Major interaction on record — check this product against your medications before combining. Based on 12 of 15 ingredients. Check your meds →
Dietary supplement

SST X Cinnamon Ingredients & Drug Interactions

by Performix

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

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

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

The interaction bottom line Most serious interaction: Major

SST X Cinnamon is a dietary supplement by Performix with 15 active ingredients. Its ingredients are commonly taken for treating or preventing b12 deficiency, pernicious anemia, low energy and fatigue.Based on those ingredients, 1,476 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Synephrine, Caffeine, Coffee Bean Extract. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

Jump to a section

Check Your Meds Against SST X Cinnamon by Performix

Ask about any prescription or over-the-counter medication and we check it for interactions with SST X Cinnamon by Performix — and tell you which ingredient is responsible.

Pharmacist-reviewed data Checks every ingredient Answer in seconds
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HelloPharmacist Scorecard of SST X Cinnamon by Performix

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

From our pharmacy team — supplement deep dive

Generated from HelloPharmacist’s pharmacist-curated databases and editorial rules · Last generated Jul 11, 2026

What’s inside

Full disclosure
Ingredient Transparency · database check
Full

Every active ingredient lists its own amount on the label.

Why this rating?
  • The label discloses an exact amount for 15 of its 15 active ingredients.
  • No proprietary blends here — you can verify the dose of every single component.

SST X Cinnamon contains 15 active ingredients blending vitamins, herbal extracts, and botanical oils. Vitamin B12 supports energy and nerve function.

TeaCrine (theacrine) and caffeine are stimulants meant to promote alertness and athletic performance. 5-HTP, L-theanine, and toothed clubmoss extract target focus and cognitive support.

Coffee Bean Extract adds additional caffeine. Flaxseed Oil and Borage Seed Oil contribute omega fatty acids.

D-Limonene, Wasabi, and Cinnamon bark extract round out the formula with plant compounds. CoreBiome, Dynamine, Medium Chain Triglyceride, and Synephrine are also included.

Several inactive ingredients—gelatin, various starches, silicon dioxide, and food colorants—serve as binders and capsule materials.

Does it work?

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

Clinical evidence supports at least one of this product's ingredients for its stated purpose.

Why this rating?
  • The label markets this product for: Thermogenic support and metabolic performance.
  • We looked for evidence on: Athletic performance, Attention, Cognitive function, Fatigue, Energy and endurance, Mental focus — and 1 related terms.
  • The strongest evidence on file: Caffeine is rated "Likely Effective" for Athletic performance (Natural Medicines).
  • Also on file: Theanine is rated "Possibly Effective" for Cognitive function.
  • Also on file: Caffeine is rated "Possibly Ineffective" for Attention deficit-hyperactivity disorder (ADHD).

The evidence for this product's ingredients is mixed. Vitamin B12 is effective for B12 deficiency and cyanide poisoning, and possibly effective for canker sores and nerve pain.

Coffee Bean Extract's caffeine is likely effective for mental alertness and athletic performance, and possibly effective for Parkinson disease, heart failure, and diabetes. Caffeine itself is rated effective for neonatal apnea and postoperative headache, and likely effective for alertness and athletic performance.

L-Theanine is possibly effective for cognitive function. 5-HTP is possibly effective for depression.

For the remaining ingredients—TeaCrine, Flaxseed Oil, Borage Seed Oil, D-Limonene, Wasabi, Toothed Clubmoss, and several others—the evidence is insufficient to rate, meaning we lack reliable human data on whether they deliver their intended effects.

The evidence, ingredient by ingredient Vitamin B12 Theacrine 5-htp Theanine Coffee Caffeine Flaxseed Oil Borage

How safe is it?

Well-documented data
Safety Information · database check
Well characterized

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

Why this rating?
  • We hold adverse-effect (side-effect) data for 11 of the 12 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 11 of 12.
  • General safety write-ups exist for 12 of 12.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Most individual ingredients are generally well tolerated in short-term use, but the product carries multiple cautions. Vitamin B12 is safe in normal amounts, including during pregnancy and breastfeeding.

Caffeine and Coffee Bean Extract are generally safe at moderate doses for healthy adults but can cause jitteriness, insomnia, anxiety, and headache; high amounts pose risks. TeaCrine and L-Theanine have insufficient long-term safety data.

5-HTP is generally well tolerated short-term but may cause gastrointestinal upset (nausea, diarrhea, abdominal pain), drowsiness, or mood changes; it is not recommended in pregnancy or while breastfeeding. Flaxseed Oil is generally well tolerated but may cause loose stools at high doses.

Borage Seed Oil, when certified free of hepatotoxic alkaloids, is generally well tolerated but carries liver-toxicity concerns if contaminated; it is not advised in pregnancy or while breastfeeding. D-Limonene, Wasabi, Toothed Clubmoss, and other ingredients lack adequate pregnancy and breastfeeding safety data.

Rare serious effects reported across the formula include allergic reactions, seizure risk (with phenothiazines), and potential liver harm (borage).

Side effects, ingredient by ingredient Vitamin B12 Theacrine 5-htp Theanine Coffee Caffeine Flaxseed Oil Borage

Meds to double-check

Major interaction found
Known Interaction Concern · database check
Major identified

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

Why this rating?
  • 12 of the 12 matched ingredients can interact with medications — Toothed Clubmoss, Borage, 5-htp, Vitamin B12, Bitter Orange, among others.
  • The most serious interaction on file is rated Major.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; diabetes medications; heart-rhythm medications; lithium; Parkinson's medications.
  • For scale: 1,477 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.

Stop and check with your pharmacist if you take ephedrine or any stimulant medication (Major risk with caffeine). Avoid with antidepressants, other serotonergic drugs, or sedating medications (5-HTP and theacrine carry Moderate risks).

Double-check blood thinners like warfarin or aspirin before use (flaxseed oil, borage seed oil, and wasabi all interact). Be cautious with antihypertensive drugs and seizure medications (lamotrigine, phenobarbital, carbamazepine).

If you take cimetidine, clozapine, or quinolone antibiotics, confirm it is safe first. No interactions are documented in our data for Medium Chain Triglyceride, Dynamine, CoreBiome, or Synephrine.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFully disclosed formula with clinical evidence supporting its stated purpose. Major medication interactions have been identified, and safety information is well characterized.

SST X Cinnamon is a multi-ingredient stimulant and cognitive support formula best suited for healthy adults seeking mental alertness and athletic performance support. If you take any prescription medications—especially stimulants, antidepressants, sedatives, blood thinners, or seizure medications—you must check your specific drugs with the tool on this page before starting, as the interaction risk is substantial.

Pregnant or breastfeeding individuals should talk with their doctor first, as several ingredients lack adequate safety data. Start with a low dose to assess tolerance, and discuss this product with your pharmacist if you have any chronic health conditions.

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

Assessment coverage: 12 of 15 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Jan 23, 2025.

This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed

At a glance

General information

Key facts about SST X Cinnamon, straight from the product label.

Brand Performix
Barcode (UPC) 811274027095
Net contents 60 Capsule(s)
Market status On market
Date entered into DSLD Jan 23, 2025
DSLD ID 322796
Product type Other Combinations
Supplement form Capsule
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Adult (18 - 50 Years), Women (not pregnant or lactating)
From the label
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.

Supplement Facts

The label details for SST X Cinnamon by Performix, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
1 Capsule(s)
Maximum serving Sizes:
2 Capsule(s)
Servings per container
30
UPC/BARCODE
811274027095
IngredientAmount% DV
Calories10 Calorie(s)--
Total Fat1 Gram(s)1%
Saturated Fat1 Gram(s)5%
Vitamin B12100 mcg4167%
Medium Chain Triglyceride450 mg--
Dynamine75 mg--
TeaCrine25 mg--
5-HTP5 mg--
L-Theanine6.6 mg--
Coffee Bean Extract10 mg--
Caffeine290 mg--
Flaxseed Oil10 mg--
Borage Seed Oil10 mg--
D-Limonene10 mg--
Wasabi10 mg--
CoreBiome300 mg--
Synephrine20 mg--
Toothed Clubmoss whole plant extract100 mcg--

Other ingredients: Gelatin, Sugar, Vegetable, Silicon Dioxide, Starch, Polyvinylpyrrolidone, Corn Zein, Cinnamon bark extract, FD&C Blue No. 2 Lake, FD&C Red No. 40 lake, FD&C Yellow No. 6 Lake, Titanium Dioxide, Calcium Silicate, Maltodextrin, FD&C Blue No. 1 lake

Tap any ingredient to jump to its full detail below.

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

In 2014, Performix disrupted the thermogenic category with the release of Performix SST. Now with the release of SST X, we will take the category to the next level once again. There is growing evidence to suggest that a healthy gut microbiome plays a critical role in weight management and weight loss. Simply put, a healthy gut and a healthy metabolism are linked, by targeting key hunger hormones produced in the gut, Corebiome may provide the foundation for optimal health and metabolism. Plus, Corebiome is gentle on your system and easy to incorporate into your daily routine. By combining key features of Performix SST with the revolutionary ingredient, Corebiome, don't be surprised if SST X makes you feel better and lighter. SST X may: Help control hunger and cravings Rev up your metabolism Maintain blood sugar in healthy ranges Improve nutrient absorption Help maintain a healthy inflammatory response in the gut In addition, SST X features the powerhouse ingredient, synephrine, which has been clinically proven to significantly increase resting metabolic rate and energy expenditure, as well as improvements in blood pressure and heart rate. Each capsule is cinnamon flavor coated, to give you a quick burst of flavor when you take your daily dose. All powered by Performix's Terra intelligent dosing technology. SST X. It's time for a smarter thermogenic.

Cinnamon flavored coating Naturally & artificially flavored coating

Powered by: CoreBiome is the #1 Postbiotic. It helps your gut by aiding in the body's inflammatory response and stimulating growth of new cells in the gut wall. Dynamine Fast acting energy and focus ingredient that has a synergistic effect with Teacrine and caffeine. TeaCrine Patented ingredient that helps increase energy, focus, and performance without the jitters.

Precautions

Warning: Do not use if pregnant, nursing, or plan on becoming pregnant.

This product is intended for use by healthy adults over the age of 18 and should be avoided by those sensitive to caffeine or other ingredients that have known stimulant effects.

Do not combine with alcohol. Not intended for use by those with a medical condition. Use only as directed. Do not exceed recommended daily intake.

Consult a physician or licensed qualified health care professional prior to use if you are taking medication including, but not limited to, MAO inhibitors, antidepressants, aspirin, nonsteroidal anti-inflammatory drugs or products containing phenylene, ephedrine, pseudoephedrine, or other stimulants, or if you have a medical condition including, but not limited to heart, liver, kidney, or thyroid disease, psychiatric or epileptic disorders, difficulty urinating diabetes, high blood pressure, cardiac arrhythmia, recurrent headaches, enlarged prostate or glaucoma.

Discontinue 2 weeks prior to surgery or if you experience rapid heartbeat, dizziness, severe headache, or shortness of breath. Product should not be consumed for more than 8 continuous weeks, followed by a 2 week "off" period. Do not use if safety seal under cap is broken.

Keep out of reach of children.

Do not exceed one (1) serving per day. The product should not be taken in combination with other products containing caffeine or other stimulants. Do not take within six hours of bedtime. Please read the entire label before use.

Storage

Store in a cool, dry place.

General Statements

Please recycle.

Seals/Symbols

Made in the USA

cGMP

Formulation

Proudly made in the USA with carefully selected ingredients of international and domestic origin.

A smarter thermogenic Time release energy and focus Burn fat and increase lean muscle Support gut health, nutrient absorption and appetite control Supports healthy blood sugar and inflammatory response

Terra Intelligent dosing

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.

Brand IP Statement(s)

Performix Powdered by super strength technology

TeaCrine Patented ingredient that helps increase energy, focus, and performance without the jitters. TeaCrine, Dynamine and CoreBiome are protected by patents and under exclusive distribution by Compound Solutions, Inc.

FDA Statement of Identity

Dietary Supplement

Suggested/Recommended/Usage/Directions

Suggested use: Adults take 1 serving (2 capsules) in the morning on an empty stomach. To assess your tolerance, start with 1/2 serving (1 capsule) and work up to the full dose.

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

See for yourself

SST X Cinnamon by Performix label

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

SST X Cinnamon label

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

View the full label (PDF)
What’s inside

The Ingredients in SST X Cinnamon by Performix

These are the 15 active ingredients this product is made of. Select any to open its full monograph.

Serving size1 Capsule(s) Dosage formCapsule Servings per container30 Amounts shown are per serving.

Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.

Vitamin B12

Interacts with
20 drugs
100 mcg per serving Form: Methylcobalamin

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 & interactions

Medium Chain Triglyceride

450 mg per serving

Dynamine

75 mg per serving Form: Methylliberine

TeaCrine

Interacts with
248 drugs
25 mg per serving Form: Theacrine

Theacrine is a caffeine-like compound found naturally in certain tea plants and is sold in supplements for energy, focus, and mood. Early human studie...

TeaCrine monograph & interactions

5-HTP

Interacts with
398 drugs
5 mg per serving Form: Griffonia simplicifolia Seed Extract

5-HTP is a compound your body uses to make serotonin, and people take it as a supplement hoping to improve mood, sleep, and headaches. Some early rese...

5-HTP monograph & interactions

L-Theanine

Interacts with
565 drugs
6.6 mg per serving

Theanine (usually L-theanine) is an amino acid found naturally in tea leaves that many people take to feel calmer and less stressed without strong dro...

L-Theanine monograph & interactions

Coffee Bean Extract

Interacts with
591 drugs
10 mg per serving

Coffee is a widely consumed beverage made from roasted coffee beans, valued mainly for its caffeine, which boosts alertness and energy. For most healt...

Coffee Bean Extract monograph & interactions

Caffeine

Interacts with
655 drugs
290 mg per serving

Caffeine is a natural stimulant found in coffee, tea, and many other plants and products. In moderate amounts it can boost alertness and reduce tiredn...

Caffeine monograph & interactions

Flaxseed Oil

Interacts with
293 drugs
10 mg per serving

Flaxseed oil is a plant-based source of the omega-3 fatty acid ALA, which the body can partly convert to the omega-3s found in fish oil. It may help s...

Flaxseed Oil monograph & interactions

Borage Seed Oil

Interacts with
226 drugs
10 mg per serving

Borage is a Mediterranean herb whose seed oil is rich in gamma-linolenic acid (GLA), an omega-6 fatty acid studied mostly for skin conditions and arth...

Borage Seed Oil monograph & interactions

D-Limonene

Interacts with
229 drugs
10 mg per serving

Limonene is a natural compound found in the peel of citrus fruits like oranges and lemons, and it is used as a flavoring agent and dietary supplement....

D-Limonene monograph & interactions

Wasabi

Interacts with
122 drugs
10 mg per serving

Wasabi is best known as the pungent green condiment served with sushi, made from a Japanese plant in the cabbage family. Its natural compounds (isothi...

Wasabi monograph & interactions

CoreBiome

300 mg per serving Form: Tributyrin

Synephrine

Interacts with
957 drugs
20 mg per serving Form: Bitter Orange

Bitter orange is a citrus fruit whose extracts contain synephrine, a mild stimulant often added to weight-loss and energy supplements. Evidence that i...

Synephrine monograph & interactions

Toothed Clubmoss whole plant extract

Interacts with
219 drugs
100 mcg per serving

Toothed Clubmoss is a moss-like plant best known as the natural source of huperzine A, a compound studied mainly for memory and Alzheimer's disease. S...

Toothed Clubmoss whole plant extract monograph & interactions

Other (inactive) ingredients: Gelatin, Sugar, Vegetable, Silicon Dioxide, Starch, Polyvinylpyrrolidone, Corn Zein, Cinnamon bark extract, FD&C Blue No. 2 Lake, FD&C Red No. 40 lake, FD&C Yellow No. 6 Lake, Titanium Dioxide, Calcium Silicate, Maltodextrin, FD&C Blue No. 1 lake. These complete the product’s ingredient list but are not active constituents.

Interaction report

SST X Cinnamon by Performix Drug Interactions

Want to check YOUR meds against SST X Cinnamon?

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

 Go to the checker
1,476Drugs
18 Major 1,440 Moderate 18 Minor

Ingredients driving the most interactions

Synephrine 957
Caffeine 655
Coffee Bean Extract 591
L-Theanine 565
5-HTP 398

Individual Drug Interactions

The ingredients in SST X Cinnamon interact with 1,476 drugs. Click any drug to see the details.

12 of the 15 ingredients in SST X Cinnamon interact with drugs. Each result below shows which ingredient is responsible. Synephrine Caffeine Coffee Bean Extract L-Theanine 5-HTP Flaxseed Oil TeaCrine D-Limonene Borage Seed Oil Toothed Clubmoss whole plant extract Wasabi Vitamin B12

Each ingredient & the kinds of drugs it affects

For each ingredient in SST X Cinnamon 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.

Synephrine13 drug types · 957 drugs

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.

Likelihood Probable Evidence B
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.

Likelihood Probable Evidence D
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.

Likelihood Possible Evidence B
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.

Likelihood Possible Evidence B
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.

Likelihood Possible Evidence B
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.

Likelihood Possible Evidence B
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.

Likelihood Possible Evidence B
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.

Likelihood Probable Evidence B
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.

Likelihood Possible Evidence B
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.

Likelihood Possible Evidence D
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.

Likelihood Probable Evidence B
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.

Likelihood Possible Evidence B
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.

Likelihood Possible Evidence D
Synephrine full monograph & interactions

Caffeine41 drug types · 655 drugs

Ephedrine

Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Use of ephedrine with caffeine can increase the risk of stimulatory adverse effects. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death.

Likelihood Probable Evidence D
Adenosine (Adenocard)

Theoretically, caffeine might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Some evidence shows that caffeine is a competitive inhibitor of adenosine and can reduce the vasodilatory effects of adenosine in humans. However, other research shows that caffeine does not seem to affect supplemental adenosine because high interstitial levels of adenosine overcome the antagonistic effects of caffeine. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. However, methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.

Likelihood Possible Evidence B
Anticoagulant/Antiplatelet Drugs

Theoretically, caffeine may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Caffeine is reported to have antiplatelet activity. Theoretically, it might increase the risk of bleeding when used concomitantly with these agents; however, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Beta-Adrenergic Agonists

Theoretically, large amounts of caffeine might increase the cardiac inotropic effects of beta-agonists.

Likelihood Probable Evidence D
Carbamazepine (Tegretol)

Theoretically, caffeine might reduce the effects of carbamazepine and increase the risk for convulsions.
Animal research suggests that taking caffeine can lower the anticonvulsant effects of carbamazepine and can induce seizures when taken in doses above 400 mg/kg. Human research has shown that taking caffeine 300 mg in three divided doses along with carbamazepine 200 mg reduces the bioavailability of carbamazepine by 32% and prolongs the plasma half-life of carbamazepine 2-fold in healthy individuals.

Likelihood Possible Evidence D
Cimetidine (Tagamet)

Theoretically, cimetidine might increase the levels and adverse effects of caffeine.
Cimetidine decreases the rate of caffeine clearance by 31% to 42%.

Likelihood Likely Evidence B
Clozapine (Clozaril)

Caffeine might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
Caffeine might increase the effects and toxicity of clozapine. Caffeine doses of 400-1000 mg per day inhibit clozapine metabolism. Clozapine is metabolized by cytochrome P450 1A2 (CYP1A2). Although researchers speculate that caffeine might inhibit CYP1A2, there is no reliable evidence that caffeine affects CYP1A2. There is also speculation that genetic factors might make some patients more sensitive to an interaction between clozapine and caffeine. In one case report, severe, life-threatening clozapine toxicity and multiorgan system failure occurred in a patient with schizophrenia stabilized on clozapine who consumed caffeine 600 mg daily.

Likelihood Possible Evidence B
Dipyridamole (Persantine)

Theoretically, caffeine might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Caffeine inhibits dipyridamole-induced vasodilation. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. Methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.

Likelihood Probable Evidence B
Disulfiram (Antabuse)

Theoretically, disulfiram use might increase the levels and adverse effects of caffeine.
Disulfiram decreases the rate of caffeine clearance.

Likelihood Probable Evidence B
Diuretic Drugs

Theoretically, using caffeine with diuretic drugs might increase the risk of hypokalemia.
Caffeine, especially in excessive amounts, can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also cause lower potassium levels.

Likelihood Possible Evidence D
Estrogens

Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Estrogen inhibits caffeine metabolism.

Likelihood Probable Evidence B
Ethosuximide (Zarontin)

Theoretically, caffeine might reduce the effects of ethosuximide and increase the risk for convulsions.
Animal research suggests that caffeine 92.4 mg/kg can decrease the anticonvulsant activity of ethosuximide. However, this effect has not been reported in humans.

Likelihood Possible Evidence D
Felbamate (Felbatol)

Theoretically, caffeine might reduce the effects of felbamate and increase the risk for convulsions.
Animal research suggests that a high dose of caffeine 161.7 mg/kg can decreases the anticonvulsant activity of felbamate. However, this effect has not been reported in humans.

Likelihood Possible Evidence D
Flutamide (Eulexin)

Theoretically, caffeine might increase the levels and adverse effects of flutamide.
In vitro evidence suggests that caffeine can inhibit the metabolism of flutamide. However, this effect has not been reported in humans.

Likelihood Probable Evidence D
Fluvoxamine (Luvox)

Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Fluvoxamine reduces caffeine metabolism.

Likelihood Probable Evidence D
Lithium

Abrupt caffeine withdrawal might increase the levels and adverse effects of lithium.
Caffeine has diuretic activity. When abruptly discontinued, caffeine may alter the clearance of lithium. There are two case reports of lithium tremor that worsened upon abrupt coffee withdrawal and 6 case reports of elevated serum lithium levels after reducing or eliminating caffeine intake. In one case, a male with schizoaffective disorder stabilized on lithium had an elevated lithium level after reducing his caffeine intake by 87%. At a later date, he increased his caffeine intake by 6-fold, resulting in a subtherapeutic lithium level and a recurrence of psychiatric symptoms.

Likelihood Probable Evidence D
Monoamine Oxidase Inhibitors (Maois)

Theoretically, concomitant use might increase the risk of a hypertensive crisis.
Caffeine has been shown to inhibit monoamine oxidase (MAO) A and B in laboratory studies. Concomitant intake of large amounts of caffeine with MAOIs might precipitate a hypertensive crisis. In a case report, a patient that consumed 10-12 cups of caffeinated coffee and took the MAOI tranylcypromine presented with severe hypertension. Hypertension was resolved after the patient switched to drinking decaffeinated coffee.

Likelihood Possible Evidence D
Nicotine

Theoretically, concomitant use might increase the risk of hypertension.
Concomitant use of caffeine and nicotine has been shown to have additive cardiovascular effects, including increased heart rate and blood pressure. Blood pressure was increased by 10.8/12.4 mmHg when the agents were used concomitantly.

Likelihood Probable Evidence B
Pentobarbital (Nembutal)

Theoretically, caffeine might decrease the effects of pentobarbital.
Caffeine might negate the hypnotic effects of pentobarbital.

Likelihood Possible Evidence B
Phenobarbital (Luminal)

Theoretically, caffeine might reduce the effects of phenobarbital and increase the risk for convulsions.
Animal research suggests that caffeine can decrease the anticonvulsant activity of phenobarbital. However, the exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D
Phenylpropanolamine

Theoretically, phenylpropanolamine might increase the risk of hypertension, as well as the levels and adverse effects of caffeine.
Concomitant use of phenylpropanolamine and caffeine might cause an additive increase in blood pressure. Phenylpropanolamine also seems to increase caffeine serum levels.

Likelihood Probable Evidence B
Phenytoin (Dilantin)

Theoretically, caffeine might reduce the effects of phenytoin and increase the risk for convulsions.
Animal research suggests that caffeine can decrease the anticonvulsant activity of phenytoin. The effect does not seem to be related to the seizure threshold-lowering effects of caffeine. However, the exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D
Pioglitazone (Actos)

Theoretically, caffeine might increase the levels and clinical effects of pioglitazone.
Animal research suggests that caffeine can modestly increase the maximum concentration, area under the curve, and half-life of pioglitazone, and also reduce its clearance. This increased the antidiabetic effects of pioglitazone. However, the exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D
Quinolone Antibiotics

Theoretically, quinolone antibiotics might increase the levels and adverse effects of caffeine.
Quinolones (also called fluoroquinolones) can decrease caffeine clearance by inhibiting cytochrome P450 1A2 (CYP1A2) enzyme.

Likelihood Probable Evidence B
Riluzole (Rilutek)

Theoretically, concomitant use might increase the levels and adverse effects of both caffeine and riluzole.
Caffeine and riluzole are both metabolized by cytochrome P450 1A2 (CYP1A2), and concomitant use might reduce the metabolism of one or both agents.

Likelihood Possible Evidence D
Caffeine full monograph & all 41 interactions

Coffee Bean Extract33 drug types · 591 drugs

Ephedrine

Theoretically, concomitant use might increase the risk of stimulant adverse effects.
Coffee contains caffeine. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death. Tell patients to avoid taking caffeine with ephedrine and other stimulants.

Likelihood Probable Evidence D
Adenosine (Adenocard)

Theoretically, coffee might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Coffee contains caffeine. Caffeine is a competitive inhibitor of adenosine at the cellular level. However, caffeine does not seem to affect supplemental adenosine because high interstitial levels of adenosine overcome the antagonistic effects of caffeine. It is recommended that methylxanthines such as caffeine, as well as methylxanthine-containing products, be stopped 24 hours prior to pharmacological stress tests. However, methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.

Likelihood Possible Evidence B
Alendronate (Fosamax)

Coffee reduces alendronate bioavailability.
Separate coffee ingestion and alendronate administration by two hours. Coffee reduces alendronate bioavailability by 60%.

Likelihood Probable Evidence B
Anticoagulant/Antiplatelet Drugs

Theoretically, coffee may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Coffee contains caffeine. Caffeine is reported to have antiplatelet activity. Theoretically, the caffeine in coffee might increase the risk of bleeding when used concomitantly with these agents. However, this interaction has not been reported in humans. There is some evidence that caffeinated coffee might increase the fibrinolytic activity in blood.

Likelihood Unlikely Evidence D
Beta-Adrenergic Agonists

Theoretically, concomitant use of large amounts of coffee might increase cardiac inotropic effects of beta-agonists.
Coffee contains caffeine. Caffeine can increase cardiac inotropic effects of beta-agonists.

Likelihood Probable Evidence D
Cimetidine (Tagamet)

Theoretically, cimetidine might increase the effects and adverse effects of caffeine in coffee.
Coffee contains caffeine. Cimetidine can reduce caffeine clearance by 31% to 42%.

Likelihood Likely Evidence B
Clozapine (Clozaril)

Theoretically, coffee might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
Coffee contains caffeine. Caffeine can increase the effects and toxicity of clozapine. Caffeine doses of 400-1000 mg daily inhibit clozapine metabolism. Clozapine is metabolized by cytochrome P450 1A2 (CYP1A2). Researchers speculate that caffeine might inhibit CYP1A2. However, there is no reliable evidence that caffeine affects CYP1A2. There is also speculation that genetic factors might make some patients be more sensitive to the interaction between clozapine and caffeine.

Likelihood Possible Evidence B
Contraceptive Drugs

Theoretically, concomitant use might increase the effects and adverse effects of caffeine found in coffee.
Coffee contains caffeine. Oral contraceptive drugs can decrease caffeine clearance by 40% to 65%.

Likelihood Probable Evidence B
Dipyridamole (Persantine)

Theoretically, coffee might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Coffee contains caffeine. Caffeine is a methylxyanthine that may inhibit dipyridamole-induced vasodilation. It is recommended that methylxanthines such as caffeine, as well as methylxanthine-containing products such as coffee, be stopped 24 hours prior to pharmacological stress tests. Methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.

Likelihood Probable Evidence B
Disulfiram (Antabuse)

Theoretically, disulfiram might increase the risk of adverse effects from caffeine.
Coffee contains caffeine. In human research, disulfiram decreases the clearance and increases the half-life of caffeine.

Likelihood Probable Evidence B
Diuretic Drugs

Theoretically, concomitant use might increase the risk of hypokalemia.
Coffee contains caffeine. Caffeine, especially in excessive amounts, can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also cause lower potassium levels.

Likelihood Possible Evidence D
Estrogens

Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Coffee contains caffeine. Estrogen inhibits caffeine metabolism.

Likelihood Probable Evidence B
Fluvoxamine (Luvox)

Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Coffee contains caffeine. Fluvoxamine reduces caffeine metabolism.

Likelihood Probable Evidence B
Lamotrigine (Lamictal)

Coffee consumption can decrease the levels and clinical effects of lamotrigine.
A pharmacokinetic study in patients taking lamotrigine shows that consumption of coffee, both caffeinated and decaffeinated, can decrease the area under the concentration-time curve (AUC) and the peak plasma level (Cmax) of lamotrigine. Each additional cup of coffee reduced the AUC and Cmax by 4% and 3%, respectively. It is unclear whether this interaction is due to induction of lamotrigine metabolism or inhibition of lamotrigine absorption.

Likelihood Probable Evidence B
Levothyroxine (Synthroid, Others)

Coffee can reduce the absorption of levothyroxine.
In some patients, coffee can reduce levothyroxine absorption, possibly through the formation of non-absorbable complexes. A pharmacokinetic study in these patients found that 25-30 mL of espresso coffee consumed with levothyroxine tablets delayed the time to peak plasma levels by 38-43 minutes, reduced the peak plasma level (Cmax) by 19% to 36%, and reduced the area under the curve (AUC) by 27% to 36%. Coffee consumed one hour after levothyroxine did not affect absorption. It is not known whether this interaction occurs with other types of coffee. Tell patients to avoid drinking coffee at the same time that they take their levothyroxine, and for up to an hour afterwards.

Likelihood Possible Evidence B
Lithium

Theoretically, abrupt coffee withdrawal might increase the levels and adverse effects of lithium.
Coffee contains caffeine. Abrupt caffeine withdrawal can increase serum lithium levels. Two cases of lithium tremor that worsened with abrupt coffee withdrawal have been reported. There is also one case of a 2.8-fold increase in blood lithium levels after a patient taking lithium reduced his coffee consumption from 13-20 cups daily to 10 cups daily.

Likelihood Probable Evidence D
Monoamine Oxidase Inhibitors (Maois)

Theoretically, concomitant use might increase the risk of a hypertensive crisis.
Coffee contains caffeine. Caffeine has been shown to inhibit monoamine oxidase (MAO) A and B in laboratory studies. Concomitant intake of large amounts of caffeine with MAOIs might precipitate a hypertensive crisis. In a case report, a patient that consumed 10-12 cups of caffeinated coffee and took the MAOI tranylcypromine presented with severe hypertension. Hypertension was resolved after the patient switched to drinking decaffeinated coffee.

Likelihood Possible Evidence D
Nicotine

Theoretically, concomitant use might increase the risk of hypertension.
Coffee contains caffeine. Concomitant use of caffeine and nicotine has been shown to have additive cardiovascular effects, including increased heart rate and blood pressure. Blood pressure was increased by 10.8/12.4 mmHg when the agents were used concomitantly.

Likelihood Probable Evidence B
Pentobarbital (Nembutal)

Theoretically, coffee might reduce the effects of pentobarbital.
Coffee contains caffeine. Theoretically, caffeine might negate the hypnotic effects of pentobarbital.

Likelihood Possible Evidence B
Phenylpropanolamine

Theoretically, phenylpropanolamine might increase the risk of hypertension, as well as the levels and adverse effects of caffeine.
Coffee contains caffeine. Concomitant use of phenylpropanolamine and caffeine might cause an additive increase in blood pressure. Phenylpropanolamine also seems to increase caffeine serum levels.

Likelihood Probable Evidence B
Pioglitazone (Actos)

Theoretically, coffee might increase the levels and clinical effects of pioglitazone.
Coffee contains caffeine. Animal research suggests that caffeine can modestly increase the maximum concentration, area under the curve, and half-life of pioglitazone, and also reduce its clearance. This increased the antidiabetic effects of pioglitazone. However, the exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D
Quinolone Antibiotics

Theoretically, quinolone antibiotics might increase the levels and adverse effects of caffeine.
Coffee contains caffeine. Concomitant use of caffeine and quinolones can decrease caffeine clearance and increase effects and risk of adverse effects.

Likelihood Probable Evidence B
Riluzole (Rilutek)

Theoretically, concomitant use might increase the levels and adverse effects of both caffeine and riluzole.
Coffee contains caffeine. Caffeine and riluzole are both metabolized by cytochrome P450 1A2 (CYP1A2), and concomitant use might reduce metabolism of one or both agents.

Likelihood Possible Evidence D
Stimulant Drugs

Theoretically, concomitant use might increase stimulant adverse effects.
Coffee contains caffeine. Due to the central nervous system (CNS) stimulant effects of caffeine, concomitant use with stimulant drugs can increase the risk of adverse effects.

Likelihood Probable Evidence C
Theophylline

Theoretically, coffee might increase the levels and adverse effects of theophylline.
Coffee contains caffeine, which can increase theophylline levels.

Likelihood Probable Evidence B
Coffee Bean Extract full monograph & all 33 interactions

L-Theanine3 drug types · 565 drugs

Antihypertensive Drugs

Theanine might lower blood pressure, potentiating the effects of antihypertensive drugs.
Animal research shows that theanine can lower blood pressure in spontaneously hypertensive animals. Theoretically, concomitant use of theanine and antihypertensive drugs might potentiate the antihypertensive activity.

Likelihood Possible Evidence D
Cns Depressants

Theoretically, theanine might have additive sedative effects when used in conjunction with CNS depressants. However, it is unclear if this concern is clinically relevant.
Theoretically, theanine may compete with glutamate and/or increase plasma gamma-aminobutyric acid (GABA) levels, which could cause CNS depression. In one clinical study, some subjects taking oral theanine reported drowsiness.

Likelihood Unlikely Evidence D
Serotonergic Drugs

Clinical studies regarding the effects of L-theanine on serotonin levels are conflicting. Some studies suggest it can increase serotonin levels in the brain while others report that it may decrease them. Nevertheless, there have been no reports of l-theanine being a causative agent in serotonergic-related side effects or serotonin syndrome.

Likelihood Unlikely Evidence C
L-Theanine full monograph & interactions

5-HTP3 drug types · 398 drugs

Carbidopa (Lodosyn)

Combining 5-HTP and carbidopa can increase the risk of serotonergic side effects.
Carbidopa is sometimes used with 5-HTP to minimize peripheral 5-HTP metabolism and boost the amount that reaches the brain. However, this combination might also increase the risk of some side effects including hypomania, restlessness, rapid speech, anxiety, insomnia, and aggressiveness. Combining carbidopa and 5-HTP might also increase the risk of scleroderma-like skin changes due to elevated serotonin levels.

Likelihood Possible Evidence D
Cns Depressants

Theoretically, concomitant use of 5-HTP with medications that cause sedation might have additive effects.
In clinical trials, 5-HTP has been associated with drowsiness and somnolence.

Likelihood Possible Evidence D
Serotonergic Drugs

Combining serotonergic drugs with 5-HTP might cause additive serotonergic effects.
5-HTP can increase serotonin levels and cause serotonergic effects. Theoretically, combining serotonergic drugs with 5-HTP might increase the risk of serotonergic side effects, including serotonin syndrome and cerebral vasoconstrictive disorders. However, serotonin syndrome with 5-HTP has not yet been reported in humans. Monitor patients for signs of serotonin syndrome and other serotonergic side effects if using 5-HTP with serotonergic drugs.

Likelihood Possible Evidence D
5-HTP full monograph & interactions

Flaxseed Oil3 drug types · 293 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, using flaxseed oil in combination with anticoagulant or antiplatelet drugs might have additive effects and increase the risk of bleeding.
Small clinical studies show that consuming flaxseed oil might decrease platelet aggregation and increase bleeding time.

Likelihood Possible Evidence D
Antihypertensive Drugs

Theoretically, combining flaxseed oil with other antihypertensive drugs might have additive effects and increase the risk of hypotension.
Some clinical evidence suggests that long-term consumption of flaxseed oil can modestly lower systolic and diastolic blood pressure, while other clinical research shows no effect.

Likelihood Possible Evidence D
Ezetimibe (Zetia)

Concomitant use of flaxseed oil and ezetimibe reduces the absorption of alpha-linolenic acid from flaxseed oil.
In one clinical study, concomitant consumption of ezetimibe 10 mg daily with flaxseed oil 2 grams providing 1 gram of alpha-linolenic acid daily blocked the absorption of alpha-linolenic acid, resulting in an overall reduction in alpha-linolenic plasma levels from baseline.

Likelihood Probable Evidence B
Flaxseed Oil full monograph & interactions

TeaCrine1 drug type · 248 drugs

Cns Depressants

Theoretically, theacrine might alter the effects of CNS depressants.
Animal research shows that low doses of theacrine have sedating effects, whereas high doses might have stimulant effects. Depending on the dose of theacrine used, it might increase or decrease the effects of CNS depressants. However, these effects have not yet been reported in humans.

Likelihood Possible Evidence D
TeaCrine full monograph & interactions

D-Limonene5 drug types · 229 drugs

Cytochrome P450 2C19 (Cyp2C19) Inducers

There's preliminary evidence that limonene might be a substrate for cytochrome P450 2C19 (CYP2C19). CYP2C19 inducers might decrease the effects of limonene. So far, this interaction has not been reported in humans. Inducers of CYP2C19 include carbamazepine (Tegretol), prednisone (Deltasone), and rifampin (Rifadin, Rimactane).

Likelihood Possible Evidence D
Cytochrome P450 2C19 (Cyp2C19) Inhibitors

There's preliminary evidence that limonene might be a substrate for cytochrome P450 2C19 (CYP2C19). So far, this interaction has not been reported in humans. However, watch for an increase in the limonene levels when it is taken with drugs that inhibit CYP2C19. Some drugs that inhibit CYP2C19 include cimetidine (Tagamet), fluvoxamine (Luvox), omeprazole (Prilosec); ticlopidine (Ticlid), topiramate (Topamax), and others.

Likelihood Possible Evidence D
Cytochrome P450 2C9 (Cyp2C9) Inducers

There's preliminary evidence that limonene might be a substrate for cytochrome P450 2C9 (CYP2C9). Inducers of CYP2C9 might decrease limonene levels. Inducers of CYP2C9 include rifampin (Rifadin, Rimactane) and secobarbital (Seconal).

Likelihood Possible Evidence D
Cytochrome P450 2C9 (Cyp2C9) Inhibitors

There's preliminary evidence that limonene might be a substrate for cytochrome P450 2C9 (CYP2C9). So far, this interaction has not been reported in humans. However, watch for side effects in patients taking limonene and CYP2C9 inhibitors. Some CYP2C9 inhibitors include amiodarone (Cordarone), fluconazole (Diflucan), lovastatin (Mevacor), paroxetine (Paxil), zafirlukast (Accolate), and many others.

Likelihood Possible Evidence D
Cytochrome P450 2C9 (Cyp2C9) Substrates

There's preliminary evidence that limonene might be a substrate for cytochrome P450 2C9 (CYP2C9), as well causing its induction. So far, this interaction has not been reported in humans. However, watch for a decrease in the levels of drugs metabolized by CYP2C9 in patients taking limonene. Some drugs metabolized by CYP2C9 include nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac (Cataflam, Voltaren), ibuprofen (Motrin), meloxicam (Mobic), and piroxicam (Feldene); celecoxib (Celebrex); amitriptyline (Elavil); warfarin (Coumadin); glipizide (Glucotrol); losartan (Cozaar); and others.

Likelihood Possible Evidence D
D-Limonene full monograph & interactions

Borage Seed Oil3 drug types · 226 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, borage seed oil may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
In healthy individuals, borage seed oil supplementation does not seem to affect platelet aggregation. However, gamma-linolenic acid, a constituent of borage seed oil, seems to decrease platelet aggregation by 45% and increase the risk of bleeding by 40% in animal and clinical research.

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

Theoretically, taking borage with drugs that induce CYP3A4 might increase levels of pyrrolizidine alkaloid (PA) toxic metabolites.
Although borage seed oil contains little to no PAs, some borage plant parts, such as the leaf, flower, and seed, can contain hepatotoxic PAs. Hepatotoxic PAs are substrates of CYP3A4, which converts these chemicals into toxic metabolites. Tell patients to avoid borage preparations that are not certified and labeled as hepatotoxic PA-free.

Likelihood Possible Evidence D
Phenothiazines

Theoretically, taking borage sed oil with phenothiazines might increase the risk of seizures.
Borage seed oil contains gamma-linolenic acid (GLA). There is concern that taking supplements containing GLA might cause seizures, or lower the seizure threshold, when taken with phenothiazines. This is based on limited data from two reports published in the 1980s. In one report, three patients with schizophrenia who had received phenothiazines developed EEG changes suggestive of temporal lobe epilepsy after starting treatment with evening primrose, another source of GLA. However, none experienced an actual seizure. In the other report, two patients with schizophrenia who were stabilized on phenothiazines developed seizures when evening primrose 4 grams daily was added. One of these patients had a prior history of seizures. It is unclear whether evening primrose had any additive epileptogenic effects with the phenothiazines, but there is no evidence that taking GLA-containing supplements alone can cause seizures.

Likelihood Possible Evidence D
Borage Seed Oil full monograph & interactions

Toothed Clubmoss whole plant extract2 drug types · 219 drugs

Anticholinergic Drugs

In animal models, toothed clubmoss and huperzine A, an active constituent of toothed clubmoss, reversed cognitive deficits induced by scopolamine. Theoretically, concurrent use of anticholinergic drugs and toothed clubmoss might decrease the effectiveness of toothed clubmoss or the anticholinergic drug.
Some anticholinergic drugs include atropine, benztropine (Cogentin), biperiden (Akineton), procyclidine (Kemadrin), and trihexyphenidyl (Artane).

Likelihood Possible Evidence D
Cholinergic Drugs

Huperzine A, a constituent of toothed clubmoss, has demonstrated acetylcholinesterase inhibitory properties. Theoretically, concurrent use of toothed clubmoss with cholinergic drugs might have additive effects and increase the risk of cholinergic side effects.
Cholinergic drugs include bethanechol (Urecholine), donepezil (Aricept), echothiophate (Phospholine Iodide), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmin), physostigmine (Antilirium), pyridostigmine (Mestinon, Regonol), succinylcholine (Anectine, Quelicin), and tacrine (Cognex).

Likelihood Possible Evidence D
Toothed Clubmoss whole plant extract full monograph & interactions

Wasabi1 drug type · 122 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, wasabi might increase the risk of bleeding with anticoagulant or antiplatelet drugs.
In vitro research shows that 6-(methylsulfinyl) hexyl isothiocyanate, a constituent of wasabi, inhibits platelet aggregation.

Likelihood Possible Evidence D
Wasabi full monograph & interactions

Vitamin B121 drug type · 20 drugs

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.

Likelihood Possible Evidence A
Vitamin B12 full monograph & interactions
The maker

Brand information

Manufacturer and brand details for SST X Cinnamon, from the product label.

Performix

See all Performix products
Name
Performix LLC
Street Address
2255 Sheridan Blvd., Unit C-#108
City
Edgewater
State
CO
ZipCode
80214
Web Address
www.PerformixDriven.com
Pharmacist Counseling Corner

SST X Cinnamon by Performix: Common Questions

Does SST X Cinnamon by Performix interact with any medications?
Yes. Based on its ingredients, SST X Cinnamon has a known interaction with 1,476 medications, including 18 rated major. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
SST X Cinnamon contains 15 active ingredients, and an interaction can come from any of them. We check every ingredient, combine the results into one list per medication, and show which ingredient and mechanism is responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.
Can I take this if I'm pregnant or breastfeeding?
Several ingredients lack adequate safety data for pregnancy and breastfeeding, including 5-HTP, TeaCrine, L-Theanine, Borage Seed Oil, D-Limonene, Wasabi, and Toothed Clubmoss. Vitamin B12 is considered safe at normal amounts in pregnancy and breastfeeding, but caffeine should be limited during both. Talk with your doctor or pharmacist about whether this product is right for you.
What are the most common side effects?
Because this is a stimulant-heavy formula, you may experience jitteriness, insomnia, anxiety, headache, or restlessness from the caffeine and theacrine. 5-HTP can cause nausea, diarrhea, or abdominal pain, especially if doses are increased quickly. L-Theanine may cause drowsiness or headaches. Borage Seed Oil and Flaxseed Oil can cause loose stools or bloating.
Will this help me lose weight or build muscle?
The data we hold does not establish that this product helps with weight loss or muscle gain. Caffeine is likely effective for athletic performance, and some ingredients are possibly effective for athletic performance, but we have no evidence this formula as a whole promotes either weight loss or muscle building.
Is this safe to use long-term?
Long-term safety is not well established for most ingredients. TeaCrine, L-Theanine, Flaxseed Oil, Borage Seed Oil, D-Limonene, Wasabi, and Toothed Clubmoss all have limited long-term safety data. Caffeine, while generally safe at moderate doses, can lead to dependence and tolerance with chronic use. Talk with your pharmacist about how long it is appropriate for you to take this product.
Does this contain any allergens?
The product contains gelatin (which may be from animal sources) and various food dyes (FD&C colorants). Rare allergic reactions to caffeine and limonene have been reported. If you have known allergies to any of these or the other ingredients, avoid this product.
Can I take this with my other supplements?
That depends on which supplements you take. If they contain stimulants, sedatives, serotonergic compounds, or blood thinners, there may be overlap or interaction. Check the label on your other supplements and run both through the interaction tool on this page, or ask your pharmacist.

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

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Label information is sourced from the NIH Dietary Supplement Label Database and reflects the product version on file; always read your actual product label. This page is for education only and is not a substitute for professional medical advice. Confirm with your pharmacist or doctor before combining supplements and medications.

SST X Cinnamon label
Go deeper

The Full Monographs Behind SST X Cinnamon’s Ingredients

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

Herb & supplement monograph

Vitamin B12

Interacts with 20 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 helpful for people who are deficient — su...

Read the full Vitamin B12 monograph → Herb & supplement monograph

Theacrine

Interacts with 248 drugs

Theacrine is a caffeine-like compound found naturally in certain tea plants and is sold in supplements for energy, focus, and mood. Early human studies suggest it may give a stimulant-like b...

Read the full Theacrine monograph → Herb & supplement monograph

5-htp

Interacts with 398 drugs

5-HTP is a compound your body uses to make serotonin, and people take it as a supplement hoping to improve mood, sleep, and headaches. Some early research is promising, but the overall evide...

Read the full 5-htp monograph → Herb & supplement monograph

Theanine

Interacts with 565 drugs

Theanine (usually L-theanine) is an amino acid found naturally in tea leaves that many people take to feel calmer and less stressed without strong drowsiness. Early research suggests it may...

Read the full Theanine monograph → Herb & supplement monograph

Coffee

Interacts with 591 drugs

Coffee is a widely consumed beverage made from roasted coffee beans, valued mainly for its caffeine, which boosts alertness and energy. For most healthy adults, moderate coffee intake is gen...

Read the full Coffee monograph → Herb & supplement monograph

Caffeine

Interacts with 655 drugs

Caffeine is a natural stimulant found in coffee, tea, and many other plants and products. In moderate amounts it can boost alertness and reduce tiredness for most healthy adults, but too muc...

Read the full Caffeine monograph → Herb & supplement monograph

Flaxseed Oil

Interacts with 293 drugs

Flaxseed oil is a plant-based source of the omega-3 fatty acid ALA, which the body can partly convert to the omega-3s found in fish oil. It may help support heart health and provide healthy...

Read the full Flaxseed Oil monograph → Herb & supplement monograph

Borage

Interacts with 226 drugs

Borage is a Mediterranean herb whose seed oil is rich in gamma-linolenic acid (GLA), an omega-6 fatty acid studied mostly for skin conditions and arthritis with mixed results. The plant's le...

Read the full Borage monograph → Herb & supplement monograph

Limonene

Interacts with 229 drugs

Limonene is a natural compound found in the peel of citrus fruits like oranges and lemons, and it is used as a flavoring agent and dietary supplement. People take it for heartburn, digestion...

Read the full Limonene monograph → Herb & supplement monograph

Wasabi

Interacts with 122 drugs

Wasabi is best known as the pungent green condiment served with sushi, made from a Japanese plant in the cabbage family. Its natural compounds (isothiocyanates) show antimicrobial and antiox...

Read the full Wasabi monograph → Herb & supplement monograph

Bitter Orange

Interacts with 957 drugs

Bitter 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 → Herb & supplement monograph

Toothed Clubmoss

Interacts with 219 drugs

Toothed Clubmoss is a moss-like plant best known as the natural source of huperzine A, a compound studied mainly for memory and Alzheimer's disease. Some early research is promising, but the...

Read the full Toothed Clubmoss monograph →
Sources

Sources & How We Checked

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

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

The 574 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.

Vitamin B12 30 references
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Theacrine 1 reference
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5-htp 32 references
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Theanine 6 references
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Coffee 175 references
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See these in context on the Coffee monograph →

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Limonene 10 references
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See these in context on the Bitter Orange monograph →

Toothed Clubmoss 3 references
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See these in context on the Toothed Clubmoss monograph →

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DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

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