds Against Fortitude by ANS Performance

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

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HelloPharmacist Scorecard of Fortitude by ANS Performance

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 30, 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 6 of its 14 active ingredients.
  • “Boron Citrate” is listed as a grouped ingredient — the label doesn't break down how much of each component you get.
  • “Zinc Aspartate” is listed as a grouped ingredient — the label doesn't break down how much of each component you get.

Fortitude contains 14 ingredients. The active ones are zinc (for immune and wound-healing support), boron (a trace mineral), vitamin E (a fat-soluble antioxidant), Japanese knotweed extract (hu zhang, a traditional herb), fenugreek seed extract (used for sexual function and blood sugar), oat extract (for cardiovascular health), long jack or Eurycoma longifolia root (linked to sexual performance and testosterone), 7-methoxyflavone (a flavonoid compound), bee propolis (an apiary byproduct with antimicrobial properties), and a few proprietary blends called Aromatase Inhibiting Complex, TEST HIT, FERUTEST, Estrogen Modulation Complex, and white button mushroom extract.

The inactive ingredients are microcrystalline cellulose, magnesium stearate, silicon dioxide, and the capsule itself.

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

This product doesn't appear to be marketed for a specific use, so we graded its ingredients' overall clinical evidence instead.

Strong

Strong clinical evidence supports its ingredients for:

Why this rating?
  • We looked at the product name, claims, and label statements and couldn't find a stated purpose to grade.
  • Since the label doesn't commit to one use, we graded the ingredients' overall clinical evidence instead.
  • On file: Vitamin E deficiency — rated "Effective" (Vitamin E) (Natural Medicines).
  • On file: Zinc deficiency — rated "Effective" (Zinc) (Natural Medicines).
  • On file: Ataxia with vitamin E deficiency (AVED) — rated "Effective" (Vitamin E) (Natural Medicines).
  • On file: Coronary heart disease (CHD) — rated "Likely Effective" (Oats) (Natural Medicines).
  • On file: Dyslipidemia — rated "Likely Effective" (Oats) (Natural Medicines).

Zinc is effective for zinc deficiency and likely effective for Wilson disease; it's possibly effective for acne, age-related macular degeneration, and blood-sugar control in diabetes. Boron is likely effective for boron deficiency and possibly effective for vaginal yeast infections.

Vitamin E is effective for vitamin E deficiency and possibly effective for Alzheimer disease and a few other rare neurological conditions. Japanese knotweed extract has insufficient evidence for the conditions it's traditionally used for—hepatitis, rheumatoid arthritis, wound healing, gout, and osteoarthritis.

Fenugreek is possibly effective for sexual function and diabetes. Oats are likely effective for high cholesterol and heart disease risk.

Long jack extract is possibly effective for sexual desire but possibly ineffective for athletic performance. We hold no effectiveness ratings for 7-methoxyflavone, bee propolis (beyond possibly effective for cold sores and mouth sores, and diabetes), or the proprietary blends.

The evidence, ingredient by ingredient Vitamin E Boron Hu Zhang Zinc Fenugreek Oats Eurycoma Longifolia 7-methoxyflavone

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 7 of the 9 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 8 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.

Zinc is generally well tolerated below 40 mg daily, the adult upper limit; higher doses risk copper deficiency, anemia, and other harms. Most common side effects are mild—nausea, diarrhea, metallic taste, abdominal cramps.

Boron is safe in small food amounts and low-dose supplements but should be avoided in pregnancy (possibly harmful to the fetus) and while breastfeeding. Vitamin E from food and prenatal vitamins is fine, but high-dose long-term supplements raise the risk of bleeding and stroke, especially in smokers.

Fenugreek is generally well tolerated but can cause abdominal pain, bloating, diarrhea, and nausea; avoid medicinal doses in pregnancy due to uterine effects, though it's possibly safe while breastfeeding. Oats are safe as food in pregnancy and breastfeeding; concentrated extracts are less studied.

Long jack extract has limited long-term safety data and possible hormonal effects; avoid in pregnancy and breastfeeding. 7-Methoxyflavone has very limited human safety data and unknown hormonal effects—best avoided in pregnancy and breastfeeding.

Bee propolis is well tolerated short-term but can trigger allergic reactions in those sensitive to bee products; avoid in pregnancy and breastfeeding. Japanese knotweed extract has limited safety data; its emodin content may upset the stomach, and it's best avoided in pregnancy and breastfeeding.

Side effects, ingredient by ingredient Vitamin E Boron Hu Zhang Zinc Fenugreek Oats Eurycoma Longifolia 7-methoxyflavone

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 — Propolis, Fenugreek, Oats, Vitamin E, Zinc, 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.
  • For scale: 1,188 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 starting Fortitude, double-check with your pharmacist if you take blood thinners like warfarin or other anticoagulant/antiplatelet drugs—vitamin E and several other ingredients increase bleeding risk. Also flag any quinolone or tetracycline antibiotics, cephalexin, diabetes medications, ritonavir (HIV), propranolol, penicillamine, or aromatase inhibitors (for breast cancer).

Fenugreek and oats can amplify the effects of blood-sugar-lowering drugs. We could not check interaction data for Aromatase Inhibiting Complex, TEST HIT, FERUTEST, Estrogen Modulation Complex, and white button mushroom extract.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFormula with limited ingredient disclosure with strong clinical evidence behind its ingredients' uses. Moderate medication interactions have been identified, and safety information is well characterized.

Fortitude is a multi-ingredient testosterone and sexual-function support product aimed at men interested in athletic performance or sexual health. It's not for you if you take blood thinners (anticoagulants or antiplatelets), diabetes medications, certain antibiotics, propranolol, or aromatase inhibitors for cancer—or if you're pregnant or breastfeeding.

Talk it over with your own doctor or pharmacist before adding it, especially if you're on any prescription drugs or have concerns about hormonal effects.

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

Assessment coverage: 9 of 14 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Apr 25, 2013.

This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed

At a glance

General information

Key facts about Fortitude, straight from the product label.

Brand ANS Performance
Barcode (UPC) 609613521249
Net contents 120 Capsule(s)
Market status On market
Date entered into DSLD Apr 25, 2013
DSLD ID 14568
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 Fortitude by ANS Performance, 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:
4 Capsule(s)
Maximum serving Sizes:
4 Capsule(s)
Servings per container
30
UPC/BARCODE
609613521249
IngredientAmount% DV
Zinc15 mg--
Boron10 mg--
Vitamin E4.1 mg41%
Boron Citrate0 NP--
Aromatase Inhibiting Complex500 mg--
Japanese knotweed extract0 NP--
Zinc Aspartate0 NP--
TEST HIT(TM) Rapid Free Testosterone Amplifier1476 mg--
TESTOFEN(R) Fenugreek extract0 NP--
FERUTEST(TM)0 NP--
Wild oat 10:1 extract0 NP--
Long jack extract 100:10 NP--
White button mushroom extract0 NP--
7-Methoxyflavone0 NP--
Estrogen Modulation Complex400 mg--
Bee propolis extract0 NP--

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

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

DIRECTIONS: Take 1 serving (4 capsules) of FORTITUDE daily in the evening on an empty stomach (at least 30 minutes after dinner). Cycle use of FORTITUDE for 8 weeks, followed by 2 weeks off. Do not exceed 4 capsules in a 24-hour period.

Precautions

Consult a medical doctor before starting any diet or exercise program. Do not exceed recommended serving. Improper use of this product will not improve results and is not advised. Use only as directed.

KEEP OUT OF REACH OF CHILDREN.

WARNING: Not intended for use by persons under 18.

Do not use if pregnant or nursing.

Consult a medical doctor before use if you have been treated for, or diagnosed with any medical condition, or if you are using any prescription or over-the-counter drug(s).

Do not use if packaging has been tampered with.

Discontinue use and call a medical doctor if you experience unusual symptoms.

Seals/Symbols

MADE IN THE USA

GMP CERTIFIED

Capture this QR code on your Smartphone for more information about FORTITUDE(TM) ansperformance.com (QR Code)

Storage

Store in a cool dry place.

General Statements

TEST BOOSTING PHENOMENON

Get BIG. Get HARD. Get LEAN. INCREASE MUSCLE GROWTH & STRENGTH AMPLIFY FREE TESTOSTERONE LEVELS SIZE - STRENGTH - LIBIDO - STAMINA

FULL 30-DAY CYCLE

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

Fortitude by ANS Performance label

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

Fortitude 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 Fortitude by ANS Performance

These are the 14 active ingredients this product is made of. Select any to open its full monograph.

Serving size4 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.

Vitamin E

Interacts with
764 drugs
4.1 mg per serving Form: D-Alpha-Tocopherol Acetate

Vitamin E is an essential fat-soluble vitamin and antioxidant that most people get in adequate amounts from a normal diet. Supplements can help correc...

Vitamin E monograph & interactions

Boron Citrate

No known
interactions
0 NP per serving

Boron is a trace mineral found in many plant foods and sold as a supplement, mainly promoted for bone, joint, and hormone health. The human evidence f...

Boron Citrate monograph & interactions

Aromatase Inhibiting Complex

500 mg per serving

Japanese knotweed extract

Interacts with
826 drugs
0 NP per serving Form: Resveratrol

Hu Zhang (Japanese knotweed root) is a traditional Chinese herb that is one of the richest natural sources of resveratrol and emodin. Some lab and ear...

Japanese knotweed extract monograph & interactions

Zinc Aspartate

Interacts with
67 drugs
0 NP per serving

Zinc is an essential mineral that your body needs for immune function, wound healing, taste, and smell. Most people get enough from food, but suppleme...

Zinc Aspartate monograph & interactions

TEST HIT(TM) Rapid Free Testosterone Amplifier

1476 mg per serving

TESTOFEN(R) Fenugreek extract

Interacts with
389 drugs
0 NP per serving Form: fenusides

Fenugreek is a common kitchen spice that is also taken as a supplement, mainly for blood sugar, cholesterol, and to support breast milk production. So...

TESTOFEN(R) Fenugreek extract monograph & interactions

FERUTEST(TM)

0 NP per serving

Wild oat 10:1 extract

Interacts with
86 drugs
0 NP per serving

Oats are a well-studied whole grain whose soluble fiber (beta-glucan) can help lower cholesterol and support heart health when eaten regularly. As a f...

Wild oat 10:1 extract monograph & interactions

Long jack extract 100:1

Interacts with
248 drugs
0 NP per serving

Eurycoma longifolia (tongkat ali) is a Southeast Asian herb most popular for supporting testosterone, libido, and male fertility, with some small huma...

Long jack extract 100:1 monograph & interactions

White button mushroom extract

0 NP per serving

7-Methoxyflavone

Interacts with
12 drugs
0 NP per serving

7-Methoxyflavone is a lab-made or plant-derived flavonoid marketed mainly in testosterone-boosting and bodybuilding supplements based on the idea that...

7-Methoxyflavone monograph & interactions

Estrogen Modulation Complex

400 mg per serving

Bee propolis extract

Interacts with
921 drugs
0 NP per serving Form: Caffeic Acid Phenethyl Ester

Propolis is a natural, resin-like substance made by bees that has antimicrobial and anti-inflammatory properties in lab studies. Early research sugges...

Bee propolis extract monograph & interactions

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

Interaction report

Fortitude by ANS Performance Drug Interactions

Want to check YOUR meds against Fortitude?

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
1,187Drugs
1,071 Moderate 116 Minor

Ingredients driving the most interactions

Bee propolis extract 921
Japanese knotweed extract 826
Vitamin E 764
TESTOFEN(R) Fenugreek extract 389
Long jack extract 100:1 248

Individual Drug Interactions

The ingredients in Fortitude interact with 1,187 drugs. Click any drug to see the details.

8 of the 14 ingredients in Fortitude interact with drugs. Each result below shows which ingredient is responsible. Bee propolis extract Japanese knotweed extract Vitamin E TESTOFEN(R) Fenugreek extract Long jack extract 100:1 Wild oat 10:1 extract Zinc Aspartate 7-Methoxyflavone

Each ingredient & the kinds of drugs it affects

For each ingredient in Fortitude 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.

Bee propolis extract8 drug types · 921 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, propolis might increase the risk of bleeding when taken with antiplatelet or anticoagulant drugs.
In vitro research shows that propolis water extract and the propolis constituent, caffeic acid phenethyl ester, can inhibit platelet aggregation. Additionally, evidence from an animal model shows that taking propolis in addition to warfarin decreases INR, suggesting that propolis can decrease the effectiveness of warfarin.

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

Theoretically, high doses of propolis might increase blood levels of drugs metabolized by CYP1A2.
In vitro research shows that propolis extract can inhibit CYP1A2. However, animal research shows that propolis extract does not significantly affect CYP1A2 activity when administered to rats at doses up to 250 mg/kg. It is postulated that the constituents of propolis that inhibit CYP1A2 in vitro do not have significant effects in vivo due to low bioavailability and hepatic first-pass effect. This effect has not been reported in humans.

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

Theoretically, high doses of propolis might increase blood levels of drugs metabolized by CYP2C19.
In vitro research shows that propolis extract can inhibit CYP2C19. However, animal research shows that propolis extract does not significantly affect CYP2C19 activity when administered to rats at doses up to 250 mg/kg. It is postulated that the constituents of propolis that inhibit CYP2C19 in vitro do not have significant effects in vivo due to low bioavailability and hepatic first-pass effect. This effect has not been reported in humans.

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

Theoretically, high doses of propolis might increase blood levels of drugs metabolized by CYP2C9.
In vitro research shows that propolis extract can inhibit CYP2C9. However, animal research shows that propolis extract does not significantly affect CYP2C9 activity when administered to rats at doses up to 250 mg/kg. It is postulated that the constituents of propolis that inhibit CYP2C9 in vitro do not have significant effects in vivo due to low bioavailability and hepatic first-pass effect. This effect has not been reported in humans.

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

Theoretically, high doses of propolis might increase blood levels of drugs metabolized by CYP2D6.
In vitro research shows that propolis extract can inhibit CYP2D6. However, animal research shows that propolis extract does not significantly affect CYP2D6 activity when administered to rats at doses up to 250 mg/kg. It is postulated that the constituents of propolis that inhibit CYP2D6 in vitro do not have significant effects in vivo due to low bioavailability and hepatic first-pass effect. This effect has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2E1 (Cyp2E1) Substrates

Theoretically, propolis might increase levels of drugs metabolized by CYP2E1.
In vitro research shows that propolis can inhibit CYP2E1. This effect has not been reported in humans.

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

Theoretically, high doses of propolis might increase blood levels of drugs metabolized by CYP3A4.
Some in vitro research shows that propolis extract can inhibit CYP3A4; however, other in vitro research shows that propolis has no effect on CYP3A4 activity. Furthermore, animal research shows that propolis extract does not significantly affect CYP3A4 activity when administered to rats at doses up to 250 mg/kg. It is postulated that the constituents of propolis that might in inhibit CYP3A4 in vitro do not have significant effects in vivo due to low bioavailability and hepatic first-pass effect. This effect has not been reported in humans.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, propolis might decrease the effectiveness of warfarin.
Animal research shows that taking propolis in addition to warfarin decreases the international normalized ratio (INR). This effect has not been reported in humans.

Likelihood Possible Evidence D
Bee propolis extract full monograph & interactions

Japanese knotweed extract7 drug types · 826 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, hu zhang might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.
Hu zhang contains the constituent resveratrol. Resveratrol seems to have antiplatelet effects.

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

Theoretically, hu zhang might increase levels of drugs metabolized by CYP1A2.
Hu zhang contains the constituent resveratrol. In vitro research shows that resveratrol might inhibit the CYP1A2 enzyme. This interaction has not been reported in humans.

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

Theoretically, hu zhang might increase levels of drugs metabolized by CYP2C19.
Hu zhang contains the constituent resveratrol. In vitro research shows that resveratrol might inhibit the CYP2C19 enzyme. This interaction has not been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2E1 (Cyp2E1) Substrates

Theoretically, hu zhang might increase levels of drugs metabolized by CYP2E1.
Hu zhang contains the constituent resveratrol. In vitro research shows that resveratrol might inhibit the CYP2E1 enzyme. Also, a pharmacokinetic study shows that taking resveratrol 500 mg daily for 10 days prior to taking a single dose of chlorzoxazone 250 mg increases the maximum concentration of chlorzoxazone by about 54%, the area under the curve of chlorzoxazone by about 72%, and the half-life of chlorzoxazone by about 35%. Chlorzoxazone is used as a probe drug for CYP2E1.

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

Theoretically, hu zhang might increase levels of drugs metabolized by CYP3A4.
Hu zhang contains the constituent resveratrol. In vitro research shows that resveratrol might inhibit the CYP3A4 enzyme. However, a clinical study in adults with NAFLD found that adding resveratrol 3000 mg daily for 8 weeks did not necessitate dose adjustments to any established medications metabolized by CYP3A4.

Likelihood Possible Evidence D
Estrogens

Theoretically, hu zhang might competitively inhibit the effects of estrogen replacement therapy.
In vitro research shows that hu zhang might have estrogenic activity.

Likelihood Possible Evidence D
Carbamazepine (Tegretol)

Theoretically, hu zhang might increase the effects and adverse effects of carbamazepine.
In animals, blood and tissue levels of carbamazepine were increased when given in combination with hu zhang. It is thought that increased levels of carbamazepine are due to cytochrome P450 3A4 (CYP3A4) inhibition. This interaction has not been reported in humans.

Likelihood Possible Evidence D
Japanese knotweed extract full monograph & interactions

Vitamin E8 drug types · 764 drugs

Alkylating Agents

Theoretically, antioxidant effects of vitamin E might reduce the effectiveness of alkylating agents.
There's concern that antioxidants could reduce the activity of chemotherapy drugs which generate free radicals, such as cyclophosphamide, chlorambucil, carmustine, busulfan, and thiotepa. However, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that might interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin E have on chemotherapy. Advise patients to consult their oncologist before using vitamin E supplements, especially in high doses.

Likelihood Possible Evidence D
Anticoagulant/Antiplatelet Drugs

Concomitant use of vitamin E and anticoagulant or antiplatelet agents might increase the risk of bleeding.
Vitamin E seems to inhibit of platelet aggregation and antagonize the effects of vitamin K-dependent clotting factors. These effects appear to be dose-dependent, and are probably only likely to be clinically significant with doses of at least 800 units daily. Mixed tocopherols, such as those found in food, might have a greater antiplatelet effect than alpha-tocopherol. RRR alpha-tocopherol (natural vitamin E) 1000 IU daily antagonizes vitamin K-dependent clotting factors. Advise patients to avoid high doses of vitamin E, especially in people with low vitamin K intake or other risk factors for bleeding.

Likelihood Possible Evidence B
Antitumor Antibiotics

Theoretically, antioxidant effects of vitamin E might reduce the effectiveness of antitumor antibiotics.
There's concern that antioxidants could reduce the activity of antitumor antibiotic drugs such as doxorubicin, which generate free radicals. However, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that might interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin E have on chemotherapy involving antitumor antibiotics. Advise patients to consult their oncologist before using vitamin E supplements, especially in high doses.

Likelihood Possible Evidence D
Cyclosporine (Neoral, Sandimmune)

A specific form of vitamin E might increase absorption and levels of cyclosporine.
There is some evidence that one specific formulation of vitamin E (D-alpha-tocopheryl-polyethylene glycol-1000 succinate, TPGS, tocophersolan, Liqui-E) might increase absorption of cyclosporine. This vitamin E formulation forms micelles which seems to increase absorption of cyclosporine by 40% to 72% in some patients. However, this interaction is unlikely to occur with the usual forms of vitamin E.

Likelihood Unlikely Evidence B
Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Vitamin E appears to bind with the nuclear receptor, pregnane X receptor (PXR), which results in increased expression of CYP3A4. Although the clinical significance of this is not known, use caution when considering concomitant use of vitamin E and other drugs affected by these enzymes.

Likelihood Possible Evidence D
Selumetinib (Koselugo)

Taking selumetinib with vitamin E can result in a total daily dose of vitamin E that exceeds safe limits and therefore might increase the risk of bleeding.
Selumetinib contains 48-54 IU vitamin E per capsule. The increased risk of bleeding with vitamin E appears to be dose-dependent. Be cautious when using selumetinib in combination with supplemental vitamin E, especially in patients at higher risk of bleed, such as those with chronic conditions and those taking antiplatelet drugs.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Using vitamin E with warfarin might increase the risk of bleeding.
Due to interference with production of vitamin K-dependent clotting factors, use of more than 400 IU of vitamin E daily with warfarin might increase prothrombin time (PT), INR, and the risk of bleeding,. At a dose of 1000 IU per day, vitamin E can antagonize vitamin K-dependent clotting factors even in people not taking warfarin. Limited clinical evidence suggests that doses up to 1200 IU daily may be used safely by patients taking warfarin, but this may not be applicable in all patient populations.

Likelihood Possible Evidence B
Niacin

Vitamin E might decrease the beneficial effects of niacin on high-density lipoprotein (HDL) cholesterol levels.
A combination of niacin and simvastatin (Zocor) effectively raises high-density lipoprotein (HDL) cholesterol levels in people with coronary disease and low HDL levels. Clinical research shows that taking a combination of antioxidants (vitamin C, vitamin E, beta-carotene, and selenium) along with niacin and simvastatin (Zocor) attenuates this rise in HDL, specifically the HDL-2 and apolipoprotein A1 fractions, by more than 50%. Vitamin E alone combined with a statin does not seem to decrease HDL levels. It is not known whether the adverse effect on HDL is due to one of the other antioxidants or to the combination. It also is not known whether it will occur in other patient populations.

Likelihood Possible Evidence A
Vitamin E full monograph & interactions

TESTOFEN(R) Fenugreek extract9 drug types · 389 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, fenugreek might have additive effects when used with anticoagulant or antiplatelet drugs.
Some of the constituents in fenugreek have antiplatelet effects in animal and in vitro research. However, common fenugreek products might not contain sufficient concentrations of these constituents for clinical effects. A clinical study in patients with coronary artery disease or diabetes shows that taking fenugreek seed powder 2.5 grams twice daily for 3 months does not affect platelet aggregation, fibrinolytic activity, or fibrinogen levels .

Likelihood Unlikely Evidence B
Antidiabetes Drugs

Theoretically, fenugreek seed might have additive hypoglycemic effects when used with antidiabetes drugs.
Clinical research shows that fenugreek seed can reduce fasting blood glucose and 2-hour postprandial glucose levels in adults with type 2 diabetes.

Likelihood Probable Evidence B
Clopidogrel (Plavix)

Theoretically, fenugreek seed might alter the clinical effects of clopidogrel by inhibiting its conversion to the active form.
Animal research shows that fenugreek seed 200 mg/kg daily for 14 days increases the maximum serum concentration of clopidogrel by 21%. It is unclear how this affects the pharmacokinetics of the active metabolite of clopidogrel; however, this study found that concomitant use of fenugreek seed and clopidogrel prolonged bleeding time by an additional 11%.

Likelihood Possible Evidence D
Metoprolol (Toprol)

Theoretically, fenugreek seed might have additive hypotensive effects when used with metoprolol.
Animal research shows that fenugreek seed 300 mg/kg daily for 2 weeks decreases systolic and diastolic blood pressure by 9% and 11%, respectively, when administered alone, and by 15% and 22%, respectively, when given with metoprolol 10 mg/kg.

Likelihood Probable Evidence B
Phenytoin (Dilantin)

Theoretically, fenugreek might decrease plasma levels of phenytoin.
Animal research shows that taking fenugreek seeds for 1 week decreases maximum concentrations and the area under the curve of a single dose of phenytoin by 44% and 72%, respectively. This seems to be related to increased clearance. So far, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Sildenafil (Viagra)

Theoretically, concurrent use of sildenafil and fenugreek might reduce levels and therapeutic effects of sildenafil.
Animal research shows that taking fenugreek seeds for 1 week reduces maximum concentrations and the area under the curve of a single dose of sildenafil by 27% and 48%, respectively. So far, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Theophylline

Theoretically, fenugreek may reduce the levels and clinical effects of theophylline.
Animal research shows that fenugreek 50 grams daily for 7 days reduces the maximum serum concentration (Cmax) of theophylline by 28% and the area under the plasma drug concentration-time curve (AUC) by 22%.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, fenugreek might have additive effects with warfarin and increase the international normalized ratio (INR).
Some fenugreek constituents have antiplatelet effects, although these might not be present in concentrations that are clinically significant. In one case report, a patient taking warfarin experienced an increased INR when starting to take fenugreek in combination with boldo.

Likelihood Possible Evidence D
Antihypertensive Drugs

Fenugreek may also have an additive effect on blood pressure-lowering medications. Studies on animals have shown that fenugreek seed can decrease both systolic and diastolic blood pressure by up to 22% when combined with metoprolol. Therefore, it is essential to monitor your blood pressure regularly if you are taking fenugreek and metoprolol together or any other antihypertensive drugs.

Likelihood Possible Evidence C
TESTOFEN(R) Fenugreek extract full monograph & interactions

Long jack extract 100:15 drug types · 248 drugs

Propranolol (Inderal)

Eurycoma longifolia can reduce the levels and clinical effects of propranolol.
A small clinical study in healthy persons shows that taking a single dose of a water-based Eurycoma longifolia extract 200 mg, in combination with a single dose of propranolol 80 mg, reduces the propranolol area under the curve (AUC) by 29%, reduces the peak concentration by 42%, and increases time to peak concentration by 86% when compared with control. Since the elimination half-life of propranolol did not change, it seems that Eurycoma longifolia alters the kinetics of propranolol by decreasing its absorption in the gut, and not by altering its metabolism. It is not known if separating administration will prevent this interaction.

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

Theoretically, Eurycoma longifolia might increase levels CYP1A2 substrates.
In vitro research suggests that methanolic Eurycoma longifolia root extract weakly inhibits CYP1A2 enzymes. This effect has not been reported in humans.

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

Theoretically, Eurycoma longifolia might increase levels of CYP2A6 substrates.
In vitro research suggests that methanolic Eurycoma longifolia root extract weakly inhibits CYP2A6 enzymes. This effect has not been reported in humans.

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

Theoretically, Eurycoma longifolia might increase levels of CYP2C19 substrates.
In vitro research suggests that methanolic Eurycoma longifolia root extract weakly inhibits CYP2C19 enzymes. This effect has not been reported in humans.

Likelihood Possible Evidence D
Testosterone

Theoretically, Eurycoma longifolia may further increase levels of testosterone.
A clinical study in aging males with testosterone levels below 300 ng/dL shows that taking a specific water extract of Eurycoma longifolia roots (Physta; Biotropics Malaysia) 100-200 mg daily with breakfast for 12 weeks increases total testosterone levels by 8% to 11% when compared with placebo. It is unclear whether this increase would occur in individuals with normal testosterone levels.

Likelihood Possible Evidence D
Long jack extract 100:1 full monograph & interactions

Wild oat 10:1 extract2 drug types · 86 drugs

Antidiabetes Drugs

Theoretically, oats may have additive effects with antidiabetic agents and might increase the risk of hypoglycemia.
Consuming oats can decrease blood glucose in patients with diabetes. In those who require insulin, taking oats 100 grams daily for 2 days reduces the insulin dose required to achieve metabolic control.

Likelihood Possible Evidence D
Insulin

Concomitant use of oats and insulin might increase the risk of hypoglycemia.
In patients with insulin-dependent type 2 diabetes, taking oats 100 grams daily for 2 days reduces the insulin dose required to achieve metabolic control.

Likelihood Possible Evidence B
Wild oat 10:1 extract full monograph & interactions

Zinc Aspartate10 drug types · 67 drugs

Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)

Theoretically, zinc might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Advise patients that bictegravir/emtricitabine/tenofovir alafenamide should be taken at least 2 hours before or 6 hours after zinc containing products.

Likelihood Probable Evidence D
Cephalexin (Keflex)

Zinc might decrease cephalexin levels by chelating with cephalexin in the gut and preventing its absorption.
A pharmacokinetic study shows that zinc sulfate 250 mg taken concomitantly with cephalexin 500 mg decreases peak levels of cephalexin by 31% and reduces the exposure to cephalexin by 27%. Also, taking zinc sulfate 3 hours before cephalexin decreases peak levels of cephalexin by 11% and reduces the exposure to cephalexin by 18%. By decreasing cephalexin levels, zinc might increase the risk of treatment failure. This effect does not occur when zinc is taken 3 hours after the cephalexin dose. To avoid an interaction, advise patients take zinc sulfate 3 hours after taking cephalexin.

Likelihood Probable Evidence B
Cisplatin (Platinol-Aq)

Theoretically, zinc might interfere with the therapeutic effects of cisplatin.
Animal research suggests that zinc stimulates tumor cell production of the protein metallothionein, which binds and inactivates cisplatin. It is not known whether zinc supplements or high dietary zinc intake can cause clinically significant interference with cisplatin therapy. Cisplatin might also increase zinc excretion.

Likelihood Possible Evidence D
Integrase Inhibitors

Theoretically, taking zinc along with integrase inhibitors might decrease the levels and clinical effects of these drugs.
Zinc is a divalent cation. Pharmacokinetic studies have shown that other divalent cations such as calcium and iron can decrease blood levels of the integrase inhibitor dolutegravir through chelation.

Likelihood Possible Evidence D
Penicillamine (Cuprimine, Depen)

Zinc might reduce the levels and clinical effects of penicillamine.
By forming an insoluble complex with penicillamine, zinc interferes with penicillamine absorption and activity. Zinc supplements reduce the efficacy of low-dose penicillamine (0.5-1 gram/day), but do not seem to affect higher doses (1-2.75 gram/day), provided dosing times are separated. Advise patients to take zinc and penicillamine at least 2 hours apart.

Likelihood Probable Evidence B
Quinolone Antibiotics

Zinc can decrease the levels and clinical effects of quinolones antibiotics.
Quinolones form complexes with zinc in the gastrointestinal tract, reducing absorption of both the quinolone and zinc if taken at the same time. Advise patients to take these drugs at least 2 hours before, or 4-6 hours after, zinc supplements.

Likelihood Probable Evidence B
Ritonavir (Norvir)

Zinc modestly reduces levels of ritonavir.
Clinical research shows that zinc might reduce serum ritonavir levels by chelating with ritonavir in the gut and preventing its absorption. In patients with HIV, ritonavir is taken with atazanavir to prevent the metabolism and increase the effects of atazanavir. A pharmacokinetic study shows that, in patients being treated with atazanavir/ritonavir, co-administration of zinc sulfate (Solvazinc tablets) 125 mg as a single dose or as multiple daily doses for 2 weeks reduces plasma levels of ritonavir by about 16%. However, atazanavir levels still remains high enough to prevent HIV virus replication. Therefore, the decrease in ritonavir levels is not likely to be clinically significant.

Likelihood Probable Evidence B
Tetracycline Antibiotics

Zinc might reduce levels of tetracycline antibiotics.
Tetracyclines form complexes with zinc in the gastrointestinal tract, which can reduce absorption of both the tetracycline and zinc when taken at the same time. Taking zinc sulfate 200 mg with tetracycline reduces absorption of the antibiotic by 30% to 40%. Demeclocycline and minocycline cause a similar interaction. However, doxycycline does not seem to interact significantly with zinc. Advise patients to take tetracyclines at least 2 hours before, or 4-6 hours after, zinc supplements to avoid any interactions.

Likelihood Probable Evidence B
Amiloride (Midamor)

Amiloride can modestly reduce zinc excretion and increase zinc levels.
Clinical research shows that amiloride can reduce urinary zinc excretion, especially at doses of 10 mg per day or more. This zinc-sparing effect can help to counteract zinc losses caused by thiazide diuretics, but it is unlikely to cause zinc toxicity at usual amiloride doses. The other potassium-sparing diuretics, spironolactone (Aldactone) and triamterene (Dyrenium), do not seem to have a zinc-sparing effect.

Likelihood Probable Evidence B
Atazanavir (Reyataz)

Zinc modestly reduces levels of atazanavir, although this effect does not seem to be clinically significant.
Clinical research shows that zinc might decrease serum atazanavir levels by chelating with atazanavir in the gut and preventing its absorption. Although a single dose of zinc sulfate (Solvazinc tablets) 125 mg orally does not affect atazanavir concentrations in patients being treated with atazanavir/ritonavir, co-administration of zinc sulfate 125 mg daily for 2 weeks reduces plasma levels of atazanavir by about 22% in these patients. However, despite this decrease, atazanavir levels still remain at high enough concentrations for the prevention of HIV virus replication.

Likelihood Probable Evidence B
Zinc Aspartate full monograph & interactions

7-Methoxyflavone2 drug types · 12 drugs

Aromatase Inhibitors

In vitro evidence shows that 7-methoxyflavone inhibits aromatase. Theoretically, 7-methoxyflavone might have an additive effects when used with other aromatase inhibitors, potentially increasing the therapeutic effects and adverse effects associated with these drugs. Some aromatase inhibitors include anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara).

Likelihood Possible Evidence D
Testosterone

In vitro evidence shows that 7-methoxyflavone inhbits aromatase. Inhibiting aromatase reduces the conversion of testosterone and other androgens to estrogens. Theoretically, use of 7-methoxyflavone with testosterone might increase the effects and side effects of testosterone therapy.

Likelihood Possible Evidence D
7-Methoxyflavone full monograph & interactions
The maker

Brand information

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

ANS Performance

See all ANS Performance products
Name
Advanced Nutraceutical Sciences Inc.
Pharmacist Counseling Corner

Fortitude by ANS Performance: Common Questions

Does Fortitude by ANS Performance interact with any medications?
Yes. Based on its ingredients, Fortitude has a known interaction with 1,187 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Fortitude contains 14 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.
Is this safe to take if I'm on warfarin or another blood thinner?
No—Fortitude contains vitamin E and fenugreek, both of which may increase bleeding risk when combined with blood thinners. Check with your doctor or pharmacist before taking it.
Can I take this if I'm diabetic and on insulin or diabetes pills?
Talk to your doctor first. Fenugreek and oats in this product can lower blood sugar further, which may require a dose adjustment to your diabetes medication to avoid low blood sugar episodes.
Does zinc in here interact with my antibiotic?
Yes, if it's a quinolone (like ciprofloxacin), cephalexin, or tetracycline. These antibiotics and zinc form complexes that reduce absorption of both. Take zinc at least 2–6 hours away from your antibiotic.
Is it safe to take while pregnant or breastfeeding?
No. Fenugreek, boron, long jack, and bee propolis should all be avoided during pregnancy and/or breastfeeding due to insufficient safety data or possible hormonal effects. Talk with your doctor.
What's the most common side effect from the zinc in this?
Nausea, diarrhea, and a metallic taste are the most common, especially if you're sensitive. Taking it with food may help.
Will this boost my testosterone?
Long jack extract and 7-methoxyflavone are included for that purpose, but the evidence for long jack is only 'possibly effective' for sexual desire. 7-Methoxyflavone's real-world effects in humans are unknown.

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.

Fortitude label
Go deeper

The Full Monographs Behind Fortitude’s Ingredients

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

Herb & supplement monograph

Vitamin E

Interacts with 764 drugs

Vitamin E is an essential fat-soluble vitamin and antioxidant that most people get in adequate amounts from a normal diet. Supplements can help correct a true deficiency, but high-dose vitam...

Read the full Vitamin E monograph → Herb & supplement monograph

Boron

Boron is a trace mineral found in many plant foods and sold as a supplement, mainly promoted for bone, joint, and hormone health. The human evidence for most of these uses is limited or prel...

Read the full Boron monograph → Herb & supplement monograph

Hu Zhang

Interacts with 826 drugs

Hu Zhang (Japanese knotweed root) is a traditional Chinese herb that is one of the richest natural sources of resveratrol and emodin. Some lab and early human research looks interesting for...

Read the full Hu Zhang monograph → Herb & supplement monograph

Zinc

Interacts with 67 drugs

Zinc is an essential mineral that your body needs for immune function, wound healing, taste, and smell. Most people get enough from food, but supplements can help correct or prevent a defici...

Read the full Zinc monograph → Herb & supplement monograph

Fenugreek

Interacts with 389 drugs

Fenugreek is a common kitchen spice that is also taken as a supplement, mainly for blood sugar, cholesterol, and to support breast milk production. Some early research is encouraging for blo...

Read the full Fenugreek monograph → Herb & supplement monograph

Oats

Interacts with 86 drugs

Oats are a well-studied whole grain whose soluble fiber (beta-glucan) can help lower cholesterol and support heart health when eaten regularly. As a food, oats are safe for most people, and...

Read the full Oats monograph → Herb & supplement monograph

Eurycoma Longifolia

Interacts with 248 drugs

Eurycoma longifolia (tongkat ali) is a Southeast Asian herb most popular for supporting testosterone, libido, and male fertility, with some small human studies suggesting possible benefits....

Read the full Eurycoma Longifolia monograph → Herb & supplement monograph

7-methoxyflavone

Interacts with 12 drugs

7-Methoxyflavone is a lab-made or plant-derived flavonoid marketed mainly in testosterone-boosting and bodybuilding supplements based on the idea that it blocks the aromatase enzyme. However...

Read the full 7-methoxyflavone monograph → Herb & supplement monograph

Propolis

Interacts with 921 drugs

Propolis is a natural, resin-like substance made by bees that has antimicrobial and anti-inflammatory properties in lab studies. Early research suggests it may help with cold sores, mouth so...

Read the full Propolis monograph →
Sources

Sources & How We Checked

Fortitude'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 246 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.

Zinc 88 references
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  45. DeCook CA, Hirsch AR. Anosmia due to inhalational zinc: a case report (abstract). Chem Senses 2000;25:659.
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  52. GlaxoSmithKline Consumer Advisory. GlaxoSmithKline (GSK) warns about a potential health risk associated with long-term, excessive use of GSK's zinc-containing denture adhesives Super Polygrip Original, Ultra Fresh and Extra Care. February 18, 2010. Availa
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  55. Sharquie, K. E., Najim, R. A., Farjou, I. B., and Al Timimi, D. J. Oral zinc sulphate in the treatment of acute cutaneous leishmaniasis. Clin.Exp.Dermatol. 2001;26(1):21-26. PubMed
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  58. Jafek, B. W., Linschoten, M. R., and Murrow, B. W. Anosmia after intranasal zinc gluconate use. Am J Rhinol. 2004;18(3):137-141. DOI
  59. Simonart, T. and de, Maertelaer, V. Systemic treatments for cutaneous warts: a systematic review. J Dermatolog.Treat. 2012;23(1):72-77. PubMed
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Oats 13 references
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Eurycoma Longifolia 4 references
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7-methoxyflavone 1 reference
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See these in context on the 7-methoxyflavone monograph →

Propolis 21 references
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See these in context on the Propolis 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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