Pro-Digestion Ingredients & Drug Interactions
What is this page for?
First and foremost: checking Pro-Digestion 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
Pro-Digestion is a dietary supplement by Higher Nature with 12 active ingredients. Its ingredients are commonly taken for bone health and osteoporosis prevention, dietary calcium deficiency, heartburn relief (calcium carbonate antacids).Based on those ingredients, 431 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Bifidobacterium animalis subsp. lactis (CUL34 ), Bifidobacterium bifidum (CUL20), Lactobacillus acidophilus (CUL60). Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Pro-Digestion by Higher Nature
Ask about any prescription or over-the-counter medication and we check it for interactions with Pro-Digestion by Higher Nature — 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 Pro-Digestion by Higher Nature
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
Partial disclosure
Pro-Digestion contains 12 active and inactive ingredients, including calcium, three digestive enzymes (amylase, protease, and lipase), and the protein-digesting enzyme bromelain. It also includes four live-organism probiotics: Bifidobacterium animalis subsp. lactis (CUL34), Bifidobacterium bifidum (CUL20), Lactobacillus acidophilus (CUL60 and CUL21), and Lactobacillus salivarius (CUL61), plus lactase (an enzyme for breaking down milk sugar) and cellulase (a plant-fiber enzyme).
The remaining ingredients are inactive excipients, including capsule material, binders, and flow agents.
Does it work?
Strong evidence
Calcium in this product is rated Likely Effective for osteoporosis and Effective for kidney failure, dyspepsia (indigestion), and low blood calcium (hypocalcemia). The probiotics—Bifidobacterium and Lactobacillus strains—are rated Possibly Effective for irritable bowel syndrome, respiratory infections, constipation, and related digestive concerns.
Bromelain, lactase, lipase, and protease have insufficient reliable evidence in our data to establish their effectiveness for the conditions listed. Lactase is Effective specifically for lactose intolerance.
How safe is it?
Well-documented data
Calcium is generally well tolerated at recommended doses, though high doses can cause problems; it's likely safe in pregnancy and breastfeeding when you stay within recommended amounts. The most common oral side effects are belching, constipation, diarrhea, flatulence, and stomach upset.
Some research links high calcium intake (over 1,500–2,000 mg/day) to an increased risk of prostate cancer and cardiovascular disease, though these findings are debated. Bromelain is generally well tolerated short-term but should be avoided during pregnancy and breastfeeding.
Protease and lactase are generally well tolerated but have limited long-term and pregnancy/breastfeeding safety data. The probiotics are generally well tolerated in healthy people; the most common side effects are diarrhea, bloating, and flatulence.
Rare serious infections from probiotics have been reported, though they're uncommon.
Meds to double-check
Major interaction found
Before taking Pro-Digestion, check with your doctor or pharmacist if you take HIV integrase inhibitors like dolutegravir or elvitegravir (calcium can cut their levels by up to 40%), intravenous ceftriaxone (dangerous interaction with calcium), blood thinners or antiplatelet drugs (bromelain may increase bleeding risk), levothyroxine or other thyroid medication, sotalol or diltiazem (blood pressure or heart rhythm drugs), or antibiotics (will reduce probiotic effectiveness). No interactions are documented for amylase, cellulase, or Lactobacillus salivarius, as we hold no data for them.
The bottom line
Scorecard at a glancePartially disclosed formula with clinical evidence supporting its stated purpose. Major medication interactions have been identified, and safety information is well characterized.
Pro-Digestion may help with indigestion and digestive support, especially if you have low calcium or lactose intolerance. If you take HIV medications (especially integrase inhibitors), blood thinners, thyroid medication, heart rhythm drugs, or antibiotics, check with your doctor or pharmacist before starting this product—several ingredients can interfere with how these drugs work.
The probiotics and enzymes are generally well tolerated, but pregnancy and breastfeeding safety varies by ingredient; talk it over with your healthcare provider if you're in either situation.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 9 of 12 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Apr 22, 2021.
This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed
General information
Key facts about Pro-Digestion, straight from the product label.
| Brand | Higher Nature |
|---|---|
| Barcode (UPC) | 5031013108594 |
| Net contents | 60 Capsule(s) |
| Market status | On market |
| Date entered into DSLD | Apr 22, 2021 |
| DSLD ID | 246050 |
| Product type | Non-nutrient/non-botanical |
| Supplement form | Capsule |
| Dietary claims / uses | All Other, Structure/Function |
| Intended target group(s) | Children 4 or More Years of Age, Vegan, Vegetarian, Adult (18 - 50 Years), Gluten Free, Dairy 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 Pro-Digestion by Higher Nature, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Calcium | 120 mg | 15% |
| Amylase | 10 mg | -- |
| Bromelain | 10 mg | -- |
| Protease | 50 mg | -- |
| Lipase | 10 mg | -- |
| Lactase | 10 mg | -- |
| Cellulase | 10 mg | -- |
| Blend | 0 NP | -- |
| Bifidobacterium animalis subsp. lactis (CUL34 ) | 0 NP | -- |
| Bifidobacterium bifidum (CUL20) | 0 NP | -- |
| Lactobacillus acidophilus (CUL60) | 0 NP | -- |
| Lactobacillus acidophilus (CUL21) | 0 NP | -- |
| Lactobacillus salivarius (CUL61) | 0 NP | -- |
Other ingredients: natural Lithothamnion calcarea, Hydroxypropyl Methylcellulose, Microcrystalline Cellulose, Lactobacillus acidophillus, Silicon Dioxide, Bifidobacterium bifidum, Bifidobacterium animalis subsp. lactis, Magnesium Stearate, Lactobacillus salivarius
Tap any ingredient to jump to its full detail below.
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
FDA Statement of Identity
Food Supplement
Formulation
Comprehensive formula for digestive discomfort
Free from: Artificial colours, flavourings or preservatives, dairy products, gluten, lactose, soya, wheat, yeast.
Vegetarian and vegan
Dual action digestive support
Formula
Dual support for the digestive system with enzymes and live bacteria With calcium which supports digestive enzyme function Provides 10 billion live bacteria (5 strains) per daily dose
Suitable for dairy, gluten and soya free diets
Live bacteria Optimal benefit
10 billion live organisms per daily dose
Storage
No need for refrigeration
Storage: Store in a cool, dry place out of reach of children.
Suggested/Recommended/Usage/Directions
Directions: Adults and children over 13 years take 2 capsules a day, 1 with each of the two largest meals of the day. Children over 8 years take 1 capsule per day with the largest meal of the day.
Precautions
Do not exceed recommended daily intake. Food supplements should not be used as a substitute for a varied and balanced diet and healthy lifestyle.
Storage: Store in a cool, dry place out of reach of children.
General Statements
NRV = Nutrient Reference Value
Everyday Essentials
One month's supply
This product has not been tested on animals.
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Pro-Digestion by Higher Nature 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 Pro-Digestion by Higher Nature
These are the 12 active ingredients this product is made of. Select any to open its full monograph.
Serving size1 Capsule(s) Dosage formCapsule 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.
Calcium
Interacts with168 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 f...
Calcium monograph & interactionsAmylase
Bromelain
Interacts with141 drugs
Bromelain is a group of protein-digesting enzymes from pineapple that people take mainly for inflammation, swelling, and sinus problems. Some early st...
Bromelain monograph & interactionsProtease
No knowninteractions
Proteolytic enzymes are proteins that help break down other proteins, and common examples include bromelain (from pineapple), papain (from papaya), tr...
Protease monograph & interactionsLipase
No knowninteractions
Lipase is a digestive enzyme that helps your body break down dietary fats. It is well established as part of prescription pancreatic enzyme therapy fo...
Lipase monograph & interactionsLactase
No knowninteractions
Lactase is a digestive enzyme supplement that helps people who lack enough natural lactase break down lactose, the sugar in milk and dairy. It can red...
Lactase monograph & interactionsCellulase
Blend
- › Bifidobacterium animalis subsp. lactis (CUL34 )
- › Bifidobacterium bifidum (CUL20)
- › Lactobacillus acidophilus (CUL60)
- › Lactobacillus acidophilus (CUL21)
- › Lactobacillus salivarius (CUL61)
Other (inactive) ingredients: Natural Lithothamnion calcarea, Hydroxypropyl Methylcellulose, Microcrystalline Cellulose, Lactobacillus acidophillus, Silicon Dioxide, Bifidobacterium bifidum, Bifidobacterium animalis subsp. lactis, Magnesium Stearate, Lactobacillus salivarius. These complete the product’s ingredient list but are not active constituents.
Pro-Digestion by Higher Nature Drug Interactions
HelloPharmacist Interaction Report
Pro-Digestion by Higher Nature interacts with medications through its calcium, bromelain, and probiotic (Bifidobacterium and Lactobacillus) content.
The most serious interaction involves calcium and HIV integrase inhibitors: calcium can reduce blood levels of dolutegravir (Tivicay) and elvitegravir (Vitekta) by up to 40%, potentially reducing their effectiveness — if you take either, space them 2–6 hours apart from calcium. Calcium also poses a Major risk with intravenous ceftriaxone (Rocephin), as combining them can cause dangerous salt precipitation in the lungs and kidneys; avoid IV calcium within 48 hours of IV ceftriaxone.
Read the full breakdown — every affected drug type, severity by severity
Calcium carries Moderate interactions with several other drug types: it may lower blood levels of raltegravir (an HIV medication), reduce the absorption of levothyroxine (thyroid hormone), sotalol (a heart rhythm drug), and diltiazem (a blood pressure medication); it can also theoretically increase the risk of high blood calcium (hypercalcemia) if combined with calcipotriene (a psoriasis topical). Bromelain may increase bleeding risk if taken with blood thinners or antiplatelet drugs (a Moderate concern) and might raise tetracycline antibiotic levels (Minor).
The probiotics—Bifidobacterium animalis subsp. lactis, Bifidobacterium bifidum, and two strains of Lactobacillus acidophilus—each interact with antibiotic drugs (Moderate); antibiotics can kill the live organisms in these supplements, reducing their effectiveness.
We could not check amylase, cellulase, or Lactobacillus salivarius for interactions because we hold no data for them. Altogether, these interactions span 431 individual medications.
Check your exact medications with the search tool on this page before starting this product.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Pro-Digestion?
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 Pro-Digestion interact with 431 drugs. Click any drug to see the details.
5 of the 12 ingredients in Pro-Digestion interact with drugs. Each result below shows which ingredient is responsible. Bifidobacterium animalis subsp. lactis (CUL34 ) Bifidobacterium bifidum (CUL20) Lactobacillus acidophilus (CUL60) Calcium Bromelain
Amiloride, HydrochlorothiazideAmil-Co, Amilzide, Moduret 25, Moduretic
How Amiloride, Hydrochlorothiazide interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
CalciumThiazide Diuretics Moderate
Interaction Summary
Taking calcium along with thiazides might increase the risk of hypercalcemia and renal failure.
Read the full Calcium + Amiloride, Hydrochlorothiazide interactionAmoxicillinAmix, Amoram, Amoxident, Amoxil Capsules, Amoxil Injection, Galenamox +3 more
How Amoxicillin interacts with Pro-Digestion — through 3 ingredients. Tap an ingredient for the detail:
Lactobacillus Acidophilus (cul21)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Lactobacillus acidophilus with antibiotic drugs might decrease the effectiveness of L.
Read the full Lactobacillus Acidophilus (cul21) + Amoxicillin interactionBifidobacterium Bifidum (cul20)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium.
Read the full Bifidobacterium Bifidum (cul20) + Amoxicillin interactionBifidobacterium Animalis Subsp. Lactis (cul34 )Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium lactis with antibiotic drugs might decrease the effectiveness of B.
Read the full Bifidobacterium Animalis Subsp. Lactis (cul34 ) + Amoxicillin interactionAmoxicillin VeterinaryBiomox
How Amoxicillin Veterinary interacts with Pro-Digestion — through 3 ingredients. Tap an ingredient for the detail:
Bifidobacterium Animalis Subsp. Lactis (cul34 )Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium lactis with antibiotic drugs might decrease the effectiveness of B.
Read the full Bifidobacterium Animalis Subsp. Lactis (cul34 ) + Amoxicillin Veterinary interactionLactobacillus Acidophilus (cul21)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Lactobacillus acidophilus with antibiotic drugs might decrease the effectiveness of L.
Read the full Lactobacillus Acidophilus (cul21) + Amoxicillin Veterinary interactionBifidobacterium Bifidum (cul20)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium.
Read the full Bifidobacterium Bifidum (cul20) + Amoxicillin Veterinary interactionAmoxicillin, Clavulanate PotassiumAugmentin, Augmentin '125/31 SF', Augmentin '250/62 SF', Augmentin XR, Augmentin-Duo 400/57, Clavulin
How Amoxicillin, Clavulanate Potassium interacts with Pro-Digestion — through 3 ingredients. Tap an ingredient for the detail:
Bifidobacterium Bifidum (cul20)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium.
Read the full Bifidobacterium Bifidum (cul20) + Amoxicillin, Clavulanate Potassium interactionBifidobacterium Animalis Subsp. Lactis (cul34 )Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium lactis with antibiotic drugs might decrease the effectiveness of B.
Read the full Bifidobacterium Animalis Subsp. Lactis (cul34 ) + Amoxicillin, Clavulanate Potassium interactionLactobacillus Acidophilus (cul21)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Lactobacillus acidophilus with antibiotic drugs might decrease the effectiveness of L.
Read the full Lactobacillus Acidophilus (cul21) + Amoxicillin, Clavulanate Potassium interactionAmoxicillin, Omeprazole Magnesium, RifabutinTalicia
How Amoxicillin, Omeprazole Magnesium, Rifabutin interacts with Pro-Digestion — through 3 ingredients. Tap an ingredient for the detail:
Bifidobacterium Bifidum (cul20)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium.
Read the full Bifidobacterium Bifidum (cul20) + Amoxicillin, Omeprazole Magnesium, Rifabutin interactionBifidobacterium Animalis Subsp. Lactis (cul34 )Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium lactis with antibiotic drugs might decrease the effectiveness of B.
Read the full Bifidobacterium Animalis Subsp. Lactis (cul34 ) + Amoxicillin, Omeprazole Magnesium, Rifabutin interactionLactobacillus Acidophilus (cul21)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Lactobacillus acidophilus with antibiotic drugs might decrease the effectiveness of L.
Read the full Lactobacillus Acidophilus (cul21) + Amoxicillin, Omeprazole Magnesium, Rifabutin interactionAmphotericin, TetracyclineMysteclin-F
How Amphotericin, Tetracycline interacts with Pro-Digestion — through 5 ingredients. Tap an ingredient for the detail:
Lactobacillus Acidophilus (cul21)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Lactobacillus acidophilus with antibiotic drugs might decrease the effectiveness of L.
Read the full Lactobacillus Acidophilus (cul21) + Amphotericin, Tetracycline interactionBifidobacterium Animalis Subsp. Lactis (cul34 )Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium lactis with antibiotic drugs might decrease the effectiveness of B.
Read the full Bifidobacterium Animalis Subsp. Lactis (cul34 ) + Amphotericin, Tetracycline interactionBifidobacterium Bifidum (cul20)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium.
Read the full Bifidobacterium Bifidum (cul20) + Amphotericin, Tetracycline interactionCalciumTetracycline Antibiotics Moderate
Interaction Summary
Calcium seems to reduce the absorption of tetracycline antibiotics.
Read the full Calcium + Amphotericin, Tetracycline interactionBromelainTetracycline Antibiotics Minor
Interaction Summary
Theoretically, bromelain might increase levels of tetracycline antibiotics.
Read the full Bromelain + Amphotericin, Tetracycline interactionAmpicillinOmnipen, Omnipen-N, Penbritin, Principen, Rimacillin
How Ampicillin interacts with Pro-Digestion — through 3 ingredients. Tap an ingredient for the detail:
Bifidobacterium Bifidum (cul20)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium.
Read the full Bifidobacterium Bifidum (cul20) + Ampicillin interactionBifidobacterium Animalis Subsp. Lactis (cul34 )Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium lactis with antibiotic drugs might decrease the effectiveness of B.
Read the full Bifidobacterium Animalis Subsp. Lactis (cul34 ) + Ampicillin interactionLactobacillus Acidophilus (cul21)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Lactobacillus acidophilus with antibiotic drugs might decrease the effectiveness of L.
Read the full Lactobacillus Acidophilus (cul21) + Ampicillin interactionAmpicillin, SulbactamUnasyn
How Ampicillin, Sulbactam interacts with Pro-Digestion — through 3 ingredients. Tap an ingredient for the detail:
Bifidobacterium Bifidum (cul20)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium.
Read the full Bifidobacterium Bifidum (cul20) + Ampicillin, Sulbactam interactionBifidobacterium Animalis Subsp. Lactis (cul34 )Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Bifidobacterium lactis with antibiotic drugs might decrease the effectiveness of B.
Read the full Bifidobacterium Animalis Subsp. Lactis (cul34 ) + Ampicillin, Sulbactam interactionLactobacillus Acidophilus (cul21)Antibiotic Drugs Moderate
Interaction Summary
Theoretically, taking Lactobacillus acidophilus with antibiotic drugs might decrease the effectiveness of L.
Read the full Lactobacillus Acidophilus (cul21) + Ampicillin, Sulbactam interactionAnacaulase-bcdbNexoBrid
How Anacaulase-bcdb interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Anacaulase-bcdb interactionAnagrelideAgrylin
How Anagrelide interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Anagrelide interactionAnisindioneMiradon
How Anisindione interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Anisindione interactionAntithrombin IiiThrombate III
How Antithrombin Iii interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Antithrombin Iii interactionApixabanEliquis
How Apixaban interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Apixaban interactionArgatrobanArgatroban
How Argatroban interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Argatroban interactionAspirinAngettes 75, ASA, Asaphen, Aspirin, Caprin, Cartia +8 more
How Aspirin interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin interactionAspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium HydroxideAscriptin Codeine #3
How Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium Hydroxide interacts with Pro-Digestion — through 2 ingredients. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium Hydroxide interactionCalciumAluminum Moderate
Interaction Summary
Calcium citrate might increase aluminum absorption and toxicity.
Read the full Calcium + Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium Hydroxide interactionAspirin, ButalbitalAxotal
How Aspirin, Butalbital interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Butalbital interactionAspirin, Butalbital, CaffeineFiorinal
How Aspirin, Butalbital, Caffeine interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Butalbital, Caffeine interactionAspirin, Butalbital, Caffeine, Codeine PhosphateFiorinal w/ Codeine
How Aspirin, Butalbital, Caffeine, Codeine Phosphate interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Butalbital, Caffeine, Codeine Phosphate interactionAspirin, Butalbital, Caffeine, PhenacetinMarnal
How Aspirin, Butalbital, Caffeine, Phenacetin interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Butalbital, Caffeine, Phenacetin interactionAspirin, CaffeineAnacin
How Aspirin, Caffeine interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine interactionAspirin, Caffeine, Codeine PhosphateAnacin w/ Codeine
How Aspirin, Caffeine, Codeine Phosphate interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Codeine Phosphate interactionAspirin, Caffeine, Dihydrocodeine BitartrateSynalgos DC
How Aspirin, Caffeine, Dihydrocodeine Bitartrate interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Dihydrocodeine Bitartrate interactionAspirin, Caffeine, Dover's PwdAcedoval, Dovacet
How Aspirin, Caffeine, Dover's Pwd interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Dover's Pwd interactionAspirin, Caffeine, HydrocodoneDamason-P
How Aspirin, Caffeine, Hydrocodone interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Hydrocodone interactionAspirin, Caffeine, Isobutylallylbarbituric Acid, PhenacetinLanorinal
How Aspirin, Caffeine, Isobutylallylbarbituric Acid, Phenacetin interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Isobutylallylbarbituric Acid, Phenacetin interactionAspirin, Caffeine, OrphenadrineInvagesic, Invagesic Forte, Norgesic, Norgesic Forte, Orphengesic, Orphengesic Forte
How Aspirin, Caffeine, Orphenadrine interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Orphenadrine interactionAspirin, Caffeine, Phenacetin, PropoxypheneMargesic Comp. 65
How Aspirin, Caffeine, Phenacetin, Propoxyphene interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Phenacetin, Propoxyphene interactionAspirin, Calcium Carbonate, Magnesium Carbonate, Magnesium OxideBufferin
How Aspirin, Calcium Carbonate, Magnesium Carbonate, Magnesium Oxide interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Calcium Carbonate, Magnesium Carbonate, Magnesium Oxide interactionAspirin, CarisoprodolSoma Compound
How Aspirin, Carisoprodol interacts with Pro-Digestion — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Carisoprodol interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Pro-Digestion 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.
Bifidobacterium animalis subsp. lactis (CUL34 )
Antibiotic Drugs
Theoretically, taking Bifidobacterium lactis with antibiotic drugs might decrease the effectiveness of B. lactis.
Since B. lactis preparations usually contain live and active organisms, simultaneously taking antibiotics might kill a significant number of the organisms. Tell patients to separate administration of antibiotics and B. lactis preparations by at least 2 hours.
Bifidobacterium bifidum (CUL20)
Antibiotic Drugs
Theoretically, taking Bifidobacterium. bifidum with antibiotic drugs might decrease the effectiveness of B. bifidum.
Since B. bifidum preparations usually contain live and active organisms, simultaneously taking antibiotics might kill a significant number of the organisms. Tell patients to separate administration of antibiotics and B. bifidum preparations by at least 2 hours.
Lactobacillus acidophilus (CUL60)
Antibiotic Drugs
Theoretically, taking Lactobacillus acidophilus with antibiotic drugs might decrease the effectiveness of L. acidophilus.
L. acidophilus preparations usually contain live and active organisms. Therefore, simultaneously taking antibiotics might kill a significant number of the organisms. Tell patients to separate administration of antibiotics and L. acidophilus preparations by at least two hours.
Calcium
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Bromelain
Anticoagulant/Antiplatelet Drugs
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
There is one case report of a patient experiencing minor bruising while taking bromelain with naproxen. Bromelain is thought to have antiplatelet activity. Whether this interaction is of concern with topical bromelain is unclear. Interference with coagulation of burn wounds has been reported in a patient receiving bromelain-based enzymatic debridement. However, observational research has found that topical bromelain debridement is not associated with increases or decreases in laboratory markers of coagulation when compared with surgical debridement.
Tetracycline Antibiotics
Theoretically, bromelain might increase levels of tetracycline antibiotics.
Laboratory research suggests that bromelain might increase the absorption of tetracycline antibiotics. However, a study in healthy adults reported no difference in tetracycline plasma levels when a 500 mg dose was taken with or without bromelain 80 mg.
Brand information
Manufacturer and brand details for Pro-Digestion, from the product label.
Higher Nature
See all Higher Nature products- Name
- Higher Nature Ltd
- Street Address
- 10 Discovery Way
- City
- Horam, East Sussex
- ZipCode
- TN21 0GE
- Web Address
- highernature.com
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Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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Our pharmacists answer your medication & supplement questions — free.
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.
The Full Monographs Behind Pro-Digestion’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Calcium
Interacts with 168 drugsCalcium 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 monographBromelain
Interacts with 141 drugsBromelain is a group of protein-digesting enzymes from pineapple that people take mainly for inflammation, swelling, and sinus problems. Some early studies are promising, but the overall evi...
Read the full Bromelain monograph → Herb & supplement monographProteolytic Enzymes (proteases)
Proteolytic enzymes are proteins that help break down other proteins, and common examples include bromelain (from pineapple), papain (from papaya), trypsin, chymotrypsin, and pancreatin. Peo...
Read the full Proteolytic Enzymes (proteases) monograph → Herb & supplement monographLipase
Lipase is a digestive enzyme that helps your body break down dietary fats. It is well established as part of prescription pancreatic enzyme therapy for people who cannot make enough of their...
Read the full Lipase monograph → Herb & supplement monographLactase
Lactase is a digestive enzyme supplement that helps people who lack enough natural lactase break down lactose, the sugar in milk and dairy. It can reduce gas, bloating, cramping, and diarrhe...
Read the full Lactase monograph → Herb & supplement monographBifidobacterium Animalis Subsp. Lactis
Interacts with 182 drugsBifidobacterium animalis subsp. lactis is a well-studied probiotic bacterium commonly added to supplements and yogurts to support digestion and gut health. It appears generally safe for most...
Read the full Bifidobacterium Animalis Subsp. Lactis monograph → Herb & supplement monographBifidobacterium Bifidum
Interacts with 182 drugsBifidobacterium bifidum is a 'friendly' bacteria (probiotic) that naturally lives in the human gut and is taken to support digestion and gut balance. Some evidence suggests probiotics may he...
Read the full Bifidobacterium Bifidum monograph → Herb & supplement monographLactobacillus Acidophilus
Interacts with 182 drugsLactobacillus acidophilus is a 'friendly' bacterium used as a probiotic to support gut and vaginal health. It is generally well tolerated in healthy people, and there is reasonable evidence...
Read the full Lactobacillus Acidophilus monograph →Sources & How We Checked
Pro-Digestion'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 116 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.
Calcium 62 references
- Shils M, Olson A, Shike M. Modern Nutrition in Health and Disease. 8th ed. Philadelphia, PA: Lea and Febiger, 1994.
- Hernandez-Avila M, Gonzalez-Cossio T, Hernandez-Avila JE, et al. Dietary calcium supplements to lower blood lead levels in lactating women: a randomized placebo-controlled trial. Epidemiology 2003;14:206-12.. PubMed
- Thys-Jacobs S, Ceccarelli S, Bierman A, et al. Calcium supplementation in premenstrual syndrome: a randomized crossover trial. J Gen Intern Med 1989;4:183-9. PubMed
- Maton PN, Burton ME. Antacids revisited: a review of their clinical pharmacology and recommended therapeutic use. Drugs 1999;57:855-70.
- Clemens JD, Feinstein AR. Calcium carbonate and constipation: a historical review of medical mythopoeia. Gastroenterology 1977;72:957-61. DOI
- Saunders D, Sillery J, Chapman R. Effect of calcium carbonate and aluminum hydroxide on human intestinal function. Dig Dis Sci 1988;33:409-13. PubMed
- Friedman PA, Bushinsky DA. Diuretic effects on calcium metabolism. Semin Nephrol 1999;19:551-6.
- Koo WK, Walters JC, Esterlitz J, et al. Maternal calcium supplementation and fetal bone mineralization. Obstet Gynecol 1999;94:577-82. DOI
- Raman L, Rajalakshmi K, Krishnamachari KAVR, et al. Effect of calcium supplementation to undernourished mothers during pregnancy on the bone density of the neonates. Am J Clin Nutr 1978; 31:466-9. DOI
- Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
- Chan JM, Giovannucci E, Andersson SO, et al. Dairy products, calcium, phosphorous, vitamin D, and risk of prostate cancer. Cancer Causes Control 1998;9:559-66.
- Butner LE, Fulco PP, Feldman G, et al. Calcium carbonate-induced hypothyroidism. Ann Intern Med 2000:132:595. PubMed
- Schneyer CR. Calcium carbonate and reduction of levothyroxine efficacy. JAMA 1998;279:750. PubMed
- Moser LR, Smythe MA, Tisdale JE. The use of calcium salts in the prevention and management of verapamil-induced hypotension. Ann Pharmacother 2000;34:622-9. PubMed
- Singh N, Singh PN, Hershman JM. Effect of calcium carbonate on the absorption of levothyroxine. JAMA 2000;283:2822-5. PubMed
- Kahela P, Anttila M, Tikkanen R, Sundquist H. Effect of food, food constituents and fluid volume on the bioavailability of sotalol. Acta Pharmacol Toxicol (Copenh) 1979;44:7-12.. PubMed
- Pletz MW, Petzold P, Allen A, et al. Effect of calcium carbonate on bioavailability of orally administered gemifloxacin. Antimicrob Agents Chemother 2003;47:2158-60.. PubMed
- Bar-Or D, Yoel G. Calcium and calciferol antagonize effect of verapamil in atrial fibrillation. Br Med J 1981;282:1585-6.
- Decktor DL, Robinson M, Maton PN, et al. Effects of aluminum/magnesium hydroxide and calcium carbonate on esophageal and gastric pH in subjects with heartburn. Am J Ther 1995;2:546-52. PubMed
- Simoneau G. Absence of rebound effect with calcium carbonate. Eur J Drug Metab Pharmacokinet 1996;21:351-7. PubMed
- Peters ML, Leonard M, Licata AA. Role of alendronate and risedronate in preventing and treating osteoporosis. Cleve Clin J Med 2001;68:945-51. PubMed
- Bourke JF, Mumford R, Whittaker P, et al. The effects of topical calcipotriol on systemic calcium homeostasis in patients with chronic plaque psoriasis. J Am Acad Dermatol 1997;37:929-34.
- Gueguen L, Pointillart A. The bioavailability of dietary calcium. J Am Coll Nutr 2000;19:119s-136s. PubMed
- Vella A, Gerber TC, Hayes DL, Reeder GS. Digoxin, hypercalcaemia, and cardiac conduction. Postgrad Med J 1999;75:554-6. PubMed
- Bania TC, Blaufeux B, Hughes S, et al. Calcium and digoxin vs. calcium alone for severe verapamil toxicity. Acad Emerg Med 2000;7:1089-96. PubMed
- Tseng M, Breslow RA, Graubard BI, Ziegler RG. Dairy, calcium, and vitamin D intakes and prostate cancer risk in the National Health and Nutrition Examination Epidemiologic Follow-up Study cohort. Am J Clin Nutr 2005;81:1147-54. PubMed
- Weingarten MA, Zalmanovici A, Yaphe J. Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. Cochrane Database Syst Rev 2004;(1):CD003548. PubMed
- Tavani A, Bertuccio P, Bosetti C, et al. Dietary intake of calcium, vitamin D, phosphorus and the risk of prostate cancer. Eur Urol 2005;48:27-33. PubMed
- Giovannucci E, Liu Y, Stampfer MJ, Willett WC. A prospective study of calcium intake and incident and fatal prostate cancer. Cancer Epidemiol Biomarkers Prev 2006;15:203-10. PubMed
- Rocephin (ceftriaxone) and calcium interaction. Pharmacist's Letter / Prescriber's Letter 2007;23(10):231005.
- Bolland MJ, Barber PA, Doughty RN, et al. Vascular events in healthy older women receiving calcium supplementation: randomised control trial. BMJ 2008;336:262-6.
- Bolland MJ, Avenell A, Baron JA, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010;341:c3691. PubMed
- Calcium supplementation and vascular events. Pharmacist's Letter / Prescriber's Letter 2008;24(3):240306.
- Dietary reference intakes for calcium and vitamin D. Institute of Medicine, November 30, 2010. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Vitamin%20D%20and%20Calcium%202010%20Repo
- Coburn JW, Mischel MG, Goodman WG, et al. Calcium citrate markedly enhances aluminum absorption from aluminum hydroxide. Am J Kidney Dis. 1991;17(6):708-11. PubMed
- Bradley JS, Wassel RT, Lee L, et al. Intravenous ceftriaxone and calcium in the neonate: assessing the risk for cardiopulmonary adverse events. Pediatrics. 2009;123(4):e609-13. PubMed
- Kays MB, Overholser BR, Mueller BA, et al. Effects of sevelamer hydrochloride and calcium acetate on the oral bioavailability of ciprofloxacin. Am J Kidney Dis. 2003;42(6):1253-9. PubMed
- Neuhofel, A. L., Wilton, J. H., Victory, J. M., Hejmanowsk, L. G., and Amsden, G. W. Lack of bioequivalence of ciprofloxacin when administered with calcium-fortified orange juice: a new twist on an old interaction. J Clin Pharmacol. 2002;42(4):461-466. DOI
- Dickinson, H. O., Nicolson, D. J., Cook, J. V., Campbell, F., Beyer, F. R., Ford, G. A., and Mason, J. Calcium supplementation for the management of primary hypertension in adults. Cochrane.Database.Syst.Rev. 2006;(2):CD004639. PubMed
- Jones, B. J. and Twomey, P. J. Requesting patterns for serum calcium concentration in patients on long-term lithium therapy. Int J Clin Pract. 2009;63(1):170-172. PubMed
- Levine, M., Nikkanen, H., and Pallin, D. J. The effects of intravenous calcium in patients with digoxin toxicity. J Emerg.Med. 2011;40(1):41-46. PubMed
- Castelo-Branco, C., Ciria-Recasens, M., Cancelo-Hidalgo, M. J., Palacios, S., Haya-Palazuelos, J., Carbonell-Abello, J., Blanch-Rubio, J., Martinez-Zapata, M. J., Manasanch, J., and Perez-Edo, L. Efficacy of ossein-hydroxyapatite complex compared with ca
- Li K, Kaaks R, Linseisen J, Rohrmann S. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation i
- Chung M, Tang AM, Fu Z. Calcium Intake and Cardiovascular Disease Risk: An Updated Systematic Review and Meta-analysis. Ann Intern Med. 2016 Oct 25. PubMed
- Nolan CR, Califano JR, Butzin CA. Influence of calcium acetate or calcium citrate on intestinal aluminum absorption. Kidney Int. 1990;38(5):937-41. PubMed
- Lewis JR, Radavelli-Bagatini S, Rejnmark L, et al. The effects of calcium supplementation on verified coronary heart disease hospitalization and death in postmenopausal women: a collaborative meta-analysis of randomized controlled trials. J Bone Miner Res PubMed
- Jalloh MA, Gregory PJ, Hein D, et al. Dietary supplement interactions with antiretrovirals: a systematic review. Int J STD AIDS. 2017 Jan;28(1):4-15. PubMed
- Lappe J, Watson P, Travers-Gustafson D, Recker R, Garland C, Gorham E, Baggerly K, McDonnell SL. Effect of Vitamin D and Calcium Supplementation on Cancer Incidence in Older Women: A Randomized Clinical Trial. JAMA. 2017 Mar 28;317(12):1234-1243. PubMed
- Grove ML, Cook D. Calcium and heart attacks. Doesn't apply to most calcium prescriptions. BMJ. 2010;341:c5003. PubMed
- Insentress [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp.; 2014.
- Roberts JL, Kiser JJ, Hindman JT, Meditz AL. Virologic failure with a raltegravir-containing antiretroviral regimen and concomitant calcium administration. Pharmacotherapy 2011;31(10):298e-302e. DOI
- Vitekta [package insert]. Foster City, CA: Gilead Sciences, Inc.; 2014.
- Storan ER, O'Gorman SM, Murphy A, Laing M. Case Report of Calciphylaxis Secondary to Calcium and Vitamin D<sub>3</sub> Supplementation. J Cutan Med Surg. 2017;21(2):162-163. DOI
- Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental vitamins and minerals for CVD prevention and treatment. J Am Coll Cardiol 2018;71(22):2570-84. PubMed
- Borkenhagen JF, Connor EL, Stafstrom CE. Neonatal hypocalcemic seizures due to excessive maternal calcium ingestion. Pediatr Neurol 2013;48(6):469-71. PubMed
- WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016 (http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/ anc-positive-pregnancy-experience/en/).
- Aune D, Navarro Rosenblatt DA, Chan DS, et al. Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. Am J Clin Nutr. 2015;101(1):87-117. PubMed
- Lan T, Park Y, Colditz GA, et al. Adolescent dairy product and calcium intake in relation to later prostate cancer risk and mortality in the NIH-AARP Diet and Health Study. Cancer Causes Control. 2020;31(10):891-904. PubMed
- Zhang Y, Li Y, Liu J, et al. Association of Vitamin D or Calcium Supplementation with Cardiovascular Outcomes and Mortality: A Meta-Analysis with Trial Sequential Analysis. J Nutr Health Aging 2021;25(2):263-270. PubMed
- Myung SK, Kim HB, Lee YJ, Choi YJ, Oh SW. Calcium Supplements and Risk of Cardiovascular Disease: A Meta-Analysis of Clinical Trials. Nutrients 2021;13(2):368. PubMed
- Hetaimish B. Neonatal Calcinosis Cutis After Treatment of Hypocalcemia with Calcium Gluconate: A Report of 2 Cases. Am J Case Rep 2024;25:e943397. PubMed
- US Food and Drug Administration (FDA). Biktarvy Prescribing Information. October 2024. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/210251Orig1s020lbl.pdf. Accessed July 16, 2025.
Bromelain 19 references
- Nettis E, Napoli G, Ferrannini A, Tursi A. IgE-mediated allergy to bromelain. Allergy 2001;56:257-8. PubMed
- Taussig SJ, Batkin S. Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application. An update. J Ethnopharmacol 1988;22:191-203.. PubMed
- Bradbrook ID, Morrison PJ, Rogers HJ. The effect of bromelain on the absorption of orally administered tetracycline. Br J Clin Pharmacol 1978;6:552-4. PubMed
- Bush TM, Rayburn KS, Holloway SW, et al. Adverse interactions between herbal and dietary substances and prescription medications: a clinical survey. Altern Ther Health Med 2007;13:30-5.
- Brien S, Lewith G, Walker AF, et al. Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study. QJM 2006;99:841-50. PubMed
- Mori S, Ojima Y, Hirose T, et al. The clinical effect of proteolytic enzyme containing bromelain and trypsin on urinary tract infection evaluated by double blind method. Acta Obstet Gynaecol Jpn 1972;19:147-53.
- Glaser D, Hilberg T. The influence of bromelain on platelet count and platelet activity in vitro. Platelets 2006;17:37-41. PubMed
- Heinicke R M, van der Wal L, Yokoyama M. Effect of bromelain (Ananase) on human platelet aggregation. Experientia 1972;28:844-5. PubMed
- Gailhofer, G., Wilders-Truschnig, M., Smolle, J., and Ludvan, M. Asthma caused by bromelain: an occupational allergy. Clin Allergy 1988;18(5):445-450. PubMed
- Mattei, O., Fabri, G., and Farina, G. [Occupational health experience regarding four cases of asthma due to bromelain (author's transl)]. Medicina del Lavoro 1979;70(5):404-409.
- Galleguillos, F. and Rodriguez, J. C. Asthma caused by bromelin inhalation. Clin Allergy 1978;8(1):21-24. PubMed
- Perez-Camo I, Quirce S, Duran MA, and et al. Latex allergy: evidence of cross-reactivity with papain and bromelain [abstract]. Allergy 1996;51(suppl 31):48.
- Martin GJ, Ehrenreich J, and Asbell N. Bromelain: pineapple proteases with anti-edema activity. Exp Med Surg 1962;20:227-247.
- Kasemsuk T, Saengpetch N, Sibmooh N, Unchern S. Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis. Clin Rheumatol. 2016 Oct;35(10):2531-40. PubMed
- Kutlu Ö, DemirbaS A, Elmas ÖF, Güvenç U, Metin A. Fixed drug eruption: a new side effect of bromelain. Contact Dermatitis 2020. Online ahead of print. PubMed
- Shoham Y, Shapira E, Haik J, et al. Bromelain-based enzymatic debridement of chronic wounds: Results of a multicentre randomized controlled trial. Wound Repair Regen 2021;29(6):899-907. PubMed
- Pfister P, Garcia Wendel PD, Kim BS, et al. Coagulation side effects of enzymatic debridement in burned patients. Burns 2022. PubMed
- Hasham S, Riyat H, Fletcher A, O'Boyle CP, Alexander S. To bleed or not to bleed? Case series and discussion of haemorrhage risk with enzymatic debridement in burn injuries. Scars Burn Heal 2023;9:20595131231168333. PubMed
- Leelakanok N, Petchsomrit A, Janurai T, Saechan C, Sunsandee N. Efficacy and safety of bromelain: A systematic review and meta-analysis. Nutr Health 2023. PubMed
Proteolytic Enzymes (proteases) 3 references
- Weeks JA, Harper RA, Simon RA, Burdick JD. Assessment of sensitization risk of a laundry pre-spotter containing protease. Cutan Ocul Toxicol. 2011;30(4):272-9. PubMed
- Marquès LI, Lara S, Abós T, Bartolomé B. Occupational rhinitis due to pepsin. J Investig Allergol Clin Immunol. 2006;16(2):136-7. DOI
- Cartier A, Malo JL, Pineau L, Dolovich J. Occupational asthma due to pepsin. J Allergy Clin Immunol. 1984;73(5 Pt 1):574-7. PubMed
See these in context on the Proteolytic Enzymes (proteases) monograph →
Lipase 1 reference
- Casper C, Hascoet JM, Ertl T, et al. Recombinant bile salt-stimulated lipase in preterm infant feeding: A randomized phase 3 study. PLoS One. 2016;11(5):e0156071. PubMed
Lactase 1 reference
- Laukkanen A, Ruoppi P, Remes S, Koistinen T, Mäkinen-Kiljunen S. Lactase-induced occupational protein contact dermatitis and allergic rhinoconjunctivitis. Contact Dermatitis. 2007;57(2):89-93. PubMed
Bifidobacterium Animalis Subsp. Lactis 8 references
- Pierce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: The Stonesong Press, 1999:19.
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Bifidobacterium Bifidum 7 references
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Lactobacillus Acidophilus 15 references
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See these in context on the Lactobacillus Acidophilus monograph →
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