Healthy Heart Ingredients & Drug Interactions
by NutraPro (Neutraceutical Corp.)
What is this page for?
First and foremost: checking Healthy Heart 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
Healthy Heart is a dietary supplement by NutraPro (Neutraceutical Corp.) with 22 active ingredients. Its ingredients are commonly taken for high cholesterol, vitamin b3 deficiency (pellagra), heart health support.Based on those ingredients, 1,663 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Green Tea leaf 98% extract, Trans-Resveratrol, Vitamin E. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Healthy Heart by NutraPro (Neutraceutical Corp.)
Ask about any prescription or over-the-counter medication and we check it for interactions with Healthy Heart by NutraPro (Neutraceutical Corp.) — 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 Healthy Heart by NutraPro (Neutraceutical Corp.)
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
Full disclosure
Healthy Heart contains 22 active ingredients, including vitamins (niacin, B6, C, and E), minerals (calcium, chromium, magnesium, and selenium), amino acids and their derivatives (L-citrulline, L-arginine, N-acetyl L-carnitine, and betaine HCl), plant extracts (green tea 98%, hawthorn berry, policosanol, alpha-lipoic acid, and Polygonum cuspidatum 50%), coenzyme Q10, and plant sterols. The product also contains inactive ingredients: gelatin, vegetable magnesium stearate, and silicon dioxide (used as a capsule and flow agent).
Does it work?
Moderate evidence
The evidence for this product's overall benefit to heart health is mixed and ingredient-specific. Niacin is likely effective for pellagra (a B3 deficiency disease) and possibly effective for improving cholesterol and metabolic syndrome markers in HIV/AIDS-related dyslipidemia.
Vitamin C, E, and selenium are established for their respective deficiency states but show only modest evidence for broader cardiovascular benefit. Calcium is effective for bone health and certain digestive conditions, and magnesium is effective for constipation and indigestion.
Coenzyme Q10 is possibly effective for heart failure and migraine. Policosanol is likely effective for intermittent claudication (leg pain on exertion) but evidence for coronary heart disease benefit is insufficient.
Plant sterols are likely effective for lowering cholesterol. Green tea extract is likely effective for human papillomavirus and possibly effective for cholesterol.
L-citrulline, L-arginine, chromium, alpha-lipoic acid, and hawthorn all show either possibly effective, insufficient, or possibly ineffective ratings for various heart and metabolic conditions. For several ingredients—including betaine HCl, Polygonum cuspidatum, and the blended resveratrol component—the evidence in our data is insufficient to rate.
How safe is it?
Well-documented data
Most ingredients in this product are generally well tolerated at recommended doses. However, several carry important cautions.
Niacin at high supplemental doses can cause flushing (affecting up to 70% of users), liver problems, and gastrointestinal upset; high-dose niacin should be avoided unless prescribed by your doctor. Vitamin B6 at very high doses (over 1,000 mg daily or cumulative intake above 1,000 grams) can damage nerves (sensory neuropathy).
Folic acid at very high doses can cause sleep disturbances and confusion and may mask pernicious anemia. Magnesium commonly causes diarrhea and gastrointestinal irritation.
Vitamin E at high doses increases bleeding risk and may raise the risk of hemorrhagic stroke. Green tea extract, particularly concentrated forms, has been linked to rare liver injury.
L-citrulline and L-arginine can lower blood pressure and may cause gastrointestinal discomfort. Hawthorn and policosanol are generally well tolerated but require medical supervision if you have heart disease.
Betaine HCl may irritate the stomach and should be avoided if you have ulcers or gastritis.
Meds to double-check
Major interaction found
Before taking this product, double-check the following medications with your doctor or pharmacist, starting with the most serious: HIV integrase inhibitors (dolutegravir, elvitegravir), levodopa/carbidopa (for Parkinson's), beta-blockers and other blood pressure drugs, nitrates and phosphodiesterase-5 inhibitors, blood thinners and antiplatelet agents (warfarin, aspirin), thyroid medication (levothyroxine), seizure medications (phenobarbital, phenytoin, valproate), diabetes drugs, statin medications, liver-toxic drugs, and heart rhythm medications. Calcium and magnesium in this product can bind or reduce absorption of several drugs; spacing doses 2–6 hours apart may help but requires your doctor's guidance.
Green tea extract may reduce the effectiveness of some heart and cholesterol drugs.
The bottom line
Scorecard at a glanceFully disclosed formula with some supporting evidence for its stated purpose. Major medication interactions have been identified, and safety information is well characterized.
Healthy Heart is a multi-ingredient supplement aimed at cardiovascular and metabolic support, with some ingredients backed by solid evidence (niacin for deficiency, plant sterols for cholesterol, magnesium for digestion) and others showing promise but lacking full proof. However, the product carries numerous interactions with common medications—especially blood pressure drugs, diabetes medications, blood thinners, and psychiatric or cardiac drugs—as well as with several HIV treatments.
If you take any prescription medication, check your specific drugs against the interaction tool before starting. Talk with your doctor or pharmacist about whether this product is right for you and whether it might interfere with your current treatment.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 20 of 22 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Jul 27, 2021.
This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed
General information
Key facts about Healthy Heart, straight from the product label.
| Brand | NutraPro (Neutraceutical Corp.) |
|---|---|
| Barcode (UPC) | 092617967302 |
| Net contents | 90 Capsule(s) |
| Market status | On market |
| Date entered into DSLD | Jul 27, 2021 |
| DSLD ID | 253174 |
| Product type | Other Combinations |
| Supplement form | Capsule |
| Dietary claims / uses | All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years) |
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 Healthy Heart by NutraPro (Neutraceutical Corp.), sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Niacin | 12.5 mg | 63% |
| Vitamin B6 | 25 mg | 1250% |
| Folic Acid | 400 mcg | 100% |
| Calcium | 250 mg | 25% |
| L-Citrulline | 150 mg | -- |
| Policosanol | 5 mg | -- |
| Chromium | 60 mcg | 50% |
| Vitamin E | 15 IU | 50% |
| Vitamin C | 30 mg | 50% |
| MSM | 125 mg | -- |
| Selenium | 30 mcg | 43% |
| Betaine HCl | 75 mg | -- |
| Coenzyme Q10 | 25 mg | -- |
| N-Acetyl L-Carnitine | 50 mg | -- |
| L-Arginine Hydrochloride | 150 mg | -- |
| Magnesium | 200 mg | 50% |
| Guggulsterones | 2.5 mg | -- |
| ALA | 75 mg | -- |
| Green Tea leaf 98% extract | 150 mg | -- |
| Plant Sterols 95% extract | 150 mg | -- |
| Gugulipid 2.5% extract | 100 mg | -- |
| Hawthorn berry extract | 50 mg | -- |
| Trans-Resveratrol | 15 mg | -- |
| Polygonum cuspidatum 50% extract | 30 mg | -- |
Other ingredients: Gelatin, Vegetable Magnesium Stearate, Silicon Dioxide
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.
Suggested/Recommended/Usage/Directions
Suggested Use: 3 capsules taken daily preferably with meals, For best results, take 1 capsule with breakfast, 1 capsule with lunch, and 1 capsule with dinner or as directed by a healthcare professional. Do not exceed 3 capsules daily.
Precautions
Caution: Do not exceed recommended dose. This product should not be used by individuals with a history of peptic ulcers or any condition associated with excess acidity.
Pregnant or nursing mothers children under 18 and individuals with a known medical condition including heartburn should consult a physician before using this or any dietary supplement.
Pregnant or nursing mothers children under 18 and individuals with a known medical condition including heartburn should consult a physician before using this or any dietary supplement.
Notice: Most people should not experience "Niacin skin flush" when using this product. However a few sensitive individuals may experience some flushing. Do not take on an empty stomach.
Keep out of the reach of children.
Do not use if safety seal is damaged or missing.
Allergen Warning: Contains soy.
This product is manufactured and packaged in a facility which may also process milk, soy, wheat, egg, peanuts, tree nuts, fish and crustacean shellfish.
Storage
Store is 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.
Seals/Symbols
Sourced From A GMP Certified Facility FDA Manufactured in an FDA Inspected Facility
Formulation
Formulated in the USA
Cardiovascular Support Supports healthy cholesterol, triglyceride homocysteine & CRP levels
FDA Statement of Identity
Dietary Supplement
General Statements
100% Satisfaction Guarantee Already within a normal range
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Healthy Heart by NutraPro (Neutraceutical Corp.) 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 Healthy Heart by NutraPro (Neutraceutical Corp.)
These are the 22 active ingredients this product is made of. Select any to open its full monograph.
Serving size3 Capsule(s) Dosage formCapsule Servings per container30 Amounts shown are per serving.
Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.
Niacin
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 B6
Interacts with210 drugs
Vitamin B6 (pyridoxine) is an essential water-soluble vitamin that your body needs for metabolism, brain function, and making red blood cells. It is b...
Vitamin B6 monograph & interactionsFolic Acid
Interacts with40 drugs
Folic acid is the man-made form of vitamin B9 and is one of the most well-studied supplements, especially for preventing serious birth defects when ta...
Folic Acid monograph & interactionsCalcium
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 & interactionsL-Citrulline
Interacts with178 drugs
L-citrulline is an amino acid that the body turns into L-arginine to help make nitric oxide, which relaxes blood vessels and may improve blood flow. I...
L-Citrulline monograph & interactionsPolicosanol
Interacts with242 drugs
Policosanol is a mix of waxy alcohols (mostly octacosanol) made from sugar cane or other plant waxes, and it is often marketed as a natural way to low...
Policosanol monograph & interactionsChromium
Interacts with178 drugs
Chromium is an essential trace mineral involved in how the body handles sugar and fat. Some studies suggest it may modestly help blood sugar control i...
Chromium monograph & interactionsVitamin E
Interacts with764 drugs
Vitamin E is an essential fat-soluble vitamin and antioxidant that most people get in adequate amounts from a normal diet. Supplements can help correc...
Vitamin E monograph & interactionsVitamin C
Interacts with207 drugs
Vitamin C (ascorbic acid) is an essential nutrient your body needs but cannot make, so you must get it from food or supplements. It's important for im...
Vitamin C monograph & interactionsMSM
Selenium
Interacts with321 drugs
Selenium is an essential trace mineral your body needs in small amounts for thyroid function, antioxidant defense, and immune health. Most people who...
Selenium monograph & interactionsBetaine HCl
Interacts with36 drugs
Betaine hydrochloride is a supplement used to temporarily increase stomach acid in people who may have low acid levels. Evidence for its benefits is l...
Betaine HCl monograph & interactionsCoenzyme Q10
Interacts with198 drugs
CoQ10 is a vitamin-like substance your body makes naturally that helps cells produce energy and acts as an antioxidant. It is generally well tolerated...
Coenzyme Q10 monograph & interactionsN-Acetyl L-Carnitine
Interacts with203 drugs
Acetyl-L-carnitine is a form of the amino acid carnitine that the body uses to help produce energy in cells. It is most studied for nerve pain and mem...
N-Acetyl L-Carnitine monograph & interactionsL-Arginine Hydrochloride
Interacts with403 drugs
L-arginine is an amino acid that the body uses to make nitric oxide, a substance that helps blood vessels relax and widen. It is popularly used for bl...
L-Arginine Hydrochloride monograph & interactionsMagnesium
Interacts with295 drugs
Magnesium is an essential mineral your body needs for muscles, nerves, blood pressure, and many other functions, and supplements are useful for preven...
Magnesium monograph & interactionsALA
Interacts with263 drugs
Alpha-lipoic acid (ALA) is an antioxidant made naturally by the body and found in small amounts in foods. It is most studied for diabetic nerve pain,...
ALA monograph & interactionsGreen Tea leaf 98% extract
Interacts with1,293 drugs
Green tea is a popular beverage rich in antioxidants called catechins, and drinking it in normal amounts is considered safe for most people. Concentra...
Green Tea leaf 98% extract monograph & interactionsPlant Sterols 95% extract
No knowninteractions
Plant sterols (and their close relatives, plant stanols) are natural compounds found in plants that can modestly lower LDL ('bad') cholesterol when ta...
Plant Sterols 95% extract monograph & interactionsGugulipid 2.5% extract
Interacts with757 drugs
Guggul is a gum resin from the Commiphora wightii tree, long used in Ayurvedic medicine for cholesterol, joint, and skin problems. Modern studies are...
Gugulipid 2.5% extract monograph & interactions- › Guggulsterones
Hawthorn berry extract
Interacts with191 drugs
Hawthorn is a plant traditionally used for heart-related complaints, and some studies suggest it may modestly help symptoms of mild heart failure when...
Hawthorn berry extract monograph & interactionsTrans-Resveratrol
Interacts with822 drugs
Resveratrol is a plant compound found in red grapes, berries, and peanuts that is popular for heart health, anti-aging, and antioxidant support. While...
Trans-Resveratrol monograph & interactionsOther (inactive) ingredients: Gelatin, Vegetable Magnesium Stearate, Silicon Dioxide. These complete the product’s ingredient list but are not active constituents.
Healthy Heart by NutraPro (Neutraceutical Corp.) Drug Interactions
HelloPharmacist Interaction Report
Healthy Heart by NutraPro contains multiple ingredients with documented interactions: niacin, vitamin B6, folic acid, calcium, L-citrulline, policosanol, chromium, vitamin E, vitamin C, selenium, betaine HCl, coenzyme Q10, N-acetyl L-carnitine, L-arginine, magnesium, alpha-lipoic acid, green tea extract, and hawthorn berry extract.
The most serious interaction involves magnesium and levodopa/carbidopa — magnesium can reduce levodopa bioavailability by 35%, potentially diminishing the drug's effectiveness for Parkinson's disease. This is a Major severity interaction.
Read the full breakdown — every affected drug type, severity by severity
Several ingredients carry Major interactions with HIV medications. Calcium significantly reduces levels of dolutegravir and elvitegravir (by roughly 40% and more, respectively), requiring separation of doses by 2–6 hours.
Green tea extract reduces nadolol levels by about 85% and atorvastatin levels by 24%; it also poses a theoretical Major risk when combined with ephedrine. Hawthorn berry extract has Major theoretical concerns with nitrates and phosphodiesterase-5 inhibitors (PDE-5 inhibitors like sildenafil), both of which can cause serious additive blood pressure drops.
Moderate interactions are widespread across multiple drug categories. Niacin interacts with antihypertensive drugs, drugs that harm the liver (hepatotoxic drugs), blood thinners and antiplatelet agents, diabetes medications, statins, gout drugs, bile acid binders, and uric acid-lowering agents.
Vitamin B6 can reduce levels of seizure medications (phenobarbital and phenytoin) and worsen photosensitivity from amiodarone. Folic acid antagonizes seizure control with phenobarbital, phenytoin, and primidone, and may reduce methotrexate effectiveness.
Calcium interferes with thyroid medication, heart rhythm drugs, and HIV integrase inhibitors. L-citrulline, policosanol, chromium, and multiple others interact with blood pressure drugs, diabetes medications, and anticoagulants in ways that could lower blood sugar or blood pressure further or increase bleeding risk.
Altogethe, these interactions span 1,664 individual medications. Many ingredients we hold no data for—specifically MSM, Guggulsterones, and the resveratrol within Trans-Resveratrol (listed as a blend container)—so we could not check them.
Check your exact medications with the search tool on this page before starting.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Healthy Heart?
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 Healthy Heart interact with 1,663 drugs. Click any drug to see the details.
20 of the 22 ingredients in Healthy Heart interact with drugs. Each result below shows which ingredient is responsible. Green Tea leaf 98% extract Trans-Resveratrol Vitamin E Gugulipid 2.5% extract Niacin L-Arginine Hydrochloride Selenium Magnesium ALA Policosanol Vitamin B6 Vitamin C N-Acetyl L-Carnitine Coenzyme Q10 Hawthorn berry extract L-Citrulline Chromium Calcium Folic Acid Betaine HCl
Aminophylline, Amobarbital, EphedrineAmesec
How Aminophylline, Amobarbital, Ephedrine interacts with Healthy Heart — through 2 ingredients. Tap an ingredient for the detail:
Green Tea Leaf 98% ExtractStimulant Drugs, Ephedrine Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Green Tea Leaf 98% Extract + Aminophylline, Amobarbital, Ephedrine interactionSeleniumBarbiturates Moderate
Interaction Summary
Theoretically, selenium might prolong the sedating effects of barbiturates.
Read the full Selenium + Aminophylline, Amobarbital, Ephedrine interactionAtorvastatinAtorvaliq
How Atorvastatin interacts with Healthy Heart — through 6 ingredients. Tap an ingredient for the detail:
Green Tea Leaf 98% ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Atorvastatin (lipitor) +2 Major
Interaction Summary
Green tea is unlikely to produce clinically significant changes in the levels and clinical effects of CYP3A4 substrates.
Read the full Green Tea Leaf 98% Extract + Atorvastatin interactionGugulipid 2.5% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, guggul might reduce the effects of CYP3A4 substrates.
Read the full Gugulipid 2.5% Extract + Atorvastatin interactionPolygonum Cuspidatum 50% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, hu zhang might increase levels of drugs metabolized by CYP3A4.
Read the full Polygonum Cuspidatum 50% Extract + Atorvastatin interactionTrans-resveratrolCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, resveratrol might increase levels of drugs metabolized by CYP3A4.
Read the full Trans-resveratrol + Atorvastatin interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Atorvastatin interactionNiacinHepatotoxic Drugs, Hmg-coa Reductase Inhibitors ("statins") Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Atorvastatin interactionAtorvastatin CalciumLipitor
How Atorvastatin Calcium interacts with Healthy Heart — through 6 ingredients. Tap an ingredient for the detail:
Green Tea Leaf 98% ExtractOrganic Anion-transporting Polypeptide Substrates (oatp), Cytochrome P450 3a4 (cyp3a4) Substrates +2 Major
Interaction Summary
Theoretically, green tea might reduce the absorption of organic anion-transporting polypeptide (OATP) substrates.
Read the full Green Tea Leaf 98% Extract + Atorvastatin Calcium interactionNiacinHepatotoxic Drugs, Hmg-coa Reductase Inhibitors ("statins") Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Atorvastatin Calcium interactionPolygonum Cuspidatum 50% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, hu zhang might increase levels of drugs metabolized by CYP3A4.
Read the full Polygonum Cuspidatum 50% Extract + Atorvastatin Calcium interactionGugulipid 2.5% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, guggul might reduce the effects of CYP3A4 substrates.
Read the full Gugulipid 2.5% Extract + Atorvastatin Calcium interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Atorvastatin Calcium interactionTrans-resveratrolCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, resveratrol might increase levels of drugs metabolized by CYP3A4.
Read the full Trans-resveratrol + Atorvastatin Calcium interactionAvanafilStendra
How Avanafil interacts with Healthy Heart — through 7 ingredients. Tap an ingredient for the detail:
Hawthorn Berry ExtractPhosphodiesterase-5 Inhibitors Major
Interaction Summary
Theoretically, concomitant use might result in additive vasodilation and hypotension.
Read the full Hawthorn Berry Extract + Avanafil interactionTrans-resveratrolCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, resveratrol might increase levels of drugs metabolized by CYP3A4.
Read the full Trans-resveratrol + Avanafil interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Avanafil interactionL-citrullinePhosphodiesterase-5 Inhibitors Moderate
Interaction Summary
Theoretically, concurrent use of phosphodiesterase-5 (PDE-5) inhibitors and L-citrulline might result in additive vasodilation.
Read the full L-citrulline + Avanafil interactionPolygonum Cuspidatum 50% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, hu zhang might increase levels of drugs metabolized by CYP3A4.
Read the full Polygonum Cuspidatum 50% Extract + Avanafil interactionGugulipid 2.5% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, guggul might reduce the effects of CYP3A4 substrates.
Read the full Gugulipid 2.5% Extract + Avanafil interactionGreen Tea Leaf 98% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Green tea is unlikely to produce clinically significant changes in the levels and clinical effects of CYP3A4 substrates.
Read the full Green Tea Leaf 98% Extract + Avanafil interactionBendroflumethiazide, NadololCorzide
How Bendroflumethiazide, Nadolol interacts with Healthy Heart — through 9 ingredients. Tap an ingredient for the detail:
Green Tea Leaf 98% ExtractDiuretic Drugs, Nadolol (corgard) Major
Interaction Summary
Theoretically, using green tea with diuretic drugs might increase the risk of hypokalemia.
Read the full Green Tea Leaf 98% Extract + Bendroflumethiazide, Nadolol interactionNiacinAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, niacin may increase the risk of hypotension when used with antihypertensive drugs.
Read the full Niacin + Bendroflumethiazide, Nadolol interactionVitamin B6Antihypertensive Drugs Moderate
Interaction Summary
Theoretically, vitamin B6 may have additive effects when used with antihypertensive drugs.
Read the full Vitamin B6 + Bendroflumethiazide, Nadolol interactionHawthorn Berry ExtractBeta-blockers Moderate
Interaction Summary
Theoretically, concomitant use might cause additive effects on blood pressure and heart rate.
Read the full Hawthorn Berry Extract + Bendroflumethiazide, Nadolol interactionPolicosanolBeta-blockers Moderate
Interaction Summary
Concomitant use of policosanol with beta-blockers can cause additive blood pressure-lowering effects.
Read the full Policosanol + Bendroflumethiazide, Nadolol interactionL-arginine HydrochlorideAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, concomitant use of L-arginine and antihypertensive drugs may increase the risk of hypotension.
Read the full L-arginine Hydrochloride + Bendroflumethiazide, Nadolol interactionCalciumThiazide Diuretics Moderate
Interaction Summary
Taking calcium along with thiazides might increase the risk of hypercalcemia and renal failure.
Read the full Calcium + Bendroflumethiazide, Nadolol interactionL-citrullineAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, concomitant use of L-citrulline with antihypertensive drugs might have additive effects and increase the chance of hypotension.
Read the full L-citrulline + Bendroflumethiazide, Nadolol interactionCoenzyme Q10Antihypertensive Drugs Minor
Interaction Summary
Theoretically, coenzyme Q10 might have additive effects with antihypertensive drugs.
Read the full Coenzyme Q10 + Bendroflumethiazide, Nadolol interactionBenserazide, LevodopaMadopar, Prolopa
How Benserazide, Levodopa interacts with Healthy Heart — through 2 ingredients. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Benserazide, Levodopa interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Benserazide, Levodopa interactionCarbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine TannateQuadratuss, Ry Tuss, Rynatuss, Tri Tannate Plus
How Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interacts with Healthy Heart — through 6 ingredients. Tap an ingredient for the detail:
Green Tea Leaf 98% ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Ephedrine +1 Major
Interaction Summary
Green tea is unlikely to produce clinically significant changes in the levels and clinical effects of CYP3A4 substrates.
Read the full Green Tea Leaf 98% Extract + Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interactionPolygonum Cuspidatum 50% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, hu zhang might increase levels of drugs metabolized by CYP3A4.
Read the full Polygonum Cuspidatum 50% Extract + Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interactionGugulipid 2.5% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, guggul might reduce the effects of CYP3A4 substrates.
Read the full Gugulipid 2.5% Extract + Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interactionN-acetyl L-carnitineSerotonergic Drugs Moderate
Interaction Summary
Theoretically, acetyl-L-carnitine might increase the risk of serotonergic side effects, including serotonin syndrome and cerebral vasoconstrictive disorders, when taken with serotonergic drugs.
Read the full N-acetyl L-carnitine + Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interactionTrans-resveratrolCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, resveratrol might increase levels of drugs metabolized by CYP3A4.
Read the full Trans-resveratrol + Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interactionCarbidopaLodosyn
How Carbidopa interacts with Healthy Heart — through 1 ingredient. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Carbidopa interactionCarbidopa, LevodopaDhivy, Rytary, Sinemet, Sinemet CR
How Carbidopa, Levodopa interacts with Healthy Heart — through 2 ingredients. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Carbidopa, Levodopa interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Carbidopa, Levodopa interactionCarbidopa, Levodopa, EntacaponeStalevo
How Carbidopa, Levodopa, Entacapone interacts with Healthy Heart — through 2 ingredients. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Carbidopa, Levodopa, Entacapone interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Carbidopa, Levodopa, Entacapone interactionCeftriaxoneRocephin
How Ceftriaxone interacts with Healthy Heart — 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 Healthy Heart — through 8 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 interactionGugulipid 2.5% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, guggul might reduce the effects of CYP3A4 substrates.
Read the full Gugulipid 2.5% Extract + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionGreen Tea Leaf 98% ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Moderate
Interaction Summary
Green tea might increase the levels and adverse effects of P-glycoprotein (P-gp) substrates.
Read the full Green Tea Leaf 98% Extract + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + 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 interactionMagnesiumBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Magnesium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Read the full Magnesium + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionPolygonum Cuspidatum 50% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, hu zhang might increase levels of drugs metabolized by CYP3A4.
Read the full Polygonum Cuspidatum 50% Extract + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionTrans-resveratrolCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, resveratrol might increase levels of drugs metabolized by CYP3A4.
Read the full Trans-resveratrol + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionDolutegravirTivicay
How Dolutegravir interacts with Healthy Heart — 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 interactionGreen Tea Leaf 98% ExtractP-glycoprotein Substrates Moderate
Interaction Summary
Green tea might increase the levels and adverse effects of P-glycoprotein (P-gp) substrates.
Read the full Green Tea Leaf 98% Extract + Dolutegravir interactionDolutegravir, Emtricitabine, Tenofovir AlafenamideDolutegravir, Emtricitabine, Tenofovir Alafenamide
How Dolutegravir, Emtricitabine, Tenofovir Alafenamide interacts with Healthy Heart — through 4 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 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 interactionMagnesiumBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Magnesium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Read the full Magnesium + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionGreen Tea Leaf 98% ExtractP-glycoprotein Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Green tea might increase the levels and adverse effects of P-glycoprotein (P-gp) substrates.
Read the full Green Tea Leaf 98% Extract + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionDolutegravir, RilpivirineJuluca
How Dolutegravir, Rilpivirine interacts with Healthy Heart — through 6 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 interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Dolutegravir, Rilpivirine interactionGreen Tea Leaf 98% ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Green tea might increase the levels and adverse effects of P-glycoprotein (P-gp) substrates.
Read the full Green Tea Leaf 98% Extract + Dolutegravir, Rilpivirine interactionGugulipid 2.5% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, guggul might reduce the effects of CYP3A4 substrates.
Read the full Gugulipid 2.5% Extract + Dolutegravir, Rilpivirine interactionPolygonum Cuspidatum 50% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, hu zhang might increase levels of drugs metabolized by CYP3A4.
Read the full Polygonum Cuspidatum 50% Extract + Dolutegravir, Rilpivirine interactionTrans-resveratrolCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, resveratrol might increase levels of drugs metabolized by CYP3A4.
Read the full Trans-resveratrol + Dolutegravir, Rilpivirine interactionDyphylline, Ephedrine, Guaifenesin, PhenobarbitalLufyllin-EPG
How Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interacts with Healthy Heart — through 4 ingredients. Tap an ingredient for the detail:
Green Tea Leaf 98% ExtractPhenobarbital (luminal), Ephedrine +1 Major
Interaction Summary
Theoretically, green tea might reduce the effects of phenobarbital and increase the risk for convulsions.
Read the full Green Tea Leaf 98% Extract + Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interactionVitamin B6Phenobarbital (luminal) Moderate
Interaction Summary
High doses of vitamin B6 may reduce the levels and clinical effects of phenobarbital.
Read the full Vitamin B6 + Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interactionSeleniumBarbiturates Moderate
Interaction Summary
Theoretically, selenium might prolong the sedating effects of barbiturates.
Read the full Selenium + Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interactionFolic AcidPhenobarbital (luminal) Moderate
Interaction Summary
Folic acid might have antagonistic effects on phenobarbital and increase the risk for seizures.
Read the full Folic Acid + Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interactionElvitegravirVitekta
How Elvitegravir interacts with Healthy Heart — through 6 ingredients. Tap an ingredient for the detail:
CalciumElvitegravir (vitekta) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium + Elvitegravir interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Elvitegravir interactionPolygonum Cuspidatum 50% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, hu zhang might increase levels of drugs metabolized by CYP3A4.
Read the full Polygonum Cuspidatum 50% Extract + Elvitegravir interactionTrans-resveratrolCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, resveratrol might increase levels of drugs metabolized by CYP3A4.
Read the full Trans-resveratrol + Elvitegravir interactionGugulipid 2.5% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, guggul might reduce the effects of CYP3A4 substrates.
Read the full Gugulipid 2.5% Extract + Elvitegravir interactionGreen Tea Leaf 98% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Green tea is unlikely to produce clinically significant changes in the levels and clinical effects of CYP3A4 substrates.
Read the full Green Tea Leaf 98% Extract + Elvitegravir interactionElvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil FumarateStribild
How Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interacts with Healthy Heart — through 8 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 interactionGugulipid 2.5% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, guggul might reduce the effects of CYP3A4 substrates.
Read the full Gugulipid 2.5% Extract + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionTrans-resveratrolCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, resveratrol might increase levels of drugs metabolized by CYP3A4.
Read the full Trans-resveratrol + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionGreen Tea Leaf 98% ExtractHepatotoxic Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, concomitant use might have additive adverse hepatotoxic effects.
Read the full Green Tea Leaf 98% Extract + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionPolygonum Cuspidatum 50% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, hu zhang might increase levels of drugs metabolized by CYP3A4.
Read the full Polygonum Cuspidatum 50% Extract + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionMagnesiumBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Magnesium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Read the full Magnesium + 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 interactionEphedrine, Guaifenesin (otc Drug)Ephedrine Formula 400, Ephedrine Plus Tabs
How Ephedrine, Guaifenesin (otc Drug) interacts with Healthy Heart — through 1 ingredient. Tap an ingredient for the detail:
Green Tea Leaf 98% ExtractStimulant Drugs, Ephedrine Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Green Tea Leaf 98% Extract + Ephedrine, Guaifenesin (otc Drug) interactionEphedrine, Guaifenesin, Phenobarbital, TheophyllineMudrane GG
How Ephedrine, Guaifenesin, Phenobarbital, Theophylline interacts with Healthy Heart — through 6 ingredients. Tap an ingredient for the detail:
Green Tea Leaf 98% ExtractTheophylline, Phenobarbital (luminal) +2 Major
Interaction Summary
Theoretically, green tea might increase the levels and adverse effects of theophylline.
Read the full Green Tea Leaf 98% Extract + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionTrans-resveratrolCytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, resveratrol might increase levels of drugs metabolized by CYP1A2.
Read the full Trans-resveratrol + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionPolygonum Cuspidatum 50% ExtractCytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, hu zhang might increase levels of drugs metabolized by CYP1A2.
Read the full Polygonum Cuspidatum 50% Extract + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionSeleniumBarbiturates Moderate
Interaction Summary
Theoretically, selenium might prolong the sedating effects of barbiturates.
Read the full Selenium + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionFolic AcidPhenobarbital (luminal) Moderate
Interaction Summary
Folic acid might have antagonistic effects on phenobarbital and increase the risk for seizures.
Read the full Folic Acid + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionVitamin B6Phenobarbital (luminal) Moderate
Interaction Summary
High doses of vitamin B6 may reduce the levels and clinical effects of phenobarbital.
Read the full Vitamin B6 + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionEphedrine, Hydroxyzine, TheophyllineAmi Rax, Marax
How Ephedrine, Hydroxyzine, Theophylline interacts with Healthy Heart — through 3 ingredients. Tap an ingredient for the detail:
Green Tea Leaf 98% ExtractStimulant Drugs, Theophylline +1 Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Green Tea Leaf 98% Extract + Ephedrine, Hydroxyzine, Theophylline interactionTrans-resveratrolCytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, resveratrol might increase levels of drugs metabolized by CYP1A2.
Read the full Trans-resveratrol + Ephedrine, Hydroxyzine, Theophylline interactionPolygonum Cuspidatum 50% ExtractCytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, hu zhang might increase levels of drugs metabolized by CYP1A2.
Read the full Polygonum Cuspidatum 50% Extract + Ephedrine, Hydroxyzine, Theophylline interactionEphedrine, Phenobarbital, Potassium Iodide, TheophyllineMudrane, Quadrinal
How Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interacts with Healthy Heart — through 4 ingredients. Tap an ingredient for the detail:
Green Tea Leaf 98% ExtractTheophylline, Phenobarbital (luminal) +2 Major
Interaction Summary
Theoretically, green tea might increase the levels and adverse effects of theophylline.
Read the full Green Tea Leaf 98% Extract + Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interactionSeleniumBarbiturates Moderate
Interaction Summary
Theoretically, selenium might prolong the sedating effects of barbiturates.
Read the full Selenium + Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interactionFolic AcidPhenobarbital (luminal) Moderate
Interaction Summary
Folic acid might have antagonistic effects on phenobarbital and increase the risk for seizures.
Read the full Folic Acid + Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interactionVitamin B6Phenobarbital (luminal) Moderate
Interaction Summary
High doses of vitamin B6 may reduce the levels and clinical effects of phenobarbital.
Read the full Vitamin B6 + Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interactionEphedrine, Phenobarbital, TheophyllineTedral
How Ephedrine, Phenobarbital, Theophylline interacts with Healthy Heart — through 4 ingredients. Tap an ingredient for the detail:
Green Tea Leaf 98% ExtractStimulant Drugs, Theophylline +2 Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Green Tea Leaf 98% Extract + Ephedrine, Phenobarbital, Theophylline interactionSeleniumBarbiturates Moderate
Interaction Summary
Theoretically, selenium might prolong the sedating effects of barbiturates.
Read the full Selenium + Ephedrine, Phenobarbital, Theophylline interactionFolic AcidPhenobarbital (luminal) Moderate
Interaction Summary
Folic acid might have antagonistic effects on phenobarbital and increase the risk for seizures.
Read the full Folic Acid + Ephedrine, Phenobarbital, Theophylline interactionVitamin B6Phenobarbital (luminal) Moderate
Interaction Summary
High doses of vitamin B6 may reduce the levels and clinical effects of phenobarbital.
Read the full Vitamin B6 + Ephedrine, Phenobarbital, Theophylline interactionEzetimibe, AtorvastatinLiptruzet
How Ezetimibe, Atorvastatin interacts with Healthy Heart — through 6 ingredients. Tap an ingredient for the detail:
Green Tea Leaf 98% ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Organic Anion-transporting Polypeptide Substrates (oatp) +2 Major
Interaction Summary
Green tea is unlikely to produce clinically significant changes in the levels and clinical effects of CYP3A4 substrates.
Read the full Green Tea Leaf 98% Extract + Ezetimibe, Atorvastatin interactionNiacinHmg-coa Reductase Inhibitors ("statins"), Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and statins might increase the risk of myopathy and rhabdomyolysis in some patients.
Read the full Niacin + Ezetimibe, Atorvastatin interactionPolygonum Cuspidatum 50% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, hu zhang might increase levels of drugs metabolized by CYP3A4.
Read the full Polygonum Cuspidatum 50% Extract + Ezetimibe, Atorvastatin interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Ezetimibe, Atorvastatin interactionGugulipid 2.5% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, guggul might reduce the effects of CYP3A4 substrates.
Read the full Gugulipid 2.5% Extract + Ezetimibe, Atorvastatin interactionTrans-resveratrolCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, resveratrol might increase levels of drugs metabolized by CYP3A4.
Read the full Trans-resveratrol + Ezetimibe, Atorvastatin interactionFinasteride, TadalafilEntadfi
How Finasteride, Tadalafil interacts with Healthy Heart — through 7 ingredients. Tap an ingredient for the detail:
Hawthorn Berry ExtractPhosphodiesterase-5 Inhibitors Major
Interaction Summary
Theoretically, concomitant use might result in additive vasodilation and hypotension.
Read the full Hawthorn Berry Extract + Finasteride, Tadalafil interactionGugulipid 2.5% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, guggul might reduce the effects of CYP3A4 substrates.
Read the full Gugulipid 2.5% Extract + Finasteride, Tadalafil interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Finasteride, Tadalafil interactionL-citrullinePhosphodiesterase-5 Inhibitors Moderate
Interaction Summary
Theoretically, concurrent use of phosphodiesterase-5 (PDE-5) inhibitors and L-citrulline might result in additive vasodilation.
Read the full L-citrulline + Finasteride, Tadalafil interactionPolygonum Cuspidatum 50% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, hu zhang might increase levels of drugs metabolized by CYP3A4.
Read the full Polygonum Cuspidatum 50% Extract + Finasteride, Tadalafil interactionTrans-resveratrolCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, resveratrol might increase levels of drugs metabolized by CYP3A4.
Read the full Trans-resveratrol + Finasteride, Tadalafil interactionGreen Tea Leaf 98% ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Green tea is unlikely to produce clinically significant changes in the levels and clinical effects of CYP3A4 substrates.
Read the full Green Tea Leaf 98% Extract + Finasteride, Tadalafil interactionGlyceryl TrinitrateNitronal
How Glyceryl Trinitrate interacts with Healthy Heart — through 1 ingredient. Tap an ingredient for the detail:
Hawthorn Berry ExtractNitrates Major
Interaction Summary
Theoretically, concomitant use might cause additive coronary vasodilatory effects.
Read the full Hawthorn Berry Extract + Glyceryl Trinitrate interactionIsosorbide DinitrateAngitak, Cedocard Retard, Isoket, Isoket Retard, Isordil
How Isosorbide Dinitrate interacts with Healthy Heart — through 1 ingredient. Tap an ingredient for the detail:
Hawthorn Berry ExtractNitrates Major
Interaction Summary
Theoretically, concomitant use might cause additive coronary vasodilatory effects.
Read the full Hawthorn Berry Extract + Isosorbide Dinitrate interactionIsosorbide Dinitrate, HydralazineBiDil
How Isosorbide Dinitrate, Hydralazine interacts with Healthy Heart — through 6 ingredients. Tap an ingredient for the detail:
Hawthorn Berry ExtractNitrates Major
Interaction Summary
Theoretically, concomitant use might cause additive coronary vasodilatory effects.
Read the full Hawthorn Berry Extract + Isosorbide Dinitrate, Hydralazine interactionNiacinAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, niacin may increase the risk of hypotension when used with antihypertensive drugs.
Read the full Niacin + Isosorbide Dinitrate, Hydralazine interactionL-arginine HydrochlorideAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, concomitant use of L-arginine and antihypertensive drugs may increase the risk of hypotension.
Read the full L-arginine Hydrochloride + Isosorbide Dinitrate, Hydralazine interactionVitamin B6Antihypertensive Drugs Moderate
Interaction Summary
Theoretically, vitamin B6 may have additive effects when used with antihypertensive drugs.
Read the full Vitamin B6 + Isosorbide Dinitrate, Hydralazine interactionL-citrullineAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, concomitant use of L-citrulline with antihypertensive drugs might have additive effects and increase the chance of hypotension.
Read the full L-citrulline + Isosorbide Dinitrate, Hydralazine interactionCoenzyme Q10Antihypertensive Drugs Minor
Interaction Summary
Theoretically, coenzyme Q10 might have additive effects with antihypertensive drugs.
Read the full Coenzyme Q10 + Isosorbide Dinitrate, Hydralazine interactionIsosorbide MononitrateAngeze, Angeze SR, Chemydur 60XL, Dynamin, Elantan, Elantan LA +13 more
How Isosorbide Mononitrate interacts with Healthy Heart — through 1 ingredient. Tap an ingredient for the detail:
Hawthorn Berry ExtractNitrates Major
Interaction Summary
Theoretically, concomitant use might cause additive coronary vasodilatory effects.
Read the full Hawthorn Berry Extract + Isosorbide Mononitrate interactionLevodopaInbrija, Larodopa
How Levodopa interacts with Healthy Heart — through 2 ingredients. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Levodopa interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Levodopa interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Healthy Heart 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.
Green Tea leaf 98% extract
Atorvastatin (Lipitor)
Green tea extract seems to reduce the levels and clinical effects of atorvastatin.
In healthy humans, taking green tea extract 300 mg or 600 mg along with atorvastatin reduces plasma levels of atorvastatin by approximately 24%. The elimination of atorvastatin is not affected. Atorvastatin is a substrate of organic anion-transporting polypeptides (OATPs). Research shows that two of the major catechins found in green tea, epicatechin gallate (ECG) and epigallocatechin gallate (EGCG), inhibit OATPs. Some OATPs are expressed in the small intestine and are responsible for the uptake of drugs and other compounds, which may have resulted in reduced plasma levels of atorvastatin. It is not clear if drinking green tea alters the absorption of atorvastatin.
Ephedrine
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Green tea contains caffeine. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death.
Nadolol (Corgard)
Green tea seems to reduce the levels and clinical effects of nadolol.
Preliminary clinical research shows that green tea consumption reduces plasma concentrations of nadolol. Compared to a control group, both peak levels and total drug exposure (AUC) of nadolol were reduced by approximately 85% in subjects who drank green tea daily for two weeks. Drinking green tea with nadolol also significantly reduced nadolol's systolic blood pressure lowering effect. Other clinical research shows that a single dose of green tea can affect plasma nadolol levels for at least one hour. Green tea catechins have been shown to inhibit organic anion transporting polypeptides (OATP), one of which, OATP1A2, is involved in the uptake of nadolol in the intestine The interaction is thought to be due primarily to the epigallocatechin gallate (EGCG) content of green tea.
5-Fluorouracil
Theoretically, high doses of green tea might increase the effects and side effects of 5-fluorouracil.
Animal research shows that taking green tea in amounts equivalent to about 6 cups daily in humans for 4 weeks prior to receiving a single injection of 5-fluorouracil increases the maximum plasma levels of 5-fluorouracil by about 2.5-fold and the area under the curve by 425%.
Adenosine (Adenocard)
Theoretically, green tea might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Green tea contains caffeine. Caffeine is a competitive inhibitor of adenosine at the cellular level. However, caffeine doesn't seem to affect supplemental adenosine because high interstitial levels of adenosine overcome the antagonistic effects of caffeine. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. However, methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.
Anticoagulant/Antiplatelet Drugs
Theoretically, green tea may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Conflicting reports exist regarding the effect of green tea on bleeding risk when used with anticoagulant or antiplatelet drugs; however, most evidence suggests that drinking green tea in moderate amounts is unlikely to cause a significant interaction. Green tea contains small amounts of vitamin K, approximately 7 mcg per cup. Some case reports have associated the antagonism of warfarin with the vitamin K content of green tea. However, these reports are rare, and very large doses of green tea (about 8-16 cups daily) appear to be needed to cause these effects. Furthermore, the catechins and caffeine in green tea are reported to have antiplatelet activity.
Beta-Adrenergic Agonists
Green tea contains caffeine. Theoretically, concomitant use of large amounts of caffeine might increase cardiac inotropic effects of beta-agonists.
Bortezomib (Velcade)
Theoretically, green tea might interfere with the effects of bortezomib.
In vitro research shows that green tea polyphenols, such as epigallocatechin gallate (EGCG), interact with bortezomib and block its proteasome inhibitory action. This prevents the induction of cell death in multiple myeloma or glioblastoma cancer cell lines. Advise patients taking bortezomib, not to take green tea.
Carbamazepine (Tegretol)
Theoretically, green tea might reduce the effects of carbamazepine and increase the risk for convulsions.
Green tea contains caffeine. Animal research suggests that taking caffeine can lower the anticonvulsant effects of carbamazepine and can induce seizures when taken in doses above 400 mg/kg. Human research has shown that taking caffeine 300 mg in three divided doses along with carbamazepine 200 mg reduces the bioavailability of carbamazepine by 32% and prolongs the plasma half-life of carbamazepine 2-fold in healthy individuals.
Celiprolol (Celicard)
Theoretically, green tea might reduce the levels and clinical effects of celiprolol.
In a small human study, taking green tea daily for 4 days appears to decrease blood and urine levels of celiprolol by at least 98%. This interaction is possibly due to the inhibition of organic anion transporting polypeptide (OATP). Green tea catechins have been shown to inhibit organic anion transporting polypeptides (OATP), one of which, OATP1A2, is found in the intestine The interaction is thought to be due primarily to the epigallocatechin gallate (EGCG) content of green tea.
Cimetidine (Tagamet)
Theoretically, concomitant use might increase the effects and adverse effects of caffeine in green tea.
Green tea contains caffeine. Cimetidine can reduce caffeine clearance by 31% to 42%.
Clozapine (Clozaril)
Theoretically, green tea might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
Animal research suggests that, although green tea extract does not affect the elimination of clozapine, it delays the time to reach peak concentration and reduces the peak plasma levels. Also, concomitant administration of green tea and clozapine might theoretically cause acute exacerbation of psychotic symptoms due to the caffeine in green tea. Caffeine can increase the effects and toxicity of clozapine. Caffeine doses of 400-1000 mg daily inhibit clozapine metabolism. Clozapine is metabolized by cytochrome P450 1A2 (CYP1A2). Researchers speculate that caffeine might inhibit CYP1A2. However, there is no reliable evidence that caffeine affects CYP1A2. There is also speculation that genetic factors might make some patients be more sensitive to the interaction between clozapine and caffeine.
Contraceptive Drugs
Theoretically, concomitant use might increase the effects and adverse effects of caffeine found in green tea.
Green tea contains caffeine. Oral contraceptives can decrease caffeine clearance by 40% to 65%.
Cytochrome P450 1A2 (Cyp1A2) Inhibitors
Theoretically, concomitant use might increase the levels and adverse effects of caffeine.
Green tea contains caffeine. Caffeine is metabolized by cytochrome P450 1A2 (CYP1A2),. Theoretically, drugs that inhibit CYP1A2 may decrease the clearance rate of caffeine from green tea and increase caffeine levels.
Dipyridamole (Persantine)
Theoretically, green tea might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Green tea contains caffeine. Caffeine might inhibit dipyridamole-induced vasodilation. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. Methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.
Disulfiram (Antabuse)
Theoretically, disulfiram might increase the risk of adverse effects from caffeine.
In human research, disulfiram decreases the clearance and increases the half-life of caffeine.
Diuretic Drugs
Theoretically, using green tea with diuretic drugs might increase the risk of hypokalemia.
Green tea contains caffeine. In excessive amounts, caffeine can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also cause lower potassium levels.
Estrogens
Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Green tea contains caffeine. Estrogen inhibits caffeine metabolism.
Ethosuximide (Zarontin)
Theoretically, green tea might reduce the effects of ethosuximide and increase the risk for convulsions.
Green tea contains caffeine. Animal research suggests that caffeine 92.4 mg/kg can decrease the anticonvulsant activity of ethosuximide. However, this effect has not been reported in humans.
Felbamate (Felbatol)
Theoretically, green tea might reduce the effects of felbamate and increase the risk for convulsions.
Green tea contains caffeine. Animal research suggests that a high dose of caffeine 161.7 mg/kg can decreases the anticonvulsant activity of felbamate. However, this effect has not been reported in humans.
Fexofenadine (Allegra)
Green tea can decrease blood levels of fexofenadine.
Clinical research shows that green tea can significantly decrease blood levels and excretion of fexofenadine. Taking green tea extract with a dose of fexofenadine decreased bioavailability of fexofenadine by about 30%. In vitro, green tea inhibits the cellular accumulation of fexofenadine by inhibiting the organic anion transporting polypeptide (OATP) drug transporter. Research shows that two of the major catechins found in green tea, epicatechin gallate (ECG) and epigallocatechin gallate (EGCG), inhibit OATPs, specifically OATP1A2, OATP1B1, and OATP2B1. In addition, green tea has been shown to reduce the absorption of some drugs that are OATP substrates.
Flutamide (Eulexin)
Theoretically, green tea might increase the levels and adverse effects of flutamide.
Green tea contains caffeine. In vitro evidence suggests that caffeine can inhibit the metabolism of flutamide. Theoretically, concomitant use of caffeine and flutamide might increase serum concentrations of flutamide and increase the risk adverse effects.
Fluvoxamine (Luvox)
Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Green tea contains caffeine. Fluvoxamine reduces caffeine metabolism.
Hepatotoxic Drugs
Theoretically, concomitant use might have additive adverse hepatotoxic effects.
Green tea extract supplements have been linked to several cases of hepatotoxicity and might have additive hepatotoxic effects with other drugs..
Imatinib (Gleevec)
Theoretically, green tea might reduce the levels and clinical effects of imatinib.
In animal research, a single dose of green tea extract reduces the area under the curve (AUC) of imatinib by up to approximately 64% and its main metabolite N-desmethyl imatinib by up to approximately 81%. This interaction has not been shown in humans. The mechanism of action is unclear but may involve multiple pathways.
Trans-Resveratrol
Anticoagulant/Antiplatelet Drugs
Resveratrol may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Resveratrol seems to have antiplatelet effects.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, resveratrol might increase levels of drugs metabolized by CYP1A2.
In vitro research shows that resveratrol can inhibit CYP1A2 enzymes. However, this interaction has not been reported in humans.
Cytochrome P450 2C19 (Cyp2C19) Substrates
Theoretically, resveratrol might increase levels of drugs metabolized by CYP2C19.
In vitro research shows that resveratrol can inhibit CYP2C19 enzymes. However, this interaction has not been reported in humans.
Cytochrome P450 2E1 (Cyp2E1) Substrates
Resveratrol might increase levels of drugs metabolized by CYP2E1.
In vitro research suggests that resveratrol inhibits CYP2E1 isoenzyme. Also, a pharmacokinetic study shows that taking resveratrol 500 mg daily for 10 days prior to taking a single dose of chlorzoxazone 250 mg increases the maximum concentration of chlorzoxazone by about 54%, the area under the curve of chlorzoxazone by about 72%, and the half-life of chlorzoxazone by about 35%. Chlorzoxazone is used as a probe drug for CYP2E1.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, resveratrol might increase levels of drugs metabolized by CYP3A4.
In vitro research shows that resveratrol can inhibit the CYP3A4 enzyme. However, clinical research shows that taking resveratrol 3000 mg daily for 8 weeks does not necessitate dose adjustments to medications metabolized by CYP3A4.
Vitamin E
Alkylating Agents
Theoretically, antioxidant effects of vitamin E might reduce the effectiveness of alkylating agents.
There's concern that antioxidants could reduce the activity of chemotherapy drugs which generate free radicals, such as cyclophosphamide, chlorambucil, carmustine, busulfan, and thiotepa. However, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that might interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin E have on chemotherapy. Advise patients to consult their oncologist before using vitamin E supplements, especially in high doses.
Anticoagulant/Antiplatelet Drugs
Concomitant use of vitamin E and anticoagulant or antiplatelet agents might increase the risk of bleeding.
Vitamin E seems to inhibit of platelet aggregation and antagonize the effects of vitamin K-dependent clotting factors. These effects appear to be dose-dependent, and are probably only likely to be clinically significant with doses of at least 800 units daily. Mixed tocopherols, such as those found in food, might have a greater antiplatelet effect than alpha-tocopherol. RRR alpha-tocopherol (natural vitamin E) 1000 IU daily antagonizes vitamin K-dependent clotting factors. Advise patients to avoid high doses of vitamin E, especially in people with low vitamin K intake or other risk factors for bleeding.
Antitumor Antibiotics
Theoretically, antioxidant effects of vitamin E might reduce the effectiveness of antitumor antibiotics.
There's concern that antioxidants could reduce the activity of antitumor antibiotic drugs such as doxorubicin, which generate free radicals. However, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that might interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin E have on chemotherapy involving antitumor antibiotics. Advise patients to consult their oncologist before using vitamin E supplements, especially in high doses.
Cyclosporine (Neoral, Sandimmune)
A specific form of vitamin E might increase absorption and levels of cyclosporine.
There is some evidence that one specific formulation of vitamin E (D-alpha-tocopheryl-polyethylene glycol-1000 succinate, TPGS, tocophersolan, Liqui-E) might increase absorption of cyclosporine. This vitamin E formulation forms micelles which seems to increase absorption of cyclosporine by 40% to 72% in some patients. However, this interaction is unlikely to occur with the usual forms of vitamin E.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Vitamin E appears to bind with the nuclear receptor, pregnane X receptor (PXR), which results in increased expression of CYP3A4. Although the clinical significance of this is not known, use caution when considering concomitant use of vitamin E and other drugs affected by these enzymes.
Selumetinib (Koselugo)
Taking selumetinib with vitamin E can result in a total daily dose of vitamin E that exceeds safe limits and therefore might increase the risk of bleeding.
Selumetinib contains 48-54 IU vitamin E per capsule. The increased risk of bleeding with vitamin E appears to be dose-dependent. Be cautious when using selumetinib in combination with supplemental vitamin E, especially in patients at higher risk of bleed, such as those with chronic conditions and those taking antiplatelet drugs.
Warfarin (Coumadin)
Using vitamin E with warfarin might increase the risk of bleeding.
Due to interference with production of vitamin K-dependent clotting factors, use of more than 400 IU of vitamin E daily with warfarin might increase prothrombin time (PT), INR, and the risk of bleeding,. At a dose of 1000 IU per day, vitamin E can antagonize vitamin K-dependent clotting factors even in people not taking warfarin. Limited clinical evidence suggests that doses up to 1200 IU daily may be used safely by patients taking warfarin, but this may not be applicable in all patient populations.
Niacin
Vitamin E might decrease the beneficial effects of niacin on high-density lipoprotein (HDL) cholesterol levels.
A combination of niacin and simvastatin (Zocor) effectively raises high-density lipoprotein (HDL) cholesterol levels in people with coronary disease and low HDL levels. Clinical research shows that taking a combination of antioxidants (vitamin C, vitamin E, beta-carotene, and selenium) along with niacin and simvastatin (Zocor) attenuates this rise in HDL, specifically the HDL-2 and apolipoprotein A1 fractions, by more than 50%. Vitamin E alone combined with a statin does not seem to decrease HDL levels. It is not known whether the adverse effect on HDL is due to one of the other antioxidants or to the combination. It also is not known whether it will occur in other patient populations.
Gugulipid 2.5% extract
Anticoagulant/Antiplatelet Drugs
Theoretically, guggul might increase the risk of bleeding when taken with anticoagulant/antiplatelet drugs.
In vitro research and preliminary clinical studies suggest that guggul might have antiplatelet and anticoagulant effects.
Contraceptive Drugs
Theoretically, guggul might increase the risk of adverse effects when taken with contraceptive drugs.
In vitro research shows that guggul has estrogen-alpha receptor agonist activity.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, guggul might reduce the effects of CYP3A4 substrates.
In vitro research shows that guggul constituents known as guggulsterones can induce CYP3A4.
Diltiazem (Cardizem, Others)
Guggul might reduce the effects of diltiazem.
A small pharmacokinetic study shows that concomitant use of guggul with diltiazem reduces the bioavailability of diltiazem.
Estrogens
Theoretically, guggul might increase the risk of adverse effects when taken with estrogens.
In vitro research shows that guggul constituents known as guggulsterones have estrogen-alpha receptor agonist activity.
Propranolol (Inderal)
Guggul might reduce the effects of propranolol.
A small pharmacokinetic study shows that concomitant use of guggul with propranolol reduces the bioavailability of propranolol.
Rosuvastatin (Crestor)
Theoretically, guggul might increase the effects and adverse effects of rosuvastatin.
Animal research shows that guggul increases the bioavailability and hypolipidemic effects of rosuvastatin. The mechanism of this interaction is unclear.
Tamoxifen (Nolvadex)
Theoretically, guggul might interfere with tamoxifen therapy.
In vitro research shows that guggul has estrogen-alpha receptor agonist activity.
Thyroid Hormone
Theoretically, guggul might increase the risk for adverse effects when taken with thyroid hormone therapy.
Animal research suggests that guggul has thyroid-stimulating effects.
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.
L-Arginine Hydrochloride
Ace Inhibitors (Aceis)
Theoretically, concomitant use of L-arginine and ACE inhibitors may increase the risk for hypotension and hyperkalemia.
Combining L-arginine with some antihypertensive drugs, especially ACE inhibitors, seems to have additive vasodilating and blood pressure-lowering effects. Furthermore, ACE inhibitors can increase potassium levels. Use of L-arginine has been associated with hyperkalemia in some patients. Theoretically, concomitant use of ACE inhibitors with L-arginine may increases the risk of hyperkalemia.
Angiotensin Receptor Blockers (Arbs)
Theoretically, concomitant use of L-arginine and ARBs may increase the risk of hypotension and hyperkalemia.
L-arginine increases nitric oxide, which causes vasodilation. Combining L-arginine with ARBs seems to increase L-arginine-induced vasodilation. Furthermore, ARBs can increase potassium levels. Use of L-arginine has been associated with hyperkalemia in some patients. Theoretically, concomitant use of ARBs with L-arginine may increases the risk of hyperkalemia.
Anticoagulant/Antiplatelet Drugs
Theoretically, concomitant use of L-arginine with anticoagulant and antiplatelet drugs might have additive effects and increase the risk of bleeding.
Preliminary research suggests that L-arginine infusions reduce platelet aggregation in humans. The clinical significance of this effect is unclear.
Antidiabetes Drugs
Theoretically, concomitant use of L-arginine might have additive effects with antidiabetes drugs.
Preliminary clinical research shows that L-arginine decreases blood glucose levels in patients with type 2 diabetes.
Antihypertensive Drugs
Theoretically, concomitant use of L-arginine and antihypertensive drugs may increase the risk of hypotension.
L-arginine increases nitric oxide, which causes vasodilation. Clinical evidence shows that L-arginine can reduce blood pressure in some individuals with hypertension. Furthermore, combining L-arginine with some antihypertensive drugs seems to have additive vasodilating and blood pressure-lowering effects.
Isoproterenol (Isuprel)
Theoretically, concurrent use of isoproterenol and L-arginine might result in additive effects and hypotension.
Preliminary clinical evidence suggests that L-arginine enhances isoproterenol-induced vasodilation in patients with essential hypertension or a family history of essential hypertension.
Potassium-Sparing Diuretics
Theoretically concomitant use of potassium-sparing diuretics with L-arginine may increases the risk of hyperkalemia.
Potassium-sparing diuretics can increase potassium levels. Use of L-arginine has been associated with hyperkalemia in some patients.
Sildenafil (Viagra)
Theoretically, concurrent use of sildenafil and L-arginine might increase the risk for hypotension.
In vivo, concurrent use of L-arginine and sildenafil has resulted in increased vasodilation. Theoretically, concurrent use might have additive vasodilatory and hypotensive effects. However, in studies evaluating the combined use of L-arginine and sildenafil for erectile dysfunction, hypotension was not reported.
Testosterone
Theoretically, concomitant use of L-arginine and testosterone might have additive effects.
In clinical research, L-arginine increases the level of testosterone in male patients with erectile dysfunction. The clinical significance of this finding is unclear.
Selenium
Anticoagulant/Antiplatelet Drugs
Selenium may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Clinical research suggests that taking selenium 10 mcg/kg/day can increase bleeding times by increasing prostacyclin production, which inhibits platelet activity. Other clinical research suggests that taking selenium 75 mcg daily, in combination with ascorbic acid 600 mg, alpha-tocopherol 300 mg, and beta-carotene 27 mg, reduces platelet aggregation.
Barbiturates
Theoretically, selenium might prolong the sedating effects of barbiturates.
Laboratory research suggests that selenium can inhibit the hepatic metabolism of barbiturates. Selenium seems to prolong the sedative effect of pentobarbital in animal models.
Immunosuppressants
Theoretically, selenium supplementation may reduce the effectiveness of immunosuppressant therapy.
In vitro research and preliminary clinical evidence suggests that selenium may stimulate the immune system.
Warfarin (Coumadin)
Theoretically, selenium might interfere with warfarin activity.
Animal research suggests that selenium can increase warfarin activity. Selenium might interact with warfarin by displacing it from albumin binding sites, reducing its metabolism in the liver, or by decreasing production of vitamin K-dependent clotting factors. Selenium can also prolong bleeding times in humans by increasing prostacyclin production, which inhibits platelet activity.
Contraceptive Drugs
Contraceptive drugs might increase levels of selenium, although the clinical significance of this effect is unclear.
Some research suggests that oral contraceptives increase serum selenium levels in women taking oral contraceptives; however, other research shows no change in selenium levels. It is suggested that an increase could be due to increased carrier proteins, indicating a redistribution of selenium rather than a change in total body selenium.
Niacin
Selenium might reduce the beneficial effects of niacin on high-density lipoprotein (HDL) levels.
A combination of niacin and simvastatin (Zocor) effectively raises HDL cholesterol levels in patients with coronary disease and low HDL levels. Clinical research shows that taking a combination of antioxidants (vitamin C, vitamin E, beta-carotene, and selenium) along with niacin and simvastatin (Zocor) attenuates this rise in HDL, specifically the HDL-2 and apolipoprotein A1 fractions, by more than 50% in patients with coronary disease. It is not known whether this adverse effect is due to a single antioxidant such as selenium, or to the combination. It also is not known whether it will occur in other patient populations.
Magnesium
Levodopa/Carbidopa (Sinemet)
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Clinical research in healthy volunteers shows that taking magnesium oxide 1000 mg with levodopa 100 mg/carbidopa 10 mg reduces the area under the curve (AUC) of levodopa by 35% and of carbidopa by 81%. In vitro and animal research shows that magnesium produces an alkaline environment in the digestive tract, which might lead to degradation and reduced bioavailability of levodopa/carbidopa.
Aminoglycoside Antibiotics
Concomitant use of aminoglycoside antibiotics and magnesium can increase the risk for neuromuscular weakness.
Both aminoglycosides and magnesium reduce presynaptic acetylcholine release, which can lead to neuromuscular blockade and possible paralysis. This is most likely to occur with high doses of magnesium given intravenously.
Antacids
Use of acid reducers may reduce the laxative effect of magnesium oxide.
A retrospective analysis shows that, in the presence of H2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs), a higher dose of magnesium oxide is needed for a laxative effect. This may also occur with antacids. Under acidic conditions, magnesium oxide is converted to magnesium chloride and then to magnesium bicarbonate, which has an osmotic laxative effect. By reducing acidity, antacids may reduce the conversion of magnesium oxide to the active bicarbonate salt.
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)
Magnesium 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 magnesium containing products.
Bisphosphonates
Magnesium can decrease absorption of bisphosphonates.
Cations, including magnesium, can decrease bisphosphonate absorption. Advise patients to separate doses of magnesium and these drugs by at least 2 hours.
Calcium Channel Blockers
Magnesium can have additive effects with calcium channel blockers, although evidence is conflicting.
Magnesium inhibits calcium entry into smooth muscle cells and may therefore have additive effects with calcium channel blockers. Severe hypotension and neuromuscular blockades may occur when nifedipine is used with intravenous magnesium, although some contradictory evidence suggests that concurrent use of magnesium with nifedipine does not increase the risk of neuromuscular weakness. High doses of magnesium could theoretically have additive effects with other calcium channel blockers.
Digoxin
Magnesium salts may reduce absorption of digoxin.
Clinical evidence suggests that treatment with oral magnesium hydroxide or magnesium trisilicate reduces absorption of digoxin from the intestines. This may reduce the blood levels of digoxin and decrease its therapeutic effects.
Potassium-Sparing Diuretics
Potassium-sparing diuretics decrease excretion of magnesium, possibly increasing magnesium levels.
Potassium-sparing diuretics also have magnesium-sparing properties, which can counteract the magnesium losses associated with loop and thiazide diuretics. Theoretically, increased magnesium levels could result from concomitant use of potassium-sparing diuretics and magnesium supplements.
Quinolone Antibiotics
Magnesium decreases absorption of quinolones.
Magnesium can form insoluble complexes with quinolones and decrease their absorption. Advise patients to take these drugs at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Skeletal Muscle Relaxants
Parenteral magnesium alters the pharmacokinetics of skeletal muscle relaxants, increasing their effects and accelerating the onset of effect.
Parenteral magnesium shortens the time to onset of skeletal muscle relaxants by about 1 minute and prolongs the duration of action by about 2 minutes. Magnesium potentiates the effects of skeletal muscle relaxants by decreasing calcium-mediated release of acetylcholine from presynaptic nerve terminals, reducing postsynaptic sensitivity to acetylcholine, and having a direct effect on the membrane potential of myocytes. Magnesium also has vasodilatory actions and increases cardiac output, allowing a greater amount of muscle relaxant to reach the motor end plate. A clinical study found that low-dose rocuronium (0.45 mg/kg), when given after administration of magnesium 30 mg/kg over 10 minutes, has an accelerated onset of effect, which matches the onset of effect seen with a full-dose rocuronium regimen (0.6 mg/kg). In another clinical study, onset times for rocuronium doses of 0.3, 0.6, and 1.2 mg/kg were 86, 76, and 50 seconds, respectively, when given alone, but were reduced to 66, 44, and 38 seconds, respectively, when the doses were given after a 15-minute infusion of magnesium sulfate 60 mg/kg. Giving intraoperative intravenous magnesium sulfate, 50 mg/kg loading dose followed by 15 mg/kg/hour, reduces the onset time of rocuronium, enhances its clinical effects, reduces the dose of intraoperative opiates, and prolongs the spontaneous recovery time. It does not affect the activity of subsequently administered neostigmine.
Sulfonylureas
Magnesium increases the systemic absorption of sulfonylureas, increasing their effects and side effects.
Clinical research shows that administration of magnesium hydroxide with glyburide increases glyburide absorption, increases maximal insulin response by 35-fold, and increases the risk of hypoglycemia, when compared with glyburide alone. A similar interaction occurs between magnesium hydroxide and glipizide. The mechanism of this effect appears to be related to the elevation of gastrointestinal pH by magnesium-based antacids, increasing solubility and enhancing absorption of sulfonylureas.
Tetracycline Antibiotics
Magnesium decreases absorption of tetracyclines.
Magnesium can form insoluble complexes with tetracyclines in the gut and decrease their absorption and antibacterial activity. Advise patients to take these drugs 1 hour before or 2 hours after magnesium supplements.
Anticoagulant/Antiplatelet Drugs
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
In vitro evidence shows that magnesium sulfate inhibits platelet aggregation, even at low concentrations. Some preliminary clinical evidence shows that infusion of magnesium sulfate increases bleeding time by 48% and reduces platelet activity. However, other clinical research shows that magnesium does not affect platelet aggregation, although inhibition of platelet-dependent thrombosis can occur.
Gabapentin (Neurontin)
Gabapentin absorption can be decreased by magnesium.
Clinical research shows that giving magnesium oxide orally along with gabapentin decreases the maximum plasma concentration of gabapentin by 33%, time to maximum concentration by 36%, and area under the curve by 43%. Advise patients to take gabapentin at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Sevelamer (Renagel, Renvela)
Sevelamer may increase serum magnesium levels.
In patients on hemodialysis, sevelamer use was associated with a 0.28 mg/dL increase in serum magnesium. The mechanism of this interaction remains unclear.
ALA
Alkylating Agents
Theoretically, the antioxidant effects of alpha-lipoic acid might alter the effectiveness of alkylating agents.
The use of antioxidants like alpha-lipoic acid during chemotherapy is controversial. There are concerns that antioxidants could reduce the activity of chemotherapy drugs that generate free radicals. However, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that might interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as alpha-lipoic acid have on chemotherapy. Advise patients to consult their oncologist before using alpha-lipoic acid.
Anticoagulant/Antiplatelet Drugs
Theoretically, alpha-lipoic acid may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
In vitro, alpha-lipoic acid inhibits platelet aggregation.
Antitumor Antibiotics
Theoretically, the antioxidant effects of alpha-lipoic acid might alter the effectiveness of antitumor antibiotics.
The use of antioxidants like alpha-lipoic acid during chemotherapy is controversial. There are concerns that antioxidants could reduce the activity of antitumor antibiotic drugs, which work by generating free radicals. However, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that might interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as alpha-lipoic acid have on chemotherapy involving antitumor antibiotics. Advise patients to consult their oncologist before using alpha-lipoic acid.
Thyroid Hormone
Theoretically, alpha-lipoic acid might decrease the effects of thyroid hormone drugs.
Animal research suggests that co-administration of thyroxine with alpha-lipoic acid reduces conversion into the active T3 form.
Antidiabetes Drugs
Theoretically, taking alpha-lipoic acid with antidiabetes drugs might increase the risk of hypoglycemia.
Although some small clinical studies have suggested that alpha-lipoic acid can lower blood glucose levels, larger clinical studies in patients with diabetes have shown no clinically meaningful effect. Additionally, co-administration of single doses of alpha-lipoic acid and glyburide or acarbose did not cause detectable drug interactions in healthy volunteers.
Policosanol
Anticoagulant/Antiplatelet Drugs
Theoretically, taking policosanol with other antiplatelet or anticoagulant drugs might increase the risk of bruising and bleeding.
Some clinical research shows that taking policosanol 10-50 mg daily for 7-15 days can inhibit platelet aggregation in healthy patients. Although, one clinical trial shows that taking policosanol 10 mg twice daily for 2 weeks prior to warfarin dosing does not affect warfarin pharmacokinetics or warfarin response. Furthermore, a study in patients undergoing percutaneous coronary intervention with a drug-eluting stent found that taking policosanol 40 mg plus clopidogrel and aspirin daily for 30 days modestly reduced the risk for minor bleeding events when compared with taking clopidogrel and aspirin alone. Until more is known, use with caution.
Antidiabetes Drugs
Theoretically, policosanol might have additive effects with antidiabetes drugs and increase the risk of hypoglycemia.
Clinical research shows that policosanol can lower blood glucose levels.
Beta-Blockers
Concomitant use of policosanol with beta-blockers can cause additive blood pressure-lowering effects.
Clinical research shows that policosanol 5 mg daily can have additive blood pressure-lowering effects in patients with hypertension who are taking beta-blockers. Also, animal research shows that policosanol can increase the blood-pressure lowering effects of propranolol.
Nitroprusside (Nitropress)
Theoretically, concomitant use of policosanol with nitroprusside might cause additive blood pressure-lowering effects.
Animal research shows that taking policosanol along with nitroprusside can increase the blood pressure-lowering effects of nitroprusside.
Propranolol (Inderal)
Animal research shows that taking policosanol along with propranolol can increase the blood pressure-lowering effects of propranolol.
Warfarin (Coumadin)
Theoretically, taking policosanol with warfarin might increase the risk of bruising and bleeding.
Some clinical research shows that taking policosanol 10-50 mg daily for 7-15 days can inhibit platelet aggregation in healthy patients. However, one clinical trial shows that taking policosanol 10 mg twice daily for 2 weeks prior to warfarin dosing does not affect warfarin pharmacokinetics or warfarin response.
Vitamin B6
Amiodarone (Cordarone)
Theoretically, vitamin B6 might increase the photosensitivity caused by amiodarone.
Despite initial case reports suggesting that pyridoxine may have a protective effect against amiodarone-induced photosensitivity, preliminary clinical research suggests that pyridoxine may actually exacerbate this adverse effect.
Antihypertensive Drugs
Theoretically, vitamin B6 may have additive effects when used with antihypertensive drugs.
Research in hypertensive rats shows that vitamin B6 can decrease systolic blood pressure. Similarly, clinical research in patients with hypertension shows that taking high doses of vitamin B6 may reduce systolic and diastolic blood pressure, possibly by reducing plasma levels of epinephrine and norepinephrine.
Phenobarbital (Luminal)
High doses of vitamin B6 may reduce the levels and clinical effects of phenobarbital.
Preliminary clinical evidence suggests that vitamin B6 200 mg daily can reduce plasma levels of phenobarbital, possibly by increasing metabolism. It is not known whether lower doses have any effect. Advise people taking phenobarbital to avoid high doses of vitamin B6.
Phenytoin (Dilantin)
High doses of vitamin B6 may reduce the levels and clinical effects of phenytoin.
Preliminary clinical evidence suggests that vitamin B6 200 mg daily can reduce plasma levels of phenytoin, possibly by increasing metabolism. It is not known whether lower doses have any effect. Advise people taking phenytoin to avoid high doses of vitamin B6.
Levodopa
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Vitamin B6 (pyridoxine) enhances the metabolism of levodopa, reducing its clinical effects. However, this interaction does not occur when carbidopa is used concurrently with levodopa (Sinemet). Therefore, it is not likely to be a problem in most people.
Vitamin C
Alkylating Agents
Theoretically, antioxidant effects of vitamin C might reduce the effectiveness of alkylating agents.
The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs that generate free radicals, such as cyclophosphamide, chlorambucil, carmustine, busulfan, and thiotepa. In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin C have on chemotherapy.
Aluminum
Vitamin C can increase the amount of aluminum absorbed from aluminum compounds.
Research in animals and humans shows that vitamin C increases aluminum absorption, theoretically by chelating aluminum and keeping it in solution where it is available for absorption. In people with normal renal function, urinary excretion of aluminum will likely increase, making aluminum retention and toxicity unlikely. Patients with renal failure who take aluminum-containing compounds such as phosphate binders should avoid vitamin C supplements in doses above the recommended dietary allowances.
Antitumor Antibiotics
Theoretically, the antioxidant effects of vitamin C might reduce the effectiveness of antitumor antibiotics.
The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs which generate free radicals, such as doxorubicin. In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effects, if any, antioxidants such as vitamin C have on chemotherapy.
Estrogens
Vitamin C might increase blood levels of estrogens.
Increases in plasma estrogen levels of up to 55% occur under some circumstances when vitamin C is taken concurrently with oral contraceptives or hormone replacement therapy, including topical products. It is suggested that vitamin C prevents oxidation of estrogen in the tissues, regenerates oxidized estrogen, and reduces sulfate conjugation of estrogen in the gut wall. When tissue levels of vitamin C are high, these processes are already maximized and supplemental vitamin C does not have any effect on estrogen levels. Increases in plasma estrogen levels may occur when patients who are deficient in vitamin C take supplements. Monitor these patients for estrogen-related side effects.
Fluphenazine (Prolixin)
Theoretically, vitamin C might decrease levels of fluphenazine.
In one patient there was a clinically significant decrease in fluphenazine levels when vitamin C (500 mg twice daily) was started. The mechanism is not known, and there is no further data to confirm this interaction.
Indinavir (Crixivan)
Vitamin C can modestly reduce indinavir levels.
One pharmacokinetic study shows that taking vitamin C 1 gram orally once daily along with indinavir 800 mg orally three times daily reduces the area under the concentration-time curve of indinavir by 14%. The mechanism of this interaction is unknown, but it is unlikely to be clinically significant in most patients. The effect of higher doses of vitamin C on indinavir levels is unknown.
Levothyroxine (Synthroid, Others)
Vitamin C can increase levothyroxine absorption.
Two clinical studies in adults with poorly controlled hypothyroidism show that swallowing levothyroxine with a glass of water containing vitamin C 500-1000 mg in solution reduces thyroid stimulating hormone (TSH) levels and increases thyroxine (T4) levels when compared with taking levothyroxine alone. This suggests that vitamin C increases the oral absorption of levothyroxine, possibly due to a reduction in pH.
Warfarin (Coumadin)
High-dose vitamin C might reduce the levels and effectiveness of warfarin.
Vitamin C in high doses may cause diarrhea and possibly reduce warfarin absorption. There are reports of two people who took up to 16 grams daily of vitamin C and had a reduction in prothrombin time. Lower doses of 5-10 grams daily can also reduce warfarin absorption. In many cases, this does not seem to be clinically significant. However, a case of warfarin resistance has been reported for a patient who took vitamin C 500 mg twice daily. Cessation of vitamin C supplementation resulted in a rapid increase in international normalized ratio (INR). Tell patients taking warfarin to avoid taking vitamin C in excessively high doses (greater than 10 grams daily). Lower doses may be safe, but the anticoagulation activity of warfarin should be monitored. Patients who are stabilized on warfarin while taking vitamin C should avoid adjusting vitamin C dosage to prevent the possibility of warfarin resistance.
Acetaminophen (Tylenol, Others)
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
A small pharmacokinetic study in healthy volunteers shows that taking high-dose vitamin C (3 grams) 1.5 hours after taking acetaminophen 1 gram slightly increases the apparent half-life of acetaminophen from around 2.3 hours to 3.1 hours. Ascorbic acid competitively inhibits sulfate conjugation of acetaminophen. However, to compensate, elimination of acetaminophen glucuronide and unconjugated acetaminophen increases. This effect is not likely to be clinically significant.
Aspirin
Acidification of the urine by vitamin C might increase aspirin levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction is not clinically significant.
Choline Magnesium Trisalicylate (Trilisate)
Acidification of the urine by vitamin C might increase choline magnesium trisalicylate levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction probably is not clinically significant.
Niacin
Vitamin C might decrease the beneficial effects of niacin on high-density lipoprotein (HDL) cholesterol levels.
A combination of niacin and simvastatin (Zocor) effectively raises HDL cholesterol levels in patients with coronary disease and low HDL levels. Clinical research shows that taking a combination of antioxidants (vitamin C, vitamin E, beta-carotene, and selenium) along with niacin and simvastatin (Zocor) attenuates this rise in HDL, specifically the HDL-2 and apolipoprotein A1 fractions, by more than 50% in patients with coronary disease. It is not known whether this adverse effect is due to a single antioxidant such as vitamin C, or to the combination. It also is not known whether it will occur in other patient populations.
Salsalate (Disalcid)
Acidification of the urine by vitamin C might increase salsalate levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams/day vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction probably is not clinically significant.
N-Acetyl L-Carnitine
Acenocoumarol (Sintrom)
Theoretically, acetyl-L-carnitine might increase the anticoagulant effects of acenocoumarol.
L-carnitine, the parent compound of acetyl-L-carnitine, might enhance the anticoagulant effects of acenocoumarol, an oral anticoagulant that is similar to warfarin, but shorter-acting. There are at least two case reports of INR elevation when L-carnitine was taken with acenocoumarol. In one case, a 33-year-old male with a previously stable INR had an elevated INR of 4.65 after L-carnitine was started and continued for 10 weeks. INR normalized after discontinuation of the L-carnitine-containing product. It is unclear if such an interaction would also occur with acetyl-L-carnitine.
Serotonergic Drugs
Theoretically, acetyl-L-carnitine might increase the risk of serotonergic side effects, including serotonin syndrome and cerebral vasoconstrictive disorders, when taken with serotonergic drugs.
Animal research shows that acetyl-L-carnitine can increase levels of serotonin in the brain.
Thyroid Hormone
Theoretically, acetyl-L-carnitine might decrease the effectiveness of thyroid hormone replacement.
L-carnitine appears to act as a peripheral thyroid hormone antagonist by inhibiting entry of thyroid hormone into the nucleus of cells. Taking L-carnitine also seems to diminish some of the symptoms of hyperthyroidism. It is unclear if such an interaction would occur with acetyl-L-carnitine.
Warfarin (Coumadin)
Theoretically, acetyl-L-carnitine might increase the anticoagulant effects of warfarin.
L-carnitine, the parent compound of acetyl-L-carnitine, might increase the anticoagulant effects of acenocoumarol, a shorter-acting oral anticoagulant similar to warfarin. There is not enough information to know whether this interaction occurs with acetyl-L-carnitine and warfarin.
Coenzyme Q10
Alkylating Agents
Coenzyme Q10 has antioxidant effects. Theoretically, this may reduce the activity of chemotherapy drugs that generate free radicals.
Theoretically, antioxidants such as coenzyme Q10 might protect tumor cells from chemotherapeutic agents that work by inducing oxidative stress, such as alkylating agents (e.g., cyclophosphamide) and radiation therapy. The clinical importance of this interaction is unknown.
Warfarin (Coumadin)
Coenzyme Q10 is chemically similar to menaquinone and might have vitamin K-like procoagulant effects, which could decrease the effects of warfarin.
Concomitant use of coenzyme Q10 and warfarin might reduce the anticoagulant effects of warfarin. Four cases of decreased warfarin efficacy thought to be due to coenzyme Q10 have been reported. However, there is some preliminary clinical research that suggests coenzyme Q10 might not significantly decrease the effects of warfarin in patients who have a stable INR.
Antihypertensive Drugs
Theoretically, coenzyme Q10 might have additive effects with antihypertensive drugs.
Some clinical research shows that coenzyme Q10 can significantly lower blood pressure, although other studies have shown conflicting results.
Hawthorn berry extract
Nitrates
Theoretically, concomitant use might cause additive coronary vasodilatory effects.
Some evidence shows that hawthorn might lower blood pressure due to vasodilatory effects.
Phosphodiesterase-5 Inhibitors
Theoretically, concomitant use might result in additive vasodilation and hypotension.
Hawthorn might inhibit PDE-5 and cause vasodilation.
Anticoagulant/Antiplatelet Drugs
Theoretically, hawthorn may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
In vitro and animal research shows that hawthorn can inhibit platelet aggregation. However, its effect in humans is unclear. One observational study shows that patients taking hawthorn shortly before undergoing coronary artery bypass graft (CABG) surgery or valve replacement surgery have a 10% incidence of postoperative bleeding, compared with 1% in those who never consumed hawthorn extract. However, clinical research shows that taking a specific preparation of dried hawthorn leaves and flowers (Crataesor, Soria Natural Lab) 800 mg three times daily for 15 days does not affect platelet aggregation or levels of thromboxane B2, the metabolite of thromboxane A2, in healthy humans.
Beta-Blockers
Theoretically, concomitant use might cause additive effects on blood pressure and heart rate.
Some evidence shows that hawthorn might lower blood pressure and heart rate.
Calcium Channel Blockers
Theoretically, concomitant use might cause additive coronary vasodilation and hypotensive effects.
Some evidence shows that hawthorn might lower blood pressure due to vasodilatory effects.
Digoxin (Lanoxin)
Theoretically, hawthorn might potentiate the effects and adverse effects of digoxin.
Hawthorn appears to improve cardiac output; however, hawthorn does not appear to affect digoxin pharmacokinetics. Case reports suggest that at least one species of hawthorn root extract (Crataegus mexicana) may produce adverse effects similar to digoxin and can cross-react with digoxin assays, leading to falsely elevated plasma digoxin levels.
L-Citrulline
Antihypertensive Drugs
Theoretically, concomitant use of L-citrulline with antihypertensive drugs might have additive effects and increase the chance of hypotension.
L-citrulline is converted to L-arginine, which can increase nitric oxide and cause vasodilation. However, a meta-analysis of 5 small clinical studies suggests that taking L-citrulline 3-6 grams daily for 1-8 weeks does not lower blood pressure when compared with control.
Phosphodiesterase-5 Inhibitors
Theoretically, concurrent use of phosphodiesterase-5 (PDE-5) inhibitors and L-citrulline might result in additive vasodilation.
L-citrulline is converted to L-arginine, which can increase nitric oxide and cause vasodilation. Theoretically, taking L-arginine with PDE-5 inhibitors might have additive vasodilatory and hypotensive effects. However, in studies evaluating the combined use of L-arginine and sildenafil for erectile dysfunction, hypotension was not reported.
Chromium
Antidiabetes Drugs
Theoretically, chromium may have additive effects with antidiabetic agents and increase the risk of hypoglycemia.
Some research shows that taking chromium might lower blood glucose levels, especially in patients with poorly controlled type 2 diabetes.
Insulin
Theoretically, concomitant use of chromium and insulin might increase the risk of hypoglycemia.
In clinical research, chromium has been shown to increase insulin sensitivity,
Levothyroxine (Synthroid, Others)
Chromium might bind levothyroxine in the intestinal tract and decrease levothyroxine absorption.
Clinical research in healthy volunteers shows that taking chromium picolinate 1000 mcg with levothyroxine 1 mg decreases serum levels of levothyroxine by 17% when compared to taking levothyroxine alone. Advise patients to take levothyroxine at least 30 minutes before or 3-4 hours after taking chromium.
Aspirin
Theoretically, aspirin might increase chromium absorption.
Animal research suggests that aspirin may increase chromium absorption and chromium levels in the blood.
Nonsteroidal Anti-Inflammatory Drugs (Nsaids)
NSAIDs might increase chromium levels in the body.
Drugs that are prostaglandin inhibitors, such as NSAIDs, seem to increase chromium absorption and retention.
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.
Folic Acid
5-Fluorouracil
Theoretically, high doses of folic acid might increase the toxicity of 5-fluorouracil.
Increases in gastrointestinal side effects of 5-fluorouracil, such as stomatitis and diarrhea, have been described in two clinical studies when leucovorin, a form of folic acid, was administered with 5-fluorouracil.
Capecitabine (Xeloda)
Use of high-dose folic acid might contribute to capecitabine toxicity.
Clinical research suggests that higher serum folate levels are associated with an increased risk for moderate or severe toxicity during capecitabine-based treatment for colorectal cancer. Additionally, in one case report, taking folic acid 15 mg daily might have contributed to increased toxicity, including severe diarrhea, vomiting, edema, hand-foot syndrome, and eventually death, in a patient prescribed capecitabine.
Methotrexate (Trexall, Others)
Folic acid might reduce the efficacy of methotrexate as a cancer treatment when given concurrently.
Methotrexate exerts its cytotoxic effects by preventing conversion of folic acid to the active form needed by cells. There is some evidence that folic acid supplements reduce the efficacy of methotrexate in the treatment of acute lymphoblastic leukemia, and theoretically they could reduce its efficacy in the treatment of other cancers. Advise cancer patients to consult their oncologist before using folic acid supplements. In patients treated with long-term, low-dose methotrexate for rheumatoid arthritis (RA) or psoriasis, folic acid supplements can reduce the incidence of side effects, without reducing efficacy.
Phenobarbital (Luminal)
Folic acid might have antagonistic effects on phenobarbital and increase the risk for seizures.
Folic acid can have direct convulsant activity in some people, reversing the effects of phenobarbital and worsening seizure control. Monitor closely for increased seizure activity.
Phenytoin (Dilantin)
Folic acid might reduce serum levels of phenytoin in some patients.
Folic acid may be a cofactor in phenytoin metabolism. Folic acid, in doses of 1 mg daily or more, can reduce serum levels of phenytoin in some patients. Increases in seizure frequency have been reported. If folic acid supplements are added to established phenytoin therapy, monitor serum phenytoin levels closely. If phenytoin and folic acid are started at the same time and continued together, adverse changes in phenytoin pharmacokinetics are avoided. Note that phenytoin also reduces serum folate levels.
Primidone (Mysoline)
Folic acid might have antagonistic effects on primidone and increase the risk for seizures.
Folic acid can have direct convulsant activity in some people, reversing the effects of primidone and worsening seizure control. Monitor closely for increased seizure activity. Note that primidone also reduces serum folate levels.
Pyrimethamine (Daraprim)
Folic acid might antagonize the effects of pyrimethamine.
Folic acid can antagonize the antiparasitic effects of pyrimethamine against toxoplasmosis and Pneumocystis carinii pneumonia. Folic acid doesn't antagonize the effects of pyrimethamine in the treatment of malaria, because malarial parasites cannot use exogenous folic acid. Use folinic acid as an alternative to folic acid when indicated.
Betaine HCl
Antacids
Betaine hydrochloride increases stomach acidity and could decrease the effects of antacids.
In human research, betaine hydrochloride increases stomach acidity. Antacids are taken to decrease stomach acidity. Theoretically, taking betaine hydrochloride along with antacids might decrease the effects of the antacids.
H2-Blockers
Betaine hydrochloride increases stomach acidity and could decrease the effects of H2-blockers.
In human research, betaine hydrochloride increases stomach acidity. H2-blockers are used to decrease stomach acidity. Theoretically, taking betaine hydrochloride along with H2-blockers might decrease the effects of H2-blockers.
Proton Pump Inhibitors (Ppis)
Betaine hydrochloride increases stomach acidity and could decrease the effects of PPIs.
In human research, betaine hydrochloride increases stomach acidity. PPIs are used to decrease stomach acidity. Theoretically, taking betaine hydrochloride along with PPIs might decrease the effects of PPIs
Brand information
Manufacturer and brand details for Healthy Heart, from the product label.
NutraPro (Neutraceutical Corp.)
See all NutraPro (Neutraceutical Corp.) products- Name
- Better Price LLC
- City
- Miami Beach
- State
- FL
- ZipCode
- 33139
- Phone Number
- 718-841-8382 Ext 1
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The Full Monographs Behind Healthy Heart’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Niacin
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 B6
Interacts with 210 drugsVitamin B6 (pyridoxine) is an essential water-soluble vitamin that your body needs for metabolism, brain function, and making red blood cells. It is best known for helping with pregnancy-rel...
Read the full Vitamin B6 monograph → Herb & supplement monographFolic Acid
Interacts with 40 drugsFolic acid is the man-made form of vitamin B9 and is one of the most well-studied supplements, especially for preventing serious birth defects when taken before and during early pregnancy. I...
Read the full Folic Acid 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 monographL-citrulline
Interacts with 178 drugsL-citrulline is an amino acid that the body turns into L-arginine to help make nitric oxide, which relaxes blood vessels and may improve blood flow. It is popular for exercise performance an...
Read the full L-citrulline monograph → Herb & supplement monographPolicosanol
Interacts with 242 drugsPolicosanol is a mix of waxy alcohols (mostly octacosanol) made from sugar cane or other plant waxes, and it is often marketed as a natural way to lower cholesterol. Early studies from Cuba...
Read the full Policosanol monograph → Herb & supplement monographChromium
Interacts with 178 drugsChromium is an essential trace mineral involved in how the body handles sugar and fat. Some studies suggest it may modestly help blood sugar control in certain people with type 2 diabetes, b...
Read the full Chromium monograph → Herb & supplement monographVitamin E
Interacts with 764 drugsVitamin E is an essential fat-soluble vitamin and antioxidant that most people get in adequate amounts from a normal diet. Supplements can help correct a true deficiency, but high-dose vitam...
Read the full Vitamin E monograph → Herb & supplement monographVitamin C
Interacts with 207 drugsVitamin C (ascorbic acid) is an essential nutrient your body needs but cannot make, so you must get it from food or supplements. It's important for immune function, collagen, and acts as an...
Read the full Vitamin C monograph → Herb & supplement monographSelenium
Interacts with 321 drugsSelenium is an essential trace mineral your body needs in small amounts for thyroid function, antioxidant defense, and immune health. Most people who eat a varied diet get enough, and supple...
Read the full Selenium monograph → Herb & supplement monographBetaine Hydrochloride
Interacts with 36 drugsBetaine hydrochloride is a supplement used to temporarily increase stomach acid in people who may have low acid levels. Evidence for its benefits is limited and mostly based on tradition rat...
Read the full Betaine Hydrochloride monograph → Herb & supplement monographCoenzyme Q10
Interacts with 198 drugsCoQ10 is a vitamin-like substance your body makes naturally that helps cells produce energy and acts as an antioxidant. It is generally well tolerated and is most studied for heart condition...
Read the full Coenzyme Q10 monograph → Herb & supplement monographAcetyl-l-carnitine
Interacts with 203 drugsAcetyl-L-carnitine is a form of the amino acid carnitine that the body uses to help produce energy in cells. It is most studied for nerve pain and memory-related conditions, though the evide...
Read the full Acetyl-l-carnitine monograph → Herb & supplement monographL-arginine
Interacts with 403 drugsL-arginine is an amino acid that the body uses to make nitric oxide, a substance that helps blood vessels relax and widen. It is popularly used for blood pressure, erectile dysfunction, and...
Read the full L-arginine monograph → Herb & supplement monographMagnesium
Interacts with 295 drugsMagnesium is an essential mineral your body needs for muscles, nerves, blood pressure, and many other functions, and supplements are useful for preventing or correcting deficiency. Some othe...
Read the full Magnesium monograph → Herb & supplement monographAlpha-lipoic Acid
Interacts with 263 drugsAlpha-lipoic acid (ALA) is an antioxidant made naturally by the body and found in small amounts in foods. It is most studied for diabetic nerve pain, where some evidence suggests it may help...
Read the full Alpha-lipoic Acid monograph → Herb & supplement monographGreen Tea
Interacts with 1,293 drugsGreen tea is a popular beverage rich in antioxidants called catechins, and drinking it in normal amounts is considered safe for most people. Concentrated green tea extracts are a different s...
Read the full Green Tea monograph → Herb & supplement monographPlant Sterols
Plant sterols (and their close relatives, plant stanols) are natural compounds found in plants that can modestly lower LDL ('bad') cholesterol when taken regularly in adequate amounts, usual...
Read the full Plant Sterols monograph → Herb & supplement monographGuggul
Interacts with 757 drugsGuggul is a gum resin from the Commiphora wightii tree, long used in Ayurvedic medicine for cholesterol, joint, and skin problems. Modern studies are mixed and often low-quality, and it can...
Read the full Guggul monograph → Herb & supplement monographHawthorn
Interacts with 191 drugsHawthorn is a plant traditionally used for heart-related complaints, and some studies suggest it may modestly help symptoms of mild heart failure when added to standard care. However, the ev...
Read the full Hawthorn monograph → Herb & supplement monographResveratrol
Interacts with 822 drugsResveratrol is a plant compound found in red grapes, berries, and peanuts that is popular for heart health, anti-aging, and antioxidant support. While lab and animal studies are promising, s...
Read the full Resveratrol monograph → Herb & supplement monographHu Zhang
Interacts with 826 drugsHu Zhang (Japanese knotweed root) is a traditional Chinese herb that is one of the richest natural sources of resveratrol and emodin. Some lab and early human research looks interesting for...
Read the full Hu Zhang monograph →Sources & How We Checked
Healthy Heart'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 1,014 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.
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
- Kahn SE, Beard JC, Schwartz MW, et al. Increased B-cell secretory capacity as mechanism for islet adaptation to nicotinic acid-induced insulin resistance. Diabetes 1989;38:562-8.
- 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
- NIH News. NIH stops clinical trial on combination cholesterol treatment. May 26, 2011. http://www.nih.gov/news/health/may2011/nhlbi-26.htm. (Accessed 3 June 2011).
- 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
- Henkin Y, Johnson KC, Segrest JP. Rechallenge with crystalline niacin after drug-induced hepatitis from sustained-release niacin. JAMA. 1990;264(2):241-3. DOI
- Henkin Y, Oberman A, Hurst DC, Segrest JP. Niacin revisited: clinical observations on an important but underutilized drug. Am J Med. 1991;91(3):239-46. PubMed
- Brown BG, Bardsley J, Poulin D, et al. Moderate dose, three-drug therapy with niacin, lovastatin, and colestipol to reduce low-density lipoprotein cholesterol <100 mg/dl in patients with hyperlipidemia and coronary artery disease. Am J Cardiol. 1997;80(2)
- Goldberg A, Alagona P Jr, Capuzzi DM, et al. Multiple-dose efficacy and safety of an extended-release form of niacin in the management of hyperlipidemia. Am J Cardiol. 2000;85(9):1100-5. PubMed
- Aronov DM, Keenan JM, Akhmedzhanov NM, et al. Clinical trial of wax-matrix sustained-release niacin in a Russian population with hypercholesterolemia. Arch Fam Med. 1996;5(10):567-75. PubMed
- Morgan JM, Capuzzi DM, Guyton JR, et al. Treatment Effect of Niaspan, a Controlled-release Niacin, in Patients With Hypercholesterolemia: A Placebo-controlled Trial. J Cardiovasc Pharmacol Ther. 1996;1(3):195-202. PubMed
- Andersson RG, Aberg G, Brattsand R, Ericsson E, Lundholm L. Studies on the mechanism of flush induced by nicotinic acid. Acta Pharmacol Toxicol (Copenh). 1977 Jul;41(1):1-10. PubMed
- Brown WV. Niacin for lipid disorders. Indications, effectiveness, and safety. Postgrad Med. 1995 Aug;98(2):185-9, 192-3. PubMed
- O'REILLY PO, CALLBECK MJ, HOFFER A. Sustained-release nicotinic acid (nicospan); effect on (1) cholesterol levels and (2) leukocytes. Can Med Assoc J. 1959;80(5):359-62.
- Gharavi AG, Diamond JA, Smith DA, Phillips RA. Niacin-induced myopathy. Am J Cardiol. 1994;74(8):841-2. PubMed
- Litin SC, Anderson CF. Nicotinic acid-associated myopathy: a report of three cases. Am J Med. 1989;86(4):481-3. PubMed
- Fraunfelder FW, Fraunfelder FT, Illingworth DR. Adverse ocular effects associated with niacin therapy. Br J Ophthalmol 1995;79:54-56. PubMed
- Ali EH, McJunkin B, Jubelirer S, Hood W. Niacin induced coagulopathy as a manifestation of occult liver injury. W V Med J. 2013 Jan-Feb;109(1):12-4
- Aramwit P, Srisawadwong R, Supasyndh O. Effectiveness and safety of extended-release nicotinic acid for reducing serum phosphorus in hemodialysis patients. J Nephrol. 2012 May-Jun;25(3):354-62. PubMed
- Bassan M. A case for immediate-release niacin. Heart Lung. 2012 Jan-Feb;41(1):95-8. PubMed
- Davidson MH, Rooney M, Pollock E, Drucker J, Choy Y. Effect of colesevelam and niacin on low-density lipoprotein cholesterol and glycemic control in subjects with dyslipidemia and impaired fasting glucose. J Clin Lipidol. 2013 Sep-Oct;7(5):423-32. PubMed
- Guyton JR, Fazio S, Adewale AJ, Jensen E, Tomassini JE, Shah A, Tershakovec AM. Effect of extended-release niacin on new-onset diabetes among hyperlipidemic patients treated with ezetimibe/simvastatin in a randomized controlled trial. Diabetes Care. 2012 PubMed
- Loebl T, Raskin S. A novel case report: acute manic psychotic episode after treatment with niacin. J Neuropsychiatry Clin Neurosci. 2013 Fall;25(4):E14. PubMed
- Teo KK, Goldstein LB, Chaitman BR, Grant S, Weintraub WS, Anderson DC, Sila CA, Cruz-Flores S, Padley RJ, Kostuk WJ, Boden WE; AIM-HIGH Investigators. Extended-release niacin therapy and risk of ischemic stroke in patients with cardiovascular disease: the
- Goldie C, Taylor AJ, Nguyen P, McCoy C, Zhao XQ, Preiss D. Niacin therapy and the risk of new-onset diabetes: a meta-analysis of randomized controlled trials. Heart. 2016 Feb;102(3):198-203.
- Schandelmaier S, Briel M, Saccilotto R, Olu KK, Arpagaus A, Hemkens LG, Nordmann AJ. Niacin for primary and secondary prevention of cardiovascular events. Cochrane Database Syst Rev. 2017 Jun 14;6:CD009744. PubMed
- Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental vitamins and minerals for CVD prevention and treatment. J Am Coll Cardiol 2018;71(22):2570-84. PubMed
- Song S, Lee CJ, Oh J, Park S, Kang SM, Lee SH. Effect of Niacin on Carotid Atherosclerosis in Patients at Low-Density Lipoprotein-Cholesterol Goal but High Lipoprotein (a) Level: a 2-Year Follow-Up Study. J Lipid Atheroscler. 2019;8(1):58-66. PubMed
- Kimura H, Umemori Y, Yuki D. Anaphylactic shock-like symptoms due to niacin overdose: A case report. J Dermatol 2022;49(8):e287-e288. PubMed
- Nawaz N, Mistretta T, Karime C, Lewis J, Wolf E. Cholestatic Drug-Induced Liver Injury in a Patient Taking High-Dose Niacin for Hyperlipidemia. J Investig Med High Impact Case Rep 2024;12:23247096231224349. PubMed
Vitamin B6 32 references
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Folic Acid 56 references
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Betaine Hydrochloride 2 references
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See these in context on the Betaine Hydrochloride monograph →
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Hu Zhang 19 references
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- Pace-Asciak CR, Hahn S, Diamandis EP, et al. The red wine phenolics trans-resveratrol and quercetin block human platelet aggregation and eicosanoid synthesis: implications for protection against coronary heart disease. Clin Chim Acta 1995;235:207-19.
- Bertelli A, Bertelli AA, Gozzini A, Giovannini L. Plasma and tissue resveratrol concentrations and pharmacological activity. Drugs Exp Clin Res 1998;24:133-8.
- Bertelli AA, Giovannini L, Giannessi D, et al. Antiplatelet activity of synthetic and natural resveratrol in red wine. Int J Tissue React 1995;17:1-3.
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