Power Cocktail Ingredients & Drug Interactions
by FitLine
What is this page for?
First and foremost: checking Power Cocktail 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
Power Cocktail is a dietary supplement by FitLine with 17 active ingredients. Its ingredients are commonly taken for high cholesterol, vitamin b3 deficiency (pellagra), heart health support.Based on those ingredients, 2,273 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Dietary Fiber, Vitamin E, Niacin. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Power Cocktail by FitLine
Ask about any prescription or over-the-counter medication and we check it for interactions with Power Cocktail by FitLine — 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 Power Cocktail by FitLine
Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.
What’s inside
Full disclosure
Power Cocktail contains 14 active ingredients across B vitamins, antioxidants, minerals, and plant extracts. Niacin, folic acid, vitamin B6, vitamin B12, vitamin B2 (riboflavin), and pantothenic acid support energy and metabolism.
Vitamin C and vitamin E are antioxidants. Vitamin A supports vision and skin health.
Folate is a form of B vitamin. Selenium is a mineral with antioxidant properties.
Sodium is an electrolyte. Caffeine from guarana extract provides a stimulant effect.
The powder also contains inactive ingredients — fructose, fiber sources (oat, pea, apple), gums, pectin, flavor, citric acid, maltodextrin, beta-carotene, beet juice concentrate, and amylase.
Does it work?
Strong evidence
The evidence on Power Cocktail's ingredients is mixed. Niacin is likely effective for pellagra (a deficiency disease) and possibly effective for cholesterol problems related to HIV.
Folic acid is effective for folate deficiency and likely effective for preventing birth defects and treating methotrexate side effects. Vitamin C is effective for vitamin C deficiency and possibly effective for anemia and infections related to exercise.
Vitamin A is effective for vitamin A deficiency and possibly effective for measles and skin conditions. Vitamin B6 is effective for certain types of anemia and seizures linked to B6 deficiency, and possibly effective for nausea in pregnancy.
Vitamin B12 is effective for B12 deficiency and cyanide poisoning. Vitamin E is effective for vitamin E deficiency.
Biotin is likely effective for biotin deficiency but possibly ineffective for hair loss and skin conditions. Pantothenic acid is effective for pantothenic acid deficiency.
Selenium is likely effective for selenium deficiency. Caffeine is effective for alertness and athletic performance.
The product's overall value depends on whether you have a specific deficiency or are seeking general energy support.
How safe is it?
Well-documented data
Most of these ingredients are generally well tolerated at normal dietary and supplement amounts. However, several carry cautions at high doses.
Niacin at high supplemental doses can cause flushing, stomach upset, liver problems, and muscle damage. Vitamin A at high doses accumulates in your body and can damage the liver, cause severe headaches, and — critically — cause birth defects in pregnancy.
Folic acid at high doses can cause sleep problems, confusion, and in very rare cases, cancer or heart complications; high-dose use in late pregnancy has been linked to childhood asthma in population studies. Vitamin B6 at high doses over time can damage nerves.
Vitamin C at very high doses can cause kidney stones and diarrhea. Vitamin E at high doses raises bleeding risk.
Selenium at high doses can cause hair and nail loss, nerve damage, and organ failure. Sodium in excess is linked to high blood pressure and kidney disease.
Caffeine can cause anxiety, sleep disruption, and heart palpitations. Biotin is very safe even at high doses.
Pantothenic acid is well tolerated. Vitamin B2 and vitamin B12 are very safe because excess is removed in urine.
Meds to double-check
Major interaction found
Before taking Power Cocktail, check with your pharmacist if you take: retinoids or other vitamin A derivatives (Major severity), ephedrine (Major severity), blood pressure medications, blood thinners or anticoagulants, diabetes drugs, seizure-control medications, cholesterol-lowering statins, gout medications, cancer chemotherapy agents, birth control pills, acid reflux drugs, sedatives, antibiotics, psychiatric medications, Parkinson's medication, or immunosuppressants. If you take any of these, a pharmacist review is essential because the ingredient interactions could reduce your medication's effectiveness or raise your risk of serious side effects.
The bottom line
Scorecard at a glanceFully disclosed formula with clinical evidence supporting its stated purpose. Major medication interactions have been identified, and safety information is well characterized.
Power Cocktail is a multivitamin powder that may help if you're deficient in B vitamins, vitamin C, vitamin A, vitamin E, or selenium, or if you want a caffeine boost for focus and performance. If you take any prescription medication — especially blood pressure drugs, blood thinners, seizure medications, diabetes drugs, birth control, or cancer chemotherapy — you must check your exact medications against the interaction tool below before using this product.
Talk to your pharmacist or doctor first; don't start this without reviewing your personal medication list.
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 Feb 23, 2025.
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 Power Cocktail, straight from the product label.
| Brand | FitLine |
|---|---|
| Net contents | 15.9 Ounce(s); 450 Gram(s); 30 Packet(s) |
| Market status | On market |
| Date entered into DSLD | Feb 23, 2025 |
| DSLD ID | 321597 |
| Product type | Other Combinations |
| Supplement form | Powder |
| Dietary claims / uses | Nutrient, All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years), Gluten Free |
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 Power Cocktail by FitLine, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Calories | 45 Calorie(s) | -- |
| Total Carbohydrates | 12.9 Gram(s) | 5% |
| Sugar | 7.7 Gram(s) | -- |
| Niacin | 46 mg | 288% |
| Folic Acid | 270 mcg | -- |
| Sodium | 32 mg | 1% |
| Vitamin C | 135 mg | 150% |
| Vitamin A | 135 mcg RAE | 15% |
| Vitamin B6 | 2.7 mg | 159% |
| Vitamin B12 | 1.3 mcg | 54% |
| Biotin | 180 mcg | 600% |
| Vitamin E | 9 mg | 60% |
| Added Sugars | 6.9 Gram(s) | 14% |
| Total Fat | 0 Gram(s) | -- |
| Folate | 450 mcg DFE | 113% |
| Dietary Fiber | 5 Gram(s) | 18% |
| Protein | 0 Gram(s) | -- |
| Selenium | 24 mcg | 44% |
| Vitamin B2 | 2.1 mg | 162% |
| Vitamin B1 | 1.8 mg | 150% |
| Pantothenic Acid | 7.5 mg | 150% |
| Caffeine | 30 mg | -- |
Other ingredients: Fructose, Acacia Gum, Oat Fiber, Pea Fiber, Guar Gum, Pectin, Flavor, Citric Acid, Maltodextrin, Guarana Extract, Caffeine, Beta-Carotene, Beet Root Juice Concentrate, Maltodextrin, Citric Acid, Apple Fiber, Amylase, Lactase, Protease, Cellulase, Lipase, Inulin, Rice Fiber, Lactobacillus acidophilus, Lactobacillus reuteri, Green Tea Extract, Broccoli sprout concentrate, Onion extract, Apple Extract, Acerola Extract, Tomato concentrate, Broccoli concentrate, Turmeric concentrate, Garlic Concentrate, Basil concentrate, Oregano concentrate, Cinnamon Concentrate, Carrot Concentrate, Elderberry concentrate, Black Currant Extract, Blueberry Concentrate, Raspberry concentrate, Chokeberry concentrate, Blackberry concentrate, Spinach concentrate, Sweet Cherry concentrate, Blueberry Extract, Brussels Sprout concentrate, Curcuma Extract, Steviol Glycosides, Selenium-enriched Yeast, Seaweed, Powder, Ginger Extract, Powder, Grape Seed Extract
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.
Formula
Dietary supplement in powder form with vitamins, provitamin A, fiber, caffeine and the trace element selenium. Flavor: Orange-black currant. With sugar and sweetener. Contains Caffeine. (30 mg Caffeine per daily portion) Sweetener: Steviol glycosides of vegetable origin.
Rich in Vitamin B6 - contributes to normal energy - yielding metabolism.
Precautions
Not recommended for children or pregnant women.
Not recommended for children or pregnant women.
Caution: Do not exceed the stated recommended daily dose. Food supplements should not be used as a substitute for a varied and balanced diet and a healthy lifestyle.
Keep out of reach of children. Not suitable for children.
Suggested/Recommended/Usage/Directions
Preparation: Mix 1 packet of powder (15 g/0.53 oz) into 180 ml/6 fl. oz. of water. Daily recommendation: 1 portion (1 packet) per day.
Formulation
Excellent product quality according to international GMP standards.
PM-International Made in Germany NTC Nutrient Transport Concept Made in Germany
Not a significant source of cholesterol
Gluten free.
Product quality regularly independently tested by TUV SUD ELAB www.tuev-sued.de/elab/pm
General Statements
30 packets/15g = 450g 30 - 0.53 oz/ 15 g packets Fitline basic supply
FDA Disclaimer Statement
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to treat, cure or prevent any disease.
FDA Statement of Identity
Dietary Supplement
Brand IP Statement(s)
Patented 3 times
Storage
Store in a cool, dry place.
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Power Cocktail by FitLine 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 Power Cocktail by FitLine
These are the 17 active ingredients this product is made of. Select any to open its full monograph.
Serving size15 Gram(s) Dosage formPowder Servings per container30 Amounts shown are per serving.
Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.
Sugar
Niacin
Interacts with727 drugs
Niacin (vitamin B3) is an essential nutrient your body needs for energy and metabolism, and deficiency is uncommon in most developed countries. Prescr...
Niacin monograph & interactionsSodium
Interacts with205 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 g...
Sodium monograph & interactionsVitamin C
Interacts with207 drugs
Vitamin C (ascorbic acid) is an essential nutrient your body needs but cannot make, so you must get it from food or supplements. It's important for im...
Vitamin C monograph & interactionsVitamin A
Interacts with387 drugs
Vitamin A is an essential nutrient important for vision, skin, immune function, and growth. Most people get enough from a balanced diet, and supplemen...
Vitamin A monograph & interactionsVitamin B6
Interacts with210 drugs
Vitamin B6 (pyridoxine) is an essential water-soluble vitamin that your body needs for metabolism, brain function, and making red blood cells. It is b...
Vitamin B6 monograph & interactionsVitamin B12
Interacts with20 drugs
Vitamin B12 (cobalamin) is an essential nutrient your body needs to make red blood cells, keep nerves healthy, and support DNA. Supplements are very h...
Vitamin B12 monograph & interactionsBiotin
No knowninteractions
Biotin (vitamin B7) is a water-soluble vitamin your body needs to turn food into energy and to support healthy hair, skin, and nails. Most people get...
Biotin monograph & interactionsVitamin E
Interacts with764 drugs
Vitamin E is an essential fat-soluble vitamin and antioxidant that most people get in adequate amounts from a normal diet. Supplements can help correc...
Vitamin E monograph & interactionsFolate
Dietary Fiber
Interacts with2,025 drugs
Black psyllium is a soluble-fiber supplement made from the seeds of a Plantago plant, used mostly to ease constipation and support digestive health. I...
Dietary Fiber monograph & interactionsProtein
Selenium
Interacts with321 drugs
Selenium is an essential trace mineral your body needs in small amounts for thyroid function, antioxidant defense, and immune health. Most people who...
Selenium monograph & interactionsVitamin B2
Interacts with20 drugs
Riboflavin (vitamin B2) is an essential nutrient your body needs to turn food into energy and to keep skin, eyes, and nerves healthy. It is generally...
Vitamin B2 monograph & interactionsVitamin B1
Pantothenic Acid
No knowninteractions
Pantothenic acid is vitamin B5, an essential nutrient your body uses to turn food into energy. True deficiency is very rare because it is found in nea...
Pantothenic Acid monograph & interactionsCaffeine
Interacts with655 drugs
Caffeine is a natural stimulant found in coffee, tea, and many other plants and products. In moderate amounts it can boost alertness and reduce tiredn...
Caffeine monograph & interactionsOther (inactive) ingredients: Fructose, Acacia Gum, Oat Fiber, Pea Fiber, Guar Gum, Pectin, Flavor, Citric Acid, Maltodextrin, Guarana Extract, Caffeine, Beta-Carotene, Beet Root Juice Concentrate, Maltodextrin, Citric Acid, Apple Fiber, Amylase, Lactase, Protease, Cellulase, Lipase, Inulin, Rice Fiber, Lactobacillus acidophilus, Lactobacillus reuteri, Green Tea Extract, Broccoli sprout concentrate, Onion extract, Apple Extract, Acerola Extract, Tomato concentrate, Broccoli concentrate, Turmeric concentrate, Garlic Concentrate, Basil concentrate, Oregano concentrate, Cinnamon Concentrate, Carrot Concentrate, Elderberry concentrate, Black Currant Extract, Blueberry Concentrate, Raspberry concentrate, Chokeberry concentrate, Blackberry concentrate, Spinach concentrate, Sweet Cherry concentrate, Blueberry Extract, Brussels Sprout concentrate, Curcuma Extract, Steviol Glycosides, Selenium-enriched Yeast, Seaweed, Powder, Ginger Extract, Powder, Grape Seed Extract. These complete the product’s ingredient list but are not active constituents.
Power Cocktail by FitLine Drug Interactions
HelloPharmacist Interaction Report
Power Cocktail by FitLine contains several active ingredients with documented interactions affecting a substantial number of medications.
The most serious interaction is between vitamin A and retinoids (acne medications, psoriasis treatments) — these are vitamin A derivatives that can have additive toxic effects, potentially causing serious liver damage, bone pain, and severe birth defects. This interaction carries Major severity.
Read the full breakdown — every affected drug type, severity by severity
Niacin interacts with blood pressure medications, drugs that stress the liver, blood thinners, diabetes medications, cholesterol-lowering statins, and gout medications — all at Moderate severity. Folic acid can interfere with seizure-control drugs (phenobarbital, phenytoin, primidone), cancer chemotherapy agents, and antiparasitic medications.
Vitamin C may interact with birth control pills, some chemotherapy drugs, blood thinners, and certain psychiatric and HIV medications. Vitamin B6 can reduce the effectiveness of seizure drugs and Parkinson's medication.
Caffeine — present in this powder via guarana extract — carries a Major interaction with ephedrine and Moderate interactions with sedatives, stress-test medications, antipsychotics, acid reflux drugs, antibiotics, and seizure medications.
Sodium, vitamin E, and selenium each interact with multiple drug categories including blood pressure medications, blood thinners, immunosuppressants, and others at Moderate or Minor severity. Vitamin B12 has a Minor interaction with diabetes medication.
Altogether, these interactions span 1,460 individual medications.
Vitamin B2 and pantothenic acid have no interactions documented in our data. We could not check vitamin B1.
Run your exact medications through the search tool below before starting this product.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Power Cocktail?
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 Power Cocktail interact with 2,273 drugs. Click any drug to see the details.
12 of the 17 ingredients in Power Cocktail interact with drugs. Each result below shows which ingredient is responsible. Dietary Fiber Vitamin E Niacin Caffeine Vitamin A Selenium Vitamin B6 Vitamin C Sodium Folic Acid Vitamin B12 Vitamin B2
AcitretinSoriatane
How Acitretin interacts with Power Cocktail — through 2 ingredients. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Acitretin interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acitretin interactionAlitretinoinPanretin
How Alitretinoin interacts with Power Cocktail — through 2 ingredients. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Alitretinoin interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Alitretinoin interactionAminophylline, Amobarbital, EphedrineAmesec
How Aminophylline, Amobarbital, Ephedrine interacts with Power Cocktail — through 3 ingredients. Tap an ingredient for the detail:
CaffeineStimulant Drugs, Ephedrine Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Caffeine + Aminophylline, Amobarbital, Ephedrine interactionSeleniumBarbiturates Moderate
Interaction Summary
Theoretically, selenium might prolong the sedating effects of barbiturates.
Read the full Selenium + Aminophylline, Amobarbital, Ephedrine interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Aminophylline, Amobarbital, Ephedrine interactionBexaroteneTargretin
How Bexarotene interacts with Power Cocktail — through 3 ingredients. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Bexarotene 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 + Bexarotene interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Bexarotene interactionCarbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine TannateQuadratuss, Ry Tuss, Rynatuss, Tri Tannate Plus
How Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interacts with Power Cocktail — through 3 ingredients. Tap an ingredient for the detail:
CaffeineEphedrine, Stimulant Drugs Major
Interaction Summary
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Read the full Caffeine + Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interactionVitamin ECytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, vitamin E might induce metabolism of CYP3A4, possibly reducing the levels CYP3A4 substrates.
Read the full Vitamin E + Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interactionDyphylline, Ephedrine, Guaifenesin, PhenobarbitalLufyllin-EPG
How Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interacts with Power Cocktail — through 5 ingredients. Tap an ingredient for the detail:
CaffeinePhenobarbital (luminal), Ephedrine +1 Major
Interaction Summary
Theoretically, caffeine might reduce the effects of phenobarbital and increase the risk for convulsions.
Read the full Caffeine + Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interactionSeleniumBarbiturates Moderate
Interaction Summary
Theoretically, selenium might prolong the sedating effects of barbiturates.
Read the full Selenium + Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interactionFolic AcidPhenobarbital (luminal) Moderate
Interaction Summary
Folic acid might have antagonistic effects on phenobarbital and increase the risk for seizures.
Read the full Folic Acid + Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interactionVitamin B6Phenobarbital (luminal) Moderate
Interaction Summary
High doses of vitamin B6 may reduce the levels and clinical effects of phenobarbital.
Read the full Vitamin B6 + Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interactionEphedrine, Guaifenesin (otc Drug)Ephedrine Formula 400, Ephedrine Plus Tabs
How Ephedrine, Guaifenesin (otc Drug) interacts with Power Cocktail — through 2 ingredients. Tap an ingredient for the detail:
CaffeineStimulant Drugs, Ephedrine Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Caffeine + Ephedrine, Guaifenesin (otc Drug) interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Ephedrine, Guaifenesin (otc Drug) interactionEphedrine, Guaifenesin, Phenobarbital, TheophyllineMudrane GG
How Ephedrine, Guaifenesin, Phenobarbital, Theophylline interacts with Power Cocktail — through 5 ingredients. Tap an ingredient for the detail:
CaffeineTheophylline, Phenobarbital (luminal) +2 Major
Interaction Summary
Theoretically, caffeine might increase the levels and adverse effects of theophylline.
Read the full Caffeine + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionSeleniumBarbiturates Moderate
Interaction Summary
Theoretically, selenium might prolong the sedating effects of barbiturates.
Read the full Selenium + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionFolic AcidPhenobarbital (luminal) Moderate
Interaction Summary
Folic acid might have antagonistic effects on phenobarbital and increase the risk for seizures.
Read the full Folic Acid + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionVitamin B6Phenobarbital (luminal) Moderate
Interaction Summary
High doses of vitamin B6 may reduce the levels and clinical effects of phenobarbital.
Read the full Vitamin B6 + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionEphedrine, Hydroxyzine, TheophyllineAmi Rax, Marax
How Ephedrine, Hydroxyzine, Theophylline interacts with Power Cocktail — through 2 ingredients. Tap an ingredient for the detail:
CaffeineStimulant Drugs, Theophylline +1 Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Caffeine + Ephedrine, Hydroxyzine, Theophylline interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Ephedrine, Hydroxyzine, Theophylline interactionEphedrine, Phenobarbital, Potassium Iodide, TheophyllineMudrane, Quadrinal
How Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interacts with Power Cocktail — through 5 ingredients. Tap an ingredient for the detail:
CaffeineTheophylline, Phenobarbital (luminal) +2 Major
Interaction Summary
Theoretically, caffeine might increase the levels and adverse effects of theophylline.
Read the full Caffeine + Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interactionVitamin B6Phenobarbital (luminal) Moderate
Interaction Summary
High doses of vitamin B6 may reduce the levels and clinical effects of phenobarbital.
Read the full Vitamin B6 + Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interactionSeleniumBarbiturates Moderate
Interaction Summary
Theoretically, selenium might prolong the sedating effects of barbiturates.
Read the full Selenium + Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interactionFolic AcidPhenobarbital (luminal) Moderate
Interaction Summary
Folic acid might have antagonistic effects on phenobarbital and increase the risk for seizures.
Read the full Folic Acid + Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interactionEphedrine, Phenobarbital, TheophyllineTedral
How Ephedrine, Phenobarbital, Theophylline interacts with Power Cocktail — through 5 ingredients. Tap an ingredient for the detail:
CaffeineStimulant Drugs, Theophylline +2 Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Caffeine + Ephedrine, Phenobarbital, Theophylline interactionSeleniumBarbiturates Moderate
Interaction Summary
Theoretically, selenium might prolong the sedating effects of barbiturates.
Read the full Selenium + Ephedrine, Phenobarbital, Theophylline interactionFolic AcidPhenobarbital (luminal) Moderate
Interaction Summary
Folic acid might have antagonistic effects on phenobarbital and increase the risk for seizures.
Read the full Folic Acid + Ephedrine, Phenobarbital, Theophylline interactionVitamin B6Phenobarbital (luminal) Moderate
Interaction Summary
High doses of vitamin B6 may reduce the levels and clinical effects of phenobarbital.
Read the full Vitamin B6 + Ephedrine, Phenobarbital, Theophylline interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Ephedrine, Phenobarbital, Theophylline interactionHalobetasol Propionate,tazaroteneDuobrii
How Halobetasol Propionate,tazarotene interacts with Power Cocktail — through 1 ingredient. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Halobetasol Propionate,tazarotene interactionIsotretinoinAbsorica, Accutane, Amnesteem, Claravis, Roaccutane, Sotret
How Isotretinoin interacts with Power Cocktail — through 2 ingredients. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Isotretinoin interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Isotretinoin interactionTazaroteneArazlo, Avage, Fabior, Tazorotene, Zorac
How Tazarotene interacts with Power Cocktail — through 1 ingredient. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Tazarotene interactionTretinoinAltreno, Renova, Retin-A, Vesanoid
How Tretinoin interacts with Power Cocktail — through 2 ingredients. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Tretinoin interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Tretinoin interactionTretinoin, Benzoyl PeroxideTwyneo
How Tretinoin, Benzoyl Peroxide interacts with Power Cocktail — through 1 ingredient. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Tretinoin, Benzoyl Peroxide interactionEtretinateTegison
How Etretinate interacts with Power Cocktail — through 2 ingredients. Tap an ingredient for the detail:
Vitamin ARetinoids Major
Interaction Summary
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Read the full Vitamin A + Etretinate interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Etretinate interaction6-mercaptopurinePurinethol
How 6-mercaptopurine interacts with Power Cocktail — through 4 ingredients. Tap an ingredient for the detail:
SeleniumImmunosuppressants Moderate
Interaction Summary
Theoretically, selenium supplementation may reduce the effectiveness of immunosuppressant therapy.
Read the full Selenium + 6-mercaptopurine interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + 6-mercaptopurine interactionVitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + 6-mercaptopurine interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + 6-mercaptopurine interactionAdo-trastuzumab EmtansineKadcyla
How Ado-trastuzumab Emtansine interacts with Power Cocktail — through 1 ingredient. 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 + Ado-trastuzumab Emtansine interactionAbacavir Sulfate, Dolutegravir, LamivudineTriumeq
How Abacavir Sulfate, Dolutegravir, Lamivudine interacts with Power Cocktail — through 3 ingredients. Tap an ingredient for the detail:
Vitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + Abacavir Sulfate, Dolutegravir, Lamivudine interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abacavir Sulfate, Dolutegravir, Lamivudine interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Abacavir Sulfate, Dolutegravir, Lamivudine interactionAbacavir, LamivudineEpzicom
How Abacavir, Lamivudine interacts with Power Cocktail — through 3 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abacavir, Lamivudine interactionVitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + Abacavir, Lamivudine interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Abacavir, Lamivudine interactionAbciximabReoPro
How Abciximab interacts with Power Cocktail — through 5 ingredients. Tap an ingredient for the detail:
SeleniumAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Selenium may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Selenium + Abciximab 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 + Abciximab interactionCaffeineAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, caffeine may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Caffeine + Abciximab interactionNiacinAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Abciximab interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Abciximab interactionAbemaciclibVerzenio
How Abemaciclib interacts with Power Cocktail — through 2 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 + Abemaciclib interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Abemaciclib interactionAbiraterone
How Abiraterone interacts with Power Cocktail — through 5 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abiraterone 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 + Abiraterone interactionVitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + Abiraterone interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Abiraterone interactionCaffeineCytochrome P450 1a2 (cyp1a2) Inhibitors Minor
Interaction Summary
Theoretically, concomitant use might increase the levels and adverse effects of caffeine.
Read the full Caffeine + Abiraterone interactionAbiraterone AcetateYonsa, Zytiga
How Abiraterone Acetate interacts with Power Cocktail — through 4 ingredients. Tap an ingredient for the detail:
Vitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + Abiraterone Acetate 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 + Abiraterone Acetate interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abiraterone Acetate interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Abiraterone Acetate interactionAbrocitinibCibinqo
How Abrocitinib interacts with Power Cocktail — through 5 ingredients. Tap an ingredient for the detail:
NiacinAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Abrocitinib 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 + Abrocitinib interactionCaffeineAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, caffeine may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Caffeine + Abrocitinib interactionSeleniumAnticoagulant/antiplatelet Drugs, Immunosuppressants Moderate
Interaction Summary
Selenium may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Selenium + Abrocitinib interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Abrocitinib interactionAcalabrutinibCalquence
How Acalabrutinib interacts with Power Cocktail — through 2 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 + Acalabrutinib interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acalabrutinib interactionAcarboseGlucobay, Prandase, Precose
How Acarbose interacts with Power Cocktail — through 4 ingredients. Tap an ingredient for the detail:
Vitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + Acarbose interactionNiacinAntidiabetes Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Niacin can increase blood glucose levels and may diminish the effects of antidiabetes drugs.
Read the full Niacin + Acarbose interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acarbose interactionCaffeineAntidiabetes Drugs Minor
Interaction Summary
Theoretically, taking caffeine with antidiabetes drugs might interfere with blood glucose control.
Read the full Caffeine + Acarbose interactionAcebutololRhotral, Sectral
How Acebutolol interacts with Power Cocktail — through 5 ingredients. Tap an ingredient for the detail:
NiacinAntihypertensive Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, niacin may increase the risk of hypotension when used with antihypertensive drugs.
Read the full Niacin + Acebutolol interactionVitamin B6Antihypertensive Drugs Moderate
Interaction Summary
Theoretically, vitamin B6 may have additive effects when used with antihypertensive drugs.
Read the full Vitamin B6 + Acebutolol interactionSodiumAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, a high intake of dietary sodium might reduce the effectiveness of antihypertensive drugs.
Read the full Sodium + Acebutolol interactionVitamin AHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
Read the full Vitamin A + Acebutolol interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acebutolol interactionAcenocoumarolSintrom
How Acenocoumarol interacts with Power Cocktail — through 5 ingredients. Tap an ingredient for the detail:
CaffeineAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, caffeine may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Caffeine + Acenocoumarol 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 + Acenocoumarol interactionNiacinAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Acenocoumarol interactionSeleniumAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Selenium may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Selenium + Acenocoumarol interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acenocoumarol interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Power Cocktail 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.
Dietary Fiber
Carbamazepine (Tegretol)
Theoretically, black psyllium might reduce the effects of carbamazepine and increase the risk for convulsions.
Theoretically, black psyllium might reduce carbamazepine absorption. A preliminary study using blond psyllium reported decreased carbamazepine bioavailability due to binding of the drug to psyllium, as well as reduction of available fluid in the gut for dissolution of the drug. This interaction may also occur with black psyllium.
Lithium
Theoretically, taking black psyllium at the same time as lithium might reduce lithium absorption.
The fiber in black psyllium might reduce lithium absorption and plasma levels. Some case reports describe a reduction in plasma lithium levels with concomitant administration of blond psyllium. This was reversed when psyllium was stopped. This interaction may also occur with black psyllium.
Metformin (Glucophage)
Theoretically, black psyllium might increase the therapeutic and adverse effects of metformin.
Animal research shows that concurrent consumption of blond psyllium with metformin slows and increases the absorption of metformin. This interaction may also occur with black psyllium. To avoid changes in absorption, take psyllium 30-60 minutes after metformin.
Olanzapine (Zyprexa)
Theoretically, taking black psyllium at the same time as olanzapine might reduce olanzapine absorption.
The fiber in black psyllium might decrease the absorption of olanzapine. A single case report describes a reduction in the effectiveness of olanzapine when it was concomitantly administered with an unspecified type of psyllium 3 grams orally twice daily. This effect was reversed when psyllium was stopped.
Digoxin (Lanoxin)
Theoretically, taking black psyllium at the same time as digoxin might reduce digoxin absorption and decrease digoxin levels.
Psyllium might bind digoxin in the gut. However, some clinical evidence suggests that psyllium does not impact digoxin absorption.
Ethinyl Estradiol
Theoretically, taking black psyllium at the same time as ethinyl estradiol might alter levels of estradiol.
Concurrent use of blond psyllium with ethinyl estradiol results in a slight increase in the extent of ethinyl estradiol absorption and a slower rate of absorption. This is unlikely to be clinically significant.
Oral Drugs
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Psyllium seems to have variable effects on drug absorption. To avoid changes in absorption, take psyllium 30-60 minutes after oral medications. Animal research shows that blond psyllium delays and increases the absorption of metformin and ethinyl estradiol. Case reports and animal research suggest that blond psyllium might reduce absorption of lithium, digoxin, olanzapine, and carbamazepine. Finally, some pharmacokinetic studies show that psyllium does not affect the absorption of levothyroxine or warfarin. Although many of these studies evaluated blond psyllium, the fiber content in black psyllium may have similar effects.
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.
Niacin
Alcohol (Ethanol)
Concomitant use of alcohol and niacin might increase the risk of flushing and hepatotoxicity.
Alcohol can exacerbate the flushing and pruritus associated with niacin. Large doses of niacin might also exacerbate liver dysfunction associated with chronic alcohol use. A case report describes delirium and lactic acidosis in a patient taking niacin 3 grams daily who ingested 1 liter of wine. Advise patients to avoid large amounts of alcohol while taking niacin.
Allopurinol (Zyloprim)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as allopurinol.
Large doses of niacin can reduce urinary excretion of uric acid, potentially resulting in hyperuricemia. Doses of uricosurics such as allopurinol might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Anticoagulant/Antiplatelet Drugs
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Several cases of clotting factor synthesis deficiency and coagulopathy have been reported in patients taking sustained-release niacin. Also, thrombocytopenia has been reported in patients treated with niacin or niacin plus lovastatin.
Antidiabetes Drugs
Niacin can increase blood glucose levels and may diminish the effects of antidiabetes drugs.
Niacin impairs glucose tolerance in a dose-dependent manner, probably by causing or aggravating insulin resistance and increasing hepatic production of glucose. In diabetes patients, niacin 4.5 grams daily for 5 weeks can increase plasma glucose by an average of 16% and glycated hemoglobin (HbA1c) by 21%. However, lower doses of 1.5 grams daily or less appear to have minimal effects on blood glucose. In some patients, glucose levels increase when niacin is started, but then return to baseline when a stable dose is reached. Up to 35% of patients with diabetes may need adjustments in hypoglycemic therapy when niacin is added.
Antihypertensive Drugs
Theoretically, niacin may increase the risk of hypotension when used with antihypertensive drugs.
The vasodilating effects of niacin can cause hypotension. Furthermore, some clinical evidence suggests that a one-hour infusion of niacin can reduce systolic, diastolic, and mean blood pressure in hypertensive patients. This effect is not observed in normotensive patients.
Bile Acid Sequestrants
Bile acid sequestrants can bind niacin and decrease absorption. Separate administration by 4-6 hours to avoid an interaction.
In vitro studies show that colestipol (Colestid) binds about 98% of available niacin and cholestyramine (Questran) binds 10% to 30%.
Gemfibrozil (Lopid)
Theoretically, concomitant use of niacin and gemfibrozil might increase the risk of myopathy in some patients.
A case of myopathy from concomitant use of niacin and gemfibrozil has been reported. Niacin alone has also been associated with cases of myopathy. Using gemfibrozil with niacin might further increase the risk of developing myopathy.
Hepatotoxic Drugs
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Niacin has been associated with cases of liver toxicity, especially when used in pharmacologic doses. Sustained-release niacin preparations appear to be associated with a higher risk of hepatotoxicity than immediate-release niacin.
Hmg-Coa Reductase Inhibitors ("Statins")
Theoretically, concomitant use of niacin and statins might increase the risk of myopathy and rhabdomyolysis in some patients.
Some case reports have raised concerns that niacin might increase the risk of myopathy and rhabdomyolysis when combined with statins. However, a significantly increased risk of myopathy has not been demonstrated in clinical trials, including those using an FDA-approved combination of lovastatin and niacin (Advicor).
Probenecid (Benemid)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as probenecid.
Large doses of niacin reduce urinary excretion of uric acid, potentially causing hyperuricemia. Doses of uricosurics such as probenecid might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Sulfinpyrazone (Anturane)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as sulfinpyrazone.
Large doses of niacin reduce urinary excretion of uric acid, potentially causing hyperuricemia. Doses of uricosurics such as sulfinpyrazone might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Thyroid Hormone
Theoretically, niacin might antagonize the therapeutic effects of thyroid hormones.
Clinical research and case reports suggests that taking niacin can reduce serum levels of thyroxine-binding globulin by up to 25% and moderately reduce levels of thyroxine (T4). Patients taking thyroid hormone for hypothyroidism might need dose adjustments when using niacin.
Transdermal Nicotine (Nicoderm)
Theoretically, concomitant use of niacin and transdermal nicotine might increase the risk of flushing and dizziness.
Niacin and nicotine can both cause flushing and dizziness.
Warfarin (Coumadin)
There is limited evidence that niacin may increase the anticoagulant effects of warfarin.
In a case report, a patient on warfarin developed an elevated international normalized ratio (INR) of 3.9 after taking niacin for two weeks. The patient's INR was previously stable, ranging between 2 and 3 in recent months, and no other medication changes were identified. The elevated INR returned to therapeutic range within 4 days following the discontinuation of niacin.
Aspirin
Large doses of aspirin might alter the clearance of niacin.
Aspirin is often used with niacin to reduce niacin-induced flushing. Doses of 80-975 mg aspirin have been used, but 325 mg appears to be optimal. Aspirin also seems to reduce the clearance of niacin by competing for glycine conjugation. Taking aspirin 1 gram seems to reduce niacin clearance by 45%. This is probably a dose-related effect and not clinically significant with the more common aspirin dose of 325 mg.
Caffeine
Ephedrine
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
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.
Adenosine (Adenocard)
Theoretically, caffeine might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Some evidence shows that caffeine is a competitive inhibitor of adenosine and can reduce the vasodilatory effects of adenosine in humans. However, other research shows that 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.
Anticoagulant/Antiplatelet Drugs
Theoretically, caffeine may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Caffeine is reported to have antiplatelet activity. Theoretically, it might increase the risk of bleeding when used concomitantly with these agents; however, this interaction has not been reported in humans.
Beta-Adrenergic Agonists
Theoretically, large amounts of caffeine might increase the cardiac inotropic effects of beta-agonists.
Carbamazepine (Tegretol)
Theoretically, caffeine 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 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.
Cimetidine (Tagamet)
Theoretically, cimetidine might increase the levels and adverse effects of caffeine.
Cimetidine decreases the rate of caffeine clearance by 31% to 42%.
Clozapine (Clozaril)
Caffeine might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
Caffeine might 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). Although researchers speculate that caffeine might inhibit CYP1A2, there is no reliable evidence that caffeine affects CYP1A2. There is also speculation that genetic factors might make some patients more sensitive to an interaction between clozapine and caffeine. In one case report, severe, life-threatening clozapine toxicity and multiorgan system failure occurred in a patient with schizophrenia stabilized on clozapine who consumed caffeine 600 mg daily.
Dipyridamole (Persantine)
Theoretically, caffeine might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Caffeine inhibits dipyridamole-induced vasodilation. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. Methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.
Disulfiram (Antabuse)
Theoretically, disulfiram use might increase the levels and adverse effects of caffeine.
Disulfiram decreases the rate of caffeine clearance.
Diuretic Drugs
Theoretically, using caffeine with diuretic drugs might increase the risk of hypokalemia.
Caffeine, especially in excessive amounts, can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also cause lower potassium levels.
Estrogens
Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Estrogen inhibits caffeine metabolism.
Ethosuximide (Zarontin)
Theoretically, caffeine might reduce the effects of ethosuximide and increase the risk for convulsions.
Animal research suggests that caffeine 92.4 mg/kg can decrease the anticonvulsant activity of ethosuximide. However, this effect has not been reported in humans.
Felbamate (Felbatol)
Theoretically, caffeine might reduce the effects of felbamate and increase the risk for convulsions.
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.
Flutamide (Eulexin)
Theoretically, caffeine might increase the levels and adverse effects of flutamide.
In vitro evidence suggests that caffeine can inhibit the metabolism of flutamide. However, this effect has not been reported in humans.
Fluvoxamine (Luvox)
Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Fluvoxamine reduces caffeine metabolism.
Lithium
Abrupt caffeine withdrawal might increase the levels and adverse effects of lithium.
Caffeine has diuretic activity. When abruptly discontinued, caffeine may alter the clearance of lithium. There are two case reports of lithium tremor that worsened upon abrupt coffee withdrawal and 6 case reports of elevated serum lithium levels after reducing or eliminating caffeine intake. In one case, a male with schizoaffective disorder stabilized on lithium had an elevated lithium level after reducing his caffeine intake by 87%. At a later date, he increased his caffeine intake by 6-fold, resulting in a subtherapeutic lithium level and a recurrence of psychiatric symptoms.
Monoamine Oxidase Inhibitors (Maois)
Theoretically, concomitant use might increase the risk of a hypertensive crisis.
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.
Nicotine
Theoretically, concomitant use might increase the risk of hypertension.
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.
Pentobarbital (Nembutal)
Theoretically, caffeine might decrease the effects of pentobarbital.
Caffeine might negate the hypnotic effects of pentobarbital.
Phenobarbital (Luminal)
Theoretically, caffeine might reduce the effects of phenobarbital and increase the risk for convulsions.
Animal research suggests that caffeine can decrease the anticonvulsant activity of phenobarbital. However, the exact mechanism of this interaction is unclear.
Phenylpropanolamine
Theoretically, phenylpropanolamine might increase the risk of hypertension, as well as the levels and adverse effects of caffeine.
Concomitant use of phenylpropanolamine and caffeine might cause an additive increase in blood pressure. Phenylpropanolamine also seems to increase caffeine serum levels.
Phenytoin (Dilantin)
Theoretically, caffeine might reduce the effects of phenytoin and increase the risk for convulsions.
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.
Pioglitazone (Actos)
Theoretically, caffeine might increase the levels and clinical effects of pioglitazone.
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.
Quinolone Antibiotics
Theoretically, quinolone antibiotics might increase the levels and adverse effects of caffeine.
Quinolones (also called fluoroquinolones) can decrease caffeine clearance by inhibiting cytochrome P450 1A2 (CYP1A2) enzyme.
Riluzole (Rilutek)
Theoretically, concomitant use might increase the levels and adverse effects of both caffeine and riluzole.
Caffeine and riluzole are both metabolized by cytochrome P450 1A2 (CYP1A2), and concomitant use might reduce the metabolism of one or both agents.
Vitamin A
Retinoids
Concomitant use of retinoids with vitamin A supplements might produce supratherapeutic vitamin A levels.
Retinoids, which are vitamin A derivatives, could have additive toxic effects when taken with vitamin A supplements.
Hepatotoxic Drugs
Theoretically, taking high doses of vitamin A in combination with other potentially hepatotoxic drugs might increase the risk of liver disease.
The tolerable upper intake level (UL) is the highest level of intake that is likely to pose no risk of adverse effects. Doses of vitamin A above the UL can cause hepatotoxicity, ranging from elevated liver enzymes to liver failure.
Tetracycline Antibiotics
Theoretically, taking tetracycline antibiotics with high doses of vitamin A can increase the risk of pseudotumor cerebri.
Benign intracranial hypertension (pseudotumor cerebri) can occur with tetracyclines and with acute or chronic vitamin A toxicity. Case reports suggest that taking tetracyclines and vitamin A concurrently can increase the risk of this condition. Avoid high doses of vitamin A in people taking tetracyclines chronically.
Warfarin (Coumadin)
Theoretically, high doses of vitamin A could increase the risk of bleeding with warfarin.
Vitamin A toxicity is associated with hemorrhage and hypoprothrombinemia, possibly due to vitamin K antagonism. Advise patients taking warfarin to avoid doses of vitamin A above the tolerable upper intake level of 10,000 IU/day for adults.
Selenium
Anticoagulant/Antiplatelet Drugs
Selenium may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Clinical research suggests that taking selenium 10 mcg/kg/day can increase bleeding times by increasing prostacyclin production, which inhibits platelet activity. Other clinical research suggests that taking selenium 75 mcg daily, in combination with ascorbic acid 600 mg, alpha-tocopherol 300 mg, and beta-carotene 27 mg, reduces platelet aggregation.
Barbiturates
Theoretically, selenium might prolong the sedating effects of barbiturates.
Laboratory research suggests that selenium can inhibit the hepatic metabolism of barbiturates. Selenium seems to prolong the sedative effect of pentobarbital in animal models.
Immunosuppressants
Theoretically, selenium supplementation may reduce the effectiveness of immunosuppressant therapy.
In vitro research and preliminary clinical evidence suggests that selenium may stimulate the immune system.
Warfarin (Coumadin)
Theoretically, selenium might interfere with warfarin activity.
Animal research suggests that selenium can increase warfarin activity. Selenium might interact with warfarin by displacing it from albumin binding sites, reducing its metabolism in the liver, or by decreasing production of vitamin K-dependent clotting factors. Selenium can also prolong bleeding times in humans by increasing prostacyclin production, which inhibits platelet activity.
Contraceptive Drugs
Contraceptive drugs might increase levels of selenium, although the clinical significance of this effect is unclear.
Some research suggests that oral contraceptives increase serum selenium levels in women taking oral contraceptives; however, other research shows no change in selenium levels. It is suggested that an increase could be due to increased carrier proteins, indicating a redistribution of selenium rather than a change in total body selenium.
Niacin
Selenium might reduce the beneficial effects of niacin on high-density lipoprotein (HDL) levels.
A combination of niacin and simvastatin (Zocor) effectively raises HDL cholesterol levels in patients with coronary disease and low HDL levels. Clinical research shows that taking a combination of antioxidants (vitamin C, vitamin E, beta-carotene, and selenium) along with niacin and simvastatin (Zocor) attenuates this rise in HDL, specifically the HDL-2 and apolipoprotein A1 fractions, by more than 50% in patients with coronary disease. It is not known whether this adverse effect is due to a single antioxidant such as selenium, or to the combination. It also is not known whether it will occur in other patient populations.
Vitamin B6
Amiodarone (Cordarone)
Theoretically, vitamin B6 might increase the photosensitivity caused by amiodarone.
Despite initial case reports suggesting that pyridoxine may have a protective effect against amiodarone-induced photosensitivity, preliminary clinical research suggests that pyridoxine may actually exacerbate this adverse effect.
Antihypertensive Drugs
Theoretically, vitamin B6 may have additive effects when used with antihypertensive drugs.
Research in hypertensive rats shows that vitamin B6 can decrease systolic blood pressure. Similarly, clinical research in patients with hypertension shows that taking high doses of vitamin B6 may reduce systolic and diastolic blood pressure, possibly by reducing plasma levels of epinephrine and norepinephrine.
Phenobarbital (Luminal)
High doses of vitamin B6 may reduce the levels and clinical effects of phenobarbital.
Preliminary clinical evidence suggests that vitamin B6 200 mg daily can reduce plasma levels of phenobarbital, possibly by increasing metabolism. It is not known whether lower doses have any effect. Advise people taking phenobarbital to avoid high doses of vitamin B6.
Phenytoin (Dilantin)
High doses of vitamin B6 may reduce the levels and clinical effects of phenytoin.
Preliminary clinical evidence suggests that vitamin B6 200 mg daily can reduce plasma levels of phenytoin, possibly by increasing metabolism. It is not known whether lower doses have any effect. Advise people taking phenytoin to avoid high doses of vitamin B6.
Levodopa
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Vitamin B6 (pyridoxine) enhances the metabolism of levodopa, reducing its clinical effects. However, this interaction does not occur when carbidopa is used concurrently with levodopa (Sinemet). Therefore, it is not likely to be a problem in most people.
Vitamin C
Alkylating Agents
Theoretically, antioxidant effects of vitamin C might reduce the effectiveness of alkylating agents.
The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs that generate free radicals, such as cyclophosphamide, chlorambucil, carmustine, busulfan, and thiotepa. In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin C have on chemotherapy.
Aluminum
Vitamin C can increase the amount of aluminum absorbed from aluminum compounds.
Research in animals and humans shows that vitamin C increases aluminum absorption, theoretically by chelating aluminum and keeping it in solution where it is available for absorption. In people with normal renal function, urinary excretion of aluminum will likely increase, making aluminum retention and toxicity unlikely. Patients with renal failure who take aluminum-containing compounds such as phosphate binders should avoid vitamin C supplements in doses above the recommended dietary allowances.
Antitumor Antibiotics
Theoretically, the antioxidant effects of vitamin C might reduce the effectiveness of antitumor antibiotics.
The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs which generate free radicals, such as doxorubicin. In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effects, if any, antioxidants such as vitamin C have on chemotherapy.
Estrogens
Vitamin C might increase blood levels of estrogens.
Increases in plasma estrogen levels of up to 55% occur under some circumstances when vitamin C is taken concurrently with oral contraceptives or hormone replacement therapy, including topical products. It is suggested that vitamin C prevents oxidation of estrogen in the tissues, regenerates oxidized estrogen, and reduces sulfate conjugation of estrogen in the gut wall. When tissue levels of vitamin C are high, these processes are already maximized and supplemental vitamin C does not have any effect on estrogen levels. Increases in plasma estrogen levels may occur when patients who are deficient in vitamin C take supplements. Monitor these patients for estrogen-related side effects.
Fluphenazine (Prolixin)
Theoretically, vitamin C might decrease levels of fluphenazine.
In one patient there was a clinically significant decrease in fluphenazine levels when vitamin C (500 mg twice daily) was started. The mechanism is not known, and there is no further data to confirm this interaction.
Indinavir (Crixivan)
Vitamin C can modestly reduce indinavir levels.
One pharmacokinetic study shows that taking vitamin C 1 gram orally once daily along with indinavir 800 mg orally three times daily reduces the area under the concentration-time curve of indinavir by 14%. The mechanism of this interaction is unknown, but it is unlikely to be clinically significant in most patients. The effect of higher doses of vitamin C on indinavir levels is unknown.
Levothyroxine (Synthroid, Others)
Vitamin C can increase levothyroxine absorption.
Two clinical studies in adults with poorly controlled hypothyroidism show that swallowing levothyroxine with a glass of water containing vitamin C 500-1000 mg in solution reduces thyroid stimulating hormone (TSH) levels and increases thyroxine (T4) levels when compared with taking levothyroxine alone. This suggests that vitamin C increases the oral absorption of levothyroxine, possibly due to a reduction in pH.
Warfarin (Coumadin)
High-dose vitamin C might reduce the levels and effectiveness of warfarin.
Vitamin C in high doses may cause diarrhea and possibly reduce warfarin absorption. There are reports of two people who took up to 16 grams daily of vitamin C and had a reduction in prothrombin time. Lower doses of 5-10 grams daily can also reduce warfarin absorption. In many cases, this does not seem to be clinically significant. However, a case of warfarin resistance has been reported for a patient who took vitamin C 500 mg twice daily. Cessation of vitamin C supplementation resulted in a rapid increase in international normalized ratio (INR). Tell patients taking warfarin to avoid taking vitamin C in excessively high doses (greater than 10 grams daily). Lower doses may be safe, but the anticoagulation activity of warfarin should be monitored. Patients who are stabilized on warfarin while taking vitamin C should avoid adjusting vitamin C dosage to prevent the possibility of warfarin resistance.
Acetaminophen (Tylenol, Others)
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
A small pharmacokinetic study in healthy volunteers shows that taking high-dose vitamin C (3 grams) 1.5 hours after taking acetaminophen 1 gram slightly increases the apparent half-life of acetaminophen from around 2.3 hours to 3.1 hours. Ascorbic acid competitively inhibits sulfate conjugation of acetaminophen. However, to compensate, elimination of acetaminophen glucuronide and unconjugated acetaminophen increases. This effect is not likely to be clinically significant.
Aspirin
Acidification of the urine by vitamin C might increase aspirin levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction is not clinically significant.
Choline Magnesium Trisalicylate (Trilisate)
Acidification of the urine by vitamin C might increase choline magnesium trisalicylate levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction probably is not clinically significant.
Niacin
Vitamin C might decrease the beneficial effects of niacin on high-density lipoprotein (HDL) cholesterol levels.
A combination of niacin and simvastatin (Zocor) effectively raises HDL cholesterol levels in patients with coronary disease and low HDL levels. Clinical research shows that taking a combination of antioxidants (vitamin C, vitamin E, beta-carotene, and selenium) along with niacin and simvastatin (Zocor) attenuates this rise in HDL, specifically the HDL-2 and apolipoprotein A1 fractions, by more than 50% in patients with coronary disease. It is not known whether this adverse effect is due to a single antioxidant such as vitamin C, or to the combination. It also is not known whether it will occur in other patient populations.
Salsalate (Disalcid)
Acidification of the urine by vitamin C might increase salsalate levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams/day vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction probably is not clinically significant.
Sodium
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.
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.
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.
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.
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.
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.
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.
Folic Acid
5-Fluorouracil
Theoretically, high doses of folic acid might increase the toxicity of 5-fluorouracil.
Increases in gastrointestinal side effects of 5-fluorouracil, such as stomatitis and diarrhea, have been described in two clinical studies when leucovorin, a form of folic acid, was administered with 5-fluorouracil.
Capecitabine (Xeloda)
Use of high-dose folic acid might contribute to capecitabine toxicity.
Clinical research suggests that higher serum folate levels are associated with an increased risk for moderate or severe toxicity during capecitabine-based treatment for colorectal cancer. Additionally, in one case report, taking folic acid 15 mg daily might have contributed to increased toxicity, including severe diarrhea, vomiting, edema, hand-foot syndrome, and eventually death, in a patient prescribed capecitabine.
Methotrexate (Trexall, Others)
Folic acid might reduce the efficacy of methotrexate as a cancer treatment when given concurrently.
Methotrexate exerts its cytotoxic effects by preventing conversion of folic acid to the active form needed by cells. There is some evidence that folic acid supplements reduce the efficacy of methotrexate in the treatment of acute lymphoblastic leukemia, and theoretically they could reduce its efficacy in the treatment of other cancers. Advise cancer patients to consult their oncologist before using folic acid supplements. In patients treated with long-term, low-dose methotrexate for rheumatoid arthritis (RA) or psoriasis, folic acid supplements can reduce the incidence of side effects, without reducing efficacy.
Phenobarbital (Luminal)
Folic acid might have antagonistic effects on phenobarbital and increase the risk for seizures.
Folic acid can have direct convulsant activity in some people, reversing the effects of phenobarbital and worsening seizure control. Monitor closely for increased seizure activity.
Phenytoin (Dilantin)
Folic acid might reduce serum levels of phenytoin in some patients.
Folic acid may be a cofactor in phenytoin metabolism. Folic acid, in doses of 1 mg daily or more, can reduce serum levels of phenytoin in some patients. Increases in seizure frequency have been reported. If folic acid supplements are added to established phenytoin therapy, monitor serum phenytoin levels closely. If phenytoin and folic acid are started at the same time and continued together, adverse changes in phenytoin pharmacokinetics are avoided. Note that phenytoin also reduces serum folate levels.
Primidone (Mysoline)
Folic acid might have antagonistic effects on primidone and increase the risk for seizures.
Folic acid can have direct convulsant activity in some people, reversing the effects of primidone and worsening seizure control. Monitor closely for increased seizure activity. Note that primidone also reduces serum folate levels.
Pyrimethamine (Daraprim)
Folic acid might antagonize the effects of pyrimethamine.
Folic acid can antagonize the antiparasitic effects of pyrimethamine against toxoplasmosis and Pneumocystis carinii pneumonia. Folic acid doesn't antagonize the effects of pyrimethamine in the treatment of malaria, because malarial parasites cannot use exogenous folic acid. Use folinic acid as an alternative to folic acid when indicated.
Vitamin B12
Metformin (Glucophage)
Metformin, a common medication used to manage type 2 diabetes, has been associated with lower vitamin B12 levels in some individuals. Prolonged use of metformin can interfere with the absorption of B12 in the digestive system, potentially leading to a deficiency in this essential vitamin.
Vitamin B2
Tetracycline Antibiotics
Theoretically, taking riboflavin with tetracycline antibiotics may decrease the potency of these antibiotics.
In vitro research suggests that riboflavin may inhibit the potency of tetracycline antibiotics. It is not clear if this effect is clinically significant, as this interaction has not been reported in humans.
Brand information
Manufacturer and brand details for Power Cocktail, from the product label.
Power Cocktail by FitLine: Common Questions
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Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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The Full Monographs Behind Power Cocktail’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Niacin
Interacts with 727 drugsNiacin (vitamin B3) is an essential nutrient your body needs for energy and metabolism, and deficiency is uncommon in most developed countries. Prescription-strength niacin has been used to...
Read the full Niacin monograph → Herb & supplement monographSodium
Interacts with 205 drugsSodium 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 monographVitamin C
Interacts with 207 drugsVitamin C (ascorbic acid) is an essential nutrient your body needs but cannot make, so you must get it from food or supplements. It's important for immune function, collagen, and acts as an...
Read the full Vitamin C monograph → Herb & supplement monographVitamin A
Interacts with 387 drugsVitamin A is an essential nutrient important for vision, skin, immune function, and growth. Most people get enough from a balanced diet, and supplements are mainly useful for correcting a tr...
Read the full Vitamin A monograph → Herb & supplement monographVitamin B6
Interacts with 210 drugsVitamin B6 (pyridoxine) is an essential water-soluble vitamin that your body needs for metabolism, brain function, and making red blood cells. It is best known for helping with pregnancy-rel...
Read the full Vitamin B6 monograph → Herb & supplement monographVitamin B12
Interacts with 20 drugsVitamin B12 (cobalamin) is an essential nutrient your body needs to make red blood cells, keep nerves healthy, and support DNA. Supplements are very helpful for people who are deficient — su...
Read the full Vitamin B12 monograph → Herb & supplement monographBiotin
Biotin (vitamin B7) is a water-soluble vitamin your body needs to turn food into energy and to support healthy hair, skin, and nails. Most people get plenty from a normal diet, and true defi...
Read the full Biotin monograph → Herb & supplement monographVitamin E
Interacts with 764 drugsVitamin E is an essential fat-soluble vitamin and antioxidant that most people get in adequate amounts from a normal diet. Supplements can help correct a true deficiency, but high-dose vitam...
Read the full Vitamin E monograph → Herb & supplement monographFolic Acid
Interacts with 40 drugsFolic acid is the man-made form of vitamin B9 and is one of the most well-studied supplements, especially for preventing serious birth defects when taken before and during early pregnancy. I...
Read the full Folic Acid monograph → Herb & supplement monographBlack Psyllium
Interacts with 2,025 drugsBlack psyllium is a soluble-fiber supplement made from the seeds of a Plantago plant, used mostly to ease constipation and support digestive health. It is best known and most studied for rel...
Read the full Black Psyllium monograph → Herb & supplement monographSelenium
Interacts with 321 drugsSelenium is an essential trace mineral your body needs in small amounts for thyroid function, antioxidant defense, and immune health. Most people who eat a varied diet get enough, and supple...
Read the full Selenium monograph → Herb & supplement monographRiboflavin
Interacts with 20 drugsRiboflavin (vitamin B2) is an essential nutrient your body needs to turn food into energy and to keep skin, eyes, and nerves healthy. It is generally very safe at typical doses, and the stro...
Read the full Riboflavin monograph → Herb & supplement monographPantothenic Acid
Pantothenic acid is vitamin B5, an essential nutrient your body uses to turn food into energy. True deficiency is very rare because it is found in nearly all foods, and most people meet thei...
Read the full Pantothenic Acid monograph → Herb & supplement monographCaffeine
Interacts with 655 drugsCaffeine is a natural stimulant found in coffee, tea, and many other plants and products. In moderate amounts it can boost alertness and reduce tiredness for most healthy adults, but too muc...
Read the full Caffeine monograph →Sources & How We Checked
Power Cocktail'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 678 references behind this product’s interaction data
Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.
Niacin 66 references
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- Anon. Inositol hexaniacinate. Altern Med Rev 1998;3:222-3.
- Knodel LC, Talbert RL. Adverse effects of hypolipidaemic drugs. Med Toxicol 1987;2:10-32. PubMed
- Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group. Arch Intern Med 2000;160:1177-84. PubMed
- Gibbons LW, Gonzalez V, Gordon N, Grundy S. The prevalence of side effects with regular and sustained-release nicotinic acid. Am J Med 1995;99:378-85. PubMed
- Whelan AM, Price SO, Fowler SF, Hainer BL. The effect of aspirin on niacin-induced cutaneous reactions. J Fam Pract 1992;34:165-8.
- Jungnickel PW, Maloley PA, Vander Tuin EL, et al. Effect of two aspirin pretreatment regimens on niacin-induced cutaneous reactions. J Gen Intern Med 1997;12:591-6. PubMed
- Capuzzi DM, Guyton JR, Morgan JM, et al. Efficacy and safety of an extended-release niacin (Niaspan): a long-term study. Am J Cardiol 1998;82:74-81;disc. 85U-6U. PubMed
- Gray DR, Morgan T, Chretien SD, Kashyap ML. Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med 1994;121:252-8. PubMed
- McKenney JM, Proctor JD, Harris S, Chinchili VM. A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients. JAMA 1994;271:672-7. DOI
- Knopp RH, Alagona P, Davidson M, et al. Equivalent efficacy of a time-release form of niacin (Niaspan) given once-a-night versus plain niacin in the management of hyperlipidemia. Metabolism 1998;47:1097-104. PubMed
- Knopp RH. Clinical profiles of plain versus sustained-release niacin (Niaspan) and the physiologic rationale for nighttime dosing. Am J Cardiol 1998;82:24U-28U;discussion 39U-41U. PubMed
- Garg A, Grundy SM. Nicotinic acid as therapy for dyslipidemia in non-insulin-dependent diabetes mellitus. JAMA 1990;264:723-6. DOI
- Leighton RF, Gordon NF, Small GS, et al. Dental and gingival pain as side effects of niacin therapy. Chest 1998;114:1472-4. PubMed
- American Society of Health-System Pharmacists. ASHP Therapeutic Position Statement on the safe use of niacin in the management of dyslipidemias. Am J Health Syst Pharm 1997;54:2815-9. DOI
- Vega GL, Grundy SM. Lipoprotein responses to treatment with lovastatin, gemfibrozil, and nicotinic acid in normolipidemic patients with hypoalphalipoproteinemia. Arch Intern Med 1994;154:73-82. DOI
- Guyton JR, Goldberg AC, Kreisberg RA, et al. Effectiveness of once-nightly dosing of extended-release niacin alone and in combination for hypercholesterolemia. Am J Cardiol 1998;82:737-43.
- Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (2000). Washington, DC: National Academy Press, 2000. Available at: http://b
- Brown BG, Zhao XQ, Chait A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001;345:1583-93. DOI
- Bays HE, Dujovne CA. Drug interactions of lipid-altering drugs. Drug Saf 1998;19:355-71. PubMed
- Rader JI, Calvert RJ, Hathcock JN. Hepatic toxicity of unmodified and time-release preparations of niacin. Am J Med 1992;92:77-81. PubMed
- Kahn SE, Beard JC, Schwartz MW, et al. Increased B-cell secretory capacity as mechanism for islet adaptation to nicotinic acid-induced insulin resistance. Diabetes 1989;38:562-8.
- Schwartz ML. Severe reversible hyperglycemia as a consequence of niacin therapy. Arch Int Med 1993;153:2050-2. DOI
- Raising HDL and Niacin Use. Pharmacist's Letter/Prescriber's Letter 2004;20(5):200504.
- McKenney J. New perspectives on the use of niacin in the treatment of lipid disorders. Arch Intern Med 2004;164:697-705. PubMed
- Reaven P, Witztum JL. Lovastatin, nicotinic acid and rhabdomyolysis (letter). Ann Int Med 1988;109:597-8. PubMed
- Ito MK. Advances in the understanding and management of dyslipidemia: using niacin-based therapies. Am J Health-Syst Pharm 2003;60(suppl 2):s15-21. PubMed
- Schwab RA, Bachhuber BH. Delirium and lactic acidosis caused by ethanol and niacin coingestion. Am J Emerg Med 1991;9:363-5. PubMed
- Product information: Niaspan. Kos Pharmaceuticals. Cranbury, NJ. 2005. Available at www.niaspan.com/professional/content/pdfs/productinfo.pdf. (Accessed 3 March 2006).
- Ding RW, Kolbe K, Merz B, et al. Pharmacokinetics of nicotinic acid-salicylic acid interaction. Clin Pharmacol Ther 1989;46:642-7. PubMed
- NIH News. NIH stops clinical trial on combination cholesterol treatment. May 26, 2011. http://www.nih.gov/news/health/may2011/nhlbi-26.htm. (Accessed 3 June 2011).
- Dearing BD, Lavie CJ, Lohmann TP, Genton E. Niacin-induced clotting factor synthesis deficiency with coagulopathy. Arch Intern Med. 1992;152(4):861-3. DOI
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