Major interaction on record — check this product against your medications before combining. Based on 5 of 8 ingredients. Check your meds →
Dietary supplement

Hybrid N.O. Fruit Punch Ingredients & Drug Interactions

by MusclePharm

Powder Category: Other Combinations
Most serious interaction: Major
The interaction bottom line Most serious interaction: Major

Hybrid N.O. Fruit Punch is a dietary supplement by MusclePharm with 8 active ingredients. Its ingredients are commonly taken for high cholesterol, vitamin b3 deficiency (pellagra), heart health support.Based on those ingredients, 1,244 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Beet root extract, Niacin, Agmatine Sulfate. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

HelloPharmacist Scorecard of Hybrid N.O. Fruit Punch by MusclePharm

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

From our pharmacy team — supplement deep dive

What’s inside

Full disclosure
Ingredient Transparency · database check
Full

Every active ingredient lists its own amount on the label.

Why this rating?
  • The label discloses an exact amount for 8 of its 8 active ingredients.
  • No proprietary blends here — you can verify the dose of every single component.

Hybrid N.O. Fruit Punch contains 8 active ingredients designed to support muscle performance and blood flow.

Niacin (also called vitamin B3) helps convert food to energy and supports blood vessel function. Citrulline malate, calcium, beet root extract, glycocarn, rutaecarpine 98%, agmatine sulfate, and hawthorn berry powder round out the formula.

The product also contains inactive ingredients — glucose polymers, malic acid, calcium silicate, natural and artificial flavors, red beet juice powder, sucralose, and acesulfame potassium — which serve as fillers, sweeteners, and flavor carriers.

Does it work?

Moderate evidence
Evidence for Intended Use · database check
By FDA rules, dietary supplements can’t claim to treat, cure, or prevent disease — so labels speak in careful marketing language. We discern each product’s intended use from its name, label claims, and label statements, then grade the clinical evidence for that use. How these ratings are computed
Moderate

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

Why this rating?
  • The label markets this product for: enhance muscle pumps and vascularity.
  • We looked for evidence on: Athletic performance, Exercise-induced muscle damage, Exercise-induced muscle soreness, Muscle strength, Nitric oxide function, Endothelial function — and 1 related terms.
  • The strongest evidence on file: Beet is rated "Possibly Effective" for Athletic performance (Natural Medicines).
  • Also on file: Beet is rated "Possibly Effective" for Exercise-induced muscle soreness.
  • Also on file: Beet is rated "Insufficient Reliable Evidence To Rate" for Muscle strength, Exercise-induced muscle damage.

The evidence for most of these ingredients is limited or mixed. Niacin is likely effective for pellagra (a B3 deficiency disease) and possibly effective for certain types of high cholesterol tied to HIV.

Calcium is effective for preventing kidney disease-related bone problems and possibly effective for osteoporosis. Beet root extract is possibly effective for athletic performance and exercise-induced muscle soreness, though possibly ineffective for chronic lung disease.

Agmatine sulfate, hawthorn berry powder, glycocarn, rutaecarpine, and citrulline malate lack sufficient evidence in our data to rate their effectiveness for any condition. If you're considering this product for a specific goal, talk it over with your doctor or pharmacist about whether the evidence supports it.

The evidence, ingredient by ingredient Niacin Calcium Beet Agmatine Hawthorn

How safe is it?

Well-documented data
Safety Information · database check
Well characterized

Adverse-effect, pregnancy, and general safety data are on file for most of these ingredients.

Why this rating?
  • We hold adverse-effect (side-effect) data for 5 of the 5 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 5 of 5.
  • General safety write-ups exist for 5 of 5.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Niacin is generally well tolerated at the doses found in food and standard prenatal vitamins, but high-dose supplemental niacin can cause flushing (which affects up to 70% of users at larger doses), stomach upset, and rarely liver problems or muscle damage. High-dose niacin should be avoided in pregnancy unless prescribed by your doctor.

Calcium is generally well tolerated at recommended amounts; common side effects are mild stomach upset and constipation. Beet root extract is well tolerated as a food, though concentrated supplements lack safety data — expect harmless red or black stools.

Agmatine sulfate may cause diarrhea, indigestion, or nausea in short-term use, and safety in pregnancy and lactation is not established — avoid it during those times. Hawthorn berry powder is generally well tolerated in studies, but should be avoided in pregnancy and lactation due to insufficient safety data.

Anyone with a heart condition should use it only under medical supervision.

Side effects, ingredient by ingredient Niacin Calcium Beet Agmatine Hawthorn

Meds to double-check

Major interaction found
Known Interaction Concern · database check
Major identified

At least one ingredient has a documented Major-severity interaction. Check your medications for a personalized result.

Why this rating?
  • 5 of the 5 matched ingredients can interact with medications — Beet, Hawthorn, Calcium, Niacin, Agmatine.
  • The most serious interaction on file is rated Major.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; diabetes medications; heart-rhythm medications; lithium.
  • For scale: 1,245 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.

Before taking Hybrid N.O. Fruit Punch, check with your own doctor or pharmacist if you take HIV integrase inhibitors (dolutegravir, elvitegravir) — calcium in this product can sharply reduce their blood levels.

Also check if you take nitrates or erectile dysfunction drugs (phosphodiesterase-5 inhibitors) — hawthorn can cause unsafe drops in blood pressure when combined with these. Moderate-severity concerns include blood pressure medications, diabetes drugs, blood thinners, statins, gout medications, heart medications (beta-blockers, calcium channel blockers, digoxin), thyroid medication (levothyroxine), and liver-affecting drugs.

No interactions are documented for the ingredients we could not check: citrulline malate, glycocarn, and rutaecarpine 98%.

Check your own medication Run your meds through the checker above

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.

This product is marketed as a workout supplement combining nitric oxide boosters and minerals. If you take blood pressure medications, diabetes drugs, blood thinners, heart medications, HIV antiretrovirals, thyroid medication, or gout treatments, you'll need to check your specific medications before starting — several ingredients interact with these drug types.

Even if you don't take medications, talk with your doctor or pharmacist first, especially if you have heart problems, liver disease, or are pregnant or breastfeeding.

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

Assessment coverage: 5 of 8 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Jan 25, 2013.

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

At a glance

General information

Key facts about Hybrid N.O. Fruit Punch, straight from the product label.

Brand MusclePharm
Barcode (UPC) 713757920209
Net contents 0.265 lb; 120 g
Market status On market
Date entered into DSLD Jan 25, 2013
DSLD ID 18033
Product type Other Combinations
Supplement form Powder
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Adult (18 - 50 Years)
From the label
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.

Supplement Facts

The label details for Hybrid N.O. Fruit Punch by MusclePharm, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
6 Gram(s)
Maximum serving Sizes:
6 Gram(s)
Servings per container
20
UPC/BARCODE
713757920209
IngredientAmount% DV
Calories10 {Calories}--
Total Carbohydrates3 g1%
Niacin60 mg300%
Citrulline Malate750 mg--
Calcium170 mg17%
Beet root extract200 mg--
Glycocarn500 mg--
Rutaecarpine 98%10 mg--
Agmatine Sulfate750 None--
Hawthorn Berry Powder200 mg--

Other ingredients: Glucose Polymers, Malic Acid, Calcium Silicate, Natural & Artificial flavors, Red Beet juice powder, Sucralose, Acesulfame Potassium

Tap any ingredient to jump to its full detail below.

Label statements
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
General Statements

NATURAL & ARTIFICIAL FLAVORS HYBRID SERIES

GET SWOLE. LIVE SWOLE. NITRIC OXIDE AMPLIFIER -DRAMATICALLY ENHANCE MUSCLE PUMPS -INCREASE MUSCLE FULLNESS & VASCULARITY -MAXIMIZE VASODILATATION

BANNED-SUBSTANCE FREE CERTIFICATIONS

ADVANCED NITRIC OXIDE AMPLIFYING SYSTEM: YOUR PUMPS WILL EXPLODE. Only the MP sports science team brings you this meticulous formulation of precisely-engineered nutrients. High intensity athletes: get ready for massive pumps, muscle fullness, vascularity, enhanced size and strength, and reduced fatigue.

{QR code f} FACEBOOK.COM/MUSCLEPHARM

MADE IN USA

FDA Statement of Identity

DIETARY SUPPLEMENT

Brand IP Statement(s)

MP MUSCLEPHARM(R)

OFFICIAL NUTRITIONAL SUPPLEMENT PROVIDER OF THE UFC(R) ULTIMATE FIGHTING(R) CHAMPIONSHIP(R)

GlycoCarn(R) is a registered trademark of Sigma-tau HealthScience and is manufactured under USA production patent 6703042 and Worldwide production patent EP1202956

FUELING ATHLETES SAFELY(TM)

MADE IN A cGMP AND NSF(R) CERTIFIED FACILITY

Suggested/Recommended/Usage/Directions

DIRECTIONS: Consume 1 scoop with water prior to workout. For optimal results, take 30 minutes before your workout.

Precautions

ALLERGEN WARNING: This product was produced in a facility that may also process ingredients containing milk, egg, soybeans, shellfish, fish, tree nuts, and peanuts.

WARNING: Do not exceed the recommended daily dose.

Do not use if you are pregnant, contemplating pregnancy or are nursing.

This product is only intended for use by healthy adults over 18 years of age. Do not take this product if you are at risk or are being treated for any medical condition.

KEEP OUT OF REACH OF CHILDREN.

Storage

STORAGE CONDITIONS: Store in a cool dry place.

Seals/Symbols

GLYCOCARN(R) USP

{check} INFORMED CHOICE

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.

General

Dom v1.5 20120717

See for yourself

Hybrid N.O. Fruit Punch by MusclePharm label

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

What’s inside

The Ingredients in Hybrid N.O. Fruit Punch by MusclePharm

These are the 8 active ingredients this product is made of. Select any to open its full monograph.

Serving size6 Gram(s) Dosage formPowder Servings per container20 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 with
727 drugs
60 mg per serving Form: Niacinamide

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 & interactions

Citrulline Malate

750 mg per serving

Calcium

Interacts with
168 drugs
170 mg per serving Form: Calcium Carbonate, Calcium Silicate

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 & interactions

Beet root extract

Interacts with
861 drugs
200 mg per serving

Beet, especially beetroot juice, is a nitrate-rich food that may modestly lower blood pressure and slightly improve exercise performance in some peopl...

Beet root extract monograph & interactions

Glycocarn

500 mg per serving

Rutaecarpine 98%

10 mg per serving

Agmatine Sulfate

Interacts with
258 drugs
750 None per serving

Agmatine is a compound your body makes from the amino acid arginine, and it is sold mainly as a workout and 'pump' supplement. Human evidence for most...

Agmatine Sulfate monograph & interactions

Hawthorn Berry Powder

Interacts with
191 drugs
200 mg per serving

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 Powder monograph & interactions

Other (inactive) ingredients: Glucose Polymers, Malic Acid, Calcium Silicate, Natural & Artificial flavors, Red Beet juice powder, Sucralose, Acesulfame Potassium. These complete the product’s ingredient list but are not active constituents.

Interaction report

Hybrid N.O. Fruit Punch by MusclePharm Drug Interactions

Want to check YOUR meds against Hybrid N.O. Fruit Punch?

Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.

Go to the checker
1,244Drugs
21 Major 1,195 Moderate 28 Minor

Ingredients driving the most interactions

Niacin 727
Calcium 168

Each ingredient & the kinds of drugs it affects

For each ingredient in Hybrid N.O. Fruit Punch 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.

Beet root extract3 drug types · 861 drugs

Cytochrome P450 3A4 (Cyp3A4) Substrates

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

Likelihood Possible Evidence D
Antihypertensive Drugs

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

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

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

Likelihood Possible Evidence D

Niacin15 drug types · 727 drugs

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.

Likelihood Probable Evidence D
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.

Likelihood Probable Evidence C
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.

Likelihood Possible Evidence D
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.

Likelihood Probable Evidence B
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.

Likelihood Possible Evidence B
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%.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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).

Likelihood Possible Evidence D
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.

Likelihood Probable Evidence C
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.

Likelihood Probable Evidence C
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.

Likelihood Probable Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Likely Evidence B

Agmatine Sulfate2 drug types · 258 drugs

Antidiabetes Drugs

Theoretically, agmatine might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Animal and in vitro research suggest that agmatine has mild hypoglycemic effects.

Likelihood Possible Evidence D
Antihypertensive Drugs

Theoretically, agmatine might increase the risk of hypotension when taken with antihypertensive drugs.
Animal research suggests that agmatine can modestly decrease heart rate and blood pressure.

Likelihood Possible Evidence D

Hawthorn Berry Powder6 drug types · 191 drugs

Nitrates

Theoretically, concomitant use might cause additive coronary vasodilatory effects.
Some evidence shows that hawthorn might lower blood pressure due to vasodilatory effects.

Likelihood Probable Evidence D
Phosphodiesterase-5 Inhibitors

Theoretically, concomitant use might result in additive vasodilation and hypotension.
Hawthorn might inhibit PDE-5 and cause vasodilation.

Likelihood Probable Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D

Calcium18 drug types · 168 drugs

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.

Likelihood Probable Evidence D
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.

Likelihood Probable Evidence B
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.

Likelihood Probable Evidence B
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.

Likelihood Possible Evidence B
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.

Likelihood Probable Evidence D
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.

Likelihood Probable Evidence C
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.

Likelihood Possible Evidence B
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.

Likelihood Possible Evidence B
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.

Likelihood Probable Evidence D
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.

Likelihood Probable Evidence B
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.

Likelihood Possible Evidence B
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.

Likelihood Probable Evidence B
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.

Likelihood Possible Evidence B
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.

Likelihood Possible Evidence B
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.

Likelihood Probable Evidence C
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.

Likelihood Probable Evidence C
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.

Likelihood Probable Evidence D
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.

Likelihood Unlikely Evidence D
The maker

Brand information

Manufacturer and brand details for Hybrid N.O. Fruit Punch, from the product label.

Pharmacist Counseling Corner

Hybrid N.O. Fruit Punch by MusclePharm: Common Questions

Does Hybrid N.O. Fruit Punch by MusclePharm interact with any medications?
Yes. Based on its ingredients, Hybrid N.O. Fruit Punch has a known interaction with 1,244 medications, including 21 rated major. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Hybrid N.O. Fruit Punch contains 8 active ingredients, and an interaction can come from any of them. We check every ingredient, combine the results into one list per medication, and show which ingredient and mechanism is responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.
Can I take this if I'm pregnant or breastfeeding?
Niacin at high supplemental doses should be avoided in pregnancy unless your doctor prescribes it, though the amounts in prenatal vitamins are fine. Agmatine sulfate and hawthorn berry powder lack safety data in pregnancy and lactation — the evidence advises against them. Calcium is likely safe at recommended amounts during pregnancy and lactation. Talk with your doctor or pharmacist about whether this product is right for you.
What are the most common side effects?
Niacin commonly causes flushing (warmth, redness, tingling on the face), stomach upset, and nausea — these usually fade within two weeks. Calcium can cause constipation, diarrhea, and mild stomach discomfort. Beet root extract may turn your stools red or black, which is harmless. Agmatine sulfate may cause diarrhea, indigestion, or nausea.
Will this actually boost my athletic performance?
Beet root extract is possibly effective for athletic performance and exercise-related muscle soreness based on the evidence we hold. The other active ingredients either lack sufficient evidence or are not rated for performance in our data. Whether this product works for you depends on your individual response and training — talk with your doctor or trainer about realistic expectations.
Is niacin safe at the dose in this product?
Niacin from food and standard doses are generally well tolerated, but we don't have the specific dose in this product listed in our data. High supplemental doses of niacin can cause flushing, stomach problems, and rarely liver issues. If you're taking this regularly or have liver disease, check with your pharmacist or doctor about the dose and any monitoring you might need.
Can I take this with my thyroid medication?
Calcium in this product can reduce how well your body absorbs levothyroxine (Synthroid). If you take thyroid medication, separate it from this product by at least 4 hours. Talk with your pharmacist about the best timing for your doses.
What if I'm on blood thinners?
Niacin, beet root extract, and hawthorn berry powder may all increase bleeding risk when combined with blood thinners. Check your exact blood thinner with your doctor or pharmacist before taking this product — they may need to monitor you more closely.

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

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

Hybrid N.O. Fruit Punch label
Go deeper

The Full Monographs Behind Hybrid N.O. Fruit Punch’s Ingredients

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

Sources

Sources & How We Checked

Hybrid N.O. Fruit Punch's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

The 170 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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  8. 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
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  47. 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
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  52. Litin SC, Anderson CF. Nicotinic acid-associated myopathy: a report of three cases. Am J Med. 1989;86(4):481-3. PubMed
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  54. 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
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  58. 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
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  64. 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
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See these in context on the Niacin monograph →

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See these in context on the Calcium monograph →

Beet 14 references
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Agmatine 3 references
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DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

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