Major interaction on record — check this product against your medications before combining. Based on 14 of 15 ingredients. Check your meds →
Dietary supplement

Mega Energy Ingredients & Drug Interactions

by Naturalist

Mega Energy label
See full label image
Tablet Or Pill Category: Other Combinations
Most serious interaction: Major
Clinical methodology reviewed by · Updated Sep 16, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Mega Energy 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

Mega Energy is a dietary supplement by Naturalist with 15 active ingredients. Its ingredients are commonly taken for replacing fluids and electrolytes, preventing dehydration during exercise or illness, treating low blood sodium (under medical care).Based on those ingredients, 1,602 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Korean Ginseng extract, Guarana extract, Kola Nut extract. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

Jump to a section

Check Your Meds Against Mega Energy by Naturalist

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

Pharmacist-reviewed data Checks every ingredient Answer in seconds
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HelloPharmacist Scorecard of Mega Energy by Naturalist

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 Aug 27, 2026

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 15 of its 15 active ingredients.
  • No proprietary blends here — you can verify the dose of every single component.

Mega Energy contains 15 active ingredients. The product delivers sodium, bee pollen, royal jelly, octacosanol, Korean ginseng extract, gotu kola extract, parsley, guarana extract, kola nut extract, phytosterols concentrate, alfalfa, barley grass, inosine phosphate, suma, and wheat grass.

Several of these—guarana and kola nut—are high in natural caffeine and serve as stimulants; others like ginseng, gotu kola, and guarana are marketed for energy support. Bee pollen and royal jelly are bee-derived substances traditionally used as tonics.

Korean ginseng, parsley, barley grass, and alfalfa round out the blend with herbal and plant compounds. The inactive ingredients are whey, dicalcium phosphate, cellulose, croscarmellose, stearic acid, and vegetable magnesium stearate—standard tablet binders and fillers.

Does it work?

Couldn't assess
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
Not assessable

We hold no graded evidence for this product's ingredients for its stated purpose.

Why this rating?
  • The label markets this product for: high energy blend of natural herbs.
  • We looked for evidence on: energy and stamina, vitality, general wellness.
  • Our graded evidence for these ingredients doesn't cover that particular purpose.

The evidence for most of Mega Energy's ingredients is sparse or inconclusive. Barley grass shows the strongest support: it's likely effective for lowering cholesterol and supporting heart health.

Korean ginseng is possibly effective for erectile function, sexual arousal, influenza, cognitive function, and multiple sclerosis-related fatigue. Gotu kola is possibly effective for venous insufficiency and burns.

Royal jelly is possibly effective for menopausal symptoms. For the rest—sodium (in the doses here), bee pollen, octacosanol, parsley, guarana, kola nut, alfalfa, inosine, suma, and wheat grass—the evidence is either insufficient to rate or the product uses them for purposes we hold no reliable data on.

If you're considering Mega Energy for a specific health goal, the facts we hold don't support its use for most of those claims.

The evidence, ingredient by ingredient Sodium Bee Pollen Royal Jelly Octacosanol Panax Ginseng Gotu Kola Parsley Guarana

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 13 of the 14 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 14 of 14.
  • General safety write-ups exist for 14 of 14.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Mega Energy's safety profile is mixed and depends heavily on how much you take and your own health history. Sodium, while essential, raises blood pressure and heart strain at high intakes—normal dietary amounts are fine, but avoid supplementing without medical advice.

Bee pollen and royal jelly can trigger severe allergic reactions, including anaphylaxis, especially in people with pollen allergies or asthma; both are generally well tolerated by most people but carry real risk for sensitive individuals. Guarana and kola nut are high in caffeine, which causes insomnia, nervousness, and tremors in some people and can be dangerous at large doses.

Korean ginseng is generally well tolerated for up to 6 months but may cause insomnia, headache, and hormone-like effects long-term. Gotu kola, parsley, alfalfa, and barley grass are generally well tolerated but have rare reports of liver toxicity (gotu kola, parsley), lupus-like syndrome (alfalfa), or allergic reactions.

Inosine raises uric acid, which can trigger gout or kidney stones. Pregnancy and breastfeeding: bee pollen, Korean ginseng, octacosanol, gotu kola, parsley, guarana, kola nut, inosine, suma, and wheat grass each lack enough safety data—talk with your own doctor or pharmacist before use in pregnancy or while nursing.

Alfalfa is possibly unsafe in pregnancy due to its estrogen-like activity.

Side effects, ingredient by ingredient Sodium Bee Pollen Royal Jelly Octacosanol Panax Ginseng Gotu Kola Parsley Guarana

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?
  • 12 of the 14 matched ingredients can interact with medications — Alfalfa, Bee Pollen, Octacosanol, Royal Jelly, Inosine, among others.
  • The most serious interaction on file is rated Major.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; immunosuppressants / transplant drugs; diabetes medications; heart-rhythm medications; lithium; Parkinson's medications.
  • For scale: 1,603 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 Mega Energy, double-check with your own doctor or pharmacist if you take any of these: ephedrine (Major severity—serious risk of heart attack, stroke, seizure); blood pressure medications, blood thinners (warfarin), seizure drugs (carbamazepine, valproate, felbamate), diabetes medications, psychiatric drugs (clozapine), antidepressants (fluvoxamine, MAOIs), gout drugs, heart and blood vessel drugs (beta-blockers, nitroprusside, dipyridamole), diuretics, immune-suppressing drugs, or stress-test medications (dipyridamole). If no interactions are documented for the ingredients we could check, we will tell you plainly—but the data here show multiple Moderate-severity interactions across the product.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFully disclosed formula with no assessable stated purpose. Major medication interactions have been identified, and safety information is well characterized.

Mega Energy is a broad-spectrum energy and herbal supplement with more caffeine and active compounds than many single-ingredient products. It's not a good fit if you take blood pressure medications, blood thinners, seizure drugs, diabetes medications, or psychiatric medications—the interactions are real and can be serious.

If you have pollen allergies, asthma, gout, kidney problems, or are pregnant or breastfeeding, talk with your own doctor or pharmacist before taking it. For most healthy adults with no medications, short-term use of modest doses is generally tolerated, but long-term safety data are limited.

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

Assessment coverage: 14 of 15 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Dec 23, 2011.

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 Mega Energy, straight from the product label.

Brand Naturalist
Barcode (UPC) 030768000707
Net contents 45 Tablet(s)
Market status On market
Date entered into DSLD Dec 23, 2011
DSLD ID 2930
Product type Other Combinations
Supplement form Tablet Or Pill
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 Mega Energy by Naturalist, 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:
2 Tablet(s)
Maximum serving Sizes:
2 Tablet(s)
Servings per container
22
UPC/BARCODE
030768000707
IngredientAmount% DV
Calories5 {Calories}--
Total Carbohydrates1 g1%
Sodium10 mg1%
Bee Pollen16 mg--
Royal Jelly65 mg--
Octacosanol16 mg--
Korean Ginseng extract64 mg--
Gotu Kola extract22 mg--
Parsley16 mg--
Guarana extract225 mg--
Kola Nut extract200 mg--
Phytosterols concentrate27 mg--
Alfalfa16 mg--
Barley Grass16 mg--
Inosine Phosphate16 mg--
Suma16 mg--
Wheat Grass16 mg--

Other ingredients: Whey, Dicalcium Phosphate, Cellulose, Croscarmellose, Stearic Acid, Vegetable Magnesium Stearate

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

Prod. No. 44610 02B R1154-45 B44607 EZG

General Statements

High energy blend of natural herbs

Brand IP Statement(s)

Rexall Sundown

2007

FDA Statement of Identity

Herbal Supplement

Suggested/Recommended/Usage/Directions

Directions: For adults, take two (2) tablets up to 4 times a day. If you have never taken bee products, start with a small serving per day and increase gradually in order to assess whether you are allergic. As a reminder, discuss the medications and supplements you the medications and supplements you take with your health care providers.

Precautions

If you have never taken bee products, start with a small serving per day and increase gradually in order to assess whether you are allergic.

As a reminder, discuss the medications and supplements you take with your health care providers.

Contains milk and wheat ingredients.

Warning: Not intended for use by pregnant or nursing women. If you are taking any medications, consult your doctor before use.

Avoid this product if you are allergic to bees or bee products.

Discontinue use and consult your doctor if any adverse reactions occur.

Not intended for use by persons under the age of 18. Keep out of reach of children.

Tamper Resistant: Do not use if seal under cap is broken or missing.

Formula

Contains milk and wheat ingredients.

Storage

Store in a dry place and avoid excessive heat.

FDA Disclaimer Statement

This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

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

See for yourself

Mega Energy by Naturalist label

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

Mega Energy 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 Mega Energy by Naturalist

These are the 15 active ingredients this product is made of. Select any to open its full monograph.

Serving size2 Tablet(s) Dosage formTablet Or Pill Servings per container22 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.

Sodium

Interacts with
205 drugs
10 mg per serving

Sodium is an essential mineral and electrolyte your body needs to balance fluids, support nerves, and help muscles work. Most people in modern diets g...

Sodium monograph & interactions

Bee Pollen

Interacts with
2 drugs
16 mg per serving

Bee pollen is a nutrient-rich product collected by bees and marketed as a 'superfood' for energy and immune support, but solid human evidence for most...

Bee Pollen monograph & interactions

Royal Jelly

Interacts with
174 drugs
65 mg per serving

Royal jelly is a nutrient-rich substance made by worker bees to feed the queen bee. People take it for menopause symptoms, energy, skin, and immune su...

Royal Jelly monograph & interactions

Octacosanol

Interacts with
248 drugs
16 mg per serving

Octacosanol is a waxy long-chain alcohol from plant sources that is most often promoted for exercise endurance and cholesterol support, but solid huma...

Octacosanol monograph & interactions

Korean Ginseng extract

Interacts with
1,130 drugs
64 mg per serving

Panax ginseng is a popular traditional herb used to boost energy, ease stress, and support overall wellness, though scientific evidence is mixed and m...

Korean Ginseng extract monograph & interactions

Gotu Kola extract

Interacts with
579 drugs
22 mg per serving

Gotu kola is a traditional Ayurvedic and Asian herb that people use for wound healing, circulation, skin problems, and as a calming or memory-supporti...

Gotu Kola extract monograph & interactions

Parsley

Interacts with
443 drugs
16 mg per serving

Parsley is a popular culinary herb that is safe to eat in normal food amounts and is a good source of vitamins K and C. It is traditionally used as a...

Parsley monograph & interactions

Guarana extract

Interacts with
655 drugs
225 mg per serving Form: Caffeine

Guarana is an Amazonian seed that is naturally high in caffeine, which explains most of its stimulant and energy effects. While it may give a short-te...

Guarana extract monograph & interactions

Kola Nut extract

Interacts with
655 drugs
200 mg per serving Form: Caffeine

Cola nut is a caffeine-containing seed from West Africa used mainly as a natural stimulant for energy and alertness. Most of its effects come from caf...

Kola Nut extract monograph & interactions

Phytosterols concentrate

27 mg per serving Form: Soy Bean

Alfalfa

Interacts with
583 drugs
16 mg per serving

Alfalfa is a nutrient-rich legume that people use for high cholesterol, menopause symptoms, and general wellness, but solid human evidence for most of...

Alfalfa monograph & interactions

Barley Grass

Interacts with
1 drug
16 mg per serving

Barley is a nutritious whole grain that is a good source of soluble fiber called beta-glucan, which has solid evidence for modestly lowering LDL ('bad...

Barley Grass monograph & interactions

Inosine Phosphate

Interacts with
9 drugs
16 mg per serving

Inosine is a nucleoside (a building block of DNA and RNA) that the body makes on its own and is also sold as a supplement, mostly marketed for athleti...

Inosine Phosphate monograph & interactions

Suma

No known
interactions
16 mg per serving

Suma is a South American root often marketed as a 'Brazilian ginseng' and used as an adaptogen for energy, stamina, and stress. Human evidence is very...

Suma monograph & interactions

Wheat Grass

No known
interactions
16 mg per serving

Couch grass is a common lawn weed whose rhizome has long been used in traditional European herbal medicine, mainly for urinary and bladder complaints....

Wheat Grass monograph & interactions

Other (inactive) ingredients: Whey, Dicalcium Phosphate, Cellulose, Croscarmellose, Stearic Acid, Vegetable Magnesium Stearate. These complete the product’s ingredient list but are not active constituents.

Interaction report

Mega Energy by Naturalist Drug Interactions

Want to check YOUR meds against Mega Energy?

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
1,602Drugs
10 Major 1,588 Moderate 4 Minor

Ingredients driving the most interactions

Korean Ginseng extract 1,130
Guarana extract 655
Kola Nut extract 655
Alfalfa 583
Gotu Kola extract 579

Individual Drug Interactions

The ingredients in Mega Energy interact with 1,602 drugs. Click any drug to see the details.

12 of the 15 ingredients in Mega Energy interact with drugs. Each result below shows which ingredient is responsible. Korean Ginseng extract Guarana extract Kola Nut extract Alfalfa Gotu Kola extract Parsley Octacosanol Sodium Royal Jelly Inosine Phosphate Bee Pollen Barley Grass

Each ingredient & the kinds of drugs it affects

For each ingredient in Mega Energy 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.

Korean Ginseng extract20 drug types · 1,130 drugs

Anticoagulant/Antiplatelet Drugs

Although Panax ginseng has shown antiplatelet effects in the laboratory, it is unlikely to increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
In vitro evidence suggests that ginsenoside constituents in Panax ginseng might decrease platelet aggregation. However, research in humans suggests that ginseng does not affect platelet aggregation. Animal research indicates low oral bioavailability of Rb1 and rapid elimination of Rg1, which might explain the discrepancy between in vitro and human research. Until more is known, use with caution in patients concurrently taking anticoagulant or antiplatelet drugs.

Likelihood Unlikely Evidence B
Antidiabetes Drugs

Theoretically, taking Panax ginseng with antidiabetes drugs might increase the risk of hypoglycemia.
Clinical research suggests that Panax ginseng might decrease blood glucose levels. Monitor blood glucose levels closely.

Likelihood Probable Evidence B
Caffeine

Theoretically, taking Panax ginseng with caffeine might increase the risk of adverse stimulant effects.
Panax ginseng has been shown to have stimulant effects. Theoretically, caffeine might have an additive effect on the stimulant effects of Panax ginseng.

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

Theoretically, Panax ginseng might increase levels of drugs metabolized by CYP2D6. However, research is conflicting.
There is some evidence that Panax ginseng can inhibit the CYP2D6 enzyme by approximately 6%. In addition, in animal research, Panax ginseng inhibits the metabolism of dextromethorphan, a drug metabolized by CYP2D6, by a small amount. However, contradictory research suggests Panax ginseng might not inhibit CYP2D6. Until more is known, use Panax ginseng cautiously in patients taking drugs metabolized by these enzymes.

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

Theoretically, Panax ginseng might increase or decrease levels of drugs metabolized by CYP3A4.
Panax ginseng may affect the clearance of drugs metabolized by CYP3A4. One such drug is imatinib. Inhibition of CYP3A4 was believed to be responsible for a case of imatinib-induced hepatotoxicity. In contrast, Panax ginseng has been shown to increase the clearance of midazolam, another drug metabolized by CYP3A4. Clinical research shows that Panax ginseng can reduce midazolam area under the curve by 44%, maximum plasma concentration by 26%, and time to reach maximum plasma concentration by 29%. Midazolam metabolism was also increased in animals given Panax ginseng. Until more is known, use Panax ginseng cautiously in combination with CYP3A4 substrates.

Likelihood Possible Evidence B
Estrogens

Theoretically, concomitant use of large amounts of Panax ginseng might interfere with hormone replacement therapy.
Laboratory research and some case reports suggest that Panax ginseng can have estrogenic effects due to competition for estrogen receptors. The estrogenic activity is attributed to the ginsenoside constituents of Panax ginseng.

Likelihood Possible Evidence D
Furosemide (Lasix)

Theoretically, Panax ginseng might reduce the effects of furosemide.
There is some concern that Panax ginseng might contribute to furosemide resistance. There is one case of resistance to furosemide diuresis in a patient taking a germanium-containing ginseng product.

Likelihood Possible Evidence D
Imatinib (Gleevec)

Theoretically, Panax ginseng might increase the effects and adverse effects of imatinib.
A case of imatinib-induced hepatotoxicity has been reported for a 26-year-old male with chronic myelogenous leukemia stabilized on imatinib for 7 years. The patient took imatinib 400 mg along with a Panax ginseng-containing energy drink daily for 3 months. Since imatinib-associated hepatotoxicity typically occurs within 2 years of initiating therapy, it is believed that Panax ginseng affected imatinib toxicity though inhibition of cytochrome P450 3A4. CYP3A4 is the primary enzyme involved in imatinib metabolism.

Likelihood Possible Evidence D
Immunosuppressants

Theoretically, Panax ginseng use might interfere with immunosuppressive therapy.
Panax ginseng might have immune system stimulating properties.

Likelihood Possible Evidence B
Insulin

Theoretically, taking Panax ginseng with insulin might increase the risk of hypoglycemia.
Clinical research suggests that Panax ginseng might decrease blood glucose levels. Insulin dose adjustments might be necessary in patients taking Panax ginseng; use with caution.

Likelihood Probable Evidence B
Midazolam (Versed)

Theoretically, Panax ginseng may increase the clearance of midazolam.
Midazolam is metabolized by cytochrome P450 3A4 (CYP3A4). Clinical research suggests that Panax ginseng can reduce midazolam area under the curve by 44%, maximum plasma concentration by 26%, and time to reach maximum plasma concentration by 29%. Midazolam metabolism was also increased in animals given Panax ginseng.

Likelihood Probable Evidence B
Monoamine Oxidase Inhibitors (Maois)

Theoretically, Panax ginseng can interfere with MAOI therapy.
Concomitant use of Panax ginseng with phenelzine (Nardil) is associated with insomnia, headache, tremors, and hypomania.

Likelihood Probable Evidence D
Nifedipine (Procardia)

Theoretically, taking Panax ginseng with nifedipine might increase serum levels of nifedipine and the risk of hypotension.
Preliminary clinical research shows that concomitant use can increase serum levels of nifedipine in healthy volunteers. This might cause the blood pressure lowering effects of nifedipine to be increased when taken concomitantly with Panax ginseng.

Likelihood Possible Evidence B
Qt Interval-Prolonging Drugs

Theoretically, Panax ginseng has an additive effect with drugs that prolong the QT interval and potentially increase the risk of ventricular arrhythmias. However, research is conflicting.
Clinical research shows that short-term use of Panax ginseng can increase the QT interval. However, no changes in QT interval have been identified with prolonged use.

Likelihood Possible Evidence B
Raltegravir (Isentress)

Theoretically, taking Panax ginseng with raltegravir might increase the risk of liver toxicity.
A case report suggests that concomitant use of Panax ginseng with raltegravir can increase serum levels of raltegravir, resulting in elevated liver enzymes levels.

Likelihood Possible Evidence D
Selegiline (Eldepryl)

Theoretically, Panax ginseng might increase or decrease levels of selegiline, possibly altering the effects and side effects of selegiline.
Animal research shows that taking selegiline with a low dose of Panax ginseng extract (1 gram/kg) reduces selegiline bioavailability, while taking a high dose of Panax ginseng extract (3 grams/kg) increases selegiline bioavailability. More research is needed to confirm these effects.

Likelihood Possible Evidence D
Stimulant Drugs

Theoretically, taking Panax ginseng with stimulant drugs might increase the risk of adverse stimulant effects.
Panax ginseng has been shown to have stimulant effects.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Panax ginseng might affect the clearance of warfarin. However, this interaction appears to be unlikely.
There has been a single case report of decreased effectiveness of warfarin in a patient who also took Panax ginseng. However, it is questionable whether Panax ginseng was the cause of this decrease in warfarin effectiveness. Some research in humans and animals suggests that Panax ginseng does not affect the pharmacokinetics of warfarin. However, other research in humans suggests that Panax ginseng might modestly increase the clearance of the S-warfarin isomer. More evidence is needed to determine whether Panax ginseng causes a significant interaction with warfarin.

Likelihood Unlikely Evidence B
Fexofenadine (Allegra)

Theoretically, Panax ginseng might decrease blood levels of oral or intravenous fexofenadine.
Animal research suggests that taking Panax ginseng in combination with oral or intravenous fexofenadine may reduce the bioavailability of fexofenadine. Some scientists have attributed this effect to the ability of Panax ginseng to increase the expression of P-glycoprotein.

Likelihood Possible Evidence D
Lopinavir/Ritonavir (Kaletra)

Although Panax ginseng has demonstrated variable effects on cytochrome P450 3A4 (CYP3A4), which metabolizes lopinavir, Panax ginseng is unlikely to alter levels of lopinavir/ritonavir.
Lopinavir is metabolized by CYP3A4 and is administered with the CYP3A4 inhibitor ritonavir to increase its plasma concentrations. Panax ginseng has shown variable effects on CYP3A4 activity in humans. However, taking Panax ginseng (Vitamer Laboratories) 500 mg twice daily for 14 days did not alter the pharmacokinetics of lopinavir/ritonavir in 12 healthy volunteers.

Likelihood Unlikely Evidence B
Korean Ginseng extract full monograph & interactions

Guarana extract41 drug types · 655 drugs

Ephedrine

Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Guarana contains caffeine. Use of ephedrine with caffeine can increase the risk of stimulatory adverse effects. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death.

Likelihood Probable Evidence D
Adenosine (Adenocard)

Theoretically, guarana might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Guarana contains caffeine. Caffeine is a competitive inhibitor of adenosine at the cellular level. However, caffeine does not seem to affect supplemental adenosine because high interstitial levels of adenosine overcome the antagonistic effects of caffeine. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. However, methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.

Likelihood Possible Evidence B
Anticoagulant/Antiplatelet Drugs

Theoretically, guarana may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
In vitro and animal research suggests that guarana extract can inhibit platelet aggregation. This effect may be due to the caffeine in guarana, which is also reported to have antiplatelet activity. This interaction has not been reported in humans.

Likelihood Possible Evidence D
Beta-Adrenergic Agonists

Theoretically, concomitant use might increase the clinical effects of beta-adrenergic agonists.
Guarana contains caffeine. Theoretically, concomitant use of large amounts of caffeine might increase cardiac inotropic effects of beta-agonists.

Likelihood Probable Evidence D
Carbamazepine (Tegretol)

Theoretically, guarana might reduce the effects of carbamazepine and increase the risk for convulsions.
Animal research suggests that taking caffeine can lower the anticonvulsant effects of carbamazepine and can induce seizures when given to animals in doses above 400 mg/kg. Human research has shown that taking caffeine 300 mg in three divided doses along with carbamazepine 200 mg reduces the bioavailability of carbamazepine by 32% and prolongs the plasma half-life of carbamazepine two-fold in healthy individuals.

Likelihood Possible Evidence D
Cimetidine (Tagamet)

Theoretically, concomitant use might increase the effects and adverse effects of caffeine in guarana.
Guarana contains caffeine. Cimetidine decreases the rate of caffeine clearance by 31% to 42%.

Likelihood Likely Evidence B
Clozapine (Clozaril)

Theoretically, guarana might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
Guarana contains caffeine. Caffeine can increase the effects and toxicity of clozapine. Caffeine doses of 400-1000 mg per day inhibit clozapine metabolism. Clozapine is metabolized by cytochrome P450 1A2 (CYP1A2). Researchers speculate that caffeine might inhibit CYP1A2. However, there is no reliable evidence that caffeine affects CYP1A2. There is also speculation that genetic factors might make some patients more sensitive to the interaction between clozapine and caffeine.

Likelihood Possible Evidence B
Dipyridamole (Persantine)

Theoretically, guarana might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Guarana contains caffeine. Caffeine might inhibit dipyridamole-induced vasodilation. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. Methylxanthines appear more likely to interfere with dipyridamole than adenosine-induced stress testing.

Likelihood Probable Evidence B
Disulfiram (Antabuse)

Theoretically, disulfiram might increase the risk of adverse effects from caffeine.
In human research, disulfiram decreases the clearance and increases the half-life of caffeine.

Likelihood Probable Evidence D
Diuretic Drugs

Theoretically, using guarana with diuretic drugs might increase the risk of hypokalemia.
Guarana contains caffeine. Caffeine, especially in excessive amounts, can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also lower potassium levels.

Likelihood Possible Evidence D
Estrogens

Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Guarana contains caffeine. Estrogen inhibits caffeine metabolism.

Likelihood Probable Evidence B
Ethosuximide (Zarontin)

Theoretically, guarana might reduce the effects of ethosuximide and increase the risk for convulsions.
Guarana contains caffeine. Animal research shows that caffeine 92.4 mg/kg can decrease the anticonvulsant activity of ethosuximide. This effect has not been observed in humans.

Likelihood Possible Evidence D
Felbamate (Felbatol)

Theoretically, guarana might reduce the effects of felbamate and increase the risk for convulsions.
Guarana contains caffeine. Animal research shows that a high dose of caffeine 161.7 mg/kg can decreases the anticonvulsant activity of felbamate. This effect has not been observed in humans.

Likelihood Possible Evidence D
Flutamide (Eulexin)

Theoretically, guarana might increase the levels and adverse effects of flutamide.
Guarana contains caffeine. In vitro evidence shows that caffeine can inhibit the metabolism of flutamide. However, this effect has not been reported in humans.

Likelihood Probable Evidence D
Fluvoxamine (Luvox)

Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Guarana contains caffeine. Fluvoxamine reduces caffeine metabolism.

Likelihood Probable Evidence D
Lithium

Theoretically, abrupt guarana withdrawal might increase the levels and adverse effects of lithium.
Guarana contains caffeine. Theoretically, abrupt caffeine withdrawal might increase serum lithium levels. There are two case reports of lithium tremor that worsened upon abrupt coffee withdrawal.

Likelihood Probable Evidence D
Monoamine Oxidase Inhibitors (Maois)

Theoretically, concomitant use might increase the risk of a hypertensive crisis.
Guarana contains caffeine. Caffeine has been shown to inhibit MAO-A and -B in laboratory studies. Concomitant intake of large amounts of caffeine with MAOIs might precipitate a hypertensive crisis. In a case report, a patient that consumed 10-12 cups of caffeinated coffee and took the MAOI tranylcypromine presented with severe hypertension. Hypertension was resolved after the patient switched to drinking decaffeinated coffee.

Likelihood Possible Evidence D
Nicotine

Theoretically, concomitant use might increase the risk of hypertension.
Guarana contains caffeine. Concomitant use of caffeine and nicotine has been shown to have additive cardiovascular effects, including increased heart rate and blood pressure. Blood pressure was increased by 10.8/12.4 mmHg when the agents were used concomitantly.

Likelihood Probable Evidence D
Pentobarbital (Nembutal)

Theoretically, guarana might decrease the effects of pentobarbital.
Guarana contains caffeine. In vivo evidence suggests that caffeine can negate the hypnotic effects of pentobarbital in humans. However, animal research suggests that guarana does not alter the hypnotic effect of pentobarbital.

Likelihood Possible Evidence B
Phenobarbital (Luminal)

Theoretically, guarana might reduce the effects of phenobarbital and increase the risk for convulsions.
Guarana contains caffeine. Animal research shows that caffeine can decrease the anticonvulsant activity of phenobarbital. The exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D
Phenylpropanolamine

Theoretically, phenylpropanolamine might increase the risk of hypertension, as well as the levels and adverse effects of caffeine.
Guarana contains caffeine. Concomitant use of phenylpropanolamine and caffeine might cause an additive increase in blood pressure. Phenylpropanolamine also seems to increase caffeine serum levels.

Likelihood Probable Evidence B
Phenytoin (Dilantin)

Theoretically, guarana might reduce the effects of phenytoin and increase the risk for convulsions.
Guarana contains caffeine. Animal research shows that caffeine can decrease the anticonvulsant activity of phenytoin. The effect does not seem to be related to the seizure threshold-lowering effects of caffeine. However, the exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D
Pioglitazone (Actos)

Theoretically, guarana might increase the levels and clinical effects of pioglitazone.
Guarana contains caffeine. Animal research suggests that caffeine can modestly increase the maximum concentration, area under the curve, and half-life of pioglitazone, and also reduce its clearance. This increased the antidiabetic effects of pioglitazone. However, the exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D
Riluzole (Rilutek)

Theoretically, concomitant use might increase the levels and adverse effects of both caffeine and riluzole.
Guarana contains caffeine. Caffeine and riluzole are both metabolized by cytochrome P450 1A2 (CYP1A2), and concomitant use might reduce the metabolism of one or both agents.

Likelihood Possible Evidence D
Stimulant Drugs

Theoretically, concomitant use might increase stimulant adverse effects.
Guarana contains caffeine. Due to the central nervous system (CNS) stimulant effects of caffeine, concomitant use with stimulant drugs can increase the risk of adverse effects.

Likelihood Possible Evidence D
Guarana extract full monograph & all 41 interactions

Kola Nut extract41 drug types · 655 drugs

Adenosine (Adenocard)

Theoretically, cola nut might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Cola nut contains caffeine. Caffeine is a competitive inhibitor of adenosine at the cellular level. However, caffeine does not seem to affect supplemental adenosine because high interstitial levels of adenosine overcome the antagonistic effects of caffeine. It is recommended that methylxanthines and methylxanthine-containing products (including cola nut) be stopped 24 hours prior to pharmacological stress tests. However, methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.

Likelihood Possible Evidence B
Alcohol (Ethanol)

Theoretically, alcohol might increase the levels and adverse effects of the caffeine in cola nut.
Cola nut contains caffeine. Concomitant use of alcohol and caffeine can increase caffeine serum concentrations and the risk of caffeine adverse effects. Alcohol reduces caffeine metabolism.

Likelihood Probable Evidence D
Anticoagulant/Antiplatelet Drugs

Theoretically, cola nut may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Cola nut contains caffeine. Caffeine is reported to have antiplatelet activity. This interaction has not been reported in humans.

Likelihood Unlikely Evidence D
Beta-Adrenergic Agonists

Theoretically, the caffeine in cola nut might increase the clinical effects of beta-adrenergic agonists.
Cola nut contains caffeine. Theoretically, concomitant use of large amounts of caffeine might increase the cardiac inotropic effects of beta-agonists.

Likelihood Probable Evidence D
Carbamazepine (Tegretol)

Theoretically, cola nut might reduce the effects of carbamazepine and increase the risk for convulsions.
Cola nut contains caffeine. Animal research suggests that taking caffeine can lower the anticonvulsant effects of carbamazepine and can induce seizures when taken in doses above 400 mg/kg. Human research has shown that taking caffeine 300 mg in three divided doses along with carbamazepine 200 mg reduces the bioavailability of carbamazepine by 32% and prolongs the plasma half-life of carbamazepine 2-fold in healthy individuals.

Likelihood Possible Evidence D
Clozapine (Clozaril)

Theoretically, cola nut might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
Cola nut contains caffeine. Caffeine can increase the effects and toxicity of clozapine. Caffeine doses of 400-1000 mg daily inhibit clozapine metabolism. Clozapine is metabolized by cytochrome P450 1A2 (CYP1A2). Researchers speculate that caffeine might inhibit CYP1A2. However, there is no reliable evidence that caffeine affects CYP1A2. There is also speculation that genetic factors might make some patients more sensitive to the interaction between clozapine and caffeine.

Likelihood Possible Evidence B
Cytochrome P450 1A2 (Cyp1A2) Inhibitors

Theoretically, CYP1A2 inhibitors might increase the levels and adverse effects of the caffeine in cola nut.
Cola nut contains caffeine. Caffeine is metabolized by CYP1A2,.

Likelihood Possible Evidence D
Dipyridamole (Persantine)

Theoretically, cola nut might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Cola nut contains caffeine. Caffeine may inhibit dipyridamole-induced vasodilation. It is recommended that methylxanthines and methylxanthine-containing products, such as cola nut, be stopped 24 hours prior to pharmacological stress tests. Methylxanthines appear more likely to interfere with dipyridamole than with adenosine-induced stress testing.

Likelihood Probable Evidence B
Disulfiram (Antabuse)

Theoretically, disulfiram might increase the levels and adverse effects of the caffeine in cola nut.
Cola nut contains caffeine. In human research, disulfiram decreases the rate of caffeine clearance.

Likelihood Probable Evidence D
Diuretic Drugs

Theoretically, using cola nut with diuretic drugs might increase the risk of hypokalemia.
Cola nut contains caffeine. In excessive amounts, caffeine can reduce potassium levels due to stimulation of the sodium-potassium pump. Certain diuretics can also lower potassium levels.

Likelihood Possible Evidence D
Ephedrine

Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Cola nut contains caffeine. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death.

Likelihood Possible Evidence D
Estrogens

Theoretically, estrogens might increase the levels and adverse effects of the caffeine in cola nut.
Cola nut contains caffeine. Estrogen inhibits caffeine metabolism.

Likelihood Probable Evidence B
Ethosuximide (Zarontin)

Theoretically, cola nut might reduce the effects of ethosuximide and increase the risk for convulsions.
Cola nut contains caffeine. Animal research suggests that caffeine 92.4 mg/kg can decrease the anticonvulsant activity of ethosuximide. However, this effect has not been reported in humans

Likelihood Possible Evidence D
Felbamate (Felbatol)

Theoretically, cola nut might reduce the effects of felbamate and increase the risk for convulsions.
Cola nut contains caffeine. Animal research suggests that a high dose of caffeine 161.7 mg/kg can decreases the anticonvulsant activity of felbamate. However, this effect has not been reported in humans.

Likelihood Possible Evidence D
Flutamide (Eulexin)

Theoretically, cola nut might increase the levels and adverse effects of flutamide.
Cola nut contains caffeine. In vitro evidence suggests that caffeine can inhibit the metabolism of flutamide. This effect has not been reported in humans.

Likelihood Possible Evidence D
Fluvoxamine (Luvox)

Theoretically, fluvoxamine might increase the levels and adverse effects of the caffeine in cola nut.
Cola nut contains caffeine. Fluvoxamine reduces caffeine metabolism.

Likelihood Probable Evidence D
Lithium

Theoretically, abrupt cola nut withdrawal might increase the levels and adverse effects of lithium.
Cola nut contains caffeine. Abrupt caffeine withdrawal can increase serum lithium levels. There are two case reports of lithium tremor that worsened upon abrupt coffee withdrawal.

Likelihood Probable Evidence D
Monoamine Oxidase Inhibitors (Maois)

Theoretically, concomitant use might increase the risk of a hypertensive crisis.
Cola nut contains caffeine. Caffeine has been shown to inhibit monoamine oxidase (MAO) A and B in laboratory studies. Concomitant intake of large amounts of caffeine with MAOIs might precipitate a hypertensive crisis. In a case report, a patient that consumed 10-12 cups of caffeinated coffee and took the MAOI tranylcypromine presented with severe hypertension. Hypertension was resolved after the patient switched to drinking decaffeinated coffee.

Likelihood Possible Evidence D
Nicotine

Theoretically, concomitant use might increase the risk of hypertension.
Cola nut contains caffeine. Concomitant use of caffeine and nicotine has been shown to have additive cardiovascular effects, including increased heart rate and blood pressure. Blood pressure was increased by 10.8/12.4 mmHg when the agents were used concomitantly.

Likelihood Probable Evidence D
Pentobarbital (Nembutal)

Theoretically, cola nut might decrease the effects of pentobarbital.
Cola nut contains caffeine. Theoretically, caffeine might negate the hypnotic effects of pentobarbital.

Likelihood Possible Evidence B
Phenobarbital (Luminal)

Theoretically, cola nut might reduce the effects of phenobarbital and increase the risk for convulsions.
Cola nut contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of phenobarbital. However, this effect has not been reported in humans.

Likelihood Possible Evidence D
Phenylpropanolamine

Theoretically, phenylpropanolamine might increase the risk of hypertension, as well as the levels and adverse effects of the caffeine in cola nut.
Cola nut contains caffeine. Concomitant use of phenylpropanolamine and caffeine might cause an additive increase in blood pressure. Phenylpropanolamine also seems to increase caffeine serum levels.

Likelihood Probable Evidence B
Phenytoin (Dilantin)

Theoretically, cola nut might reduce the effects of phenytoin and increase the risk for convulsions.
Cola nut contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of phenytoin. The effect does not seem to be related to the seizure threshold-lowering effects of caffeine. However, the exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D
Pioglitazone (Actos)

Theoretically, cola nut might increase the levels and clinical effects of pioglitazone.
Cola nut contains caffeine. Animal research suggests that caffeine can modestly increase the maximum concentration, area under the curve, and half-life of pioglitazone, and also reduce its clearance. This increased the antidiabetic effects of pioglitazone. However, the exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D
Quinolone Antibiotics

Theoretically, quinolone antibiotics might increase the levels and adverse effects of the caffeine in cola nut.
Cola nut contains caffeine. Quinolones (also called fluoroquinolones) can decrease caffeine clearance by inhibiting cytochrome P450 1A2 (CYP1A2).

Likelihood Probable Evidence B
Kola Nut extract full monograph & all 41 interactions

Alfalfa6 drug types · 583 drugs

Warfarin (Coumadin)

Theoretically, alfalfa might reduce the anticoagulant activity of warfarin.
Alfalfa contains a large amount of vitamin K. This could theoretically interfere with the activity of warfarin.

Likelihood Probable Evidence D
Antidiabetes Drugs

Theoretically, alfalfa might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Animal research suggests that alfalfa decreases blood sugar in diabetic mice. Also, in one case report, a diabetic patient experienced hypoglycemia after consuming alfalfa extract. Monitor blood glucose levels closely. Dose adjustments might be necessary.

Likelihood Possible Evidence D
Contraceptive Drugs

Theoretically, alfalfa might interfere with the activity of contraceptive drugs.
Alfalfa contains coumestrol, a phytoestrogen, and isoflavonoids, which have estrogenic effects.

Likelihood Possible Evidence D
Estrogens

Theoretically, alfalfa might interfere with hormone therapy.
Alfalfa contains coumestrol, a phytoestrogen, and isoflavonoids, which have estrogenic effects.

Likelihood Possible Evidence D
Immunosuppressants

Theoretically, alfalfa might decrease the efficacy of immunosuppressive therapy.
In vitro research and human case reports suggest that alfalfa may have immunostimulant effects.

Likelihood Possible Evidence D
Photosensitizing Drugs

Theoretically, concomitant use of alfalfa with photosensitizing drugs might have additive effects.
Animal research suggests that excessive doses of alfalfa may increase photosensitivity, possibly due to its chlorophyll content. It is unclear if this effect would be clinically relevant in humans.

Likelihood Possible Evidence D
Alfalfa full monograph & interactions

Gotu Kola extract2 drug types · 579 drugs

Cns Depressants

Theoretically, taking gotu kola might increase the sedative effects of CNS depressants.
In vitro research suggests that gotu kola may have sedative effects via binding of GABA receptors.

Likelihood Possible Evidence D
Hepatotoxic Drugs

Theoretically, taking gotu kola with hepatotoxic drugs might have additive adverse effects.
There are at least four case reports of hepatotoxicity associated with the use of gotu kola. However, more information is needed to determine if gotu kola was the causative factor in these cases.

Likelihood Possible Evidence D
Gotu Kola extract full monograph & interactions

Parsley8 drug types · 443 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, parsley might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.
Animal research suggests that parsley has antiplatelet effects.

Likelihood Possible Evidence D
Antidiabetes Drugs

Theoretically, parsley might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Animal research suggests that parsley might decrease blood glucose. Monitor blood glucose levels closely. Dose adjustments might be necessary.

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

Theoretically, parsley might increase serum levels of CYP1A2 substrates.
Laboratory research suggests that parsley can inhibit CYP1A2.

Likelihood Possible Evidence D
Diuretic Drugs

Theoretically, parsley might enhance or interfere with the effects of diuretic drugs.
Animal research suggests that parsley seed extract increases urine elimination. Parsley leaf and root might also interfere with diuretic therapy due their purported aquaretic effects.

Likelihood Possible Evidence D
Pentobarbital (Nembutal)

Theoretically, parsley might increase the duration of pentobarbital effects.
Animal research suggests that parsley juice prolongs the action of pentobarbital, perhaps by decreasing cytochrome P450 levels. It is not known if this occurs in humans or if this applies to other barbiturates or sedatives.

Likelihood Possible Evidence D
Sirolimus (Rapamune)

Theoretically, large quantities of parsley might increase sirolimus levels.
In one case report, an adult female with a history of kidney transplant presented with elevated blood sirolimus levels, approximately 4-7 times greater than previous measures, after daily consumption of a juice containing approximately 30 grams of parsley for 7 days. Sirolimus levels returned to normal a week after the parsley juice was discontinued.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, large amounts of parsley leaf and root might decrease the effects of warfarin.
Parlsey contains vitamin K.

Likelihood Possible Evidence D
Aspirin

Theoretically, aspirin might increase the severity of allergic reactions to parsley.
In one case, severe urticaria and swelling were reported after taking aspirin with parsley in an individual with a known mild parsley allergy.

Likelihood Unlikely Evidence D
Parsley full monograph & interactions

Octacosanol7 drug types · 248 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, octacosanol might inhibit platelet aggregation; however, clinical research suggests that this effect may not be clinically significant.
Octacosanol is the main component of policosanol. Some clinical research shows that taking policosanol 10-50 mg daily for 7-15 days can inhibit platelet aggregation in healthy patients. However, one clinical trial shows that taking policosanol 10 mg twice daily for 2 weeks prior to initiating warfarin does not affect warfarin pharmacokinetics or warfarin response. Furthermore, a study in patients undergoing percutaneous coronary intervention with a drug-eluting stent found that taking policosanol 40 mg plus clopidogrel and aspirin daily for 30 days modestly reduced the risk for minor bleeding events when compared with taking clopidogrel and aspirin alone.

Likelihood Possible Evidence B
Antidiabetes Drugs

Theoretically, octacosanol might have additive effects when used in combination with antidiabetes drugs.
Octacosanol is the main component of policosanol. In humans, policosanol can decrease blood glucose. It is not clear if these effects occur with the use of octacosanol.

Likelihood Possible Evidence B
Beta-Blockers

Theoretically, concomitant use of octacosanol with beta-blockers might result in additive hypotensive effects.
Octacosanol is the main component of policosanol. Clinical research shows that policosanol 5 mg daily can have additive blood pressure-lowering effects in patients with hypertension who are taking beta-blockers. Also, animal research shows that policosanol can increase the hypotensive effects of propranolol. It is not clear if these effects occur with the use of octacosanol.

Likelihood Probable Evidence A
Levodopa/Carbidopa (Sinemet)

Concomitant use may worsen symptoms of Parkinson disease.
One small clinical study suggests that octacosanol might worsen dyskinesias and increase nervous tension in some patients being treated with levodopa/carbidopa.

Likelihood Probable Evidence D
Nitroprusside (Nitropress)

Theoretically, octacosanol might enhance the hypotensive effects of nitroprusside.
Octacosanol is the main component of policosanol. Animal research shows that taking policosanol along with nitroprusside can increase the hypotensive effects of nitroprusside. It is not clear if these effects occur with the use of octacosanol.

Likelihood Possible Evidence D
Propranolol (Inderal)

Theoretically, octacosanol might enhance the hypotensive effects of propranolol.
Octacosanol is the main component of policosanol. Animal research shows that taking policosanol along with propranolol can increase the blood pressure-lowering effects of propranolol. It is not clear if these effects occur with the use of octacosanol.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, octacosanol might inhibit platelet aggregation; however, clinical research suggests that this effect may not be clinically significant.
Octacosanol is the main component of policosanol. Some clinical research shows that taking policosanol 10-50 mg daily for 7-15 days can inhibit platelet aggregation in healthy patients. Therefore, there is concern that taking policosanol with warfarin might increase the risk of bruising and bleeding. However, one clinical trial shows that taking policosanol 10 mg twice daily for 2 weeks prior to warfarin dosing does not affect warfarin pharmacokinetics or warfarin response. It is not clear if these effects occur with the use of octacosanol.

Likelihood Possible Evidence B
Octacosanol full monograph & interactions

Sodium7 drug types · 205 drugs

Antihypertensive Drugs

Theoretically, a high intake of dietary sodium might reduce the effectiveness of antihypertensive drugs.
High intake of dietary sodium can increase systolic and diastolic blood pressure. Also, high intake of sodium may necessitate increased use of antihypertensive medications to achieve blood pressure control in some patients, such as those with chronic kidney disease.

Likelihood Probable Evidence A
Corticosteroids

Concomitant use of mineralocorticoids and some glucocorticoids with sodium supplements might increase the risk of hypernatremia.
Mineralocorticoids and some glucocorticoids (corticosteroids) cause sodium retention. This effect is dose-related and depends on mineralocorticoid potency. It is most common with hydrocortisone, cortisone, and fludrocortisone, followed by prednisone and prednisolone.

Likelihood Possible Evidence D
Didanosine (Videx)

Concomitant use of didanosine with additional sodium from dietary or supplemental sources may increase the risk of hypernatremia.
Didanosine formulations contain a significant amount of sodium.

Likelihood Probable Evidence C
Lithium

Altering dietary intake of sodium might alter the levels and clinical effects of lithium.
High sodium intake can reduce plasma concentrations of lithium by increasing lithium excretion. Reducing sodium intake can significantly increase plasma concentrations of lithium and cause lithium toxicity in patients being treated with lithium carbonate. Stabilizing sodium intake is shown to reduce the percentage of patients with lithium level fluctuations above 0.8 mEq/L. Patients taking lithium should avoid significant alterations in their dietary intake of sodium.

Likelihood Probable Evidence B
Sodium Phosphates

Theoretically, concomitant use of sodium phosphate with sodium supplements might increase the risk of hypernatremia.
Use of high doses (> 45 mL in 24 hours) of sodium phosphate, such as those used for bowel cleansing before surgery, can lead to serious electrolyte disturbances, including hypernatremia. The risk of hypernatremia is highest in the elderly and people with other risk factors for electrolyte disturbances.

Likelihood Possible Evidence D
Sodium-Containing Drugs

Concomitant use of sodium-containing drugs with additional sodium from dietary or supplemental sources may increase the risk of hypernatremia and long-term sodium-related complications.
The Chronic Disease Risk Reduction (CDRR) intake level of 2.3 grams of sodium daily indicates the intake at which it is believed that chronic disease risk increases for the apparently healthy population. Some medications contain high quantities of sodium. When used in conjunction with sodium supplements or high-sodium diets, the CDRR may be exceeded. Additionally, concomitant use may increase the risk for hypernatremia; this risk is highest in the elderly and people with other risk factors for electrolyte disturbances.

Likelihood Possible Evidence D
Tolvaptan (Samsca)

Theoretically, concomitant use of tolvaptan with sodium might increase the risk of hypernatremia.
Tolvaptan is a vasopressin receptor 2 antagonist that is used to increase sodium levels in patients with hyponatremia. Patients taking tolvaptan should use caution with the use of sodium salts such as sodium chloride.

Likelihood Probable Evidence C
Sodium full monograph & interactions

Royal Jelly2 drug types · 174 drugs

Antihypertensive Drugs

Theoretically, royal jelly might increase the risk of hypotension when taken with antihypertensive drugs.
Animal research suggests that royal jelly might lower blood pressure.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Royal jelly might increase the risk of bleeding when taken with warfarin.
In one case, an 87-year-old male who was previously stabilized on warfarin developed hematuria and was found to have an INR of 7.29 after taking a royal jelly supplement for one week.

Likelihood Possible Evidence D
Royal Jelly full monograph & interactions

Inosine Phosphate1 drug type · 9 drugs

Antigout Drugs

Inosine might reduce the effects of antigout medications.
Inosine increases uric acid levels in the serum and urine, potentially resulting in hyperuricemia and reducing the effects of medications used for the prevention and treatment of gout.

Likelihood Possible Evidence D
Inosine Phosphate full monograph & interactions

Bee Pollen1 drug type · 2 drugs

Warfarin (Coumadin)

There is some concern that bee pollen might interact with warfarin and increase the risk of bleeding.
In one case report, a patient on warfarin had a stable international normalized ratio (INR) of 1.9-3.3 for 9 months. The patient's INR was found to be 7.1 after starting bee pollen granules one teaspoon twice daily for approximately one month. The patient's warfarin dose was decreased by approximately 11% in order to return the INR to the therapeutic range while continuing the bee pollen supplement.

Likelihood Possible Evidence D
Bee Pollen full monograph & interactions

Barley Grass1 drug type · 1 drug

Triclabendazole (Egaten)

Theoretically, barley might decrease the clinical effects of triclabendazole.
Animal research suggests that a diet supplemented with barley can reduce the bioavailability of triclabendazole when taken concomitantly. This effect has not been shown in humans.

Likelihood Possible Evidence D
Barley Grass full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Mega Energy, from the product label.

Naturalist

See all Naturalist products
Name
Rexall Sundown, Inc.
City
Boca Raton
State
FL
ZipCode
33487
Pharmacist Counseling Corner

Mega Energy by Naturalist: Common Questions

Does Mega Energy by Naturalist interact with any medications?
Yes. Based on its ingredients, Mega Energy has a known interaction with 1,602 medications, including 10 rated major. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Mega Energy contains 15 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 Mega Energy if I'm on a blood thinner like warfarin?
No, not without checking with your own doctor or pharmacist first. Alfalfa, bee pollen, royal jelly, and parsley in this product may all interfere with warfarin or increase bleeding risk. Your doctor may need to monitor your blood levels or adjust your dose.
Does this product have a lot of caffeine?
Yes. Guarana extract and kola nut extract are both high in caffeine. If you're sensitive to caffeine, you may experience insomnia, nervousness, tremors, or headache. Avoid taking it late in the day or combining it with other caffeinated products.
Is Mega Energy safe during pregnancy?
Most of the ingredients lack enough safety data in pregnancy. Alfalfa is possibly unsafe because it has estrogen-like activity. Bee pollen is possibly unsafe, and guarana has mixed data. Talk with your own doctor or pharmacist before taking it while pregnant.
What is bee pollen supposed to do in this formula?
Bee pollen is traditionally used as a general tonic and energy support, but the evidence is weak. It can trigger serious allergic reactions in people with pollen allergies or asthma, so if you have either, be cautious.
Will this help me lose weight or build muscle?
The product facts we hold don't show reliable evidence that any of these ingredients work for weight loss or muscle building. Guarana and kola nut may give you a stimulant boost, but that's not the same as addressing body composition.
Can I take this with my diabetes medication?
Potentially not—several ingredients (parsley, alfalfa, and Korean ginseng) may lower blood sugar and could increase your risk of low blood sugar if combined with diabetes drugs. Talk with your own doctor or pharmacist before starting it, and monitor your blood glucose 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.

Mega Energy label
Go deeper

The Full Monographs Behind Mega Energy’s Ingredients

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

Herb & supplement monograph

Sodium

Interacts with 205 drugs

Sodium is an essential mineral and electrolyte your body needs to balance fluids, support nerves, and help muscles work. Most people in modern diets get more than enough—often too much—from...

Read the full Sodium monograph → Herb & supplement monograph

Bee Pollen

Interacts with 2 drugs

Bee pollen is a nutrient-rich product collected by bees and marketed as a 'superfood' for energy and immune support, but solid human evidence for most of these claims is lacking. It can caus...

Read the full Bee Pollen monograph → Herb & supplement monograph

Royal Jelly

Interacts with 174 drugs

Royal jelly is a nutrient-rich substance made by worker bees to feed the queen bee. People take it for menopause symptoms, energy, skin, and immune support, but solid human evidence is limit...

Read the full Royal Jelly monograph → Herb & supplement monograph

Octacosanol

Interacts with 248 drugs

Octacosanol is a waxy long-chain alcohol from plant sources that is most often promoted for exercise endurance and cholesterol support, but solid human evidence is limited and results are mi...

Read the full Octacosanol monograph → Herb & supplement monograph

Panax Ginseng

Interacts with 1,130 drugs

Panax ginseng is a popular traditional herb used to boost energy, ease stress, and support overall wellness, though scientific evidence is mixed and mostly preliminary. It is generally well...

Read the full Panax Ginseng monograph → Herb & supplement monograph

Gotu Kola

Interacts with 579 drugs

Gotu kola is a traditional Ayurvedic and Asian herb that people use for wound healing, circulation, skin problems, and as a calming or memory-supporting herb. Some early studies suggest poss...

Read the full Gotu Kola monograph → Herb & supplement monograph

Parsley

Interacts with 443 drugs

Parsley is a popular culinary herb that is safe to eat in normal food amounts and is a good source of vitamins K and C. It is traditionally used as a diuretic and for digestion, but solid hu...

Read the full Parsley monograph → Herb & supplement monograph

Guarana

Interacts with 655 drugs

Guarana is an Amazonian seed that is naturally high in caffeine, which explains most of its stimulant and energy effects. While it may give a short-term boost in alertness and reduce fatigue...

Read the full Guarana monograph → Herb & supplement monograph

Cola Nut

Interacts with 655 drugs

Cola nut is a caffeine-containing seed from West Africa used mainly as a natural stimulant for energy and alertness. Most of its effects come from caffeine, and strong human evidence for spe...

Read the full Cola Nut monograph → Herb & supplement monograph

Alfalfa

Interacts with 583 drugs

Alfalfa is a nutrient-rich legume that people use for high cholesterol, menopause symptoms, and general wellness, but solid human evidence for most of these uses is limited. It is best avoid...

Read the full Alfalfa monograph → Herb & supplement monograph

Barley

Interacts with 1 drug

Barley is a nutritious whole grain that is a good source of soluble fiber called beta-glucan, which has solid evidence for modestly lowering LDL ('bad') cholesterol when eaten regularly. It...

Read the full Barley monograph → Herb & supplement monograph

Inosine

Interacts with 9 drugs

Inosine is a nucleoside (a building block of DNA and RNA) that the body makes on its own and is also sold as a supplement, mostly marketed for athletic performance. Solid evidence that it bo...

Read the full Inosine monograph → Herb & supplement monograph

Suma

Suma is a South American root often marketed as a 'Brazilian ginseng' and used as an adaptogen for energy, stamina, and stress. Human evidence is very limited, and most claims come from trad...

Read the full Suma monograph → Herb & supplement monograph

Couch Grass

Couch grass is a common lawn weed whose rhizome has long been used in traditional European herbal medicine, mainly for urinary and bladder complaints. High-quality human studies are lacking,...

Read the full Couch Grass monograph →
Sources

Sources & How We Checked

Mega Energy'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 516 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.

Sodium 38 references
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  9. Okusa MD, Crystal LJ. Clinical manifestations and management of acute lithium intoxication. Am J Med 1994;97(4):383-9. PubMed
  10. Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. Washington, DC: National Academy Press, 2005. Available at: http://www.nap.edu/openbook.php?record_id=10925. DOI
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  14. Chen L, Zhang Z, Chen W, Whelton PK, Appel LJ. Lower Sodium Intake and Risk of Headaches: Results From the Trial of Nonpharmacologic Interventions in the Elderly. Am J Public Health. 2016;106(7):1270-5. PubMed
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  24. He FJ, Campbell NRC, Ma Y, MacGregor GA, Cogswell ME, Cook NR. Errors in estimating usual sodium intake by the Kawasaki formula alter its relationship with mortality: implications for public health. Int J Epidemiol. 2018;47(6):1784-1795. PubMed
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  26. Messerli FH, Hofstetter L, Syrogiannouli L, et al. Sodium intake, life expectancy, and all-cause mortality. Eur Heart J 2021;42(21):2103-2112. PubMed
  27. Graudal NA, Hubeck-Graudal T, Jurgens G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database Syst Rev 2020;12(12):CD004022. PubMed
  28. Giatti S, Santos RB, Aielo AN, et al. Association of sodium with obstructive sleep apnea. The ELSA-Brasil study. Ann Am Thorac Soc 2021;18(3):502-510. PubMed
  29. Nan X, Lu H, Wu J, et al. The interactive association between sodium intake, alcohol consumption and hypertension among elderly in northern China: a cross-sectional study. BMC Geriatr 2021;21(1):135. PubMed
  30. Kyozuka H, Fukusda T, Murata T, et al. Impact of preconception sodium intake on hypertensive disorders of pregnancy: The Japan Environment and Children's study. Pregnancy Hypertens 2021;23:66-72. PubMed
  31. Zhao L, Ogden CL, Yang Q, et al. Association of usual sodium intake with obesity among US children and adolescents, NHANES 2009-2016. Obesity (Silver Spring) 2021;29(3):587-594. PubMed
  32. Ma Y, He FJ, Sun Q, et al. 24-Hour urinary sodium and potassium excretion and cardiovascular risk. N Engl J Med 2022;386(3):252-263. PubMed
  33. Liu J, Yang X, Zhang P, et al. Association of urinary sodium excretion and left ventricular hypertrophy in people with type 2 diabetes mellitus: A cross-sectional study. Front Endocrinol (Lausanne) 2021;12:728493. PubMed
  34. Filippini T, Malavolti M, Whelton PK, Vinceti M. Sodium intake and risk of hypertension: A systematic review and dose-response meta-analysis of observational cohort studies. Curr Hypertens Rep 2022;24(5):133-144. PubMed
  35. Wang DD, Li Y, Nguyen XT, et al. Dietary sodium and potassium intake and risk of non-fatal cardiovascular diseases: The million veteran program. Nutrients 2022;14(5):1121. PubMed
  36. Kwak JH, Park CH, Eun CS, et al. The associations of dietary intake of high sodium and low zinc with gastric cancer mortality: A prospective cohort study in Korea. Nutr Cancer 2022;74(10):3501-3508. PubMed
  37. George S, Maiti R, Mishra BR, Jena M, Mohapatra D. Effect of regulated add-on sodium chloride intake on stabilization of serum lithium concentration in bipolar disorder: A randomized controlled trial. Bipolar Disord 2023;25(1):66-75. PubMed
  38. Zhou TL, Schütten MTJ, Kroon AA, et al. Urinary Sodium Excretion and Salt Intake Are Not Associated With Blood Pressure Variability in a White General Population. J Am Heart Assoc 2023;12(1):e026578. PubMed

See these in context on the Sodium monograph →

Bee Pollen 15 references
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  5. Puente S, Iniguez A, Subirats M, et al. [Eosinophilic gastroenteritis caused by bee pollen sensitization]. Med Clin (Barc) 1997;108:698-700.
  6. Winther K, Hedman C. Assessment of the Effects of the Herbal Remedy Femal on the Symptoms of Premenstrual Syndrome: A Randomized, Double-Blind, Placebo-Controlled Study. Curr Ther Res Clin Exp 2002;63:344-53. DOI
  7. Cohen SH, Yunginger JW, Rosenberg N, Fink JN. Acute allergic reaction after composite pollen ingestion. J Allergy Clin Immunol 1979;64:270-4. PubMed
  8. Hurren KM, Lewis CL. Probable interaction between warfarin and bee pollen. Am J Health Syst Pharm 2010;67:2034-7. PubMed
  9. Akiyasu T, Paudyal B, Paudyal P, et al. A case report of acute renal failure associated with bee pollen contained in nutritional supplements. Ther Apher Dial 2010;14:93-7. PubMed
  10. Greenberger, P. A. and Flais, M. J. Bee pollen-induced anaphylactic reaction in an unknowingly sensitized subject. Ann.Allergy Asthma Immunol 2001;86(2):239-242. PubMed
  11. Lin FL, Vaughan TR, Vandewalker ML, et al. Hypereosinophilia, neurologic, and gastrointestinal symptoms after bee-pollen ingestion. J Allergy Clin Immunol 1989;83(4):793-796. PubMed
  12. Mansfield LE, Goldstein GB. Anaphylactic reaction after ingestion of local bee pollen. Ann Allergy 1981;47(3):154-156.
  13. Choi JH, Jang YS, Oh JW, Kim CH, Hyun IG. Bee pollen-induced anaphylaxis: a case report and literature review. Allergy Asthma Immunol Res 2015 Sep;7(5):513-7. PubMed
  14. Nonotte-Varly C. Allergenicity of Artemisia contained in bee pollen is proportional to its mass. Eur Ann Allergy Clin Immunol 2015;47(6):218-24.
  15. Leang ZX, Thalayasingam M, O'Sullivan M. A paediatric case of exercise-augmented anaphylaxis following bee pollen ingestion in Western Australia. Asia Pac Allergy. 2022 Jul 12;12(3):e23. PubMed

See these in context on the Bee Pollen monograph →

Royal Jelly 14 references
  1. Takahashi M, Matsuo I, Ohkido M. Contact dermatitis due to honeybee royal jelly. Contact Dermatitis 1983;9:452-5.
  2. Bullock RJ, et al. Fatal royal jelly-induced asthma. Med J Aust 1994;160:44. DOI
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  4. Yonei Y, Shibagaki K, Tsukada N, et al. Case report: haemorrhagic colitis associated with royal jelly intake. J Gastroenterol Hepatol 1997;12:495-9.
  5. Harwood M, Harding S, Beasley R, Frankish PD. Asthma following royal jelly. N Z Med J 1996;109:325.
  6. Laporte JR, Ibaanez L, Vendrell L, Ballarin E. Bronchospasm induced by royal jelly. Allergy 1996;51:440. DOI
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  11. Tokunaga, K. H., Yoshida, C., Suzuki, K. M., Maruyama, H., Futamura, Y., Araki, Y., and Mishima, S. Antihypertensive effect of peptides from royal jelly in spontaneously hypertensive rats. Biol.Pharm.Bull. 2004;27(2):189-192. PubMed
  12. Sultana, A., Nabi, A. H., Nasir, U. M., Maruyama, H., Suzuki, K. M., Mishima, S., and Suzuki, F. A dipeptide YY derived from royal jelly proteins inhibits renin activity. Int.J.Mol.Med. 2008;21(6):677-681. DOI
  13. Gómez Torrijos E, Méndez Diaz Y, Borja Segade JM, et al. Occupational allergic respiratory disease due to royal jelly. Ann Allergy Asthma Immunol. 2016;117(1):102-3. PubMed
  14. Li JD, Cui L, Xu YY, Guan K. A case of anaphylaxis caused by major royal jelly protein 3 of royal jelly and its cross-reactivity with honeycomb. J Asthma Allergy 2021;14:1555-7. PubMed

See these in context on the Royal Jelly monograph →

Octacosanol 16 references
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See these in context on the Octacosanol monograph →

Panax Ginseng 66 references
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  35. Mateo-Carrasco, H., Galvez-Contreras, M. C., Fernandez-Gines, F. D., and Nguyen, T. V. Elevated liver enzymes resulting from an interaction between Raltegravir and Panax ginseng: a case report and brief review. Drug Metabol.Drug Interact. 2012;27(3):171-1
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  37. Kim, T. H., Jeon, S. H., Hahn, E. J., Paek, K. Y., Park, J. K., Youn, N. Y., and Lee, H. L. Effects of tissue-cultured mountain ginseng (Panax ginseng CA Meyer) extract on male patients with erectile dysfunction. Asian J Androl 2009;11(3):356-361. PubMed
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See these in context on the Guarana monograph →

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Barley 15 references
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Inosine 7 references
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Suma 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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