SizeOn Fruit Punch Ingredients & Drug Interactions
What is this page for?
First and foremost: checking SizeOn Fruit Punch 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
SizeOn Fruit Punch is a dietary supplement by Gaspari Nutrition with 19 active ingredients. Its ingredients are commonly taken for constipation, diarrhea, high cholesterol.Based on those ingredients, 2,175 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Dietary Fiber, Niacin, Magnesium. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against SizeOn Fruit Punch by Gaspari Nutrition
Ask about any prescription or over-the-counter medication and we check it for interactions with SizeOn Fruit Punch by Gaspari Nutrition — 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 SizeOn Fruit Punch by Gaspari Nutrition
Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.
What’s inside
Partial disclosure
SizeOn Fruit Punch contains 26 active and inactive ingredients. The active ingredients include key electrolytes—sodium, potassium, calcium, magnesium, and phosphorus—along with B vitamins (thiamine, niacin, pantothenic acid, riboflavin, vitamin B6, folate, and vitamin B12), vitamin C, branched-chain amino acids (L-leucine, L-isoleucine, L-valine), the amino acids L-taurine, L-ornithine L-aspartate, and Sustamine (glutamine), whey protein hydrolysate, and creatine compounds (disodium creatine phosphate and creatine MagnaPower).
The remaining ingredients are inactive fillers and flavorings—citric acid, malic acid, silica, lecithin, natural and artificial flavors, sucralose, acesulfame potassium, and Red #40.
Does it work?
Moderate evidence
The effectiveness evidence in our data varies by ingredient. Calcium is effective for bone health (osteoporosis) and managing high potassium levels and kidney disease symptoms.
Magnesium is effective for constipation and indigestion, and for preventing seizures in pregnancy (pre-eclampsia). Thiamine is effective for thiamine deficiency and Wernicke-Korsakoff syndrome.
Vitamin C is effective for vitamin C deficiency, possibly effective for certain types of anemia and post-exercise respiratory infections. Niacin is likely effective for pellagra and possibly effective for certain lipid problems.
Vitamin B6 is effective for certain types of anemia and seizure disorders. Whey protein is possibly effective for athletic performance.
Creatine (in two forms here) is possibly effective for muscle strength and sarcopenia. L-ornithine L-aspartate is possibly effective for hepatic encephalopathy.
For most other ingredients—potassium, phosphorus, pantothenic acid, niacin's other uses, riboflavin, vitamin B12, L-taurine, L-leucine, L-isoleucine, and L-valine—evidence of effectiveness is either insufficient or not held in our data.
How safe is it?
Well-documented data
Most ingredients in SizeOn are generally well tolerated at normal amounts. Sodium must be monitored—too much can raise blood pressure and strain the heart; normal dietary sodium is fine, but avoid sodium supplements without medical advice.
Potassium from food is safe, but supplements can cause dangerously high blood levels, especially in people with kidney disease. Calcium, magnesium, thiamine, pantothenic acid, niacin (at recommended doses), riboflavin, and vitamin B12 are all generally safe at recommended amounts.
Vitamin C is safe at normal doses but can cause kidney stones in those prone to them and diarrhea at very high doses. Vitamin B6 is safe at normal amounts but high doses over time can damage nerves.
Whey protein is generally well tolerated but has been reported to trigger or worsen acne in some people. Creatine may cause water retention and muscle cramps.
Glutamine is generally well tolerated. Regarding pregnancy and breastfeeding: sodium's safety is uncertain (rated possibly unsafe), potassium and glutamine are likely safe, and magnesium is likely safe (though one rating notes possibly unsafe).
Calcium safety is uncertain (possibly unsafe in one rating). For breastfeeding, potassium and vitamin B12 are safe, but data on taurine, creatine, and L-ornithine L-aspartate in breastfeeding is absent or advises caution or avoidance.
Meds to double-check
Major interaction found
Before taking SizeOn Fruit Punch, check with your doctor or pharmacist if you use HIV integrase inhibitors (dolutegravir, elvitegravir), blood pressure medications, blood thinners (especially warfarin), thyroid medication (levothyroxine), potassium-sparing diuretics or ACE inhibitors/ARBs, corticosteroids, seizure medications, diabetes pills, heart medications (calcium channel blockers, sotalol, diltiazem), or any other prescription drugs. The product's sodium and potassium content alone warrant caution in anyone managing blood pressure or heart disease.
The bottom line
Scorecard at a glancePartially disclosed formula with some supporting evidence for its stated purpose. Major medication interactions have been identified, and safety information is well characterized.
SizeOn Fruit Punch is a multi-ingredient sports supplement with electrolytes, vitamins, amino acids, and creatine—useful as a workout aid, but the high sodium and potassium content, combined with multiple drug interactions, means it's not for everyone. If you take blood pressure medication, a blood thinner, thyroid hormone, diabetes pills, seizure drugs, or any medication for heart disease or HIV, check with your doctor or pharmacist before using this product.
Pregnant or nursing women should also confirm with their healthcare provider before starting it.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 22 of 27 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Nov 25, 2011.
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 SizeOn Fruit Punch, straight from the product label.
| Brand | Gaspari Nutrition |
|---|---|
| Barcode (UPC) | 646511005136 |
| Net contents | 1.62 lb; 734.3 g |
| Market status | On market |
| Date entered into DSLD | Nov 25, 2011 |
| DSLD ID | 2046 |
| Product type | Other Combinations |
| Supplement form | Powder |
| Dietary claims / uses | All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years) |
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 SizeOn Fruit Punch by Gaspari Nutrition, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Calories | 50 {Calories} | -- |
| Total Carbohydrates | 2 g | 1% |
| Sugar | 0 g | -- |
| Calories from Fat | 5 {Calories} | -- |
| Total Fat | 1 g | 1% |
| Dietary Fiber | 0 g | -- |
| Protein | 10 g | 19% |
| Saturated Fat | 0 g | -- |
| Sodium | 130 mg | 5% |
| Trans Fat | 0 g | -- |
| Potassium | 210 mg | 6% |
| Cholesterol | 23 mg | 8% |
| Phosphorus | 214 mg | 21% |
| Calcium | 118 mg | 12% |
| Magnesium | 46 mg | 12% |
| Thiamine | 10 mg | 667% |
| L-Leucine | 5 Gram(s) | -- |
| L-Isoleucine | 0 NP | -- |
| L-Valine | 0 NP | -- |
| Vitamin C | 60 mg | 101% |
| Pantothenic Acid | 9 mg | 92% |
| Niacin | 50 mg | 250% |
| Folate | 200 mcg | 50% |
| Vitamin B12 | 75 mcg | 1250% |
| L-Taurine | 0 NP | -- |
| Sodium Glycerophosphate | 0 NP | -- |
| Riboflavin | 7.6 mg | 447% |
| Vitamin B6 | 16.8 mg | 838% |
| Whey Protein hydrolysate | 0 NP | -- |
| Sustamine | 0 NP | -- |
| Potassium Glycerophosphate | 0 NP | -- |
| Calcium Glycerophosphate | 0 NP | -- |
| Disodium Creatine Phosphate | 0 NP | -- |
| Creatine MagnaPower | 0 NP | -- |
| L-Ornithine L-Aspartate | 0 NP | -- |
| Creapure | 0 NP | -- |
| SizeOn Blend | 27.3 Gram(s) | -- |
| Protein Synthesis Acceleration Matrix | 0 NP | -- |
| OsmoDrive Advanced Hydration Complex | 0 NP | -- |
| PhosphoDrive Endurance Complex | 0 NP | -- |
Other ingredients: Citric Acid, Natural and Artificial flavors, Malic Acid, Lecithin, Silica, Sucralose, Acesulfame Potassium, Red #40
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.
Suggested/Recommended/Usage/Directions
DIRECTIONS: SizeOn is meant to be taken on training days WHILE you train. Mix one scoop in 20-30 ounces cold water and sip throughout your workout. Should the need arise, add more water as necessary throughout your workout for proper hydration.
Precautions
KEEP OUT OF REACH OF CHILDREN.
Do not use if pregnant or nursing.
ALLERGEN WARNING: Contains ingredients from milk.
CONTAINS: Milk, soy
Not suggested for use in children under the age of 18 or in people who have been diagnosed with hypertension, kidney disease, liver disease, metabolic syndrome, diabetes, neoplastic condition such as cancer or thalassemia.
WARNING: Seek the advise of a health care practitioner before use.
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.
Storage
Note: Do not store in direct sunlight, store in a cool dry place.
Formula
HYBRID INTRA-WORKOUT WHEY HYDROLYSATE CREATINE FORMULA
ONLY 2 GRAMS OF CARBOHYDRATES
General Statements
AMINO ACID POWERHOUSE
BASED ON VALID CLINICAL RESEARCH
FULL MONTH SUPPLY
NEW
PRE-CONTEST
PROMOTES MAXIMAL MUSCLE VOLUME AND ACCELERATES PROTEIN SYNTHESIS
TRAIN HARDER, FASTER & LONGER WITH SIZEON!
General
Rev. 1009
Brand IP Statement(s)
Creapure is a registered trademark of AlzChem Trostberg GmbH, covered by US patent 5,719,319.
DRAMATIC RESULTS FAST - FULL MONTH SUPPLY Gaspari Nutrition took Sports Nutrition to the highest level with the original SizeOn(TM), the original intra-workout creatine drink. There wasn’t any doubt it represented a serious innovative leap forward in the creatine category. SizeOn clearly demonstrated in a clinical setting that it destroyed its competition and quickly became known as the King of Creatines. As clinical research advances, so does Gaspari Nutrition which is why SizeOn has now evolved into the Ultimate Hybrid Intra-Workout Whey Hydrolysate Creatine Formula. Once again Gaspari Nutrition raises the bar even higher in the sports nutrition industry and has offered you a low carb version (only 2g per serving!) of its original masterpiece! Your body requires that proteins from whole food, whey isolate, casein, etc., be broken down in a process called “hydrolyzation.” This is an integral process which allows di and tripeptides to be absorbed and utilized for numerous processes including muscle building and repair. The problem is that while your muscles are starving for these nutrients (i.e., during exercise) your body must digest them into smaller peptides. Research has shown that these are absorbed even faster than free form amino acids. For this reason Gaspari Nutrition uses 12 grams of a high quality whey hydrolysate that contains over 50% di and tripeptides as well as a large array of anabolic promoting ingredients such as a high dose of L-LEUCINE (5 grams) to allow for unparalleled increases in athletic performance, skeletal muscle recovery, explosiveness and most notably, immediate increases in muscle size WHILE YOU ARE STILL TRAINING. To top it off, we also included LOLA(TM), our cutting-edge, ammonia scavenging amino acid salt of L-Ornithine and L-Aspartate to help battle fatigue. The bottom line is that Gaspari Nutrition has once again outdone itself and yet again redefined the very category it created. Every single ingredient in SizeOn was selected specifically and solely for the scientific evidence to support efficacy and safety. You can be assured this product is based on VALID scientific research and not overhyped nonsense which doesn’t deliver the results you demand and pay for.
Sustamine(TM) is a registered trademark of KYOWA HAKKO BIO Co., Ltd.
There is ZERO Doubt SizeOn(TM) Pre-Contest Will: -Accelerate Protein Synthesis & Muscle Force Recovery -Increase Muscle Volume, Muscle Fiber Size, Cell Volume & Plasma Amino Acid Levels -Amplify S6K1 and 4E-BP1 Signaling and Hypertrophic mTOR Pathway Conduction -Initiate & Sustain Myogenesis and Muscle Recovery While You Are Still Training -Deliver Vital Nutrients, Essential Minerals, and Growth Cofactors To Skeletal Muscle Tissue -Includes 12 Grams of Growth Potentiating Whey Hydrolysate and 5 Grams of Leucine Per Serving
Creatine MagnaPower is a registered trademark of Albion Laboratories, Inc., covered by U.S. Patent 6,114,379 and patents pending.
Seals/Symbols
Creapure(R)
SUSTAMINE(TM)
FDA Statement of Identity
DIETARY SUPPLEMENT
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
SizeOn Fruit Punch by Gaspari Nutrition 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 SizeOn Fruit Punch by Gaspari Nutrition
These are the 19 active ingredients this product is made of. Select any to open its full monograph.
Serving size30.6 Gram(s) Dosage formPowder Servings per container24 Amounts shown are per serving.
Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.
Sugar
Dietary Fiber
Interacts with2,025 drugs
Black psyllium is a soluble-fiber supplement made from the seeds of a Plantago plant, used mostly to ease constipation and support digestive health. I...
Dietary Fiber monograph & interactionsProtein
Sodium
Interacts with205 drugs
Sodium is an essential mineral and electrolyte your body needs to balance fluids, support nerves, and help muscles work. Most people in modern diets g...
Sodium monograph & interactionsPotassium
Interacts with62 drugs
Potassium is an essential mineral your body needs for nerve signals, muscle function, and a steady heartbeat, and most people get enough from a balanc...
Potassium monograph & interactionsPhosphorus
Calcium
Interacts with168 drugs
Calcium is an essential mineral your body needs for strong bones, nerve signaling, and muscle function, and supplements can help fill gaps when diet f...
Calcium monograph & interactionsMagnesium
Interacts with295 drugs
Magnesium is an essential mineral your body needs for muscles, nerves, blood pressure, and many other functions, and supplements are useful for preven...
Magnesium monograph & interactionsThiamine
Interacts with3 drugs
Thiamine (vitamin B1) is an essential nutrient your body needs to turn food into energy and to keep your nerves and heart healthy. Most people get eno...
Thiamine 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 & interactionsPantothenic Acid
No knowninteractions
Pantothenic acid is vitamin B5, an essential nutrient your body uses to turn food into energy. True deficiency is very rare because it is found in nea...
Pantothenic Acid monograph & interactionsNiacin
Interacts with727 drugs
Niacin (vitamin B3) is an essential nutrient your body needs for energy and metabolism, and deficiency is uncommon in most developed countries. Prescr...
Niacin monograph & interactionsFolate
Vitamin B12
Interacts with20 drugs
Vitamin B12 (cobalamin) is an essential nutrient your body needs to make red blood cells, keep nerves healthy, and support DNA. Supplements are very h...
Vitamin B12 monograph & interactionsRiboflavin
Interacts with20 drugs
Riboflavin (vitamin B2) is an essential nutrient your body needs to turn food into energy and to keep skin, eyes, and nerves healthy. It is generally...
Riboflavin monograph & interactionsVitamin B6
Interacts with210 drugs
Vitamin B6 (pyridoxine) is an essential water-soluble vitamin that your body needs for metabolism, brain function, and making red blood cells. It is b...
Vitamin B6 monograph & interactionsSizeOn Blend
- › Protein Synthesis Acceleration Matrix
- › OsmoDrive Advanced Hydration Complex
- › PhosphoDrive Endurance Complex
Other (inactive) ingredients: Citric Acid, Natural and Artificial flavors, Malic Acid, Lecithin, Silica, Sucralose, Acesulfame Potassium, Red #40. These complete the product’s ingredient list but are not active constituents.
SizeOn Fruit Punch by Gaspari Nutrition Drug Interactions
HelloPharmacist Interaction Report
SizeOn Fruit Punch by Gaspari Nutrition contains several ingredients with documented drug interactions, chiefly through its sodium, potassium, calcium, magnesium, vitamin C, niacin, vitamin B6, whey protein, and glutamine content.
The most serious interaction involves calcium with two HIV integrase inhibitors—dolutegravir (Tivicay) and elvitegravir (Vitekta)—where calcium can reduce drug levels by up to 40%, potentially compromising viral control. Altogether, these interactions span 983 individual medications.
Read the full breakdown — every affected drug type, severity by severity
Beyond the Major concerns, Moderate interactions are documented across a wide range of drug types. Sodium in this product may reduce the effectiveness of blood pressure medications (antihypertensives) and can dangerously raise sodium levels if you're taking corticosteroids, lithium, didanosine, sodium phosphate bowel-prep drugs, or the sodium-regulating drug tolvaptan.
Potassium poses a risk of dangerously high blood potassium (hyperkalemia) if combined with potassium-sparing water pills, ACE inhibitors, or angiotensin receptor blockers (ARBs)—drugs commonly used for blood pressure and heart disease.
Calcium also interacts with thyroid medication (levothyroxine), certain heart drugs (sotalol, diltiazem), and psoriasis treatments (calcipotriene). Magnesium can reduce the absorption of Parkinson's medication (levodopa), certain antibiotics (quinolones, tetracyclines), bone drugs (bisphosphonates), and diabetes pills (sulfonylureas), and may add to the blood-pressure-lowering effect of calcium channel blockers.
Vitamin C at higher doses may weaken blood thinners like warfarin and can interfere with certain cancer drugs and antipsychotics. Niacin interacts with blood pressure drugs, diabetes medications, cholesterol pills, gout treatments, and drugs that bind bile acids.
Vitamin B6 at high doses can reduce levels of seizure medications and blood pressure control. Whey protein may reduce absorption of certain antibiotics and bone medications.
Glutamine may interfere with seizure control medications.
If you take any prescription medication, run your exact drugs through the interaction checker on this page before starting SizeOn.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against SizeOn Fruit Punch?
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 SizeOn Fruit Punch interact with 2,175 drugs. Click any drug to see the details.
11 of the 19 ingredients in SizeOn Fruit Punch interact with drugs. Each result below shows which ingredient is responsible. Dietary Fiber Niacin Magnesium Vitamin B6 Vitamin C Sodium Calcium Potassium Vitamin B12 Riboflavin Thiamine
Benserazide, LevodopaMadopar, Prolopa
How Benserazide, Levodopa interacts with SizeOn Fruit Punch — through 4 ingredients. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Benserazide, Levodopa interactionWhey Protein HydrolysateLevodopa Major
Interaction Summary
Theoretically, whey protein might decrease levodopa absorption.
Read the full Whey Protein Hydrolysate + Benserazide, Levodopa interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Benserazide, Levodopa interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Benserazide, Levodopa interactionCarbidopaLodosyn
How Carbidopa interacts with SizeOn Fruit Punch — through 2 ingredients. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Carbidopa interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Carbidopa interactionCarbidopa, LevodopaDhivy, Rytary, Sinemet, Sinemet CR
How Carbidopa, Levodopa interacts with SizeOn Fruit Punch — through 4 ingredients. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Carbidopa, Levodopa interactionWhey Protein HydrolysateLevodopa Major
Interaction Summary
Theoretically, whey protein might decrease levodopa absorption.
Read the full Whey Protein Hydrolysate + Carbidopa, Levodopa interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Carbidopa, Levodopa interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Carbidopa, Levodopa interactionCarbidopa, Levodopa, EntacaponeStalevo
How Carbidopa, Levodopa, Entacapone interacts with SizeOn Fruit Punch — through 4 ingredients. Tap an ingredient for the detail:
Whey Protein HydrolysateLevodopa Major
Interaction Summary
Theoretically, whey protein might decrease levodopa absorption.
Read the full Whey Protein Hydrolysate + Carbidopa, Levodopa, Entacapone interactionMagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Carbidopa, Levodopa, Entacapone interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Carbidopa, Levodopa, Entacapone interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Carbidopa, Levodopa, Entacapone interactionCeftriaxoneRocephin
How Ceftriaxone interacts with SizeOn Fruit Punch — through 1 ingredient. Tap an ingredient for the detail:
Calcium GlycerophosphateCeftriaxone (rocephin) Major
Interaction Summary
Co-administration of intravenous calcium and ceftriaxone can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys.
Read the full Calcium Glycerophosphate + Ceftriaxone interactionCobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide FumarateGenvoya
How Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interacts with SizeOn Fruit Punch — through 4 ingredients. Tap an ingredient for the detail:
Calcium GlycerophosphateElvitegravir (vitekta), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium Glycerophosphate + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionMagnesiumBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Magnesium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Read the full Magnesium + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionDolutegravirTivicay
How Dolutegravir interacts with SizeOn Fruit Punch — through 2 ingredients. Tap an ingredient for the detail:
Calcium GlycerophosphateDolutegravir (tivicay) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium Glycerophosphate + Dolutegravir interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Dolutegravir interactionDolutegravir, Emtricitabine, Tenofovir AlafenamideDolutegravir, Emtricitabine, Tenofovir Alafenamide
How Dolutegravir, Emtricitabine, Tenofovir Alafenamide interacts with SizeOn Fruit Punch — through 4 ingredients. Tap an ingredient for the detail:
Calcium GlycerophosphateDolutegravir (tivicay), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium Glycerophosphate + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionMagnesiumBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Magnesium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Read the full Magnesium + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionDolutegravir, RilpivirineJuluca
How Dolutegravir, Rilpivirine interacts with SizeOn Fruit Punch — through 2 ingredients. Tap an ingredient for the detail:
Calcium GlycerophosphateDolutegravir (tivicay) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium Glycerophosphate + Dolutegravir, Rilpivirine interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Dolutegravir, Rilpivirine interactionElvitegravirVitekta
How Elvitegravir interacts with SizeOn Fruit Punch — through 2 ingredients. Tap an ingredient for the detail:
Calcium GlycerophosphateElvitegravir (vitekta) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium Glycerophosphate + Elvitegravir interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Elvitegravir interactionElvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil FumarateStribild
How Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interacts with SizeOn Fruit Punch — through 4 ingredients. Tap an ingredient for the detail:
Calcium GlycerophosphateElvitegravir (vitekta), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium Glycerophosphate + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionNiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionMagnesiumBictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Moderate
Interaction Summary
Magnesium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Read the full Magnesium + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionLevodopaInbrija, Larodopa
How Levodopa interacts with SizeOn Fruit Punch — through 4 ingredients. Tap an ingredient for the detail:
Whey Protein HydrolysateLevodopa Major
Interaction Summary
Theoretically, whey protein might decrease levodopa absorption.
Read the full Whey Protein Hydrolysate + Levodopa interactionMagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Levodopa interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Levodopa interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Levodopa interactionLevodopa, CarbidopaDuodopa
How Levodopa, Carbidopa interacts with SizeOn Fruit Punch — through 3 ingredients. Tap an ingredient for the detail:
MagnesiumLevodopa/carbidopa (sinemet) Major
Interaction Summary
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Read the full Magnesium + Levodopa, Carbidopa interactionWhey Protein HydrolysateLevodopa Major
Interaction Summary
Theoretically, whey protein might decrease levodopa absorption.
Read the full Whey Protein Hydrolysate + Levodopa, Carbidopa interactionVitamin B6Levodopa Minor
Interaction Summary
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Read the full Vitamin B6 + Levodopa, Carbidopa interaction6-mercaptopurinePurinethol
How 6-mercaptopurine interacts with SizeOn Fruit Punch — through 2 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + 6-mercaptopurine interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + 6-mercaptopurine interactionAbacavir Sulfate, Dolutegravir, LamivudineTriumeq
How Abacavir Sulfate, Dolutegravir, Lamivudine interacts with SizeOn Fruit Punch — through 2 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abacavir Sulfate, Dolutegravir, Lamivudine interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Abacavir Sulfate, Dolutegravir, Lamivudine interactionAbacavir, LamivudineEpzicom
How Abacavir, Lamivudine interacts with SizeOn Fruit Punch — through 2 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abacavir, Lamivudine interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Abacavir, Lamivudine interactionAbciximabReoPro
How Abciximab interacts with SizeOn Fruit Punch — through 3 ingredients. Tap an ingredient for the detail:
NiacinAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Abciximab interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Abciximab interactionMagnesiumAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium + Abciximab interactionAbiraterone
How Abiraterone interacts with SizeOn Fruit Punch — through 2 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abiraterone interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Abiraterone interactionAbiraterone AcetateYonsa, Zytiga
How Abiraterone Acetate interacts with SizeOn Fruit Punch — through 2 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Abiraterone Acetate interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Abiraterone Acetate interactionAbrocitinibCibinqo
How Abrocitinib interacts with SizeOn Fruit Punch — through 3 ingredients. Tap an ingredient for the detail:
NiacinAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Abrocitinib interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Abrocitinib interactionMagnesiumAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium + Abrocitinib interactionAcarboseGlucobay, Prandase, Precose
How Acarbose interacts with SizeOn Fruit Punch — through 2 ingredients. Tap an ingredient for the detail:
NiacinAntidiabetes Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Niacin can increase blood glucose levels and may diminish the effects of antidiabetes drugs.
Read the full Niacin + Acarbose interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acarbose interactionAcebutololRhotral, Sectral
How Acebutolol interacts with SizeOn Fruit Punch — through 5 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs, Antihypertensive Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acebutolol interactionSodium GlycerophosphateAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, a high intake of dietary sodium might reduce the effectiveness of antihypertensive drugs.
Read the full Sodium Glycerophosphate + Acebutolol interactionVitamin B6Antihypertensive Drugs Moderate
Interaction Summary
Theoretically, vitamin B6 may have additive effects when used with antihypertensive drugs.
Read the full Vitamin B6 + Acebutolol interactionL-taurineAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, taurine might increase the risk of hypotension when taken with antihypertensive drugs.
Read the full L-taurine + Acebutolol interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acebutolol interactionAcenocoumarolSintrom
How Acenocoumarol interacts with SizeOn Fruit Punch — through 3 ingredients. Tap an ingredient for the detail:
NiacinAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Acenocoumarol interactionMagnesiumAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium + Acenocoumarol interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acenocoumarol interactionAcetaminophenChildren's Tylenol, Children's Tylenol Meltaways, Tylenol, Tylenol Ex Strength
How Acetaminophen interacts with SizeOn Fruit Punch — through 3 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acetaminophen interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acetaminophen interactionVitamin CAcetaminophen (tylenol, Others) Minor
Interaction Summary
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
Read the full Vitamin C + Acetaminophen interactionAcetaminophen, AspirinGemnisyn
How Acetaminophen, Aspirin interacts with SizeOn Fruit Punch — through 4 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs, Anticoagulant/antiplatelet Drugs +1 Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acetaminophen, Aspirin interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acetaminophen, Aspirin interactionMagnesiumAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium + 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 SizeOn Fruit Punch — through 4 ingredients. Tap an ingredient for the detail:
NiacinAnticoagulant/antiplatelet Drugs, Aspirin +1 Moderate
Interaction Summary
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Read the full Niacin + Acetaminophen, Aspirin, Caffeine interactionVitamin CAspirin, Acetaminophen (tylenol, Others) Minor
Interaction Summary
Acidification of the urine by vitamin C might increase aspirin levels.
Read the full Vitamin C + Acetaminophen, Aspirin, Caffeine interactionMagnesiumAnticoagulant/antiplatelet Drugs Minor
Interaction Summary
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
Read the full Magnesium + Acetaminophen, Aspirin, Caffeine interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acetaminophen, Aspirin, Caffeine interactionAcetaminophen, Brompheniramine, PhenylpropanolamineDimetapp Cold and Flu
How Acetaminophen, Brompheniramine, Phenylpropanolamine interacts with SizeOn Fruit Punch — through 3 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acetaminophen, Brompheniramine, Phenylpropanolamine interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acetaminophen, Brompheniramine, Phenylpropanolamine interactionVitamin CAcetaminophen (tylenol, Others) Minor
Interaction Summary
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
Read the full Vitamin C + Acetaminophen, Brompheniramine, Phenylpropanolamine interactionAcetaminophen, ButalbitalAxocet, Bancap, Bucet, Butex Forte, Esgic CF, Orbivan CF +5 more
How Acetaminophen, Butalbital interacts with SizeOn Fruit Punch — through 3 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acetaminophen, Butalbital interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acetaminophen, Butalbital interactionVitamin CAcetaminophen (tylenol, Others) Minor
Interaction Summary
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
Read the full Vitamin C + Acetaminophen, Butalbital interactionAcetaminophen, Butalbital, CaffeineEsgic, Esgic Plus, Fiogesic, Fioricet, Repan, Tecnal +1 more
How Acetaminophen, Butalbital, Caffeine interacts with SizeOn Fruit Punch — through 3 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acetaminophen, Butalbital, Caffeine interactionVitamin CAcetaminophen (tylenol, Others) Minor
Interaction Summary
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
Read the full Vitamin C + Acetaminophen, Butalbital, Caffeine interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acetaminophen, Butalbital, Caffeine interactionAcetaminophen, Butalbital, Caffeine, CodeineEsgic with Codeine, Fioricet w/ Codeine
How Acetaminophen, Butalbital, Caffeine, Codeine interacts with SizeOn Fruit Punch — through 3 ingredients. Tap an ingredient for the detail:
NiacinHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Read the full Niacin + Acetaminophen, Butalbital, Caffeine, Codeine interactionDietary FiberOral Drugs Minor
Interaction Summary
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Read the full Dietary Fiber + Acetaminophen, Butalbital, Caffeine, Codeine interactionVitamin CAcetaminophen (tylenol, Others) Minor
Interaction Summary
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
Read the full Vitamin C + Acetaminophen, Butalbital, Caffeine, Codeine interactionEach ingredient & the kinds of drugs it affects
For each ingredient in SizeOn Fruit Punch with known interactions, here are the types of medications they can affect. Open any type for the detail — or search your exact drug in the checker above.
Dietary Fiber
Carbamazepine (Tegretol)
Theoretically, black psyllium might reduce the effects of carbamazepine and increase the risk for convulsions.
Theoretically, black psyllium might reduce carbamazepine absorption. A preliminary study using blond psyllium reported decreased carbamazepine bioavailability due to binding of the drug to psyllium, as well as reduction of available fluid in the gut for dissolution of the drug. This interaction may also occur with black psyllium.
Lithium
Theoretically, taking black psyllium at the same time as lithium might reduce lithium absorption.
The fiber in black psyllium might reduce lithium absorption and plasma levels. Some case reports describe a reduction in plasma lithium levels with concomitant administration of blond psyllium. This was reversed when psyllium was stopped. This interaction may also occur with black psyllium.
Metformin (Glucophage)
Theoretically, black psyllium might increase the therapeutic and adverse effects of metformin.
Animal research shows that concurrent consumption of blond psyllium with metformin slows and increases the absorption of metformin. This interaction may also occur with black psyllium. To avoid changes in absorption, take psyllium 30-60 minutes after metformin.
Olanzapine (Zyprexa)
Theoretically, taking black psyllium at the same time as olanzapine might reduce olanzapine absorption.
The fiber in black psyllium might decrease the absorption of olanzapine. A single case report describes a reduction in the effectiveness of olanzapine when it was concomitantly administered with an unspecified type of psyllium 3 grams orally twice daily. This effect was reversed when psyllium was stopped.
Digoxin (Lanoxin)
Theoretically, taking black psyllium at the same time as digoxin might reduce digoxin absorption and decrease digoxin levels.
Psyllium might bind digoxin in the gut. However, some clinical evidence suggests that psyllium does not impact digoxin absorption.
Ethinyl Estradiol
Theoretically, taking black psyllium at the same time as ethinyl estradiol might alter levels of estradiol.
Concurrent use of blond psyllium with ethinyl estradiol results in a slight increase in the extent of ethinyl estradiol absorption and a slower rate of absorption. This is unlikely to be clinically significant.
Oral Drugs
Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Psyllium seems to have variable effects on drug absorption. To avoid changes in absorption, take psyllium 30-60 minutes after oral medications. Animal research shows that blond psyllium delays and increases the absorption of metformin and ethinyl estradiol. Case reports and animal research suggest that blond psyllium might reduce absorption of lithium, digoxin, olanzapine, and carbamazepine. Finally, some pharmacokinetic studies show that psyllium does not affect the absorption of levothyroxine or warfarin. Although many of these studies evaluated blond psyllium, the fiber content in black psyllium may have similar effects.
Niacin
Alcohol (Ethanol)
Concomitant use of alcohol and niacin might increase the risk of flushing and hepatotoxicity.
Alcohol can exacerbate the flushing and pruritus associated with niacin. Large doses of niacin might also exacerbate liver dysfunction associated with chronic alcohol use. A case report describes delirium and lactic acidosis in a patient taking niacin 3 grams daily who ingested 1 liter of wine. Advise patients to avoid large amounts of alcohol while taking niacin.
Allopurinol (Zyloprim)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as allopurinol.
Large doses of niacin can reduce urinary excretion of uric acid, potentially resulting in hyperuricemia. Doses of uricosurics such as allopurinol might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Anticoagulant/Antiplatelet Drugs
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Several cases of clotting factor synthesis deficiency and coagulopathy have been reported in patients taking sustained-release niacin. Also, thrombocytopenia has been reported in patients treated with niacin or niacin plus lovastatin.
Antidiabetes Drugs
Niacin can increase blood glucose levels and may diminish the effects of antidiabetes drugs.
Niacin impairs glucose tolerance in a dose-dependent manner, probably by causing or aggravating insulin resistance and increasing hepatic production of glucose. In diabetes patients, niacin 4.5 grams daily for 5 weeks can increase plasma glucose by an average of 16% and glycated hemoglobin (HbA1c) by 21%. However, lower doses of 1.5 grams daily or less appear to have minimal effects on blood glucose. In some patients, glucose levels increase when niacin is started, but then return to baseline when a stable dose is reached. Up to 35% of patients with diabetes may need adjustments in hypoglycemic therapy when niacin is added.
Antihypertensive Drugs
Theoretically, niacin may increase the risk of hypotension when used with antihypertensive drugs.
The vasodilating effects of niacin can cause hypotension. Furthermore, some clinical evidence suggests that a one-hour infusion of niacin can reduce systolic, diastolic, and mean blood pressure in hypertensive patients. This effect is not observed in normotensive patients.
Bile Acid Sequestrants
Bile acid sequestrants can bind niacin and decrease absorption. Separate administration by 4-6 hours to avoid an interaction.
In vitro studies show that colestipol (Colestid) binds about 98% of available niacin and cholestyramine (Questran) binds 10% to 30%.
Gemfibrozil (Lopid)
Theoretically, concomitant use of niacin and gemfibrozil might increase the risk of myopathy in some patients.
A case of myopathy from concomitant use of niacin and gemfibrozil has been reported. Niacin alone has also been associated with cases of myopathy. Using gemfibrozil with niacin might further increase the risk of developing myopathy.
Hepatotoxic Drugs
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Niacin has been associated with cases of liver toxicity, especially when used in pharmacologic doses. Sustained-release niacin preparations appear to be associated with a higher risk of hepatotoxicity than immediate-release niacin.
Hmg-Coa Reductase Inhibitors ("Statins")
Theoretically, concomitant use of niacin and statins might increase the risk of myopathy and rhabdomyolysis in some patients.
Some case reports have raised concerns that niacin might increase the risk of myopathy and rhabdomyolysis when combined with statins. However, a significantly increased risk of myopathy has not been demonstrated in clinical trials, including those using an FDA-approved combination of lovastatin and niacin (Advicor).
Probenecid (Benemid)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as probenecid.
Large doses of niacin reduce urinary excretion of uric acid, potentially causing hyperuricemia. Doses of uricosurics such as probenecid might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Sulfinpyrazone (Anturane)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as sulfinpyrazone.
Large doses of niacin reduce urinary excretion of uric acid, potentially causing hyperuricemia. Doses of uricosurics such as sulfinpyrazone might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Thyroid Hormone
Theoretically, niacin might antagonize the therapeutic effects of thyroid hormones.
Clinical research and case reports suggests that taking niacin can reduce serum levels of thyroxine-binding globulin by up to 25% and moderately reduce levels of thyroxine (T4). Patients taking thyroid hormone for hypothyroidism might need dose adjustments when using niacin.
Transdermal Nicotine (Nicoderm)
Theoretically, concomitant use of niacin and transdermal nicotine might increase the risk of flushing and dizziness.
Niacin and nicotine can both cause flushing and dizziness.
Warfarin (Coumadin)
There is limited evidence that niacin may increase the anticoagulant effects of warfarin.
In a case report, a patient on warfarin developed an elevated international normalized ratio (INR) of 3.9 after taking niacin for two weeks. The patient's INR was previously stable, ranging between 2 and 3 in recent months, and no other medication changes were identified. The elevated INR returned to therapeutic range within 4 days following the discontinuation of niacin.
Aspirin
Large doses of aspirin might alter the clearance of niacin.
Aspirin is often used with niacin to reduce niacin-induced flushing. Doses of 80-975 mg aspirin have been used, but 325 mg appears to be optimal. Aspirin also seems to reduce the clearance of niacin by competing for glycine conjugation. Taking aspirin 1 gram seems to reduce niacin clearance by 45%. This is probably a dose-related effect and not clinically significant with the more common aspirin dose of 325 mg.
Magnesium
Levodopa/Carbidopa (Sinemet)
Magnesium can reduce the bioavailability of levodopa/carbidopa.
Clinical research in healthy volunteers shows that taking magnesium oxide 1000 mg with levodopa 100 mg/carbidopa 10 mg reduces the area under the curve (AUC) of levodopa by 35% and of carbidopa by 81%. In vitro and animal research shows that magnesium produces an alkaline environment in the digestive tract, which might lead to degradation and reduced bioavailability of levodopa/carbidopa.
Aminoglycoside Antibiotics
Concomitant use of aminoglycoside antibiotics and magnesium can increase the risk for neuromuscular weakness.
Both aminoglycosides and magnesium reduce presynaptic acetylcholine release, which can lead to neuromuscular blockade and possible paralysis. This is most likely to occur with high doses of magnesium given intravenously.
Antacids
Use of acid reducers may reduce the laxative effect of magnesium oxide.
A retrospective analysis shows that, in the presence of H2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs), a higher dose of magnesium oxide is needed for a laxative effect. This may also occur with antacids. Under acidic conditions, magnesium oxide is converted to magnesium chloride and then to magnesium bicarbonate, which has an osmotic laxative effect. By reducing acidity, antacids may reduce the conversion of magnesium oxide to the active bicarbonate salt.
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)
Magnesium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption.
Advise patients that bictegravir/emtricitabine/tenofovir alafenamide should be taken at least 2 hours before or 6 hours after magnesium containing products.
Bisphosphonates
Magnesium can decrease absorption of bisphosphonates.
Cations, including magnesium, can decrease bisphosphonate absorption. Advise patients to separate doses of magnesium and these drugs by at least 2 hours.
Calcium Channel Blockers
Magnesium can have additive effects with calcium channel blockers, although evidence is conflicting.
Magnesium inhibits calcium entry into smooth muscle cells and may therefore have additive effects with calcium channel blockers. Severe hypotension and neuromuscular blockades may occur when nifedipine is used with intravenous magnesium, although some contradictory evidence suggests that concurrent use of magnesium with nifedipine does not increase the risk of neuromuscular weakness. High doses of magnesium could theoretically have additive effects with other calcium channel blockers.
Digoxin
Magnesium salts may reduce absorption of digoxin.
Clinical evidence suggests that treatment with oral magnesium hydroxide or magnesium trisilicate reduces absorption of digoxin from the intestines. This may reduce the blood levels of digoxin and decrease its therapeutic effects.
Potassium-Sparing Diuretics
Potassium-sparing diuretics decrease excretion of magnesium, possibly increasing magnesium levels.
Potassium-sparing diuretics also have magnesium-sparing properties, which can counteract the magnesium losses associated with loop and thiazide diuretics. Theoretically, increased magnesium levels could result from concomitant use of potassium-sparing diuretics and magnesium supplements.
Quinolone Antibiotics
Magnesium decreases absorption of quinolones.
Magnesium can form insoluble complexes with quinolones and decrease their absorption. Advise patients to take these drugs at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Skeletal Muscle Relaxants
Parenteral magnesium alters the pharmacokinetics of skeletal muscle relaxants, increasing their effects and accelerating the onset of effect.
Parenteral magnesium shortens the time to onset of skeletal muscle relaxants by about 1 minute and prolongs the duration of action by about 2 minutes. Magnesium potentiates the effects of skeletal muscle relaxants by decreasing calcium-mediated release of acetylcholine from presynaptic nerve terminals, reducing postsynaptic sensitivity to acetylcholine, and having a direct effect on the membrane potential of myocytes. Magnesium also has vasodilatory actions and increases cardiac output, allowing a greater amount of muscle relaxant to reach the motor end plate. A clinical study found that low-dose rocuronium (0.45 mg/kg), when given after administration of magnesium 30 mg/kg over 10 minutes, has an accelerated onset of effect, which matches the onset of effect seen with a full-dose rocuronium regimen (0.6 mg/kg). In another clinical study, onset times for rocuronium doses of 0.3, 0.6, and 1.2 mg/kg were 86, 76, and 50 seconds, respectively, when given alone, but were reduced to 66, 44, and 38 seconds, respectively, when the doses were given after a 15-minute infusion of magnesium sulfate 60 mg/kg. Giving intraoperative intravenous magnesium sulfate, 50 mg/kg loading dose followed by 15 mg/kg/hour, reduces the onset time of rocuronium, enhances its clinical effects, reduces the dose of intraoperative opiates, and prolongs the spontaneous recovery time. It does not affect the activity of subsequently administered neostigmine.
Sulfonylureas
Magnesium increases the systemic absorption of sulfonylureas, increasing their effects and side effects.
Clinical research shows that administration of magnesium hydroxide with glyburide increases glyburide absorption, increases maximal insulin response by 35-fold, and increases the risk of hypoglycemia, when compared with glyburide alone. A similar interaction occurs between magnesium hydroxide and glipizide. The mechanism of this effect appears to be related to the elevation of gastrointestinal pH by magnesium-based antacids, increasing solubility and enhancing absorption of sulfonylureas.
Tetracycline Antibiotics
Magnesium decreases absorption of tetracyclines.
Magnesium can form insoluble complexes with tetracyclines in the gut and decrease their absorption and antibacterial activity. Advise patients to take these drugs 1 hour before or 2 hours after magnesium supplements.
Anticoagulant/Antiplatelet Drugs
Theoretically, magnesium may have antiplatelet effects, but the evidence is conflicting.
In vitro evidence shows that magnesium sulfate inhibits platelet aggregation, even at low concentrations. Some preliminary clinical evidence shows that infusion of magnesium sulfate increases bleeding time by 48% and reduces platelet activity. However, other clinical research shows that magnesium does not affect platelet aggregation, although inhibition of platelet-dependent thrombosis can occur.
Gabapentin (Neurontin)
Gabapentin absorption can be decreased by magnesium.
Clinical research shows that giving magnesium oxide orally along with gabapentin decreases the maximum plasma concentration of gabapentin by 33%, time to maximum concentration by 36%, and area under the curve by 43%. Advise patients to take gabapentin at least 2 hours before, or 4 to 6 hours after, magnesium supplements.
Sevelamer (Renagel, Renvela)
Sevelamer may increase serum magnesium levels.
In patients on hemodialysis, sevelamer use was associated with a 0.28 mg/dL increase in serum magnesium. The mechanism of this interaction remains unclear.
Vitamin B6
Amiodarone (Cordarone)
Theoretically, vitamin B6 might increase the photosensitivity caused by amiodarone.
Despite initial case reports suggesting that pyridoxine may have a protective effect against amiodarone-induced photosensitivity, preliminary clinical research suggests that pyridoxine may actually exacerbate this adverse effect.
Antihypertensive Drugs
Theoretically, vitamin B6 may have additive effects when used with antihypertensive drugs.
Research in hypertensive rats shows that vitamin B6 can decrease systolic blood pressure. Similarly, clinical research in patients with hypertension shows that taking high doses of vitamin B6 may reduce systolic and diastolic blood pressure, possibly by reducing plasma levels of epinephrine and norepinephrine.
Phenobarbital (Luminal)
High doses of vitamin B6 may reduce the levels and clinical effects of phenobarbital.
Preliminary clinical evidence suggests that vitamin B6 200 mg daily can reduce plasma levels of phenobarbital, possibly by increasing metabolism. It is not known whether lower doses have any effect. Advise people taking phenobarbital to avoid high doses of vitamin B6.
Phenytoin (Dilantin)
High doses of vitamin B6 may reduce the levels and clinical effects of phenytoin.
Preliminary clinical evidence suggests that vitamin B6 200 mg daily can reduce plasma levels of phenytoin, possibly by increasing metabolism. It is not known whether lower doses have any effect. Advise people taking phenytoin to avoid high doses of vitamin B6.
Levodopa
Vitamin B6 may increase the metabolism of levodopa when taken alone, but not when taken in conjunction with carbidopa.
Vitamin B6 (pyridoxine) enhances the metabolism of levodopa, reducing its clinical effects. However, this interaction does not occur when carbidopa is used concurrently with levodopa (Sinemet). Therefore, it is not likely to be a problem in most people.
Vitamin C
Alkylating Agents
Theoretically, antioxidant effects of vitamin C might reduce the effectiveness of alkylating agents.
The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs that generate free radicals, such as cyclophosphamide, chlorambucil, carmustine, busulfan, and thiotepa. In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin C have on chemotherapy.
Aluminum
Vitamin C can increase the amount of aluminum absorbed from aluminum compounds.
Research in animals and humans shows that vitamin C increases aluminum absorption, theoretically by chelating aluminum and keeping it in solution where it is available for absorption. In people with normal renal function, urinary excretion of aluminum will likely increase, making aluminum retention and toxicity unlikely. Patients with renal failure who take aluminum-containing compounds such as phosphate binders should avoid vitamin C supplements in doses above the recommended dietary allowances.
Antitumor Antibiotics
Theoretically, the antioxidant effects of vitamin C might reduce the effectiveness of antitumor antibiotics.
The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs which generate free radicals, such as doxorubicin. In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effects, if any, antioxidants such as vitamin C have on chemotherapy.
Estrogens
Vitamin C might increase blood levels of estrogens.
Increases in plasma estrogen levels of up to 55% occur under some circumstances when vitamin C is taken concurrently with oral contraceptives or hormone replacement therapy, including topical products. It is suggested that vitamin C prevents oxidation of estrogen in the tissues, regenerates oxidized estrogen, and reduces sulfate conjugation of estrogen in the gut wall. When tissue levels of vitamin C are high, these processes are already maximized and supplemental vitamin C does not have any effect on estrogen levels. Increases in plasma estrogen levels may occur when patients who are deficient in vitamin C take supplements. Monitor these patients for estrogen-related side effects.
Fluphenazine (Prolixin)
Theoretically, vitamin C might decrease levels of fluphenazine.
In one patient there was a clinically significant decrease in fluphenazine levels when vitamin C (500 mg twice daily) was started. The mechanism is not known, and there is no further data to confirm this interaction.
Indinavir (Crixivan)
Vitamin C can modestly reduce indinavir levels.
One pharmacokinetic study shows that taking vitamin C 1 gram orally once daily along with indinavir 800 mg orally three times daily reduces the area under the concentration-time curve of indinavir by 14%. The mechanism of this interaction is unknown, but it is unlikely to be clinically significant in most patients. The effect of higher doses of vitamin C on indinavir levels is unknown.
Levothyroxine (Synthroid, Others)
Vitamin C can increase levothyroxine absorption.
Two clinical studies in adults with poorly controlled hypothyroidism show that swallowing levothyroxine with a glass of water containing vitamin C 500-1000 mg in solution reduces thyroid stimulating hormone (TSH) levels and increases thyroxine (T4) levels when compared with taking levothyroxine alone. This suggests that vitamin C increases the oral absorption of levothyroxine, possibly due to a reduction in pH.
Warfarin (Coumadin)
High-dose vitamin C might reduce the levels and effectiveness of warfarin.
Vitamin C in high doses may cause diarrhea and possibly reduce warfarin absorption. There are reports of two people who took up to 16 grams daily of vitamin C and had a reduction in prothrombin time. Lower doses of 5-10 grams daily can also reduce warfarin absorption. In many cases, this does not seem to be clinically significant. However, a case of warfarin resistance has been reported for a patient who took vitamin C 500 mg twice daily. Cessation of vitamin C supplementation resulted in a rapid increase in international normalized ratio (INR). Tell patients taking warfarin to avoid taking vitamin C in excessively high doses (greater than 10 grams daily). Lower doses may be safe, but the anticoagulation activity of warfarin should be monitored. Patients who are stabilized on warfarin while taking vitamin C should avoid adjusting vitamin C dosage to prevent the possibility of warfarin resistance.
Acetaminophen (Tylenol, Others)
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
A small pharmacokinetic study in healthy volunteers shows that taking high-dose vitamin C (3 grams) 1.5 hours after taking acetaminophen 1 gram slightly increases the apparent half-life of acetaminophen from around 2.3 hours to 3.1 hours. Ascorbic acid competitively inhibits sulfate conjugation of acetaminophen. However, to compensate, elimination of acetaminophen glucuronide and unconjugated acetaminophen increases. This effect is not likely to be clinically significant.
Aspirin
Acidification of the urine by vitamin C might increase aspirin levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction is not clinically significant.
Choline Magnesium Trisalicylate (Trilisate)
Acidification of the urine by vitamin C might increase choline magnesium trisalicylate levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction probably is not clinically significant.
Niacin
Vitamin C might decrease the beneficial effects of niacin on high-density lipoprotein (HDL) cholesterol levels.
A combination of niacin and simvastatin (Zocor) effectively raises HDL cholesterol levels in patients with coronary disease and low HDL levels. Clinical research shows that taking a combination of antioxidants (vitamin C, vitamin E, beta-carotene, and selenium) along with niacin and simvastatin (Zocor) attenuates this rise in HDL, specifically the HDL-2 and apolipoprotein A1 fractions, by more than 50% in patients with coronary disease. It is not known whether this adverse effect is due to a single antioxidant such as vitamin C, or to the combination. It also is not known whether it will occur in other patient populations.
Salsalate (Disalcid)
Acidification of the urine by vitamin C might increase salsalate levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams/day vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction probably is not clinically significant.
Sodium
Antihypertensive Drugs
Theoretically, a high intake of dietary sodium might reduce the effectiveness of antihypertensive drugs.
High intake of dietary sodium can increase systolic and diastolic blood pressure. Also, high intake of sodium may necessitate increased use of antihypertensive medications to achieve blood pressure control in some patients, such as those with chronic kidney disease.
Corticosteroids
Concomitant use of mineralocorticoids and some glucocorticoids with sodium supplements might increase the risk of hypernatremia.
Mineralocorticoids and some glucocorticoids (corticosteroids) cause sodium retention. This effect is dose-related and depends on mineralocorticoid potency. It is most common with hydrocortisone, cortisone, and fludrocortisone, followed by prednisone and prednisolone.
Didanosine (Videx)
Concomitant use of didanosine with additional sodium from dietary or supplemental sources may increase the risk of hypernatremia.
Didanosine formulations contain a significant amount of sodium.
Lithium
Altering dietary intake of sodium might alter the levels and clinical effects of lithium.
High sodium intake can reduce plasma concentrations of lithium by increasing lithium excretion. Reducing sodium intake can significantly increase plasma concentrations of lithium and cause lithium toxicity in patients being treated with lithium carbonate. Stabilizing sodium intake is shown to reduce the percentage of patients with lithium level fluctuations above 0.8 mEq/L. Patients taking lithium should avoid significant alterations in their dietary intake of sodium.
Sodium Phosphates
Theoretically, concomitant use of sodium phosphate with sodium supplements might increase the risk of hypernatremia.
Use of high doses (> 45 mL in 24 hours) of sodium phosphate, such as those used for bowel cleansing before surgery, can lead to serious electrolyte disturbances, including hypernatremia. The risk of hypernatremia is highest in the elderly and people with other risk factors for electrolyte disturbances.
Sodium-Containing Drugs
Concomitant use of sodium-containing drugs with additional sodium from dietary or supplemental sources may increase the risk of hypernatremia and long-term sodium-related complications.
The Chronic Disease Risk Reduction (CDRR) intake level of 2.3 grams of sodium daily indicates the intake at which it is believed that chronic disease risk increases for the apparently healthy population. Some medications contain high quantities of sodium. When used in conjunction with sodium supplements or high-sodium diets, the CDRR may be exceeded. Additionally, concomitant use may increase the risk for hypernatremia; this risk is highest in the elderly and people with other risk factors for electrolyte disturbances.
Tolvaptan (Samsca)
Theoretically, concomitant use of tolvaptan with sodium might increase the risk of hypernatremia.
Tolvaptan is a vasopressin receptor 2 antagonist that is used to increase sodium levels in patients with hyponatremia. Patients taking tolvaptan should use caution with the use of sodium salts such as sodium chloride.
Calcium
Ceftriaxone (Rocephin)
Co-administration of intravenous calcium and ceftriaxone can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys.
Avoid administering intravenous calcium in any form, such as parenteral nutrition or Lactated Ringers, within 48 hours of intravenous ceftriaxone. Case reports in neonates show that administering intravenous ceftriaxone and calcium can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys. In several cases, neonates have died as a result of this interaction. So far there are no reports in adults; however, there is still concern that this interaction might occur in adults.
Dolutegravir (Tivicay)
Calcium seems to reduce levels of dolutegravir.
Advise patients to take dolutegravir either 2 hours before or 6 hours after taking calcium supplements. Pharmacokinetic research suggests that taking calcium carbonate 1200 mg concomitantly with dolutegravir 50 mg reduces plasma levels of dolutegravir by almost 40%. Calcium appears to decrease levels of dolutegravir through chelation.
Elvitegravir (Vitekta)
Calcium seems to reduce levels of elvitegravir.
Advise patients to take elvitegravir either 2 hours before or 2 hours after taking calcium supplements. Pharmacokinetic research suggests that taking calcium along with elvitegravir can reduce blood levels of elvitegravir through chelation.
Aluminum
Calcium citrate might increase aluminum absorption and toxicity. Other types of calcium do not increase aluminum absorption.
Calcium citrate can increase the absorption of aluminum when taken with aluminum hydroxide. The increase in aluminum levels may become toxic, particularly in individuals with kidney disease. However, the effect of calcium citrate on aluminum absorption is due to the citrate anion rather than calcium cation. Calcium acetate does not appear to increase aluminum absorption.
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)
Calcium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption when taken in a fasting state.
Advise patients that bictegravir/emtricitabine/tenofovir alafenamide and calcium can be taken together if taken with food. However, if taken on an empty stomach, bictegravir/emtricitabine/tenofovir alafenamide should not be taken with, or 2 hours after, calcium containing products.
Bisphosphonates
Calcium reduces the absorption of bisphosphonates.
Advise patients to take bisphosphonates at least 30 minutes before calcium, but preferably at a different time of day. Calcium supplements decrease absorption of bisphosphonates.
Calcipotriene (Dovonex)
Taking calcipotriene with calcium might increase the risk for hypercalcemia.
Calcipotriene is a vitamin D analog used topically for psoriasis. It can be absorbed in sufficient amounts to cause systemic effects, including hypercalcemia. Theoretically, combining calcipotriene with calcium supplements might increase the risk of hypercalcemia.
Digoxin (Lanoxin)
Using intravenous calcium with digoxin might increase the risk of fatal cardiac arrhythmias.
Hypercalcemia increases the risk of fatal cardiac arrhythmias with digoxin. However, one retrospective analysis of clinical data suggests that intravenous calcium does not increase the risk of dysrhythmias or mortality in patients receiving digoxin.
Diltiazem (Cardizem, Others)
Theoretically, calcium may reduce the therapeutic effects of diltiazem.
Hypercalcemia can reduce the effectiveness of verapamil in atrial fibrillation. Theoretically, calcium might increase this risk of hypercalcemia and reduce the effectiveness of diltiazem.
Levothyroxine (Synthroid, Others)
Calcium seems to reduce the absorption and effectiveness of levothyroxine.
Advise patients to take levothyroxine and calcium supplements at least 4 hours apart. Calcium reduces levothyroxine absorption, probably by forming insoluble complexes. Calcium carbonate supplements reduce effectiveness of levothyroxine in patients with hypothyroidism.
Lithium
Theoretically, concomitant use of calcium and lithium may increase this risk of hypercalcemia.
Clinical research suggests that long-term use of lithium may cause hypercalcemia in 10% to 60% of patients. Theoretically, concomitant use of lithium and calcium supplements may further increase this risk.
Quinolone Antibiotics
Calcium seems to reduce the absorption of quinolone antibiotics.
Advise patients to take oral quinolones at least 2 hours before or 4-6 hours after calcium supplements or calcium-fortified foods. Taking calcium at the same time as oral quinolones can reduce quinolone absorption. Calcium binds to quinolones in the gut.
Raltegravir (Isentress)
Calcium may reduce levels of raltegravir.
Pharmacokinetic research shows that taking a single dose of calcium carbonate 3000 mg along with raltegravir 400 mg twice daily modestly decreases the mean area under the curve of raltegravir, but the decrease does not necessitate a dose adjustment of raltegravir. However, a case of elevated HIV-1 RNA levels and documented resistance to raltegravir has been reported for a patient taking calcium carbonate 1 gram three times daily plus vitamin D3 (cholecalciferol) 400 IU three times daily in combination with raltegravir 400 mg twice daily for 11 months. It is thought that calcium reduced raltegravir levels by chelation, leading to treatment failure.
Sotalol (Betapace)
Calcium seems to reduce the absorption of sotalol.
Advise patients to separate doses by at least 2 hours before or 4-6 hours after calcium. Calcium appears to reduce the absorption of sotalol, probably by forming insoluble complexes.
Tetracycline Antibiotics
Calcium seems to reduce the absorption of tetracycline antibiotics.
Advise patients to take oral tetracyclines at least 2 hours before, or 4-6 hours after calcium supplements. Taking calcium at the same time as oral tetracyclines can reduce tetracycline absorption. Calcium binds to tetracyclines in the gut.
Thiazide Diuretics
Taking calcium along with thiazides might increase the risk of hypercalcemia and renal failure.
Thiazides reduce calcium excretion by the kidneys. Using thiazides along with moderately large amounts of calcium carbonate increases the risk of milk-alkali syndrome (hypercalcemia, metabolic alkalosis, renal failure). Patients may need to have their serum calcium levels and/or parathyroid function monitored regularly.
Verapamil (Calan, Others)
Theoretically, calcium may reduce the therapeutic effects of verapamil.
Hypercalcemia can reduce the effectiveness of verapamil in atrial fibrillation. Theoretically, use of calcium supplements may increase this risk of hypercalcemia and reduce the effectiveness of verapamil.
Calcium Channel Blockers
Intravenous calcium may decrease the effects of calcium channel blockers; oral calcium is unlikely to have this effect.
Intravenous calcium is used to decrease the effects of calcium channel blockers in the management of overdose. Intravenous calcium gluconate has been used before intravenous verapamil (Isoptin) to prevent or reduce the hypotensive effects without affecting the antiarrhythmic effects. But there is no evidence that dietary or supplemental calcium when taken orally interacts with calcium channel blockers.
Potassium
Ace Inhibitors (Aceis)
Using ACEIs with high doses of potassium increases the risk of hyperkalemia.
ACEIs block the actions of the renin-angiotensin-aldosterone system and reduce potassium excretion. Concomitant use of these drugs with potassium supplements increases the risk of hyperkalemia. However, concomitant use of these drugs with moderate dietary potassium intake (about 3775-5200 mg daily) does not increase serum potassium levels.
Angiotensin Receptor Blockers (Arbs)
Using ARBs with high doses of potassium increases the risk of hyperkalemia.
ARBs block the actions of the renin-angiotensin-aldosterone system and reduce potassium excretion. Concomitant use of these drugs with potassium supplements increases the risk of hyperkalemia. However, concomitant use of these drugs with moderate dietary potassium intake (about 3775-5200 mg daily) does not increase serum potassium levels.
Potassium-Sparing Diuretics
Concomitant use increases the risk of hyperkalemia.
Using potassium-sparing diuretics with potassium supplements increases the risk of hyperkalemia.
Vitamin B12
Metformin (Glucophage)
Metformin, a common medication used to manage type 2 diabetes, has been associated with lower vitamin B12 levels in some individuals. Prolonged use of metformin can interfere with the absorption of B12 in the digestive system, potentially leading to a deficiency in this essential vitamin.
Riboflavin
Tetracycline Antibiotics
Theoretically, taking riboflavin with tetracycline antibiotics may decrease the potency of these antibiotics.
In vitro research suggests that riboflavin may inhibit the potency of tetracycline antibiotics. It is not clear if this effect is clinically significant, as this interaction has not been reported in humans.
Thiamine
Trimethoprim (Proloprim)
Trimethoprim might increase blood levels of thiamine.
In vitro, animal, and clinical research suggest that trimethoprim inhibits intestinal thiamine transporter ThTR-2, hepatic transporter OCT1, and renal transporters OCT2, MATE1, and MATE2, resulting in paradoxically increased thiamine plasma concentrations.
Brand information
Manufacturer and brand details for SizeOn Fruit Punch, from the product label.
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Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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The Full Monographs Behind SizeOn Fruit Punch’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Black Psyllium
Interacts with 2,025 drugsBlack psyllium is a soluble-fiber supplement made from the seeds of a Plantago plant, used mostly to ease constipation and support digestive health. It is best known and most studied for rel...
Read the full Black Psyllium monograph → Herb & supplement monographSodium
Interacts with 205 drugsSodium is an essential mineral and electrolyte your body needs to balance fluids, support nerves, and help muscles work. Most people in modern diets get more than enough—often too much—from...
Read the full Sodium monograph → Herb & supplement monographPotassium
Interacts with 62 drugsPotassium is an essential mineral your body needs for nerve signals, muscle function, and a steady heartbeat, and most people get enough from a balanced diet rich in fruits and vegetables. P...
Read the full Potassium monograph → Herb & supplement monographCalcium
Interacts with 168 drugsCalcium is an essential mineral your body needs for strong bones, nerve signaling, and muscle function, and supplements can help fill gaps when diet falls short. Most people do best getting...
Read the full Calcium monograph → Herb & supplement monographMagnesium
Interacts with 295 drugsMagnesium is an essential mineral your body needs for muscles, nerves, blood pressure, and many other functions, and supplements are useful for preventing or correcting deficiency. Some othe...
Read the full Magnesium monograph → Herb & supplement monographThiamine
Interacts with 3 drugsThiamine (vitamin B1) is an essential nutrient your body needs to turn food into energy and to keep your nerves and heart healthy. Most people get enough from food, but supplements are clear...
Read the full Thiamine 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 monographPantothenic Acid
Pantothenic acid is vitamin B5, an essential nutrient your body uses to turn food into energy. True deficiency is very rare because it is found in nearly all foods, and most people meet thei...
Read the full Pantothenic Acid monograph → Herb & supplement monographNiacin
Interacts with 727 drugsNiacin (vitamin B3) is an essential nutrient your body needs for energy and metabolism, and deficiency is uncommon in most developed countries. Prescription-strength niacin has been used to...
Read the full Niacin monograph → Herb & supplement monographVitamin B12
Interacts with 20 drugsVitamin B12 (cobalamin) is an essential nutrient your body needs to make red blood cells, keep nerves healthy, and support DNA. Supplements are very helpful for people who are deficient — su...
Read the full Vitamin B12 monograph → Herb & supplement monographRiboflavin
Interacts with 20 drugsRiboflavin (vitamin B2) is an essential nutrient your body needs to turn food into energy and to keep skin, eyes, and nerves healthy. It is generally very safe at typical doses, and the stro...
Read the full Riboflavin monograph → Herb & supplement monographVitamin B6
Interacts with 210 drugsVitamin B6 (pyridoxine) is an essential water-soluble vitamin that your body needs for metabolism, brain function, and making red blood cells. It is best known for helping with pregnancy-rel...
Read the full Vitamin B6 monograph →Sources & How We Checked
SizeOn Fruit Punch'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 560 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.
Black Psyllium 18 references
- McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
- Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
- Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
- Etman M. Effect of a bulk forming laxative on the bioavailablility of carbamazepine in man. Drug Dev Ind Pharm 1995;21:1901-6.
- Perlman BB. Interaction between lithium salts and ispaghula husk. Lancet 1990;335:416.
- Vaswani SK, Hamilton RG, Valentine MD, Adkinson NF. Psyllium laxative-induced anaphylaxis, asthma, and rhinitis. Allergy 1996;51:266-8. PubMed
- Lantner RR, Espiritu BR, Zumerchik P, Tobin MC. Anaphylaxis following ingestion of a psyllium-containing cereal. JAMA 1990;264:2534-6. DOI
- Kaplan MJ. Anaphylactic reaction to "Heartwise." N Engl J Med 1990;323:1072-3. DOI
- Nordstrom M, Melander A, Robertsson E, Steen B. Influence of wheat bran and of a bulk-forming ispaghula cathartic on the bioavailability of digoxin in geriatric in-patients. Drug Nutr Interact 1987;5:67-9..
- Robinson DS, Benjamin DM, McCormack JJ. Interaction of warfarin and nonsystemic gastrointestinal drugs. Clin Pharmacol Ther 1971;12:491-5. PubMed
- Garcia JJ, Fernandez N, Diez MJ, et al. Influence of two dietary fibers in the oral bioavailability and other pharmacokinetic parameters of ethinyloestradiol. Contraception 2000;62:253-7. PubMed
- Fernandez N, Lopez C, Díez R, et al. Drug interactions with the dietary fiber Plantago ovata husk. Expert Opin Drug Metab Toxicol 2012;8(11):1377-86.
- Semen plantaginis in: WHO Monographs on Selected Medicinal Plants, volume 1. World Health Organization, Geneva, 1999. Available at http://apps.who.int/medicinedocs/en/d/Js2200e/. Accessed November 26, 1026.
- Code of Federal Regulations, Title 21 (21CFR 101.17). Food labeling warning, notice, and safe handling statements. Available at www.ecfr.gov/cgi-bin/text-idx?SID=20f647d3b74161501f46564b915b4048&mc=true&node=se21.2.101_117&rgn=div8. Accessed December 3, 2
- Code of Federal Regulations, Title 21 (21CFR 201.319). Specific labeling requirements - water-soluble gums, hydrophilic gums, and hydrophilic mucilloids. Available at www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=201.319. Accessed Dece
- Diez R, Garcia JJ, Diez MJ, Sierra M, Sahagun AM, Fernandez N. Influence of Plantago ovata husk (dietary fiber) on the bioavailability and other pharmacokinetic parameters of metformin in diabetic rabbits. BMC Complement Altern Med. 2017 Jun 7;17(1):298. PubMed
- Chiu AC, Sherman SI. Effects of pharmacological fiber supplements on levothyroxine absorption. Thyroid. 1998;8(8):667-71. PubMed
- Merrick C, Madden CA, Capurso NA. A Case of Blunted Orally Disintegrating Olanzapine Effect Due to Coadministered Psyllium. J Clin Psychiatry 2021;82(2):20cr13633. PubMed
Sodium 38 references
- Garabedian-Ruffalo SM, Ruffalo RL. Drug and nutrient interactions. Am Fam Physician 1986;33:165-74.
- Food and Drug Administration Science Background: Safety of Sodium Phosphates Oral Solution. September 17, 2001. Available at: http://www.fda.gov/cder/drug/safety/sodiumphospate.htm
- Coton T, Mallaret C, Coilliot C, Carre D, Guisset M. Severe acute ulcerated gastritis induced by salt. Presse Med 2009;38(3):499-500. PubMed
- Frings-Meuthen P, Buehlmeier J, Baecker N, et al. High sodium chloride intake exacerbates immobilization-induced bone resorption and protein losses. J Appl Physiol 2011;111(2):537-542. PubMed
- Frings-Meuthen P, Baecker N, Heer M. Low-grade metabolic acidosis may be the cause of sodium chloride-induced exaggerated bone resorption. J Bone Miner Res 2008;23(4):517-524. PubMed
- Alam S, Johnson AG. A meta-analysis of randomised controlled trials (RCT) among healthy normotensive and essential hypertensive elderly patients to determine the effect of high salt (NaCl) diet of blood pressure. J Hum Hypertens 1999;13(6):367-74.
- Boudville N, Ward S, Benaroia M, House AA. Increased sodium intake correlates with greater use of antihypertensive agents by subjects with chronic kidney disease. Am J Hypertens 2005;18(10):1300-5. PubMed
- Bennett WM. Drug interactions and consequences of sodium restriction. Am J Clin Nutr 1997;65(2 Suppl):678S-681S. PubMed
- Okusa MD, Crystal LJ. Clinical manifestations and management of acute lithium intoxication. Am J Med 1994;97(4):383-9. PubMed
- Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. Washington, DC: National Academy Press, 2005. Available at: http://www.nap.edu/openbook.php?record_id=10925. DOI
- D'Elia L, Rossi G, Ippolito R, Cappuccio FP, Strazzullo P. Habitual salt intake and risk of gastric cancer: a meta-analysis of prospective studies. Clin Nutr 2012;31(4):489-98. PubMed
- Goldsmith SR. Hyponatremia in heart failure: time for a trial. J Card Fail 2013;19(6):398-400. PubMed
- Willocks L, Brettle R, Keen J, Valentine C, Pinching AJ. Formulations of didanosine (ddI) and salt overload. Lancet 1992;339(8786):190.
- Chen L, Zhang Z, Chen W, Whelton PK, Appel LJ. Lower Sodium Intake and Risk of Headaches: Results From the Trial of Nonpharmacologic Interventions in the Elderly. Am J Public Health. 2016;106(7):1270-5. PubMed
- Cook NR, Appel LJ, Whelton PK. Lower levels of sodium intake and reduced cardiovascular risk. Circulation. 2014;129(9):981-9. PubMed
- Cook NR, Appel LJ, Whelton PK. Sodium Intake and All-Cause Mortality Over 20 Years in the Trials of Hypertension Prevention. J Am Coll Cardiol. 2016;68(15):1609-1617. PubMed
- Mente A, O'Donnell M, Rangarajan S, et al. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies. Lancet. 2016;388(10043):465-75. PubMed
- Moosavian SP, Haghighatdoost F, Surkan PJ, Azadbakht L. Salt and obesity: a systematic review and meta-analysis of observational studies. Int J Food Sci Nutr. 2017;68(3):265-277. PubMed
- O'Donnell M, Mente A, Rangarajan S, et al. Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med. 2014;371(7):612-23. DOI
- Poggio R, Gutierrez L, Matta MG, Elorriaga N, Irazola V, Rubinstein A. Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies. Public Health Nutr. 2015;18(4):695-704. PubMed
- Stallings VA, Harrison M, Oria M; Committee to Review the Dietary Reference Intakes for Sodium and Potassium, Food and Nutrition Board, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine. Washington (DC): National Acad
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L-ornithine-l-aspartate 3 references
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