Major interaction on record — check this product against your medications before combining. Based on 6 of 10 ingredients. Check your meds →
Dietary supplement

Baby Care Prenatal Omega 3-6-9 Ingredients & Drug Interactions

by Country Life

Baby Care Prenatal Omega 3-6-9 label
See full label image
Softgel Capsule Category: Botanical With Nutrients
Most serious interaction: Major
Clinical methodology reviewed by · Updated Sep 16, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Baby Care Prenatal Omega 3-6-9 against your medications. The heart of this page is the interaction checker and the full interaction report — how this product’s ingredients may interact with prescription and over-the-counter medicines you may be taking.

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

The interaction bottom line Most serious interaction: Major

Baby Care Prenatal Omega 3-6-9 is a dietary supplement by Country Life with 10 active ingredients. Its ingredients are commonly taken for treating or preventing b12 deficiency, pernicious anemia, low energy and fatigue.Based on those ingredients, 1,166 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Ginger root extract, Peppermint Oil, Borage seed Oil. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

Jump to a section

Check Your Meds Against Baby Care Prenatal Omega 3-6-9 by Country Life

Ask about any prescription or over-the-counter medication and we check it for interactions with Baby Care Prenatal Omega 3-6-9 by Country Life — and tell you which ingredient is responsible.

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HelloPharmacist Scorecard of Baby Care Prenatal Omega 3-6-9 by Country Life

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

From our pharmacy team — supplement deep dive

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

What’s inside

Partial disclosure
Ingredient Transparency · database check
Partial

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

Why this rating?
  • The label discloses an exact amount for 9 of its 11 active ingredients.
  • “Calcium” is listed as a grouped ingredient — the label gives one combined amount (204 mg) without saying how much of each component you get.
  • “Proprietary Blend” is a proprietary blend — the label gives one combined amount (24 mg) without saying how much of each component you get.
  • “Linoleic Acid” is listed as a grouped ingredient — the label gives one combined amount (65 mg) without saying how much of each component you get.

This prenatal supplement contains 11 ingredients, including several active components. Vitamin B12 supports blood cell formation and nervous system function — it's needed during pregnancy and breastfeeding at recommended doses.

Calcium (as tribasic calcium phosphate) is included for bone and fetal skeletal development. The product also contains omega fatty acids: docosahexaenoic acid and eicosapentaenoic acid (from marine sources), along with linoleic acid, alpha-linolenic acid, oleic acid, and gamma-linolenic acid from seed oils like borage and other sources.

Ginger root extract and peppermint oil are added, likely for digestive comfort in pregnancy. The remaining inactive ingredients include gelatin, glycerin, beeswax, carob color, purified water, sunflower lecithin, and natural lemon flavor — these are fillers, binders, and capsule materials.

Does it work?

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

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

Why this rating?
  • The label markets this product for: prenatal nutrition with omega fatty acids.
  • We looked for evidence on: Fetal bone mineralization, Maternal nutritional support during pregnancy, Fetal development, Essential fatty acid supplementation.
  • The strongest evidence on file: Calcium is rated "Possibly Effective" for Fetal bone mineralization (Natural Medicines).

Vitamin B12 in this product is effective for treating B12 deficiency and has been found likely effective for cyanide poisoning and possibly effective for canker sores and nerve pain. Calcium is effective for bone and mineral disorders, likely effective for osteoporosis, and supports fetal development in pregnancy.

Oleic acid, one of the omega fatty acids here, is possibly effective for high cholesterol and heart disease risk. Ginger root extract is possibly effective for pregnancy-related nausea and vomiting and period pain, though the data rates it possibly ineffective for muscle soreness.

Peppermint oil is likely effective for irritable bowel syndrome and possibly effective for indigestion and nausea. Borage seed oil shows insufficient evidence or possibly ineffective ratings for the conditions tested so far.

The evidence for the other ingredients — polyunsaturated fats, phosphorus, gamma-linolenic acid, linoleic acid, docosahexaenoic acid, and eicosapentaenoic acid — is not established in our data.

The evidence, ingredient by ingredient Vitamin B12 Calcium Ginger Peppermint Borage Oleic Acid

How safe is it?

Well-documented data
Safety Information · database check
Well characterized

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

Why this rating?
  • We hold adverse-effect (side-effect) data for 5 of the 6 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 6 of 6.
  • General safety write-ups exist for 6 of 6.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Vitamin B12 is generally very well tolerated and has no established upper limit; excess is removed in the urine. It is safe at recommended amounts during pregnancy and breastfeeding.

Calcium is safe when taken at recommended doses, though high doses can cause constipation, bloating, or diarrhea, and there is rare concern about kidney stones at very high intakes. Calcium is considered safe in pregnancy and breastfeeding at recommended amounts.

Ginger is generally well tolerated at typical amounts but higher doses (5 grams per day or more) increase the risk of side effects like heartburn, diarrhea, and abdominal discomfort. Ginger is often used for morning sickness but check with your doctor first and keep amounts moderate.

Peppermint oil in food and tea amounts is likely safe, though concentrated oil should be used cautiously; information is limited during pregnancy. Borage seed oil that is certified free of pyrrolizidine alkaloids is generally better tolerated, but the safety data advises against it in pregnancy because of possible liver-toxic alkaloids and theoretical risk to the uterus.

During breastfeeding, borage is best avoided due to limited safety data.

Side effects, ingredient by ingredient Vitamin B12 Calcium Ginger Peppermint Borage Oleic Acid

Meds to double-check

Major interaction found
Known Interaction Concern · database check
Major identified

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

Why this rating?
  • 6 of the 6 matched ingredients can interact with medications — Borage, Peppermint, Calcium, Vitamin B12, Ginger, among others.
  • The most serious interaction on file is rated Major.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; immunosuppressants / transplant drugs; diabetes medications; heart-rhythm medications; lithium.
  • For scale: 1,167 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.

If you take dolutegravir or elvitegravir for HIV, separate them from this product by 2 to 6 hours — calcium can cut their effectiveness sharply. Blood thinners (warfarin) and antiplatelet drugs (aspirin, clopidogrel) need careful timing with the ginger and borage here, as they may increase bleeding risk.

Levothyroxine for thyroid should be taken at least 4 hours away from the calcium. Antidiabetes medications (metformin, insulin, sulfonylureas) may have their effects increased by ginger, raising the risk of low blood sugar.

Check any CYP3A4, CYP2C9, or CYP2C19 substrate drugs you take — ginger and peppermint may alter their levels. No interactions are documented for the polyunsaturated fats, phosphorus, gamma-linolenic acid, linoleic acid, or marine omega fatty acids we hold data for.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glancePartially disclosed formula with some supporting evidence for its stated purpose. Major medication interactions have been identified, and safety information is well characterized.

This prenatal omega supplement may appeal to you if you're seeking vitamin B12, calcium, and omega fatty acids with added digestive herbs for pregnancy support. Be especially careful if you take HIV medications (dolutegravir, elvitegravir), levothyroxine for thyroid, blood thinners (warfarin), antidiabetes drugs, or antipsychotics — the calcium and herbal ingredients here can interfere.

Talk to your pharmacist or doctor before starting, particularly to review timing and your current medications.

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

Assessment coverage: 6 of 11 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Oct 25, 2018.

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

At a glance

General information

Key facts about Baby Care Prenatal Omega 3-6-9, straight from the product label.

Brand Country Life
Barcode (UPC) 015794041061
Net contents 90 Softgel(s)
Market status On market
Date entered into DSLD Oct 25, 2018
DSLD ID 182476
Product type Botanical With Nutrients
Supplement form Softgel Capsule
Dietary claims / uses Nutrient, All Other, Structure/Function
Intended target group(s) Pregnant Women, Adult Female (18 - 50 Years), Gluten Free, Dairy Free, Sugar Free
From the label
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.

Supplement Facts

The label details for Baby Care Prenatal Omega 3-6-9 by Country Life, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Pregnant and Lactating
Minimum serving Sizes:
2 Softgel(s)
Maximum serving Sizes:
2 Softgel(s)
Servings per container
45
UPC/BARCODE
015794041061
IngredientAmount% DV
Calories10 Calorie(s)--
Calories from Fat10 Calorie(s)--
Polyunsaturated Fat1 Gram(s)--
Vitamin B12100 mcg1250%
Phosphorus114 mg9%
Calcium204 mg16%
Gamma-Linolenic Acid40 mg--
Total Fat1 Gram(s)2%
Proprietary Blend24 mg--
Linoleic Acid65 mg--
Oleic Acid28 mg--
Tribasic Calcium Phosphate600 mg--
Docosahexaenoic Acid400 mg--
Eicosapentaenoic Acid100 mg--
Ginger root extract0 NP--
Peppermint Oil0 NP--
Borage seed Oil210 mg--

Other ingredients: Gelatin, Glycerin, Beeswax, Carob color, purified Water, Sunflower Lecithin, natural Lemon flavor, Gelatin

Tap any ingredient to jump to its full detail below.

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

The nutritional demands placed on a mother during pregnancy are enormous. Supplementation with many nutrients, including Omega fatty acids and essential fatty acids, may be helpful to both fetus and mother. Country Life recognized the unique needs during pregnancy and introduced the first Omega product specifically for prenatal women.

Baby Care Prenatal Omega 3-6-9 offers over 600mg of Omega fatty acids, including a triple blend of DHA, EPA and GLA. It also includes Vitamin B12, calcium, and phosphorus for additional nutritional support.

Provides 633 mg of Omega-3, 6 and 9 fatty acids.

Supports nutritional demands of both fetus and expectant Mom

Triple blend of DHA, EPA and GLA Over 600 mg of Omegas in 2 softgels DHA + EPA Fish Oil Concentrate 500 mg Borage Seed Oil (Non-GMO) 210 mg

Contains fish (anchovy, sardine, mackerel, herring, salmon, tuna).

The Omega fatty acids contained in this product are derived from fish and borage seed oil. The fish oil, derived from anchovy, sardine, mackerel, herring, salmon, and tuna, has been processed using molecular distillation to ensure its purity. The borage seed oil was also 100% expeller pressed without hexane or harsh chemicals.

And understanding the sensitive palate of the expectant mother, each softgel is natural lemon flavored - no fishy taste, and also includes ginger root extract and peppermint oil.

The body needs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). To make these, the body requires alpha-linolenic acid (ALA). This is an Omega-3 essential fatty acid that is converted in the body to the fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Linoleic acid (LA) is an Omega-6 fatty acid that also complements the diet.

First Omega product designed specifically for women during pregnancy.

FDA Disclaimer Statement

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

Formulation

Yes Certified gluten-free by GFCO.org

No Yeast, wheat or corn No Milk, salt or sugar No Preservatives No Artificial flavors or sweeteners No Magnesium stearate

Borage Seed Oil (Non-GMO) 210 mg

The borage seed oil was also 100% expeller pressed without hexane or harsh chemicals.

General Statements

Yes Recyclable packaging Yes Manufacturing supports wind power

This product has been manufactured at a GMP registered facility.

Established 1971

Natural Lemon flavored!

Our pledge of integrity Authenticity Cleanliness Freshness Consistency Accuracy

Country Life's Baby Care Prenatal Omega 3-6-9 is made according to high quality and exacting standards.

At Country Life, integrity is our #1 ingredient. Every product is rigorously tested to ensure it measures up against Country Life's 5 Integrity Standards: 1) authenticity of ingredients; 2) cleanliness of ingredients; 3) freshness of ingredients; 4) consistency of the formula; and 5) accuracy of labeling.

06N16NM

Whether for your developing fetus or yourself, Omega-3 fatty acids can help in many ways. Research with Omega-3 fatty acids supplementation has shown promise in many areas, including: Cardiovascular health Brain health Skin health Immune health

When fatty acids such as EPA are present in the body, it becomes a precursor for hormone-like agents known as eicosanoids. These help regulate fundamental processes such as cell division and growth, blood clotting, muscle activity, secretion of digestive juices and hormones, and movement of substances like calcium into and out of cells.

The Omega-3 fatty acid DHA is the major polyunsaturated fatty acid found in the brain and is important for brain function. Brain cells, as well as many other cells, in the body are rich in DHA, which suggests that this fatty acid is involved in brain health.

People with diets low in fat or heavy in saturated, hydrogenated, or trans-fat may be deficient in valuable fatty acids.

Country Life is passionate about helping you live a healthy, active life. This extends into the environment we live in and the materials we use in our packaging. We use 100% recycled paperboard.

Please help us in our mission; recycle this box & bottle after use.

Precautions

Caution: If you are pregnant or nursing, taking medication or planning a surgery, consult your doctor before using this product.

If any adverse reactions occur, stop taking the product and consult your doctor. Do not accept if seal is broken.

Keep out of the reach of children.

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

Contains fish (anchovy, sardine, mackerel, herring, salmon, tuna).

Storage

Store between 59(0)-86(0) F.

General

Product No. 4106 06L16NL

FDA Statement of Identity

Dietary Supplement

Seals/Symbols

Processed Using Molecular Distillation Third Party Tested

Suggested/Recommended/Usage/Directions

Directions: Adults take two (2) softgels per day. For best utilization, take with food. As a reminder, discuss the supplements and medications that you take with your health care providers.

In just two softgels, Country Life's Baby Care Prenatal Omega 3-6-9 is a convenient way to supplement your (and your growing fetus) diet with the Omega fatty acids and linoleic acid, an essential fatty acid that it may be missing.

Brand IP Statement(s)

FSC www.fsc.org Recycled Packaging made from recycled material FSC C005506

Consider including a multivitamin as part of your prenatal supplementation regime. Try our RealFood Organics Prenatal Daily Nutrition. Made from over 30 raw fruits and vegetables 800 mcg of whole food folic acid 18 mg of whole food iron Gentle on the stomach Now with Kelp

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

See for yourself

Baby Care Prenatal Omega 3-6-9 by Country Life label

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

Baby Care Prenatal Omega 3-6-9 label

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

View the full label (PDF)
What’s inside

The Ingredients in Baby Care Prenatal Omega 3-6-9 by Country Life

These are the 10 active ingredients this product is made of. Select any to open its full monograph.

Serving size2 Softgel(s) Dosage formSoftgel Capsule Servings per container45 Amounts shown are per serving.

Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.

Vitamin B12

Interacts with
20 drugs
100 mcg per serving Form: Cyanocobalamin

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 & interactions

Phosphorus

114 mg per serving

Calcium

Interacts with
168 drugs
204 mg per serving

Calcium is an essential mineral your body needs for strong bones, nerve signaling, and muscle function, and supplements can help fill gaps when diet f...

Calcium monograph & interactions

Gamma-Linolenic Acid

40 mg per serving

Proprietary Blend

24 mg per serving

Linoleic Acid

65 mg per serving

Oleic Acid

Interacts with
86 drugs
28 mg per serving

Oleic acid is a heart-healthy monounsaturated fat found mainly in olive oil, canola oil, avocados, and nuts. As part of a Mediterranean-style diet, it...

Oleic Acid monograph & interactions

Docosahexaenoic Acid

400 mg per serving Form: Fish Oil Concentrate

Eicosapentaenoic Acid

100 mg per serving Form: Fish Oil Concentrate

Other (inactive) ingredients: Gelatin, Glycerin, Beeswax, Carob color, Purified Water, Sunflower Lecithin, Natural Lemon flavor, Gelatin. These complete the product’s ingredient list but are not active constituents.

Interaction report

Baby Care Prenatal Omega 3-6-9 by Country Life Drug Interactions

Want to check YOUR meds against Baby Care Prenatal Omega 3-6-9?

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

 Go to the checker
1,166Drugs
7 Major 1,093 Moderate 66 Minor

Ingredients driving the most interactions

Ginger root extract 1,007
Peppermint Oil 796
Borage seed Oil 226
Calcium 168
Oleic Acid 86

Individual Drug Interactions

The ingredients in Baby Care Prenatal Omega 3-6-9 interact with 1,166 drugs. Click any drug to see the details.

6 of the 10 ingredients in Baby Care Prenatal Omega 3-6-9 interact with drugs. Each result below shows which ingredient is responsible. Ginger root extract Peppermint Oil Borage seed Oil Calcium Oleic Acid Vitamin B12

Each ingredient & the kinds of drugs it affects

For each ingredient in Baby Care Prenatal Omega 3-6-9 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.

Ginger root extract14 drug types · 1,007 drugs

Anticoagulant/Antiplatelet Drugs

Ginger may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs. However, research is conflicting.
Laboratory research suggests that ginger inhibits thromboxane synthetase and decreases platelet aggregation. However, this has not been demonstrated unequivocally in humans, with mixed results from clinical trials. Theoretically, excessive amounts of ginger might increase the risk of bleeding when used with anticoagulant/antiplatelet drugs.

Likelihood Possible Evidence B
Antidiabetes Drugs

Theoretically, taking ginger with antidiabetes drugs might increase the risk of hypoglycemia.
Animal and human research suggests that ginger might increase insulin levels and/or decrease blood glucose levels.

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

Ginger might increase or decrease the levels of CYP3A4 substrates.
In vitro research and some case reports suggest that ginger inhibits CYP3A4 activity. Three case reports from the World Health Organization (WHO) adverse drug reaction database describe increased toxicity in patients taking ginger and cancer medications that are CYP3A4 substrates (imatinib, dabrafenib, and crizotinib). However, the causality of this interaction is unclear due to the presence of multiple interacting drugs and routes of administration.
Conversely, other in vitro research suggests that ginger induces CYP3A4 activity, leading to reduced levels of CYP3A4 substrates. However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Losartan (Cozaar)

Theoretically, ginger might increase levels of losartan and the risk of hypotension.
In animal research, ginger increased the levels and hypotensive effects of a single dose of losartan. It is not clear if ginger alters the concentration or effects of losartan when taken continuously. Additionally, this interaction has not been shown in humans.

Likelihood Possible Evidence D
Nifedipine (Procardia)

Ginger may have antiplatelet effects and increase the risk of bleeding if used with nifedipine.
Clinical research shows that combined treatment with ginger 1 gram plus nifedipine 10 mg significantly inhibits platelet aggregation when compared to nifedipine or ginger alone.

Likelihood Possible Evidence B
P-Glycoprotein Substrates

Ginger might increase the absorption and blood levels of P-glycoprotein (P-gp) substrates.
In vitro research and case reports suggest that ginger inhibits drug efflux by P-gp, potentially increasing absorption and serum levels of P-gp substrates. Two case reports from the World Health Organization (WHO) adverse drug reaction database describe increased toxicity in patients taking ginger and cancer medications that are P-gp substrates (trametinib, crizotinib). However, the causality of this interaction is unclear due to the presence of multiple interacting drugs and routes of administration.

Likelihood Possible Evidence D
Phenprocoumon (Marcoumar, Others)

Ginger might increase the risk of bleeding with phenprocoumon.
Phenprocoumon, a warfarin-related anticoagulant, might increase the international normalized ratio (INR) when taken with ginger. There is one case report of a 76-year-old woman with a stable INR on phenprocoumon that increased to greater than 10 when she began consuming dried ginger and ginger tea.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Ginger might increase the risk of bleeding with warfarin.
Laboratory research suggests that ginger might inhibit thromboxane synthetase and decrease platelet aggregation. In one case report, ginger increased the INR when taken with phenprocoumon, which has similar pharmacological effects as warfarin. In another case report, ginger increased the INR when taken with a combination of warfarin, hydrochlorothiazide, and acetaminophen. A longitudinal analysis suggests that taking ginger increases the risk of bleeding in patients taking warfarin for at least 4 months. However, research in healthy people suggests that ginger has no effect on INR, or the pharmacokinetics or pharmacodynamics of warfarin. Until more is known, monitor INRs closely in patients taking large amounts of ginger.

Likelihood Possible Evidence B
Calcium Channel Blockers

Theoretically, taking ginger with calcium channel blockers might increase the risk of hypotension.
Some animal and in vitro research suggests that ginger has hypotensive and calcium channel-blocking effects. Another animal study shows that concomitant administration of ginger and the calcium channel blocker amlodipine leads to greater reductions in blood pressure when compared with amlodipine alone.

Likelihood Unlikely Evidence D
Cyclosporine (Neoral, Sandimmune)

Theoretically, when taken prior to cyclosporine, ginger might decrease cyclosporine levels.
In an animal model, ginger juice taken 2 hours prior to cyclosporine administration reduced the maximum concentration and area under the curve of cyclosporine by 51% and 40%, respectively. This effect was not observed when ginger juice and cyclosporine were administered at the same time.

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

Theoretically, ginger might increase the levels of CYP1A2 substrates.
In vitro research shows that ginger inhibits CYP1A2 activity. However, this interaction has not been reported in humans.

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

Theoretically, ginger might increase the levels of CYP2B6 substrates.
In vitro research shows that ginger inhibits CYP2B6 activity. However, this interaction has not been reported in humans.

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

Theoretically, ginger might increase the levels of CYP2C9 substrates.
In vitro research shows that ginger inhibits CYP2C9 activity. However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Metronidazole (Flagyl)

Theoretically, ginger might increase levels of metronidazole.
In an animal model, ginger increased the absorption and plasma half-life of metronidazole. In addition, the elimination rate and clearance of metronidazole was significantly reduced.

Likelihood Possible Evidence D
Ginger root extract full monograph & interactions

Peppermint Oil5 drug types · 796 drugs

Cyclosporine (Neoral, Sandimmune)

Theoretically, peppermint oil might increase the levels and adverse effects of cyclosporine.
In animal research, peppermint oil inhibits cyclosporine metabolism and increases cyclosporine levels. Inhibition of cytochrome P450 3A4 (CYP3A4) may be partially responsible for this interaction. An interaction between peppermint oil and cyclosporine has not been reported in humans.

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

Theoretically, peppermint might increase the levels of CYP2C19 substrates.
In vitro research shows that peppermint oil inhibits CYP2C19. So far, this interaction has not been reported in humans.

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

Theoretically, peppermint might increase the levels of CYP2C9 substrates.
In vitro research shows that peppermint oil inhibits CYP2C9. So far, this interaction has not been reported in humans.

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

Theoretically, peppermint might increase the levels of CYP3A4 substrates.
Clinical research in healthy volunteers shows that a single dose of peppermint oil 600 mg inhibits CYP3A4 enzymes and increases the AUC of felodipine, a CYP3A4 substrate. However, in vitro research suggests that peppermint oil only inhibits CYP3A4 at very high concentrations.

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

Theoretically, peppermint might increase the levels of CYP1A2 substrates.
In vitro and animal research shows that peppermint oil and peppermint leaf inhibit CYP1A2. However, in clinical research, peppermint tea did not significantly affect the metabolism of caffeine, a CYP1A2 substrate. It is possible that the 6-day duration of treatment may have been too short to identify a difference.

Likelihood Possible Evidence B
Peppermint Oil full monograph & interactions

Borage seed Oil3 drug types · 226 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, borage seed oil may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
In healthy individuals, borage seed oil supplementation does not seem to affect platelet aggregation. However, gamma-linolenic acid, a constituent of borage seed oil, seems to decrease platelet aggregation by 45% and increase the risk of bleeding by 40% in animal and clinical research.

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

Theoretically, taking borage with drugs that induce CYP3A4 might increase levels of pyrrolizidine alkaloid (PA) toxic metabolites.
Although borage seed oil contains little to no PAs, some borage plant parts, such as the leaf, flower, and seed, can contain hepatotoxic PAs. Hepatotoxic PAs are substrates of CYP3A4, which converts these chemicals into toxic metabolites. Tell patients to avoid borage preparations that are not certified and labeled as hepatotoxic PA-free.

Likelihood Possible Evidence D
Phenothiazines

Theoretically, taking borage sed oil with phenothiazines might increase the risk of seizures.
Borage seed oil contains gamma-linolenic acid (GLA). There is concern that taking supplements containing GLA might cause seizures, or lower the seizure threshold, when taken with phenothiazines. This is based on limited data from two reports published in the 1980s. In one report, three patients with schizophrenia who had received phenothiazines developed EEG changes suggestive of temporal lobe epilepsy after starting treatment with evening primrose, another source of GLA. However, none experienced an actual seizure. In the other report, two patients with schizophrenia who were stabilized on phenothiazines developed seizures when evening primrose 4 grams daily was added. One of these patients had a prior history of seizures. It is unclear whether evening primrose had any additive epileptogenic effects with the phenothiazines, but there is no evidence that taking GLA-containing supplements alone can cause seizures.

Likelihood Possible Evidence D
Borage seed Oil full monograph & interactions

Calcium18 drug types · 168 drugs

Ceftriaxone (Rocephin)

Co-administration of intravenous calcium and ceftriaxone can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys.
Avoid administering intravenous calcium in any form, such as parenteral nutrition or Lactated Ringers, within 48 hours of intravenous ceftriaxone. Case reports in neonates show that administering intravenous ceftriaxone and calcium can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys. In several cases, neonates have died as a result of this interaction. So far there are no reports in adults; however, there is still concern that this interaction might occur in adults.

Likelihood Probable Evidence D
Dolutegravir (Tivicay)

Calcium seems to reduce levels of dolutegravir.
Advise patients to take dolutegravir either 2 hours before or 6 hours after taking calcium supplements. Pharmacokinetic research suggests that taking calcium carbonate 1200 mg concomitantly with dolutegravir 50 mg reduces plasma levels of dolutegravir by almost 40%. Calcium appears to decrease levels of dolutegravir through chelation.

Likelihood Probable Evidence B
Elvitegravir (Vitekta)

Calcium seems to reduce levels of elvitegravir.
Advise patients to take elvitegravir either 2 hours before or 2 hours after taking calcium supplements. Pharmacokinetic research suggests that taking calcium along with elvitegravir can reduce blood levels of elvitegravir through chelation.

Likelihood Probable Evidence B
Aluminum

Calcium citrate might increase aluminum absorption and toxicity. Other types of calcium do not increase aluminum absorption.
Calcium citrate can increase the absorption of aluminum when taken with aluminum hydroxide. The increase in aluminum levels may become toxic, particularly in individuals with kidney disease. However, the effect of calcium citrate on aluminum absorption is due to the citrate anion rather than calcium cation. Calcium acetate does not appear to increase aluminum absorption.

Likelihood Possible Evidence B
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)

Calcium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption when taken in a fasting state.
Advise patients that bictegravir/emtricitabine/tenofovir alafenamide and calcium can be taken together if taken with food. However, if taken on an empty stomach, bictegravir/emtricitabine/tenofovir alafenamide should not be taken with, or 2 hours after, calcium containing products.

Likelihood Probable Evidence D
Bisphosphonates

Calcium reduces the absorption of bisphosphonates.
Advise patients to take bisphosphonates at least 30 minutes before calcium, but preferably at a different time of day. Calcium supplements decrease absorption of bisphosphonates.

Likelihood Probable Evidence C
Calcipotriene (Dovonex)

Taking calcipotriene with calcium might increase the risk for hypercalcemia.
Calcipotriene is a vitamin D analog used topically for psoriasis. It can be absorbed in sufficient amounts to cause systemic effects, including hypercalcemia. Theoretically, combining calcipotriene with calcium supplements might increase the risk of hypercalcemia.

Likelihood Possible Evidence B
Digoxin (Lanoxin)

Using intravenous calcium with digoxin might increase the risk of fatal cardiac arrhythmias.
Hypercalcemia increases the risk of fatal cardiac arrhythmias with digoxin. However, one retrospective analysis of clinical data suggests that intravenous calcium does not increase the risk of dysrhythmias or mortality in patients receiving digoxin.

Likelihood Possible Evidence B
Diltiazem (Cardizem, Others)

Theoretically, calcium may reduce the therapeutic effects of diltiazem.
Hypercalcemia can reduce the effectiveness of verapamil in atrial fibrillation. Theoretically, calcium might increase this risk of hypercalcemia and reduce the effectiveness of diltiazem.

Likelihood Probable Evidence D
Levothyroxine (Synthroid, Others)

Calcium seems to reduce the absorption and effectiveness of levothyroxine.
Advise patients to take levothyroxine and calcium supplements at least 4 hours apart. Calcium reduces levothyroxine absorption, probably by forming insoluble complexes. Calcium carbonate supplements reduce effectiveness of levothyroxine in patients with hypothyroidism.

Likelihood Probable Evidence B
Lithium

Theoretically, concomitant use of calcium and lithium may increase this risk of hypercalcemia.
Clinical research suggests that long-term use of lithium may cause hypercalcemia in 10% to 60% of patients. Theoretically, concomitant use of lithium and calcium supplements may further increase this risk.

Likelihood Possible Evidence B
Quinolone Antibiotics

Calcium seems to reduce the absorption of quinolone antibiotics.
Advise patients to take oral quinolones at least 2 hours before or 4-6 hours after calcium supplements or calcium-fortified foods. Taking calcium at the same time as oral quinolones can reduce quinolone absorption. Calcium binds to quinolones in the gut.

Likelihood Probable Evidence B
Raltegravir (Isentress)

Calcium may reduce levels of raltegravir.
Pharmacokinetic research shows that taking a single dose of calcium carbonate 3000 mg along with raltegravir 400 mg twice daily modestly decreases the mean area under the curve of raltegravir, but the decrease does not necessitate a dose adjustment of raltegravir. However, a case of elevated HIV-1 RNA levels and documented resistance to raltegravir has been reported for a patient taking calcium carbonate 1 gram three times daily plus vitamin D3 (cholecalciferol) 400 IU three times daily in combination with raltegravir 400 mg twice daily for 11 months. It is thought that calcium reduced raltegravir levels by chelation, leading to treatment failure.

Likelihood Possible Evidence B
Sotalol (Betapace)

Calcium seems to reduce the absorption of sotalol.
Advise patients to separate doses by at least 2 hours before or 4-6 hours after calcium. Calcium appears to reduce the absorption of sotalol, probably by forming insoluble complexes.

Likelihood Possible Evidence B
Tetracycline Antibiotics

Calcium seems to reduce the absorption of tetracycline antibiotics.
Advise patients to take oral tetracyclines at least 2 hours before, or 4-6 hours after calcium supplements. Taking calcium at the same time as oral tetracyclines can reduce tetracycline absorption. Calcium binds to tetracyclines in the gut.

Likelihood Probable Evidence C
Thiazide Diuretics

Taking calcium along with thiazides might increase the risk of hypercalcemia and renal failure.
Thiazides reduce calcium excretion by the kidneys. Using thiazides along with moderately large amounts of calcium carbonate increases the risk of milk-alkali syndrome (hypercalcemia, metabolic alkalosis, renal failure). Patients may need to have their serum calcium levels and/or parathyroid function monitored regularly.

Likelihood Probable Evidence C
Verapamil (Calan, Others)

Theoretically, calcium may reduce the therapeutic effects of verapamil.
Hypercalcemia can reduce the effectiveness of verapamil in atrial fibrillation. Theoretically, use of calcium supplements may increase this risk of hypercalcemia and reduce the effectiveness of verapamil.

Likelihood Probable Evidence D
Calcium Channel Blockers

Intravenous calcium may decrease the effects of calcium channel blockers; oral calcium is unlikely to have this effect.
Intravenous calcium is used to decrease the effects of calcium channel blockers in the management of overdose. Intravenous calcium gluconate has been used before intravenous verapamil (Isoptin) to prevent or reduce the hypotensive effects without affecting the antiarrhythmic effects. But there is no evidence that dietary or supplemental calcium when taken orally interacts with calcium channel blockers.

Likelihood Unlikely Evidence D
Calcium full monograph & interactions

Oleic Acid1 drug type · 86 drugs

Antidiabetes Drugs

Theoretically, oleic acid might increase the effects of antidiabetes drugs. Preliminary clinical research in patients with type 2 diabetes taking oral hypoglycemic drugs shows that eating a diet rich in oleic acid from olive oil decreases fasting blood glucose levels when compared to eating a diet rich in linoleic acid from sunflower oil. It is unknown if taking oleic acid supplements would have this effect or if this change is clinically significant. Until more is known, use caution. Dose adjustment may be necessary. Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, metformin (Glucophage), pioglitazone (Actos), rosiglitazone (Avandia), and others.

Likelihood Possible Evidence B
Oleic Acid full monograph & interactions

Vitamin B121 drug type · 20 drugs

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.

Likelihood Possible Evidence A
Vitamin B12 full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Baby Care Prenatal Omega 3-6-9, from the product label.

Country Life

See all Country Life products
Name
Country Life, LLC
Street Address
180 Vanderbilt Motor Parkway
City
Hauppauge
State
NY
ZipCode
11788
Web Address
CountryLifeVitamins.com
Pharmacist Counseling Corner

Baby Care Prenatal Omega 3-6-9 by Country Life: Common Questions

Does Baby Care Prenatal Omega 3-6-9 by Country Life interact with any medications?
Yes. Based on its ingredients, Baby Care Prenatal Omega 3-6-9 has a known interaction with 1,166 medications, including 7 rated major. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Baby Care Prenatal Omega 3-6-9 contains 10 active ingredients, and an interaction can come from any of them. We check every ingredient, combine the results into one list per medication, and show which ingredient and mechanism is responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.
Is this product safe to take during pregnancy?
Vitamin B12 and calcium are safe at recommended amounts in pregnancy and support fetal development. Ginger is often used for morning sickness but check with your doctor first and keep amounts moderate. However, borage seed oil is advised against in pregnancy due to possible liver-toxic alkaloids and theoretical risk to the uterus. Talk with your OB or midwife about the full product before starting.
Is this safe while breastfeeding?
Vitamin B12 and calcium are safe at recommended amounts during breastfeeding. Peppermint is likely safe in food and supplement amounts. Borage seed oil should be avoided during breastfeeding because there isn't enough safety data and there's concern about liver-toxic alkaloids. Check with your provider about the specific product.
Will the ginger or peppermint in this give me side effects?
Ginger at typical supplement amounts is generally well tolerated, though some people experience mild heartburn, diarrhea, or abdominal discomfort — higher doses increase the risk. Peppermint oil is also generally well tolerated in standard amounts, with occasional reports of abdominal pain, heartburn, or dry mouth. Encapsulated forms may reduce irritation compared to powders.
Does this product contain fillers?
Yes, this softgel contains inactive ingredients including gelatin (the capsule material), glycerin, beeswax, carob color, purified water, sunflower lecithin, and natural lemon flavor — these are binders, thickeners, and flavoring agents typical of softgel supplements.
Can I take this if I'm on metformin for diabetes?
Metformin can lower vitamin B12 levels with long-term use — this product's B12 may help offset that. However, the ginger in this product may theoretically increase insulin effects and the risk of low blood sugar with metformin. Check with your pharmacist about timing and whether the combination is right for you.
What is the ginger in this product for?
Ginger is included for its possibly effective use in pregnancy-related nausea and vomiting, as well as its traditional digestive benefits. However, check with your doctor before relying on it for morning sickness and keep the dose moderate.

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

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

Baby Care Prenatal Omega 3-6-9 label
Go deeper

The Full Monographs Behind Baby Care Prenatal Omega 3-6-9’s Ingredients

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

Herb & supplement monograph

Vitamin B12

Interacts with 20 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 helpful for people who are deficient — su...

Read the full Vitamin B12 monograph → Herb & supplement monograph

Calcium

Interacts with 168 drugs

Calcium is an essential mineral your body needs for strong bones, nerve signaling, and muscle function, and supplements can help fill gaps when diet falls short. Most people do best getting...

Read the full Calcium monograph → Herb & supplement monograph

Ginger

Interacts with 1,007 drugs

Ginger is a widely used culinary spice with a long history in traditional medicine, and it has the strongest evidence for helping with nausea and vomiting, including from motion sickness, pr...

Read the full Ginger monograph → Herb & supplement monograph

Peppermint

Interacts with 796 drugs

Peppermint is a popular herb with the best evidence supporting enteric-coated peppermint oil for easing IBS symptoms. It is generally well tolerated for most adults, but it can cause heartbu...

Read the full Peppermint monograph → Herb & supplement monograph

Borage

Interacts with 226 drugs

Borage is a Mediterranean herb whose seed oil is rich in gamma-linolenic acid (GLA), an omega-6 fatty acid studied mostly for skin conditions and arthritis with mixed results. The plant's le...

Read the full Borage monograph → Herb & supplement monograph

Oleic Acid

Interacts with 86 drugs

Oleic acid is a heart-healthy monounsaturated fat found mainly in olive oil, canola oil, avocados, and nuts. As part of a Mediterranean-style diet, it is widely viewed as a healthier replace...

Read the full Oleic Acid monograph →
Sources

Sources & How We Checked

Baby Care Prenatal Omega 3-6-9's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.

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

The 227 references behind this product’s interaction data

Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.

Vitamin B12 30 references
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  6. Geissbuhler, P., Mermillod, B., and Rapin, C. H. Elevated serum vitamin B12 levels associated with CRP as a predictive factor of mortality in palliative care cancer patients: a prospective study over five years. J.Pain Symptom.Manage. 2000;20(2):93-103. PubMed
  7. Salles, N., Herrmann, F., Sakbani, K., Rapin, C. H., and Sieber, C. High vitamin B12 level: a strong predictor of mortality in elderly inpatients. J Am Geriatr.Soc 2005;53(5):917-918.
  8. Looker, H. C., Fagot-Campagna, A., Gunter, E. W., Pfeiffer, C. M., Sievers, M. L., Bennett, P. H., Nelson, R. G., Hanson, R. L., and Knowler, W. C. Homocysteine and vitamin B(12) concentrations and mortality rates in type 2 diabetes. Diabetes Metab Res R
  9. Uhl, W., Nolting, A., Golor, G., Rost, K. L., and Kovar, A. Safety of hydroxocobalamin in healthy volunteers in a randomized, placebo-controlled study. Clin Toxicol (Phila) 2006;44 Suppl 1:17-28. PubMed
  10. Borron, S. W., Baud, F. J., Barriot, P., Imbert, M., and Bismuth, C. Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation. Ann Emerg.Med 2007;49(6):794-801, 801. PubMed
  11. Borron, S. W., Baud, F. J., Megarbane, B., and Bismuth, C. Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation. Am J Emerg.Med 2007;25(5):551-558. PubMed
  12. Lewis, J. G. Gout, Steatorrhoea, and Megaloblastic Anaemia. Ann Rheum.Dis 1962;21(3):284-286. PubMed
  13. Tal, S., Shavit, Y., Stern, F., and Malnick, S. Association between vitamin B12 levels and mortality in hospitalized older adults. J Am Geriatr.Soc 2010;58(3):523-526. PubMed
  14. Baztan, J. J., Gavidia, J. J., Gomez-Pavon, J., Esteve, A., and Ruiperez, I. High vitamin B12 levels and in-hospital mortality. J Am Geriatr.Soc 2010;58(11):2237-2238. PubMed
  15. Omboni, E., Checchini, M., and Longoni, F. [Hypopotassemia and megaloblastic anemia. Presentation of a case]. Minerva Med 8-31-1987;78(16):1255-1257.
  16. Aalfs As, Scholvinck LH, Horvath B. Acneiform eruption in a 5-year old due to vitamin B12 supplementation. Eur J Dermatol 2013;23(5):726-7. PubMed
  17. Balta I, Ozuguz P. Vitamin B12-induced acneiform eruption. Cutan Ocul Toxicol 2014;33(2):94-5. PubMed
  18. Carman KB, Belgemen T, Yis U. Involuntary movements misdiagnosed as seizure during vitamin B12 treatment. Pediatr Emerg Care 2013;29(11):1223-4. PubMed
  19. Djuric V, Bogic M, Popadic AP, et al. Anaphylactic reaction to hydroxycobalamin with tolerance to cyanocobalamin. Ann Allergy Asthma Immunol 2012;108(3):207-8. PubMed
  20. Kartel O, Gulec M, Demirel F, et al. Vitamin B12 allergy and successful desensitization with cyanocobalamin: A case report. Allergol Immunopath (Madr) 2012;40(5):324-5.
  21. Patiroglu T, Unal E, Yildirim S. Infantile tremor syndrome associated with cobalamin therapy: A case report. Clin Neurol Neurosurg 2013;115(9):1903-5. PubMed
  22. Schulte S, Barkema LW, Kardaun SH. Long-lasting atypical acneiform eruption with prominent comedones induced by hydroxocobalamin (vitamin B12). J Dtsch Dermatol Ges 2014;12(6):502-3.
  23. Zanus C, Alberini E, Costa P, et al. Involuntary movements after correction of vitamin B12 deficiency: A video-case report. Epileptic Disord 2012;14(2):174-80. PubMed
  24. Fanidi A, Carreras-Torres R, Larose TL, et al. Is high vitamin B12 status a cause of lung cancer? Int J Cancer. 2019 Sep 15;145(6):1499-1503. PubMed
  25. Fujita Y, Mizukami T, Maya Y, et al. Vitamin B12 allergy manifesting as lymphomatoid contact dermatitis. Eur J Dermatol. 2020;30(3):304-305. PubMed
  26. Dépret F, Hoffmann C, Daoud L, et al. Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study. Crit Care. 2019;23(1):421. PubMed
  27. Khairan P, Sobue T, Eshak ES, et al. Association of dietary intakes of vitamin B12, vitamin B6, folate, and methionine with the risk of esophageal cancer: the Japan Public Health Center-based (JPHC) prospective study. BMC Cancer 2021;21(1):982. PubMed
  28. Evans J, Pandya A, Ding Y, Qunibi WY. Hydroxocobalamin-Induced Oxalate Nephropathy in a Patient With Smoke Inhalation. Kidney Int Rep 2021;6(8):2228-2231. PubMed
  29. Lacombe V, Chabrun F, Lacout C, et al. Persistent elevation of plasma vitamin B12 is strongly associated with solid cancer. Sci Rep 2021;11(1):13361. PubMed
  30. Pegalajar-García MD, Cebolla-Verdugo M, Prados-Carmona Á, Llamas-Segura C, Navarro-Triviño FJ. Systemic allergic dermatitis to cobalt present in cyanocobalamin supplementation. Contact Dermatitis 2023;89(3):203-205. PubMed

See these in context on the Vitamin B12 monograph →

Calcium 62 references
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Oleic Acid 19 references
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Ginger 64 references
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Peppermint 41 references
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  4. Takwale A, Tan E, Agarwal S, et al. Efficacy and tolerability of borage oil in adults and children with atopic eczema: randomised, double blind, placebo controlled, parallel group trial. BMJ 2003;327:1385. PubMed
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See these in context on the Borage monograph →

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

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