Stimul8 Original Awesome Apple Ingredients & Drug Interactions
by FINAFLEX
What is this page for?
First and foremost: checking Stimul8 Original Awesome Apple 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
Stimul8 Original Awesome Apple is a dietary supplement by FINAFLEX with 10 active ingredients. Its ingredients are commonly taken for bone health and osteoporosis prevention, dietary calcium deficiency, heartburn relief (calcium carbonate antacids).Based on those ingredients, 1,515 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Green Tea Extract, Theobroma cacao extract, Caffeine Anhydrous. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Stimul8 Original Awesome Apple by FINAFLEX
Ask about any prescription or over-the-counter medication and we check it for interactions with Stimul8 Original Awesome Apple by FINAFLEX — 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 Stimul8 Original Awesome Apple by FINAFLEX
Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.
What’s inside
Full disclosure
Stimul8 Original Awesome Apple contains 10 active ingredients. Calcium supports bone health and normal muscle function.
L-phenylalanine is an amino acid that may support attention and mood. Vitamin C is an antioxidant involved in immune function and collagen formation.
Beta-alanine is an amino acid that may support athletic endurance. Caffeine anhydrous is a stimulant for mental alertness and physical performance.
TeaCrine (theacrine) is a caffeine-like compound. Guayusa extract and green tea extract both provide additional caffeine and polyphenols.
Cocoa extract (Theobroma cacao) adds caffeine and flavonoids. Rauwolfia vomitoria root extract is also included.
The product also contains inactive ingredients such as malic acid, citric acid, natural and artificial flavors, gum arabic, silica, and several others as binders and preservatives.
Does it work?
Strong evidence
Evidence for this product's active ingredients varies. Calcium is effective for bone health conditions like osteoporosis and is effective for kidney failure and upset stomach.
L-phenylalanine has possibly effective evidence for vitiligo but possibly ineffective for ADHD, with insufficient evidence for alcohol use disorder and multiple sclerosis. Vitamin C is effective for vitamin C deficiency and has possibly effective evidence for anemia and some other conditions.
Beta-alanine has possibly effective evidence for athletic and physical performance but insufficient evidence for cognitive decline, COPD, and other uses. Caffeine is effective for neonatal apnea and postoperative headache, and likely effective for mental alertness and athletic performance.
Green tea extract is likely effective for human papillomavirus and possibly effective for ovarian cancer and high cholesterol. Cocoa extract has possibly effective evidence for cardiovascular disease.
TeaCrine, guayusa extract, and rauwolfia vomitoria root extract lack sufficient evidence in the data we hold.
How safe is it?
Well-documented data
Calcium is generally well tolerated at recommended amounts; however, high doses can cause constipation, diarrhea, and stomach upset. There is some concern that very high calcium intake (over 1,500–2,000 mg daily) may increase prostate cancer risk and possibly cardiovascular disease risk, though research on this is mixed.
L-phenylalanine commonly causes anxiety, insomnia, constipation, heartburn, and nausea. It should be avoided by anyone with phenylketonuria (PKU).
Vitamin C at high doses (above 2 grams daily) can cause abdominal cramps, diarrhea, kidney stones, and heartburn. Caffeine is well tolerated in moderate amounts but can cause anxiety, insomnia, tremors, and dependence with chronic use; at very high doses it may rarely increase stroke risk.
Beta-alanine commonly causes harmless skin tingling and flushing. Green tea extract is generally safe but has rarely been linked to liver injury at high doses.
Cocoa contains caffeine and can cause stomach upset, headache, and nausea, particularly at higher amounts.
Meds to double-check
Major interaction found
Check with your pharmacist or doctor before using this product if you take: HIV integrase inhibitors (dolutegravir, elvitegravir, raltegravir), intravenous ceftriaxone, nadolol or other beta-blockers, atorvastatin or other statins, warfarin or other blood thinners, levothyroxine or other thyroid medications, levodopa for Parkinson's disease, monoamine oxidase inhibitors (MAOIs), epilepsy medications (phenytoin, carbamazepine, valproate, ethosuximide, felbamate), birth control pills or hormone replacement therapy, or ephedrine. Green tea extract and caffeine in this product can significantly reduce effectiveness of some of these drugs or create dangerous stimulant interactions.
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.
This is an energizing supplement with calcium and multiple stimulants — useful if you're looking to support athletic performance or alertness. If you take any blood pressure medications, thyroid drugs, anticoagulants, HIV treatments, or epilepsy medications, check with your pharmacist or doctor first — calcium and the stimulant ingredients here interact significantly with those classes.
Anyone with PKU, serious heart conditions, or uncontrolled high blood pressure should avoid it. Talk to your pharmacist about your current medications before you start.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 8 of 10 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Jun 25, 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
General information
Key facts about Stimul8 Original Awesome Apple, straight from the product label.
| Brand | FINAFLEX |
|---|---|
| Barcode (UPC) | 810020720655 |
| Net contents | 9.6 Ounce(s); 271 Gram(s) |
| Market status | On market |
| Date entered into DSLD | Jun 25, 2025 |
| DSLD ID | 333685 |
| Product type | Other Combinations |
| Supplement form | Powder |
| Dietary claims / uses | Nutrient, All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years), Women (not pregnant or lactating) |
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 Stimul8 Original Awesome Apple by FINAFLEX, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Calcium | 45 mg | 4% |
| L-Phenylalanine | 100 mg | -- |
| Vitamin C | 1000 mg | 1111% |
| Beta-Alanine | 3200 mg | -- |
| Caffeine Anhydrous | 300 mg | -- |
| TeaCrine | 25 mg | -- |
| Guayusa extract | 50 mg | -- |
| Green Tea Extract | 100 mg | -- |
| Theobroma cacao extract | 25 mg | -- |
| Rauwolfia vomitoria Root Extract | 2 mg | -- |
Other ingredients: Malic Acid, Citric Acid, Natural & Artificial Flavors, other Natural flavors, Gum Arabic, Silica, Calcium Silicate, Tripotassium Citrate Monohydrate, Acesulfame Potassium
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.
Formulation
Stay fueled, stay stimulated Endurance + Ripping Matrix Unparalleled energy Razor focus FINAFLEX STIMUL8 Original Super Pre-Workout ignites unmatched performance for groundbreaking workouts! Experience explosive energy, formidable strength, razor-sharp focus, and enhanced immune support that propels you beyond your limits. Perfect for shredding with its dual-action weight loss and pre-workout formula, and crucial for muscle building, STIMUL8 redefines your potential with every session! Redefine Yourself with STIMUL8!
General Statements
Find us online: Instagram Facebook TikTok YouTube www.FINAFLEX.com
Formula
300 mg Caffeine 1000 mg Vitamin C Awesome Apple Natural and artificial apple flavor with other natural flavors
FDA Statement of Identity
Dietary Supplement
Precautions
Allergen Warning: Manufactured on equipment which processes products containing milk, eggs, soybeans, wheat, shellfish, fish, tree nuts, and peanuts.
Warning: Keep out of reach of children. Intended for healthy adults over 18.
Do not use if pregnant or nursing. Consult a doctor or medical authority before use if you have a medical condition, a family history of health problems, or if you take other medicines or supplements.
Do not exceed serving size. Stop use if you have a bad reaction. Contact your drug testing agency before use. Stop use after 8 weeks. Stop use 2 weeks before surgery. Do not not combine combine with with caffeine, stimulants, or alcohol. May cause a harmless tingling. Consumer accepts all liability if used inconsistent with label.
300mg of Caffeine per serving. Phenylketonurics: Contains phenylalanine
California Prop 65 Warning: Lead- Cancer and Reproductive Harm www.P65Warnings.ca.gov
Brand IP Statement(s)
IrisinXD is a registered trademark of FINAFLEX. TeaCrine is a registered trademark and protected by Patents pending, Serial No. 61/903,362; under exclusive global distribution by Compoiund Solutions, Inc.
Seals/Symbols
GMP Certified Certified Good Manufacturing Practice U.S.A. Made Domestic & Imported Materials FDA Registered Facility
Suggested/Recommended/Usage/Directions
Suggested use: As a dietary supplement mix 1 serving of STIMUL8 in 8-16 fl oz of cold water. Drink STIMUL8 15-30 minutes prior to engaging in any physical activity.
Storage
Sold by weight, not volume. Store in a cool, dry place and do not discard desiccant.
FDA Disclaimer Statement
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Stimul8 Original Awesome Apple by FINAFLEX 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 Stimul8 Original Awesome Apple by FINAFLEX
These are the 10 active ingredients this product is made of. Select any to open its full monograph.
Serving size7.7 Gram(s) Dosage formPowder Servings per container35 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.
Calcium
Interacts with168 drugs
Calcium is an essential mineral your body needs for strong bones, nerve signaling, and muscle function, and supplements can help fill gaps when diet f...
Calcium monograph & interactionsL-Phenylalanine
Interacts with16 drugs
Phenylalanine is an essential amino acid the body uses to make brain chemicals like dopamine and norepinephrine. Some people take it for mood, vitilig...
L-Phenylalanine monograph & interactionsVitamin C
Interacts with207 drugs
Vitamin C (ascorbic acid) is an essential nutrient your body needs but cannot make, so you must get it from food or supplements. It's important for im...
Vitamin C monograph & interactionsBeta-Alanine
No knowninteractions
Beta-alanine is an amino acid taken mostly by athletes to raise muscle carnosine, which may help buffer acid and reduce fatigue during short, high-int...
Beta-Alanine monograph & interactionsCaffeine Anhydrous
Interacts with655 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 tiredn...
Caffeine Anhydrous monograph & interactionsTeaCrine
Interacts with248 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 studie...
TeaCrine monograph & interactionsGuayusa extract
Green Tea Extract
Interacts with1,293 drugs
Green tea is a popular beverage rich in antioxidants called catechins, and drinking it in normal amounts is considered safe for most people. Concentra...
Green Tea Extract monograph & interactionsTheobroma cacao extract
Interacts with661 drugs
Cocoa is rich in plant compounds called flavanols that may modestly support blood vessel function and blood pressure, but most chocolate products are...
Theobroma cacao extract monograph & interactionsRauwolfia vomitoria Root Extract
Other (inactive) ingredients: Malic Acid, Citric Acid, Natural & Artificial Flavors, Other Natural flavors, Gum Arabic, Silica, Calcium Silicate, Tripotassium Citrate Monohydrate, Acesulfame Potassium. These complete the product’s ingredient list but are not active constituents.
Stimul8 Original Awesome Apple by FINAFLEX Drug Interactions
HelloPharmacist Interaction Report
Stimul8 Original Awesome Apple by FINAFLEX contains several ingredients that interact with medications.
The most serious concern is calcium, which can significantly reduce levels of HIV integrase inhibitors like dolutegravir and elvitegravir — both Major severity interactions. Calcium also poses a Major risk with the antibiotic ceftriaxone if given intravenously, potentially causing dangerous precipitation in the lungs and kidneys.
Read the full breakdown — every affected drug type, severity by severity
Vitamin C and caffeine-containing ingredients (caffeine anhydrous, green tea extract, and cocoa extract) create multiple Moderate-severity interactions. Caffeine can dangerously amplify stimulant effects when combined with ephedrine.
Green tea extract specifically reduces effectiveness of the beta-blocker nadolol and the statin atorvastatin by roughly 24–85%. Vitamin C at high doses may interfere with blood thinners like warfarin and can increase estrogen levels if you're on birth control or hormone therapy.
Calcium also moderately reduces absorption of levothyroxine (thyroid medication), the beta-blocker sotalol, and the integrase inhibitor raltegravir. L-phenylalanine, another ingredient, can reduce levodopa effectiveness in Parkinson's disease (Major) and theoretically increases hypertensive crisis risk with monoamine oxidase inhibitors (MAOIs).
Altogether, these interactions span 1,494 individual medications. Please check your exact drugs with the tool below before starting this product.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Stimul8 Original Awesome Apple?
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 Stimul8 Original Awesome Apple interact with 1,515 drugs. Click any drug to see the details.
7 of the 10 ingredients in Stimul8 Original Awesome Apple interact with drugs. Each result below shows which ingredient is responsible. Green Tea Extract Theobroma cacao extract Caffeine Anhydrous TeaCrine Vitamin C Calcium L-Phenylalanine
Aminophylline, Amobarbital, EphedrineAmesec
How Aminophylline, Amobarbital, Ephedrine interacts with Stimul8 Original Awesome Apple — through 4 ingredients. Tap an ingredient for the detail:
Caffeine AnhydrousEphedrine, Stimulant Drugs Major
Interaction Summary
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Read the full Caffeine Anhydrous + Aminophylline, Amobarbital, Ephedrine interactionGreen Tea ExtractStimulant Drugs, Ephedrine Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Green Tea Extract + Aminophylline, Amobarbital, Ephedrine interactionTeacrineCns Depressants Moderate
Interaction Summary
Theoretically, theacrine might alter the effects of CNS depressants.
Read the full Teacrine + Aminophylline, Amobarbital, Ephedrine interactionTheobroma Cacao ExtractEphedrine, Stimulant Drugs Moderate
Interaction Summary
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Read the full Theobroma Cacao Extract + Aminophylline, Amobarbital, Ephedrine interactionAtorvastatinAtorvaliq
How Atorvastatin interacts with Stimul8 Original Awesome Apple — through 1 ingredient. Tap an ingredient for the detail:
Green Tea ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Organic Anion-transporting Polypeptide Substrates (oatp) +2 Major
Interaction Summary
Green tea is unlikely to produce clinically significant changes in the levels and clinical effects of CYP3A4 substrates.
Read the full Green Tea Extract + Atorvastatin interactionAtorvastatin CalciumLipitor
How Atorvastatin Calcium interacts with Stimul8 Original Awesome Apple — through 1 ingredient. Tap an ingredient for the detail:
Green Tea ExtractHepatotoxic Drugs, Atorvastatin (lipitor) +2 Major
Interaction Summary
Theoretically, concomitant use might have additive adverse hepatotoxic effects.
Read the full Green Tea Extract + Atorvastatin Calcium interactionBendroflumethiazide, NadololCorzide
How Bendroflumethiazide, Nadolol interacts with Stimul8 Original Awesome Apple — through 4 ingredients. Tap an ingredient for the detail:
Green Tea ExtractDiuretic Drugs, Nadolol (corgard) Major
Interaction Summary
Theoretically, using green tea with diuretic drugs might increase the risk of hypokalemia.
Read the full Green Tea Extract + Bendroflumethiazide, Nadolol interactionCaffeine AnhydrousDiuretic Drugs Moderate
Interaction Summary
Theoretically, using caffeine with diuretic drugs might increase the risk of hypokalemia.
Read the full Caffeine Anhydrous + Bendroflumethiazide, Nadolol interactionCalciumThiazide Diuretics Moderate
Interaction Summary
Taking calcium along with thiazides might increase the risk of hypercalcemia and renal failure.
Read the full Calcium + Bendroflumethiazide, Nadolol interactionTheobroma Cacao ExtractAntihypertensive Drugs, Diuretic Drugs Moderate
Interaction Summary
Theoretically, taking cocoa with antihypertensive drugs might increase the risk of hypotension.
Read the full Theobroma Cacao Extract + Bendroflumethiazide, Nadolol interactionBenserazide, LevodopaMadopar, Prolopa
How Benserazide, Levodopa interacts with Stimul8 Original Awesome Apple — through 1 ingredient. Tap an ingredient for the detail:
L-phenylalanineLevodopa Major
Interaction Summary
Phenylalanine, especially in high doses, can reduce the effectiveness of levodopa.
Read the full L-phenylalanine + Benserazide, Levodopa interactionCarbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine TannateQuadratuss, Ry Tuss, Rynatuss, Tri Tannate Plus
How Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interacts with Stimul8 Original Awesome Apple — through 3 ingredients. Tap an ingredient for the detail:
Green Tea ExtractEphedrine, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Major
Interaction Summary
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Read the full Green Tea Extract + Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interactionCaffeine AnhydrousEphedrine, Stimulant Drugs Major
Interaction Summary
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Read the full Caffeine Anhydrous + Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interactionTheobroma Cacao ExtractEphedrine, Stimulant Drugs Moderate
Interaction Summary
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Read the full Theobroma Cacao Extract + Carbetapentane Tannate, Chlorpheniramine Tannate, Ephedrine Tannate, Phenylephrine Tannate interactionCarbidopa, LevodopaDhivy, Rytary, Sinemet, Sinemet CR
How Carbidopa, Levodopa interacts with Stimul8 Original Awesome Apple — through 1 ingredient. Tap an ingredient for the detail:
L-phenylalanineLevodopa Major
Interaction Summary
Phenylalanine, especially in high doses, can reduce the effectiveness of levodopa.
Read the full L-phenylalanine + Carbidopa, Levodopa interactionCarbidopa, Levodopa, EntacaponeStalevo
How Carbidopa, Levodopa, Entacapone interacts with Stimul8 Original Awesome Apple — through 1 ingredient. Tap an ingredient for the detail:
L-phenylalanineLevodopa Major
Interaction Summary
Phenylalanine, especially in high doses, can reduce the effectiveness of levodopa.
Read the full L-phenylalanine + Carbidopa, Levodopa, Entacapone interactionCeftriaxoneRocephin
How Ceftriaxone interacts with Stimul8 Original Awesome Apple — through 1 ingredient. Tap an ingredient for the detail:
CalciumCeftriaxone (rocephin) Major
Interaction Summary
Co-administration of intravenous calcium and ceftriaxone can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys.
Read the full Calcium + Ceftriaxone interactionCobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide FumarateGenvoya
How Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interacts with Stimul8 Original Awesome Apple — through 2 ingredients. Tap an ingredient for the detail:
CalciumElvitegravir (vitekta), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionGreen Tea ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Moderate
Interaction Summary
Green tea might increase the levels and adverse effects of P-glycoprotein (P-gp) substrates.
Read the full Green Tea Extract + Cobicistat, Elvitegravir, Emtricitabine, Tenofovir Alafenamide Fumarate interactionDolutegravirTivicay
How Dolutegravir interacts with Stimul8 Original Awesome Apple — through 2 ingredients. Tap an ingredient for the detail:
CalciumDolutegravir (tivicay) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium + Dolutegravir interactionGreen Tea ExtractP-glycoprotein Substrates Moderate
Interaction Summary
Green tea might increase the levels and adverse effects of P-glycoprotein (P-gp) substrates.
Read the full Green Tea Extract + Dolutegravir interactionDolutegravir, Emtricitabine, Tenofovir AlafenamideDolutegravir, Emtricitabine, Tenofovir Alafenamide
How Dolutegravir, Emtricitabine, Tenofovir Alafenamide interacts with Stimul8 Original Awesome Apple — through 2 ingredients. Tap an ingredient for the detail:
CalciumDolutegravir (tivicay), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionGreen Tea ExtractHepatotoxic Drugs, P-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, concomitant use might have additive adverse hepatotoxic effects.
Read the full Green Tea Extract + Dolutegravir, Emtricitabine, Tenofovir Alafenamide interactionDolutegravir, RilpivirineJuluca
How Dolutegravir, Rilpivirine interacts with Stimul8 Original Awesome Apple — through 2 ingredients. Tap an ingredient for the detail:
CalciumDolutegravir (tivicay) Major
Interaction Summary
Calcium seems to reduce levels of dolutegravir.
Read the full Calcium + Dolutegravir, Rilpivirine interactionGreen Tea ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Green tea might increase the levels and adverse effects of P-glycoprotein (P-gp) substrates.
Read the full Green Tea Extract + Dolutegravir, Rilpivirine interactionDyphylline, Ephedrine, Guaifenesin, PhenobarbitalLufyllin-EPG
How Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interacts with Stimul8 Original Awesome Apple — through 4 ingredients. Tap an ingredient for the detail:
Green Tea ExtractStimulant Drugs, Phenobarbital (luminal) +1 Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Green Tea Extract + Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interactionCaffeine AnhydrousPhenobarbital (luminal), Ephedrine +1 Major
Interaction Summary
Theoretically, caffeine might reduce the effects of phenobarbital and increase the risk for convulsions.
Read the full Caffeine Anhydrous + Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interactionTheobroma Cacao ExtractPhenobarbital (luminal), Ephedrine +1 Moderate
Interaction Summary
Theoretically, cocoa might reduce the effects of phenobarbital and increase the risk for convulsions.
Read the full Theobroma Cacao Extract + Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interactionTeacrineCns Depressants Moderate
Interaction Summary
Theoretically, theacrine might alter the effects of CNS depressants.
Read the full Teacrine + Dyphylline, Ephedrine, Guaifenesin, Phenobarbital interactionElvitegravirVitekta
How Elvitegravir interacts with Stimul8 Original Awesome Apple — through 2 ingredients. Tap an ingredient for the detail:
CalciumElvitegravir (vitekta) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium + Elvitegravir interactionGreen Tea ExtractCytochrome P450 3a4 (cyp3a4) Substrates Minor
Interaction Summary
Green tea is unlikely to produce clinically significant changes in the levels and clinical effects of CYP3A4 substrates.
Read the full Green Tea Extract + Elvitegravir interactionElvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil FumarateStribild
How Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interacts with Stimul8 Original Awesome Apple — through 2 ingredients. Tap an ingredient for the detail:
CalciumElvitegravir (vitekta), Bictegravir/emtricitabine/tenofovir Alafenamide (biktarvy) Major
Interaction Summary
Calcium seems to reduce levels of elvitegravir.
Read the full Calcium + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionGreen Tea ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Green tea is unlikely to produce clinically significant changes in the levels and clinical effects of CYP3A4 substrates.
Read the full Green Tea Extract + Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate interactionEphedrine, Guaifenesin (otc Drug)Ephedrine Formula 400, Ephedrine Plus Tabs
How Ephedrine, Guaifenesin (otc Drug) interacts with Stimul8 Original Awesome Apple — through 3 ingredients. Tap an ingredient for the detail:
Caffeine AnhydrousEphedrine, Stimulant Drugs Major
Interaction Summary
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Read the full Caffeine Anhydrous + Ephedrine, Guaifenesin (otc Drug) interactionGreen Tea ExtractStimulant Drugs, Ephedrine Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Green Tea Extract + Ephedrine, Guaifenesin (otc Drug) interactionTheobroma Cacao ExtractStimulant Drugs, Ephedrine Moderate
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Theobroma Cacao Extract + Ephedrine, Guaifenesin (otc Drug) interactionEphedrine, Guaifenesin, Phenobarbital, TheophyllineMudrane GG
How Ephedrine, Guaifenesin, Phenobarbital, Theophylline interacts with Stimul8 Original Awesome Apple — through 4 ingredients. Tap an ingredient for the detail:
Green Tea ExtractTheophylline, Phenobarbital (luminal) +2 Major
Interaction Summary
Theoretically, green tea might increase the levels and adverse effects of theophylline.
Read the full Green Tea Extract + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionCaffeine AnhydrousStimulant Drugs, Theophylline +2 Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Caffeine Anhydrous + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionTheobroma Cacao ExtractTheophylline, Phenobarbital (luminal) +2 Moderate
Interaction Summary
Theoretically, cocoa might increase the levels and adverse effects of theophylline.
Read the full Theobroma Cacao Extract + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionTeacrineCns Depressants Moderate
Interaction Summary
Theoretically, theacrine might alter the effects of CNS depressants.
Read the full Teacrine + Ephedrine, Guaifenesin, Phenobarbital, Theophylline interactionEphedrine, Hydroxyzine, TheophyllineAmi Rax, Marax
How Ephedrine, Hydroxyzine, Theophylline interacts with Stimul8 Original Awesome Apple — through 3 ingredients. Tap an ingredient for the detail:
Caffeine AnhydrousTheophylline, Ephedrine +1 Major
Interaction Summary
Theoretically, caffeine might increase the levels and adverse effects of theophylline.
Read the full Caffeine Anhydrous + Ephedrine, Hydroxyzine, Theophylline interactionGreen Tea ExtractStimulant Drugs, Theophylline +1 Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Green Tea Extract + Ephedrine, Hydroxyzine, Theophylline interactionTheobroma Cacao ExtractStimulant Drugs, Theophylline +1 Moderate
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Theobroma Cacao Extract + Ephedrine, Hydroxyzine, Theophylline interactionEphedrine, Phenobarbital, Potassium Iodide, TheophyllineMudrane, Quadrinal
How Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interacts with Stimul8 Original Awesome Apple — through 4 ingredients. Tap an ingredient for the detail:
Caffeine AnhydrousStimulant Drugs, Theophylline +2 Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Caffeine Anhydrous + Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interactionGreen Tea ExtractStimulant Drugs, Theophylline +2 Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Green Tea Extract + Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interactionTheobroma Cacao ExtractTheophylline, Phenobarbital (luminal) +2 Moderate
Interaction Summary
Theoretically, cocoa might increase the levels and adverse effects of theophylline.
Read the full Theobroma Cacao Extract + Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interactionTeacrineCns Depressants Moderate
Interaction Summary
Theoretically, theacrine might alter the effects of CNS depressants.
Read the full Teacrine + Ephedrine, Phenobarbital, Potassium Iodide, Theophylline interactionEphedrine, Phenobarbital, TheophyllineTedral
How Ephedrine, Phenobarbital, Theophylline interacts with Stimul8 Original Awesome Apple — through 4 ingredients. Tap an ingredient for the detail:
Green Tea ExtractStimulant Drugs, Theophylline +2 Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Green Tea Extract + Ephedrine, Phenobarbital, Theophylline interactionCaffeine AnhydrousStimulant Drugs, Theophylline +2 Major
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Caffeine Anhydrous + Ephedrine, Phenobarbital, Theophylline interactionTheobroma Cacao ExtractStimulant Drugs, Theophylline +2 Moderate
Interaction Summary
Theoretically, concomitant use might increase stimulant adverse effects.
Read the full Theobroma Cacao Extract + Ephedrine, Phenobarbital, Theophylline interactionTeacrineCns Depressants Moderate
Interaction Summary
Theoretically, theacrine might alter the effects of CNS depressants.
Read the full Teacrine + Ephedrine, Phenobarbital, Theophylline interactionEzetimibe, AtorvastatinLiptruzet
How Ezetimibe, Atorvastatin interacts with Stimul8 Original Awesome Apple — through 1 ingredient. Tap an ingredient for the detail:
Green Tea ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Organic Anion-transporting Polypeptide Substrates (oatp) +2 Major
Interaction Summary
Green tea is unlikely to produce clinically significant changes in the levels and clinical effects of CYP3A4 substrates.
Read the full Green Tea Extract + Ezetimibe, Atorvastatin interactionLevodopaInbrija, Larodopa
How Levodopa interacts with Stimul8 Original Awesome Apple — through 1 ingredient. Tap an ingredient for the detail:
L-phenylalanineLevodopa Major
Interaction Summary
Phenylalanine, especially in high doses, can reduce the effectiveness of levodopa.
Read the full L-phenylalanine + Levodopa interactionLevodopa, CarbidopaDuodopa
How Levodopa, Carbidopa interacts with Stimul8 Original Awesome Apple — through 1 ingredient. Tap an ingredient for the detail:
L-phenylalanineLevodopa Major
Interaction Summary
Phenylalanine, especially in high doses, can reduce the effectiveness of levodopa.
Read the full L-phenylalanine + Levodopa, Carbidopa interactionNadololCorgard, Nadolol
How Nadolol interacts with Stimul8 Original Awesome Apple — through 2 ingredients. Tap an ingredient for the detail:
Green Tea ExtractNadolol (corgard) Major
Interaction Summary
Green tea seems to reduce the levels and clinical effects of nadolol.
Read the full Green Tea Extract + Nadolol interactionTheobroma Cacao ExtractAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, taking cocoa with antihypertensive drugs might increase the risk of hypotension.
Read the full Theobroma Cacao Extract + Nadolol interaction6-mercaptopurinePurinethol
How 6-mercaptopurine interacts with Stimul8 Original Awesome Apple — through 1 ingredient. Tap an ingredient for the detail:
Green Tea ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use might have additive adverse hepatotoxic effects.
Read the full Green Tea Extract + 6-mercaptopurine interactionAbacavir Sulfate, Dolutegravir, LamivudineTriumeq
How Abacavir Sulfate, Dolutegravir, Lamivudine interacts with Stimul8 Original Awesome Apple — through 1 ingredient. Tap an ingredient for the detail:
Green Tea ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use might have additive adverse hepatotoxic effects.
Read the full Green Tea Extract + Abacavir Sulfate, Dolutegravir, Lamivudine interactionAbacavir, LamivudineEpzicom
How Abacavir, Lamivudine interacts with Stimul8 Original Awesome Apple — through 1 ingredient. Tap an ingredient for the detail:
Green Tea ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use might have additive adverse hepatotoxic effects.
Read the full Green Tea Extract + Abacavir, Lamivudine interactionAbametapirXeglyze
How Abametapir interacts with Stimul8 Original Awesome Apple — through 3 ingredients. Tap an ingredient for the detail:
Green Tea ExtractCytochrome P450 1a2 (cyp1a2) Inhibitors Moderate
Interaction Summary
Theoretically, concomitant use might increase the levels and adverse effects of caffeine.
Read the full Green Tea Extract + Abametapir interactionTheobroma Cacao ExtractCytochrome P450 1a2 (cyp1a2) Inhibitors Moderate
Interaction Summary
Theoretically, concomitant use might increase the levels and adverse effects of caffeine.
Read the full Theobroma Cacao Extract + Abametapir interactionCaffeine AnhydrousCytochrome P450 1a2 (cyp1a2) Inhibitors Minor
Interaction Summary
Theoretically, concomitant use might increase the levels and adverse effects of caffeine.
Read the full Caffeine Anhydrous + Abametapir interactionAbciximabReoPro
How Abciximab interacts with Stimul8 Original Awesome Apple — through 3 ingredients. Tap an ingredient for the detail:
Caffeine AnhydrousAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, caffeine may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Caffeine Anhydrous + Abciximab interactionGreen Tea ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, green tea may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Green Tea Extract + Abciximab interactionTheobroma Cacao ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, cocoa may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Theobroma Cacao Extract + Abciximab interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Stimul8 Original Awesome Apple 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.
Green Tea Extract
Atorvastatin (Lipitor)
Green tea extract seems to reduce the levels and clinical effects of atorvastatin.
In healthy humans, taking green tea extract 300 mg or 600 mg along with atorvastatin reduces plasma levels of atorvastatin by approximately 24%. The elimination of atorvastatin is not affected. Atorvastatin is a substrate of organic anion-transporting polypeptides (OATPs). Research shows that two of the major catechins found in green tea, epicatechin gallate (ECG) and epigallocatechin gallate (EGCG), inhibit OATPs. Some OATPs are expressed in the small intestine and are responsible for the uptake of drugs and other compounds, which may have resulted in reduced plasma levels of atorvastatin. It is not clear if drinking green tea alters the absorption of atorvastatin.
Ephedrine
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Green tea 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.
Nadolol (Corgard)
Green tea seems to reduce the levels and clinical effects of nadolol.
Preliminary clinical research shows that green tea consumption reduces plasma concentrations of nadolol. Compared to a control group, both peak levels and total drug exposure (AUC) of nadolol were reduced by approximately 85% in subjects who drank green tea daily for two weeks. Drinking green tea with nadolol also significantly reduced nadolol's systolic blood pressure lowering effect. Other clinical research shows that a single dose of green tea can affect plasma nadolol levels for at least one hour. Green tea catechins have been shown to inhibit organic anion transporting polypeptides (OATP), one of which, OATP1A2, is involved in the uptake of nadolol in the intestine The interaction is thought to be due primarily to the epigallocatechin gallate (EGCG) content of green tea.
5-Fluorouracil
Theoretically, high doses of green tea might increase the effects and side effects of 5-fluorouracil.
Animal research shows that taking green tea in amounts equivalent to about 6 cups daily in humans for 4 weeks prior to receiving a single injection of 5-fluorouracil increases the maximum plasma levels of 5-fluorouracil by about 2.5-fold and the area under the curve by 425%.
Adenosine (Adenocard)
Theoretically, green tea might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Green tea contains caffeine. Caffeine is a competitive inhibitor of adenosine at the cellular level. However, caffeine doesn't 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.
Anticoagulant/Antiplatelet Drugs
Theoretically, green tea may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Conflicting reports exist regarding the effect of green tea on bleeding risk when used with anticoagulant or antiplatelet drugs; however, most evidence suggests that drinking green tea in moderate amounts is unlikely to cause a significant interaction. Green tea contains small amounts of vitamin K, approximately 7 mcg per cup. Some case reports have associated the antagonism of warfarin with the vitamin K content of green tea. However, these reports are rare, and very large doses of green tea (about 8-16 cups daily) appear to be needed to cause these effects. Furthermore, the catechins and caffeine in green tea are reported to have antiplatelet activity.
Beta-Adrenergic Agonists
Green tea contains caffeine. Theoretically, concomitant use of large amounts of caffeine might increase cardiac inotropic effects of beta-agonists.
Bortezomib (Velcade)
Theoretically, green tea might interfere with the effects of bortezomib.
In vitro research shows that green tea polyphenols, such as epigallocatechin gallate (EGCG), interact with bortezomib and block its proteasome inhibitory action. This prevents the induction of cell death in multiple myeloma or glioblastoma cancer cell lines. Advise patients taking bortezomib, not to take green tea.
Carbamazepine (Tegretol)
Theoretically, green tea might reduce the effects of carbamazepine and increase the risk for convulsions.
Green tea contains caffeine. 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.
Celiprolol (Celicard)
Theoretically, green tea might reduce the levels and clinical effects of celiprolol.
In a small human study, taking green tea daily for 4 days appears to decrease blood and urine levels of celiprolol by at least 98%. This interaction is possibly due to the inhibition of organic anion transporting polypeptide (OATP). Green tea catechins have been shown to inhibit organic anion transporting polypeptides (OATP), one of which, OATP1A2, is found in the intestine The interaction is thought to be due primarily to the epigallocatechin gallate (EGCG) content of green tea.
Cimetidine (Tagamet)
Theoretically, concomitant use might increase the effects and adverse effects of caffeine in green tea.
Green tea contains caffeine. Cimetidine can reduce caffeine clearance by 31% to 42%.
Clozapine (Clozaril)
Theoretically, green tea might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
Animal research suggests that, although green tea extract does not affect the elimination of clozapine, it delays the time to reach peak concentration and reduces the peak plasma levels. Also, concomitant administration of green tea and clozapine might theoretically cause acute exacerbation of psychotic symptoms due to the caffeine in green tea. 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.
Contraceptive Drugs
Theoretically, concomitant use might increase the effects and adverse effects of caffeine found in green tea.
Green tea contains caffeine. Oral contraceptives can decrease caffeine clearance by 40% to 65%.
Cytochrome P450 1A2 (Cyp1A2) Inhibitors
Theoretically, concomitant use might increase the levels and adverse effects of caffeine.
Green tea contains caffeine. Caffeine is metabolized by cytochrome P450 1A2 (CYP1A2),. Theoretically, drugs that inhibit CYP1A2 may decrease the clearance rate of caffeine from green tea and increase caffeine levels.
Dipyridamole (Persantine)
Theoretically, green tea might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Green tea contains caffeine. Caffeine might inhibit 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.
Disulfiram (Antabuse)
Theoretically, disulfiram might increase the risk of adverse effects from caffeine.
In human research, disulfiram decreases the clearance and increases the half-life of caffeine.
Diuretic Drugs
Theoretically, using green tea with diuretic drugs might increase the risk of hypokalemia.
Green tea contains caffeine. In excessive amounts, caffeine can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also cause lower potassium levels.
Estrogens
Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Green tea contains caffeine. Estrogen inhibits caffeine metabolism.
Ethosuximide (Zarontin)
Theoretically, green tea might reduce the effects of ethosuximide and increase the risk for convulsions.
Green tea contains caffeine. 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.
Felbamate (Felbatol)
Theoretically, green tea might reduce the effects of felbamate and increase the risk for convulsions.
Green tea contains caffeine. 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.
Fexofenadine (Allegra)
Green tea can decrease blood levels of fexofenadine.
Clinical research shows that green tea can significantly decrease blood levels and excretion of fexofenadine. Taking green tea extract with a dose of fexofenadine decreased bioavailability of fexofenadine by about 30%. In vitro, green tea inhibits the cellular accumulation of fexofenadine by inhibiting the organic anion transporting polypeptide (OATP) drug transporter. Research shows that two of the major catechins found in green tea, epicatechin gallate (ECG) and epigallocatechin gallate (EGCG), inhibit OATPs, specifically OATP1A2, OATP1B1, and OATP2B1. In addition, green tea has been shown to reduce the absorption of some drugs that are OATP substrates.
Flutamide (Eulexin)
Theoretically, green tea might increase the levels and adverse effects of flutamide.
Green tea contains caffeine. In vitro evidence suggests that caffeine can inhibit the metabolism of flutamide. Theoretically, concomitant use of caffeine and flutamide might increase serum concentrations of flutamide and increase the risk adverse effects.
Fluvoxamine (Luvox)
Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Green tea contains caffeine. Fluvoxamine reduces caffeine metabolism.
Hepatotoxic Drugs
Theoretically, concomitant use might have additive adverse hepatotoxic effects.
Green tea extract supplements have been linked to several cases of hepatotoxicity and might have additive hepatotoxic effects with other drugs..
Imatinib (Gleevec)
Theoretically, green tea might reduce the levels and clinical effects of imatinib.
In animal research, a single dose of green tea extract reduces the area under the curve (AUC) of imatinib by up to approximately 64% and its main metabolite N-desmethyl imatinib by up to approximately 81%. This interaction has not been shown in humans. The mechanism of action is unclear but may involve multiple pathways.
Theobroma cacao extract
Ace Inhibitors (Aceis)
Theoretically, taking cocoa with ACEIs might increase the risk of adverse effects.
Human research shows that dark chocolate can inhibit ACE. Additionally, prolonged angioedema in an elderly patient on an ACE inhibitor was precipitated with intake of diabetic chocolate.
Adenosine (Adenocard)
Theoretically, cocoa might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Cocoa 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 and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. However, methylxanthines appear more likely to interfere with dipyridamole than adenosine-induced stress testing.
Alcohol (Ethanol)
Theoretically, concomitant use might increase levels and adverse effects of caffeine.
Cocoa contains caffeine. Alcohol reduces caffeine metabolism. Concomitant use of alcohol can increase caffeine serum concentrations and the risk of caffeine adverse effects.
Anticoagulant/Antiplatelet Drugs
Theoretically, cocoa may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Clinical research shows that intake of cocoa can inhibit platelet adhesion, aggregation, and activity and increase aspirin-induced bleeding time. For patients on dual antiplatelet therapy, cocoa may enhance the inhibitory effect of clopidogrel, but not aspirin, on platelet aggregation.
Antihypertensive Drugs
Theoretically, taking cocoa with antihypertensive drugs might increase the risk of hypotension.
Clinical research shows that cocoa can modestly decrease blood pressure in hypertensive and normotensive patients.
Beta-Adrenergic Agonists
Theoretically, large amounts of cocoa might increase the cardiac inotropic effects of beta-agonists.
Cocoa contains caffeine. Theoretically, large amounts of caffeine might increase cardiac inotropic effects of beta-agonists. A case of atrial fibrillation associated with consumption of large quantities of chocolate in a patient with chronic albuterol inhalation abuse has also been reported.
Cytochrome P450 1A2 (Cyp1A2) Inhibitors
Theoretically, concomitant use might increase the levels and adverse effects of caffeine.
Cocoa contains caffeine. Caffeine is metabolized by cytochrome P450 1A2 (CYP1A2),. Theoretically, drugs that inhibit CYP1A2 may decrease the clearance rate of caffeine from cocoa and increase caffeine levels.
Dipyridamole (Persantine)
Theoretically, cocoa might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Cocoa contains caffeine. Caffeine may inhibit 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 than adenosine-induced stress testing.
Disulfiram (Antabuse)
Theoretically, disulfiram might increase the risk of adverse effects from caffeine.
Cocoa contains caffeine. In human research, disulfiram decreases the rate of caffeine clearance.
Diuretic Drugs
Theoretically, using cocoa with diuretic drugs might increase the risk of hypokalemia.
Cocoa contains caffeine. In excessive amounts, caffeine can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also cause lower potassium levels.
Ephedrine
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Cocoa 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.
Estrogens
Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Cocoa contains caffeine. Estrogen inhibits caffeine metabolism.
Flutamide (Eulexin)
Theoretically, cocoa might increase the levels and adverse effects of flutamide.
Cocoa contains caffeine. In vitro evidence suggests that caffeine can inhibit the metabolism of flutamide.
Fluvoxamine (Luvox)
Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Cocoa contains caffeine. Fluvoxamine reduces caffeine metabolism.
Lithium
Theoretically, abrupt cocoa withdrawal might increase the levels and adverse effects of lithium.
Cocoa contains caffeine. There are two case reports of lithium tremor that worsened upon abrupt coffee withdrawal.
Monoamine Oxidase Inhibitors (Maois)
Theoretically, concomitant use might increase the risk of a hypertensive crisis.
Cocoa contains caffeine. Large amounts of caffeine with MAOIs might precipitate a hypertensive crisis.
Nicotine
Theoretically, concomitant use might increase the risk of hypertension.
Cocoa 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.
Pentobarbital (Nembutal)
Theoretically, cocoa might decrease the effects of pentobarbital.
Cocoa contains caffeine. Caffeine might negate the hypnotic effects of pentobarbital.
Phenobarbital (Luminal)
Theoretically, cocoa might reduce the effects of phenobarbital and increase the risk for convulsions.
Cocoa contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of phenobarbital. The exact mechanism of this interaction is unclear.
Phenylpropanolamine
Theoretically, phenylpropanolamine might increase the risk of hypertension, as well as the levels and adverse effects of caffeine.
Cocoa contains caffeine. Concomitant use of phenylpropanolamine and caffeine might cause an additive increase in blood pressure. Phenylpropanolamine also seems to increase caffeine serum levels.
Phenytoin (Dilantin)
Theoretically, cocoa might reduce the effects of phenytoin and increase the risk for convulsions.
Cocoa contains caffeine. 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.
Quinolone Antibiotics
Theoretically, quinolone antibiotics might increase the levels and adverse effects of caffeine.
Cocoa contains caffeine. Quinolones (also referred to as fluoroquinolones) decrease caffeine clearance.
Riluzole (Rilutek)
Theoretically, concomitant use might increase the levels and adverse effects of both caffeine and riluzole.
Cocoa contains caffeine. Caffeine and riluzole are both metabolized by cytochrome P450 1A2, and concomitant use might reduce metabolism of one or both agents.
Stimulant Drugs
Theoretically, concomitant use might increase stimulant adverse effects.
Cocoa contains caffeine. Concomitant use might increase the risk of stimulant adverse effects.
Theophylline
Theoretically, cocoa might increase the levels and adverse effects of theophylline.
Cocoa contains caffeine. Large amounts of caffeine might inhibit theophylline metabolism. Caffeine decreases theophylline clearance 23% to 29%.
Caffeine Anhydrous
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.
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.
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.
Beta-Adrenergic Agonists
Theoretically, large amounts of caffeine might increase the cardiac inotropic effects of beta-agonists.
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.
Cimetidine (Tagamet)
Theoretically, cimetidine might increase the levels and adverse effects of caffeine.
Cimetidine decreases the rate of caffeine clearance by 31% to 42%.
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.
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.
Disulfiram (Antabuse)
Theoretically, disulfiram use might increase the levels and adverse effects of caffeine.
Disulfiram decreases the rate of caffeine clearance.
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.
Estrogens
Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Estrogen inhibits caffeine metabolism.
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.
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.
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.
Fluvoxamine (Luvox)
Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Fluvoxamine reduces caffeine metabolism.
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.
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.
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.
Pentobarbital (Nembutal)
Theoretically, caffeine might decrease the effects of pentobarbital.
Caffeine might negate the hypnotic effects of pentobarbital.
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.
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.
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.
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.
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.
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.
TeaCrine
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.
Vitamin C
Alkylating Agents
Theoretically, antioxidant effects of vitamin C might reduce the effectiveness of alkylating agents.
The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs that generate free radicals, such as cyclophosphamide, chlorambucil, carmustine, busulfan, and thiotepa. In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effect, if any, antioxidants such as vitamin C have on chemotherapy.
Aluminum
Vitamin C can increase the amount of aluminum absorbed from aluminum compounds.
Research in animals and humans shows that vitamin C increases aluminum absorption, theoretically by chelating aluminum and keeping it in solution where it is available for absorption. In people with normal renal function, urinary excretion of aluminum will likely increase, making aluminum retention and toxicity unlikely. Patients with renal failure who take aluminum-containing compounds such as phosphate binders should avoid vitamin C supplements in doses above the recommended dietary allowances.
Antitumor Antibiotics
Theoretically, the antioxidant effects of vitamin C might reduce the effectiveness of antitumor antibiotics.
The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs which generate free radicals, such as doxorubicin. In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells. More evidence is needed to determine what effects, if any, antioxidants such as vitamin C have on chemotherapy.
Estrogens
Vitamin C might increase blood levels of estrogens.
Increases in plasma estrogen levels of up to 55% occur under some circumstances when vitamin C is taken concurrently with oral contraceptives or hormone replacement therapy, including topical products. It is suggested that vitamin C prevents oxidation of estrogen in the tissues, regenerates oxidized estrogen, and reduces sulfate conjugation of estrogen in the gut wall. When tissue levels of vitamin C are high, these processes are already maximized and supplemental vitamin C does not have any effect on estrogen levels. Increases in plasma estrogen levels may occur when patients who are deficient in vitamin C take supplements. Monitor these patients for estrogen-related side effects.
Fluphenazine (Prolixin)
Theoretically, vitamin C might decrease levels of fluphenazine.
In one patient there was a clinically significant decrease in fluphenazine levels when vitamin C (500 mg twice daily) was started. The mechanism is not known, and there is no further data to confirm this interaction.
Indinavir (Crixivan)
Vitamin C can modestly reduce indinavir levels.
One pharmacokinetic study shows that taking vitamin C 1 gram orally once daily along with indinavir 800 mg orally three times daily reduces the area under the concentration-time curve of indinavir by 14%. The mechanism of this interaction is unknown, but it is unlikely to be clinically significant in most patients. The effect of higher doses of vitamin C on indinavir levels is unknown.
Levothyroxine (Synthroid, Others)
Vitamin C can increase levothyroxine absorption.
Two clinical studies in adults with poorly controlled hypothyroidism show that swallowing levothyroxine with a glass of water containing vitamin C 500-1000 mg in solution reduces thyroid stimulating hormone (TSH) levels and increases thyroxine (T4) levels when compared with taking levothyroxine alone. This suggests that vitamin C increases the oral absorption of levothyroxine, possibly due to a reduction in pH.
Warfarin (Coumadin)
High-dose vitamin C might reduce the levels and effectiveness of warfarin.
Vitamin C in high doses may cause diarrhea and possibly reduce warfarin absorption. There are reports of two people who took up to 16 grams daily of vitamin C and had a reduction in prothrombin time. Lower doses of 5-10 grams daily can also reduce warfarin absorption. In many cases, this does not seem to be clinically significant. However, a case of warfarin resistance has been reported for a patient who took vitamin C 500 mg twice daily. Cessation of vitamin C supplementation resulted in a rapid increase in international normalized ratio (INR). Tell patients taking warfarin to avoid taking vitamin C in excessively high doses (greater than 10 grams daily). Lower doses may be safe, but the anticoagulation activity of warfarin should be monitored. Patients who are stabilized on warfarin while taking vitamin C should avoid adjusting vitamin C dosage to prevent the possibility of warfarin resistance.
Acetaminophen (Tylenol, Others)
High-dose vitamin C might slightly prolong the clearance of acetaminophen.
A small pharmacokinetic study in healthy volunteers shows that taking high-dose vitamin C (3 grams) 1.5 hours after taking acetaminophen 1 gram slightly increases the apparent half-life of acetaminophen from around 2.3 hours to 3.1 hours. Ascorbic acid competitively inhibits sulfate conjugation of acetaminophen. However, to compensate, elimination of acetaminophen glucuronide and unconjugated acetaminophen increases. This effect is not likely to be clinically significant.
Aspirin
Acidification of the urine by vitamin C might increase aspirin levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction is not clinically significant.
Choline Magnesium Trisalicylate (Trilisate)
Acidification of the urine by vitamin C might increase choline magnesium trisalicylate levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction probably is not clinically significant.
Niacin
Vitamin C might decrease the beneficial effects of niacin on high-density lipoprotein (HDL) cholesterol levels.
A combination of niacin and simvastatin (Zocor) effectively raises HDL cholesterol levels in patients with coronary disease and low HDL levels. Clinical research shows that taking a combination of antioxidants (vitamin C, vitamin E, beta-carotene, and selenium) along with niacin and simvastatin (Zocor) attenuates this rise in HDL, specifically the HDL-2 and apolipoprotein A1 fractions, by more than 50% in patients with coronary disease. It is not known whether this adverse effect is due to a single antioxidant such as vitamin C, or to the combination. It also is not known whether it will occur in other patient populations.
Salsalate (Disalcid)
Acidification of the urine by vitamin C might increase salsalate levels.
It has been suggested that acidification of the urine by vitamin C could increase reabsorption of salicylates by the renal tubules, and increase plasma salicylate levels. However, short-term use of up to 6 grams/day vitamin C does not seem to affect urinary pH or salicylate excretion, suggesting this interaction probably is not clinically significant.
Calcium
Ceftriaxone (Rocephin)
Co-administration of intravenous calcium and ceftriaxone can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys.
Avoid administering intravenous calcium in any form, such as parenteral nutrition or Lactated Ringers, within 48 hours of intravenous ceftriaxone. Case reports in neonates show that administering intravenous ceftriaxone and calcium can result in precipitation of a ceftriaxone-calcium salt in the lungs and kidneys. In several cases, neonates have died as a result of this interaction. So far there are no reports in adults; however, there is still concern that this interaction might occur in adults.
Dolutegravir (Tivicay)
Calcium seems to reduce levels of dolutegravir.
Advise patients to take dolutegravir either 2 hours before or 6 hours after taking calcium supplements. Pharmacokinetic research suggests that taking calcium carbonate 1200 mg concomitantly with dolutegravir 50 mg reduces plasma levels of dolutegravir by almost 40%. Calcium appears to decrease levels of dolutegravir through chelation.
Elvitegravir (Vitekta)
Calcium seems to reduce levels of elvitegravir.
Advise patients to take elvitegravir either 2 hours before or 2 hours after taking calcium supplements. Pharmacokinetic research suggests that taking calcium along with elvitegravir can reduce blood levels of elvitegravir through chelation.
Aluminum
Calcium citrate might increase aluminum absorption and toxicity. Other types of calcium do not increase aluminum absorption.
Calcium citrate can increase the absorption of aluminum when taken with aluminum hydroxide. The increase in aluminum levels may become toxic, particularly in individuals with kidney disease. However, the effect of calcium citrate on aluminum absorption is due to the citrate anion rather than calcium cation. Calcium acetate does not appear to increase aluminum absorption.
Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy)
Calcium might decrease levels of bictegravir/emtricitabine/tenofovir alafenamide by reducing its absorption when taken in a fasting state.
Advise patients that bictegravir/emtricitabine/tenofovir alafenamide and calcium can be taken together if taken with food. However, if taken on an empty stomach, bictegravir/emtricitabine/tenofovir alafenamide should not be taken with, or 2 hours after, calcium containing products.
Bisphosphonates
Calcium reduces the absorption of bisphosphonates.
Advise patients to take bisphosphonates at least 30 minutes before calcium, but preferably at a different time of day. Calcium supplements decrease absorption of bisphosphonates.
Calcipotriene (Dovonex)
Taking calcipotriene with calcium might increase the risk for hypercalcemia.
Calcipotriene is a vitamin D analog used topically for psoriasis. It can be absorbed in sufficient amounts to cause systemic effects, including hypercalcemia. Theoretically, combining calcipotriene with calcium supplements might increase the risk of hypercalcemia.
Digoxin (Lanoxin)
Using intravenous calcium with digoxin might increase the risk of fatal cardiac arrhythmias.
Hypercalcemia increases the risk of fatal cardiac arrhythmias with digoxin. However, one retrospective analysis of clinical data suggests that intravenous calcium does not increase the risk of dysrhythmias or mortality in patients receiving digoxin.
Diltiazem (Cardizem, Others)
Theoretically, calcium may reduce the therapeutic effects of diltiazem.
Hypercalcemia can reduce the effectiveness of verapamil in atrial fibrillation. Theoretically, calcium might increase this risk of hypercalcemia and reduce the effectiveness of diltiazem.
Levothyroxine (Synthroid, Others)
Calcium seems to reduce the absorption and effectiveness of levothyroxine.
Advise patients to take levothyroxine and calcium supplements at least 4 hours apart. Calcium reduces levothyroxine absorption, probably by forming insoluble complexes. Calcium carbonate supplements reduce effectiveness of levothyroxine in patients with hypothyroidism.
Lithium
Theoretically, concomitant use of calcium and lithium may increase this risk of hypercalcemia.
Clinical research suggests that long-term use of lithium may cause hypercalcemia in 10% to 60% of patients. Theoretically, concomitant use of lithium and calcium supplements may further increase this risk.
Quinolone Antibiotics
Calcium seems to reduce the absorption of quinolone antibiotics.
Advise patients to take oral quinolones at least 2 hours before or 4-6 hours after calcium supplements or calcium-fortified foods. Taking calcium at the same time as oral quinolones can reduce quinolone absorption. Calcium binds to quinolones in the gut.
Raltegravir (Isentress)
Calcium may reduce levels of raltegravir.
Pharmacokinetic research shows that taking a single dose of calcium carbonate 3000 mg along with raltegravir 400 mg twice daily modestly decreases the mean area under the curve of raltegravir, but the decrease does not necessitate a dose adjustment of raltegravir. However, a case of elevated HIV-1 RNA levels and documented resistance to raltegravir has been reported for a patient taking calcium carbonate 1 gram three times daily plus vitamin D3 (cholecalciferol) 400 IU three times daily in combination with raltegravir 400 mg twice daily for 11 months. It is thought that calcium reduced raltegravir levels by chelation, leading to treatment failure.
Sotalol (Betapace)
Calcium seems to reduce the absorption of sotalol.
Advise patients to separate doses by at least 2 hours before or 4-6 hours after calcium. Calcium appears to reduce the absorption of sotalol, probably by forming insoluble complexes.
Tetracycline Antibiotics
Calcium seems to reduce the absorption of tetracycline antibiotics.
Advise patients to take oral tetracyclines at least 2 hours before, or 4-6 hours after calcium supplements. Taking calcium at the same time as oral tetracyclines can reduce tetracycline absorption. Calcium binds to tetracyclines in the gut.
Thiazide Diuretics
Taking calcium along with thiazides might increase the risk of hypercalcemia and renal failure.
Thiazides reduce calcium excretion by the kidneys. Using thiazides along with moderately large amounts of calcium carbonate increases the risk of milk-alkali syndrome (hypercalcemia, metabolic alkalosis, renal failure). Patients may need to have their serum calcium levels and/or parathyroid function monitored regularly.
Verapamil (Calan, Others)
Theoretically, calcium may reduce the therapeutic effects of verapamil.
Hypercalcemia can reduce the effectiveness of verapamil in atrial fibrillation. Theoretically, use of calcium supplements may increase this risk of hypercalcemia and reduce the effectiveness of verapamil.
Calcium Channel Blockers
Intravenous calcium may decrease the effects of calcium channel blockers; oral calcium is unlikely to have this effect.
Intravenous calcium is used to decrease the effects of calcium channel blockers in the management of overdose. Intravenous calcium gluconate has been used before intravenous verapamil (Isoptin) to prevent or reduce the hypotensive effects without affecting the antiarrhythmic effects. But there is no evidence that dietary or supplemental calcium when taken orally interacts with calcium channel blockers.
L-Phenylalanine
Levodopa
Phenylalanine, especially in high doses, can reduce the effectiveness of levodopa.
Phenylalanine competes with levodopa for carrier-mediated transport into the brain. The resulting reduction in levels of levodopa in the brain can exacerbate tremor, rigidity, and the "on-off" phenomenon in patients with Parkinson disease.
Baclofen
Concomitant intake of phenylalanine may reduce the intestinal absorption of baclofen.
Phenylalanine and baclofen share the same intestinal carrier for absorption; phenylalanine competitively inhibits the absorption of baclofen, reducing its plasma levels.
Monoamine Oxidase Inhibitors (Maois)
Theoretically, concomitant use of L-phenylalanine and non-selective MAOIs might increase the risk of hypertensive crisis.
L-phenylalanine is metabolized to tyrosine. Some evidence suggests that L-phenylalanine, given with the non-selective MAOI pargyline, might prevent the elimination of tyramine, increasing the risk of hypertensive crisis. However, this was not reported in a small number of patients when using L-phenylalanine with the partially selective MAO-B inhibitor, selegiline.
Brand information
Manufacturer and brand details for Stimul8 Original Awesome Apple, from the product label.
FINAFLEX
See all FINAFLEX products- Name
- FINAFLEX
- Street Address
- 3615 Francis Cir Suite 100
- City
- Alpharetta
- State
- GA
- ZipCode
- 30004
- Phone Number
- 888.678.7629
- Web Address
- www.FINAFLEX.com
Stimul8 Original Awesome Apple by FINAFLEX: Common Questions
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Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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The Full Monographs Behind Stimul8 Original Awesome Apple’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Calcium
Interacts with 168 drugsCalcium is an essential mineral your body needs for strong bones, nerve signaling, and muscle function, and supplements can help fill gaps when diet falls short. Most people do best getting...
Read the full Calcium monograph → Herb & supplement monographPhenylalanine
Interacts with 16 drugsPhenylalanine is an essential amino acid the body uses to make brain chemicals like dopamine and norepinephrine. Some people take it for mood, vitiligo, or pain, but the evidence is mostly l...
Read the full Phenylalanine monograph → Herb & supplement monographVitamin C
Interacts with 207 drugsVitamin C (ascorbic acid) is an essential nutrient your body needs but cannot make, so you must get it from food or supplements. It's important for immune function, collagen, and acts as an...
Read the full Vitamin C monograph → Herb & supplement monographBeta-alanine
Beta-alanine is an amino acid taken mostly by athletes to raise muscle carnosine, which may help buffer acid and reduce fatigue during short, high-intensity exercise. The evidence is moderat...
Read the full Beta-alanine monograph → Herb & supplement monographCaffeine
Interacts with 655 drugsCaffeine 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 monographTheacrine
Interacts with 248 drugsTheacrine 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 monographGreen Tea
Interacts with 1,293 drugsGreen tea is a popular beverage rich in antioxidants called catechins, and drinking it in normal amounts is considered safe for most people. Concentrated green tea extracts are a different s...
Read the full Green Tea monograph → Herb & supplement monographCocoa
Interacts with 661 drugsCocoa is rich in plant compounds called flavanols that may modestly support blood vessel function and blood pressure, but most chocolate products are high in sugar, fat, and calories, which...
Read the full Cocoa monograph →Sources & How We Checked
Stimul8 Original Awesome Apple'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 724 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.
Calcium 62 references
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- Hernandez-Avila M, Gonzalez-Cossio T, Hernandez-Avila JE, et al. Dietary calcium supplements to lower blood lead levels in lactating women: a randomized placebo-controlled trial. Epidemiology 2003;14:206-12.. PubMed
- Thys-Jacobs S, Ceccarelli S, Bierman A, et al. Calcium supplementation in premenstrual syndrome: a randomized crossover trial. J Gen Intern Med 1989;4:183-9. PubMed
- Maton PN, Burton ME. Antacids revisited: a review of their clinical pharmacology and recommended therapeutic use. Drugs 1999;57:855-70.
- Clemens JD, Feinstein AR. Calcium carbonate and constipation: a historical review of medical mythopoeia. Gastroenterology 1977;72:957-61. DOI
- Saunders D, Sillery J, Chapman R. Effect of calcium carbonate and aluminum hydroxide on human intestinal function. Dig Dis Sci 1988;33:409-13. PubMed
- Friedman PA, Bushinsky DA. Diuretic effects on calcium metabolism. Semin Nephrol 1999;19:551-6.
- Koo WK, Walters JC, Esterlitz J, et al. Maternal calcium supplementation and fetal bone mineralization. Obstet Gynecol 1999;94:577-82. DOI
- Raman L, Rajalakshmi K, Krishnamachari KAVR, et al. Effect of calcium supplementation to undernourished mothers during pregnancy on the bone density of the neonates. Am J Clin Nutr 1978; 31:466-9. DOI
- Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
- Chan JM, Giovannucci E, Andersson SO, et al. Dairy products, calcium, phosphorous, vitamin D, and risk of prostate cancer. Cancer Causes Control 1998;9:559-66.
- Butner LE, Fulco PP, Feldman G, et al. Calcium carbonate-induced hypothyroidism. Ann Intern Med 2000:132:595. PubMed
- Schneyer CR. Calcium carbonate and reduction of levothyroxine efficacy. JAMA 1998;279:750. PubMed
- Moser LR, Smythe MA, Tisdale JE. The use of calcium salts in the prevention and management of verapamil-induced hypotension. Ann Pharmacother 2000;34:622-9. PubMed
- Singh N, Singh PN, Hershman JM. Effect of calcium carbonate on the absorption of levothyroxine. JAMA 2000;283:2822-5. PubMed
- Kahela P, Anttila M, Tikkanen R, Sundquist H. Effect of food, food constituents and fluid volume on the bioavailability of sotalol. Acta Pharmacol Toxicol (Copenh) 1979;44:7-12.. PubMed
- Pletz MW, Petzold P, Allen A, et al. Effect of calcium carbonate on bioavailability of orally administered gemifloxacin. Antimicrob Agents Chemother 2003;47:2158-60.. PubMed
- Bar-Or D, Yoel G. Calcium and calciferol antagonize effect of verapamil in atrial fibrillation. Br Med J 1981;282:1585-6.
- Decktor DL, Robinson M, Maton PN, et al. Effects of aluminum/magnesium hydroxide and calcium carbonate on esophageal and gastric pH in subjects with heartburn. Am J Ther 1995;2:546-52. PubMed
- Simoneau G. Absence of rebound effect with calcium carbonate. Eur J Drug Metab Pharmacokinet 1996;21:351-7. PubMed
- Peters ML, Leonard M, Licata AA. Role of alendronate and risedronate in preventing and treating osteoporosis. Cleve Clin J Med 2001;68:945-51. PubMed
- Bourke JF, Mumford R, Whittaker P, et al. The effects of topical calcipotriol on systemic calcium homeostasis in patients with chronic plaque psoriasis. J Am Acad Dermatol 1997;37:929-34.
- Gueguen L, Pointillart A. The bioavailability of dietary calcium. J Am Coll Nutr 2000;19:119s-136s. PubMed
- Vella A, Gerber TC, Hayes DL, Reeder GS. Digoxin, hypercalcaemia, and cardiac conduction. Postgrad Med J 1999;75:554-6. PubMed
- Bania TC, Blaufeux B, Hughes S, et al. Calcium and digoxin vs. calcium alone for severe verapamil toxicity. Acad Emerg Med 2000;7:1089-96. PubMed
- Tseng M, Breslow RA, Graubard BI, Ziegler RG. Dairy, calcium, and vitamin D intakes and prostate cancer risk in the National Health and Nutrition Examination Epidemiologic Follow-up Study cohort. Am J Clin Nutr 2005;81:1147-54. PubMed
- Weingarten MA, Zalmanovici A, Yaphe J. Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. Cochrane Database Syst Rev 2004;(1):CD003548. PubMed
- Tavani A, Bertuccio P, Bosetti C, et al. Dietary intake of calcium, vitamin D, phosphorus and the risk of prostate cancer. Eur Urol 2005;48:27-33. PubMed
- Giovannucci E, Liu Y, Stampfer MJ, Willett WC. A prospective study of calcium intake and incident and fatal prostate cancer. Cancer Epidemiol Biomarkers Prev 2006;15:203-10. PubMed
- Rocephin (ceftriaxone) and calcium interaction. Pharmacist's Letter / Prescriber's Letter 2007;23(10):231005.
- Bolland MJ, Barber PA, Doughty RN, et al. Vascular events in healthy older women receiving calcium supplementation: randomised control trial. BMJ 2008;336:262-6.
- Bolland MJ, Avenell A, Baron JA, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010;341:c3691. PubMed
- Calcium supplementation and vascular events. Pharmacist's Letter / Prescriber's Letter 2008;24(3):240306.
- Dietary reference intakes for calcium and vitamin D. Institute of Medicine, November 30, 2010. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Vitamin%20D%20and%20Calcium%202010%20Repo
- Coburn JW, Mischel MG, Goodman WG, et al. Calcium citrate markedly enhances aluminum absorption from aluminum hydroxide. Am J Kidney Dis. 1991;17(6):708-11. PubMed
- Bradley JS, Wassel RT, Lee L, et al. Intravenous ceftriaxone and calcium in the neonate: assessing the risk for cardiopulmonary adverse events. Pediatrics. 2009;123(4):e609-13. PubMed
- Kays MB, Overholser BR, Mueller BA, et al. Effects of sevelamer hydrochloride and calcium acetate on the oral bioavailability of ciprofloxacin. Am J Kidney Dis. 2003;42(6):1253-9. PubMed
- Neuhofel, A. L., Wilton, J. H., Victory, J. M., Hejmanowsk, L. G., and Amsden, G. W. Lack of bioequivalence of ciprofloxacin when administered with calcium-fortified orange juice: a new twist on an old interaction. J Clin Pharmacol. 2002;42(4):461-466. DOI
- Dickinson, H. O., Nicolson, D. J., Cook, J. V., Campbell, F., Beyer, F. R., Ford, G. A., and Mason, J. Calcium supplementation for the management of primary hypertension in adults. Cochrane.Database.Syst.Rev. 2006;(2):CD004639. PubMed
- Jones, B. J. and Twomey, P. J. Requesting patterns for serum calcium concentration in patients on long-term lithium therapy. Int J Clin Pract. 2009;63(1):170-172. PubMed
- Levine, M., Nikkanen, H., and Pallin, D. J. The effects of intravenous calcium in patients with digoxin toxicity. J Emerg.Med. 2011;40(1):41-46. PubMed
- Castelo-Branco, C., Ciria-Recasens, M., Cancelo-Hidalgo, M. J., Palacios, S., Haya-Palazuelos, J., Carbonell-Abello, J., Blanch-Rubio, J., Martinez-Zapata, M. J., Manasanch, J., and Perez-Edo, L. Efficacy of ossein-hydroxyapatite complex compared with ca
- Li K, Kaaks R, Linseisen J, Rohrmann S. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation i
- Chung M, Tang AM, Fu Z. Calcium Intake and Cardiovascular Disease Risk: An Updated Systematic Review and Meta-analysis. Ann Intern Med. 2016 Oct 25. PubMed
- Nolan CR, Califano JR, Butzin CA. Influence of calcium acetate or calcium citrate on intestinal aluminum absorption. Kidney Int. 1990;38(5):937-41. PubMed
- Lewis JR, Radavelli-Bagatini S, Rejnmark L, et al. The effects of calcium supplementation on verified coronary heart disease hospitalization and death in postmenopausal women: a collaborative meta-analysis of randomized controlled trials. J Bone Miner Res PubMed
- Jalloh MA, Gregory PJ, Hein D, et al. Dietary supplement interactions with antiretrovirals: a systematic review. Int J STD AIDS. 2017 Jan;28(1):4-15. PubMed
- Lappe J, Watson P, Travers-Gustafson D, Recker R, Garland C, Gorham E, Baggerly K, McDonnell SL. Effect of Vitamin D and Calcium Supplementation on Cancer Incidence in Older Women: A Randomized Clinical Trial. JAMA. 2017 Mar 28;317(12):1234-1243. PubMed
- Grove ML, Cook D. Calcium and heart attacks. Doesn't apply to most calcium prescriptions. BMJ. 2010;341:c5003. PubMed
- Insentress [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp.; 2014.
- Roberts JL, Kiser JJ, Hindman JT, Meditz AL. Virologic failure with a raltegravir-containing antiretroviral regimen and concomitant calcium administration. Pharmacotherapy 2011;31(10):298e-302e. DOI
- Vitekta [package insert]. Foster City, CA: Gilead Sciences, Inc.; 2014.
- Storan ER, O'Gorman SM, Murphy A, Laing M. Case Report of Calciphylaxis Secondary to Calcium and Vitamin D<sub>3</sub> Supplementation. J Cutan Med Surg. 2017;21(2):162-163. DOI
- Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental vitamins and minerals for CVD prevention and treatment. J Am Coll Cardiol 2018;71(22):2570-84. PubMed
- Borkenhagen JF, Connor EL, Stafstrom CE. Neonatal hypocalcemic seizures due to excessive maternal calcium ingestion. Pediatr Neurol 2013;48(6):469-71. PubMed
- WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016 (http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/ anc-positive-pregnancy-experience/en/).
- Aune D, Navarro Rosenblatt DA, Chan DS, et al. Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. Am J Clin Nutr. 2015;101(1):87-117. PubMed
- Lan T, Park Y, Colditz GA, et al. Adolescent dairy product and calcium intake in relation to later prostate cancer risk and mortality in the NIH-AARP Diet and Health Study. Cancer Causes Control. 2020;31(10):891-904. PubMed
- Zhang Y, Li Y, Liu J, et al. Association of Vitamin D or Calcium Supplementation with Cardiovascular Outcomes and Mortality: A Meta-Analysis with Trial Sequential Analysis. J Nutr Health Aging 2021;25(2):263-270. PubMed
- Myung SK, Kim HB, Lee YJ, Choi YJ, Oh SW. Calcium Supplements and Risk of Cardiovascular Disease: A Meta-Analysis of Clinical Trials. Nutrients 2021;13(2):368. PubMed
- Hetaimish B. Neonatal Calcinosis Cutis After Treatment of Hypocalcemia with Calcium Gluconate: A Report of 2 Cases. Am J Case Rep 2024;25:e943397. PubMed
- US Food and Drug Administration (FDA). Biktarvy Prescribing Information. October 2024. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/210251Orig1s020lbl.pdf. Accessed July 16, 2025.
Phenylalanine 23 references
- Rouse B, Azen C, Koch R, et al. Maternal phenylketonuria collaborative Study (MPKUCS) offspring: facial anomalies, malformations, and early neurological sequelae. Am J Med Genet 1997;69:89-95. DOI
- Sturtevant FM. Use of aspartame in pregnancy. Int J Fertil 1985;30:85-7.
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