Pycnogenol 100 mg Ingredients & Drug Interactions
What is this page for?
First and foremost: checking Pycnogenol 100 mg 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
Pycnogenol 100 mg is a dietary supplement by Protocol For Life Balance with 3 active ingredients. Its ingredients are commonly taken for circulation and vein health, antioxidant support, skin health and aging.Based on those ingredients, 492 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are Pycnogenol, Organic Amla extract, Vitamin C. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Pycnogenol 100 mg by Protocol For Life Balance
Ask about any prescription or over-the-counter medication and we check it for interactions with Pycnogenol 100 mg by Protocol For Life Balance — 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 Pycnogenol 100 mg by Protocol For Life Balance
Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.
What’s inside
Full disclosure
This product contains 3 active ingredients. Vitamin C supports immune function and acts as an antioxidant.
Organic amla extract (also called Indian gooseberry) is a traditional botanical extract. The capsule itself is made from cellulose and contains inactive ingredients like cellulose powder, stearic acid, and silica.
Does it work?
Strong evidence
The evidence we hold is mixed. Vitamin C is effective for treating vitamin C deficiency and possibly effective for anemia, atrial fibrillation, cataracts, and exercise-related respiratory infections.
For organic amla extract, the data shows it's possibly effective for acid reflux (GERD) and high cholesterol, but there isn't enough reliable evidence to rate it for hair loss. We don't have effectiveness data on file for pycnogenol.
How safe is it?
Well-documented data
Vitamin C is generally well tolerated at normal doses, but very high doses can cause stomach cramping, heartburn, diarrhea, nausea, and kidney stones — especially in people prone to them. Most side effects appear above 2 grams daily.
For organic amla extract, it's generally well tolerated as a food, but supplement safety is less studied. A small number of trial participants reported stomach discomfort, fatigue, or muscle pain.
The safety notes advise avoiding high-dose vitamin C supplements in pregnancy unless your doctor recommends it, and there isn't enough data to know whether organic amla extract is safe during breastfeeding.
Meds to double-check
Moderate interaction found
Check your list before taking this if you're on blood thinners or anti-clotting drugs (warfarin, aspirin, clopidogrel) — amla extract may increase bleeding risk and vitamin C can reduce warfarin effectiveness. Also double-check if you take diabetes medications (amla can lower blood sugar), birth control or hormone therapy (vitamin C may raise estrogen levels), thyroid medication, or chemotherapy drugs.
Any of these warrant a conversation with your pharmacist.
The bottom line
Scorecard at a glanceFully disclosed formula with strong clinical evidence behind its ingredients' uses. Moderate medication interactions have been identified, and safety information is well characterized.
This product might work well for you if you take no medications or only those unaffected by vitamin C and amla extract. If you take a blood thinner, diabetes medication, thyroid medication, birth control, or any chemotherapy, talk to your pharmacist before starting — the interactions here are real and could affect how your drugs work.
Your pharmacist can review your full medication list and help you decide if this is right for you.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 3 of 3 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Dec 21, 2012.
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 Pycnogenol 100 mg, straight from the product label.
| Brand | Protocol For Life Balance |
|---|---|
| Barcode (UPC) | 707359132672 |
| Net contents | 60 Vcap(s)(R) |
| Market status | On market |
| Date entered into DSLD | Dec 21, 2012 |
| DSLD ID | 15455 |
| Product type | Botanical With Nutrients |
| Supplement form | Capsule |
| Dietary claims / uses | All Other, Structure/Function |
| Intended target group(s) | Vegan, Vegetarian, Adult (18 - 50 Years), Gluten Free, Dairy Free, Sugar 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 Pycnogenol 100 mg by Protocol For Life Balance, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Pycnogenol | 100 mg | -- |
| Vitamin C | 120 mg | 200% |
| Organic Amla extract | 240 mg | -- |
Other ingredients: Cellulose, Cellulose powder, Stearic Acid, Silica
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.
General Statements
Contains no sugar, salt, starch, yeast, wheat, gluten, corn, soy, milk, egg, shellfish or preservatives.
HOW IT WORKS: Pycnogenol(R) is a proprietary extract from French Maritime Pine bark grown exclusively in the coastal region of southwest France. The unique growing conditions and natural processing used to obtain it result in an extract with constant proportions of procyanidins, organic acids, and other bioactive compounds. Pycnogenol(R) possesses potent anti-oxidant properties and is known to support proper inflammatory and immune system responses. Clinical studies have demonstrated that Pycnogenol(R) can help to support healthy circulation and helps to maintain normal vascular function.
For more information on this product go to www.protocolforlife.com/P3267. Please Recycle.
Formulation
Vegetarian/Vegan Product.
Brand IP Statement(s)
Vcaps(R) is a registered trademark of Capsugel. Pycnogenol(R) is a registered trademark of Horphag Research Ltd. Use of this product is protected by one or more of U.S. patents #5,720,956 / #6,372,266 and other international patents.
FDA Disclaimer Statement
These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease.
Precautions
This bottle contains an AGELESS(R) Oxygen Absorber to ensure freshness. Do not eat Packet.
CAUTIONS/INTERACTIONS: Do not use if you have an allergy to pine.
Pycnogenol may interact with anti-diabetic, anti-platelet, anti-coagulant, antihypertensive, anti-inflammatory, and numerous other medications. It may also interact with immunosupressants. If you are taking any pharmaceutical medications or if you are pregnant or lactating, consult your healthcare practitioner before taking this product.
Storage
Store in a cool, dry place.
Suggested/Recommended/Usage/Directions
SUGGESTED USAGE: As a dietary supplement, take 1 to 2 Vcaps(R) daily, or as directed by your healthcare practitioner.
General
CODE P3267 V2
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Pycnogenol 100 mg by Protocol For Life Balance 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 Pycnogenol 100 mg by Protocol For Life Balance
These are the 3 active ingredients this product is made of. Select any to open its full monograph.
Serving size1 Vegetarian Capsule(s) Dosage formCapsule 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.
Pycnogenol
Interacts with327 drugs
Maritime pine bark extract (often sold as Pycnogenol) is a plant-based antioxidant most studied for circulation, vein, and skin health. Some research...
Pycnogenol monograph & interactionsVitamin C
Interacts with207 drugs
Vitamin C (ascorbic acid) is an essential nutrient your body needs but cannot make, so you must get it from food or supplements. It's important for im...
Vitamin C monograph & interactionsOrganic Amla extract
Interacts with208 drugs
Indian gooseberry (amla) is a vitamin C-rich fruit used in Ayurvedic medicine for many purposes, from antioxidant support to cholesterol and digestion...
Organic Amla extract monograph & interactionsOther (inactive) ingredients: Cellulose, Cellulose powder, Stearic Acid, Silica. These complete the product’s ingredient list but are not active constituents.
Pycnogenol 100 mg by Protocol For Life Balance Drug Interactions
HelloPharmacist Interaction Report
Pycnogenol 100 mg by Protocol For Life Balance contains vitamin C and organic amla extract, both of which have documented interactions with medications.
Vitamin C is the ingredient responsible for the most serious concerns — it can affect how your body handles blood thinners (anticoagulants) like warfarin, potentially reducing their effectiveness at high doses. It may also increase estrogen levels if you're on birth control or hormone therapy, and could interfere with certain chemotherapy drugs and other medications.
Read the full breakdown — every affected drug type, severity by severity
Organic amla extract carries moderate interactions with blood thinners and anti-clotting drugs like aspirin and clopidogrel, where it may increase your bleeding risk. It can also lower blood sugar and might require dose adjustments if you're on diabetes medications.
Vitamin C also interacts with levothyroxine (thyroid medication), some psychiatric drugs, and HIV medications; these are all moderate-severity concerns.
We cannot check pycnogenol itself — we don't have interaction data on file for it. Altogether, these interactions span 374 individual medications.
Because many of these involve common drugs, it's important you check your specific medications against our search tool below before starting this product.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Pycnogenol 100 mg?
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 Pycnogenol 100 mg interact with 492 drugs. Click any drug to see the details.
3 of the 3 ingredients in Pycnogenol 100 mg interact with drugs. Each result below shows which ingredient is responsible. Pycnogenol Organic Amla extract Vitamin C
6-mercaptopurinePurinethol
How 6-mercaptopurine interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
PycnogenolImmunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol + 6-mercaptopurine interactionAbciximabReoPro
How Abciximab interacts with Pycnogenol 100 mg — through 2 ingredients. Tap an ingredient for the detail:
PycnogenolAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol + Abciximab interactionOrganic Amla ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, Indian gooseberry may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Organic Amla Extract + Abciximab interactionAbrocitinibCibinqo
How Abrocitinib interacts with Pycnogenol 100 mg — through 2 ingredients. Tap an ingredient for the detail:
Organic Amla ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, Indian gooseberry may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Organic Amla Extract + Abrocitinib interactionPycnogenolImmunosuppressants, Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol + Abrocitinib interactionAcarboseGlucobay, Prandase, Precose
How Acarbose interacts with Pycnogenol 100 mg — through 2 ingredients. Tap an ingredient for the detail:
Organic Amla ExtractAntidiabetes Drugs Moderate
Interaction Summary
Taking Indian gooseberry with antidiabetes drugs might increase the risk of hypoglycemia.
Read the full Organic Amla Extract + Acarbose interactionPycnogenolAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of hypoglycemia when used with antidiabetes drugs.
Read the full Pycnogenol + Acarbose interactionAcenocoumarolSintrom
How Acenocoumarol interacts with Pycnogenol 100 mg — through 2 ingredients. Tap an ingredient for the detail:
PycnogenolAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol + Acenocoumarol interactionOrganic Amla ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, Indian gooseberry may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Organic Amla Extract + Acenocoumarol interactionAcetaminophen, AspirinGemnisyn
How Acetaminophen, Aspirin interacts with Pycnogenol 100 mg — through 3 ingredients. Tap an ingredient for the detail:
Organic Amla ExtractAnticoagulant/antiplatelet Drugs, Aspirin Moderate
Interaction Summary
Theoretically, Indian gooseberry may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Organic Amla Extract + Acetaminophen, Aspirin interactionPycnogenolAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol + Acetaminophen, Aspirin interactionVitamin CAcetaminophen (tylenol, Others), Aspirin Minor
Interaction Summary
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
Read the full Vitamin C + Acetaminophen, Aspirin interactionAcetaminophen, Aspirin, CaffeineExcedrin, Excedrin Extra Strength, Excedrin Migraine
How Acetaminophen, Aspirin, Caffeine interacts with Pycnogenol 100 mg — through 3 ingredients. Tap an ingredient for the detail:
PycnogenolAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol + Acetaminophen, Aspirin, Caffeine interactionOrganic Amla ExtractAnticoagulant/antiplatelet Drugs, Aspirin Moderate
Interaction Summary
Theoretically, Indian gooseberry may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Organic Amla Extract + Acetaminophen, Aspirin, Caffeine interactionVitamin CAcetaminophen (tylenol, Others), Aspirin Minor
Interaction Summary
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
Read the full Vitamin C + Acetaminophen, Aspirin, Caffeine interactionAcetaminophen, IbuprofenCombogesic
How Acetaminophen, Ibuprofen interacts with Pycnogenol 100 mg — through 3 ingredients. Tap an ingredient for the detail:
PycnogenolAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol + Acetaminophen, Ibuprofen interactionOrganic Amla ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, Indian gooseberry may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Organic Amla Extract + Acetaminophen, Ibuprofen interactionVitamin CAcetaminophen (tylenol, Others) Minor
Interaction Summary
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
Read the full Vitamin C + Acetaminophen, Ibuprofen interactionAcetohexamideDymelor
How Acetohexamide interacts with Pycnogenol 100 mg — through 2 ingredients. Tap an ingredient for the detail:
Organic Amla ExtractAntidiabetes Drugs Moderate
Interaction Summary
Taking Indian gooseberry with antidiabetes drugs might increase the risk of hypoglycemia.
Read the full Organic Amla Extract + Acetohexamide interactionPycnogenolAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of hypoglycemia when used with antidiabetes drugs.
Read the full Pycnogenol + Acetohexamide interactionAcetylsalicylic AcidEntrophen
How Acetylsalicylic Acid interacts with Pycnogenol 100 mg — through 3 ingredients. Tap an ingredient for the detail:
Organic Amla ExtractAnticoagulant/antiplatelet Drugs, Aspirin Moderate
Interaction Summary
Theoretically, Indian gooseberry may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Organic Amla Extract + Acetylsalicylic Acid interactionPycnogenolAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol + Acetylsalicylic Acid interactionVitamin CAspirin Minor
Interaction Summary
Acidification of the urine by vitamin C might increase aspirin levels.
Read the full Vitamin C + Acetylsalicylic Acid interactionAdalimumabHumira
How Adalimumab interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
PycnogenolImmunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol + Adalimumab interactionAdalimumab-adazHyrimoz
How Adalimumab-adaz interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
PycnogenolImmunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol + Adalimumab-adaz interactionAdalimumab-adbmCyltezo
How Adalimumab-adbm interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
PycnogenolImmunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol + Adalimumab-adbm interactionAdalimumab-afzbAbrilada
How Adalimumab-afzb interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
PycnogenolImmunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol + Adalimumab-afzb interactionAdalimumab-attoAmjevita
How Adalimumab-atto interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
PycnogenolImmunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol + Adalimumab-atto interactionAdalimumab-bwwdHadlima
How Adalimumab-bwwd interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
PycnogenolImmunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol + Adalimumab-bwwd interactionAdalimumab-fkjpHulio
How Adalimumab-fkjp interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
PycnogenolImmunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol + Adalimumab-fkjp interactionAlbiglutideTanzeum
How Albiglutide interacts with Pycnogenol 100 mg — through 2 ingredients. Tap an ingredient for the detail:
Organic Amla ExtractAntidiabetes Drugs Moderate
Interaction Summary
Taking Indian gooseberry with antidiabetes drugs might increase the risk of hypoglycemia.
Read the full Organic Amla Extract + Albiglutide interactionPycnogenolAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of hypoglycemia when used with antidiabetes drugs.
Read the full Pycnogenol + Albiglutide interactionAlefaceptAmevive
How Alefacept interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
PycnogenolImmunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol + Alefacept interactionAlemtuzumabCampath
How Alemtuzumab interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
PycnogenolImmunosuppressants Moderate
Interaction Summary
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
Read the full Pycnogenol + Alemtuzumab interactionAlginic Acid, Aluminum HydroxideRafton
How Alginic Acid, Aluminum Hydroxide interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
Vitamin CAluminum Moderate
Interaction Summary
Vitamin C can increase the amount of aluminum absorbed from aluminum compounds.
Read the full Vitamin C + Alginic Acid, Aluminum Hydroxide interactionAlogliptinNesina
How Alogliptin interacts with Pycnogenol 100 mg — through 2 ingredients. Tap an ingredient for the detail:
PycnogenolAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of hypoglycemia when used with antidiabetes drugs.
Read the full Pycnogenol + Alogliptin interactionOrganic Amla ExtractAntidiabetes Drugs Moderate
Interaction Summary
Taking Indian gooseberry with antidiabetes drugs might increase the risk of hypoglycemia.
Read the full Organic Amla Extract + Alogliptin interactionAlogliptin, MetforminKazano
How Alogliptin, Metformin interacts with Pycnogenol 100 mg — through 2 ingredients. Tap an ingredient for the detail:
Organic Amla ExtractAntidiabetes Drugs Moderate
Interaction Summary
Taking Indian gooseberry with antidiabetes drugs might increase the risk of hypoglycemia.
Read the full Organic Amla Extract + Alogliptin, Metformin interactionPycnogenolAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of hypoglycemia when used with antidiabetes drugs.
Read the full Pycnogenol + Alogliptin, Metformin interactionAlogliptin, PioglitazoneOseni
How Alogliptin, Pioglitazone interacts with Pycnogenol 100 mg — through 2 ingredients. Tap an ingredient for the detail:
PycnogenolAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of hypoglycemia when used with antidiabetes drugs.
Read the full Pycnogenol + Alogliptin, Pioglitazone interactionOrganic Amla ExtractAntidiabetes Drugs Moderate
Interaction Summary
Taking Indian gooseberry with antidiabetes drugs might increase the risk of hypoglycemia.
Read the full Organic Amla Extract + Alogliptin, Pioglitazone interactionAlteplase, TpaActilyse, Activase
How Alteplase, Tpa interacts with Pycnogenol 100 mg — through 2 ingredients. Tap an ingredient for the detail:
Organic Amla ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, Indian gooseberry may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Organic Amla Extract + Alteplase, Tpa interactionPycnogenolAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol + Alteplase, Tpa interactionAltretamineHexalen
How Altretamine interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
Vitamin CAlkylating Agents Moderate
Interaction Summary
Theoretically, antioxidant effects of vitamin C might reduce the effectiveness of alkylating agents.
Read the full Vitamin C + Altretamine interactionAluminum Acetate, Benzethonium ChlorideBuro-Sol Otic Solution
How Aluminum Acetate, Benzethonium Chloride interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
Vitamin CAluminum Moderate
Interaction Summary
Vitamin C can increase the amount of aluminum absorbed from aluminum compounds.
Read the full Vitamin C + Aluminum Acetate, Benzethonium Chloride interactionAluminum ChlorideAluminum Chloride, Anhydrol Forte, Driclor, Drysol
How Aluminum Chloride interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
Vitamin CAluminum Moderate
Interaction Summary
Vitamin C can increase the amount of aluminum absorbed from aluminum compounds.
Read the full Vitamin C + Aluminum Chloride interactionAluminum HydroxideAlu-Cap, Amphojel, Gaviscon
How Aluminum Hydroxide interacts with Pycnogenol 100 mg — through 1 ingredient. Tap an ingredient for the detail:
Vitamin CAluminum Moderate
Interaction Summary
Vitamin C can increase the amount of aluminum absorbed from aluminum compounds.
Read the full Vitamin C + Aluminum Hydroxide interactionAluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium HydroxideAscriptin Codeine #2
How Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide interacts with Pycnogenol 100 mg — through 3 ingredients. Tap an ingredient for the detail:
Organic Amla ExtractAspirin, Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, Indian gooseberry may increase the risk of bleeding if used with aspirin; however, research is conflicting.
Read the full Organic Amla Extract + Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide interactionVitamin CAspirin, Aluminum Moderate
Interaction Summary
Acidification of the urine by vitamin C might increase aspirin levels.
Read the full Vitamin C + Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide interactionPycnogenolAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Read the full Pycnogenol + Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Pycnogenol 100 mg 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.
Pycnogenol
Anticoagulant/Antiplatelet Drugs
Theoretically, maritime pine bark extract might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Clinical research suggests that maritime pine bark extract inhibits platelet aggregation. However, the clinical significance of this effect is unclear.
Antidiabetes Drugs
Theoretically, maritime pine bark extract might increase the risk of hypoglycemia when used with antidiabetes drugs.
One clinical study shows that maritime pine bark extract decreases blood sugar in patients with diabetes being treated with antidiabetes agents. Monitor blood glucose levels closely. Dose adjustments might be necessary.
Immunosuppressants
Theoretically, maritime pine bark extract might decrease the effectiveness of immunosuppressant therapy.
In vitro and animal research suggests that maritime pine bark extract has immunostimulant activity. This effect has not been reported in humans.
Organic Amla extract
Anticoagulant/Antiplatelet Drugs
Theoretically, Indian gooseberry may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Clinical research shows that taking Indian gooseberry 500 mg as a single dose or twice daily for 10 days reduces platelet aggregation by about 24% to 36%, increases bleeding time by about 3.8-5.9 seconds, and increases clotting time by about 9.8-12.7 seconds when compared to baseline. However, taking Indian gooseberry 500 mg along with clopidogrel 75 mg or ecosprin 75 mg, as a single dose or for 10 days, does not significantly reduce platelet aggregation or increase bleeding time or clotting time when compared with clopidogrel 75 mg or ecosprin 75 mg alone. Until more is known, use caution when taking Indian gooseberry in combination with anticoagulant/antiplatelet drugs.
Antidiabetes Drugs
Taking Indian gooseberry with antidiabetes drugs might increase the risk of hypoglycemia.
Clinical research shows that taking Indian gooseberry fruit or fruit extract alone or in conjunction with antidiabetes medications can lower blood glucose levels. Dose adjustments to diabetes medications might be necessary.
Aspirin
Theoretically, Indian gooseberry may increase the risk of bleeding if used with aspirin; however, research is conflicting.
Clinical research shows that taking Indian gooseberry 500 mg as a single dose or twice daily for 10 days reduces platelet aggregation by about 24% to 36%, increases bleeding time by about 3.8-5.9 seconds, and increases clotting time by about 9.8-12.7 seconds when compared to baseline. However, taking a single dose of Indian gooseberry 500 mg along with ecosprin 75 mg, or taking a combination of Indian gooseberry 500 mg twice daily plus ecosprin 75 mg once daily for 10 days, does not significantly reduce platelet aggregation or increase bleeding time or clotting time when compared with ecosprin 75 mg alone.
Clopidogrel (Plavix)
Theoretically, Indian gooseberry may increase the risk of bleeding if used with clopidogrel; however, research is conflicting.
Clinical research shows that taking Indian gooseberry 500 mg as a single dose or twice daily for 10 days reduces platelet aggregation by about 24% to 36%, increases bleeding time by about 3.8-5.9 seconds, and increases clotting time by about 9.8-12.7 seconds when compared to baseline. However, taking a single dose of Indian gooseberry 500 mg along with clopidogrel 75 mg, or taking a combination of Indian gooseberry 500 mg twice daily plus clopidogrel 75 mg once daily for 10 days, does not significantly reduce platelet aggregation or increase bleeding time or clotting time when compared with clopidogrel 75 mg alone.
Vitamin C
Alkylating Agents
Theoretically, antioxidant effects of vitamin C might reduce the effectiveness of alkylating agents.
The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs that generate free radicals, such as cyclophosphamide, chlorambucil, carmustine, busulfan, and thiotepa. In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin C have on chemotherapy.
Aluminum
Vitamin C can increase the amount of aluminum absorbed from aluminum compounds.
Research in animals and humans shows that vitamin C increases aluminum absorption, theoretically by chelating aluminum and keeping it in solution where it is available for absorption. In people with normal renal function, urinary excretion of aluminum will likely increase, making aluminum retention and toxicity unlikely. Patients with renal failure who take aluminum-containing compounds such as phosphate binders should avoid vitamin C supplements in doses above the recommended dietary allowances.
Antitumor Antibiotics
Theoretically, the antioxidant effects of vitamin C might reduce the effectiveness of antitumor antibiotics.
The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs which generate free radicals, such as doxorubicin. In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effects, if any, antioxidants such as vitamin C have on chemotherapy.
Estrogens
Vitamin C might increase blood levels of estrogens.
Increases in plasma estrogen levels of up to 55% occur under some circumstances when vitamin C is taken concurrently with oral contraceptives or hormone replacement therapy, including topical products. It is suggested that vitamin C prevents oxidation of estrogen in the tissues, regenerates oxidized estrogen, and reduces sulfate conjugation of estrogen in the gut wall. When tissue levels of vitamin C are high, these processes are already maximized and supplemental vitamin C does not have any effect on estrogen levels. Increases in plasma estrogen levels may occur when patients who are deficient in vitamin C take supplements. Monitor these patients for estrogen-related side effects.
Fluphenazine (Prolixin)
Theoretically, vitamin C might decrease levels of fluphenazine.
In one patient there was a clinically significant decrease in fluphenazine levels when vitamin C (500 mg twice daily) was started. The mechanism is not known, and there is no further data to confirm this interaction.
Indinavir (Crixivan)
Vitamin C can modestly reduce indinavir levels.
One pharmacokinetic study shows that taking vitamin C 1 gram orally once daily along with indinavir 800 mg orally three times daily reduces the area under the concentration-time curve of indinavir by 14%. The mechanism of this interaction is unknown, but it is unlikely to be clinically significant in most patients. The effect of higher doses of vitamin C on indinavir levels is unknown.
Levothyroxine (Synthroid, Others)
Vitamin C can increase levothyroxine absorption.
Two clinical studies in adults with poorly controlled hypothyroidism show that swallowing levothyroxine with a glass of water containing vitamin C 500-1000 mg in solution reduces thyroid stimulating hormone (TSH) levels and increases thyroxine (T4) levels when compared with taking levothyroxine alone. This suggests that vitamin C increases the oral absorption of levothyroxine, possibly due to a reduction in pH.
Warfarin (Coumadin)
High-dose vitamin C might reduce the levels and effectiveness of warfarin.
Vitamin C in high doses may cause diarrhea and possibly reduce warfarin absorption. There are reports of two people who took up to 16 grams daily of vitamin C and had a reduction in prothrombin time. Lower doses of 5-10 grams daily can also reduce warfarin absorption. In many cases, this does not seem to be clinically significant. However, a case of warfarin resistance has been reported for a patient who took vitamin C 500 mg twice daily. Cessation of vitamin C supplementation resulted in a rapid increase in international normalized ratio (INR). Tell patients taking warfarin to avoid taking vitamin C in excessively high doses (greater than 10 grams daily). Lower doses may be safe, but the anticoagulation activity of warfarin should be monitored. Patients who are stabilized on warfarin while taking vitamin C should avoid adjusting vitamin C dosage to prevent the possibility of warfarin resistance.
Acetaminophen (Tylenol, Others)
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
A small pharmacokinetic study in healthy volunteers shows that taking high-dose vitamin C (3 grams) 1.5 hours after taking acetaminophen 1 gram slightly increases the apparent half-life of acetaminophen from around 2.3 hours to 3.1 hours. Ascorbic acid competitively inhibits sulfate conjugation of acetaminophen. However, to compensate, elimination of acetaminophen glucuronide and unconjugated acetaminophen increases. This effect is not likely to be clinically significant.
Aspirin
Acidification of the urine by vitamin C might increase aspirin levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction is not clinically significant.
Choline Magnesium Trisalicylate (Trilisate)
Acidification of the urine by vitamin C might increase choline magnesium trisalicylate levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction probably is not clinically significant.
Niacin
Vitamin C might decrease the beneficial effects of niacin on high-density lipoprotein (HDL) cholesterol levels.
A combination of niacin and simvastatin (Zocor) effectively raises HDL cholesterol levels in patients with coronary disease and low HDL levels. Clinical research shows that taking a combination of antioxidants (vitamin C, vitamin E, beta-carotene, and selenium) along with niacin and simvastatin (Zocor) attenuates this rise in HDL, specifically the HDL-2 and apolipoprotein A1 fractions, by more than 50% in patients with coronary disease. It is not known whether this adverse effect is due to a single antioxidant such as vitamin C, or to the combination. It also is not known whether it will occur in other patient populations.
Salsalate (Disalcid)
Acidification of the urine by vitamin C might increase salsalate levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams/day vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction probably is not clinically significant.
Brand information
Manufacturer and brand details for Pycnogenol 100 mg, from the product label.
Protocol For Life Balance
See all Protocol For Life Balance products- Name
- Protocol For Life Balance(TM)
- Street Address
- 395 S. Glen Ellyn Rd
- City
- Bloomingdale
- State
- IL
- ZipCode
- 60108
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The Full Monographs Behind Pycnogenol 100 mg’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Maritime Pine
Interacts with 327 drugsMaritime pine bark extract (often sold as Pycnogenol) is a plant-based antioxidant most studied for circulation, vein, and skin health. Some research is promising, but many studies are small...
Read the full Maritime Pine monograph → Herb & supplement monographVitamin C
Interacts with 207 drugsVitamin C (ascorbic acid) is an essential nutrient your body needs but cannot make, so you must get it from food or supplements. It's important for immune function, collagen, and acts as an...
Read the full Vitamin C monograph → Herb & supplement monographIndian Gooseberry
Interacts with 208 drugsIndian gooseberry (amla) is a vitamin C-rich fruit used in Ayurvedic medicine for many purposes, from antioxidant support to cholesterol and digestion. Early research is promising for some u...
Read the full Indian Gooseberry monograph →Sources & How We Checked
Pycnogenol 100 mg'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 71 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.
Maritime Pine 14 references
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- Liu X, Zhou HJ, Rohdewald P. French maritime pine bark extract pycnogenol dose-dependently lowers glucose in type 2 diabetic patients (letter). Diabetes Care 2004;27:839. PubMed
- Liu X, Wei J, Tan F, et al. Antidiabetic effect of Pycnogenol French maritime pine bark extract in patients with diabetes type II. Life Sci 2004;75:2505-13. PubMed
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- Araghi-Niknam, M., Hosseini, S., Larson, D., Rohdewald, P., and Watson, R. R. Pine bark extract reduces platelet aggregation. Integr.Med. 3-21-2000;2(2):73-77. PubMed
- Trebaticka, J., Kopasova, S., Hradecna, Z., Cinovsky, K., Skodacek, I., Suba, J., Muchova, J., Zitnanova, I., Waczulikova, I., Rohdewald, P., and Durackova, Z. Treatment of ADHD with French maritime pine bark extract, Pycnogenol. Eur.Child Adolesc.Psychi PubMed
- Suzuki, N., Uebaba, K., Kohama, T., Moniwa, N., Kanayama, N., and Koike, K. French maritime pine bark extract significantly lowers the requirement for analgesic medication in dysmenorrhea: a multicenter, randomized, double-blind, placebo-controlled study
- Cisar, P., Jany, R., Waczulikova, I., Sumegova, K., Muchova, J., Vojtassak, J., Durackova, Z., Lisy, M., and Rohdewald, P. Effect of pine bark extract (Pycnogenol) on symptoms of knee osteoarthritis. Phytother.Res. 2008;22(8):1087-1092.
- Enseleit, F., Sudano, I., Periat, D., Winnik, S., Wolfrum, M., Flammer, A. J., Frohlich, G. M., Kaiser, P., Hirt, A., Haile, S. R., Krasniqi, N., Matter, C. M., Uhlenhut, K., Hogger, P., Neidhart, M., Luscher, T. F., Ruschitzka, F., and Noll, G. Effects
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- Wang S, Tan D Zhao Y et al. The effect of pycnogenol on the microcirculation, platelet function and ischemic myocardium in patients with coronary artery diseases. Eur Bull Drug Res 1999;7:19-25.
Vitamin C 51 references
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- Morris JC, Beeley L, Ballantine N. Interaction of ethinyloestradiol with ascorbic acid in man [letter]. Br Med J (Clin Res Ed) 1981;283:503.
- Labriola D, Livingston R. Possible interactions between dietary antioxidants and chemotherapy. Oncology 1999;13:1003-8.
- Dwyer JH, Merz NB, Shirocre AM, et al. Progression of early atherosclerosis and intake of vitamin C and vitamin E from supplements and food. The Los Angeles Atherosclerosis Study. 41st Annual Conference on Cardiovascular Disease Epidemiology and Prevent
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- Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: National Academy Press, 2000. Available at: http://www.nap.edu/books/0309069351/html/.
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- Domingo JL, Gomez M, Llobet JM, Corbella J. Influence of some dietary constituents on aluminum absorption and retention in rats. Kidney Int 1991;39:598-601. PubMed
- Partridge NA, Regnier FE, White JL, Hem SL. Influence of dietary constituents on intestinal absorption of aluminum. Kidney Int 1989;35:1413-7. PubMed
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- Dysken MW, Cumming RJ, Channon RA, Davis JM. Drug interaction between ascorbic acid and fluphenazine. JAMA 1979;241:2008. DOI
- Vihtamaki T, Parantainen J, Koivisto AM, et al. Oral ascorbic acid increases plasma oestradiol during postmenopausal hormone replacement therapy. Maturitas 2002;42:129-35. PubMed
- Slain D, Amsden JR, Khakoo RA, et al. Effect of high-dose vitamin C on the steady-state pharmacokinetics of the protease inhibitor indinavir in healthy volunteers. Pharmacotherapy 2005;25:165-70. PubMed
- Cheung MC, Zhao XQ, Chait A, et al. Antioxidant supplements block the response of HDL to simvastatin-niacin therapy in patients with coronary artery disease and low HDL. Arterioscler Thromb Vasc Biol 2001;21:1320-6. PubMed
- Feetam CL, Leach RH, Meynell MJ. Lack of a clinically important interaction between warfarin and ascorbic acid. Toxicol Appl Pharmacol 1975;31:544-7. PubMed
- Weintraub M, Griner PF. Warfarin and ascorbic acid: lack of evidence for a drug interaction. Toxicol Appl Pharmacol 1974;28:53-6. PubMed
- Lee DH, Folsom AR, Harnack L, et al. Does supplemental vitamin C increase cardiovascular disease risk in women with diabetes? Am J Clin Nutr 2004;80:1194-200. PubMed
- Taylor EN, Stampfer MJ, Curhan GC. Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up. J Am Soc Nephrol 2004;15:3225-32. PubMed
- Ward NC, Hodgson JM, Croft KD, et al. The combination of vitamin C and grape-seed polyphenols increases blood pressure: a randomized, double-blind, placebo-controlled trial. J Hypertens 2005;23:427-34.. PubMed
- Prasad KN. Rationale for using high-dose multiple dietary antioxidants as an adjunct to radiation therapy and chemotherapy. J Nutr 2004;134:3182S-3S. PubMed
- Conklin KA. Cancer chemotherapy and antioxidants. J Nutr 2004;134:3201S-3204S. PubMed
- Fairweather-Tait S, Hickson K, McGaw B, et al. Orange juice enhances aluminium absorption from antacid preparation. Eur J Clin Nutr. 1994;48(1):71-3.
- Gruenwald, J., Graubaum, H. J., Busch, R., and Bentley, C. Safety and tolerance of ester-C compared with regular ascorbic acid. Adv.Ther. 2006;23(1):171-178.
- Rahimi, R., Nikfar, S., Rezaie, A., and Abdollahi, M. A meta-analysis on the efficacy and safety of combined vitamin C and E supplementation in preeclamptic women. Hypertens.Pregnancy. 2009;28(4):417-434. PubMed
- Einerson, B., Nathorn, C., Kitiyakara, C., Sirada, M., and Thamlikitkul, V. The efficacy of ascorbic acid in suboptimal responsive anemic hemodialysis patients receiving erythropoietin: a meta-analysis. J Med.Assoc.Thai. 2011;94 Suppl 1:S134-S146.
- Li, G., Li, L., Yu, C., and Chen, L. Effect of vitamins C and E supplementation on Helicobacter pylori eradication: a meta-analysis. Br.J Nutr 2011;106(11):1632-1637.
- Chen X, Shen L, Gu X, et al. High-dose supplementation with vitamin C--induced pediatric urolithiasis: the first case report in a child and literature review. Urology. 2014;84(4):922-4. PubMed
- Sattar A, Willman JE, Kolluri R. Possible warfarin resistance due to interaction with ascorbic acid: case report and literature review. Am J Health Syst Pharm. 2013;70(9):782-6. PubMed
- Yaich S, Chaabouni Y, Charfeddine K, et al. Secondary oxalosis due to excess vitamin C intake: a cause of graft loss in a renal transplant recipient. Saudi J Kidney Dis Transpl. 2014;25(1):113-6. 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
- Rumbold A, Ota E, Nagata C, Shahrook S, Crowther CA. Vitamin C supplementation in pregnancy. Cochrane Database Syst Rev. 2015;(9):CD004072. PubMed
- Seo MS, Kim JK, Shim JY. High-dose vitamin C promotes regression of multiple pulmonary metastases originating from hepatocellular carcinoma. Yonsei Med J. 2015;56(5):1449-52. PubMed
- Skelin M, Lucijanic T, Amidzic Klaric D, et al. Factors Affecting Gastrointestinal Absorption of Levothyroxine: A Review. Clin Ther. 2017 Feb;39(2):378-403. PubMed
- Jiang K, Tang K, Liu H, Xu H, Ye Z, Chen Z. Ascorbic acid supplements and kidney stones incidence among men and women: a systematic review and meta-analysis. Urol J. 2019;16(2):115-120.
- Thomas S, Patel D, Bittel B, et al. Effect of High-Dose Zinc and Ascorbic Acid Supplementation vs Usual Care on Symptom Length and Reduction Among Ambulatory Patients With SARS-CoV-2 Infection: The COVID A to Z Randomized Clinical Trial. JAMA Netw Open. 2 PubMed
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- Maike A, Sturgill D, Gallan A. Oxalate Nephropathy in a Renal Transplant Recipient After Receiving High Dose Ascorbic Acid. Am J Med Sci 2021. PubMed
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Indian Gooseberry 6 references
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- Fatima N, Pingali U, Muralidhar N. Study of pharmacodynamic interaction of Phyllanthus emblica extract with clopidogrel and ecosprin in patients with type II diabetes mellitus. Phytomedicine. 2014;21(5):579-85. PubMed
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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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