Major interaction on record — check this product against your medications before combining. Based on 5 of 11 ingredients. Check your meds →
Dietary supplement

Riboflam Ingredients & Drug Interactions

by Bruno MD

Riboflam label
See full label image
Capsule Category: Other Combinations
Most serious interaction: Major
Clinical methodology reviewed by · Updated Sep 16, 2026 · Label data from the NIH DSLD
What is this page for?

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

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

The interaction bottom line Most serious interaction: Major

Riboflam is a dietary supplement by Bruno MD with 11 active ingredients. Its ingredients are commonly taken for joint pain and arthritis, inflammation, digestive upset.Based on those ingredients, 1,232 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Turmeric extract, Narrow-Leaved Coneflower extract, Astaxanthin extract. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

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Check Your Meds Against Riboflam by Bruno MD

Ask about any prescription or over-the-counter medication and we check it for interactions with Riboflam by Bruno MD — and tell you which ingredient is responsible.

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HelloPharmacist Scorecard of Riboflam by Bruno MD

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

From our pharmacy team — supplement deep dive

Generated from HelloPharmacist’s pharmacist-curated databases and editorial rules · Last generated Sep 10, 2026

What’s inside

Low disclosure
Ingredient Transparency · database check
Low

Most active ingredients don't disclose an individual amount — you can't tell how much of each you're getting.

Why this rating?
  • The label discloses an exact amount for 1 of its 11 active ingredients.
  • “Riboflam Proprietary Phytosome Complex” is a proprietary blend — the label gives one combined amount (1,350 mg) without saying how much of each component you get.
  • “Nucleoflam Proprietary Nucleotide and Nucleosides Yeast extract complex” is a proprietary blend — the label gives one combined amount (200 mg) without saying how much of each component you get.

Riboflam contains 11 active ingredients. At its core are mixed 5'-ribonucleotides and nucleotide compounds (guanosine, uridine, cytidine, adenosine, and other nucleosides)—building blocks that support cellular energy and function.

The product also delivers turmeric extract (known for its antioxidant curcumin), Indian frankincense extract (boswellia), echinacea (narrow-leaved coneflower), and astaxanthin, a carotenoid pigment from algae. These are bundled in proprietary phytosome and nucleotide-yeast complexes designed to enhance absorption.

The capsule itself contains microcrystalline cellulose, silica, and magnesium stearate as inactive ingredients.

Does it work?

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

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

Why this rating?
  • The label markets this product for: supports inflammation response, immunity, cognition and mood.
  • We looked for evidence on: Age-related cognitive decline, Anxiety, Attention deficit-hyperactivity disorder (ADHD), Depression, Exercise-induced muscle damage, Exercise-induced muscle soreness — and 4 related terms.
  • The strongest evidence on file: Turmeric is rated "Possibly Effective" for Depression (Natural Medicines).
  • Also on file: Frankincense is rated "Insufficient Reliable Evidence To Rate" for Cancer-related fatigue.
  • Also on file: Turmeric is rated "Insufficient Reliable Evidence To Rate" for Age-related cognitive decline, Anxiety, Asthma, Exercise-induced muscle soreness, and more.

Evidence for Riboflam's effectiveness is limited and uneven across its ingredients. Turmeric has been rated possibly effective for depression, high cholesterol, and hay fever symptoms.

Echinacea and astaxanthin, however, lack reliable evidence to support their use for the conditions studied—anxiety, athletic performance, skin aging, cognitive decline, and others show insufficient data. Adenosine, when given by injection for certain heart rhythm problems, is considered effective; however, the evidence for oral supplement use is sparse.

Frankincense similarly shows insufficient evidence across the conditions tested. Overall, no ingredient in this product has strong evidence backing its use as an oral supplement for general wellness.

The evidence, ingredient by ingredient Turmeric Frankincense Echinacea Adenosine Astaxanthin

How safe is it?

Well-documented data
Safety Information · database check
Well characterized

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

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

Turmeric is generally well tolerated in food amounts but can cause constipation, diarrhea, nausea, and heartburn at supplement doses. Concentrated turmeric has been linked to liver damage—at least 70 reports exist of hepatitis and other liver injury after 2 weeks to 14 months of use; most cases improved after stopping.

Headache and vertigo have also been reported. Echinacea is well tolerated short-term but may trigger allergic reactions, especially in people sensitive to ragweed; rare cases of hepatitis have occurred.

Frankincense is generally well tolerated topically but can cause dermatitis, irritation, and rare allergic skin reactions; oral safety data are limited. Astaxanthin appears well tolerated, though abdominal pain and diarrhea occur occasionally, and red-colored stools have been noted.

Adenosine supplement safety is poorly studied; the prescription injectable form carries serious cardiovascular risks and should never be used outside a medical setting. Nucleotide and nucleoside safety data are not on file for this product.

Side effects, ingredient by ingredient Turmeric Frankincense Echinacea Adenosine Astaxanthin

Meds to double-check

Major interaction found
Known Interaction Concern · database check
Major identified

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

Why this rating?
  • 4 of the 5 matched ingredients can interact with medications — Turmeric, Echinacea, Astaxanthin, Adenosine.
  • The most serious interaction on file is rated Major.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; immunosuppressants / transplant drugs; cancer treatments; diabetes medications.
  • For scale: 1,233 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.

Before taking Riboflam, double-check these medication types with your doctor or pharmacist. Most serious: blood vessel-relaxing drugs like dipyridamole (Persantine)—adenosine in this product can dangerously amplify their effects.

Also major concern: heart rhythm medications like carbamazepine that can cause heart block. Moderate concerns include cancer chemotherapy drugs (topoisomerase inhibitors, antitumor antibiotics, etoposide), immune-suppressing drugs (tacrolimus), the breast cancer drug tamoxifen, antibiotics (sulfasalazine), pain medication (tramadol), and methotrexate.

Liver enzyme–metabolized drugs (those processed via CYP3A4, CYP1A2, and CYP2B6) may have changed levels. Caffeine-containing products and foods should be reconsidered, as echinacea increases caffeine levels.

Blood thinners like warfarin may have minor interactions. Use the interaction checker below with your full medication list.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFormula with limited ingredient disclosure with some supporting evidence for its stated purpose. Major medication interactions have been identified, and safety information is well characterized.

Riboflam may appeal to people looking for plant-based support from turmeric and echinacea, though the evidence for these ingredients in supplement form is modest to absent. If you take any prescription medications—especially blood thinners, chemotherapy drugs, heart medications, or immune-suppressing drugs—you should absolutely check each one against this product before starting.

Anyone with liver disease or a history of liver problems should avoid it. Talk it over with your doctor or pharmacist before adding it to your routine.

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

Assessment coverage: 5 of 11 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Oct 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

At a glance

General information

Key facts about Riboflam, straight from the product label.

Brand Bruno MD
Barcode (UPC) 857841007213
Net contents 90 Vegetarian Capsule(s)
Market status On market
Date entered into DSLD Oct 22, 2021
DSLD ID 259681
Product type Other Combinations
Supplement form Capsule
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Vegan, Vegetarian, Adult (18 - 50 Years)
From the label
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.

Supplement Facts

The label details for Riboflam by Bruno MD, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
3 Capsule(s)
Maximum serving Sizes:
3 Capsule(s)
Servings per container
30
UPC/BARCODE
857841007213
IngredientAmount% DV
mixed 5'-Ribonucleotides0 NP--
Riboflam Proprietary Phytosome Complex1350 mg--
Turmeric extract0 NP--
Indian Frankincense extract0 NP--
Narrow-Leaved Coneflower extract0 NP--
Nucleoflam Proprietary Nucleotide and Nucleosides Yeast extract complex200 mg--
Guanosine 5' Monophosphate Disodium Salt0 NP--
Uridine 5'-Monophosphate Disodium Salt0 NP--
Disodium Adenosine 5'-phosphate0 NP--
Cytidine 5'-Monophosphate Disodium Salt0 NP--
Nucleosides0 NP--
other Nucleotides0 NP--
Astaxanthin extract4 mg--

Other ingredients: Microcrystalline Cellulose, Vegetarian Capsule, Silica, Magnesium Stearate

Tap any ingredient to jump to its full detail below.

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

Riboflam is the only vegan nucleotides & astaxanthin dietary supplement with a proprietary Phytosome Complex of clinically proven ingredients.

Nucleotides complex & Astaxanthin with Curcumin Phytosome Contains clinically proven ingredients to promote a healthy inflammation response & relief from exercise related pain

Formulation

Phytosome technology optimizes absorption, and consequently, bioavailability of key ingredients.

Supports the whole body's healthy inflammation response Supports intestinal health Helps maintain the immune system functionality Supports cognition, mental clarity and focus Helps maintain social and emotional functions performance Maintains liver health

Vegan

Made in the USA with carefully selected, clinically proven ingredients imported from Italy, Japan, and other countries.

Suggested/Recommended/Usage/Directions

Directions: Take 3 capsules daily: 1 in the morning, 1 in the afternoon, 1 in the evening, preferably with food, or as directed by your healthcare professional.

Precautions

Caution: As with any dietary supplement, consult your healthcare professional before using this product if you are pregnant, nursing, taking any medication, or under medical supervision.

Keep out of reach of children.

Do not use if safety seal is broken or missing.

Storage

Protect from heat, light and moisture. Store in a cool dry place at 15-30 degrees C (59-86 degrees F).

General Statements

Learn more When lifestyle meets science

FDA Statement of Identity

Dietary Supplement

FDA Disclaimer Statement

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

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

See for yourself

Riboflam by Bruno MD label

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

Riboflam label

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

View the full label (PDF)
What’s inside

The Ingredients in Riboflam by Bruno MD

These are the 11 active ingredients this product is made of. Select any to open its full monograph.

Serving size3 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.

Riboflam Proprietary Phytosome Complex

1350 mg per serving Form: Phospholipids

Nucleoflam Proprietary Nucleotide and Nucleosides Yeast extract complex

200 mg per serving
  • › Mixed 5'-Ribonucleotides
  • › Guanosine 5' Monophosphate Disodium Salt
  • › Uridine 5'-Monophosphate Disodium Salt
  • › Disodium Adenosine 5'-phosphate
  • › Cytidine 5'-Monophosphate Disodium Salt
  • › Nucleosides
  • › Other Nucleotides

Astaxanthin extract

Interacts with
671 drugs
4 mg per serving Form: Haematococcus pluvialis

Astaxanthin is a reddish carotenoid pigment with strong antioxidant activity in the lab, and it is widely promoted for skin, eye, heart, and exercise...

Astaxanthin extract monograph & interactions

Other (inactive) ingredients: Microcrystalline Cellulose, Vegetarian Capsule, Silica, Magnesium Stearate. These complete the product’s ingredient list but are not active constituents.

Interaction report

Riboflam by Bruno MD Drug Interactions

Want to check YOUR meds against Riboflam?

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

 Go to the checker
1,232Drugs
2 Major 1,180 Moderate 50 Minor

Ingredients driving the most interactions

Turmeric extract 1,133
Narrow-Leaved Coneflower extract 816
Astaxanthin extract 671
Disodium Adenosine 5'-phosphate 47

Individual Drug Interactions

The ingredients in Riboflam interact with 1,232 drugs. Click any drug to see the details.

4 of the 11 ingredients in Riboflam interact with drugs. Each result below shows which ingredient is responsible. Turmeric extract Narrow-Leaved Coneflower extract Astaxanthin extract Disodium Adenosine 5'-phosphate

Each ingredient & the kinds of drugs it affects

For each ingredient in Riboflam 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.

Turmeric extract24 drug types · 1,133 drugs

Alkylating Agents

Turmeric has antioxidant effects. Theoretically, this may reduce the activity of chemotherapy drugs that generate free radicals. However, research is conflicting.
In vitro research suggests that curcumin, a constituent of turmeric, inhibits mechlorethamine-induced apoptosis of breast cancer cells by up to 70%. Also, animal research shows that curcumin inhibits cyclophosphamide-induced tumor regression. However, some in vitro research shows that curcumin does not affect the apoptosis capacity of etoposide. Also, other laboratory research suggests that curcumin might augment the cytotoxic effects of alkylating agents. Reasons for the discrepancies may relate to the dose of curcumin and the specific chemotherapeutic agent. Lower doses of curcumin might have antioxidant effects while higher doses might have pro-oxidant effects. More evidence is needed to determine what effect, if any, turmeric might have on alkylating agents.

Likelihood Possible Evidence D
Amlodipine (Norvasc)

Taking turmeric with amlodipine may increase levels of amlodipine.
Animal research shows that giving amlodipine 1 mg/kg as a single dose following the use of turmeric extract 200 mg/kg daily for 2 weeks increases the maximum concentration and area under the curve by 53% and 56%, respectively, when compared with amlodipine alone. Additional animal research shows that taking amlodipine 1 mg/kg with a curcumin 2 mg/kg pretreatment for 10 days increases the maximum concentration and area under the curve by about 2-fold when compared with amlodipine alone.

Likelihood Possible Evidence D
Anticoagulant/Antiplatelet Drugs

Turmeric may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs. However, research is conflicting.
Curcumin, a constituent of turmeric, has demonstrated antiplatelet effects in vitro. Furthermore, two case reports have found that taking turmeric along with warfarin or fluindione was associated with an increased international normalized ratio (INR). However, one clinical study in healthy volunteers shows that taking curcumin 500 mg daily for 3 weeks, alone or with aspirin 100 mg, does not increase antiplatelet effects or bleeding risk. It is possible that the dose of turmeric used in this study was too low to produce a notable effect.

Likelihood Possible Evidence B
Antidiabetes Drugs

Theoretically, taking turmeric with antidiabetes drugs might increase the risk of hypoglycemia.
Animal research and case reports suggest that curcumin, a turmeric constituent, can reduce blood glucose levels in patients with diabetes. Furthermore, clinical research in adults with type 2 diabetes shows that taking curcumin 475 mg daily for 10 days prior to taking glyburide 5 mg decreased postprandial glucose levels for up to 24 hours when compared with glyburide alone, despite the lack of a significant pharmacokinetic interaction. Other clinical studies in patients with diabetes show that taking curcumin daily can reduce blood glucose levels when compared with placebo.

Likelihood Possible Evidence B
Antitumor Antibiotics

Turmeric has antioxidant effects. Theoretically, this may reduce the activity of chemotherapy drugs that generate free radicals. However, research is conflicting.
In vitro and animal research shows that curcumin, a constituent of turmeric, inhibits doxorubicin-induced apoptosis of breast cancer cells by up to 65%. However, curcumin does not seem to affect the apoptosis capacity of daunorubicin. In fact, some research shows that curcumin might augment the cytotoxic effects of antitumor antibiotics, increasing their effectiveness. Reasons for the discrepancies may relate to the dose of curcumin and the chemotherapeutic agent. Lower doses of curcumin might have antioxidant effects while higher doses might have pro-oxidant effects. More evidence is needed to determine what effects, if any, antioxidants such as turmeric have on antitumor antibiotics.

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

Turmeric might increase or decrease levels of drugs metabolized by CYP3A4.
In vitro and animal research show that turmeric and its constituents curcumin and curcuminoids inhibit CYP3A4. Also, 8 case reports from the World Health Organization (WHO) adverse drug reaction database describe increased toxicity in patients taking turmeric and cancer medications that are CYP3A4 substrates, including everolimus, ruxolitinib, ibrutinib, and palbociclib, and bortezomib. In another case report, a transplant patient presented with acute nephrotoxicity and elevated tacrolimus levels after consuming turmeric powder at a dose of 15 or more spoonfuls daily for ten days prior. It was thought that turmeric increased levels of tacrolimus due to CYP3A4 inhibition.
Conversely, other in vitro research suggests that turmeric induces CYP3A4 activity, leading to reduced levels of CYP3A4 substrates. An animal model suggests that induction of CYP3A4 occurs after daily curcumin use for 1 week. However, the induction of CYP3A4 by turmeric has not been reported in humans.

Likelihood Possible Evidence D
Hepatotoxic Drugs

Theoretically, turmeric might increase the risk of liver damage when taken with hepatotoxic drugs.
There is concern that turmeric might cause hepatotoxicity, especially when highly bioavailable formulations are used in high doses.

Likelihood Possible Evidence D
Methotrexate (Trexall, Others)

Theoretically, turmeric might have additive effects when used with hepatotoxic drugs such as methotrexate.
In one case report, a 39-year-old female taking methotrexate, turmeric, and linseed oil developed hepatotoxicity.

Likelihood Possible Evidence D
Organic Anion-Transporting Polypeptide Substrates (Oatp)

Theoretically, turmeric might increase blood levels of OATP4C1 substrates.
In vitro research shows that the turmeric constituent curcumin competitively inhibits OATP4C1 transport. This transporter is expressed in the kidney and facilitates the renal excretion of certain drugs. Theoretically, taking turmeric might decrease renal excretion of OATP substrates.

Likelihood Possible Evidence D
Sulfasalazine (Azulfidine)

Turmeric might increase the effects and adverse effects of sulfasalazine.
Clinical research shows that taking the turmeric constituent, curcumin, can increase blood levels of sulfasalazine by 3.2-fold.

Likelihood Probable Evidence B
Tacrolimus (Prograf)

Turmeric might increase the effects and adverse effects of tacrolimus.
In one case report, a transplant patient presented with acute nephrotoxicity and elevated tacrolimus levels of 29 ng/mL. The patient previously had tacrolimus levels within the therapeutic range at 9.7 ng/mL. Ten days prior to presenting at the emergency room the patient started consumption of turmeric powder at a dose of 15 or more spoonfuls daily. It was thought that turmeric increased levels of tacrolimus due to cytochrome P450 3A4 (CYP3A4) inhibition. In vitro and animal research show that turmeric and its constituent curcumin inhibit CYP3A4.

Likelihood Possible Evidence D
Talinolol

Turmeric may reduce the absorption of talinolol in some situations.
Clinical research shows that taking curcumin for 6 days decreases the bioavailability of talinolol when taken together on the seventh day. The clinical significance of this effect is unclear.

Likelihood Probable Evidence B
Tamoxifen (Nolvadex)

Theoretically, turmeric might reduce the levels and clinical effects of tamoxifen.
In a small clinical trial in patients with breast cancer taking tamoxifen 20-30 mg daily, adding curcumin 1200 mg plus piperine 10 mg three times daily reduces the 24-hour area under the curve of tamoxifen and the active metabolite endoxifen by 12.8% and 12.4%, respectively, as well as the maximum concentrations of tamoxifen, when compared with tamoxifen alone. However, in the absence of piperine, the area under the curve for endoxifen and the maximum concentration of tamoxifen were not significantly reduced. Effects were most pronounced in patients who were extensive cytochrome P450 (CYP) 2D6 metabolizers.

Likelihood Possible Evidence B
Topoisomerase I Inhibitors

Turmeric has antioxidant effects. There is some concern that this may reduce the activity of chemotherapy drugs that generate free radicals. However, research is conflicting.
In vitro research shows that curcumin, a constituent of turmeric, inhibits camptothecin-induced apoptosis of breast cancer cells by up to 71%. However, other in vitro research shows that curcumin augments the cytotoxic effects of camptothecin. Reasons for the discrepancies may relate to the dose of curcumin and the chemotherapeutic agents. Lower doses of curcumin might have antioxidant effects while higher doses might have pro-oxidant effects. More evidence is needed to determine what effect, if any, turmeric might have.

Likelihood Possible Evidence D
Tramadol (Ultram)

Theoretically, turmeric might increase or decrease levels of tramadol.
Animal research suggests that a single dose of curcumin, a constituent of turmeric, may increase tramadol's maximum concentration (Cmax) by inhibiting metabolism, while continued daily use for 7 days may reduce the area under the curve (AUC) due to the induction of drug-metabolizing enzymes such as cytochrome P450 3A4 (CYP3A4). However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Turmeric might increase the risk of bleeding with warfarin.
One case of increased international normalized ratio (INR) has been reported for a patient taking warfarin who began taking turmeric. Prior to taking turmeric, the patient had stable INR measurements. Within a few weeks of starting turmeric supplementation, the patient's INR increased to 10. Additionally, curcumin, the active constituent in turmeric, has demonstrated antiplatelet effects in vitro, which may produce additive effects when taken with warfarin.

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

Theoretically, turmeric might increase levels of drugs metabolized by CYP1A2. However, research is conflicting.
In vitro and animal research show that the turmeric constituent, curcumin, inhibits CYP1A2. However, other in vitro research suggests that curcumin does not significantly affect CYP1A2.

Likelihood Possible Evidence D
Docetaxel (Taxotere)

Theoretically, turmeric might increase blood levels of oral docetaxel.
Animal research suggests that the turmeric constituent, curcumin, enhances the oral bioavailability of docetaxel. However, the significance of this interaction is unclear, as this drug is typically administered intravenously in clinical settings.

Likelihood Possible Evidence D
Estrogens

Theoretically, large amounts of turmeric might interfere with hormone replacement therapy through competition for estrogen receptors.
In vitro research shows that curcumin, a constituent of turmeric, displaces the binding of estrogen to its receptors.

Likelihood Possible Evidence D
Glyburide (Diabeta, Others)

Theoretically, taking turmeric and glyburide in combination might increase the risk of hypoglycemia.
Clinical research shows that taking curcumin 475 mg daily for 10 days prior to taking glyburide 5 mg increases blood levels of glyburide by 12% at 2 hours after the dose in patients with type 2 diabetes. While maximal blood concentrations of glyburide were not affected, turmeric modestly decreased postprandial glucose levels for up to 24 hours when compared to glyburide alone, possibly due to the hypoglycemic effect of turmeric demonstrated in animal research.

Likelihood Possible Evidence B
Losartan (Cozaar)

Theoretically, turmeric might increase the effects of losartan.
Research in hypertensive rats shows that taking turmeric can increase the hypotensive effects of losartan.

Likelihood Possible Evidence D
Norfloxacin (Noroxin)

Theoretically, turmeric might increase the effects and adverse effects of norfloxacin.
Animal research shows that taking curcumin, a turmeric constituent, can increase blood levels of orally administered norfloxacin.

Likelihood Possible Evidence D
P-Glycoprotein Substrates

Theoretically, turmeric might increase the absorption of P-glycoprotein substrates.
In vitro and animal research shows that curcuminoids and other constituents found in turmeric can inhibit P-glycoprotein expression and activity.

Likelihood Possible Evidence D
Paclitaxel (Abraxane, Onxol)

Theoretically, turmeric might alter blood levels of paclitaxel, although any effect may not be clinically relevant.
Clinical research in adults with breast cancer receiving intravenous paclitaxel suggests that taking turmeric may modestly alter paclitaxel pharmacokinetics. Patients received paclitaxel on day 1, followed by either no treatment or turmeric 2 grams daily from days 2-22. Pharmacokinetic modeling suggests that turmeric reduces the maximum concentration and area under the curve of paclitaxel by 12.1% and 7.7%, respectively. However, these changes are not likely to be considered clinically relevant. Conversely, animal research suggests that curcumin, a constituent of turmeric, enhances the oral bioavailability of paclitaxel. However, the significance of this interaction is unclear, as this drug is typically administered intravenously in clinical settings.

Likelihood Possible Evidence D
Turmeric extract full monograph & interactions

Narrow-Leaved Coneflower extract12 drug types · 816 drugs

Caffeine

Echinacea can increase plasma levels of caffeine by inhibiting its metabolism.
Echinacea seems to increase plasma concentrations of caffeine by around 30%. This is likely due to inhibition of cytochrome P450 1A2 (CYP1A2) by echinacea.

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

Echinacea might inhibit the metabolism of CYP1A2 and increase plasma levels of some drugs.
Echinacea appears to inhibit CYP1A2 enzymes in humans. Additionally, echinacea seems to increase plasma concentrations of caffeine, a CYP1A2 substrate, by around 30%. Theoretically, echinacea might increase levels of other drugs metabolized by CYP1A2.

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

Echinacea may induce hepatic CYP3A4 and inhibit intestinal CYP3A4. This may increase or decrease levels of drugs metabolized by CYP3A4.
Several clinical trials have shown that taking echinacea for up to one month does not significantly affect the metabolism of various CYP3A4 substrates, including midazolam, docetaxel, etravirine, lopinavir-ritonavir, and darunavir-ritonavir. However, other clinical research shows that echinacea may increase the clearance of midazolam, suggesting that echinacea might induce CYP3A4. The discrepancy is thought to be due to differing effects of echinacea on intestinal versus hepatic CYP3A4 enzymes. Echinacea appears to induce hepatic CYP3A4 but inhibit intestinal CYP3A4. In some cases, these effects might cancel each other out, but in others, drug levels may be increased or decreased depending on the level of effect at hepatic and intestinal sites. The effect of echinacea on CYP3A4 activity may differ depending on the CYP3A4 substrate.

Likelihood Possible Evidence B
Etoposide (Vepesid)

Echinacea may increase levels of etoposide.
In one report, concomitant use of etoposide and echinacea was associated with more severe thrombocytopenia than the use of etoposide alone, suggesting inhibition of etoposide metabolism. Etoposide is a cytochrome P450 3A4 (CYP3A4) substrate. Echinacea has variable effects on CYP3A4, but some studies have reported inhibition of the enzyme.

Likelihood Possible Evidence D
Immunosuppressants

Echinacea has immunostimulant activity which may interfere with immunosuppressant therapy.
Theoretically, echinacea may interfere with immunosuppressant therapy because of its immunostimulant activity.

Likelihood Possible Evidence B
Darunavir (Prezista)

Theoretically, echinacea may interfere with the metabolism of darunavir; however, a small clinical study found no effect.
Darunavir is metabolized by cytochrome P450 3A4 (CYP3A4) and is administered with the CYP3A4 inhibitor ritonavir to increase its plasma concentrations. Echinacea has variable effects on CYP3A4, but administration of an E. purpurea root extract (Arkocapsulas Echinacea, Arkopharma) 500 mg four times daily for 14 days did not affect darunavir/ritonavir pharmacokinetics in 15 HIV-infected patients.

Likelihood Unlikely Evidence B
Dayquil Severe

Echinacea is reported to have varying effects on a number of Cytochrome P450 metabolizing enzymes in the liver, including CYP1A2 and CYP3A4, which play a role in acetaminophen and dextromethorphan metabolism (both contained in DayQuil Severe), respectively. Studies have reported both enzyme inhibition and induction, making it difficult to predict clinically significant drug interactions with reliability. Specific drug interaction studies reporting definitive results are rare, and potential drug interactions involving echinacea should likely be taken on a case-by-case basis. Based on what we know about how acetaminophen and dextromethorphan are metabolized, the risk of a clinically significant interaction between echinacea and DayQuil Severe is low.

Likelihood Unlikely Evidence A
Docetaxel (Taxotere)

Theoretically, echinacea may interfere with the metabolism of docetaxel; however, a small clinical study found no effect.
Docetaxel is metabolized by cytochrome P450 3A4 (CYP3A4). Echinacea has variable effects on CYP3A4, but taking E. purpurea whole plant extract (Echinaforce, A. Vogel Biopharma AG) 20 drops three times daily for 2 weeks did not alter the pharmacokinetics of docetaxel in one clinical study.

Likelihood Unlikely Evidence B
Etravirine (Intelence)

Theoretically, echinacea may interfere with the metabolism of etravirine; however, a small clinical study found no effect.
Etravirine is metabolized by cytochrome P450 3A4 (CYP3A4). Echinacea has variable effects on CYP3A4, but taking E. purpurea root extract (Arkocapsulas Echinacea, Arkopharma) 500 mg three times daily for 14 days did not alter the pharmacokinetics of etravirine in HIV-infected patients.

Likelihood Unlikely Evidence B
Lopinavir/Ritonavir (Kaletra)

Theoretically, echinacea may interfere with the metabolism of lopinavir; however, a small clinical study found no effect.
Lopinavir is metabolized by cytochrome P450 3A4 (CYP3A4) and is administered with the CYP3A4 inhibitor ritonavir to increase its plasma concentrations. Echinacea has variable effects on CYP3A4, but taking E. purpurea (Echinamide, Natural Factors Nutritional Products, Inc.) 500 mg three times daily for 14 days did not alter the pharmacokinetics of lopinavir/ritonavir in healthy volunteers.

Likelihood Unlikely Evidence B
Midazolam (Versed)

Theoretically, echinacea may increase the metabolism of intravenous midazolam.
Echinacea induces hepatic CYP3A4 and might decrease plasma levels of midazolam by about 20%, reducing the effectiveness of intravenous midazolam. Echinacea also appears to inhibit intestinal CYP3A4, which could theoretically increase the bioavailability of oral midazolam. This may cancel out the decrease in availability caused by induction of hepatic CYP3A4, such that overall plasma levels after oral administration of midazolam are not affected by echinacea.

Likelihood Possible Evidence B
Warfarin (Coumadin)

Echinacea seems to increase the clearance of warfarin, although the effect may not be clinically significant.
Preliminary clinical research in healthy male volunteers suggests that taking echinacea increases the clearance of the active S-isomer of warfarin after a single dose of warfarin, but there was not a clinically significant effect on the INR.

Likelihood Possible Evidence B
Narrow-Leaved Coneflower extract full monograph & interactions

Astaxanthin extract2 drug types · 671 drugs

Cytochrome P450 2B6 (Cyp2B6) Substrates

Theoretically, astaxanthin may decrease levels of drugs metabolized by CYP2B6.
In vitro research shows that astaxanthin induces cytochrome CYP2B6 enzyme activity in human hepatocytes. This effect has not been reported in humans.

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

Theoretically, astaxanthin may decrease levels of drugs metabolized by CYP3A4.
In vitro research shows that astaxanthin induces CYP3A4 enzyme activity in human hepatocytes. This effect has not been reported in humans.

Likelihood Possible Evidence D
Astaxanthin extract full monograph & interactions

Disodium Adenosine 5'-phosphate3 drug types · 47 drugs

Dipyridamole (Persantine)

Dipyridamole can increase the therapeutic and toxic effects of adenosine.
Dipyridamole decreases the metabolism of adenosine. Intravenous infusion of adenosine in patients who are taking dipyridamole can cause dizziness, bradycardia, and syncope. Dipyridamole should be discontinued for several days prior to a cardiac stress test using adenosine.

Likelihood Likely Evidence D
Carbamazepine (Tegretol)

Carbamazepine might increase the risk of heart block when used concomitantly with adenosine.
Carbamazepine and adenosine can both cause heart block. Giving them concurrently might produce an additive effect.

Likelihood Possible Evidence D
Methylxanthines

Methylxanthines are competitive antagonists of adenosine and can block its pharmacologic effects.
The methylxanthines, aminophylline, caffeine, and theophylline, can block the effects of adenosine by acting as competitive antagonists at adenosine cell surface receptors. It is recommended that methylxanthines be avoided for 24 hours prior to cardiac stress tests.

Likelihood Possible Evidence D
Disodium Adenosine 5'-phosphate full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Riboflam, from the product label.

Bruno MD

See all Bruno MD products
Name
Bruno Pharma Innovations, LLC
Street Address
2255 Glades Rd Suite 324A
City
Boca Raton
State
FL
ZipCode
33431
Phone Number
1.866.816.3400
Web Address
Riboflam.com
Pharmacist Counseling Corner

Riboflam by Bruno MD: Common Questions

Does Riboflam by Bruno MD interact with any medications?
Yes. Based on its ingredients, Riboflam has a known interaction with 1,232 medications, including 2 rated major. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Riboflam contains 11 active ingredients, and an interaction can come from any of them. We check every ingredient, combine the results into one list per medication, and show which ingredient and mechanism is responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.
What are nucleotides and nucleosides, and why are they in this product?
Nucleotides and nucleosides are building blocks of DNA and RNA that support cellular energy and repair. Riboflam includes mixed 5'-ribonucleotides, guanosine, uridine, cytidine, and adenosine as part of its formula. However, the evidence for oral supplement use in humans is limited, and we could not check several of these ingredients against medication databases.
Can I take Riboflam with my blood pressure or heart medication?
It depends on which medication you take. The adenosine in this product can interact seriously with certain heart drugs like dipyridamole; it may also interact with carbamazepine and other medications. Use the interaction checker on this page with your specific medications, then confirm the results with your doctor or pharmacist before starting.
What's the most common side effect I might experience?
Turmeric, the main plant ingredient, most commonly causes constipation, diarrhea, nausea, or heartburn. Echinacea may cause stomach upset or rashes. Astaxanthin can cause abdominal pain or diarrhea. If you have a history of ragweed allergy, echinacea poses a higher risk of allergic reaction.
Is Riboflam safe to take if I have liver disease?
No—turmeric in this product has been linked to liver damage in at least 70 reported cases, and echinacea has rarely caused hepatitis. If you have any liver condition, talk with your doctor or pharmacist before considering this product.
Can I take this while breastfeeding?
Turmeric is likely safe while breastfeeding, but frankincense is rated unsafe due to lack of data. Echinacea, adenosine, and astaxanthin have no safety ratings for breastfeeding in our data. Discuss with your doctor or pharmacist before use if you are nursing.
Does Riboflam actually work for the conditions listed?
Turmeric is rated possibly effective for depression, high cholesterol, and hay fever, but evidence is modest. Echinacea, astaxanthin, and frankincense lack reliable evidence for the conditions tested. Adenosine works for specific heart rhythm problems when given by injection, but oral supplement evidence is sparse. Overall, the support from scientific data is limited.

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

Not sure if Riboflam is safe with your meds?

Our pharmacists answer your medication & supplement questions — free.

Ask a pharmacist

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.

Riboflam label
Go deeper

The Full Monographs Behind Riboflam’s Ingredients

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

Herb & supplement monograph

Turmeric

Interacts with 1,133 drugs

Turmeric is a popular spice whose main active compounds, curcuminoids, are studied mostly for inflammation and joint pain. Some research is promising, but quality is mixed and curcumin is po...

Read the full Turmeric monograph → Herb & supplement monograph

Frankincense

Frankincense is the aromatic resin of the Boswellia tree and is best known for its boswellic acids, which may help with inflammation and joint pain. Early research is promising for condition...

Read the full Frankincense monograph → Herb & supplement monograph

Echinacea

Interacts with 816 drugs

Echinacea is a popular herb taken to help prevent or shorten the common cold, but study results are mixed and the overall benefit appears small at best. It is generally well tolerated for sh...

Read the full Echinacea monograph → Herb & supplement monograph

Adenosine

Interacts with 47 drugs

Adenosine is a natural building block your body uses for energy and cell signaling, and a prescription injectable version is used by doctors to treat certain fast heart rhythms. As an over-t...

Read the full Adenosine monograph → Herb & supplement monograph

Astaxanthin

Interacts with 671 drugs

Astaxanthin is a reddish carotenoid pigment with strong antioxidant activity in the lab, and it is widely promoted for skin, eye, heart, and exercise benefits. Early human studies are promis...

Read the full Astaxanthin monograph →
Sources

Sources & How We Checked

Riboflam's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.

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

The 168 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.

Turmeric 102 references
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  21. Shenouda, N. S., Zhou, C., Browning, J. D., Ansell, P. J., Sakla, M. S., Lubahn, D. B., and MacDonald, R. S. Phytoestrogens in common herbs regulate prostate cancer cell growth in vitro. Nutr.Cancer 2004;49(2):200-208. PubMed
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Frankincense 2 references
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Adenosine 10 references
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Astaxanthin 3 references
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DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

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