Hair, Skin & Nails Ingredients & Drug Interactions
by Foods Plus
What is this page for?
First and foremost: checking Hair, Skin & Nails 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
Hair, Skin & Nails is a dietary supplement by Foods Plus with 20 active ingredients. Its ingredients are commonly taken for high cholesterol, liver health, brain and memory support.Based on those ingredients, 1,538 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Fo-Ti, Niacin, Alfalfa. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Hair, Skin & Nails by Foods Plus
Ask about any prescription or over-the-counter medication and we check it for interactions with Hair, Skin & Nails by Foods Plus — and tell you which ingredient is responsible.
AI summaries are generated from our interaction database for education only — always confirm with your pharmacist. How we use AI
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HelloPharmacist Scorecard of Hair, Skin & Nails by Foods Plus
Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.
What’s inside
Partial disclosure
Hair, Skin & Nails contains 20 active ingredients. The formula includes B vitamins niacin and B12, biotin, and pantothenic acid—all involved in protein and energy metabolism.
Minerals include zinc, iron, copper, iodine, manganese, and silica (from silicon), which play roles in collagen synthesis, immune function, and connective tissue health. You'll also find soy lecithin, calcium, alfalfa, the traditional herb fo-ti, horsetail extract, and hydrolyzed collagen.
An organic sulfur complex is included as well. The product is rounded out with microcrystalline cellulose, croscarmellose sodium, stearic acid, magnesium stearate, calcium silicate, and pharmaceutical glaze as inactive ingredients.
Does it work?
Strong evidence
The evidence for most of these ingredients' effects on hair, skin, and nails is not established in the data we hold. Iron is effective for iron deficiency anemia and likely effective for osteoporosis (via calcium).
Niacin is likely effective for pellagra and possibly effective for certain cholesterol problems in people with HIV. Zinc is possibly effective for acne and age-related macular degeneration.
Vitamin B12 is effective for B12 deficiency. Biotin is likely effective for biotin deficiency.
For the remaining ingredients—including silica, copper, iodine, alfalfa, fo-ti, horsetail, and hydrolyzed collagen—the evidence we hold shows insufficient reliable evidence or is not available to establish benefit for hair, skin, or nail health specifically.
How safe is it?
Well-documented data
Most individual ingredients are generally well tolerated at recommended doses. Soy lecithin may cause abdominal pain, diarrhea, nausea, or allergic skin reactions in people with soy or egg allergies.
Niacin commonly causes flushing (up to 70% of users) and can cause liver problems at high doses. Biotin and pantothenic acid are generally safe; biotin has rarely caused mild diarrhea.
Zinc at high doses may cause abdominal cramps, nausea, diarrhea, and copper deficiency with prolonged use. Iron causes constipation and gastrointestinal upset in many people and can rarely lead to gastric ulceration.
Iodine can cause thyroid problems, goiter, nausea, and metallic taste at high doses. Manganese at very high doses carries a serious risk of neurological damage resembling Parkinson disease.
Alfalfa may cause abdominal discomfort, diarrhea, and flatulence, and has rarely been linked to a lupus-like syndrome. Fo-ti is concerning: it has been associated with approximately 450 documented cases of liver damage (hepatitis), ranging from mild to cirrhosis and liver failure.
Horsetail may contain thiaminase, which can cause thiamine deficiency with long-term use, and has rarely caused allergic skin reactions. For pregnancy and breastfeeding: iodine and vitamin B12 are likely safe; calcium, niacin, and biotin are likely safe at recommended amounts; silica is rated likely safe in pregnancy; but fo-ti, horsetail, and alfalfa lack safety data and should be avoided during pregnancy and breastfeeding, and you should not take high-dose niacin, biotin, pantothenic acid, manganese, or zinc supplements without medical advice.
Meds to double-check
Major interaction found
Check the following medication types before taking this product: HIV integrase inhibitors (dolutegravir, elvitegravir)—major risk with calcium; antibiotics, especially quinolones, tetracyclines, and cephalexin—moderate risk with zinc and iron; warfarin and other blood thinners—moderate to major risk with alfalfa and fo-ti; blood pressure medications (antihypertensives)—moderate risk with niacin; diabetes medications—moderate risk with niacin and alfalfa; thyroid medication (levothyroxine)—moderate risk with calcium and iron; statins—moderate risk with niacin; lithium—moderate risk with iodine and horsetail; bisphosphonates (osteoporosis)—moderate risk with iron; and digoxin (heart)—moderate risk with fo-ti. Additionally, if you receive intravenous ceftriaxone, inform your provider about calcium supplements due to serious precipitation risk.
The bottom line
Scorecard at a glancePartially disclosed formula with clinical evidence supporting its stated purpose. Major medication interactions have been identified, and safety information is well characterized.
This product contains multiple ingredients that interact with common medications—particularly blood pressure drugs, blood thinners, diabetes medications, antibiotics, thyroid medication, and HIV drugs. If you take any prescription medications, especially for heart rhythm, HIV, blood pressure, diabetes, or thyroid conditions, or if you're on warfarin, check each drug against the interaction tool below before starting.
The ingredient fo-ti carries a real risk of liver damage; if you choose to take this product, discuss it with your pharmacist or doctor first.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 16 of 20 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Mar 24, 2017.
This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed
General information
Key facts about Hair, Skin & Nails, straight from the product label.
| Brand | Foods Plus |
|---|---|
| Barcode (UPC) | 717284006054 |
| Net contents | 60 Caplet(s) |
| Market status | On market |
| Date entered into DSLD | Mar 24, 2017 |
| DSLD ID | 72425 |
| Product type | Other Combinations |
| Supplement form | Unknown |
| Dietary claims / uses | Nutrient, All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years), Gluten Free, Dairy Free, Sugar Free |
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.
Supplement Facts
The label details for Hair, Skin & Nails by Foods Plus, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Soy Lecithin | 50 mg | -- |
| Niacin | 35 mg | 175% |
| Vitamin B12 | 5 mcg | 83% |
| Biotin | 150 mcg | 50% |
| Pantothenic Acid | 100 mg | 1000% |
| Manganese | 4.5 mg | 225% |
| Folate | 400 mcg | 100% |
| Zinc | 10 mg | 67% |
| Silica | 27 mg | -- |
| Copper | 1 mg | 50% |
| Iron | 4.5 mg | 25% |
| Iodine | 150 mcg | 100% |
| Alfalfa | 0 NP | -- |
| PABA | 30 mg | -- |
| Fo-Ti | 0 NP | -- |
| Calcium | 150 mg | 15% |
| Herbal Base | 100 mg | -- |
| Phosphorus | 110 mg | 11% |
| Horsetail | 0 NP | -- |
| Hydrolyzed collagen | 100 mg | -- |
| organic Sulfur Complex | 25 mg | -- |
Other ingredients: Microcrystalline Cellulose, Croscarmellose Sodium, Stearic Acid, Magnesium Stearate, Calcium Silicate, Pharmaceutical Glaze
Tap any ingredient to jump to its full detail below.
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
General Statements
Promotes health hair, skin & nails
Made in the U.S.A.
Since 1962
FDA Statement of Identity
Dietary Supplement
Suggested/Recommended/Usage/Directions
Directions: Take 1 caplet daily as a dietary supplement or as directed by a healthcare professional.
General
FP #605
Precautions
Keep out of reach of children..
Caution: Transient flushing and feeling of warmth might be associated with the ingestion of niacin-containing products.
Warning: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. Keep this product out of reach of children. In case of accidental overdose call a doctor or poison control center immediately.
Storage
Protect from heat, light and moisture. 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.
Formulation
No sugar, starch, wheat, milk, artificial colors, flavors or preservatives
Preservative Free Non GMO Gluten-free
Formula
With biotin & collagen
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Hair, Skin & Nails by Foods Plus label
The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.
Label images are published by the NIH Dietary Supplement Label Database for the version of this product on file. Always read your actual product label.
View the full label (PDF)The Ingredients in Hair, Skin & Nails by Foods Plus
These are the 20 active ingredients this product is made of. Select any to open its full monograph.
Serving size1 Caplet(s) Dosage formUnknown 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.
Soy Lecithin
No knowninteractions
Lecithin is a natural fatty substance found in foods and made by the body that is widely used as a supplement and food emulsifier. Evidence supporting...
Soy Lecithin monograph & interactionsNiacin
Interacts with727 drugs
Niacin (vitamin B3) is an essential nutrient your body needs for energy and metabolism, and deficiency is uncommon in most developed countries. Prescr...
Niacin monograph & interactionsVitamin B12
Interacts with20 drugs
Vitamin B12 (cobalamin) is an essential nutrient your body needs to make red blood cells, keep nerves healthy, and support DNA. Supplements are very h...
Vitamin B12 monograph & interactionsBiotin
No knowninteractions
Biotin (vitamin B7) is a water-soluble vitamin your body needs to turn food into energy and to support healthy hair, skin, and nails. Most people get...
Biotin monograph & interactionsPantothenic Acid
No knowninteractions
Pantothenic acid is vitamin B5, an essential nutrient your body uses to turn food into energy. True deficiency is very rare because it is found in nea...
Pantothenic Acid monograph & interactionsManganese
Interacts with83 drugs
Manganese is an essential trace mineral your body needs in small amounts for bone formation, metabolism, and antioxidant defense, and most people get...
Manganese monograph & interactionsFolate
Zinc
Interacts with67 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 suppleme...
Zinc monograph & interactionsSilica
No knowninteractions
Silicon is a trace mineral found in the body and in foods like oats, barley, and certain fruits and vegetables, and it is popular in supplements for h...
Silica monograph & interactionsCopper
Interacts with31 drugs
Copper is an essential trace mineral your body needs in small amounts for making red blood cells, supporting nerves and bones, and helping enzymes wor...
Copper monograph & interactionsIron
Interacts with80 drugs
Iron is an essential mineral your body needs to make hemoglobin and carry oxygen in the blood. Supplements are mainly useful for treating or preventin...
Iron monograph & interactionsIodine
Interacts with7 drugs
Iodine is an essential mineral your body needs to make thyroid hormones, and most people get enough from iodized salt, dairy, and seafood. Supplements...
Iodine monograph & interactionsPABA
Calcium
Interacts with168 drugs
Calcium is an essential mineral your body needs for strong bones, nerve signaling, and muscle function, and supplements can help fill gaps when diet f...
Calcium monograph & interactionsPhosphorus
Hydrolyzed collagen
No knowninteractions
Collagen peptides are a well-absorbed form of protein that may modestly improve skin elasticity and joint comfort for some people, though evidence is...
Hydrolyzed collagen monograph & interactionsOrganic Sulfur Complex
Other (inactive) ingredients: Microcrystalline Cellulose, Croscarmellose Sodium, Stearic Acid, Magnesium Stearate, Calcium Silicate, Pharmaceutical Glaze. These complete the product’s ingredient list but are not active constituents.
Hair, Skin & Nails by Foods Plus Drug Interactions
HelloPharmacist Interaction Report
Hair, Skin & Nails by Foods Plus contains several ingredients with documented interactions affecting a large number of medications.
The most serious concern is calcium, which significantly reduces levels of two HIV integrase inhibitors—dolutegravir and elvitegravir—by nearly 40%, and can cause dangerous precipitation when given intravenously alongside the antibiotic ceftriaxone. Niacin poses moderate risks with blood pressure medications (raising the risk of low blood pressure), blood thinners and clotting drugs, diabetes medications, statins, gout medications, and bile acid sequestrants.
Zinc reduces absorption of several antibiotics (quinolones, tetracyclines, cephalexin), the arthritis drug penicillamine, the HIV drug ritonavir, and some newer HIV integrase inhibitors, and theoretically interferes with cisplatin chemotherapy.
Read the full breakdown — every affected drug type, severity by severity
Iron interacts with levodopa (Parkinson's), quinolone and tetracycline antibiotics, bisphosphonates (osteoporosis), methyldopa (blood pressure), levothyroxine (thyroid), mycophenolate mofetil (immunosuppressant), and penicillamine. Iodine combined with lithium, antithyroid drugs, or amiodarone (heart rhythm) raises thyroid risks.
Alfalfa—rich in vitamin K—can reduce warfarin's blood-thinning effect, and may interfere with birth control, hormone therapy, immunosuppressants, and diabetes medications. Fo-ti has been linked to acute liver failure and warfarin complications, and theoretically affects multiple drug-metabolizing pathways and digoxin.
Copper with penicillamine reduces its absorption; manganese and the herb horsetail interact with specific antibiotic and psychiatric drugs.
Several ingredients could not be checked for interactions: folate, PABA, phosphorus, hydrolyzed collagen, and organic sulfur complex. Altogether, these interactions span 1,516 individual medications.
Use the medication checker below with your exact prescriptions and over-the-counter drugs before starting this product.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Hair, Skin & Nails?
Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.
Go to the checkerIngredients driving the most interactions
Individual Drug Interactions
The ingredients in Hair, Skin & Nails interact with 1,538 drugs. Click any drug to see the details.
11 of the 20 ingredients in Hair, Skin & Nails interact with drugs. Each result below shows which ingredient is responsible. Fo-Ti Niacin Alfalfa Horsetail Calcium Manganese Iron Zinc Copper Vitamin B12 Iodine
CeftriaxoneRocephin
How Ceftriaxone interacts with Hair, Skin & Nails — through 1 ingredient. Tap an ingredient for the detail:
CalciumCeftriaxone (rocephin) Major
Interaction Summary
Co-administration of intravenous calcium and ceftriaxone can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys.
Read the full Calcium + Ceftriaxone interactionCobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide FumarateGenvoya
How Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interacts with Hair, Skin & Nails — through 6 ingredients. Tap an ingredient for the detail:
CalciumElvitegravir (vitekta), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionFo-tiHepatotoxic Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Read the full Fo-ti + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionIronBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Iron might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption when taken in a fasting state.
Read the full Iron + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionZincBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Theoretically, zinc might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Read the full Zinc + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionHorsetailNucleoside Reverse Transcriptase Inhibitors (nrtis) Moderate
Interaction Summary
Theoretically, horsetail might decrease the levels and clinical effects of NRTIs.
Read the full Horsetail + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionDolutegravirTivicay
How Dolutegravir interacts with Hair, Skin & Nails — through 2 ingredients. Tap an ingredient for the detail:
CalciumDolutegravir (tivicay) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium + Dolutegravir interactionIronDolutegravir (tivicay) Moderate
Interaction Summary
Iron might decrease dolutegravir levels by reducing its absorption.
Read the full Iron + Dolutegravir interactionDolutegravir, Emtricitabine, Tenofovir AlafenamideDolutegravir, Emtricitabine, Tenofovir Alafenamide
How Dolutegravir, Emtricitabine, Tenofovir Alafenamide interacts with Hair, Skin & Nails — through 6 ingredients. Tap an ingredient for the detail:
CalciumDolutegravir (tivicay), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionHorsetailNucleoside Reverse Transcriptase Inhibitors (nrtis) Moderate
Interaction Summary
Theoretically, horsetail might decrease the levels and clinical effects of NRTIs.
Read the full Horsetail + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionFo-tiHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Read the full Fo-ti + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionIronDolutegravir (tivicay), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Iron might decrease dolutegravir levels by reducing its absorption.
Read the full Iron + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionZincBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Theoretically, zinc might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Read the full Zinc + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionDolutegravir, RilpivirineJuluca
How Dolutegravir, Rilpivirine interacts with Hair, Skin & Nails — through 3 ingredients. Tap an ingredient for the detail:
CalciumDolutegravir (tivicay) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium + Dolutegravir, Rilpivirine interactionIronDolutegravir (tivicay) Moderate
Interaction Summary
Iron might decrease dolutegravir levels by reducing its absorption.
Read the full Iron + Dolutegravir, Rilpivirine interactionFo-tiCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti + Dolutegravir, Rilpivirine interactionElvitegravirVitekta
How Elvitegravir interacts with Hair, Skin & Nails — through 2 ingredients. Tap an ingredient for the detail:
CalciumElvitegravir (vitekta) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium + Elvitegravir interactionFo-tiCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti + Elvitegravir interactionElvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil FumarateStribild
How Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interacts with Hair, Skin & Nails — through 6 ingredients. Tap an ingredient for the detail:
CalciumElvitegravir (vitekta), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionFo-tiCytochrome P450 3a4 (cyp3a4) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionHorsetailNucleoside Reverse Transcriptase Inhibitors (nrtis) Moderate
Interaction Summary
Theoretically, horsetail might decrease the levels and clinical effects of NRTIs.
Read the full Horsetail + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionZincBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Theoretically, zinc might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Read the full Zinc + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionIronBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Iron might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption when taken in a fasting state.
Read the full Iron + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionWarfarinWarfarin
How Warfarin interacts with Hair, Skin & Nails — through 3 ingredients. Tap an ingredient for the detail:
AlfalfaWarfarin (coumadin) Major
Interaction Summary
Theoretically, alfalfa might reduce the anticoagulant activity of warfarin.
Read the full Alfalfa + Warfarin interactionFo-tiAnticoagulant/antiplatelet Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates +5 Moderate
Interaction Summary
Fo-ti has been linked to cases of acute liver failure which can decrease clotting factor production and increase the effects of anticoagulants.
Read the full Fo-ti + Warfarin interactionNiacinAnticoagulant/antiplatelet Drugs, Warfarin (coumadin) Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Warfarin interactionWarfarin SodiumCoumadin, Panwarfin, Sofarin
How Warfarin Sodium interacts with Hair, Skin & Nails — through 3 ingredients. Tap an ingredient for the detail:
AlfalfaWarfarin (coumadin) Major
Interaction Summary
Theoretically, alfalfa might reduce the anticoagulant activity of warfarin.
Read the full Alfalfa + Warfarin Sodium interactionNiacinWarfarin (coumadin), Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
There is limited evidence that niacin may increase the anticoagulant effects of warfarin.
Read the full Niacin + Warfarin Sodium interactionFo-tiCytochrome P450 3a4 (cyp3a4) Substrates, Warfarin (coumadin) +5 Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti + Warfarin Sodium interaction6-mercaptopurinePurinethol
How 6-mercaptopurine interacts with Hair, Skin & Nails — through 3 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + 6-mercaptopurine interactionFo-tiHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Read the full Fo-ti + 6-mercaptopurine interactionAlfalfaImmunosuppressants Moderate
Interaction Summary
Theoretically, alfalfa might decrease the efficacy of immunosuppressive therapy.
Read the full Alfalfa + 6-mercaptopurine interactionAdo-trastuzumab EmtansineKadcyla
How Ado-trastuzumab Emtansine interacts with Hair, Skin & Nails — through 1 ingredient. Tap an ingredient for the detail:
Fo-tiCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti + Ado-trastuzumab Emtansine interactionAbacavir Sulfate, Dolutegravir, LamivudineTriumeq
How Abacavir Sulfate, Dolutegravir, Lamivudine interacts with Hair, Skin & Nails — through 3 ingredients. Tap an ingredient for the detail:
Fo-tiHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Read the full Fo-ti + Abacavir Sulfate, Dolutegravir, Lamivudine interactionHorsetailNucleoside Reverse Transcriptase Inhibitors (nrtis) Moderate
Interaction Summary
Theoretically, horsetail might decrease the levels and clinical effects of NRTIs.
Read the full Horsetail + Abacavir Sulfate, Dolutegravir, Lamivudine interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abacavir Sulfate, Dolutegravir, Lamivudine interactionAbacavir, LamivudineEpzicom
How Abacavir, Lamivudine interacts with Hair, Skin & Nails — through 3 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abacavir, Lamivudine interactionFo-tiHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Read the full Fo-ti + Abacavir, Lamivudine interactionHorsetailNucleoside Reverse Transcriptase Inhibitors (nrtis) Moderate
Interaction Summary
Theoretically, horsetail might decrease the levels and clinical effects of NRTIs.
Read the full Horsetail + Abacavir, Lamivudine interactionAbciximabReoPro
How Abciximab interacts with Hair, Skin & Nails — through 2 ingredients. Tap an ingredient for the detail:
NiacinAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Abciximab interactionFo-tiAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Fo-ti has been linked to cases of acute liver failure which can decrease clotting factor production and increase the effects of anticoagulants.
Read the full Fo-ti + Abciximab interactionAbemaciclibVerzenio
How Abemaciclib interacts with Hair, Skin & Nails — through 1 ingredient. Tap an ingredient for the detail:
Fo-tiCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti + Abemaciclib interactionAbiraterone
How Abiraterone interacts with Hair, Skin & Nails — through 2 ingredients. Tap an ingredient for the detail:
Fo-tiCytochrome P450 3a4 (cyp3a4) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti + Abiraterone interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abiraterone interactionAbiraterone AcetateYonsa, Zytiga
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NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abiraterone Acetate interactionFo-tiCytochrome P450 3a4 (cyp3a4) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti + Abiraterone Acetate interactionAbrocitinibCibinqo
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Fo-tiCytochrome P450 2c19 (cyp2c19) Substrates, Anticoagulant/antiplatelet Drugs +1 Moderate
Interaction Summary
Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2C19.
Read the full Fo-ti + Abrocitinib interactionAlfalfaImmunosuppressants Moderate
Interaction Summary
Theoretically, alfalfa might decrease the efficacy of immunosuppressive therapy.
Read the full Alfalfa + Abrocitinib interactionNiacinAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Abrocitinib interactionAcalabrutinibCalquence
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Fo-tiCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Fo-ti + Acalabrutinib interactionAcarboseGlucobay, Prandase, Precose
How Acarbose interacts with Hair, Skin & Nails — through 4 ingredients. Tap an ingredient for the detail:
Fo-tiAntidiabetes Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, fo-ti might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Read the full Fo-ti + Acarbose interactionHorsetailAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, taking horsetail with antidiabetes drugs might increase the risk of hypoglycemia.
Read the full Horsetail + Acarbose interactionAlfalfaAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, alfalfa might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Read the full Alfalfa + Acarbose interactionNiacinAntidiabetes Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Niacin can increase blood glucose levels and may diminish the effects of antidiabetes drugs.
Read the full Niacin + Acarbose interactionAcebutololRhotral, Sectral
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NiacinHepatotoxic Drugs, Antihypertensive Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acebutolol interactionFo-tiHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Read the full Fo-ti + Acebutolol interactionAcenocoumarolSintrom
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Fo-tiAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Fo-ti has been linked to cases of acute liver failure which can decrease clotting factor production and increase the effects of anticoagulants.
Read the full Fo-ti + Acenocoumarol interactionNiacinAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Acenocoumarol interactionAcepromazineAtravet
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AlfalfaPhotosensitizing Drugs Moderate
Interaction Summary
Theoretically, concomitant use of alfalfa with photosensitizing drugs might have additive effects.
Read the full Alfalfa + Acepromazine interactionManganeseAntipsychotic Drugs Moderate
Interaction Summary
Theoretically, the risk for manganese toxicity might increase when taken with antipsychotic drugs.
Read the full Manganese + Acepromazine interactionAcetaminophenChildren's Tylenol, Children's Tylenol Meltaways, Tylenol, Tylenol Ex Strength
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Fo-tiHepatotoxic Drugs, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Read the full Fo-ti + Acetaminophen interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acetaminophen interactionAcetaminophen, AspirinGemnisyn
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NiacinHepatotoxic Drugs, Anticoagulant/antiplatelet Drugs +1 Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acetaminophen, Aspirin interactionFo-tiCytochrome P450 1a2 (cyp1a2) Substrates, Hepatotoxic Drugs +1 Moderate
Interaction Summary
Theoretically, fo-ti might increase or decrease the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Fo-ti + Acetaminophen, Aspirin interactionAcetaminophen, Aspirin, CaffeineExcedrin, Excedrin Extra Strength, Excedrin Migraine
How Acetaminophen, Aspirin, Caffeine interacts with Hair, Skin & Nails — through 2 ingredients. Tap an ingredient for the detail:
Fo-tiAnticoagulant/antiplatelet Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates +2 Moderate
Interaction Summary
Fo-ti has been linked to cases of acute liver failure which can decrease clotting factor production and increase the effects of anticoagulants.
Read the full Fo-ti + Acetaminophen, Aspirin, Caffeine interactionNiacinAspirin, Hepatotoxic Drugs +1 Moderate
Interaction Summary
Large doses of aspirin might alter the clearance of niacin.
Read the full Niacin + Acetaminophen, Aspirin, Caffeine interactionAcetaminophen, Brompheniramine, PhenylpropanolamineDimetapp Cold and Flu
How Acetaminophen, Brompheniramine, Phenylpropanolamine interacts with Hair, Skin & Nails — through 3 ingredients. Tap an ingredient for the detail:
Fo-tiCytochrome P450 1a2 (cyp1a2) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, fo-ti might increase or decrease the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Fo-ti + Acetaminophen, Brompheniramine, Phenylpropanolamine interactionAlfalfaPhotosensitizing Drugs Moderate
Interaction Summary
Theoretically, concomitant use of alfalfa with photosensitizing drugs might have additive effects.
Read the full Alfalfa + Acetaminophen, Brompheniramine, Phenylpropanolamine interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acetaminophen, Brompheniramine, Phenylpropanolamine interactionAcetaminophen, ButalbitalAxocet, Bancap, Bucet, Butex Forte, Esgic CF, Orbivan CF +5 more
How Acetaminophen, Butalbital interacts with Hair, Skin & Nails — through 2 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acetaminophen, Butalbital interactionFo-tiCytochrome P450 1a2 (cyp1a2) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, fo-ti might increase or decrease the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Fo-ti + Acetaminophen, Butalbital interactionAcetaminophen, Butalbital, CaffeineEsgic, Esgic Plus, Fiogesic, Fioricet, Repan, Tecnal +1 more
How Acetaminophen, Butalbital, Caffeine interacts with Hair, Skin & Nails — through 2 ingredients. Tap an ingredient for the detail:
Fo-tiHepatotoxic Drugs, Cytochrome P450 1a2 (cyp1a2) Substrates +1 Moderate
Interaction Summary
Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Read the full Fo-ti + Acetaminophen, Butalbital, Caffeine interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acetaminophen, Butalbital, Caffeine interactionAcetaminophen, Butalbital, Caffeine, CodeineEsgic with Codeine, Fioricet w/ Codeine
How Acetaminophen, Butalbital, Caffeine, Codeine interacts with Hair, Skin & Nails — through 2 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acetaminophen, Butalbital, Caffeine, Codeine interactionFo-tiCytochrome P450 1a2 (cyp1a2) Substrates, Hepatotoxic Drugs +2 Moderate
Interaction Summary
Theoretically, fo-ti might increase or decrease the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Fo-ti + Acetaminophen, Butalbital, Caffeine, Codeine interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Hair, Skin & Nails 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.
Fo-Ti
Anticoagulant/Antiplatelet Drugs
Fo-ti has been linked to cases of acute liver failure which can decrease clotting factor production and increase the effects of anticoagulants. In one case, a patient who had been stable on warfarin presented with acute hepatitis and an INR elevated to 14.98. The patient had been taking fo-ti for 90 days prior to admission. Discontinuation of warfarin and fo-ti lead to a decrease in the INR and full recovery. Theoretically, concomitant use of fo-ti with anticoagulant or antiplatelet drugs may increase the risk of bleeding in some patients. Until more is known, monitor patients taking fo-ti and drugs that affect bleeding.
Some of these drugs include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), dipyridamole (Persantine), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), and others.
Antidiabetes Drugs
Theoretically, fo-ti might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Fo-ti reportedly has hypoglycemic effects.
Contraceptive Drugs
Theoretically, taking large amounts of fo-ti might interfere with contraceptive drugs due to competition for estrogen receptors.
In vitro research suggests that fo-ti extract has estrogenic activity.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, fo-ti might increase or decrease the levels and clinical effects of drugs metabolized by CYP1A2.
In vitro research suggests that fo-ti might inhibit CYP1A2. Additionally, in vitro research suggests that the degree of CYP1A2 inhibition depends on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, in an animal study, an aqueous extract of fo-ti inhibited CYP1A2 while an alcoholic extract of fo-ti induced CYP1A2. Induction or inhibition of CYP1A2 by fo-ti has not been reported in humans.
Cytochrome P450 2B6 (Cyp2B6) Substrates
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP2B6.
Animal research suggests that fo-ti might inhibit CYP2B6. One in vitro study suggests that the degree of CYP2B6 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this interaction has not been reported in humans.
Cytochrome P450 2C19 (Cyp2C19) Substrates
Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2C19.
Animal and in vitro research suggests that fo-ti may inhibit CYP2C19. An in vitro study suggests that the degree of CYP2C19 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this interaction has not been reported in humans.
Cytochrome P450 2C8 (Cyp2C8) Substrates
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP2C8.
In vitro research suggests that fo-ti might inhibit CYP2C8. However, this interaction has not been reported in humans.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2C9.
Animal and in vitro research suggests that fo-ti may inhibit CYP2C9. However, this interaction has not been reported in humans.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2D6.
Animal research suggests that fo-ti might inhibit CYP2D6. Additionally, an in vitro study suggests that the degree of CYP2D6 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this interaction has not been reported in humans.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.
In vitro research suggests that fo-ti might inhibit CYP3A4. One in vitro study suggests that the degree of CYP3A4 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts). However, this evidence conflicts with animal research suggesting that fo-ti does not inhibit CYP3A4. This interaction has not been reported in humans.
Digoxin (Lanoxin)
Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of hypokalemia and cardiotoxicity when taken with digoxin.
Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects. In vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root.
Diuretic Drugs
Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of hypokalemia when taken with diuretic drugs.
Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects and compound diuretic-induced potassium loss. In vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root.
Estrogens
Theoretically, taking large amounts of fo-ti might interfere with hormone replacement therapy through competition for estrogen receptors.
In vitro research suggests that fo-ti extract has estrogenic activity.
Hepatotoxic Drugs
Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.
Fo-ti has been linked to liver damage in many reports.
Stimulant Laxatives
Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of fluid and electrolyte depletion when taken with stimulant laxatives.
Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects. However, in vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root.
Sulindac (Clinoril)
Theoretically, fo-ti might increase or decrease the levels and clinical effects of sulindac.
Animal research suggests that the type of fo-ti extract might affect the levels of sulindac differently; the raw plant may increase levels, but processed parts may decrease levels. Induction or inhibition of CYP1A2 by fo-ti has not been reported in humans.
Warfarin (Coumadin)
Theoretically, fo-ti might increase the effects and adverse effects of warfarin.
Fo-ti may have stimulant laxative effects and cause diarrhea, especially when the raw or unprocessed fo-ti root is used. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. Also, fo-ti has been linked to cases of acute liver failure which can decrease clotting factor production and increase the effects of warfarin. In one case, a patient who had been stable on warfarin presented with acute hepatitis and an INR elevated to 14.98. The patient had been taking fo-ti for 90 days prior to admission. Discontinuation of warfarin and fo-ti lead to a decrease in the INR and full recovery.
Niacin
Alcohol (Ethanol)
Concomitant use of alcohol and niacin might increase the risk of flushing and hepatotoxicity.
Alcohol can exacerbate the flushing and pruritus associated with niacin. Large doses of niacin might also exacerbate liver dysfunction associated with chronic alcohol use. A case report describes delirium and lactic acidosis in a patient taking niacin 3 grams daily who ingested 1 liter of wine. Advise patients to avoid large amounts of alcohol while taking niacin.
Allopurinol (Zyloprim)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as allopurinol.
Large doses of niacin can reduce urinary excretion of uric acid, potentially resulting in hyperuricemia. Doses of uricosurics such as allopurinol might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Anticoagulant/Antiplatelet Drugs
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Several cases of clotting factor synthesis deficiency and coagulopathy have been reported in patients taking sustained-release niacin. Also, thrombocytopenia has been reported in patients treated with niacin or niacin plus lovastatin.
Antidiabetes Drugs
Niacin can increase blood glucose levels and may diminish the effects of antidiabetes drugs.
Niacin impairs glucose tolerance in a dose-dependent manner, probably by causing or aggravating insulin resistance and increasing hepatic production of glucose. In diabetes patients, niacin 4.5 grams daily for 5 weeks can increase plasma glucose by an average of 16% and glycated hemoglobin (HbA1c) by 21%. However, lower doses of 1.5 grams daily or less appear to have minimal effects on blood glucose. In some patients, glucose levels increase when niacin is started, but then return to baseline when a stable dose is reached. Up to 35% of patients with diabetes may need adjustments in hypoglycemic therapy when niacin is added.
Antihypertensive Drugs
Theoretically, niacin may increase the risk of hypotension when used with antihypertensive drugs.
The vasodilating effects of niacin can cause hypotension. Furthermore, some clinical evidence suggests that a one-hour infusion of niacin can reduce systolic, diastolic, and mean blood pressure in hypertensive patients. This effect is not observed in normotensive patients.
Bile Acid Sequestrants
Bile acid sequestrants can bind niacin and decrease absorption. Separate administration by 4-6 hours to avoid an interaction.
In vitro studies show that colestipol (Colestid) binds about 98% of available niacin and cholestyramine (Questran) binds 10% to 30%.
Gemfibrozil (Lopid)
Theoretically, concomitant use of niacin and gemfibrozil might increase the risk of myopathy in some patients.
A case of myopathy from concomitant use of niacin and gemfibrozil has been reported. Niacin alone has also been associated with cases of myopathy. Using gemfibrozil with niacin might further increase the risk of developing myopathy.
Hepatotoxic Drugs
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Niacin has been associated with cases of liver toxicity, especially when used in pharmacologic doses. Sustained-release niacin preparations appear to be associated with a higher risk of hepatotoxicity than immediate-release niacin.
Hmg-Coa Reductase Inhibitors ("Statins")
Theoretically, concomitant use of niacin and statins might increase the risk of myopathy and rhabdomyolysis in some patients.
Some case reports have raised concerns that niacin might increase the risk of myopathy and rhabdomyolysis when combined with statins. However, a significantly increased risk of myopathy has not been demonstrated in clinical trials, including those using an FDA-approved combination of lovastatin and niacin (Advicor).
Probenecid (Benemid)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as probenecid.
Large doses of niacin reduce urinary excretion of uric acid, potentially causing hyperuricemia. Doses of uricosurics such as probenecid might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Sulfinpyrazone (Anturane)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as sulfinpyrazone.
Large doses of niacin reduce urinary excretion of uric acid, potentially causing hyperuricemia. Doses of uricosurics such as sulfinpyrazone might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Thyroid Hormone
Theoretically, niacin might antagonize the therapeutic effects of thyroid hormones.
Clinical research and case reports suggests that taking niacin can reduce serum levels of thyroxine-binding globulin by up to 25% and moderately reduce levels of thyroxine (T4). Patients taking thyroid hormone for hypothyroidism might need dose adjustments when using niacin.
Transdermal Nicotine (Nicoderm)
Theoretically, concomitant use of niacin and transdermal nicotine might increase the risk of flushing and dizziness.
Niacin and nicotine can both cause flushing and dizziness.
Warfarin (Coumadin)
There is limited evidence that niacin may increase the anticoagulant effects of warfarin.
In a case report, a patient on warfarin developed an elevated international normalized ratio (INR) of 3.9 after taking niacin for two weeks. The patient's INR was previously stable, ranging between 2 and 3 in recent months, and no other medication changes were identified. The elevated INR returned to therapeutic range within 4 days following the discontinuation of niacin.
Aspirin
Large doses of aspirin might alter the clearance of niacin.
Aspirin is often used with niacin to reduce niacin-induced flushing. Doses of 80-975 mg aspirin have been used, but 325 mg appears to be optimal. Aspirin also seems to reduce the clearance of niacin by competing for glycine conjugation. Taking aspirin 1 gram seems to reduce niacin clearance by 45%. This is probably a dose-related effect and not clinically significant with the more common aspirin dose of 325 mg.
Alfalfa
Warfarin (Coumadin)
Theoretically, alfalfa might reduce the anticoagulant activity of warfarin.
Alfalfa contains a large amount of vitamin K. This could theoretically interfere with the activity of warfarin.
Antidiabetes Drugs
Theoretically, alfalfa might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Animal research suggests that alfalfa decreases blood sugar in diabetic mice. Also, in one case report, a diabetic patient experienced hypoglycemia after consuming alfalfa extract. Monitor blood glucose levels closely. Dose adjustments might be necessary.
Contraceptive Drugs
Theoretically, alfalfa might interfere with the activity of contraceptive drugs.
Alfalfa contains coumestrol, a phytoestrogen, and isoflavonoids, which have estrogenic effects.
Estrogens
Theoretically, alfalfa might interfere with hormone therapy.
Alfalfa contains coumestrol, a phytoestrogen, and isoflavonoids, which have estrogenic effects.
Immunosuppressants
Theoretically, alfalfa might decrease the efficacy of immunosuppressive therapy.
In vitro research and human case reports suggest that alfalfa may have immunostimulant effects.
Photosensitizing Drugs
Theoretically, concomitant use of alfalfa with photosensitizing drugs might have additive effects.
Animal research suggests that excessive doses of alfalfa may increase photosensitivity, possibly due to its chlorophyll content. It is unclear if this effect would be clinically relevant in humans.
Horsetail
Antidiabetes Drugs
Theoretically, taking horsetail with antidiabetes drugs might increase the risk of hypoglycemia.
Equisetum myriochaetum has demonstrated hypoglycemic activity in clinical research. In an animal diabetic model, Equisetum giganteum had hypoglycemic effects. It is unclear whether other horsetail species have hypoglycemic effects.
Diuretic Drugs
Theoretically, taking horsetail with diuretic drugs might increase potassium loss and the risk of hypokalemia.
Laboratory research shows that various species of horsetail have diuretic properties. Due to its diuretic effects, there has been concern that taking horsetail along with potassium-depleting diuretics might increase the risk for hypokalemia. However, pharmacokinetic research in humans shows that taking horsetail 900 mg daily for 4 days does not affect urinary excretion of electrolytes, including potassium and sodium, despite having a diuretic effect similar to taking hydrochlorothiazide 25 mg daily. It is unclear if taking horsetail for a longer duration would affect electrolyte levels. Until more is known, use with caution.
Efavirenz (Sustiva)
Theoretically, horsetail might decrease the levels and clinical effects of efavirenz.
In two case reports, patients were found to have detectable viral loads when taking horsetail-containing supplements along with an antiretroviral regimen that included efavirenz. In one case, the antiretroviral regimen included zidovudine, lamivudine, and efavirenz; in the other case, the regimen consisted of emtricitabine, tenofovir disoproxil fumarate, and efavirenz. One month after discontinuing horsetail, the viral loads became undetectable in both cases. The exact mechanism of this interaction is unknown. It is also unclear if this interaction is specific to efavirenz or if it is related to various components of antiretroviral therapy.
Lithium
Theoretically, horsetail might increase the levels and adverse effects of lithium.
Animal research suggests that horsetail has diuretic properties. Theoretically, due to these potential diuretic effects, horsetail might reduce excretion and increase levels of lithium. The dose of lithium might need to be decreased.
Nucleoside Reverse Transcriptase Inhibitors (Nrtis)
Theoretically, horsetail might decrease the levels and clinical effects of NRTIs.
In two case reports, patients were found to have detectable viral loads when taking horsetail-containing supplements along with an antiretroviral therapy. In one case, the antiretroviral regimen included zidovudine, lamivudine, and efavirenz; in the other case, the regimen consisted of emtricitabine, tenofovir disoproxil fumarate, and efavirenz. One month after discontinuing the supplement, the viral loads became undetectable in both cases. The exact mechanism of these interactions is unknown. It is also unclear if these interactions are specific to NRTIs or if they are related to various components of antiretroviral therapy.
Calcium
Ceftriaxone (Rocephin)
Co-administration of intravenous calcium and ceftriaxone can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys.
Avoid administering intravenous calcium in any form, such as parenteral nutrition or Lactated Ringers, within 48 hours of intravenous ceftriaxone. Case reports in neonates show that administering intravenous ceftriaxone and calcium can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys. In several cases, neonates have died as a result of this interaction. So far there are no reports in adults; however, there is still concern that this interaction might occur in adults.
Dolutegravir (Tivicay)
Calcium seems to reduce levels of dolutegravir.
Advise patients to take dolutegravir either 2 hours before or 6 hours after taking calcium supplements. Pharmacokinetic research suggests that taking calcium carbonate 1200 mg concomitantly with dolutegravir 50 mg reduces plasma levels of dolutegravir by almost 40%. Calcium appears to decrease levels of dolutegravir through chelation.
Elvitegravir (Vitekta)
Calcium seems to reduce levels of elvitegravir.
Advise patients to take elvitegravir either 2 hours before or 2 hours after taking calcium supplements. Pharmacokinetic research suggests that taking calcium along with elvitegravir can reduce blood levels of elvitegravir through chelation.
Aluminum
Calcium citrate might increase aluminum absorption and toxicity. Other types of calcium do not increase aluminum absorption.
Calcium citrate can increase the absorption of aluminum when taken with aluminum hydroxide. The increase in aluminum levels may become toxic, particularly in individuals with kidney disease. However, the effect of calcium citrate on aluminum absorption is due to the citrate anion rather than calcium cation. Calcium acetate does not appear to increase aluminum absorption.
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)
Calcium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption when taken in a fasting state.
Advise patients that bictegravir/emtricitabine/tenofovir alafenamide and calcium can be taken together if taken with food. However, if taken on an empty stomach, bictegravir/emtricitabine/tenofovir alafenamide should not be taken with, or 2 hours after, calcium containing products.
Bisphosphonates
Calcium reduces the absorption of bisphosphonates.
Advise patients to take bisphosphonates at least 30 minutes before calcium, but preferably at a different time of day. Calcium supplements decrease absorption of bisphosphonates.
Calcipotriene (Dovonex)
Taking calcipotriene with calcium might increase the risk for hypercalcemia.
Calcipotriene is a vitamin D analog used topically for psoriasis. It can be absorbed in sufficient amounts to cause systemic effects, including hypercalcemia. Theoretically, combining calcipotriene with calcium supplements might increase the risk of hypercalcemia.
Digoxin (Lanoxin)
Using intravenous calcium with digoxin might increase the risk of fatal cardiac arrhythmias.
Hypercalcemia increases the risk of fatal cardiac arrhythmias with digoxin. However, one retrospective analysis of clinical data suggests that intravenous calcium does not increase the risk of dysrhythmias or mortality in patients receiving digoxin.
Diltiazem (Cardizem, Others)
Theoretically, calcium may reduce the therapeutic effects of diltiazem.
Hypercalcemia can reduce the effectiveness of verapamil in atrial fibrillation. Theoretically, calcium might increase this risk of hypercalcemia and reduce the effectiveness of diltiazem.
Levothyroxine (Synthroid, Others)
Calcium seems to reduce the absorption and effectiveness of levothyroxine.
Advise patients to take levothyroxine and calcium supplements at least 4 hours apart. Calcium reduces levothyroxine absorption, probably by forming insoluble complexes. Calcium carbonate supplements reduce effectiveness of levothyroxine in patients with hypothyroidism.
Lithium
Theoretically, concomitant use of calcium and lithium may increase this risk of hypercalcemia.
Clinical research suggests that long-term use of lithium may cause hypercalcemia in 10% to 60% of patients. Theoretically, concomitant use of lithium and calcium supplements may further increase this risk.
Quinolone Antibiotics
Calcium seems to reduce the absorption of quinolone antibiotics.
Advise patients to take oral quinolones at least 2 hours before or 4-6 hours after calcium supplements or calcium-fortified foods. Taking calcium at the same time as oral quinolones can reduce quinolone absorption. Calcium binds to quinolones in the gut.
Raltegravir (Isentress)
Calcium may reduce levels of raltegravir.
Pharmacokinetic research shows that taking a single dose of calcium carbonate 3000 mg along with raltegravir 400 mg twice daily modestly decreases the mean area under the curve of raltegravir, but the decrease does not necessitate a dose adjustment of raltegravir. However, a case of elevated HIV-1 RNA levels and documented resistance to raltegravir has been reported for a patient taking calcium carbonate 1 gram three times daily plus vitamin D3 (cholecalciferol) 400 IU three times daily in combination with raltegravir 400 mg twice daily for 11 months. It is thought that calcium reduced raltegravir levels by chelation, leading to treatment failure.
Sotalol (Betapace)
Calcium seems to reduce the absorption of sotalol.
Advise patients to separate doses by at least 2 hours before or 4-6 hours after calcium. Calcium appears to reduce the absorption of sotalol, probably by forming insoluble complexes.
Tetracycline Antibiotics
Calcium seems to reduce the absorption of tetracycline antibiotics.
Advise patients to take oral tetracyclines at least 2 hours before, or 4-6 hours after calcium supplements. Taking calcium at the same time as oral tetracyclines can reduce tetracycline absorption. Calcium binds to tetracyclines in the gut.
Thiazide Diuretics
Taking calcium along with thiazides might increase the risk of hypercalcemia and renal failure.
Thiazides reduce calcium excretion by the kidneys. Using thiazides along with moderately large amounts of calcium carbonate increases the risk of milk-alkali syndrome (hypercalcemia, metabolic alkalosis, renal failure). Patients may need to have their serum calcium levels and/or parathyroid function monitored regularly.
Verapamil (Calan, Others)
Theoretically, calcium may reduce the therapeutic effects of verapamil.
Hypercalcemia can reduce the effectiveness of verapamil in atrial fibrillation. Theoretically, use of calcium supplements may increase this risk of hypercalcemia and reduce the effectiveness of verapamil.
Calcium Channel Blockers
Intravenous calcium may decrease the effects of calcium channel blockers; oral calcium is unlikely to have this effect.
Intravenous calcium is used to decrease the effects of calcium channel blockers in the management of overdose. Intravenous calcium gluconate has been used before intravenous verapamil (Isoptin) to prevent or reduce the hypotensive effects without affecting the antiarrhythmic effects. But there is no evidence that dietary or supplemental calcium when taken orally interacts with calcium channel blockers.
Manganese
Antipsychotic Drugs
Theoretically, the risk for manganese toxicity might increase when taken with antipsychotic drugs.
Hallucinations and behavioral changes have been reported in a patient with liver disease who was taking haloperidol and manganese. Researchers speculate that taking manganese along with haloperidol, phenothiazine-derivatives, or other antipsychotic medications might increase the risk of manganese toxicity in some patients.
Quinolone Antibiotics
Theoretically, manganese might reduce the absorption of quinolone antibiotics.
Manganese is a multivalent cation. Interactions resulting in reduced quinolone absorption have been reported between quinolones and other multivalent cations, such as calcium and iron.
Tetracycline Antibiotics
Theoretically, manganese might reduce the absorption of tetracycline antibiotics.
Manganese is a multivalent cation. Interactions resulting in reduced tetracycline absorption have been reported between tetracyclines and other multivalent cations, such as calcium and iron.
Iron
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)
Iron might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption when taken in a fasting state.
Advise patients that bictegravir/emtricitabine/tenofovir alafenamide and iron can be taken together if taken with food. However, if taken on an empty stomach, bictegravir/emtricitabine/tenofovir alafenamide should not be taken with, or 2 hours after, iron containing products.
Bisphosphonates
Iron reduces the absorption of bisphosphonates.
Advise patients that doses of bisphosphonates should be separated by at least two hours from doses of all other medications, including supplements such as iron. Divalent cations, including iron, can decrease absorption of bisphosphonates by forming insoluble complexes in the gastrointestinal tract.
Denosumab (Prolia, Others)
Administration of intravenous iron within one month of denosumab administration might increase the risk of severe hypophosphatemia and hypocalcemia.
A case of severe hypocalcemia (albumin corrected calcium 6.88 mg/dL, ionized calcium 3.68 mg/dL) and hypophosphatemia (<0.5 mg/dL) with respiratory acidosis, QT interval prolongation, and nonsustained ventricular tachycardia was reported in a 76-year-old male who had received an iron polymaltose infusion within 2 weeks of a subcutaneous injection of denosumab. Serum parathyroid hormone was also elevated (348 pg/mL). Subsequent iron infusions with iron polymaltose and ferric carboxymaltose were followed by transient hypophosphatemia, but without hypocalcemia. Additionally, a literature review describes 6 additional cases of hypophosphatemia and hypocalcemia in patients 52-92 years of age who had been administered intravenous iron as either ferric carboxymaltose or iron polymaltose and subcutaneous denosumab within 1-4 weeks of each other.
Dolutegravir (Tivicay)
Iron might decrease dolutegravir levels by reducing its absorption.
Advise patients to take dolutegravir at least 2 hours before or 6 hours after taking iron. Pharmacokinetic research shows that iron can decrease the absorption of dolutegravir from the gastrointestinal tract through chelation. When taken under fasting conditions, a single dose of ferrous fumarate 324 mg orally along with dolutegravir 50 mg reduces overall exposure to dolutegravir by 54%.
Integrase Inhibitors
Theoretically, taking iron along with integrase inhibitors might decrease the levels and clinical effects of these drugs.
Iron is a divalent cation. There is concern that iron may decrease the absorption of integrase inhibitors from the gastrointestinal tract through chelation. One pharmacokinetic study shows that iron can decrease blood levels of the specific integrase inhibitor dolutegravir through chelation. Also, other pharmacokinetic research shows that other divalent cations such as calcium can decrease the absorption and levels of some integrase inhibitors through chelation.
Levodopa
Iron might decrease levodopa levels by reducing its absorption.
Advise patients to separate doses of levodopa and iron as much as possible. There is some evidence in healthy people that iron forms chelates with levodopa, reducing the amount of levodopa absorbed by around 50%. The clinical significance of this hasn't been determined.
Levothyroxine (Synthroid, Others)
Iron might decrease levothyroxine levels by reducing its absorption.
Advise patients to separate levothyroxine and iron doses by at least 2 hours. Iron can decrease the absorption and efficacy of levothyroxine by forming insoluble complexes in the gastrointestinal tract.
Methyldopa (Aldomet)
Iron might decrease methyldopa levels by reducing its absorption.
Advise patients to separate methyldopa and iron doses by at least 2 hours. Iron can decrease the absorption of methyldopa from the gastrointestinal tract through chelation, resulting in increases in blood pressure.
Mycophenolate Mofetil (Cellcept)
Theoretically, iron might decrease mycophenolate mofetil levels by reducing its absorption.
Advise patients to take iron 4-6 hours before, or 2 hours after, mycophenolate mofetil. It has been suggested that a decrease of absorption is possible, probably by forming nonabsorbable chelates. However, mycophenolate pharmacokinetics are not affected by iron supplementation in available clinical research.
Penicillamine (Cuprimine, Depen)
Iron might decrease penicillamine levels by reducing its absorption.
Advise patients to separate penicillamine and iron doses by at least 2 hours. Oral iron supplements can reduce absorption of penicillamine by 30% to 70%, probably due to chelate formation. In people with Wilson's disease, this interaction has led to reduced efficacy of penicillamine.
Quinolone Antibiotics
Iron might decrease levels of quinolone antibiotics by reducing their absorption.
Advise patients to separate quinolone antibiotics and iron doses by at least 2 hours. Iron decreases the absorption of quinolones due to formation of insoluble complexes in the gastrointestinal tract.
Tetracycline Antibiotics
Iron might decrease levels of tetracycline antibiotics by reducing their absorption.
Advise patients to take iron at least 2 hours before or 4 hours after tetracycline antibiotics. Concomitant use can decrease absorption of tetracycline antibiotics from the gastrointestinal tract by 50% to 90%.
Chloramphenicol
Theoretically, taking chloramphenicol with iron might reduce the response to iron therapy in iron deficiency anemia.
Chloramphenicol interferes with erythrocyte maturation. However, since chloramphenicol isn't usually taken for prolonged periods, this isn't likely to be clinically significant.
Zinc
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Copper
Penicillamine (Cuprimine, Depen)
Theoretically, taking copper with penicillamine might decrease the absorption of penicillamine; separate dosing by at least 2 hours.
Copper chelates penicillamine, which decreases its absorption and may reduce its clinical effects.
Contraceptive Drugs
Theoretically, taking copper with contraceptive drugs might increase the levels and toxic effects of copper.
A meta-analysis of clinical studies suggests that chronic use of oral contraceptives increases serum copper levels by a mean of 57 mcg/dL. In most people, this resulted in levels above the normal reference range for copper.
Vitamin B12
Metformin (Glucophage)
Metformin, a common medication used to manage type 2 diabetes, has been associated with lower vitamin B12 levels in some individuals. Prolonged use of metformin can interfere with the absorption of B12 in the digestive system, potentially leading to a deficiency in this essential vitamin.
Iodine
Amiodarone (Cordarone)
Combining iodine with amiodarone might cause excessively high iodine levels.
Amiodarone contains 37.3% iodine and can increase iodine levels. Concomitant use with iodine might increase the risk of having excessive iodine levels and adversely affecting thyroid function. Monitor thyroid function.
Antithyroid Drugs
Iodine might alter the effects of antithyroid drugs.
Iodine in high doses has been reported to cause both hyperthyroidism and hypothyroidism, depending on the individual's past medical history. Taking iodine while using antithyroid drugs could alter the effects of the antithyroid drugs.
Lithium
Combining iodine with lithium might have additive hypothyroid effects.
Lithium can inhibit thyroid function. Several case reports suggest that concomitant use of lithium and potassium iodide can reduce thyroid function in otherwise healthy adults. Monitor thyroid function.
Brand information
Manufacturer and brand details for Hair, Skin & Nails, from the product label.
Foods Plus
See all Foods Plus products- Name
- Foods Plus
- Street Address
- 10 Henderson Drive
- City
- West Caldwell
- State
- New Jersey
- ZipCode
- 07006
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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.
The Full Monographs Behind Hair, Skin & Nails’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Lecithin
Lecithin is a natural fatty substance found in foods and made by the body that is widely used as a supplement and food emulsifier. Evidence supporting most of its health claims is limited, t...
Read the full Lecithin monograph → Herb & supplement monographNiacin
Interacts with 727 drugsNiacin (vitamin B3) is an essential nutrient your body needs for energy and metabolism, and deficiency is uncommon in most developed countries. Prescription-strength niacin has been used to...
Read the full Niacin monograph → Herb & supplement monographVitamin B12
Interacts with 20 drugsVitamin B12 (cobalamin) is an essential nutrient your body needs to make red blood cells, keep nerves healthy, and support DNA. Supplements are very helpful for people who are deficient — su...
Read the full Vitamin B12 monograph → Herb & supplement monographBiotin
Biotin (vitamin B7) is a water-soluble vitamin your body needs to turn food into energy and to support healthy hair, skin, and nails. Most people get plenty from a normal diet, and true defi...
Read the full Biotin monograph → Herb & supplement monographPantothenic Acid
Pantothenic acid is vitamin B5, an essential nutrient your body uses to turn food into energy. True deficiency is very rare because it is found in nearly all foods, and most people meet thei...
Read the full Pantothenic Acid monograph → Herb & supplement monographManganese
Interacts with 83 drugsManganese is an essential trace mineral your body needs in small amounts for bone formation, metabolism, and antioxidant defense, and most people get enough from a normal diet. Supplements m...
Read the full Manganese monograph → Herb & supplement monographZinc
Interacts with 67 drugsZinc 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 monographSilicon
Silicon is a trace mineral found in the body and in foods like oats, barley, and certain fruits and vegetables, and it is popular in supplements for hair, skin, nail, and bone health. Some s...
Read the full Silicon monograph → Herb & supplement monographCopper
Interacts with 31 drugsCopper is an essential trace mineral your body needs in small amounts for making red blood cells, supporting nerves and bones, and helping enzymes work. Most people get enough copper from fo...
Read the full Copper monograph → Herb & supplement monographIron
Interacts with 80 drugsIron is an essential mineral your body needs to make hemoglobin and carry oxygen in the blood. Supplements are mainly useful for treating or preventing iron deficiency and iron-deficiency an...
Read the full Iron monograph → Herb & supplement monographIodine
Interacts with 7 drugsIodine is an essential mineral your body needs to make thyroid hormones, and most people get enough from iodized salt, dairy, and seafood. Supplements help when you are truly deficient, but...
Read the full Iodine monograph → Herb & supplement monographCalcium
Interacts with 168 drugsCalcium is an essential mineral your body needs for strong bones, nerve signaling, and muscle function, and supplements can help fill gaps when diet falls short. Most people do best getting...
Read the full Calcium monograph → Herb & supplement monographAlfalfa
Interacts with 583 drugsAlfalfa is a nutrient-rich legume that people use for high cholesterol, menopause symptoms, and general wellness, but solid human evidence for most of these uses is limited. It is best avoid...
Read the full Alfalfa monograph → Herb & supplement monographFo-ti
Interacts with 1,257 drugsFo-ti (He Shou Wu) is a root used in traditional Chinese medicine, often promoted for healthy aging and hair. High-quality human evidence for these benefits is limited, and processed Fo-ti h...
Read the full Fo-ti monograph → Herb & supplement monographHorsetail
Interacts with 188 drugsHorsetail is a traditional herb most often used as a mild diuretic and for hair, nail, and bone support, but high-quality human evidence is limited. It can cause thiamine (vitamin B1) loss w...
Read the full Horsetail monograph → Herb & supplement monographCollagen Peptides
Collagen peptides are a well-absorbed form of protein that may modestly improve skin elasticity and joint comfort for some people, though evidence is still developing and results vary. They...
Read the full Collagen Peptides monograph →Sources & How We Checked
Hair, Skin & Nails's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.
- NIH Dietary Supplement Label Database (DSLD) — The official product label on file for this supplement.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference behind the ingredient interaction data.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.
The 495 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.
Lecithin 9 references
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- Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (2000). Washington, DC: National Academy Press, 2000. Available at: http://b
- Chatellier G, Lacomblez L. Tacrine (tetrahydroaminoacridine; THA) and lecithin in senile dementia of the Alzheimer type: a multicentre trial. Groupe Francais d'Etude de la Tetrahydroaminoacridine. BMJ 1990;300:495-9.
- Gelenberg AJ, Dorer DJ, Wojcik JD, et al. A crossover study of lecithin treatment of tardive dyskinesia. J Clin Psychiatry 1990;51:149-53.
- Little A, Levy R, Chuaqui-Kidd P, Hand D. A double-blind, placebo controlled trial of high-dose lecithin in Alzheimer's disease. J Neurol Neurosurg Psychiatry 1985;48:736-42. PubMed
- Palm M, Moneret-Vautrin DA, Kanny G, et al. Food allergy to egg and soy lecithins. Allergy 1999;54:1116-7. PubMed
- Drachman DA, Glosser G, Fleming P, et al. Memory decline in the aged: treatment with lecithin and physostigmine. Neurology 1982;32:944-50. PubMed
- Gelenberg, A. J., Doller-Wojcik, J. C., and Growdon, J. H. Choline and lecithin in the treatment of tardive dyskinesia: preliminary results from a pilot study. Am J Psychiatry 1979;136(6):772-776. PubMed
- Electronic Code of Federal Regulations. Title 21, Chapter 1, Subchapter B, Part 184: Direct food substances affirmed as Generally Recognized as Safe. Subpart B - listing of specific substances affirmed as GRAS. Sec. 184.1400 Lecithin. Available at: https:
Niacin 66 references
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- Anon. Inositol hexaniacinate. Altern Med Rev 1998;3:222-3.
- Knodel LC, Talbert RL. Adverse effects of hypolipidaemic drugs. Med Toxicol 1987;2:10-32. PubMed
- Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group. Arch Intern Med 2000;160:1177-84. PubMed
- Gibbons LW, Gonzalez V, Gordon N, Grundy S. The prevalence of side effects with regular and sustained-release nicotinic acid. Am J Med 1995;99:378-85. PubMed
- Whelan AM, Price SO, Fowler SF, Hainer BL. The effect of aspirin on niacin-induced cutaneous reactions. J Fam Pract 1992;34:165-8.
- Jungnickel PW, Maloley PA, Vander Tuin EL, et al. Effect of two aspirin pretreatment regimens on niacin-induced cutaneous reactions. J Gen Intern Med 1997;12:591-6. PubMed
- Capuzzi DM, Guyton JR, Morgan JM, et al. Efficacy and safety of an extended-release niacin (Niaspan): a long-term study. Am J Cardiol 1998;82:74-81;disc. 85U-6U. PubMed
- Gray DR, Morgan T, Chretien SD, Kashyap ML. Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med 1994;121:252-8. PubMed
- McKenney JM, Proctor JD, Harris S, Chinchili VM. A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients. JAMA 1994;271:672-7. DOI
- Knopp RH, Alagona P, Davidson M, et al. Equivalent efficacy of a time-release form of niacin (Niaspan) given once-a-night versus plain niacin in the management of hyperlipidemia. Metabolism 1998;47:1097-104. PubMed
- Knopp RH. Clinical profiles of plain versus sustained-release niacin (Niaspan) and the physiologic rationale for nighttime dosing. Am J Cardiol 1998;82:24U-28U;discussion 39U-41U. PubMed
- Garg A, Grundy SM. Nicotinic acid as therapy for dyslipidemia in non-insulin-dependent diabetes mellitus. JAMA 1990;264:723-6. DOI
- Leighton RF, Gordon NF, Small GS, et al. Dental and gingival pain as side effects of niacin therapy. Chest 1998;114:1472-4. PubMed
- American Society of Health-System Pharmacists. ASHP Therapeutic Position Statement on the safe use of niacin in the management of dyslipidemias. Am J Health Syst Pharm 1997;54:2815-9. DOI
- Vega GL, Grundy SM. Lipoprotein responses to treatment with lovastatin, gemfibrozil, and nicotinic acid in normolipidemic patients with hypoalphalipoproteinemia. Arch Intern Med 1994;154:73-82. DOI
- Guyton JR, Goldberg AC, Kreisberg RA, et al. Effectiveness of once-nightly dosing of extended-release niacin alone and in combination for hypercholesterolemia. Am J Cardiol 1998;82:737-43.
- Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (2000). Washington, DC: National Academy Press, 2000. Available at: http://b
- Brown BG, Zhao XQ, Chait A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001;345:1583-93. DOI
- Bays HE, Dujovne CA. Drug interactions of lipid-altering drugs. Drug Saf 1998;19:355-71. PubMed
- Rader JI, Calvert RJ, Hathcock JN. Hepatic toxicity of unmodified and time-release preparations of niacin. Am J Med 1992;92:77-81. PubMed
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- Schwartz ML. Severe reversible hyperglycemia as a consequence of niacin therapy. Arch Int Med 1993;153:2050-2. DOI
- Raising HDL and Niacin Use. Pharmacist's Letter/Prescriber's Letter 2004;20(5):200504.
- McKenney J. New perspectives on the use of niacin in the treatment of lipid disorders. Arch Intern Med 2004;164:697-705. PubMed
- Reaven P, Witztum JL. Lovastatin, nicotinic acid and rhabdomyolysis (letter). Ann Int Med 1988;109:597-8. PubMed
- Ito MK. Advances in the understanding and management of dyslipidemia: using niacin-based therapies. Am J Health-Syst Pharm 2003;60(suppl 2):s15-21. PubMed
- Schwab RA, Bachhuber BH. Delirium and lactic acidosis caused by ethanol and niacin coingestion. Am J Emerg Med 1991;9:363-5. PubMed
- Product information: Niaspan. Kos Pharmaceuticals. Cranbury, NJ. 2005. Available at www.niaspan.com/professional/content/pdfs/productinfo.pdf. (Accessed 3 March 2006).
- Ding RW, Kolbe K, Merz B, et al. Pharmacokinetics of nicotinic acid-salicylic acid interaction. Clin Pharmacol Ther 1989;46:642-7. PubMed
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- Dearing BD, Lavie CJ, Lohmann TP, Genton E. Niacin-induced clotting factor synthesis deficiency with coagulopathy. Arch Intern Med. 1992;152(4):861-3. DOI
- O'Brien T, Silverberg JD, Nguyen TT. Nicotinic acid-induced toxicity associated with cytopenia and decreased levels of thyroxine-binding globulin. Mayo Clin Proc. 1992;67(5):465-8. PubMed
- Gadegbeku CA, Dhandayuthapani A, Shrayyef MZ, Egan BM. Hemodynamic effects of nicotinic acid infusion in normotensive and hypertensive subjects. Am J Hypertens. 2003;16(1):67-71. PubMed
- Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm. 1995;52(15):1639-45. PubMed
- Litin SC, Anderson CF. Nicotinic acid-associated myopathy: a report of three cases. Am J Med. 1989;86(4):481-3. PubMed
- Dunn RT, Ford MA, Rindone JP, Kwiecinski FA. Low-Dose Aspirin and Ibuprofen Reduce the Cutaneous Reactions Following Niacin Administration. Am J Ther. 1995;2(7):478-480. PubMed
- Cashin-Hemphill L, Spencer CA, Nicoloff JT, et al. Alterations in serum thyroid hormonal indices with colestipol-niacin therapy. Ann Intern Med. 1987;107(3):324-9. PubMed
- Drinka PJ. Alterations in thyroid and hepatic function tests associated with preparations of sustained-release niacin. Mayo Clin Proc. 1992;67(12):1206. PubMed
- Shakir KM, Kroll S, Aprill BS, Drake AJ 3rd, Eisold JF. Nicotinic acid decreases serum thyroid hormone levels while maintaining a euthyroid state. Mayo Clin Proc. 1995;70(6):556-8. PubMed
- Etchason JA, Miller TD, Squires RW, et al. Niacin-induced hepatitis: a potential side effect with low-dose time-release niacin. Mayo Clin Proc. 1991;66(1):23-8. PubMed
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