Major interaction on record — check this product against your medications before combining. Based on 16 of 18 ingredients. Check your meds →
Dietary supplement

Intestinal Repair Mixed Berry Flavor Ingredients & Drug Interactions

by Barlean's Platinum

Intestinal Repair Mixed Berry Flavor label
See full label image
Powder Category: Other Combinations
Most serious interaction: Major
Clinical methodology reviewed by · Updated Sep 23, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Intestinal Repair Mixed Berry Flavor against your medications. The heart of this page is the interaction checker and the full interaction report — how this product’s ingredients may interact with prescription and over-the-counter medicines you may be taking.

Around that, we add a pharmacist’s high-level view of the product as a whole — what’s inside, the evidence for its stated use, how transparent the label is, and what safety data exists — so you can see the full picture in one place. It’s educational information from our licensed clinical databases and the clinical staff at HelloPharmacist — not medical advice — and we don’t sell or endorse products. Our editorial policy

The interaction bottom line Most serious interaction: Major

Intestinal Repair Mixed Berry Flavor is a dietary supplement by Barlean's Platinum with 18 active ingredients. Its ingredients are commonly taken for muscle recovery and sports performance, gut health and 'leaky gut', recovery from severe illness or injury.Based on those ingredients, 2,315 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Marshmallow Extract, Dietary Fiber, Quercetin. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

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Check Your Meds Against Intestinal Repair Mixed Berry Flavor by Barlean's Platinum

Ask about any prescription or over-the-counter medication and we check it for interactions with Intestinal Repair Mixed Berry Flavor by Barlean's Platinum — and tell you which ingredient is responsible.

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HelloPharmacist Scorecard of Intestinal Repair Mixed Berry Flavor by Barlean's Platinum

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

From our pharmacy team — supplement deep dive

Generated from HelloPharmacist’s pharmacist-curated databases and editorial rules · Last generated Jul 11, 2026

What’s inside

Partial disclosure
Ingredient Transparency · database check
Partial

Most active ingredients list an amount, but at least one is hidden in a blend or missing.

Why this rating?
  • The label discloses an exact amount for 14 of its 17 active ingredients.
  • “Fiber Blend” is a proprietary blend — the label gives one combined amount (2,400 mg) without saying how much of each component you get.

Barlean's Platinum Intestinal Repair contains 16 active and inactive ingredients. The active components include L-glutamine (an amino acid), aloe vera (a plant extract), quercetin (a flavonoid), zinc, N-acetyl glucosamine, banana powder, flaxseed, deglycyrrhizinated licorice root extract, berberine, arabinogalactan, chicory inulin, sweet wormwood, marshmallow extract, perilla extract, and methylsulfonylmethane.

These are combined with inactive ingredients: tapioca starch, natural flavors, citric acid, stevia leaf extract, red beet, and silicon dioxide.

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: support gastrointestinal tract health.
  • We looked for evidence on: Antibiotic-associated diarrhea, Antiretroviral-associated diarrhea, Atopic dermatitis (eczema), Asthma, Burns, Canker sores — and 4 related terms.
  • The strongest evidence on file: Aloe is rated "Possibly Effective" for Burns (Natural Medicines).
  • Also on file: Licorice is rated "Possibly Effective" for Atopic dermatitis (eczema), Canker sores.
  • Also on file: Berberine is rated "Possibly Effective" for Canker sores.

Evidence for this product's ingredients is mixed. L-glutamine is rated effective for sickle cell disease and possibly effective for HIV/AIDS-related wasting and postoperative recovery.

Aloe vera is possibly effective for acne, obesity, diabetes, psoriasis, burns, and constipation. Quercetin, zinc, glucosamine, and other ingredients show insufficient reliable evidence for most conditions they're marketed for, though zinc is effective for zinc deficiency and likely effective for Wilson disease, and glucosamine is likely effective for osteoarthritis.

Flaxseed is possibly effective for high cholesterol, diabetes, breast pain, and hypertension. Most other ingredients—banana, licorice, berberine, inulin, sweet wormwood, marshmallow, plum, and perilla—lack established effectiveness in our data for the purposes this product suggests, or evidence is insufficient to rate them.

The evidence, ingredient by ingredient Glutamine Black Psyllium Aloe Quercetin Zinc Glucosamine Banana Licorice

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 15 of the 16 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 16 of 16.
  • General safety write-ups exist for 16 of 16.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

L-glutamine is likely safe in pregnancy and generally well tolerated, though people with kidney or liver disease should use it only under medical supervision. Common side effects include belching, bloating, constipation, diarrhea, flatulence, headache, nausea, and vomiting, especially at high doses.

Aloe vera's safety data advises against oral use in pregnancy (may stimulate the uterus and act as a strong laxative) and while breastfeeding. Long-term oral use can cause serious effects including hypokalemia (low potassium), muscle weakness, and irregular heartbeat.

Quercetin lacks sufficient safety data in pregnancy and breastfeeding—avoid supplemental doses unless your doctor advises otherwise. Zinc is generally safe in recommended amounts, though high doses can harm you; amounts within daily needs are acceptable, but high-dose supplements require medical guidance.

N-acetyl glucosamine data advises against use in pregnancy and breastfeeding. Banana is considered safe as food in pregnancy and while breastfeeding.

Flaxseed food amounts are likely fine in pregnancy, but supplement doses have hormone-like effects and should be avoided unless approved; avoid supplement doses while breastfeeding. Deglycyrrhizinated licorice root should be avoided in pregnancy (the glycyrrhizin component has been linked to harm) and while breastfeeding.

Berberine should be avoided in pregnancy (may cross the placenta and harm newborns) and while breastfeeding (passes into breast milk). Chicory inulin is likely safe in pregnancy and breastfeeding in food amounts.

Sweet wormwood, marshmallow, plum juice powder, and perilla lack sufficient pregnancy and breastfeeding safety data—concentrated supplements should be avoided unless your doctor advises. Most ingredients commonly cause gastrointestinal side effects (bloating, gas, diarrhea, constipation, nausea).

Side effects, ingredient by ingredient Glutamine Black Psyllium Aloe Quercetin Zinc Glucosamine Banana Licorice

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?
  • 15 of the 16 matched ingredients can interact with medications — Black Psyllium, Quercetin, Aloe, Sweet Annie, Marshmallow, among others.
  • The most serious interaction on file is rated Major.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; seizure medications; immunosuppressants / transplant drugs; diabetes medications; heart-rhythm medications; lithium; Parkinson's medications.
  • For scale: 2,316 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.

Check these medication types with your pharmacist before taking this product. Major interactions: digoxin (heart medication) and warfarin (blood thinner) with glucosamine; cyclosporine (immunosuppressant) with berberine.

Moderate interactions: anticonvulsants with glutamine; blood thinners, diabetes drugs, diuretics, and laxatives with aloe vera; blood pressure and cholesterol drugs, warfarin, antibiotics, cyclosporine, and chemotherapy drugs with quercetin; antibiotics and other medications with zinc; chemotherapy drugs and diabetes drugs with glucosamine; Parkinson's medications (levodopa) with banana; blood pressure, antibiotic, hormone, and blood-thinner drugs with flaxseed; digoxin, warfarin, and enzyme-metabolized drugs with licorice; blood pressure, diabetes, blood-thinner, and enzyme-metabolized drugs with berberine; immunosuppressants with arabinogalactan; liver-toxic drugs and enzyme-metabolized drugs with sweet wormwood; lithium and oral medications with marshmallow; and blood thinners with plum juice.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glancePartially 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 a multi-ingredient blend that may benefit people seeking digestive support, but it carries significant medication interactions—particularly with blood thinners, diabetes drugs, heart medications, and immune-suppressing drugs. If you take any prescription medications, use the checker on this page to verify your specific drugs before starting.

Talk to your pharmacist or doctor, especially if you take warfarin, digoxin, cyclosporine, diabetes medications, blood pressure drugs, or antibiotics.

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

Assessment coverage: 16 of 17 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Sep 25, 2024.

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 Intestinal Repair Mixed Berry Flavor, straight from the product label.

Brand Barlean's Platinum
Net contents 6.35 Ounce(s); 180 Gram(s)
Market status On market
Date entered into DSLD Sep 25, 2024
DSLD ID 314168
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 Intestinal Repair Mixed Berry Flavor by Barlean's Platinum, 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
30
IngredientAmount% DV
Calories15 Calorie(s)--
Total Carbohydrates4 Gram(s)2%
L-Glutamine500 mg--
Dietary Fiber2 Gram(s)7%
Protein1 Gram(s)--
Aloe vera50 mg--
Quercetin100 mg--
Methylsulfonylmethane150 mg--
Zinc3 mg31%
N-Acetyl Glucosamine300 mg--
Banana, Powder150 mg--
Flaxseed0 NP--
Deglycyrrhizinated Licorice Root Extract300 mg--
Berberine1 mg--
Fiber Blend2400 mg--
Arabinogalactan0 NP--
Chicory Inulin0 NP--
Sweet Wormwood200 mg--
Marshmallow Extract300 mg--
Plum Juice, Powder100 mg--
Perilla Extract50 mg--

Other ingredients: Tapioca Starch, Natural Flavors, Citric Acid, Stevia Leaf Extract, Red Beet, Silicon Dioxide

Tap any ingredient to jump to its full detail below.

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

Suggested use: 2 tsp daily. Mix into 8 oz of water or your favorite juice or smoothie.

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.

Storage

Best kept refrigerated after opening.

Precautions

Keep out of reach of children.

Formulation

Product of U.S.A.

Drink mix for daily use 16 natural ingredients to support GI tract health Promote a healthy response to bacteria & create an optimal environment for probiotics

FDA Statement of Identity

Dietary Supplement

General Statements

30 day supply

Good health begins and ends in your gut!

Pathway to a better life

Formula

Barlean's Intestinal Repair is a three-in-one product formulated to support the health of your intestinal terrain with a powerful blend of ingredients including: 1 Herbs that may help promote a healthy response to bacteria 2 Prebiotics to feed beneficial bowel flora 3 Terrain ingredients to help repair and support the semi-permeable lining of the intestines.

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

See for yourself

Intestinal Repair Mixed Berry Flavor by Barlean's Platinum label

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

Intestinal Repair Mixed Berry Flavor label

Label images are published by the NIH Dietary Supplement Label Database for the version of this product on file. Always read your actual product label.

View the full label (PDF)
What’s inside

The Ingredients in Intestinal Repair Mixed Berry Flavor by Barlean's Platinum

These are the 18 active ingredients this product is made of. Select any to open its full monograph.

Serving size6 Gram(s) Dosage formPowder 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.

L-Glutamine

Interacts with
50 drugs
500 mg per serving

Glutamine is the most abundant amino acid in the body and is usually made in your muscles. A prescription form is FDA-approved to help reduce sickle c...

L-Glutamine monograph & interactions

Dietary Fiber

Interacts with
2,025 drugs
2 Gram(s) per serving

Black psyllium is a soluble-fiber supplement made from the seeds of a Plantago plant, used mostly to ease constipation and support digestive health. I...

Dietary Fiber monograph & interactions

Protein

1 Gram(s) per serving

Aloe vera

Interacts with
461 drugs
50 mg per serving

Aloe vera gel is widely used on the skin for minor burns and irritation, and some research suggests it may help. Aloe latex (the yellow part) is a str...

Aloe vera monograph & interactions

Quercetin

Interacts with
1,169 drugs
100 mg per serving

Quercetin is a plant flavonoid with antioxidant and anti-inflammatory properties found in many common foods and sold as a supplement. While early rese...

Quercetin monograph & interactions

Methylsulfonylmethane

150 mg per serving

Zinc

Interacts with
67 drugs
3 mg per serving Form: Zinc Carnosine

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

Zinc monograph & interactions

N-Acetyl Glucosamine

Interacts with
170 drugs
300 mg per serving

Glucosamine is a natural compound found in cartilage and joint fluid, and it is one of the most popular supplements for osteoarthritis, especially of...

N-Acetyl Glucosamine monograph & interactions

Banana, Powder

Interacts with
5 drugs
150 mg per serving

Bananas are a nutritious, widely eaten fruit that provide potassium, fiber, vitamin B6, and quick energy, and they are part of a healthy diet. While s...

Banana, Powder monograph & interactions

Deglycyrrhizinated Licorice Root Extract

Interacts with
1,040 drugs
300 mg per serving

Licorice root is a traditional remedy used for sore throats, coughs, and digestive complaints, but solid human evidence is limited for most uses. Regu...

Deglycyrrhizinated Licorice Root Extract monograph & interactions

Berberine

Interacts with
1,160 drugs
1 mg per serving

Berberine is a yellow plant compound that has shown promise for lowering blood sugar and cholesterol in some studies, but the quality of research vari...

Berberine monograph & interactions

Fiber Blend

2400 mg per serving

Sweet Wormwood

Interacts with
889 drugs
200 mg per serving Form: Artemisia annua

Sweet Annie (Artemisia annua) is the source of artemisinin, a compound used in prescription antimalarial drugs. While the purified drug is well studie...

Sweet Wormwood monograph & interactions

Marshmallow Extract

Interacts with
2,040 drugs
300 mg per serving

Marshmallow root is a traditional herb rich in soothing, gel-like fibers called mucilage, which is why it has long been used for coughs, sore throats,...

Marshmallow Extract monograph & interactions

Plum Juice, Powder

Interacts with
122 drugs
100 mg per serving

Plums and their dried form (prunes) are common, nutritious foods that are best known for helping relieve constipation thanks to their fiber and sorbit...

Plum Juice, Powder monograph & interactions

Perilla Extract

No known
interactions
50 mg per serving

Perilla is an Asian mint-family plant used in cooking and traditional medicine, mainly for allergy, breathing, and digestive complaints. Most human ev...

Perilla Extract monograph & interactions

Other (inactive) ingredients: Tapioca Starch, Natural Flavors, Citric Acid, Stevia Leaf Extract, Red Beet, Silicon Dioxide. These complete the product’s ingredient list but are not active constituents.

Interaction report

Intestinal Repair Mixed Berry Flavor by Barlean's Platinum Drug Interactions

Want to check YOUR meds against Intestinal Repair Mixed Berry Flavor?

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
2,315Drugs
4 Major 1,645 Moderate 666 Minor

Ingredients driving the most interactions

Marshmallow Extract 2,040
Dietary Fiber 2,025
Quercetin 1,169
Berberine 1,160
Deglycyrrhizinated Licorice Root Extract 1,040

Individual Drug Interactions

The ingredients in Intestinal Repair Mixed Berry Flavor interact with 2,315 drugs. Click any drug to see the details.

15 of the 18 ingredients in Intestinal Repair Mixed Berry Flavor interact with drugs. Each result below shows which ingredient is responsible. Marshmallow Extract Dietary Fiber Quercetin Berberine Deglycyrrhizinated Licorice Root Extract Sweet Wormwood Flaxseed Aloe vera N-Acetyl Glucosamine Plum Juice, Powder Arabinogalactan Chicory Inulin Zinc L-Glutamine Banana, Powder

Each ingredient & the kinds of drugs it affects

For each ingredient in Intestinal Repair Mixed Berry Flavor 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.

Marshmallow Extract3 drug types · 2,040 drugs

Lithium

Theoretically, due to potential diuretic effects, marshmallow might reduce excretion and increase levels of lithium.
Marshmallow is thought to have diuretic properties. To avoid lithium toxicity, the dose of lithium might need to be decreased when used with marshmallow.

Likelihood Probable Evidence D
Anticoagulant/Antiplatelet Drugs

Theoretically, marshmallow flower might have antiplatelet effects.
Animal research suggests that marshmallow flower extract has antiplatelet effects. However, the root and leaf of marshmallow, not the flower, are the plant parts most commonly found in dietary supplements. Theoretically, use of marshmallow flower with anticoagulant/antiplatelet drugs can have additive effects, and might increase the risk for bleeding in some patients.

Likelihood Unlikely Evidence D
Oral Drugs

Theoretically, mucilage in marshmallow might impair absorption of oral drugs.
Marshmallow contains mucilage which can affect oral drug absorption. To avoid changes in absorption, take marshmallow 30-60 minutes after oral medications.

Likelihood Possible Evidence D
Marshmallow Extract full monograph & interactions

Dietary Fiber7 drug types · 2,025 drugs

Carbamazepine (Tegretol)

Theoretically, black psyllium might reduce the effects of carbamazepine and increase the risk for convulsions.
Theoretically, black psyllium might reduce carbamazepine absorption. A preliminary study using blond psyllium reported decreased carbamazepine bioavailability due to binding of the drug to psyllium, as well as reduction of available fluid in the gut for dissolution of the drug. This interaction may also occur with black psyllium.

Likelihood Probable Evidence D
Lithium

Theoretically, taking black psyllium at the same time as lithium might reduce lithium absorption.
The fiber in black psyllium might reduce lithium absorption and plasma levels. Some case reports describe a reduction in plasma lithium levels with concomitant administration of blond psyllium. This was reversed when psyllium was stopped. This interaction may also occur with black psyllium.

Likelihood Probable Evidence D
Metformin (Glucophage)

Theoretically, black psyllium might increase the therapeutic and adverse effects of metformin.
Animal research shows that concurrent consumption of blond psyllium with metformin slows and increases the absorption of metformin. This interaction may also occur with black psyllium. To avoid changes in absorption, take psyllium 30-60 minutes after metformin.

Likelihood Possible Evidence D
Olanzapine (Zyprexa)

Theoretically, taking black psyllium at the same time as olanzapine might reduce olanzapine absorption.
The fiber in black psyllium might decrease the absorption of olanzapine. A single case report describes a reduction in the effectiveness of olanzapine when it was concomitantly administered with an unspecified type of psyllium 3 grams orally twice daily. This effect was reversed when psyllium was stopped.

Likelihood Possible Evidence D
Digoxin (Lanoxin)

Theoretically, taking black psyllium at the same time as digoxin might reduce digoxin absorption and decrease digoxin levels.
Psyllium might bind digoxin in the gut. However, some clinical evidence suggests that psyllium does not impact digoxin absorption.

Likelihood Unlikely Evidence B
Ethinyl Estradiol

Theoretically, taking black psyllium at the same time as ethinyl estradiol might alter levels of estradiol.
Concurrent use of blond psyllium with ethinyl estradiol results in a slight increase in the extent of ethinyl estradiol absorption and a slower rate of absorption. This is unlikely to be clinically significant.

Likelihood Unlikely Evidence D
Oral Drugs

Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Psyllium seems to have variable effects on drug absorption. To avoid changes in absorption, take psyllium 30-60 minutes after oral medications. Animal research shows that blond psyllium delays and increases the absorption of metformin and ethinyl estradiol. Case reports and animal research suggest that blond psyllium might reduce absorption of lithium, digoxin, olanzapine, and carbamazepine. Finally, some pharmacokinetic studies show that psyllium does not affect the absorption of levothyroxine or warfarin. Although many of these studies evaluated blond psyllium, the fiber content in black psyllium may have similar effects.

Likelihood Possible Evidence B
Dietary Fiber full monograph & interactions

Quercetin21 drug types · 1,169 drugs

Antidiabetes Drugs

Theoretically, concomitant use of quercetin and antidiabetes drugs might increase the risk of hypoglycemia.

Clinical research suggests that a combination of quercetin, myricetin, and chlorogenic acid reduce levels of fasting glucose in patients with type 2 diabetes, including those already taking antidiabetes agents. The effect of quercetin alone is unknown.

Likelihood Possible Evidence B
Antihypertensive Drugs

Theoretically, taking quercetin with antihypertensive drugs might increase the risk of hypotension.

Quercetin can modestly decrease blood pressure in people with mild hypertension. Theoretically, it might have additive blood pressure lowering effects when used with antihypertensive drugs.

Likelihood Possible Evidence B
Cyclosporine (Neoral, Sandimmune)

Theoretically, concomitant use might increase the levels and adverse effects of cyclosporine.

A small study in healthy volunteers shows that pretreatment with quercetin increases plasma levels and prolongs the half-life of a single dose of cyclosporine, possibly due to inhibition of p-glycoprotein or cytochrome P450 3A4 (CYP3A4), which metabolizes cyclosporin.

Likelihood Possible Evidence B
Cytochrome P450 2C8 (Cyp2C8) Substrates

Theoretically, concomitant use might increase the levels and adverse effects of CYP2C8 substrates.

In vitro research shows that quercetin inhibits CYP2C8. Inhibition of paclitaxel (Taxol) metabolism via CYP2C8 has been reported in vitro. However, a small study in humans found no effect of quercetin on rosiglitazone (Avandia), which is also a CYP2C8 substrate.

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

Theoretically, concomitant use might increase the levels and adverse effects of CYP2C9 substrates.

A small clinical study in healthy volunteers shows that taking quercetin 500 mg twice daily for 10 days prior to taking diclofenac, a CYP2C9 substrate, increases diclofenac plasma levels by 75% and prolongs the half-life by 32.5%. Animal research also shows that pretreatment with quercetin increases plasma levels and prolongs the half-life of losartan (Cozaar), a substrate of CYP2C9. Furthermore, laboratory research shows that quercetin inhibits CYP2C9.

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

Theoretically, concomitant use might increase the levels and adverse effects of CYP2D6 substrates.

In vitro research show that quercetin inhibits CYP2D6. This effect has not been reported in humans.

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

Theoretically, concomitant use might alter the effects and adverse effects of CYP3A4 substrates.
A small clinical study in healthy volunteers shows that pretreatment with quercetin increases plasma levels and prolongs the half-life of a single dose of cyclosporine (Neoral, Sandimmune), a substrate of CYP3A4. Animal research also shows that pretreatment with quercetin increases plasma levels and prolongs the half-life of losartan (Cozaar) and quetiapine (Seroquel), substrates of CYP3A4. Other laboratory research also shows that quercetin inhibits CYP3A4. However, one clinical study shows that quercetin can increase the metabolism of midazolam, a substrate of CYP3A4, and decrease serum concentrations of midazolam by about 24% in some healthy individuals, suggesting possible induction of CYP3A4.

Likelihood Possible Evidence D
Diclofenac (Voltaren, Others)

Theoretically, concomitant use might increase the levels and adverse effects of diclofenac.

A small clinical study in healthy volunteers shows that taking quercetin 500 mg twice daily for 10 days prior to taking diclofenac increases diclofenac plasma levels by 75% and prolongs the half-life by 32.5%. This is thought to be due to inhibition of CYP2C9 by quercetin.

Likelihood Probable Evidence B
Losartan (Cozaar)

Theoretically, concomitant use might increase the effects and adverse effects of losartan and decrease the effects of its active metabolite.

Animal research shows that pretreatment with quercetin increases plasma levels and prolongs the half-life of losartan (Cozaar) while decreasing plasma levels of losartan's active metabolite. This metabolite, which is around 10-fold more potent than losartan, is the result of cytochrome P450 (CYP) 2C9- and CYP3A4-mediated transformation of losartan. Additionally, in vitro research shows that quercetin may inhibit P-glycoprotein-mediated efflux of losartan from the intestines, resulting in increased absorption of losartan. These results suggest that concomitant use of quercetin and losartan might increase systemic exposure to losartan while also decreasing plasma concentrations of losartan's active and more potent metabolite.

Likelihood Possible Evidence D
Midazolam (Versed)

Theoretically, concomitant use might decrease the levels and effects of midazolam.

A small clinical study in healthy volunteers shows that quercetin can increase the metabolism of midazolam, with a decrease in AUC of about 24%.

Likelihood Possible Evidence B
Mitoxantrone

Theoretically, quercetin might increase the effects and adverse effects of mitoxantrone.
In vitro research shows that quercetin increases the intracellular accumulation and cytotoxicity of mitoxantrone, possibly through inhibition of breast cancer resistance protein (BCRP), of which mitoxantrone is a substrate. So far, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Organic Anion Transporter 1 (Oat1) Substrates

Theoretically, concomitant use might increase the effects and adverse effects of OAT1 substrates.

In vitro research shows that quercetin is a strong non-competitive inhibitor of OAT1, with half-maximal inhibitory concentration (IC50) values less than 10 mcM. So far, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Organic Anion Transporter 3 (Oat3) Substrates

Theoretically, concomitant use might increase the effects and adverse effects of OAT3 substrates.

In vitro research shows that quercetin is a strong non-competitive inhibitor of OAT3, with half-maximal inhibitory concentration (IC50) values as low as 0.75 mcM. So far, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Organic Anion-Transporting Polypeptide Substrates (Oatp)

Theoretically, concomitant use might increase the effects and adverse effects of OATP substrates.

In vitro evidence shows that quercetin can inhibit organic anion-transporting peptide (OATP) 1B1-mediated uptake of estrone-3-sulfate and pravastatin. Furthermore, clinical research in healthy males shows that intake of quercetin along with pravastatin increases the AUC of pravastatin by 24%, prolongs its half-life by 14%, and decreases its apparent clearance by 18%, suggesting that quercetin modestly inhibits the uptake of pravastatin in hepatic cells.

Likelihood Possible Evidence B
P-Glycoprotein Substrates

Theoretically, concomitant use might alter the effects and adverse effects of P-glycoprotein substrates.

There is preliminary evidence that quercetin inhibits the gastrointestinal P-glycoprotein efflux pump, which might increase the bioavailability and serum levels of drugs transported by the pump. A small study in healthy volunteers reported that pretreatment with quercetin increased bioavailability and plasma levels after a single dose of cyclosporine (Neoral, Sandimmune). Also, two small studies have shown that quercetin might decrease the absorption of talinolol, a substrate transported by the gastrointestinal P-glycoprotein efflux pump. However, in another small study, several days of quercetin treatment did not significantly affect the pharmacokinetics of saquinavir (Invirase). The reason for these discrepancies is not entirely clear. Until more is known, use quercetin cautiously in combination with P-glycoprotein substrates.

Likelihood Possible Evidence B
Pravastatin (Pravachol)

Theoretically, concomitant use might increase the effects and adverse effects of pravastatin.
In vitro evidence shows that quercetin can inhibit OATP 1B1-mediated uptake of pravastatin. Also, preliminary clinical research in healthy males shows that intake of quercetin along with pravastatin increases the maximum concentration of pravastatin by 24%, prolongs its half-life by 14%, and decreases its apparent clearance by 18%, suggesting that quercetin modestly inhibits the uptake of pravastatin in hepatic cells.

Likelihood Possible Evidence B
Prazosin (Minipress)

Theoretically, quercetin might increase the effects and adverse effects of prazosin.
In vitro research shows that quercetin inhibits the transcellular efflux of prazosin, possibly through inhibition of breast cancer resistance protein (BCRP), of which prazosin is a substrate. BCRP is an ATP-binding cassette efflux transporter in the intestines, kidneys, and liver. So far, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Quetiapine (Seroquel)

Theoretically, concomitant use might increase the effects and adverse effects of quetiapine.
Animal research shows that pretreatment with quercetin can increase plasma levels of quetiapine and prolong its clearance, possibly due to inhibition of cytochrome P450 3A4 (CYP3A4) by quercetin. Additionally, the brain-to-plasma ratio of quetiapine concentrations increased, possibly due to inhibition of P-glycoprotein at the blood-brain barrier. This interaction has not been reported in humans.

Likelihood Possible Evidence D
Quinolone Antibiotics

Theoretically, concomitant use might inhibit the effects of quinolone antibiotics.
In vitro, quercetin binds to the DNA gyrase site on bacteria, which may interfere with the activity of quinolone antibiotics.

Likelihood Possible Evidence B
Sulfasalazine (Azulfidine)

Theoretically, quercetin might increase the effects and adverse effects of sulfasalazine.
Animal research shows that quercetin increases the maximum serum concentration (Cmax) and area under the curve (AUC) of sulfasalazine, possibly through inhibition of breast cancer resistance protein (BCRP), of which sulfasalazine is a substrate. So far, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, quercetin may increase the risk of bleeding if used with warfarin.
Animal and in vitro studies show that quercetin might increase serum levels of warfarin. Quercetin and warfarin have the same human serum albumin (HSA) binding site, and in vitro research shows that quercetin has stronger affinity for the HSA binding site and can theoretically displace warfarin, causing higher serum levels of warfarin. Animal research shows that taking quercetin for 2 weeks before initiating warfarin increases the maximum serum level of warfarin by 30%, the half-life by 10%, and the overall exposure by 63% when compared with control. Concomitant administration of quercetin and warfarin, without quercetin pre-treatment, also increased these measures, but to a lesser degree. Researchers theorize that inhibition of CYP3A4 by quercetin may explain these effects. So far, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Quercetin full monograph & interactions

Berberine15 drug types · 1,160 drugs

Cyclosporine (Neoral, Sandimmune)

Berberine can increase serum levels of cyclosporine.
Berberine can reduce metabolism and increase serum levels of cyclosporine. Berberine might inhibit cytochrome P450 3A4 (CYP3A4), which metabolizes cyclosporine.

Likelihood Probable Evidence A
Anticoagulant/Antiplatelet Drugs

Theoretically, berberine might increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.
In vitro and in vivo research suggest that berberine can inhibit platelet aggregation. Theoretically, berberine might have additive effects when used with anticoagulant and antiplatelet drugs and increase the risk of bleeding.

Likelihood Possible Evidence D
Antidiabetes Drugs

Theoretically, berberine may increase the risk of hypoglycemia when taken with antidiabetes drugs.
Clinical research shows that berberine may lower blood glucose levels. Theoretically, berberine might have additive effects with antidiabetes drugs and increase the risk of hypoglycemia.

Likelihood Possible Evidence D
Antihypertensive Drugs

Theoretically, berberine might have additive effects with antihypertensive drugs.
Animal research suggests that berberine can have hypotensive effects. Also, a clinical study suggests that taking berberine in combination with amlodipine can lower systolic and diastolic blood pressure when compared with amlodipine alone.

Likelihood Possible Evidence D
Cns Depressants

Theoretically, berberine might increase the sedative effects of CNS depressants.
Animal research suggests that berberine may have sedative effects. Theoretically, use of berberine along with CNS depressants might produce additive therapeutic and adverse effects.

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

Theoretically, berberine might increase serum levels of drugs metabolized by CYP2C9.
Preliminary clinical research shows that berberine can inhibit CYP2C9. Theoretically, taking berberine with drugs metabolized by CYP2C9 might increase drug levels and increase the risk of adverse effects.

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

Theoretically, berberine might increase serum levels of drugs metabolized by CYP2D6.
In vitro research and preliminary clinical evidence show that berberine can inhibit CYP2D6. Theoretically, use of berberine with drugs metabolized by CYP2D6 might increase drug levels and increase the risk of adverse effects.

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

Theoretically, berberine might increase serum levels of drugs metabolized by CYP3A4.
In vitro research and preliminary clinical research show that berberine moderately inhibits CYP3A4. Theoretically, use of berberine with drugs metabolized by CYP3A4 might increase drug levels and increase the risk of adverse effects.

Likelihood Possible Evidence A
Dextromethorphan (Robitussin Dm, Others)

Theoretically, berberine may increase serum levels of dextromethorphan.
Preliminary clinical research shows that berberine can inhibit cytochrome P450 2D6 (CYP2D6) activity and reduce the metabolism of dextromethorphan. This may increase the effects and side effects of dextromethorphan.

Likelihood Possible Evidence B
Losartan (Cozaar)

Berberine might reduce the therapeutic effects of losartan by decreasing its conversion to its active form.
Preliminary clinical research suggests that berberine can inhibit cytochrome P450 2C9 (CYP2C9) activity and reduce metabolism of losartan.

Likelihood Possible Evidence B
Metformin (Glucophage)

Theoretically, berberine might increase the therapeutic and adverse effects of metformin.
In vitro and animal studies show that berberine can increase the systemic exposure and half-life of metformin, potentially increasing metformin's effects and side effects. This interaction seems to be most apparent when berberine is administered 2 hours prior to metformin. Taking berberine and metformin at the same time does not appear to increase systemic exposure to metformin.

Likelihood Possible Evidence D
Midazolam (Versed)

Berberine can reduce metabolism of midazolam, which might increase the risk of severe adverse effects.
Preliminary clinical research shows that berberine can inhibit cytochrome P450 3A4 (CYP3A4) activity and reduce metabolism of midazolam.

Likelihood Possible Evidence B
Pentobarbital (Nembutal)

Berberine might increase the sedative effect of pentobarbital.
Evidence from animal research shows that berberine can prolong pentobarbital-induced sleeping time. Theoretically, combining berberine and pentobarbital might increase the sedative effects of pentobarbital.

Likelihood Possible Evidence D
Tacrolimus (Prograf)

Berberine has been associated with increased blood levels of tacrolimus.
In a 16-year-old patient with idiopathic nephrotic syndrome who was being treated with tacrolimus 6.5 mg twice daily, intake of berberine 200 mg three times daily increased the blood concentration of tacrolimus from 8 to 22 ng/mL. Following a reduction of the tacrolimus dose to 3 mg daily, blood levels of tacrolimus decreased to 12 ng/mL.

Likelihood Possible Evidence D
Acetazolamide

Laboratory studies and initial clinical findings suggest that berberine has the potential to increase acetazolamide concentrations in the body. More research is needed to confirm this interaction.

Likelihood Possible Evidence C
Berberine full monograph & interactions

Deglycyrrhizinated Licorice Root Extract18 drug types · 1,040 drugs

Antihypertensive Drugs

Theoretically, licorice might reduce the effects of antihypertensive drugs.
In human research, licorice increases blood pressure in a dose-dependent manner.

Likelihood Possible Evidence B
Cisplatin (Platinol-Aq)

Theoretically, licorice might reduce the effects of cisplatin.
In animal research, licorice diminished the therapeutic efficacy of cisplatin.

Likelihood Possible Evidence D
Corticosteroids

Theoretically, concomitant use of licorice and corticosteroids might increase the side effects of corticosteroids.
Case reports suggest that concomitant use of licorice and oral corticosteroids, such as hydrocortisone, can potentiate the duration of activity and increase blood levels of corticosteroids. Additionally, in one case report, a patient with neurogenic orthostatic hypertension stabilized on fludrocortisone 0.1 mg twice daily developed pseudohyperaldosteronism after recent consumption of large amounts of black licorice.

Likelihood Possible Evidence D
Cytochrome P450 2B6 (Cyp2B6) Substrates

Theoretically, licorice might increase levels of drugs metabolized by CYP2B6.
In vitro research shows that licorice extract and glabridin, a licorice constituent, inhibit CYP2B6 isoenzymes. Licorice extract from the species G. uralensis seems to inhibit CYP2B6 isoenzymes to a greater degree than G. glabra extract in vitro. Theoretically, these species of licorice might increase levels of drugs metabolized by CYP2B6; however, these interactions have not yet been reported in humans.

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

Theoretically, licorice might increase levels of drugs metabolized by CYP2C19.
In vitro, licorice extracts from the species G. glabra and G. uralensis inhibit CYP2C19 isoenzymes in vitro. Theoretically, these species of licorice might increase levels of drugs metabolized by CYP2C19; however, this interaction has not yet been reported in humans.

Likelihood Possible Evidence D
Cytochrome P450 2C8 (Cyp2C8) Substrates

Theoretically, licorice might increase levels of drugs metabolized by CYP2C8.
In vitro, licorice extract from the species G. glabra and G. uralensis inhibits CYP2C8 isoenzymes. Theoretically, these species of licorice might increase levels of drugs metabolized by CYP2C8; however, this interaction has not yet been reported in humans.

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

Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP2C9.
There is conflicting evidence about the effect of licorice on CYP2C9 enzyme activity. In vitro research shows that extracts from the licorice species G. glabra and G. uralensis moderately inhibit CYP2C9 isoenzymes. However, evidence from an animal model shows that licorice extract from the species G. uralensis can induce hepatic CYP2C9 activity. Until more is known, licorice should be used cautiously in people taking CYP2C9 substrates.

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

Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Pharmacokinetic research shows that the licorice constituent glycyrrhizin, taken in a dosage of 150 mg orally twice daily for 14 days, modestly decreases the area under the concentration-time curve of midazolam by about 20%. Midazolam is a substrate of CYP3A4, suggesting that glycyrrhizin modestly induces CYP3A4 activity. Animal research also shows that licorice extract from the species G. uralensis induces CYP3A4 activity. However, licorice extract from G. glabra species appear to inhibit CYP3A4-induced metabolism of testosterone in vitro. It is thought that the G. glabra inhibits CYP3A4 due to its constituent glabridin, which is a moderate CYP3A4 inhibitor in vitro and not present in other licorice species. Until more is known, licorice should be used cautiously in people taking CYP3A4 substrates.

Likelihood Possible Evidence B
Digoxin (Lanoxin)

Theoretically, concomitant use of licorice with digoxin might increase the risk of cardiac toxicity.
Overuse or misuse of licorice with cardiac glycoside therapy might increase the risk of cardiac toxicity due to potassium loss.

Likelihood Possible Evidence D
Diuretic Drugs

Theoretically, concomitant use of licorice with diuretic drugs might increase the risk of hypokalemia.
Overuse of licorice might compound diuretic-induced potassium loss. In one case report, a 72-year-old male with a past medical history of hypertension, type 2 diabetes, hyperlipidemia, arrhythmia, stroke, and hepatic dysfunction was hospitalized with severe hypokalemia and uncontrolled hypertension due to pseudohyperaldosteronism. This was thought to be provoked by concomitant daily consumption of a product containing 225 mg of glycyrrhizin, a constituent of licorice, and hydrochlorothiazide 12.5 mg for 1 month.

Likelihood Possible Evidence D
Estrogens

Theoretically, licorice might increase or decrease the effects of estrogen therapy.
Theoretically, licorice might interfere with estrogen therapy due to estrogenic and anti-estrogenic effects.

Likelihood Possible Evidence D
Loop Diuretics

Theoretically, loop diuretics might increase the mineralocorticoid effects of licorice.
Theoretically, loop diuretics might enhance the mineralocorticoid effects of licorice by inhibiting the enzyme that converts cortisol to cortisone; however, bumetanide (Bumex) does not appear to have this effect.

Likelihood Possible Evidence D
Midazolam (Versed)

Theoretically, licorice might decrease levels of midazolam.
In humans, the licorice constituent glycyrrhizin appears to moderately induce the metabolism of midazolam. This is likely due to induction of cytochrome P450 3A4 by licorice. Until more is known, licorice should be used cautiously in people taking midazolam.

Likelihood Possible Evidence B
P-Glycoprotein Substrates

Theoretically, licorice might decrease the absorption of P-glycoprotein substrates.
In vitro research shows that licorice can increase P-glycoprotein activity.

Likelihood Possible Evidence D
Paclitaxel (Abraxane, Onxol)

Theoretically, licorice might decrease plasma levels and clinical effects of paclitaxel.
Multiple doses of licorice taken concomitantly with paclitaxel might reduce the effectiveness of paclitaxel. Animal research shows that licorice 3 grams/kg given orally for 14 days before intravenous administration of paclitaxel decreases the exposure to paclitaxel and increases its clearance. Theoretically, this occurs because licorice induces cytochrome P450 3A4 enzymes, which metabolize paclitaxel. Notably, a single dose of licorice did not affect exposure or clearance of paclitaxel.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, licorice might decrease plasma levels and clinical effects of warfarin.
Licorice seems to increase metabolism and decrease levels of warfarin in animal models. This is likely due to induction of cytochrome P450 2C9 (CYP2C9) metabolism by licorice. Advise patients taking warfarin to avoid taking licorice.

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

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

Likelihood Possible Evidence D
Methotrexate (Trexall, Others)

Theoretically, licorice might increase levels of methotrexate.
Animal research suggests that intravenous administration of glycyrrhizin, a licorice constituent, and high-dose methotrexate may delay methotrexate excretion and increase systemic exposure, leading to transient elevations in liver enzymes and total bilirubin. This interaction has not yet been reported in humans.

Likelihood Unlikely Evidence D
Deglycyrrhizinated Licorice Root Extract full monograph & interactions

Sweet Wormwood3 drug types · 889 drugs

Cytochrome P450 2B6 (Cyp2B6) Substrates

Sweet Annie may alter plasma levels and clinical effects of drugs metabolized by CYP2B6.
In vitro research shows that the Sweet Annie constituent artemisinin induces CYP2B6, possibly increasing CYP2B6 activity by 1.6-fold. However, Sweet Annie extract seems to inhibit the activity of CYP2B6 in vitro, suggesting that other constituents of Sweet Annie play a role in its effects on the overall activity of this enzyme. More information is needed to determine whether taking Sweet Annie extract affects the metabolism of CYP2B6 substrates.

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

Sweet Annie may alter plasma levels and clinical effects of drugs metabolized by CYP3A4.
In vitro research shows that the Sweet Annie constituent artemisinin induces CYP3A4, possibly increasing CYP3A4 activity by 1.9-fold. However, Sweet Annie extract seems to inhibit the activity of CYP3A4 in vitro, suggesting that other constituents of Sweet Annie play a role in its effects on the overall activity of this enzyme. More information is needed to determine whether taking Sweet Annie extract affects the metabolism of CYP3A4 substrates.

Likelihood Possible Evidence D
Hepatotoxic Drugs

Theoretically, concomitant use might have additive adverse hepatotoxic effects.
There is some concern that Sweet Annie can adversely affect the liver.

Likelihood Possible Evidence D
Sweet Wormwood full monograph & interactions

Flaxseed5 drug types · 597 drugs

Antibiotic Drugs

Theoretically, antibiotics might interfere with the metabolism of flaxseed constituents, which could potentially alter the effects of flaxseed.
Some potential benefits of flaxseed are thought to be due to its lignan content. Secoisolariciresinol diglucoside (SDG), a major lignan precursor, is found in high concentrations in flaxseed. SDG is converted by bacteria in the colon to the lignans enterolactone and enterodiol. Antibiotics alter the flora of the colon, which could theoretically alter the metabolism of flaxseed.

Likelihood Possible Evidence D
Anticoagulant/Antiplatelet Drugs

Theoretically, using flaxseed in combination with anticoagulant or antiplatelet drugs might have additive effects and increase the risk of bleeding.
Some clinical evidence suggests that the oil contained in flaxseed can decrease platelet aggregation.

Likelihood Possible Evidence B
Antidiabetes Drugs

Theoretically, flaxseed might have additive effects when used with antidiabetes drugs and increase the risk for hypoglycemia.
Some clinical research suggests that flaxseed can lower blood glucose levels.

Likelihood Probable Evidence B
Antihypertensive Drugs

Theoretically, flaxseed might have additive effects when used with antihypertensive drugs and increase the risk of hypotension.
Clinical research shows that daily flaxseed consumption, especially for longer than 12 weeks, modestly reduces blood pressure.

Likelihood Possible Evidence D
Estrogens

Theoretically, taking flaxseed might decrease the effects of estrogens.
Flaxseed contains lignans with mild estrogenic and possible antiestrogenic effects. The lignans seem to compete with circulating endogenous estrogen and might reduce estrogen binding to estrogen receptors, resulting in an anti-estrogen effect. It is unclear if this effect transfers to exogenously administered estrogens.

Likelihood Possible Evidence D
Flaxseed full monograph & interactions

Aloe vera7 drug types · 461 drugs

Digoxin (Lanoxin)

Theoretically, aloe latex might increase the risk of adverse effects when taken with cardiac glycosides.
Overuse of aloe latex can increase the risk of adverse effects from cardiac glycoside drugs, such as digoxin, due to potassium depletion. Overuse of aloe, along with cardiac glycoside drugs, can increase the risk of toxicity.

Likelihood Probable Evidence D
Anticoagulant/Antiplatelet Drugs

Theoretically, aloe gel might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.
In vitro research shows that aloe gel can inhibit platelet aggregation. This inhibition was greater than that seen with celecoxib, but less than that seen with aspirin.

Likelihood Possible Evidence D
Antidiabetes Drugs

Aloe might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Preliminary clinical research suggests aloe gel might lower blood glucose levels and have additive effects when used with antidiabetes drugs. Monitor blood glucose levels closely.

Likelihood Possible Evidence D
Diuretic Drugs

Theoretically, aloe latex might increase the risk of hypokalemia when taken with diuretic drugs.
Overuse of aloe latex might compound diuretic-induced potassium loss, increasing the risk of hypokalemia.

Likelihood Possible Evidence D
Stimulant Laxatives

Theoretically, aloe latex might increase the risk for fluid and electrolyte loss when taken with stimulant laxatives.
Due to cathartic laxative effects of aloe latex, concomitant use with other stimulant laxatives might compound fluid and electrolyte loss.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, aloe latex might increase the risk of bleeding when taken with warfarin.
Aloe latex has stimulant laxative effects. In some people aloe latex can cause diarrhea. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. Advise patients who take warfarin not to take excessive amounts of aloe vera.

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

Theoretically, aloe might decrease the levels and clinical effects of CYP1A2 substrates.
In vitro research shows that aloe extract induces CYP1A2 enzymes.

Likelihood Possible Evidence D
Aloe vera full monograph & interactions

N-Acetyl Glucosamine4 drug types · 170 drugs

Warfarin (Coumadin)

Glucosamine might increase the anticoagulant effects of warfarin and increase the risk of bruising and bleeding.
In two individual case reports, glucosamine/chondroitin combinations were associated with a significant increase in international normalized ratio (INR) in patients previously stabilized on warfarin. In one case, the increase in INR occurred only after tripling the dose of a glucosamine/chondroitin supplement from 500 mg/400 mg daily to 1500/1200 mg daily. Additionally, 20 voluntary case reports to the U.S. Food & Drug Administration (FDA) have linked glucosamine plus chondroitin with increased INR, bruising, and bleeding in patients who were also taking warfarin. There have also been 20 additional case reports to the World Health Organization (WHO) that link glucosamine alone to increased INR in patients taking warfarin. The mechanism of this interaction is unclear. Glucosamine is a small component of heparin, but is not thought to have anticoagulant activity; however, animal research suggests that it might have antiplatelet activity.

Likelihood Probable Evidence D
Topoisomerase Ii Inhibitors

Theoretically glucosamine may induce resistance to topoisomerase II inhibitors.
In vitro research suggests that glucosamine might induce resistance to etoposide (VP16, VePesid) and doxorubicin (Adriamycin) by reducing inhibition of topoisomerase II, an enzyme required for DNA replication in tumor cells. This effect has not been reported in humans.

Likelihood Possible Evidence D
Acetaminophen (Tylenol, Others)

Acetaminophen might interfere with the activity of glucosamine sulfate by interacting with the sulfate portion.
Anecdotal reports suggest that adding glucosamine to an acetaminophen regimen might decrease pain control in patients with osteoarthritis. Some research suggests that the sulfate portion of glucosamine sulfate might contribute to its effect in osteoarthritis. Since acetaminophen metabolism requires sulfur and reduces serum sulfate concentrations, acetaminophen could theoretically interfere with the action of glucosamine sulfate. Conversely, the administration of sulfate could theoretically decrease the effectiveness of acetaminophen in sulfate-deficient people by increasing its clearance.

Likelihood Possible Evidence B
Antidiabetes Drugs

Despite initial concerns, it is unlikely that glucosamine will interfere with the effects of antidiabetes drugs.
In vitro and animal research has suggested that glucosamine might increase insulin resistance or decrease insulin production. This has raised concerns that taking glucosamine might worsen diabetes and decrease the effectiveness of diabetes drugs. However, clinical research suggests that glucosamine does not have adverse effects on blood glucose or glycated hemoglobin (HbA1C) in healthy, obese, or type 2 diabetes patients.

Likelihood Unlikely Evidence B
N-Acetyl Glucosamine full monograph & interactions

Plum Juice, Powder1 drug type · 122 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, plum juice might have antiplatelet effects.
Consuming plum juice while taking anticoagulant or antiplatelet drugs might increase the risk of bruising and bleeding. In healthy volunteers, drinking plum juice 200 mL daily for 28 days prolonged clotting time and inhibited platelet aggregation.

Likelihood Possible Evidence B
Plum Juice, Powder full monograph & interactions

Arabinogalactan1 drug type · 121 drugs

Immunosuppressants

Theoretically, larch arabinogalactan might interfere with immunosuppression therapy due to immunostimulant effects. Immunosuppressant drugs include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), corticosteroids (glucocorticoids), and other drugs.

Likelihood Possible Evidence D
Arabinogalactan full monograph & interactions

Chicory Inulin1 drug type · 86 drugs

Antidiabetes Drugs

Theoretically, inulin might increase the risk of hypoglycemia with antidiabetes drugs.
Some clinical research shows that inulin improves glycemic control in patients with diabetes; however, it is unclear if it has hypoglycemic effects.

Likelihood Unlikely Evidence D
Chicory Inulin full monograph & interactions

Zinc10 drug types · 67 drugs

Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)

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

Likelihood Probable Evidence D
Cephalexin (Keflex)

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

Likelihood Probable Evidence B
Cisplatin (Platinol-Aq)

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

Likelihood Possible Evidence D
Integrase Inhibitors

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

Likelihood Possible Evidence D
Penicillamine (Cuprimine, Depen)

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

Likelihood Probable Evidence B
Quinolone Antibiotics

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

Likelihood Probable Evidence B
Ritonavir (Norvir)

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

Likelihood Probable Evidence B
Tetracycline Antibiotics

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

Likelihood Probable Evidence B
Amiloride (Midamor)

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

Likelihood Probable Evidence B
Atazanavir (Reyataz)

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

Likelihood Probable Evidence B
Zinc full monograph & interactions

L-Glutamine1 drug type · 50 drugs

Anticonvulsants

Theoretically, glutamine might antagonize the effects of anticonvulsant medications.
Glutamine is metabolized to the excitatory neurotransmitter glutamate. Glutamate might have antagonistic effects with anticonvulsant drugs. However, this interaction has not yet been reported in humans.

Likelihood Possible Evidence D
L-Glutamine full monograph & interactions

Banana, Powder1 drug type · 5 drugs

Levodopa

Taking banana may reduce the effectiveness of levodopa.
A case report describes apparent wearing off in a patient with Parkinson disease after eating a banana every day. The wearing off subsided after removing dietary bananas.

Likelihood Possible Evidence D
Banana, Powder full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Intestinal Repair Mixed Berry Flavor, from the product label.

Barlean's Platinum

See all Barlean's Platinum products
Name
Barlean's
City
Ferndale
State
WA
ZipCode
98248
Phone Number
800/445-3529
Web Address
barleans.com
Pharmacist Counseling Corner

Intestinal Repair Mixed Berry Flavor by Barlean's Platinum: Common Questions

Does Intestinal Repair Mixed Berry Flavor by Barlean's Platinum interact with any medications?
Yes. Based on its ingredients, Intestinal Repair Mixed Berry Flavor has a known interaction with 2,315 medications, including 4 rated major. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Intestinal Repair Mixed Berry Flavor contains 18 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?
Safety data varies by ingredient. L-glutamine and banana are likely safe as foods in pregnancy. Aloe vera, berberine, licorice, and several others advise against use due to insufficient data or potential harm. Quercetin, sweet wormwood, marshmallow, plum, and perilla all lack sufficient safety information. Talk to your doctor or pharmacist before using this product during pregnancy or while breastfeeding.
What are the most common side effects?
Gastrointestinal symptoms are most common across the ingredients: bloating, gas, diarrhea, constipation, nausea, and abdominal discomfort. These are dose-related and typically mild, but may be more pronounced at higher doses or in people sensitive to fiber. Starting with a small amount and drinking plenty of water can help reduce these effects.
Is this product safe for people with liver or kidney disease?
No. L-glutamine should only be used under medical supervision in people with kidney or liver disease. Several other ingredients (berberine, sweet wormwood, and licorice) also carry liver-related concerns. If you have liver or kidney disease, talk to your doctor before using this product.
Does this help with constipation?
Several ingredients—aloe vera, flaxseed, chicory inulin, and plum juice powder—are rated possibly effective for constipation in the data we hold. However, evidence is preliminary, and this product combines many ingredients whose individual effects can overlap or vary by person. Results will depend on your personal response and the dose you take.
Can I take this with antibiotics?
It depends on the antibiotic. Zinc reduces absorption of quinolone and tetracycline antibiotics and cephalexin—separate doses by at least 2 hours. Quercetin may reduce quinolone effectiveness. Flaxseed theoretically may interfere with antibiotic metabolism. Talk to your pharmacist about the specific antibiotic you're taking.
What if I'm on diabetes medication?
Multiple ingredients—aloe vera, flaxseed, chicory inulin, and berberine—may lower blood sugar. Taking this product with diabetes medications could increase the risk of low blood sugar (hypoglycemia). Monitor your blood glucose closely and talk to your doctor before adding this supplement.

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.

Intestinal Repair Mixed Berry Flavor label
Go deeper

The Full Monographs Behind Intestinal Repair Mixed Berry Flavor’s Ingredients

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

Herb & supplement monograph

Glutamine

Interacts with 50 drugs

Glutamine is the most abundant amino acid in the body and is usually made in your muscles. A prescription form is FDA-approved to help reduce sickle cell disease complications, but for most...

Read the full Glutamine monograph → Herb & supplement monograph

Black Psyllium

Interacts with 2,025 drugs

Black psyllium is a soluble-fiber supplement made from the seeds of a Plantago plant, used mostly to ease constipation and support digestive health. It is best known and most studied for rel...

Read the full Black Psyllium monograph → Herb & supplement monograph

Aloe

Interacts with 461 drugs

Aloe vera gel is widely used on the skin for minor burns and irritation, and some research suggests it may help. Aloe latex (the yellow part) is a strong laxative that can cause cramping and...

Read the full Aloe monograph → Herb & supplement monograph

Quercetin

Interacts with 1,169 drugs

Quercetin is a plant flavonoid with antioxidant and anti-inflammatory properties found in many common foods and sold as a supplement. While early research is interesting for allergies, blood...

Read the full Quercetin monograph → Herb & supplement monograph

Zinc

Interacts with 67 drugs

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

Read the full Zinc monograph → Herb & supplement monograph

Glucosamine

Interacts with 170 drugs

Glucosamine is a natural compound found in cartilage and joint fluid, and it is one of the most popular supplements for osteoarthritis, especially of the knee. The evidence is mixed, with so...

Read the full Glucosamine monograph → Herb & supplement monograph

Banana

Interacts with 5 drugs

Bananas are a nutritious, widely eaten fruit that provide potassium, fiber, vitamin B6, and quick energy, and they are part of a healthy diet. While some traditional uses (like easing diarrh...

Read the full Banana monograph → Herb & supplement monograph

Licorice

Interacts with 1,040 drugs

Licorice root is a traditional remedy used for sore throats, coughs, and digestive complaints, but solid human evidence is limited for most uses. Regular licorice contains glycyrrhizin, whic...

Read the full Licorice monograph → Herb & supplement monograph

Berberine

Interacts with 1,160 drugs

Berberine is a yellow plant compound that has shown promise for lowering blood sugar and cholesterol in some studies, but the quality of research varies and it is not a replacement for presc...

Read the full Berberine monograph → Herb & supplement monograph

Flaxseed

Interacts with 597 drugs

Flaxseed is a nutritious food rich in fiber, omega-3 fats (ALA), and plant compounds called lignans. It is most reliably helpful for constipation and may modestly lower cholesterol, but evid...

Read the full Flaxseed monograph → Herb & supplement monograph

Larch Arabinogalactan

Interacts with 121 drugs

Larch arabinogalactan is a soluble fiber from larch trees that is mainly used as a prebiotic and for immune support. Early research is interesting but limited, and most claims are not yet fi...

Read the full Larch Arabinogalactan monograph → Herb & supplement monograph

Inulin

Interacts with 86 drugs

Inulin is a type of plant fiber (a prebiotic) found naturally in foods like chicory root, onions, and garlic, and it is widely added to supplements and processed foods. It may help with regu...

Read the full Inulin monograph → Herb & supplement monograph

Sweet Annie

Interacts with 889 drugs

Sweet Annie (Artemisia annua) is the source of artemisinin, a compound used in prescription antimalarial drugs. While the purified drug is well studied for malaria, the herb itself as a supp...

Read the full Sweet Annie monograph → Herb & supplement monograph

Marshmallow

Interacts with 2,040 drugs

Marshmallow root is a traditional herb rich in soothing, gel-like fibers called mucilage, which is why it has long been used for coughs, sore throats, and stomach irritation. Evidence for th...

Read the full Marshmallow monograph → Herb & supplement monograph

Plum

Interacts with 122 drugs

Plums and their dried form (prunes) are common, nutritious foods that are best known for helping relieve constipation thanks to their fiber and sorbitol content. They are generally safe as f...

Read the full Plum monograph → Herb & supplement monograph

Perilla

Perilla is an Asian mint-family plant used in cooking and traditional medicine, mainly for allergy, breathing, and digestive complaints. Most human evidence is limited or preliminary, so it...

Read the full Perilla monograph →
Sources

Sources & How We Checked

Intestinal Repair Mixed Berry Flavor'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 478 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.

Glutamine 11 references
  1. Miller AL. Therapeutic considerations of L-glutamine: a review of the literature. Altern Med Rev 1999;4:239-48..
  2. Bozzetti F, Biganzoli L, Gavazzi C, et al. Glutamine supplementation in cancer patients receiving chemotherapy: a double-blind randomized study. Nutrition 1997;13:748-51.. PubMed
  3. Mebane AH. L-Glutamine and mania. Am J Psychiatry 984;141:1302-3.
  4. Meldrum BS. Glutamate as a neurotransmitter in the brain: review of physiology and pathology. J Nutr 2000;130:1007S-15S.. PubMed
  5. Garlick PJ. Assessment of the safety of glutamine and other amino acids. J Nutr 2001;131:2556S-61S.. PubMed
  6. Chapman AG. Glutamate and epilepsy. J Nutr 2000;130:1043S-5S.. PubMed
  7. Ziegler TR. Glutamine supplementation in cancer patients receiving bone marrow transplantation and high dose chemotherapy. J Nutr 2001;131:2578S-84S.. PubMed
  8. Laviano A, Molfino A, Lacaria MT, Canelli A, De Leo S, Preziosa I, Rossi Fanelli F. Glutamine supplementation favors weight loss in nondieting obese female patients. A pilot study. Eur J Clin Nutr. 2014 Nov;68(11):1264-6. PubMed
  9. Endari (l-glutamine) [package insert]. Torrance, CA: Emmaus Medical,Inc; 2017.
  10. Niihara Y, Miller ST, Kanter J, et al. A Phase 3 Trial of l-Glutamine in Sickle Cell Disease. N Engl J Med 2018;379(3):226-35. doi: 10.1056/NEJMoa1715971.
  11. Ogden HB, Child RB, Fallowfield JL, et al. Gastrointestinal Tolerance of Low, Medium and High Dose Acute Oral l-Glutamine Supplementation in Healthy Adults: A Pilot Study. Nutrients. 2020;12(10):2953. PubMed

See these in context on the Glutamine monograph →

Black Psyllium 18 references
  1. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  2. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  3. Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
  4. Etman M. Effect of a bulk forming laxative on the bioavailablility of carbamazepine in man. Drug Dev Ind Pharm 1995;21:1901-6.
  5. Perlman BB. Interaction between lithium salts and ispaghula husk. Lancet 1990;335:416.
  6. Vaswani SK, Hamilton RG, Valentine MD, Adkinson NF. Psyllium laxative-induced anaphylaxis, asthma, and rhinitis. Allergy 1996;51:266-8. PubMed
  7. Lantner RR, Espiritu BR, Zumerchik P, Tobin MC. Anaphylaxis following ingestion of a psyllium-containing cereal. JAMA 1990;264:2534-6. DOI
  8. Kaplan MJ. Anaphylactic reaction to "Heartwise." N Engl J Med 1990;323:1072-3. DOI
  9. Nordstrom M, Melander A, Robertsson E, Steen B. Influence of wheat bran and of a bulk-forming ispaghula cathartic on the bioavailability of digoxin in geriatric in-patients. Drug Nutr Interact 1987;5:67-9..
  10. Robinson DS, Benjamin DM, McCormack JJ. Interaction of warfarin and nonsystemic gastrointestinal drugs. Clin Pharmacol Ther 1971;12:491-5. PubMed
  11. Garcia JJ, Fernandez N, Diez MJ, et al. Influence of two dietary fibers in the oral bioavailability and other pharmacokinetic parameters of ethinyloestradiol. Contraception 2000;62:253-7. PubMed
  12. Fernandez N, Lopez C, Díez R, et al. Drug interactions with the dietary fiber Plantago ovata husk. Expert Opin Drug Metab Toxicol 2012;8(11):1377-86.
  13. Semen plantaginis in: WHO Monographs on Selected Medicinal Plants, volume 1. World Health Organization, Geneva, 1999. Available at http://apps.who.int/medicinedocs/en/d/Js2200e/. Accessed November 26, 1026.
  14. Code of Federal Regulations, Title 21 (21CFR 101.17). Food labeling warning, notice, and safe handling statements. Available at www.ecfr.gov/cgi-bin/text-idx?SID=20f647d3b74161501f46564b915b4048&mc=true&node=se21.2.101_117&rgn=div8. Accessed December 3, 2
  15. Code of Federal Regulations, Title 21 (21CFR 201.319). Specific labeling requirements - water-soluble gums, hydrophilic gums, and hydrophilic mucilloids. Available at www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=201.319. Accessed Dece
  16. Diez R, Garcia JJ, Diez MJ, Sierra M, Sahagun AM, Fernandez N. Influence of Plantago ovata husk (dietary fiber) on the bioavailability and other pharmacokinetic parameters of metformin in diabetic rabbits. BMC Complement Altern Med. 2017 Jun 7;17(1):298. PubMed
  17. Chiu AC, Sherman SI. Effects of pharmacological fiber supplements on levothyroxine absorption. Thyroid. 1998;8(8):667-71. PubMed
  18. Merrick C, Madden CA, Capurso NA. A Case of Blunted Orally Disintegrating Olanzapine Effect Due to Coadministered Psyllium. J Clin Psychiatry 2021;82(2):20cr13633. PubMed

See these in context on the Black Psyllium monograph →

Aloe 41 references
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  2. Wichtl MW. Herbal Drugs and Phytopharmaceuticals. Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 1994.
  3. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  4. Nusko G, Schneider B, Schneider I, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46:651-5. PubMed
  5. Luyckx VA, Ballantine R, Claeys M, et al. Herbal remedy-associated acute renal failure secondary to Cape aloes. Am J Kidney Dis 2002;39:E13. PubMed
  6. Rajasekaran S, Sivagnanam K, Ravi K, Subramanian S. Hypoglycemic effect of Aloe vera gel on streptozotocin-induced diabetes in experimental rats. J Med Food 2004;7:61-6.
  7. Williams MS, Burk M, Loprinzi CL, et al. Phase III double-blind evaluation of an aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Radiat Oncol Biol Phys 1996;36:345-9. PubMed
  8. Vogler BK, Ernst E. Aloe vera: a systematic review of its clinical effectiveness. Br J Gen Pract 1999;49:823-8.
  9. Bottenberg MM, Wall GC, Harvey RL, Habib S. Oral aloe vera-induced hepatitis. Ann Pharmacother 2007;41:1740-3. PubMed
  10. Rabe C, Musch A, Schirmacher P, et al. Acute hepatitis induced by an Aloe vera preparation: a case report. World J Gastroenterol 2005;11:303-4. PubMed
  11. Kanat O, Ozet A, Ataergin S. Aloe vera-induced acute toxic hepatitis in a healthy young man. Eur J Int Med 2006;17:589. PubMed
  12. Mueller SO, Stopper H. Characterization of the genotoxicity of anthraquinones in mammalian cells. Biochim Biophys Acta 1999;1428:406-14. PubMed
  13. Schorkhuber M, Richter M, Dutter A, et al. Effect of anthraquinone laxatives on the proliferation and urokinase secretion of normal, premalignant and malignant colonic epithelial cells. Eur J Cancer 1998;34:1091-8. PubMed
  14. Yang HN, Kim DJ, Kim YM, et al. Aloe-induced toxic hepatitis. J Korean Med Sci 2010;25:492-5. PubMed
  15. Choonhakarn C, Busaracome P, Sripanidkulchai B, et al. A prospective, randomized clinical trial comparing topical aloe vera with 0.1% triamcinolone acetonide in mild to moderate plaque psoriasis. J.Eur.Acad.Dermatol.Venereol. 2010;24:168-72. PubMed
  16. Ishii Y, Tanizawa H, Takino Y. Studies of aloe. IV. Mechanism of cathartic effect. (3). Biol Pharm Bull. 1994;17:495-7. PubMed
  17. Ishii Y, Tanizawa H, Takino Y. Studies of aloe. V. Mechanism of cathartic effect. (4). Biol Pharm Bull. 1994;17:651-3. PubMed
  18. Nelemans FA. Clinical and toxicological aspects of anthraquinone laxatives. Pharmacology. 1976;14 Suppl 1:73-7. PubMed
  19. Paulsen E, Korsholm L, Brandrup F. A double-blind, placebo-controlled study of a commercial Aloe vera gel in the treatment of slight to moderate psoriasis vulgaris. J Eur Acad Dermatol Venereol. 2005;19:326-31.
  20. Huseini HF, Kianbakht S, Hajiaghaee R, et al. Anti-hyperglycemic and anti-hypercholesterolemic effects of Aloe vera leaf gel in hyperlipidemic type 2 diabetic patients: a randomized double-blind placebo-controlled clinical trial. Planta Med. 2012;78:311-6
  21. Ferreira, M., Teixeira, M., Silva, E., and Selores, M. Allergic contact dermatitis to Aloe vera. Contact Dermatitis 2007;57(4):278-279.
  22. Choonhakarn, C., Busaracome, P., Sripanidkulchai, B., and Sarakarn, P. The efficacy of aloe vera gel in the treatment of oral lichen planus: a randomized controlled trial. Br J Dermatol 2008;158(3):573-577. PubMed
  23. Baretta, Z., Ghiotto, C., Marino, D., and Jirillo, A. Aloe-induced hypokalemia in a patient with breast cancer during chemotherapy. Ann.Oncol. 2009;20(8):1445-1446. PubMed
  24. Hunter, D. and Frumkin, A. Adverse reactions to vitamin E and aloe vera preparations after dermabrasion and chemical peel. Cutis 1991;47(3):193-196.
  25. Alvarez-Perea, A., Garcia, A. P., Hernandez, A. L., de, Barrio M., and Baeza, M. L. Urticaria due to aloe vera: a new sensitizer? Ann.Allergy Asthma Immunol. 2010;105(5):404-405. PubMed
  26. Hogan, D. J. Widespread dermatitis after topical treatment of chronic leg ulcers and stasis dermatitis. CMAJ. 2-15-1988;138(4):336-338.
  27. Savchak VI. Acute bullous allergic dermatitis due to local application of aloe leaves. Vestnik Dermatologii i Venerologii 1977;12:44-45.
  28. Nakamura, T. and Kotajima, S. Contact dermatitis from aloe arborescens. Contact Dermatitis 1984;11(1):51. PubMed
  29. Shoji, A. Contact dermatitis to Aloe arborescens. Contact Dermatitis 1982;8(3):164-167. PubMed
  30. Morrow, D. M., Rapaport, M. J., and Strick, R. A. Hypersensitivity to aloe. Arch Dermatol. 1980;116(9):1064-1065. DOI
  31. Cosmetic Ingredient Review Expert Panel. Final report on the safety assessment of AloeAndongensis Extract, Aloe Andongensis Leaf Juice,aloe Arborescens Leaf Extract, Aloe Arborescens Leaf Juice, Aloe Arborescens Leaf Protoplasts, Aloe Barbadensis Flower E
  32. Bhalang K, Thunyakitpisal P, Rungsirisatean N. Acemannan, a polysaccharide extracted from Aloe vera, is effective in the treatment of oral aphthous ulceration. J Altern Complement Med 2013;19(5):429-34.
  33. Hajheydari Z, Saeedi M, Morteza-Semnani K, Soltani A. Effect of Aloe vera topical gel combined with tretinoin in treatment of mild and moderate acne vulgaris: a randomized, double-blind, prospective trial. J Dermatolog Treat 2014;25(2):123-9.
  34. Jiménez-Encarnación E, Ríos G, Muñoz-Mirabal A, Vilá LM. Euforia-induced acute hepatitis in a patient with scleroderma. BMJ Case Rep 2012;2012. PubMed
  35. Lee J, Lee MS, Nam KW. Acute toxic hepatitis caused by an aloe vera preparation in a young patient: a case report with a literature review. Korean J Gastroenterol 2014;64(1):54-8. PubMed
  36. Guo X, Mei N. Aloe Vera - A Review of Toxicity and Adverse Clinical Effects. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev 2016;34(2):77-96.
  37. Hoogenboom TCH, Patel N, Cook NA, Williams R, Taylor-Robinson SD, Lim AKP. The effect of Aloe vera juice on liver enzymes and hepatic structure in a healthy population. Integr Med (Encinitas) 2020;19(3):30-4.
  38. Mushtaq S, Mushtaq Z, Sarfraz J, et al. Comparison of effect of aloe vera gel with aspirin and celecoxib on platelet aggregation. Professional Med J. 2020; 27(5):973-978. DOI
  39. Haron MH, Dale O, Martin K, et al. Evaluation of the Herb-Drug Interaction Potential of Commonly Used Botanicals on the US Market with Regard to PXR- and AhR-Mediated Influences on CYP3A4 and CYP1A2. J Diet Suppl 2022. PubMed
  40. Sabbaghzadegan S, Soltani MH, Kamalinejad M, Bahrami M, Kabir A, Dadmehr M. The effect of a standardized capsule of Aloe vera gel on the quality of life in patients with systolic heart failure: A randomized double-blind placebo-controlled clinical trial.
  41. Lewis ED, Crowley DC, Guthrie N, Evans M. Healthy adults supplemented with a nutraceutical formulation containing Aloe vera gel, rosemary and Poria cocos enhances the effect of influenza vaccination in a randomized, triple-blind, placebo-controlled trial. PubMed

See these in context on the Aloe monograph →

Quercetin 26 references
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  4. Obach RS. Inhibition of human cytochrome P450 enzymes by constituents of St. John's wort, an herbal preparation used in the treatment of depression. J Pharmacol Exp Ther 2000;294:88-95. DOI
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  6. Kim KA, Park PW, Kim HK, et al. Effect of quercetin on the pharmacokinetics of rosiglitazone, a CYP2C8 substrate, in healthy subjects. J Clin Pharmacol 2005;45:941-6. PubMed
  7. DiCenzo R, Frerichs V, Larppanichpoonphol P, et al. Effect of quercetin on the plasma and intracellular concentrations of saquinavir in healthy adults. Pharmacotherapy 2006;26:1255-61. PubMed
  8. Choi JS, Choi BC, Choi KE. Effect of quercetin on the pharmacokinetics of oral cyclosporine. Am J Health Syst Pharm 2004;61:2406-9. PubMed
  9. Choi JS, Jo BW, Kim YC. Enhanced paclitaxel bioavailability after oral administration of paclitaxel or prodrug to rats pretreated with quercetin. Eur J Pharm Biopharm 2004;57:313-8. PubMed
  10. Vaclavikova R, Horsky S, Simek P, Gut I. Paclitaxel metabolism in rat and human liver microsomes is inhibited by phenolic antioxidants. Naunyn Schmiedebergs Arch Pharmacol 2003;368:200-9. PubMed
  11. Di Bari L, Ripoli S, Pradhan S, Salvadori P. Interactions between quercetin and warfarin for albumin binding: A new eye on food/drug interference. Chirality 2010;22:593-6. PubMed
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  14. Wang SY, Duan KM, Li Y, et al. Effect of quercetin on P-glycoprotein transport ability in Chinese healthy subjects. Eur J Clin Nutr 2013;67(4):390-4. PubMed
  15. Nguyen MA, Staubach P, Wolffram S, Langguth P. Effect of single-dose and short-term administration of quercetin on the pharmacokinetics of talinolol in humans - Implications for the evaluation of transporter-mediated flavonoid-drug interactions. Eur J Pha PubMed
  16. Wu LX, Guo CX, Chen WQ, et al. Inhibition of the organic anion-transporting polypeptide 1B1 by quercetin: an in vitro and in vivo assessment. Br J Clin Pharmacol 2012;73(5):750-7.
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  18. Larson A, Witman MA, Guo Y, et al. Acute, quercetin-induced reductions in blood pressure in hypertensive individuals are not secondary to lower plasma angiotensin-converting enzyme activity or endothelin-1: nitric oxide. Nutr Res. 2012;32(8):557-64. PubMed
  19. Bedada SK, Neerati P. Evaluation of the effect of quercetin treatment on CYP2C9 enzyme activity of diclofenac in healthy human volunteers. Phytother Res. 2018 Feb;32(2):305-311. doi: 10.1002/ptr.5978. PubMed
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  25. Ahmad E, Jahangir M, Ismail MA, et al. Influence of quercetin pretreatment on pharmacokinetics of warfarin in rats. Curr Drug Saf 2022. PubMed
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See these in context on the Quercetin monograph →

Zinc 88 references
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Glucosamine 58 references
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Banana 11 references
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Licorice 92 references
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Berberine 41 references
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Sweet Annie 11 references
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