SnorEase Ingredients & Drug Interactions
What is this page for?
First and foremost: checking SnorEase 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
SnorEase is a dietary supplement by Nature's Sunshine with 3 active ingredients. Its ingredients are commonly taken for heart health, statin-related muscle aches, migraine prevention.Based on those ingredients, 1,191 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Bitter Orange, Coenzyme Q10, Bromelain. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against SnorEase by Nature's Sunshine
Ask about any prescription or over-the-counter medication and we check it for interactions with SnorEase by Nature's Sunshine — 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 SnorEase by Nature's Sunshine
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
Low disclosure
SnorEase contains 3 active ingredients. Coenzyme Q10 is an antioxidant your cells use for energy production and heart function.
Bromelain is an enzyme from pineapple stems that may help with inflammation and digestion. Bitter orange (also called Seville orange) is a citrus extract that contains stimulant compounds.
The capsule itself is made from inactive ingredients including maltodextrin, a carbohydrate used as a filler and binder.
Does it work?
Not established
The evidence is mixed. Coenzyme Q10 is likely effective for CoQ10 deficiency (which occurs in some heart and statin users) and possibly effective for fibromyalgia, migraine, heart failure, and certain nerve damage.
Bromelain and bitter orange lack reliable evidence in the data we hold — they're rated insufficient for uses like hay fever, burns, diabetes, and sexual function, meaning we don't have enough data to say whether they work for those purposes.
How safe is it?
Well-documented data
Coenzyme Q10 is generally well tolerated; in clinical trials no serious side effects were reported. The most common are mild gastrointestinal effects—appetite loss, diarrhea, heartburn, nausea—occurring in less than 1% of people, though doses above 100 mg per day may be divided to reduce these.
Headache, dizziness, insomnia, and rarely skin itching or rash have been reported. There is not enough reliable safety data during pregnancy, so it's best avoided unless your doctor advises otherwise; safety while breastfeeding has not been well studied.
Bromelain is generally well tolerated short-term, though long-term evidence is limited. Common side effects are diarrhea, gas, stomach upset, and headache.
Allergic reactions (including difficulty swallowing, throat itching, eye irritation) are possible, especially if inhaled. Bromelain is not recommended during pregnancy or while breastfeeding due to lack of safety data.
Bitter orange at supplement doses is potentially unsafe — it contains stimulant compounds that raise heart rate and blood pressure, and serious but rare events (heart attack, stroke, seizure, abnormal heart rhythm) have been reported. Avoid it during pregnancy and breastfeeding.
Meds to double-check
Major interaction found
Before taking SnorEase, check with your doctor or pharmacist if you take monoamine oxidase inhibitors (MAOIs), midazolam or other sedatives, QT-prolonging heart drugs, blood thinners (warfarin or antiplatelet agents), chemotherapy, blood pressure medications, diabetes drugs, stimulants, dextromethorphan cough suppressants, or tetracycline antibiotics. These are the main drug types documented to interact with one or more ingredients in this product.
The bottom line
Scorecard at a glanceFormula with limited ingredient disclosure with no established evidence rating for its marketed use. Major medication interactions have been identified, and safety information is well characterized.
SnorEase is aimed at people looking for support with breathing or snoring, but the evidence for its ingredients is weak or missing. More importantly, the bitter orange in this product carries significant risks, especially if you take an MAOI, sedatives, heart medications, blood thinners, or diabetes drugs — and coenzyme Q10 can interfere with blood thinners and cancer treatment.
Talk with your own doctor or pharmacist about your specific medications and whether this product is right for you.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 3 of 3 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Sep 24, 2021.
This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed
General information
Key facts about SnorEase, straight from the product label.
| Brand | Nature's Sunshine |
|---|---|
| Barcode (UPC) | 099904018150 |
| Net contents | 60 Capsule(s) |
| Market status | On market |
| Date entered into DSLD | Sep 24, 2021 |
| DSLD ID | 255462 |
| Product type | Other Combinations |
| Supplement form | Capsule |
| 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 SnorEase by Nature's Sunshine, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Coenzyme Q10 | 0 NP | -- |
| Proprietary Blend | 1323 mg | -- |
| Bromelain | 0 NP | -- |
| Bitter Orange | 0 NP | -- |
Other ingredients: Capsule, Maltodextrin
Tap any ingredient to jump to its full detail below.
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
FDA 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.
General Statements
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Herbal experts since 1972
Formula
SnorEase combines bitter orange fruit, a natural source of synephrine, with bromelain and coenzyme Q10. Bromelain has been traditionally used to support a healthy respiratory tract.
Precautions
See your health care provider prior to use if pregnant or nursing.
Do not use if inner seal is missing or damaged.
Formulation
Respiratory system support Traditionally used to open nasal passages & promote normal nighttime breathing Guaranteed pure
FDA Statement of Identity
Dietary Supplement
Suggested/Recommended/Usage/Directions
Recommended Use: Take 1 to 3 capsules daily thirty minutes before bedtime.
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
SnorEase by Nature's Sunshine 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 SnorEase by Nature's Sunshine
These are the 3 active ingredients this product is made of. Select any to open its full monograph.
Serving size1 Capsule(s) Dosage formCapsule Servings per container20 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.
Proprietary Blend
Other (inactive) ingredients: Capsule, Maltodextrin. These complete the product’s ingredient list but are not active constituents.
SnorEase by Nature's Sunshine Drug Interactions
HelloPharmacist Interaction Report
SnorEase by Nature's Sunshine contains three active ingredients, and through its coenzyme Q10, bromelain, and bitter orange content, this product carries documented interactions with a significant number of medications.
The most serious concern is bitter orange's interaction with monoamine oxidase inhibitors (MAOIs) — a class of older antidepressants and blood pressure medications — where it may trigger a dangerous spike in blood pressure (hypertensive crisis).
Read the full breakdown — every affected drug type, severity by severity
Bitter orange also poses Major-level risks with midazolam (Versed), a sedative used before procedures and in anesthesia, by raising its blood levels and increasing side effects. Beyond those, bitter orange interacts Moderately with multiple drug types: QT interval-prolonging medications (heart rhythm drugs that could lead to dangerous arrhythmias), drugs metabolized by a liver enzyme called CYP3A4 (a broad category affecting many common medications), blood sugar medications, stimulants, dextromethorphan (cough suppressant), and caffeine — the last two because bitter orange can boost their levels or effects, and the rest because of additive cardiovascular or metabolic effects.
Coenzyme Q10 carries Moderate interactions with blood thinners (anticoagulants) like warfarin, where it may reduce their effectiveness, and with chemotherapy drugs that rely on free-radical damage to kill cancer cells, potentially blunting their action. It also has Minor interactions with blood pressure-lowering medications.
Bromelain carries Moderate risk with blood thinners and antiplatelet drugs (increasing bleeding risk) and Minor risk with tetracycline antibiotics. Altogether, these interactions span 1,192 individual medications.
Before you start SnorEase, run your current medications through the interaction checker below — especially if you take an MAOI, any blood thinner, heart or blood pressure drugs, diabetes medications, cough suppressants, stimulants, or anticancer agents.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against SnorEase?
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 SnorEase interact with 1,191 drugs. Click any drug to see the details.
3 of the 3 ingredients in SnorEase interact with drugs. Each result below shows which ingredient is responsible. Bitter Orange Coenzyme Q10 Bromelain
Acetaminophen, PhenylpropanolamineTetra Caps
How Acetaminophen, Phenylpropanolamine interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeStimulant Drugs Moderate
Interaction Summary
Theoretically, bitter orange might increase the risk of hypertension and adverse cardiovascular effects when taken with stimulant drugs.
Read the full Bitter Orange + Acetaminophen, Phenylpropanolamine interactionAcetaminophen, Phenylpropanolamine, PhenyltoloxamineSinubid
How Acetaminophen, Phenylpropanolamine, Phenyltoloxamine interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeStimulant Drugs Moderate
Interaction Summary
Theoretically, bitter orange might increase the risk of hypertension and adverse cardiovascular effects when taken with stimulant drugs.
Read the full Bitter Orange + Acetaminophen, Phenylpropanolamine, Phenyltoloxamine interactionAcetaminophen, PseudoephedrineChildren's Tylenol Sinus, Dristan N.D., Non-Aspirin Sinus, Ornex, Ornex-Max, Sinutab +5 more
How Acetaminophen, Pseudoephedrine interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeStimulant Drugs Moderate
Interaction Summary
Theoretically, bitter orange might increase the risk of hypertension and adverse cardiovascular effects when taken with stimulant drugs.
Read the full Bitter Orange + Acetaminophen, Pseudoephedrine interactionAcetaminophen, Pseudoephedrine, TriprolidineActifed Plus ES
How Acetaminophen, Pseudoephedrine, Triprolidine interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeStimulant Drugs Moderate
Interaction Summary
Theoretically, bitter orange might increase the risk of hypertension and adverse cardiovascular effects when taken with stimulant drugs.
Read the full Bitter Orange + Acetaminophen, Pseudoephedrine, Triprolidine interactionAcetohexamideDymelor
How Acetohexamide interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, bitter orange might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Read the full Bitter Orange + Acetohexamide interactionAcetylsalicylic AcidEntrophen
How Acetylsalicylic Acid interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Acetylsalicylic Acid interactionAclidinium Bromide, Formoterol Fumarate DihydrateDuaklir Pressair
How Aclidinium Bromide, Formoterol Fumarate Dihydrate interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeQt Interval-prolonging Drugs Moderate
Interaction Summary
Theoretically, bitter orange might have an additive effect when combined with drugs that prolong the QT interval, potentially increasing the risk of ventricular arrhythmias.
Read the full Bitter Orange + Aclidinium Bromide, Formoterol Fumarate Dihydrate interactionAcrivastine, PseudoephedrineSemprex D
How Acrivastine, Pseudoephedrine interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeStimulant Drugs Moderate
Interaction Summary
Theoretically, bitter orange might increase the risk of hypertension and adverse cardiovascular effects when taken with stimulant drugs.
Read the full Bitter Orange + Acrivastine, Pseudoephedrine interactionAdagrasibKrazati
How Adagrasib interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeQt Interval-prolonging Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, bitter orange might have an additive effect when combined with drugs that prolong the QT interval, potentially increasing the risk of ventricular arrhythmias.
Read the full Bitter Orange + Adagrasib interactionAlbiglutideTanzeum
How Albiglutide interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, bitter orange might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Read the full Bitter Orange + Albiglutide interactionAlfentanilAlfenta
How Alfentanil interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Bitter orange might increase levels of drugs metabolized by CYP3A4.
Read the full Bitter Orange + Alfentanil interactionAlfuzosinUroxatral
How Alfuzosin interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Bitter orange might increase levels of drugs metabolized by CYP3A4.
Read the full Bitter Orange + Alfuzosin interactionAliskirenTekturna
How Aliskiren interacts with SnorEase — through 2 ingredients. Tap an ingredient for the detail:
Bitter OrangeCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Bitter orange might increase levels of drugs metabolized by CYP3A4.
Read the full Bitter Orange + Aliskiren interactionCoenzyme Q10Antihypertensive Drugs Minor
Interaction Summary
Theoretically, coenzyme Q10 might have additive effects with antihypertensive drugs.
Read the full Coenzyme Q10 + Aliskiren interactionAlmotriptanAlmogran, Axert
How Almotriptan interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Bitter orange might increase levels of drugs metabolized by CYP3A4.
Read the full Bitter Orange + Almotriptan interactionAlogliptinNesina
How Alogliptin interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeCytochrome P450 3a4 (cyp3a4) Substrates, Antidiabetes Drugs Moderate
Interaction Summary
Bitter orange might increase levels of drugs metabolized by CYP3A4.
Read the full Bitter Orange + Alogliptin interactionAlogliptin, MetforminKazano
How Alogliptin, Metformin interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, bitter orange might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Read the full Bitter Orange + Alogliptin, Metformin interactionAlogliptin, PioglitazoneOseni
How Alogliptin, Pioglitazone interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeAntidiabetes Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, bitter orange might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Read the full Bitter Orange + Alogliptin, Pioglitazone interactionAlpelisibPiqray
How Alpelisib interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Bitter orange might increase levels of drugs metabolized by CYP3A4.
Read the full Bitter Orange + Alpelisib interactionAlprazolamNiravam, Xanax
How Alprazolam interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Bitter orange might increase levels of drugs metabolized by CYP3A4.
Read the full Bitter Orange + Alprazolam interactionAlteplase, TpaActilyse, Activase
How Alteplase, Tpa interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Alteplase, Tpa interactionAltretamineHexalen
How Altretamine interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Coenzyme Q10Alkylating Agents Moderate
Interaction Summary
Coenzyme Q10 has antioxidant effects.
Read the full Coenzyme Q10 + Altretamine interactionAluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium HydroxideAscriptin Codeine #2
How Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide interacts with SnorEase — through 2 ingredients. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide interactionBitter OrangeCytochrome P450 2d6 (cyp2d6) Substrates Minor
Interaction Summary
Theoretically, bitter orange might increase levels of drug metabolized by CYP2D6.
Read the full Bitter Orange + Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide interactionAluminum Hydroxide, Aspirin, Magnesium HydroxideAscriptin
How Aluminum Hydroxide, Aspirin, Magnesium Hydroxide interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aluminum Hydroxide, Aspirin, Magnesium Hydroxide interactionAmbenonium ChlorideMytelase
How Ambenonium Chloride interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeStimulant Drugs Moderate
Interaction Summary
Theoretically, bitter orange might increase the risk of hypertension and adverse cardiovascular effects when taken with stimulant drugs.
Read the full Bitter Orange + Ambenonium Chloride interactionAmbrisentanLetairis, Volibris
How Ambrisentan interacts with SnorEase — through 2 ingredients. Tap an ingredient for the detail:
Bitter OrangeCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Bitter orange might increase levels of drugs metabolized by CYP3A4.
Read the full Bitter Orange + Ambrisentan interactionCoenzyme Q10Antihypertensive Drugs Minor
Interaction Summary
Theoretically, coenzyme Q10 might have additive effects with antihypertensive drugs.
Read the full Coenzyme Q10 + Ambrisentan interactionAminophylline, Amobarbital, EphedrineAmesec
How Aminophylline, Amobarbital, Ephedrine interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeStimulant Drugs Moderate
Interaction Summary
Theoretically, bitter orange might increase the risk of hypertension and adverse cardiovascular effects when taken with stimulant drugs.
Read the full Bitter Orange + Aminophylline, Amobarbital, Ephedrine interactionAmiodaroneCordarone, Pacerone
How Amiodarone interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeCytochrome P450 3a4 (cyp3a4) Substrates, Qt Interval-prolonging Drugs Moderate
Interaction Summary
Bitter orange might increase levels of drugs metabolized by CYP3A4.
Read the full Bitter Orange + Amiodarone interactionAmisulprideBarhemsys
How Amisulpride interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeQt Interval-prolonging Drugs Moderate
Interaction Summary
Theoretically, bitter orange might have an additive effect when combined with drugs that prolong the QT interval, potentially increasing the risk of ventricular arrhythmias.
Read the full Bitter Orange + Amisulpride interactionAmitriptylineElavil
How Amitriptyline interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeQt Interval-prolonging Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Moderate
Interaction Summary
Theoretically, bitter orange might have an additive effect when combined with drugs that prolong the QT interval, potentially increasing the risk of ventricular arrhythmias.
Read the full Bitter Orange + Amitriptyline interactionAmitriptyline, ChlordiazepoxideLimbitrol DS
How Amitriptyline, Chlordiazepoxide interacts with SnorEase — through 1 ingredient. Tap an ingredient for the detail:
Bitter OrangeCytochrome P450 2d6 (cyp2d6) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Moderate
Interaction Summary
Theoretically, bitter orange might increase levels of drug metabolized by CYP2D6.
Read the full Bitter Orange + Amitriptyline, Chlordiazepoxide interactionEach ingredient & the kinds of drugs it affects
For each ingredient in SnorEase 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.
Bitter Orange
Midazolam (Versed)
Bitter orange might increase blood levels of midazolam.
One small clinical study shows that bitter orange juice can increase midazolam levels, likely through inhibition of cytochrome P450 3A4 (CYP3A4). Theoretically, bitter orange might increase the risk of midazolam-related adverse effects.
Monoamine Oxidase Inhibitors (Maois)
Theoretically, taking MAOIs with synephrine-containing bitter orange preparations might increase the hypertensive effects of synephrine, potentially leading to hypertensive crisis.
Bitter orange contains tyramine, octopamine, and synephrine, which are MAO substrates.
Antidiabetes Drugs
Theoretically, bitter orange might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Some clinical research shows that drinking a tea containing bitter orange and Indian snakeroot reduces fasting and postprandial glucose levels in patients with type 2 diabetes who are using antidiabetes drugs. However, it is unclear if these effects are due to bitter orange, Indian snakeroot, or the combination. An animal study also shows that p-synephrine in combination with gliclazide , a sulfonylurea, causes an additional 20% to 44% decrease in glucose levels when compared with gliclazide alone.
Caffeine
Bitter orange might increase blood pressure and heart rate when taken with caffeine.
Small clinical studies show that taking bitter orange in combination with caffeine can increase blood pressure and heart rate in otherwise healthy normotensive adults. Theoretically, this might increase the risk of serious cardiovascular adverse effects.
Colchicine
Bitter orange might affect colchicine levels.
Colchicine is a substrate of P-glycoprotein and cytochrome P450 3A4 (CYP3A4). Bitter orange has been reported to inhibit CYP3A4 and increase levels of CYP3A4 substrates. However, one small clinical study in healthy adults shows that drinking bitter orange juice 240 mL twice daily for 4 days and taking a single dose of colchicine 0.6 mg on the 4th day decreases colchicine peak serum levels by 24%, time to peak serum level by 1 hour, and overall exposure to colchicine by 20%. The clinical significance of this finding is unclear.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Bitter orange might increase levels of drugs metabolized by CYP3A4.
Small clinical studies suggest that single or multiple doses of freshly squeezed bitter orange juice 200-240 mL can inhibit CYP3A4 metabolism of drugs, causing increased drug levels and potentially increasing the risk of adverse effects. However, the extent of the effect of bitter orange on CYP3A4-mediated drug interactions is unknown. Some evidence suggests that bitter orange selectively inhibits intestinal CYP3A4, but not hepatic CYP3A4. Its effect on P-glycoprotein, which strongly overlaps with CYP3A4 interactions, is unclear. One small clinical study shows that drinking 8 ounces of freshly squeezed bitter orange juice has no effect on cyclosporine, which seems to be more dependent on hepatic CYP3A4 and P-glycoprotein than intestinal CYP3A4.
Dextromethorphan (Robitussin Dm, Others)
Bitter orange might increase blood levels of dextromethorphan.
One small clinical study shows that bitter orange juice increases dextromethorphan levels, likely through cytochrome P450 3A4 (CYP3A4) inhibition. Theoretically, bitter orange might increase the risk for dextromethorphan-related adverse effects.
Felodipine (Plendil)
Bitter orange might increase blood levels of felodipine.
One small clinical study shows that bitter orange juice increases felodipine levels, likely through cytochrome P450 3A4 (CYP3A4) inhibition. Theoretically, bitter orange might increase the risk for felodipine-related adverse effects.
Indinavir (Crixivan)
Bitter orange might increase blood levels of indinavir.
One small clinical study shows that bitter orange juice slightly increases indinavir levels, but this effect is likely to be clinically insignificant. Bitter orange selectively inhibits intestinal cytochrome P450 3A4 (CYP3A4); however, the metabolism of indinavir seems to be more dependent on hepatic CYP3A4. The effect of bitter orange on other protease inhibitors has not been studied.
Qt Interval-Prolonging Drugs
Theoretically, bitter orange might have an additive effect when combined with drugs that prolong the QT interval, potentially increasing the risk of ventricular arrhythmias.
One case report suggests that taking bitter orange in combination with other stimulants such as caffeine might prolong the QT interval in some patients.
Sildenafil (Viagra)
Bitter orange juice might increase blood levels of sildenafil.
A small clinical study in healthy adult males shows that drinking freshly squeezed bitter orange juice 250 mL daily for 3 days and taking a single dose of sildenafil 50 mg on the 3rd day increases the peak plasma concentration of sildenafil by 18% and the overall exposure to sildenafil by 44%. Theoretically, this may be due to inhibition of cytochrome P450 3A4 by bitter orange.
Stimulant Drugs
Theoretically, bitter orange might increase the risk of hypertension and adverse cardiovascular effects when taken with stimulant drugs.
Bitter orange appears to have stimulant effects.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Theoretically, bitter orange might increase levels of drug metabolized by CYP2D6.
In vitro research shows that octopamine, a constituent of bitter orange, weakly inhibits CYP2D6 enzymes. This effect has not been reported in humans.
Coenzyme Q10
Alkylating Agents
Coenzyme Q10 has antioxidant effects. Theoretically, this may reduce the activity of chemotherapy drugs that generate free radicals.
Theoretically, antioxidants such as coenzyme Q10 might protect tumor cells from chemotherapeutic agents that work by inducing oxidative stress, such as alkylating agents (e.g., cyclophosphamide) and radiation therapy. The clinical importance of this interaction is unknown.
Warfarin (Coumadin)
Coenzyme Q10 is chemically similar to menaquinone and might have vitamin K-like procoagulant effects, which could decrease the effects of warfarin.
Concomitant use of coenzyme Q10 and warfarin might reduce the anticoagulant effects of warfarin. Four cases of decreased warfarin efficacy thought to be due to coenzyme Q10 have been reported. However, there is some preliminary clinical research that suggests coenzyme Q10 might not significantly decrease the effects of warfarin in patients who have a stable INR.
Antihypertensive Drugs
Theoretically, coenzyme Q10 might have additive effects with antihypertensive drugs.
Some clinical research shows that coenzyme Q10 can significantly lower blood pressure, although other studies have shown conflicting results.
Bromelain
Anticoagulant/Antiplatelet Drugs
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
There is one case report of a patient experiencing minor bruising while taking bromelain with naproxen. Bromelain is thought to have antiplatelet activity. Whether this interaction is of concern with topical bromelain is unclear. Interference with coagulation of burn wounds has been reported in a patient receiving bromelain-based enzymatic debridement. However, observational research has found that topical bromelain debridement is not associated with increases or decreases in laboratory markers of coagulation when compared with surgical debridement.
Tetracycline Antibiotics
Theoretically, bromelain might increase levels of tetracycline antibiotics.
Laboratory research suggests that bromelain might increase the absorption of tetracycline antibiotics. However, a study in healthy adults reported no difference in tetracycline plasma levels when a 500 mg dose was taken with or without bromelain 80 mg.
Brand information
Manufacturer and brand details for SnorEase, from the product label.
Nature's Sunshine
See all Nature's Sunshine products- Name
- Nature's Sunshine Products, Inc.
- City
- Spanish Fork
- State
- UT
- ZipCode
- 84660
- Phone Number
- 1-800-223-8225
- Web Address
- www.naturessunshine.com
SnorEase by Nature's Sunshine: Common Questions
Does SnorEase by Nature's Sunshine interact with any medications?
How can one product interact with so many drugs?
Where does this information come from?
What is coenzyme Q10 supposed to do?
What's bromelain?
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The Full Monographs Behind SnorEase’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Coenzyme Q10
Interacts with 198 drugsCoQ10 is a vitamin-like substance your body makes naturally that helps cells produce energy and acts as an antioxidant. It is generally well tolerated and is most studied for heart condition...
Read the full Coenzyme Q10 monograph → Herb & supplement monographBromelain
Interacts with 141 drugsBromelain is a group of protein-digesting enzymes from pineapple that people take mainly for inflammation, swelling, and sinus problems. Some early studies are promising, but the overall evi...
Read the full Bromelain monograph → Herb & supplement monographBitter Orange
Interacts with 957 drugsBitter orange is a citrus fruit whose extracts contain synephrine, a mild stimulant often added to weight-loss and energy supplements. Evidence that it works for weight loss or performance i...
Read the full Bitter Orange monograph →Sources & How We Checked
SnorEase'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 106 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.
Coenzyme Q10 40 references
- Kamikawa T, Kobayashi A, Yamashita T, et al. Effects of coenzyme Q10 on exercise tolerance in chronic stable angina pectoris. Am J Cardiol 1985;56:247-51. PubMed
- Langsjoen P, Willis R, Folkers K. Treatment of essential hypertension with coenzyme Q10. Mol Aspects Med 1994;S265-72. PubMed
- Spigset O. Reduced effect of warfarin caused by ubidecarenone. Lancet 1994;334:1372-3. PubMed
- Singh RB, Niaz MA, Rastogi SS, et al. Effect of hydrosoluble coenzyme Q10 on blood pressures and insulin resistance in hypertensive patients with coronary artery disease. J Hum Hypertens 1999;13:203-8. PubMed
- Portakal O, Ozkaya O, Erden Inal M, et al. Coenzyme Q10 concentrations and antioxidant status in tissues of breast cancer patients. Clin Biochem 2000;33:279-84. PubMed
- Lund EL, Quistorff B, Spang-Thomsen M, Kristjansen PE. Effect of radiation therapy on small-cell lung cancer is reduced by ubiquinone intake. Folia Microbiol (Praha) 1998;43:505-6. PubMed
- Langsjoen PH, Langsjoen PH, Folkers K. Long-term efficacy and safety of coenzyme Q10 therapy for idiopathic dilated cardiomyopathy. Am J Cardiol 1990;65:521-3. PubMed
- Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm 2000;57:1221-7. DOI
- Landbo C, Almdal TP. [Interaction between warfarin and coenzyme Q10]. Ugeskr Laeger 1998;160:3226-7.
- Baggio E, Gandini R, Plauncher AC, et al. Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunctive therapy in heart failure. CoQ10 Drug Surveillance Investigators. Mol Aspects Med 1994;15 Suppl:S287-94. PubMed
- Burke BE, Neuenschwander R, Olson RD. Randomized, double-blind, placebo-controlled trial of coenzyme Q10 in isolated systolic hypertension. South Med J 2001;94:1112-7. PubMed
- The Huntington Study Group. A randomized, placebo-controlled trial of coenzyme Q10 and remacemide in Huntington's disease. Neurology 2001;57:397-404.
- Hodgson JM, Watts GF, Playford DA, et al. Coenzyme Q10 improves blood pressure and glycaemic control: a controlled trial in subjects with type 2 diabetes. Eur J Clin Nutr 2002;56:1137-42. PubMed
- Singh RB, Neki NS, Kartikey K, et al. Effect of coenzyme Q10 on risk of atherosclerosis in patients with recent myocardial infarction. Mol Cell Biochem 2003;246:75-82. DOI
- Porterfield LM. Why did the response to warfarin change? RN 2000;63:107.
- Sandor PS, Di Clemente L, Coppola G, et al. Efficacy of coenzyme Q10 in migraine prophylaxis: A randomized controlled trial. Neurology 2005;64:713-5. PubMed
- Engelsen J, Nielsen JD, Winther K. Effect of coenzyme Q10 and Ginkgo biloba on warfarin dosage in stable, long-term warfarin treated outpatients. A randomised, double blind, placebo-crossover trial. Thromb Haemost 2002;87:1075-6. DOI
- Berman M, Erman A, Ben-Gal T, et al. Coenzyme Q10 in patients with end-stage heart failure awaiting cardiac transplantation: a randomized, placebo-controlled study. Clin Cardiol 2004;27:295–9. PubMed
- Storch A, Jost WH, Vieregge P, et al. Randomized, double-blind, placebo-controlled trial on symptomatic effects of coenzyme Q10 in Parkinson disease. Arch Neurol 2007;64:938-44. DOI
- Digiesi V, Cantini F, Oradei A, et al. Coenzyme Q10 in essential hypertension. Mol Aspects Med 1994;15 Suppl:s257-63. PubMed
- Yamagami T, Takagi M, Akagami H, et al. Effect of coenzyme Q10 on essential hypertension, a double blind controlled study. In: Folkers KA, Yamamura Y, eds. Biomedical and Clinical Aspects of Coenzyme Q, Vol. 5. Amsterdam: Elsevier Science Publications, 19
- Ho MJ, Bellusci A, Wright JM. Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension (review). Cochrane Database Syst Rev 2009;(4):CD007435. PubMed
- Rosenfeldt, F. L., Haas, S. J., Krum, H., Hadj, A., Ng, K., Leong, J. Y., and Watts, G. F. Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials. J Hum.Hypertens. 2007;21(4):297-306. PubMed
- Stamelou, M., Reuss, A., Pilatus, U., Magerkurth, J., Niklowitz, P., Eggert, K. M., Krisp, A., Menke, T., Schade-Brittinger, C., Oertel, W. H., and Hoglinger, G. U. Short-term effects of coenzyme Q10 in progressive supranuclear palsy: a randomized, place DOI
- Keogh A, Fenton S, Leslie C, et al. Randomised double-blind, placebo-controlled trial of coenzyme Q, therapy in class II and III systolic heart failure. Heart Lung Circ. 2003;12:135-41.
- Gane, E. J., Weilert, F., Orr, D. W., Keogh, G. F., Gibson, M., Lockhart, M. M., Frampton, C. M., Taylor, K. M., Smith, R. A., and Murphy, M. P. The mitochondria-targeted anti-oxidant mitoquinone decreases liver damage in a phase II study of hepatitis C
- Lynch, D. R., Perlman, S. L., and Meier, T. A phase 3, double-blind, placebo-controlled trial of idebenone in friedreich ataxia. Arch Neurol. 2010;67(8):941-947. PubMed
- Young, J. M., Florkowski, C. M., Molyneux, S. L., McEwan, R. G., Frampton, C. M., Nicholls, M. G., Scott, R. S., and George, P. M. A randomized, double-blind, placebo-controlled crossover study of coenzyme Q10 therapy in hypertensive patients with the me
- Ishiyama, T., Morita, Y., Toyama, S., Yamagami, T., and Tsukamoto, N. A clinical study of the effect of coenzyme Q on congestive heart failure. Jpn.Heart J 1976;17(1):32-42. PubMed
- Matthews, P. M., Ford, B., Dandurand, R. J., Eidelman, D. H., O'Connor, D., Sherwin, A., Karpati, G., Andermann, F., and Arnold, D. L. Coenzyme Q10 with multiple vitamins is generally ineffective in treatment of mitochondrial disease. Neurology 1993;43(5
- Malm, C., Svensson, M., Sjoberg, B., Ekblom, B., and Sjodin, B. Supplementation with ubiquinone-10 causes cellular damage during intense exercise. Acta Physiol Scand. 1996;157(4):511-512. PubMed
- Singh, R. B., Wander, G. S., Rastogi, A., Shukla, P. K., Mittal, A., Sharma, J. P., Mehrotra, S. K., Kapoor, R., and Chopra, R. K. Randomized, double-blind placebo-controlled trial of coenzyme Q10 in patients with acute myocardial infarction. Cardiovasc. PubMed
- Digiesi V, Cantini F, and Brodbeck B. Effect of coenzyme Q10 on essential arterial hypertension. Current Therapeutic Research 1990;47(5):841-845.
- Parkinson Study Group QE3 Investigators, Beal MF, Oakes D, et al. A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit. JAMA Neurol. 2014;71(5):543-52.
- Alehagen U, Johansson P, Bjornstedt M, et al. Cardiovascular mortality and N-terminal-proBNP reduced after combined selenium and coenzyme Q10 supplementation: A 5-year prospective randomized double-blind placebo-controlled trial among elderly Swedish citi
- Ho MJ, Li EC, Wright JM. Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane Database Syst Rev. 2016 Mar 3;3:CD007435. doi: 10.1002/14651858.CD007435.pub3. PubMed
- Tabrizi R, Akbari M, Sharifi N, Lankarani KB, Moosazadeh M, Kolahdooz F, et al. The effects of coenzyme Q10 supplementation on blood pressures among patients with metabolic diseases: a systematic review and meta-analysis of randomized controlled trials. PubMed
- Tsai IC, Hsu CW, Chang CH, Tseng PT, Chang KV. Effectiveness of coenzyme Q10 supplementation for reducing fatigue: A systematic review and meta-analysis of randomized controlled trials. Front Pharmacol 2022;13:883251. PubMed
- Yaghini O, Hoseini N, Ghazavi MR, et al. A comparative study on the efficacy of coenzyme Q10 and amitriptyline in the prophylactic treatment of migraine headaches in children: A randomized controlled trial. Adv Biomed Res 2022;11:43. PubMed
- Hansen KS, Mogensen TH, Agergaard J, et al. High-dose coenzyme Q10 therapy versus placebo in patients with post COVID-19 condition: A randomized, phase 2, crossover trial. Lancet Reg Health Eur 2022. PubMed
Bromelain 19 references
- Nettis E, Napoli G, Ferrannini A, Tursi A. IgE-mediated allergy to bromelain. Allergy 2001;56:257-8. PubMed
- Taussig SJ, Batkin S. Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application. An update. J Ethnopharmacol 1988;22:191-203.. PubMed
- Bradbrook ID, Morrison PJ, Rogers HJ. The effect of bromelain on the absorption of orally administered tetracycline. Br J Clin Pharmacol 1978;6:552-4. PubMed
- Bush TM, Rayburn KS, Holloway SW, et al. Adverse interactions between herbal and dietary substances and prescription medications: a clinical survey. Altern Ther Health Med 2007;13:30-5.
- Brien S, Lewith G, Walker AF, et al. Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study. QJM 2006;99:841-50. PubMed
- Mori S, Ojima Y, Hirose T, et al. The clinical effect of proteolytic enzyme containing bromelain and trypsin on urinary tract infection evaluated by double blind method. Acta Obstet Gynaecol Jpn 1972;19:147-53.
- Glaser D, Hilberg T. The influence of bromelain on platelet count and platelet activity in vitro. Platelets 2006;17:37-41. PubMed
- Heinicke R M, van der Wal L, Yokoyama M. Effect of bromelain (Ananase) on human platelet aggregation. Experientia 1972;28:844-5. PubMed
- Gailhofer, G., Wilders-Truschnig, M., Smolle, J., and Ludvan, M. Asthma caused by bromelain: an occupational allergy. Clin Allergy 1988;18(5):445-450. PubMed
- Mattei, O., Fabri, G., and Farina, G. [Occupational health experience regarding four cases of asthma due to bromelain (author's transl)]. Medicina del Lavoro 1979;70(5):404-409.
- Galleguillos, F. and Rodriguez, J. C. Asthma caused by bromelin inhalation. Clin Allergy 1978;8(1):21-24. PubMed
- Perez-Camo I, Quirce S, Duran MA, and et al. Latex allergy: evidence of cross-reactivity with papain and bromelain [abstract]. Allergy 1996;51(suppl 31):48.
- Martin GJ, Ehrenreich J, and Asbell N. Bromelain: pineapple proteases with anti-edema activity. Exp Med Surg 1962;20:227-247.
- Kasemsuk T, Saengpetch N, Sibmooh N, Unchern S. Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis. Clin Rheumatol. 2016 Oct;35(10):2531-40. PubMed
- Kutlu Ö, DemirbaS A, Elmas ÖF, Güvenç U, Metin A. Fixed drug eruption: a new side effect of bromelain. Contact Dermatitis 2020. Online ahead of print. PubMed
- Shoham Y, Shapira E, Haik J, et al. Bromelain-based enzymatic debridement of chronic wounds: Results of a multicentre randomized controlled trial. Wound Repair Regen 2021;29(6):899-907. PubMed
- Pfister P, Garcia Wendel PD, Kim BS, et al. Coagulation side effects of enzymatic debridement in burned patients. Burns 2022. PubMed
- Hasham S, Riyat H, Fletcher A, O'Boyle CP, Alexander S. To bleed or not to bleed? Case series and discussion of haemorrhage risk with enzymatic debridement in burn injuries. Scars Burn Heal 2023;9:20595131231168333. PubMed
- Leelakanok N, Petchsomrit A, Janurai T, Saechan C, Sunsandee N. Efficacy and safety of bromelain: A systematic review and meta-analysis. Nutr Health 2023. PubMed
Bitter Orange 47 references
- Penzak SR, Jann MW, Cold JA, et al. Seville (sour) orange juice: synephrine content and cardiovascular effects in normotensive adults. J Clin Pharmacol 2001;41:1059-63. PubMed
- Electronic Code of Federal Regulations. Title 21. Part 182 -- Substances Generally Recognized As Safe. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=182
- Calapai G, Firenzuoli F, Saitta A, et al. Antiobesity and cardiovascular toxic effects of Citrus aurantium extracts in the rat: A preliminary report. Fitoterapia 1999;70:586-92. DOI
- Keogh AM, Baron DW. Sympathomimetic abuse and coronary artery spasm. Br Med J 1985;291:940.
- Malhotra S, Bailey DG, Paine MF, Watkins PB. Seville orange juice-felodipine interaction: comparison with dilute grapefruit juice and involvement of furocoumarins. Clin Pharmacol Ther 2001;69:14-23. PubMed
- Pellati F, Benvenuti S, Melegari M, Firenzuoli F. Determination of adrenergic agonists from extracts and herbal products of Citrus aurantium L. var. amara by LC. J Pharm Biomed Anal 2002;29:1113-9. . PubMed
- Colker CM, Kalman DS, Torina GC, et al. Effects of Citrus aurantium extract, caffeine, and St. John's wort on body fat loss, lipid levels, and mood states in overweight healthy adults. Curr Ther Res 1999;60:145-153. DOI
- Penzak SR, Acosta EP, Turner M, et al. Effect of Seville orange juice and grapefruit juice on indinavir pharmacokinetics. J Clin Pharmacol 2002;42:1165-70. PubMed
- Edwards DJ, Fitzsimmons ME, Schuetz EG, et al. 6',7'-Dihydroxybergamottin in grapefruit juice and Seville orange juice: effects on cyclosporine disposition, enterocyte CYP3A4, and P-glycoprotein. Clin Pharmacol Ther 1999;65:237-44. PubMed
- Di Marco MP, Edwards DJ, Wainer IW, Ducharme MP. The effect of grapefruit juice and seville orange juice on the pharmacokinetics of dextromethorphan: the role of gut CYP3A and P-glycoprotein. Life Sci 2002;71:1149-60. PubMed
- Visentin V, Morin N, Fontana E, et al. Dual action of octopamine on glucose transport into adipocytes: inhibition via beta3-adrenoceptor activation and stimulation via oxidation by amine oxidases. J Pharmacol Exp Ther 2001;299:96-104.
- Nykamp DL, Fackih MN, Compton AL. Possible association of acute lateral-wall myocardial infarction and bitter orange supplement. Ann Pharmacother 2004;38:812-6. PubMed
- Fugh-Berman A, Myers A. Citrus aurantium, an ingredient of dietary supplements marketed for weight loss: Current status of clinical and basic Research. Exp Biol Med 2004;229:698-704.
- Suzuki O, Matsumoto T, Oya M, Katsumata Y. Oxidation of synephrine by type A and type B monoamine oxidase. Experientia 1979;35:1283-4. PubMed
- Nasir JM, Durning SJ, Ferguson M, et al. Exercise-induced syncope associated with QT prolongation and ephedra-free Xenadrine. Mayo Clin Proc 2004;79:1059-62.. PubMed
- Firenzuoli F, Gori L, Galapai C. Adverse reaction to an adrenergic herbal extract (Citrus aurantium). Phytomedicine 2005;12:247-8. PubMed
- Bouchard NC, Howland MA, Greller HA, et al. Ischemic stroke associated with use of an ephedra-free dietary supplement containing synephrine. Mayo Clin Proc 2005;80:541-5. PubMed
- Haller CA, Benowitz NL, Jacob P 3rd. Hemodynamic effects of ephedra-free weight-loss supplements in humans. Am J Med 2005;118:998-1003.. PubMed
- Bui LT, Nguyen DT, Ambrose PJ. Blood pressure and heart rate effects following a single dose of bitter orange. Ann Pharmacother 2006;40:53-7. PubMed
- Min B, Cios D, Kluger J, White CM. Absence of QTc-interval-prolonging or hemodynamic effects of a single dose of bitter-orange extract in healthy subjects. Pharmacotherapy 2005;25:1719-24. PubMed
- Gange CA, Madias C, Felix-Getzik EM, et al. Variant angina associated with bitter orange in a dietary supplement. Mayo Clin Proc 2006;81:545-8. PubMed
- Jordan S, Murty M, Pilon K. Products containing bitter orange or synephrine: suspected cardiovascular adverse reactions. Canadian Adverse Reaction Newsletter 2004;14:3-4.
- Burke J, Seda G, Allen D, Knee TS. A case of severe exercise-induced rhabdomyolysis associated with a weight loss dietary supplement. Mil Med 2007;172:656-8. PubMed
- Gray, S. and Woolf, A. D. Citrus aurantium used for weight loss by an adolescent with anorexia nervosa. J Adolesc.Health 2005;37(5):414-415. PubMed
- Haller, C. A., Duan, M., Jacob, P., III, and Benowitz, N. Human pharmacology of a performance-enhancing dietary supplement under resting and exercise conditions. Br J Clin Pharmacol 2008;65(6):833-840. PubMed
- Thomas, J. E., Munir, J. A., McIntyre, P. Z., and Ferguson, M. A. STEMI in a 24-year-old man after use of a synephrine-containing dietary supplement: a case report and review of the literature. Tex.Heart Inst.J 2009;36(6):586-590.
- Campbell-Tofte, J. I., Molgaard, P., Josefsen, K., Abdallah, Z., Hansen, S. H., Cornett, C., Mu, H., Richter, E. A., Petersen, H. W., Norregaard, J. C., and Winther, K. Randomized and double-blinded pilot clinical study of the safety and anti-diabetic ef
- Seifert, J. G., Nelson, A., Devonish, J., Burke, E. R., and Stohs, S. J. Effect of acute administration of an herbal preparation on blood pressure and heart rate in humans. Int J Med Sci 2011;8(3):192-197. PubMed
- Stohs, S. J., Preuss, H. G., Keith, S. C., Keith, P. L., Miller, H., and Kaats, G. R. Effects of p-synephrine alone and in combination with selected bioflavonoids on resting metabolism, blood pressure, heart rate and self-reported mood changes. Int J Med
- Wason, S., DiGiacinto, J. L., and Davis, M. W. Effects of grapefruit and Seville orange juices on the pharmacokinetic properties of colchicine in healthy subjects. Clin Ther 2012;34(10):2161-2173. PubMed
- Kaats, G. R., Miller, H., Preuss, H. G., and Stohs, S. J. A 60day double-blind, placebo-controlled safety study involving Citrus aurantium (bitter orange) extract. Food Chem Toxicol. 2013;55:358-362.
- Calapai, G., Firenzuoli, F., Saitta, A., Squadrito, F. R., Arlotta, M., Costantino, G., and Inferrera, G. Antiobesity and cardiovascular toxic effects of Citrus aurantium extracts in the rat: a preliminary report. Fitoterapia 12-1-1999;70(6):586-592. DOI
- Colker, C., Kalman, D., and Torina, G. Effects of Citrus aurantium extract, caffeine, and St. John's Wort on body fat loss, lipid levels, and mood states in overweight healthy adults. Curr Ther Res 1999;60:145-153. DOI
- Shara M, Stohs SJ. Safety evaluation of Bitter orange extract (p-synephrine) in healthy volunteers. J.Amer.Coll.Nutr. 2011;30:358.
- Lynch B. Review of the safety of p-synephrine and caffeine. Intertek-Cantox Report, 2013;1-20.
- Smith TB, Staub BA, Natarajan GM, et al. Acute myocardial infarction associated with dietary supplements containing 1,3-dimethylamylamine and Citrus aurantium. Tex Heart Inst J 2014;41(1):70-2. PubMed
- Shara M, Stohs SJ, Mukattash TL. Cardiovascular safety of oral p-synephrine (bitter orange) in healthy subjects: a randomized placebo-controlled cross-over clinical trial. Phytother Res. 2016;30(5):842-7.
- Liu Y, Santillo MF. Cytochrome P450 2D6 and 3A4 enzyme inhibition by amine stimulants in dietary supplements. Drug Test Anal. 2016;8(3-4):307-10. PubMed
- Abdelkawy KS, Donia AM, Turner RB, Elbarbry F. Effects of Lemon and Seville Orange Juices on the Pharmacokinetic Properties of Sildenafil in Healthy Subjects. Drugs R D. 2016 Sep;16(3):271-278. PubMed
- Gutiérrez-Hellín J, Salinero JJ, Abían-Vicen J, Areces F, Lara B, Gallo C, et al. Acute consumption of p-synephrine does not enhance performance in sprint athletes.J. Appl Physiol Nutr Metab. 2016;41(1):63-9. doi: 10.1139/apnm-2015-0299.
- Jung YP, Earnest CP, Koozehchian M, et al. Effects of ingesting a pre-workout dietary supplement with and without synephrine for 8 weeks on training adaptations in resistance-trained males. J Int Soc Sports Nutr. 2017;3;14:1. doi: 10.1186/s12970-016-0158- PubMed
- Jung YP, Earnest CP, Koozehchian M, et al. Effects of acute ingestion of a pre-workout dietary supplement with and without synephrine on resting energy expenditure, cognitive function and exercise performance. J Int Soc Sports Nutr. 2017;14:3. doi: 10.118
- Vatsavai LK, Kilari EK. Interaction of p-synephrine on the pharmacodynamic and pharmacokinetics of gliclazide in animal models. J Ayurveda Integr Med 2017; S0975-9476(16)30487-9. doi: 10.1016/j.jaim.2017.04.010.
- Ratamess NA, Bush JA, Stohs SJ, et al. Acute cardiovascular effects of bitter orange extract (p-synephrine) consumed alone and in combination with caffeine in human subjects: A placebo-controlled, double-blind study. Phytother Res. 2018;32(1):94-102.
- Gutiérrez-Hellín J, Ruiz-Moreno C, Del Coso J. Acute p-synephrine ingestion increases whole-body fat oxidation during 1-h of cycling at Fatmax. Eur J Nutr. 2019 Nov 5. PubMed
- Karimzadeh Z, Azizzadeh Forouzi M, Tajadini H, Ahmadinejad M, Roy C, Dehghan M. Effects of lavender and Citrus aurantium on pain of conscious intensive care unit patients: a parallel randomized placebo-controlled trial. J Integr Med 2021:S2095-4964(21)000 PubMed
- Koncz D, Tóth B, Bahar MA, Roza O, Csupor D. The Safety and Efficacy of Citrus aurantium (Bitter Orange) Extracts and p-Synephrine: A Systematic Review and Meta-Analysis. Nutrients 2022;14(19):4019. PubMed
Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
© 2021 Therapeutic Research Center, LLC