Melatonin Extra Ingredients & Drug Interactions
What is this page for?
First and foremost: checking Melatonin Extra 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
Melatonin Extra is a dietary supplement by Nature's Sunshine with 5 active ingredients. Its ingredients are commonly taken for general antioxidant support, skin and hair care, heart health.Based on those ingredients, 1,554 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Melatonin, Ginkgo, Eleuthero. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Melatonin Extra by Nature's Sunshine
Ask about any prescription or over-the-counter medication and we check it for interactions with Melatonin Extra by Nature's Sunshine — and tell you which ingredient is responsible.
AI summaries are generated from our interaction database for education only — always confirm with your pharmacist. How we use AI
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HelloPharmacist Scorecard of Melatonin Extra by Nature's Sunshine
Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.
What’s inside
Low disclosure
Melatonin Extra contains 5 active ingredients: vitamin E, eleuthero (an adaptogenic herb), melatonin (a sleep-promoting hormone), and ginkgo leaf extract (a brain-supporting plant), plus a proprietary blend that combines some of these in a specific ratio. The product also includes inactive ingredients—cellulose, vegetable magnesium stearate, stearic acid, silicon dioxide, and a vegetable capsule—which are fillers and binders that help deliver the actives.
Vitamin E is a fat-soluble antioxidant that protects cells from damage. Eleuthero is used traditionally to support stress resilience and energy.
Melatonin is your body's natural sleep regulator. Ginkgo has been used to support memory and circulation.
Together, they're meant to combine sleep support with general wellness, though the blend's exact potency of each ingredient isn't specified on the label.
Does it work?
Strong evidence
Melatonin itself is Likely Effective for delayed sleep phase syndrome and non-24-hour sleep-wake disorder, and Possibly Effective for pre-procedural anxiety. Vitamin E is Effective for vitamin E deficiency and Possibly Effective for Alzheimer's disease and a few other conditions.
Eleuthero is Possibly Effective for genital herpes but has Insufficient Reliable Evidence for chronic fatigue, bipolar disorder, osteoporosis, and familial Mediterranean fever. Ginkgo is Possibly Effective for dementia, anxiety, hearing loss, stroke, schizophrenia, and premenstrual syndrome.
Because this is a blend, the actual benefit depends on the doses of each ingredient, which aren't broken out on the label. For a sleep aid specifically, melatonin is the primary active; the others are supporting ingredients with mixed or limited evidence for the product's overall sleep purpose.
How safe is it?
Well-documented data
Vitamin E is generally well tolerated at usual dietary doses, but high-dose supplements carry a rare risk of bleeding, hemorrhagic stroke, and other cardiovascular issues. Eleuthero is generally well tolerated for short-term use, though long-term safety data are limited; it may raise blood pressure and cause nervousness, especially at higher doses.
Melatonin is generally well tolerated for short-term use, with the most common side effects being dizziness, drowsiness, headache, and nausea; rare serious effects include seizure risk. Ginkgo is generally well tolerated but carries a documented risk of bleeding and rare cardiac arrhythmias.
Pregnancy: Vitamin E from food and prenatal vitamins is appropriate, but avoid high-dose supplements unless your doctor directs it. Eleuthero and ginkgo should be avoided during pregnancy due to insufficient safety data.
Melatonin is Possibly Unsafe in pregnancy. Lactation: Vitamin E is Likely Safe in normal amounts but check with your doctor before high-dose supplements.
Eleuthero and ginkgo should be avoided while breastfeeding. Melatonin safety while breastfeeding has not been established—talk with your doctor or pharmacist before use.
Meds to double-check
Major interaction found
Before taking Melatonin Extra, double-check with your doctor or pharmacist if you take blood thinners (warfarin, anticoagulants, antiplatelet drugs)—ginkgo, vitamin E, eleuthero, and melatonin all carry Moderate bleeding risk. Also flag any heart medications (especially digoxin or nifedipine), diabetes drugs, seizure medications, immunosuppressants, cholesterol drugs, anxiety medications, or antiviral drugs.
If you take talinolol (a beta-blocker), the Major interaction with ginkgo requires careful discussion. No interactions are documented for the proprietary blend itself.
The bottom line
Scorecard at a glanceFormula with limited ingredient disclosure with clinical evidence supporting its stated purpose. Major medication interactions have been identified, and safety information is well characterized.
Melatonin Extra is built mainly around melatonin for sleep support, reinforced by herbs and vitamin E that target general wellness. It may help if you struggle with sleep timing disorders or need short-term sleep support.
However, the combination of ingredients and their interactions with common medications—especially blood thinners, heart drugs, diabetes drugs, and immune-suppressing meds—means you should check your full medication list before taking it. Talk it over with your doctor or pharmacist to make sure it's right for your situation.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 5 of 5 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Sep 24, 2021.
This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed
General information
Key facts about Melatonin Extra, straight from the product label.
| Brand | Nature's Sunshine |
|---|---|
| Barcode (UPC) | 099904028302 |
| Net contents | 60 Capsule(s) |
| Market status | On market |
| Date entered into DSLD | Sep 24, 2021 |
| DSLD ID | 255365 |
| Product type | Other Combinations |
| Supplement form | Capsule |
| Dietary claims / uses | Nutrient, All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years), Women (not pregnant or lactating) |
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 Melatonin Extra by Nature's Sunshine, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Vitamin E | 22 mg | 147% |
| Proprietary Blend | 105 mg | -- |
| Eleuthero | 0 NP | -- |
| Melatonin | 3 mg | -- |
| Ginkgo | 0 NP | -- |
| Ginkgo leaf extract | 0 NP | -- |
Other ingredients: Cellulose, Capsule, Vegetable Magnesium Stearate, Stearic Acid, Silicon Dioxide
Tap any ingredient to jump to its full detail below.
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
FDA Disclaimer Statement
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
General Statements
Bottle made from 100% post consumer recycled material. We are committed to you and our planet. Scan to learn more.
New look! Same great product
Herbal experts since 1972
Formula
Melatonin, a hormone produced by the pineal gland, controls sleep patterns and influences our biological clock, affecting the way we age. Melatonin levels drop as we age, which may explain why sleep patterns change. Melatonin Extra provides 3mg of pure melatonin combined with herbs and natural vitamin E, a powerful antioxidant for optimal benefits.
Precautions
Warning: For adult use only.
Not for use by children, teenagers, or pregnant or lactating women.
Not for use by children, teenagers, or pregnant or lactating women.
Do not take this product during the day as it can cause drowsiness. Do not take this product when driving a motor vehicle or operating machinery. Use only at bedtime.
Keep out of the reach of children.
Do not use if inner seal is missing or damaged.
Formulation
Sleep support Guaranteed pure
FDA Statement of Identity
Dietary Supplement
Suggested/Recommended/Usage/Directions
Recommended Use: Take 1 capsule daily before bedtime.
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Melatonin Extra by Nature's Sunshine label
The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.
Label images are published by the NIH Dietary Supplement Label Database for the version of this product on file. Always read your actual product label.
View the full label (PDF)The Ingredients in Melatonin Extra by Nature's Sunshine
These are the 5 active ingredients this product is made of. Select any to open its full monograph.
Serving size1 Capsule(s) Dosage formCapsule Servings per container60 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.
Vitamin E
Interacts with764 drugs
Vitamin E is an essential fat-soluble vitamin and antioxidant that most people get in adequate amounts from a normal diet. Supplements can help correc...
Vitamin E monograph & interactionsProprietary Blend
Melatonin
Interacts with1,461 drugs
Melatonin is a hormone your body makes naturally to help control your sleep-wake cycle, and the supplement form is widely used to help with sleep timi...
Melatonin monograph & interactionsOther (inactive) ingredients: Cellulose, Capsule, Vegetable Magnesium Stearate, Stearic Acid, Silicon Dioxide. These complete the product’s ingredient list but are not active constituents.
Melatonin Extra by Nature's Sunshine Drug Interactions
HelloPharmacist Interaction Report
Melatonin Extra by Nature's Sunshine has documented interactions with medications, mainly through its vitamin E, eleuthero, melatonin, and ginkgo leaf extract content.
The most serious is a Major interaction: ginkgo can increase blood levels of talinolol, a beta-blocker, raising the risk of side effects.
Read the full breakdown — every affected drug type, severity by severity
Vitamin E poses Moderate risks with blood thinners (anticoagulants and antiplatelet drugs like warfarin), which may raise bleeding risk. It also theoretically affects how your liver processes certain medications (CYP3A4 substrates), potentially lowering their effectiveness, and may reduce the benefit of some chemotherapy drugs and niacin.
Melatonin carries Moderate interactions with blood thinners, blood pressure medications, diabetes drugs, seizure medications, and immunosuppressants—it may either increase bleeding risk or interfere with how those drugs work.
Eleuthero similarly shows Moderate interactions with blood thinners, diabetes drugs, heart medications (digoxin), immunosuppressants, and several drug-metabolizing enzymes (CYP1A2, CYP2C9, P-glycoprotein). Ginkgo leaf extract also has Moderate interactions with blood thinners, anxiety medications (alprazolam), cholesterol drugs (simvastatin), antiviral drugs (efavirenz), diabetes drugs (rosiglitazone), and transplant rejection medications (tacrolimus).
Altogether, these interactions span 1,555 individual medications. Before starting this product, check your exact prescriptions with the search tool on this page or discuss it with your doctor or pharmacist.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Melatonin Extra?
Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.
Go to the checkerIngredients driving the most interactions
Individual Drug Interactions
The ingredients in Melatonin Extra interact with 1,554 drugs. Click any drug to see the details.
4 of the 5 ingredients in Melatonin Extra interact with drugs. Each result below shows which ingredient is responsible. Melatonin Ginkgo Eleuthero Vitamin E
Amlodipine BenzoateKaterzia
How Amlodipine Benzoate interacts with Melatonin Extra — through 4 ingredients. Tap an ingredient for the detail:
Vitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Amlodipine Benzoate interactionMelatoninCytochrome P450 3a4 (cyp3a4) Substrates, Antihypertensive Drugs Moderate
Interaction Summary
Theoretically, melatonin might increase levels of drugs metabolized by CYP3A4.
Read the full Melatonin + Amlodipine Benzoate interactionGinkgo Leaf ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, ginkgo might decrease levels of drugs metabolized by CYP3A4.
Read the full Ginkgo Leaf Extract + Amlodipine Benzoate interactionEleutheroCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, eleuthero might increase levels of drugs metabolized by CYP3A4.
Read the full Eleuthero + Amlodipine Benzoate interactionAmlodipine BesilateIstin
How Amlodipine Besilate interacts with Melatonin Extra — through 4 ingredients. Tap an ingredient for the detail:
MelatoninAntihypertensive Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, taking melatonin with antihypertensive drugs might increase the risk of hypotension or hypertension.
Read the full Melatonin + Amlodipine Besilate interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Amlodipine Besilate interactionGinkgo Leaf ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, ginkgo might decrease levels of drugs metabolized by CYP3A4.
Read the full Ginkgo Leaf Extract + Amlodipine Besilate interactionEleutheroCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, eleuthero might increase levels of drugs metabolized by CYP3A4.
Read the full Eleuthero + Amlodipine Besilate interactionAmlodipine BesylateNorvasc
How Amlodipine Besylate interacts with Melatonin Extra — through 4 ingredients. Tap an ingredient for the detail:
Ginkgo Leaf ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, ginkgo might decrease levels of drugs metabolized by CYP3A4.
Read the full Ginkgo Leaf Extract + Amlodipine Besylate interactionMelatoninCytochrome P450 3a4 (cyp3a4) Substrates, Antihypertensive Drugs Moderate
Interaction Summary
Theoretically, melatonin might increase levels of drugs metabolized by CYP3A4.
Read the full Melatonin + Amlodipine Besylate interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Amlodipine Besylate interactionEleutheroCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, eleuthero might increase levels of drugs metabolized by CYP3A4.
Read the full Eleuthero + Amlodipine Besylate interactionAmlodipine Besylate, BenazeprilLotrel
How Amlodipine Besylate, Benazepril interacts with Melatonin Extra — through 4 ingredients. Tap an ingredient for the detail:
Vitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Amlodipine Besylate, Benazepril interactionMelatoninCytochrome P450 3a4 (cyp3a4) Substrates, Antihypertensive Drugs Moderate
Interaction Summary
Theoretically, melatonin might increase levels of drugs metabolized by CYP3A4.
Read the full Melatonin + Amlodipine Besylate, Benazepril interactionGinkgo Leaf ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, ginkgo might decrease levels of drugs metabolized by CYP3A4.
Read the full Ginkgo Leaf Extract + Amlodipine Besylate, Benazepril interactionEleutheroCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, eleuthero might increase levels of drugs metabolized by CYP3A4.
Read the full Eleuthero + Amlodipine Besylate, Benazepril interactionAmlodipine, CelecoxibConsensi
How Amlodipine, Celecoxib interacts with Melatonin Extra — through 4 ingredients. Tap an ingredient for the detail:
MelatoninAntihypertensive Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, taking melatonin with antihypertensive drugs might increase the risk of hypotension or hypertension.
Read the full Melatonin + Amlodipine, Celecoxib interactionEleutheroCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 2c9 (cyp2c9) Substrates Moderate
Interaction Summary
Theoretically, eleuthero might increase levels of drugs metabolized by CYP3A4.
Read the full Eleuthero + Amlodipine, Celecoxib interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Amlodipine, Celecoxib interactionGinkgo Leaf ExtractCytochrome P450 2c9 (cyp2c9) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, ginkgo might increase levels of drugs metabolized by CYP2C9.
Read the full Ginkgo Leaf Extract + Amlodipine, Celecoxib interactionAmmonium ChlorideAmmonium Chloride
How Ammonium Chloride interacts with Melatonin Extra — through 1 ingredient. Tap an ingredient for the detail:
MelatoninAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, taking melatonin with antihypertensive drugs might increase the risk of hypotension or hypertension.
Read the full Melatonin + Ammonium Chloride interactionAmobarbitalAmytal
How Amobarbital interacts with Melatonin Extra — through 2 ingredients. Tap an ingredient for the detail:
Ginkgo Leaf ExtractAnticonvulsants Moderate
Interaction Summary
Theoretically, ginkgo might reduce the effectiveness of anticonvulsants.
Read the full Ginkgo Leaf Extract + Amobarbital interactionMelatoninCns Depressants, Anticonvulsants Moderate
Interaction Summary
Theoretically, taking melatonin might increase the sedative effects of CNS depressants.
Read the full Melatonin + Amobarbital interactionAmobarbital, Ephedrine SulfateEphedrine & Amytal
How Amobarbital, Ephedrine Sulfate interacts with Melatonin Extra — through 2 ingredients. Tap an ingredient for the detail:
MelatoninAnticonvulsants, Cns Depressants Moderate
Interaction Summary
Theoretically, melatonin may reduce the effects of anticonvulsants.
Read the full Melatonin + Amobarbital, Ephedrine Sulfate interactionGinkgo Leaf ExtractAnticonvulsants Moderate
Interaction Summary
Theoretically, ginkgo might reduce the effectiveness of anticonvulsants.
Read the full Ginkgo Leaf Extract + Amobarbital, Ephedrine Sulfate interactionAmobarbital, SecobarbitalTuinal
How Amobarbital, Secobarbital interacts with Melatonin Extra — through 2 ingredients. Tap an ingredient for the detail:
Ginkgo Leaf ExtractAnticonvulsants Moderate
Interaction Summary
Theoretically, ginkgo might reduce the effectiveness of anticonvulsants.
Read the full Ginkgo Leaf Extract + Amobarbital, Secobarbital interactionMelatoninCns Depressants, Anticonvulsants Moderate
Interaction Summary
Theoretically, taking melatonin might increase the sedative effects of CNS depressants.
Read the full Melatonin + Amobarbital, Secobarbital interactionAmoxicillinAmix, Amoram, Amoxident, Amoxil Capsules, Amoxil Injection, Galenamox +3 more
How Amoxicillin interacts with Melatonin Extra — through 2 ingredients. Tap an ingredient for the detail:
MelatoninSeizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, taking melatonin with drugs that lower the seizure threshold might increase the risk of seizure activity.
Read the full Melatonin + Amoxicillin interactionGinkgo Leaf ExtractSeizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, taking ginkgo with drugs that lower the seizure threshold might increase the risk for convulsions.
Read the full Ginkgo Leaf Extract + Amoxicillin interactionAmoxicillin, Clavulanate PotassiumAugmentin, Augmentin '125/31 SF', Augmentin '250/62 SF', Augmentin XR, Augmentin-Duo 400/57, Clavulin
How Amoxicillin, Clavulanate Potassium interacts with Melatonin Extra — through 2 ingredients. Tap an ingredient for the detail:
Ginkgo Leaf ExtractSeizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, taking ginkgo with drugs that lower the seizure threshold might increase the risk for convulsions.
Read the full Ginkgo Leaf Extract + Amoxicillin, Clavulanate Potassium interactionMelatoninSeizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, taking melatonin with drugs that lower the seizure threshold might increase the risk of seizure activity.
Read the full Melatonin + Amoxicillin, Clavulanate Potassium interactionAmoxicillin, Omeprazole Magnesium, RifabutinTalicia
How Amoxicillin, Omeprazole Magnesium, Rifabutin interacts with Melatonin Extra — through 4 ingredients. Tap an ingredient for the detail:
Ginkgo Leaf ExtractOmeprazole (prilosec), Cytochrome P450 2c19 (cyp2c19) Substrates +3 Moderate
Interaction Summary
Theoretically, taking ginkgo with omeprazole might decrease the levels and clinical effects of omeprazole.
Read the full Ginkgo Leaf Extract + Amoxicillin, Omeprazole Magnesium, Rifabutin interactionMelatoninCytochrome P450 2c19 (cyp2c19) Substrates, Seizure Threshold Lowering Drugs +1 Moderate
Interaction Summary
Theoretically, melatonin might increase levels of drugs metabolized by CYP2C19.
Read the full Melatonin + Amoxicillin, Omeprazole Magnesium, Rifabutin interactionEleutheroCytochrome P450 2c9 (cyp2c9) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, eleuthero might increase levels of drugs metabolized by CYP2C9.
Read the full Eleuthero + Amoxicillin, Omeprazole Magnesium, Rifabutin interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Amoxicillin, Omeprazole Magnesium, Rifabutin interactionAmphetamineAdensys XR-ODT, Adzenys ER, Dyanavel XR, Mydayis
How Amphetamine interacts with Melatonin Extra — through 3 ingredients. Tap an ingredient for the detail:
Ginkgo Leaf ExtractSeizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, taking ginkgo with drugs that lower the seizure threshold might increase the risk for convulsions.
Read the full Ginkgo Leaf Extract + Amphetamine interactionMelatoninSeizure Threshold Lowering Drugs, Cytochrome P450 2d6 (cyp2d6) Substrates Moderate
Interaction Summary
Theoretically, taking melatonin with drugs that lower the seizure threshold might increase the risk of seizure activity.
Read the full Melatonin + Amphetamine interactionEleutheroCytochrome P450 2d6 (cyp2d6) Substrates Minor
Interaction Summary
Theoretically, eleuthero might increase levels of drugs metabolized by CYP2D6.
Read the full Eleuthero + Amphetamine interactionAmphetamine SulfateBenzedrine, Evekeo ODT
How Amphetamine Sulfate interacts with Melatonin Extra — through 3 ingredients. Tap an ingredient for the detail:
MelatoninCytochrome P450 2d6 (cyp2d6) Substrates, Seizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, melatonin might increase levels of drugs metabolized by CYP2D6.
Read the full Melatonin + Amphetamine Sulfate interactionGinkgo Leaf ExtractSeizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, taking ginkgo with drugs that lower the seizure threshold might increase the risk for convulsions.
Read the full Ginkgo Leaf Extract + Amphetamine Sulfate interactionEleutheroCytochrome P450 2d6 (cyp2d6) Substrates Minor
Interaction Summary
Theoretically, eleuthero might increase levels of drugs metabolized by CYP2D6.
Read the full Eleuthero + Amphetamine Sulfate interactionAmphotericin BAbelcet, AmBisome, Amphocil, Amphocin, Fungizone IV
How Amphotericin B interacts with Melatonin Extra — through 2 ingredients. Tap an ingredient for the detail:
MelatoninSeizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, taking melatonin with drugs that lower the seizure threshold might increase the risk of seizure activity.
Read the full Melatonin + Amphotericin B interactionGinkgo Leaf ExtractSeizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, taking ginkgo with drugs that lower the seizure threshold might increase the risk for convulsions.
Read the full Ginkgo Leaf Extract + Amphotericin B interactionAmphotericin, TetracyclineMysteclin-F
How Amphotericin, Tetracycline interacts with Melatonin Extra — through 3 ingredients. Tap an ingredient for the detail:
Ginkgo Leaf ExtractSeizure Threshold Lowering Drugs, P-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, taking ginkgo with drugs that lower the seizure threshold might increase the risk for convulsions.
Read the full Ginkgo Leaf Extract + Amphotericin, Tetracycline interactionEleutheroP-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, eleuthero might increase levels of P-glycoprotein substrates.
Read the full Eleuthero + Amphotericin, Tetracycline interactionMelatoninSeizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, taking melatonin with drugs that lower the seizure threshold might increase the risk of seizure activity.
Read the full Melatonin + Amphotericin, Tetracycline interactionAmpicillinOmnipen, Omnipen-N, Penbritin, Principen, Rimacillin
How Ampicillin interacts with Melatonin Extra — through 2 ingredients. Tap an ingredient for the detail:
MelatoninSeizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, taking melatonin with drugs that lower the seizure threshold might increase the risk of seizure activity.
Read the full Melatonin + Ampicillin interactionGinkgo Leaf ExtractSeizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, taking ginkgo with drugs that lower the seizure threshold might increase the risk for convulsions.
Read the full Ginkgo Leaf Extract + Ampicillin interactionAmpicillin, SulbactamUnasyn
How Ampicillin, Sulbactam interacts with Melatonin Extra — through 2 ingredients. Tap an ingredient for the detail:
Ginkgo Leaf ExtractSeizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, taking ginkgo with drugs that lower the seizure threshold might increase the risk for convulsions.
Read the full Ginkgo Leaf Extract + Ampicillin, Sulbactam interactionMelatoninSeizure Threshold Lowering Drugs Moderate
Interaction Summary
Theoretically, taking melatonin with drugs that lower the seizure threshold might increase the risk of seizure activity.
Read the full Melatonin + Ampicillin, Sulbactam interactionAmprenavirAgenerase
How Amprenavir interacts with Melatonin Extra — through 4 ingredients. Tap an ingredient for the detail:
Ginkgo Leaf ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, taking ginkgo with P-glycoprotein substrates might increase the levels and adverse effects of these substrates.
Read the full Ginkgo Leaf Extract + Amprenavir interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Amprenavir interactionEleutheroCytochrome P450 3a4 (cyp3a4) Substrates, P-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, eleuthero might increase levels of drugs metabolized by CYP3A4.
Read the full Eleuthero + Amprenavir interactionMelatoninCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, melatonin might increase levels of drugs metabolized by CYP3A4.
Read the full Melatonin + Amprenavir interactionAnacaulase-bcdbNexoBrid
How Anacaulase-bcdb interacts with Melatonin Extra — through 4 ingredients. Tap an ingredient for the detail:
Vitamin EAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Concomitant use of vitamin E and anticoagulant or antiplatelet agents might increase the risk of bleeding.
Read the full Vitamin E + Anacaulase-bcdb interactionEleutheroAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, eleuthero may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Eleuthero + Anacaulase-bcdb interactionGinkgo Leaf ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Ginkgo has been shown to increase the risk of bleeding in some people when taken with warfarin.
Read the full Ginkgo Leaf Extract + Anacaulase-bcdb interactionMelatoninAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, melatonin may have anticoagulant effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Melatonin + Anacaulase-bcdb interactionAnagrelideAgrylin
How Anagrelide interacts with Melatonin Extra — through 4 ingredients. Tap an ingredient for the detail:
MelatoninAnticoagulant/antiplatelet Drugs, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, melatonin may have anticoagulant effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Melatonin + Anagrelide interactionVitamin EAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Concomitant use of vitamin E and anticoagulant or antiplatelet agents might increase the risk of bleeding.
Read the full Vitamin E + Anagrelide interactionEleutheroCytochrome P450 1a2 (cyp1a2) Substrates, Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, eleuthero might increase levels of drugs metabolized by CYP1A2.
Read the full Eleuthero + Anagrelide interactionGinkgo Leaf ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, ginkgo might increase levels of drugs metabolized by CYP1A2.
Read the full Ginkgo Leaf Extract + Anagrelide interactionAnifrolumab-fniaSaphnelo
How Anifrolumab-fnia interacts with Melatonin Extra — through 2 ingredients. Tap an ingredient for the detail:
EleutheroImmunosuppressants Moderate
Interaction Summary
Theoretically, eleuthero might interfere with immunosuppressive drugs because of its immunostimulant activity.
Read the full Eleuthero + Anifrolumab-fnia interactionMelatoninImmunosuppressants Moderate
Interaction Summary
Theoretically, melatonin might interfere with immunosuppressive therapy.
Read the full Melatonin + Anifrolumab-fnia interactionAnisindioneMiradon
How Anisindione interacts with Melatonin Extra — through 4 ingredients. Tap an ingredient for the detail:
MelatoninAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, melatonin may have anticoagulant effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Melatonin + Anisindione interactionEleutheroAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, eleuthero may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Eleuthero + Anisindione interactionVitamin EAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Concomitant use of vitamin E and anticoagulant or antiplatelet agents might increase the risk of bleeding.
Read the full Vitamin E + Anisindione interactionGinkgo Leaf ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Ginkgo has been shown to increase the risk of bleeding in some people when taken with warfarin.
Read the full Ginkgo Leaf Extract + Anisindione interactionAntidiabetes, Dipeptidyl Peptidase-4 (dpp-iv) InhibitorGlyxambi
How Antidiabetes, Dipeptidyl Peptidase-4 (dpp-iv) Inhibitor interacts with Melatonin Extra — through 3 ingredients. Tap an ingredient for the detail:
MelatoninAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, taking melatonin with antidiabetes drugs might increase the risk of hypoglycemia.
Read the full Melatonin + Antidiabetes, Dipeptidyl Peptidase-4 (dpp-iv) Inhibitor interactionEleutheroP-glycoprotein Substrates, Antidiabetes Drugs Moderate
Interaction Summary
Theoretically, eleuthero might increase levels of P-glycoprotein substrates.
Read the full Eleuthero + Antidiabetes, Dipeptidyl Peptidase-4 (dpp-iv) Inhibitor interactionGinkgo Leaf ExtractAntidiabetes Drugs, P-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, taking ginkgo with antidiabetes drugs might alter the response to antidiabetes drugs.
Read the full Ginkgo Leaf Extract + Antidiabetes, Dipeptidyl Peptidase-4 (dpp-iv) Inhibitor interactionAntithrombin IiiThrombate III
How Antithrombin Iii interacts with Melatonin Extra — through 4 ingredients. Tap an ingredient for the detail:
EleutheroAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, eleuthero may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Eleuthero + Antithrombin Iii interactionVitamin EAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Concomitant use of vitamin E and anticoagulant or antiplatelet agents might increase the risk of bleeding.
Read the full Vitamin E + Antithrombin Iii interactionMelatoninAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, melatonin may have anticoagulant effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Melatonin + Antithrombin Iii interactionGinkgo Leaf ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Ginkgo has been shown to increase the risk of bleeding in some people when taken with warfarin.
Read the full Ginkgo Leaf Extract + Antithrombin Iii interactionAntithymocyte GlobulinThymoglobulin
How Antithymocyte Globulin interacts with Melatonin Extra — through 2 ingredients. Tap an ingredient for the detail:
EleutheroImmunosuppressants Moderate
Interaction Summary
Theoretically, eleuthero might interfere with immunosuppressive drugs because of its immunostimulant activity.
Read the full Eleuthero + Antithymocyte Globulin interactionMelatoninImmunosuppressants Moderate
Interaction Summary
Theoretically, melatonin might interfere with immunosuppressive therapy.
Read the full Melatonin + Antithymocyte Globulin interactionApalutamideErleada
How Apalutamide interacts with Melatonin Extra — through 4 ingredients. Tap an ingredient for the detail:
Ginkgo Leaf ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, ginkgo might decrease levels of drugs metabolized by CYP3A4.
Read the full Ginkgo Leaf Extract + Apalutamide interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Apalutamide interactionMelatoninCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, melatonin might increase levels of drugs metabolized by CYP3A4.
Read the full Melatonin + Apalutamide interactionEleutheroCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Theoretically, eleuthero might increase levels of drugs metabolized by CYP3A4.
Read the full Eleuthero + Apalutamide interactionApixabanEliquis
How Apixaban interacts with Melatonin Extra — through 4 ingredients. Tap an ingredient for the detail:
EleutheroCytochrome P450 3a4 (cyp3a4) Substrates, Anticoagulant/antiplatelet Drugs +1 Moderate
Interaction Summary
Theoretically, eleuthero might increase levels of drugs metabolized by CYP3A4.
Read the full Eleuthero + Apixaban interactionVitamin EAnticoagulant/antiplatelet Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Concomitant use of vitamin E and anticoagulant or antiplatelet agents might increase the risk of bleeding.
Read the full Vitamin E + Apixaban interactionMelatoninCytochrome P450 3a4 (cyp3a4) Substrates, Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, melatonin might increase levels of drugs metabolized by CYP3A4.
Read the full Melatonin + Apixaban interactionGinkgo Leaf ExtractAnticoagulant/antiplatelet Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Moderate
Interaction Summary
Ginkgo has been shown to increase the risk of bleeding in some people when taken with warfarin.
Read the full Ginkgo Leaf Extract + Apixaban interactionApomorphineAPO-go, APO-go Pen, APO-go PFS, Apokyn, Uprima
How Apomorphine interacts with Melatonin Extra — through 2 ingredients. Tap an ingredient for the detail:
Ginkgo Leaf ExtractP-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, taking ginkgo with P-glycoprotein substrates might increase the levels and adverse effects of these substrates.
Read the full Ginkgo Leaf Extract + Apomorphine interactionEleutheroP-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, eleuthero might increase levels of P-glycoprotein substrates.
Read the full Eleuthero + Apomorphine interactionApomorphine HydrochlorideKynmobi
How Apomorphine Hydrochloride interacts with Melatonin Extra — through 2 ingredients. Tap an ingredient for the detail:
EleutheroP-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, eleuthero might increase levels of P-glycoprotein substrates.
Read the full Eleuthero + Apomorphine Hydrochloride interactionGinkgo Leaf ExtractP-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, taking ginkgo with P-glycoprotein substrates might increase the levels and adverse effects of these substrates.
Read the full Ginkgo Leaf Extract + Apomorphine Hydrochloride interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Melatonin Extra 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.
Melatonin
Anticoagulant/Antiplatelet Drugs
Theoretically, melatonin may have anticoagulant effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
There are isolated case reports of minor bleeding and decreased prothrombin activity in people taking melatonin with warfarin (Coumadin). The mechanism, if any, of this interaction is unknown. Taking melatonin orally seems to decrease coagulation activity within one hour of dosing in healthy men.
Anticonvulsants
Theoretically, melatonin may reduce the effects of anticonvulsants. Some clinical research suggests that melatonin may increase the frequency of seizures in certain patients, particularly children with neurological impairment.
Antidiabetes Drugs
Theoretically, taking melatonin with antidiabetes drugs might increase the risk of hypoglycemia.
Some clinical research shows that melatonin reduces levels of fasting blood glucose and improves glycemic control. However, other research suggests that melatonin might impair glucose utilization and increase insulin resistance, while other research has found no effect on glucose levels. Until more is known, use melatonin cautiously in combination with antidiabetes drugs.
Antihypertensive Drugs
Theoretically, taking melatonin with antihypertensive drugs might increase the risk of hypotension or hypertension.
Some clinical research suggests that taking melatonin decreases blood pressure in healthy adults. Also, melatonin seems to lower systolic and diastolic blood pressure in individuals with high blood pressure at nighttime or untreated essential hypertension. However, melatonin seems to worsen blood pressure in patients who are taking antihypertensive medications. Immediate-release melatonin 5 mg at night in combination with nifedipine GITS (Procardia XL) increases systolic blood pressure an average of 6.5 mmHg, diastolic blood pressure by an average of 4.9 mmHg, and heart rate by 3.9 bpm. Also, results from animal research suggest that melatonin reduces the effectiveness of certain antihypertensive drugs, including methoxamine and clonidine.
Caffeine
Theoretically, taking caffeine with melatonin might increase levels of melatonin.
Some evidence suggests that caffeine consumption can decrease endogenous melatonin levels, while other evidence suggests that caffeine increases endogenous melatonin levels. When administered in combination with melatonin supplements, caffeine seems to increase melatonin effects and levels. The reason for this discrepancy is not completely clear. Part of the discrepancy may result from the fact that caffeine can inhibit melatonin synthesis as well as inhibit melatonin metabolism. By functioning as an adenosine receptor antagonist, caffeine may indirectly inhibit the synthesis of melatonin. Conversely, because melatonin and caffeine are both metabolized by cytochrome P450 1A2 (CYP1A2) enzyme, concomitant use of melatonin and caffeine may reduce the metabolism of melatonin, resulting in higher serum levels.
Cns Depressants
Theoretically, taking melatonin might increase the sedative effects of CNS depressants.
Melatonin has sedative effects. Theoretically, concomitant use of melatonin with alcohol, benzodiazepines, or other sedative drugs might cause additive sedation.
Contraceptive Drugs
Theoretically, taking contraceptive drugs with melatonin might increase the effects and adverse effects of melatonin.
Contraceptive drugs can increase the levels of endogenous melatonin. Theoretically, these drugs may increase the effects and adverse effects of oral melatonin.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, melatonin might increase levels of drugs metabolized by CYP1A2. Also, other CYP1A2 substrates might decrease the metabolism of melatonin, increasing melatonin levels.
Melatonin is metabolized in the liver primarily by the CYP2C19 and CYP1A2 enzymes. Theoretically, combined administration of melatonin with drugs metabolized by the CYP1A2 enzyme might reduce the metabolism of these drugs, resulting in increased serum levels. Conversely, some drugs metabolized by CYP1A2 may inhibit the metabolism of melatonin, resulting in increased serum levels of melatonin. Until more is known, use melatonin cautiously in patients taking drugs metabolized by these enzymes.
Cytochrome P450 2C19 (Cyp2C19) Substrates
Theoretically, melatonin might increase levels of drugs metabolized by CYP2C19. Also, other CYP2C19 substrates might decrease the metabolism of melatonin, increasing melatonin levels.
Melatonin is metabolized in the liver primarily by the CYP2C19 and CYP1A2 enzymes. Theoretically, combined administration of melatonin with certain drugs metabolized by the CYP2C19 enzyme may reduce the metabolism of these drugs, resulting in increased serum levels. Conversely, some drugs metabolized by CYP2C19 may inhibit the metabolism of melatonin, resulting in increased serum levels of melatonin. Until more is known, use melatonin cautiously in patients taking drugs metabolized by these enzymes.
Fluvoxamine (Luvox)
Theoretically, taking fluvoxamine with melatonin might increase levels of melatonin.
Fluvoxamine can significantly increase melatonin levels. In some cases, fluvoxamine might increase bioavailability of exogenously administered melatonin by up to 20 times. Some researchers think this might be a beneficial interaction and be potentially useful for cases of refractory insomnia. However, this interaction might also cause unwanted excessive drowsiness and possibly other adverse effects. Fluvoxamine is known to increase endogenous melatonin secretion. It seems to increase serum levels of exogenously administered melatonin possibly by decreasing melatonin metabolism by inhibiting cytochrome P450 (CYP450) 1A2 and 2C19 or by inhibiting melatonin elimination. This effect has been found in healthy people taking fluvoxamine 50-75 mg and melatonin 5 mg.
Immunosuppressants
Theoretically, melatonin might interfere with immunosuppressive therapy.
Melatonin can stimulate immune function. Theoretically, melatonin might interfere with immunosuppressive therapy.
Methamphetamine (Desoxyn)
Theoretically, taking melatonin with methamphetamine may increase the adverse effects of methamphetamine.
Animal research suggests that melatonin exacerbates the adverse effects of methamphetamine, resulting in greater depression of tryptophan hydroxylase (TPH) and tyrosine hydroxylase (TH) activity, as well as a significant reduction in dopamine levels. This has not been shown in humans.
Nifedipine Gits (Procardia Xl)
Theoretically, taking melatonin with extended release nifedipine reduces the effects of nifedipine.
Melatonin can decrease the effectiveness of extended release nifedipine (GITS). Immediate-release melatonin 5 mg at night in combination with nifedipine GITS 30-60 mg daily increases systolic and blood pressure by an average of 6.5 mmHg and 4.9 mmHg, respectively. Concomitant use with melatonin also increases heart rate by 3.9 bpm. The mechanism of this interaction is not known.
Seizure Threshold Lowering Drugs
Theoretically, taking melatonin with drugs that lower the seizure threshold might increase the risk of seizure activity.
Some clinical evidence suggests that melatonin may increase the frequency of seizures in certain patients, particularly children with neurological disabilities.
Warfarin (Coumadin)
Theoretically, melatonin may have antiplatelet effects and may increase the risk of bleeding with warfarin.
Three cases of increased prothrombin time have been reported for patients aged 48-72 years who took melatonin orally in combination with warfarin. However, three cases of decreased prothrombin time have also been reported for patients aged 51-84 years who took melatonin orally in combination with warfarin. Until more is known, use melatonin cautiously in patients taking warfarin.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Theoretically, melatonin might increase levels of drugs metabolized by CYP2D6.
Laboratory research suggests that certain lots of melatonin inhibit CYP2D6. Theoretically, combined administration of melatonin with certain drugs metabolized by the CYP2D6 enzyme may reduce the metabolism of these drugs, resulting in increased serum levels. Until more is known, use melatonin cautiously in patients taking drugs metabolized by these enzymes.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, melatonin might increase levels of drugs metabolized by CYP3A4.
Laboratory research shows that certain lots of melatonin inhibit CYP3A4. Theoretically, combined administration of melatonin with certain drugs metabolized by CYP3A4 may reduce the metabolism of these drugs, resulting in increased serum levels. Until more is known, use melatonin cautiously in patients taking drugs metabolized by these enzymes.
Flumazenil (Romazicon)
Theoretically, taking flumazenil with melatonin might reduce the effects of melatonin.
Animal research shows that flumazenil may inhibit the effect of melatonin.
Ginkgo
Talinolol
Taking ginkgo with talinolol seems to increase blood levels of talinolol.
There is some evidence that using ginkgo leaf extract 120 mg orally three times daily for 14 days can increase levels of talinolol by 36% in healthy male individuals. However, single doses of ginkgo do not seem to affect talinolol pharmacokinetics.
Alprazolam (Xanax)
Theoretically, ginkgo might decrease the levels and clinical effects of alprazolam.
In clinical research, ginkgo extract (Ginkgold) 120 mg twice daily seems to decrease alprazolam levels by about 17%. However, ginkgo does not appear to decrease the elimination half-life of alprazolam. This suggests that ginkgo is more likely to decrease absorption of alprazolam rather than induce hepatic metabolism of alprazolam.
Anticoagulant/Antiplatelet Drugs
Ginkgo has been shown to increase the risk of bleeding in some people when taken with warfarin. Theoretically, ginkgo might increase the risk of bleeding if used with other anticoagulant or antiplatelet drugs.
Several pharmacodynamic studies suggest that ginkgo inhibits platelet aggregation. It is thought that the ginkgo constituent, ginkgolide B, displaces platelet-activating factor (PAF) from its binding sites, decreasing blood coagulation. Several case reports have documented serious bleeding events in patients taking ginkgo. However, population and clinical studies have produced mixed results. Some evidence shows that short-term use of ginkgo leaf does not significantly reduce platelet aggregation and blood clotting. A study in healthy males who took a specific ginkgo leaf extract (EGb 761) 160 mg twice daily for 7 days found no change in prothrombin time. An analysis of a large medical record database suggests that ginkgo increases the risk of a bleeding adverse event by 38% when taken concurrently with warfarin. It has been suggested that ginkgo has to be taken for at least 2-3 weeks to have a significant effect on platelet aggregation. However, a meta-analysis of 18 studies using standardized ginkgo extracts, 80-480 mg daily for up to 32 weeks, did not find a significant effect on platelet aggregation, fibrinogen concentration, or PT/aPTT. In addition, a single dose of ginkgo plus clopidogrel or ticlopidine does not seem to significantly increase bleeding time or platelet aggregation. Also, taking ginkgo leaf extract daily for 8 days in conjunction with rivaroxaban does not affect anti-factor Xa activity; however, this study did not evaluate bleeding time.
Anticonvulsants
Theoretically, ginkgo might reduce the effectiveness of anticonvulsants.
Ginkgo seeds contain ginkgotoxin. Large amounts of ginkgotoxin can cause neurotoxicity and seizure. Ginkgotoxin is present in much larger amounts in ginkgo seeds than leaves. Ginkgo leaf extract contains trace amounts of ginkgotoxin. The amount of ginkgotoxin in ginkgo leaf and leaf extract seems unlikely to cause toxicity. However, there are anecdotal reports of seizure occurring after use of ginkgo leaf both in patients without a history of seizure disorder and in those with previously well-controlled epilepsy.
Antidiabetes Drugs
Theoretically, taking ginkgo with antidiabetes drugs might alter the response to antidiabetes drugs.
Ginkgo leaf extract seems to alter insulin secretion and metabolism, and might affect blood glucose levels in people with type 2 diabetes. The effect of ginkgo seems to differ depending on the insulin and treatment status of the patient. In diet-controlled diabetes patients with hyperinsulinemia, taking ginkgo does not seem to significantly affect insulin or blood glucose levels. In patients with hyperinsulinemia who are treated with oral hypoglycemic agents, taking ginkgo seems to decrease insulin levels and increase blood glucose following an oral glucose tolerance test. Researchers speculate that this could be due to ginkgo-enhanced hepatic metabolism of insulin. In patients with pancreatic exhaustion, taking ginkgo seems to stimulate pancreatic beta-cells, resulting in increased insulin and C-peptide levels, but with no significant change in blood glucose levels in response to an oral glucose tolerance test.
Atorvastatin (Lipitor)
Theoretically, ginkgo might decrease the levels and clinical effects of atorvastatin.
In humans, intake of ginkgo extract appears to increase atorvastatin clearance, reducing the area under the curve of atorvastatin by 10% to 14% and the maximum concentration by 29%. However, this interaction does not appear to affect cholesterol synthesis and absorption. Further, a model in rats with hyperlipidemia suggests that administering ginkgo extract does not impact blood levels of atorvastatin and leads to lower total cholesterol, low-density lipoprotein cholesterol, and triglycerides when compared with rats given atorvastatin alone.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, ginkgo might increase levels of drugs metabolized by CYP1A2.
Laboratory research suggests that ginkgo leaf extract can mildly inhibit CYP1A2 enzymes. However, clinical research suggests ginkgo might not affect CYP1A2. Until more is known, use ginkgo cautiously in patients taking drugs metabolized by these enzymes.
Cytochrome P450 2C19 (Cyp2C19) Substrates
Theoretically, ginkgo might decrease levels of drugs metabolized by CYP2C19.
Some clinical research shows that a specific ginkgo leaf extract (Remembrance, Herbs Product LTD) 140 mg twice daily can induce CYP2C19 enzymes and potentially decrease levels of drugs metabolized by these enzymes. However, other clinical research shows that taking ginkgo 120 mg twice daily for 12 days has no effect on levels of drugs metabolized by CYP2C19.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, ginkgo might increase levels of drugs metabolized by CYP2C9.
In vitro, a specific standardized extract of ginkgo leaf (EGb 761) inhibits CYP2C9 activity . The terpenoid (ginkgolides) and flavonoid (quercetin, kaempferol, etc.) constituents seem to be responsible for this effect. Most ginkgo extracts contain some amount of these constituents. Therefore, other ginkgo leaf extracts might also inhibit the CYP2C9 enzyme. However, clinical research suggests that ginkgo might not have a significant effect on CYP2C9 in humans. Ginkgo does not seem to significantly affect the pharmacokinetics of CYP2C9 substrates diclofenac or tolbutamide.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, ginkgo might decrease levels of drugs metabolized by CYP3A4.
There is conflicting evidence about whether ginkgo induces or inhibits CYP3A4. Ginkgo does not appear to affect hepatic CYP3A4. However, it is not known if ginkgo affects intestinal CYP3A4. Preliminary clinical research suggests that taking ginkgo does not significantly affect levels of donepezil, lopinavir, or ritonavir, which are all CYP3A4 substrates. Other clinical research also suggests ginkgo does not significantly affect CYP3A4 activity. However, there are two case reports of decreased efavirenz concentrations and increased viral load in patients taking ginkgo. It is suspected that terpenoids from the ginkgo extract reduced drug levels by inducing cytochrome P450 3A4 (CYP3A4).
Efavirenz (Sustiva)
Theoretically, ginkgo might decrease the levels and clinical effects of efavirenz.
There are two case reports of decreased efavirenz concentrations and increased viral load in patients taking ginkgo. In one case, an HIV-positive male experienced over a 50% decrease in efavirenz levels over the course of 14 months while taking ginkgo extract. HIV-1 RNA copies also increased substantially, from less than 50 to more than 1500. It is suspected that terpenoids from the ginkgo extract reduced drug levels by inducing cytochrome P450 3A4 (CYP3A4). In another case report, a patient stable on antiviral therapy including efavirenz for 10 years, had an increase in viral load from <50 copies/mL to 1350 copies/mL after 2 months of taking a combination of supplements including ginkgo. After stopping ginkgo, the viral load was again controlled with the same antiviral therapy regimen.
Ibuprofen (Advil, Others)
Theoretically, ginkgo might increase the risk of bleeding when used with ibuprofen.
Ginkgo might have antiplatelet effects and has been associated with several case reports of spontaneous bleeding. In one case, a 71-year-old male had taken a specific ginkgo extract (Gingium, Biocur) 40 mg twice daily for 2.5 years. About 4 weeks after starting ibuprofen 600 mg daily he experienced a fatal intracerebral hemorrhage. However, the antiplatelet effects of ginkgo have been questioned. A meta-analysis and other studies have not found a significant antiplatelet effect with standardized ginkgo extracts, 80 mg to 480 mg taken daily for up to 32 weeks.
P-Glycoprotein Substrates
Theoretically, taking ginkgo with P-glycoprotein substrates might increase the levels and adverse effects of these substrates.
A small clinical study in healthy volunteers shows that using ginkgo leaf extract 120 mg orally three times daily for 14 days can increase levels of the P-glycoprotein substrate, talinolol, by 36% in healthy male individuals. However, single doses of ginkgo do not have the same effect.
Risperidone (Risperdal)
Theoretically, taking ginkgo with risperidone might increase the levels and adverse effects of risperidone.
A single case of priapism has been reported for a 26-year-old male with schizophrenia who used risperidone 3 mg daily along with ginkgo extract 160 mg daily. Risperidone is metabolized by cytochrome P450 (CYP) 2D6 and CYP3A4. CYP3A4 activity might be affected by ginkgo. Theoretically, ginkgo may inhibit the metabolism of risperidone and increase the risk of adverse effects.
Rosiglitazone (Avandia)
Theoretically, ginkgo might decrease the levels and clinical effects of rosiglitazone.
Animal research shows that ginkgo leaf extract orally 100 or 200 mg/kg daily for 10 days alters the pharmacodynamics of rosiglitazone in a dose-dependent manner. The 100 mg/kg and 200 mg/kg doses reduce the area under the concentration time curve (AUC) of rosiglitazone by 39% and 52%, respectively, and the half-life by 28% and 39%, respectively. It is hypothesized that these changes may be due to induction of cytochrome P450 2C8 by ginkgo.
Seizure Threshold Lowering Drugs
Theoretically, taking ginkgo with drugs that lower the seizure threshold might increase the risk for convulsions.
Ginkgo seeds contain ginkgotoxin. Large amounts of ginkgotoxin can cause neurotoxicity and seizure. Ginkgotoxin is present in much larger amounts in ginkgo seeds than leaves. Ginkgo leaf extract contains trace amounts of ginkgotoxin. The amount of ginkgotoxin in ginkgo leaf and leaf extract seems unlikely to cause toxicity. However, there are anecdotal reports of seizure occurring after use of ginkgo leaf both in patients without a history of seizure disorder and in those with previously well-controlled epilepsy.
Simvastatin (Zocor)
Theoretically, ginkgo might decrease the levels and clinical effects of simvastatin.
Clinical research shows that taking ginkgo extract can reduce the area under the curve and maximum concentration of simvastatin by 32% to 39%. However, ginkgo extract does not seem to affect the cholesterol-lowering ability of simvastatin.
Sofosbuvir (Sovaldi)
Theoretically, ginkgo might increase the levels and clinical effects of sofosbuvir.
Animal research in rats shows that giving a ginkgo extract 25 mg/kg orally daily for 14 days increases the area under the concentration time curve (AUC) after a single sofosbuvir dose of 40 mg/kg by 11%, increases the half-life by 60%, and increases the plasma concentration at 4 hours by 38%. This interaction appears to be related to the inhibition of intestinal P-glycoprotein by ginkgo.
Tacrolimus (Prograf)
Theoretically, ginkgo might increase the blood levels of tacrolimus.
In vitro evidence suggests that certain biflavonoids in ginkgo leaves (i.e. amentoflavone, ginkgetin, bilobetin) may inhibit the metabolism of tacrolimus by up to 50%. This interaction appears to be time-dependent and due to inhibition of cytochrome P450 (CYP) 3A4 by these bioflavonoids. In rats given tacrolimus 1 mg/kg orally, amentoflavone was shown to increase the area under the concentration time curve (AUC) of tacrolimus by 3.8-fold.
Trazodone (Desyrel)
Theoretically, ginkgo might increase the levels and clinical effects of trazodone.
In a case report, an Alzheimer patient taking trazodone 20 mg twice daily and ginkgo leaf extract 80 mg twice daily for four doses became comatose. The coma was reversed by administration of flumazenil (Romazicon). Coma might have been induced by excessive GABA-ergic activity. Ginkgo flavonoids are thought to have GABA-ergic activity and act directly on benzodiazepine receptors. Ginkgo might also increase metabolism of trazodone to active GABA-ergic metabolites, possibly by inducing cytochrome P450 3A4 (CYP3A4) metabolism.
Warfarin (Coumadin)
Ginkgo has been shown to increase the risk of bleeding in some people when taken with warfarin.
Several pharmacodynamic studies suggest that ginkgo inhibits platelet aggregation. It is thought that the ginkgo constituent, ginkgolide B, displaces platelet-activating factor (PAF) from its binding sites, decreasing blood coagulation. Several case reports have documented serious bleeding events in patients taking ginkgo. Information from a medical database suggests that when taken concurrently with warfarin, ginkgo increases the risk of a bleeding adverse event by 38%. There is also some evidence that ginkgo leaf extract can inhibit cytochrome P450 2C9, an enzyme that metabolizes warfarin. This could result in increased warfarin levels. However, population and clinical research has produced mixed results. Clinical research in healthy people suggests that ginkgo has no effect on INR, or the pharmacokinetics or pharmacodynamics of warfarin. A meta-analysis of 18 studies using standardized ginkgo extracts, 80 mg to 480 mg daily for up to 32 weeks, did not find a significant effect on platelet aggregation, fibrinogen concentration, or PT/aPTT. There is also some preliminary clinical research that suggests ginkgo might not significantly increase the effects of warfarin in patients that have a stable INR.
Nifedipine (Procardia)
Theoretically, taking ginkgo with oral, but not intravenous, nifedipine might increase levels and adverse effects of nifedipine.
Animal research and some clinical evidence suggests that taking ginkgo leaf extract orally in combination with oral nifedipine might increase nifedipine levels and cause increased side effects, such as headaches, dizziness, and hot flushes. However, taking ginkgo orally does not seem to affect the pharmacokinetics of intravenous nifedipine.
Omeprazole (Prilosec)
Theoretically, taking ginkgo with omeprazole might decrease the levels and clinical effects of omeprazole.
Clinical research shows that a specific ginkgo leaf extract (Remembrance, Herbs Product LTD) 140 mg twice daily can induce cytochrome P450 (CYP) 2C19 enzymes and decrease levels of omeprazole by about 27% to 42%.
Eleuthero
Anticoagulant/Antiplatelet Drugs
Theoretically, eleuthero may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
In vitro and animal research shows that a constituent of eleuthero, dihydroxybenzoic acid, appears to inhibit platelet aggregation. Concomitant use with anticoagulant or antiplatelet drugs might increase the risk of bleeding. This effect has not been reported in humans.
Antidiabetes Drugs
Theoretically, eleuthero might have additive effects when used with antidiabetes drugs.
Animal research suggests that certain constituents of eleuthero have hypoglycemic activity in both healthy and diabetic animals. A small study in adults with type 2 diabetes also shows that taking eleuthero for 3 months can lower blood glucose levels. However, one very small study in healthy individuals shows that taking powdered eleuthero 3 grams, 40 minutes prior to a 75-gram oral glucose tolerance test, significantly increases postprandial blood glucose levels when compared with placebo. These contradictory findings might be due to patient-specific variability and variability in active ingredient ratios.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, eleuthero might increase levels of drugs metabolized by CYP1A2.
In vitro and animal research suggest that standardized extracts of eleuthero inhibit CYP1A2. This effect has not been reported in humans.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, eleuthero might increase levels of drugs metabolized by CYP2C9.
In vitro and animal research suggest that standardized extracts of eleuthero might inhibit CYP2C9. This effect has not been reported in humans.
Digoxin (Lanoxin)
Eleuthero might increase serum digoxin levels and increase the risk of side effects.
In one case report, a 74-year-old male who was stabilized on digoxin presented with an elevated serum digoxin level after starting an eleuthero supplement, without symptoms of toxicity. After stopping the supplement, serum digoxin levels returned to normal. It is not clear whether this was due to a pharmacokinetic interaction or to interference with the digoxin assay. Although the product was found to be free of digoxin and digitoxin, it was not tested for other contaminants.
Immunosuppressants
Theoretically, eleuthero might interfere with immunosuppressive drugs because of its immunostimulant activity.
Animal and in vitro research shows that eleuthero extracts have immunomodulatory effects, including increasing cellular and humoral activity.
P-Glycoprotein Substrates
Theoretically, eleuthero might increase levels of P-glycoprotein substrates.
In vitro research suggests that eleuthero can inhibit the multi-drug transporter protein, P-glycoprotein. However, it is too soon to tell if this is clinically important. This interaction has not been reported in humans.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Theoretically, eleuthero might increase levels of drugs metabolized by CYP2D6.
In vitro and animal research suggest that standardized extracts of eleuthero might inhibit CYP2D6. However, research in healthy human volunteers has found that taking eleuthero 485 mg twice daily for 14 days does not inhibit CYP2D6 drug metabolism.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, eleuthero might increase levels of drugs metabolized by CYP3A4.
In vitro and animal research suggest that standardized extracts of eleuthero might inhibit CYP3A4. However, research in healthy human volunteers has found that taking eleuthero 485 mg twice daily for 14 days does not inhibit CYP3A4 drug metabolism.
Organic Anion-Transporting Polypeptide Substrates (Oatp)
Theoretically, eleuthero might decrease levels of drugs metabolized by OATP.
In vitro research suggests that eleuthero inhibits OATP2B1, which might reduce the bioavailability of oral drugs that are substrates of OATP2B1. Due to the weak inhibitory effect identified in this study, this interaction is not likely to be clinically significant.
Vitamin E
Alkylating Agents
Theoretically, antioxidant effects of vitamin E might reduce the effectiveness of alkylating agents.
There's concern that antioxidants could reduce the activity of chemotherapy drugs which generate free radicals, such as cyclophosphamide, chlorambucil, carmustine, busulfan, and thiotepa. However, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that might interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin E have on chemotherapy. Advise patients to consult their oncologist before using vitamin E supplements, especially in high doses.
Anticoagulant/Antiplatelet Drugs
Concomitant use of vitamin E and anticoagulant or antiplatelet agents might increase the risk of bleeding.
Vitamin E seems to inhibit of platelet aggregation and antagonize the effects of vitamin K-dependent clotting factors. These effects appear to be dose-dependent, and are probably only likely to be clinically significant with doses of at least 800 units daily. Mixed tocopherols, such as those found in food, might have a greater antiplatelet effect than alpha-tocopherol. RRR alpha-tocopherol (natural vitamin E) 1000 IU daily antagonizes vitamin K-dependent clotting factors. Advise patients to avoid high doses of vitamin E, especially in people with low vitamin K intake or other risk factors for bleeding.
Antitumor Antibiotics
Theoretically, antioxidant effects of vitamin E might reduce the effectiveness of antitumor antibiotics.
There's concern that antioxidants could reduce the activity of antitumor antibiotic drugs such as doxorubicin, which generate free radicals. However, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that might interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin E have on chemotherapy involving antitumor antibiotics. Advise patients to consult their oncologist before using vitamin E supplements, especially in high doses.
Cyclosporine (Neoral, Sandimmune)
A specific form of vitamin E might increase absorption and levels of cyclosporine.
There is some evidence that one specific formulation of vitamin E (D-alpha-tocopheryl-polyethylene glycol-1000 succinate, TPGS, tocophersolan, Liqui-E) might increase absorption of cyclosporine. This vitamin E formulation forms micelles which seems to increase absorption of cyclosporine by 40% to 72% in some patients. However, this interaction is unlikely to occur with the usual forms of vitamin E.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Vitamin E appears to bind with the nuclear receptor, pregnane X receptor (PXR), which results in increased expression of CYP3A4. Although the clinical significance of this is not known, use caution when considering concomitant use of vitamin E and other drugs affected by these enzymes.
Selumetinib (Koselugo)
Taking selumetinib with vitamin E can result in a total daily dose of vitamin E that exceeds safe limits and therefore might increase the risk of bleeding.
Selumetinib contains 48-54 IU vitamin E per capsule. The increased risk of bleeding with vitamin E appears to be dose-dependent. Be cautious when using selumetinib in combination with supplemental vitamin E, especially in patients at higher risk of bleed, such as those with chronic conditions and those taking antiplatelet drugs.
Warfarin (Coumadin)
Using vitamin E with warfarin might increase the risk of bleeding.
Due to interference with production of vitamin K-dependent clotting factors, use of more than 400 IU of vitamin E daily with warfarin might increase prothrombin time (PT), INR, and the risk of bleeding,. At a dose of 1000 IU per day, vitamin E can antagonize vitamin K-dependent clotting factors even in people not taking warfarin. Limited clinical evidence suggests that doses up to 1200 IU daily may be used safely by patients taking warfarin, but this may not be applicable in all patient populations.
Niacin
Vitamin E might decrease the beneficial effects of niacin on high-density lipoprotein (HDL) cholesterol levels.
A combination of niacin and simvastatin (Zocor) effectively raises high-density lipoprotein (HDL) cholesterol levels in people with coronary disease and low HDL levels. Clinical research shows that taking a combination of antioxidants (vitamin C, vitamin E, beta-carotene, and selenium) along with niacin and simvastatin (Zocor) attenuates this rise in HDL, specifically the HDL-2 and apolipoprotein A1 fractions, by more than 50%. Vitamin E alone combined with a statin does not seem to decrease HDL levels. It is not known whether the adverse effect on HDL is due to one of the other antioxidants or to the combination. It also is not known whether it will occur in other patient populations.
Brand information
Manufacturer and brand details for Melatonin Extra, from the product label.
Nature's Sunshine
See all Nature's Sunshine products- Name
- Nature's Sunshine Products, Inc.
- City
- Spanish Fork
- State
- UT
- ZipCode
- 84660
- Phone Number
- 1-800-223-8225
- Web Address
- www.naturessunshine.com
Melatonin Extra by Nature's Sunshine: Common Questions
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The Full Monographs Behind Melatonin Extra’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Vitamin E
Interacts with 764 drugsVitamin E is an essential fat-soluble vitamin and antioxidant that most people get in adequate amounts from a normal diet. Supplements can help correct a true deficiency, but high-dose vitam...
Read the full Vitamin E monograph → Herb & supplement monographEleuthero
Interacts with 1,140 drugsEleuthero is an herb traditionally used as an 'adaptogen' to fight fatigue, boost energy, and help the body handle stress. The scientific evidence behind these uses is limited and mixed, so...
Read the full Eleuthero monograph → Herb & supplement monographGinkgo
Interacts with 1,266 drugsGinkgo is one of the world's most popular herbal supplements, mostly taken to support memory and circulation. The evidence for these uses is mixed and generally weak, and it is not proven to...
Read the full Ginkgo monograph → Herb & supplement monographMelatonin
Interacts with 1,461 drugsMelatonin is a hormone your body makes naturally to help control your sleep-wake cycle, and the supplement form is widely used to help with sleep timing problems and jet lag. The evidence is...
Read the full Melatonin monograph →Sources & How We Checked
Melatonin Extra's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.
- NIH Dietary Supplement Label Database (DSLD) — The official product label on file for this supplement.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference behind the ingredient interaction data.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.
The 303 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.
Vitamin E 64 references
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- Labriola D, Livingston R. Possible interactions between dietary antioxidants and chemotherapy. Oncology 1999;13:1003-8.
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Eleuthero 24 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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