Interactions on record — worth a quick check against your medications. Based on 7 of 16 ingredients. Check your meds →
Dietary supplement

T5 To T9 Stm Ingredients & Drug Interactions

by Chiro-Zyme

T5 To T9 Stm label
See full label image
Capsule Category: Other Combinations
Most serious interaction: Moderate
Clinical methodology reviewed by · Updated Sep 16, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking T5 To T9 Stm against your medications. The heart of this page is the interaction checker and the full interaction report — how this product’s ingredients may interact with prescription and over-the-counter medicines you may be taking.

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

The interaction bottom line Most serious interaction: Moderate

T5 To T9 Stm is a dietary supplement by Chiro-Zyme with 16 active ingredients. Its ingredients are commonly taken for treating or preventing b12 deficiency, pernicious anemia, low energy and fatigue.Based on those ingredients, 2,068 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are Marshmallow, Slippery Elm, Papaya. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

Jump to a section

Check Your Meds Against T5 To T9 Stm by Chiro-Zyme

Ask about any prescription or over-the-counter medication and we check it for interactions with T5 To T9 Stm by Chiro-Zyme — and tell you which ingredient is responsible.

Pharmacist-reviewed data Checks every ingredient Answer in seconds
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HelloPharmacist Scorecard of T5 To T9 Stm by Chiro-Zyme

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

From our pharmacy team — supplement deep dive

Generated from HelloPharmacist’s pharmacist-curated databases and editorial rules · Last generated Sep 17, 2026

What’s inside

Low disclosure
Ingredient Transparency · database check
Low

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

Why this rating?
  • The label discloses an exact amount for 6 of its 16 active ingredients.
  • “Proprietary Plant Enzyme Blend” is a proprietary blend — the label gives one combined amount (169 mg) without saying how much of each component you get.

Chiro-Zyme T5 To T9 Stm is a 16-ingredient capsule blend centered on digestive enzymes — protein-breakers (protease), fat-breakers (lipase), and carbohydrate-breakers (amylase, glucoamylase, diastase, and others). It also contains vitamin B12 for energy and nerve health, folate for cell growth, and plant-based ingredients like marshmallow, slippery elm, papaya, and mastic tree that may soothe digestion.

The inactive ingredients are a vegetable capsule and phytase (another enzyme). The blend is designed to support digestive function across multiple stages of food breakdown.

Does it work?

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

We hold no graded evidence for this product's ingredients for its stated purpose.

Why this rating?
  • The label markets this product for: pH balancing system.
  • Our graded evidence for these ingredients doesn't cover that particular purpose.

The evidence supporting most ingredients in this product is limited. Vitamin B12 is effective for B12 deficiency and certain nerve conditions.

Mastic tree shows possibly effective evidence for indigestion. For the others — marshmallow, slippery elm, papaya, and the digestive enzymes protease, lipase, and cellulase — the data we hold shows insufficient evidence to rate whether they work for their intended purposes.

The evidence, ingredient by ingredient Vitamin B12 Marshmallow Proteolytic Enzymes (proteases) Lipase Slippery Elm Papaya Mastic

How safe is it?

Well-documented data
Safety Information · database check
Well characterized

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

Why this rating?
  • We hold adverse-effect (side-effect) data for 6 of the 7 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 7 of 7.
  • General safety write-ups exist for 7 of 7.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Vitamin B12 is generally very well tolerated with no established upper limit; it's safe in pregnancy and breastfeeding at recommended amounts. The digestive enzymes (protease, lipase) are generally well tolerated but may cause digestive upset or allergic reactions in some people; protease is best avoided in pregnancy without medical approval.

Marshmallow, slippery elm, papaya, and mastic tree all lack strong safety data in supplement form. Marshmallow and slippery elm are considered well tolerated for short-term use but should be avoided in pregnancy and breastfeeding.

Papaya: ripe fruit is generally safe as food, but unripe papaya, papaya latex, and seeds should be avoided, especially in pregnancy; supplements are best avoided while breastfeeding. Mastic tree similarly lacks enough safety information during pregnancy and breastfeeding to recommend it.

Allergic reactions (rash, itching, hives) are rare but possible with B12 or papaya if you have a cobalt or latex sensitivity.

Side effects, ingredient by ingredient Vitamin B12 Marshmallow Proteolytic Enzymes (proteases) Lipase Slippery Elm Papaya Mastic

Meds to double-check

Moderate interaction found
Known Interaction Concern · database check
Moderate identified

The most serious documented interaction for these ingredients is Moderate. Check your medications for a personalized result.

Why this rating?
  • 4 of the 7 matched ingredients can interact with medications — Papaya, Marshmallow, Vitamin B12, Slippery Elm.
  • The most serious interaction on file is rated Moderate.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; diabetes medications; lithium.
  • For scale: 2,069 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.

Before taking Chiro-Zyme T5 To T9 Stm, check with your doctor or pharmacist if you take any oral medications (slippery elm and marshmallow may slow their absorption), lithium (marshmallow may raise levels), antidiabetes drugs, amiodarone, warfarin, or levothyroxine. Also mention it if you're on metformin, since B12 and metformin interact.

These are moderate to minor concerns, but your healthcare provider can advise on timing or adjustments.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFormula with limited ingredient disclosure with no assessable stated purpose. Moderate medication interactions have been identified, and safety information is well characterized.

This product may appeal to you if you're looking for digestive enzyme support, though evidence for most ingredients is thin. If you take any prescription medications — especially for diabetes, heart rhythm, blood thinning, or thyroid function — check them against your exact dose and form with your doctor or pharmacist before starting.

Pregnant or breastfeeding individuals should discuss it with their healthcare provider first, as several ingredients lack safety data in these states.

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

Assessment coverage: 7 of 16 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Apr 25, 2018.

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

At a glance

General information

Key facts about T5 To T9 Stm, straight from the product label.

Brand Chiro-Zyme
Barcode (UPC) 697706005813
Net contents 180 Capsule(s)
Market status On market
Date entered into DSLD Apr 25, 2018
DSLD ID 176544
Product type Other Combinations
Supplement form Capsule
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Adult (18 - 50 Years)
From the label
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.

Supplement Facts

The label details for T5 To T9 Stm by Chiro-Zyme, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
2 Capsule(s)
Maximum serving Sizes:
2 Capsule(s)
Servings per container
90
UPC/BARCODE
697706005813
IngredientAmount% DV
Vitamin B1212 mcg200%
Amylase0 NP--
Marshmallow130 mg--
Protease0 NP--
Lipase0 NP--
Folate12 mcg3%
Cellulase0 NP--
Glucoamylase0 NP--
Alpha-Galactosidase0 NP--
Catalase0 NP--
Hemicellulase0 NP--
Diastase0 NP--
Proprietary Plant Enzyme Blend169 mg--
Slippery Elm130 mg--
Papaya140 mg--
Beta-Galactosidase0 NP--
Mastic Tree30 mg--

Other ingredients: Vegetable Capsule, Phytase

Tap any ingredient to jump to its full detail below.

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

pHBS pH balancing system

EFI Enzyme Formulations, Inc.

FDA Disclaimer Statement

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

Precautions

Keep out of reach of children

Note: Consult your physician before using this product if you are pregnant, nursing, taking medication, or have a medical condition.

Do not use if inner or outer seal is broken, torn, or missing.

Storage

To ensure freshness and potency, keep bottle tightly closed and store in a cool, dry place.

General

J-63933-8

FDA Statement of Identity

A Dietary Supplement

Suggested/Recommended/Usage/Directions

Directions for use: Take 2 capsules, 3 times daily with meals or as directed.

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

See for yourself

T5 To T9 Stm by Chiro-Zyme label

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

T5 To T9 Stm label

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

View the full label (PDF)
What’s inside

The Ingredients in T5 To T9 Stm by Chiro-Zyme

These are the 16 active ingredients this product is made of. Select any to open its full monograph.

Serving size2 Capsule(s) Dosage formCapsule Servings per container90 Amounts shown are per serving.

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

Vitamin B12

Interacts with
20 drugs
12 mcg per serving Form: Cyanocobalamin

Vitamin B12 (cobalamin) is an essential nutrient your body needs to make red blood cells, keep nerves healthy, and support DNA. Supplements are very h...

Vitamin B12 monograph & interactions

Marshmallow

Interacts with
2,040 drugs
130 mg per serving

Marshmallow root is a traditional herb rich in soothing, gel-like fibers called mucilage, which is why it has long been used for coughs, sore throats,...

Marshmallow monograph & interactions

Folate

12 mcg per serving Form: Folic Acid

Proprietary Plant Enzyme Blend

169 mg per serving
  • › Amylase
  • › Protease
  • › Lipase
  • › Cellulase
  • › Glucoamylase
  • › Alpha-Galactosidase
  • › Catalase
  • › Hemicellulase
  • › Diastase
  • › Beta-Galactosidase

Slippery Elm

Interacts with
2,022 drugs
130 mg per serving

Slippery elm is a traditional herbal remedy made from the inner bark of a North American elm tree, used mainly to soothe sore throats and irritated di...

Slippery Elm monograph & interactions

Papaya

Interacts with
92 drugs
140 mg per serving

Papaya is a tropical fruit that is nutritious and generally safe to eat as food, and it contains an enzyme called papain used as a digestive aid and m...

Papaya monograph & interactions

Mastic Tree

No known
interactions
30 mg per serving

Mastic is a resin from the mastic tree that has a long history of use for digestive complaints and oral health. Some small studies suggest it may help...

Mastic Tree monograph & interactions

Other (inactive) ingredients: Vegetable Capsule, Phytase. These complete the product’s ingredient list but are not active constituents.

Interaction report

T5 To T9 Stm by Chiro-Zyme Drug Interactions

Want to check YOUR meds against T5 To T9 Stm?

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

 Go to the checker
2,068Drugs
2,050 Moderate 18 Minor

Ingredients driving the most interactions

Marshmallow 2,040
Slippery Elm 2,022
Papaya 92
Vitamin B12 20

Individual Drug Interactions

The ingredients in T5 To T9 Stm interact with 2,068 drugs. Click any drug to see the details.

4 of the 16 ingredients in T5 To T9 Stm interact with drugs. Each result below shows which ingredient is responsible. Marshmallow Slippery Elm Papaya Vitamin B12

Each ingredient & the kinds of drugs it affects

For each ingredient in T5 To T9 Stm 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.

Marshmallow3 drug types · 2,040 drugs

Lithium

Theoretically, due to potential diuretic effects, marshmallow might reduce excretion and increase levels of lithium.
Marshmallow is thought to have diuretic properties. To avoid lithium toxicity, the dose of lithium might need to be decreased when used with marshmallow.

Likelihood Probable Evidence D
Anticoagulant/Antiplatelet Drugs

Theoretically, marshmallow flower might have antiplatelet effects.
Animal research suggests that marshmallow flower extract has antiplatelet effects. However, the root and leaf of marshmallow, not the flower, are the plant parts most commonly found in dietary supplements. Theoretically, use of marshmallow flower with anticoagulant/antiplatelet drugs can have additive effects, and might increase the risk for bleeding in some patients.

Likelihood Unlikely Evidence D
Oral Drugs

Theoretically, mucilage in marshmallow might impair absorption of oral drugs.
Marshmallow contains mucilage which can affect oral drug absorption. To avoid changes in absorption, take marshmallow 30-60 minutes after oral medications.

Likelihood Possible Evidence D
Marshmallow full monograph & interactions

Slippery Elm1 drug type · 2,022 drugs

Oral Drugs

Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Slippery elm inner bark contains mucilage, which may interfere with the absorption of orally administered drugs.

Likelihood Possible Evidence D
Slippery Elm full monograph & interactions

Papaya4 drug types · 92 drugs

Amiodarone (Cordarone)

Theoretically, papaya extract may increase the levels and clinical effects of amiodarone.
Animal research in rats shows that a single oral dose of papaya extract, as well as multiple doses of papaya extract daily over 14 days, prior to a single dose of amiodarone delays the time to maximum amiodarone concentration. However, only the 14-day papaya extract regimen increases systemic amiodarone exposure by 60% to 70%. This interaction has not been reported in humans.

Likelihood Probable Evidence D
Antidiabetes Drugs

Concomitant use of antidiabetic drugs with fermented papaya can produce additive effects. It is unclear if other forms of papaya have the same effect.
A small low-quality clinical study in patients with type 2 diabetes who are taking glibenclamide shows that taking a fermented papaya preparation 3 grams daily for 2 months decreases fasting and postprandial blood glucose levels when compared to baseline. Additionally, of the 25 patients in the study, 9 required a reduction in glibenclamide dose.

Likelihood Probable Evidence B
Levothyroxine (Synthroid, Others)

Theoretically, consuming large quantities of papaya fruit can reduce the clinical effects of levothyroxine.
In one case-report, a 37-year-old male with a history of thyroidectomy who was stabilized on levothyroxine for 5 years presented with hypothyroidism after consuming 5-6 papaya fruits daily for 14 days during vacation. In a controlled re-challenge test involving 5-6 papayas daily, the patient remained euthyroid for 7 days, but developed mild hypothyroidism after 14 days. Both times, thyroid levels normalized 40-45 days after discontinuing papaya.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, concomitant use of warfarin with papain-containing papaya extract might increase the effects and side effects of warfarin.
In one case report, a patient previously stable on warfarin was found to have an international normalization ratio (INR) of 7.4, which was attributed to ingestion of a supplement containing papain from papaya extract.

Likelihood Possible Evidence D
Papaya full monograph & interactions

Vitamin B121 drug type · 20 drugs

Metformin (Glucophage)

Metformin, a common medication used to manage type 2 diabetes, has been associated with lower vitamin B12 levels in some individuals. Prolonged use of metformin can interfere with the absorption of B12 in the digestive system, potentially leading to a deficiency in this essential vitamin.

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

Brand information

Manufacturer and brand details for T5 To T9 Stm, from the product label.

Chiro-Zyme

See all Chiro-Zyme products
Name
Enzyme Formulations, Inc.
City
Madison
State
Wisconsin
ZipCode
53719
Phone Number
1-800-614-4400
Web Address
www.enzymeformulations.com
Pharmacist Counseling Corner

T5 To T9 Stm by Chiro-Zyme: Common Questions

Does T5 To T9 Stm by Chiro-Zyme interact with any medications?
Yes. Based on its ingredients, T5 To T9 Stm has a known interaction with 2,068 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
T5 To T9 Stm contains 16 active ingredients, and an interaction can come from any of them. We check every ingredient, combine the results into one list per medication, and show which ingredient and mechanism is responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.
Does this product have any real proof it works?
Vitamin B12 is proven effective for B12 deficiency. Mastic tree shows possibly effective evidence for indigestion. For the digestive enzymes and most other ingredients, the evidence we have is insufficient to say whether they actually work for their intended purposes — there just isn't enough reliable research yet.
Can I take this if I'm pregnant?
Vitamin B12 is safe in pregnancy. Marshmallow, slippery elm, papaya, and mastic tree lack enough safety data — some sources caution against them. The safety data we hold advises talking with your doctor or pharmacist before taking this product during pregnancy to see if the benefits outweigh the unknowns in your case.
Is it safe while I'm breastfeeding?
Vitamin B12 is safe while breastfeeding. The others — marshmallow, slippery elm, papaya, mastic tree, and protease — either lack enough safety data or shouldn't be used without medical advice. Check with your healthcare provider before starting to make sure it's right for you and your baby.
What are the digestive enzymes in here actually supposed to do?
Protease breaks down protein, lipase breaks down fat, and the others (amylase, glucoamylase, diastase, cellulase, hemicellulase) break down different types of carbohydrates. The idea is they help your digestive system handle food more efficiently, but we don't have strong evidence that taking them as a supplement actually improves digestion in most people.
Could this cause allergic reactions?
Rare but possible. Vitamin B12 can cause rash, itching, or hives if you have a cobalt allergy. Papaya and protease may trigger allergic reactions — papaya especially if you're sensitive to latex. If you have a history of food or enzyme allergies, mention this product to your doctor or pharmacist first.
Why does this say 2,069 interacting medications?
That's the total count across all the ingredients we could check — it sounds like a lot, but it reflects the breadth of drugs that theoretically could be affected by slippery elm, marshmallow, papaya, or B12. Your own medications may or may not be on that list; use the search tool to find out what applies to you specifically.

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

Not sure if T5 To T9 Stm is safe with your meds?

Our pharmacists answer your medication & supplement questions — free.

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

T5 To T9 Stm label
Go deeper

The Full Monographs Behind T5 To T9 Stm’s Ingredients

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

Herb & supplement monograph

Vitamin B12

Interacts with 20 drugs

Vitamin B12 (cobalamin) is an essential nutrient your body needs to make red blood cells, keep nerves healthy, and support DNA. Supplements are very helpful for people who are deficient — su...

Read the full Vitamin B12 monograph → Herb & supplement monograph

Marshmallow

Interacts with 2,040 drugs

Marshmallow root is a traditional herb rich in soothing, gel-like fibers called mucilage, which is why it has long been used for coughs, sore throats, and stomach irritation. Evidence for th...

Read the full Marshmallow monograph → Herb & supplement monograph

Proteolytic Enzymes (proteases)

Proteolytic enzymes are proteins that help break down other proteins, and common examples include bromelain (from pineapple), papain (from papaya), trypsin, chymotrypsin, and pancreatin. Peo...

Read the full Proteolytic Enzymes (proteases) monograph → Herb & supplement monograph

Lipase

Lipase is a digestive enzyme that helps your body break down dietary fats. It is well established as part of prescription pancreatic enzyme therapy for people who cannot make enough of their...

Read the full Lipase monograph → Herb & supplement monograph

Slippery Elm

Interacts with 2,022 drugs

Slippery elm is a traditional herbal remedy made from the inner bark of a North American elm tree, used mainly to soothe sore throats and irritated digestive tracts. Its mucilage can coat an...

Read the full Slippery Elm monograph → Herb & supplement monograph

Papaya

Interacts with 92 drugs

Papaya is a tropical fruit that is nutritious and generally safe to eat as food, and it contains an enzyme called papain used as a digestive aid and meat tenderizer. Papaya leaf extract is b...

Read the full Papaya monograph → Herb & supplement monograph

Mastic

Mastic is a resin from the mastic tree that has a long history of use for digestive complaints and oral health. Some small studies suggest it may help with indigestion, stomach ulcers, and d...

Read the full Mastic monograph →
Sources

Sources & How We Checked

T5 To T9 Stm's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.

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

The 61 references behind this product’s interaction data

Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.

Vitamin B12 30 references
  1. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (2000). Washington, DC: National Academy Press, 2000. Available at: http://b
  2. Hartman TJ, Woodson K, Stolzenberg-Solomon R, et al. Association of the B-vitamins pyridoxal 5'-phosphate (B6), B12, and folate with lung cancer risk in older men. Am J Epidemiol 2001;153:688-94.. DOI
  3. Jansen T, Romiti R, Kreuter A, Altmeyer P. Rosacea fulminans triggered by high-dose vitamins B6 and B12. J Eur Acad Dermatol Venereol 2001;15:484-5..
  4. Lange H, Suryapranata H, De Luca G, et al. Folate therapy and in-stent restenosis after coronary stenting. N Engl J Med 2004;350:2673-81. PubMed
  5. Collin, S. M., Metcalfe, C., Refsum, H., Lewis, S. J., Zuccolo, L., Smith, G. D., Chen, L., Harris, R., Davis, M., Marsden, G., Johnston, C., Lane, J. A., Ebbing, M., Bonaa, K. H., Nygard, O., Ueland, P. M., Grau, M. V., Baron, J. A., Donovan, J. L., Nea
  6. Geissbuhler, P., Mermillod, B., and Rapin, C. H. Elevated serum vitamin B12 levels associated with CRP as a predictive factor of mortality in palliative care cancer patients: a prospective study over five years. J.Pain Symptom.Manage. 2000;20(2):93-103. PubMed
  7. Salles, N., Herrmann, F., Sakbani, K., Rapin, C. H., and Sieber, C. High vitamin B12 level: a strong predictor of mortality in elderly inpatients. J Am Geriatr.Soc 2005;53(5):917-918.
  8. Looker, H. C., Fagot-Campagna, A., Gunter, E. W., Pfeiffer, C. M., Sievers, M. L., Bennett, P. H., Nelson, R. G., Hanson, R. L., and Knowler, W. C. Homocysteine and vitamin B(12) concentrations and mortality rates in type 2 diabetes. Diabetes Metab Res R
  9. Uhl, W., Nolting, A., Golor, G., Rost, K. L., and Kovar, A. Safety of hydroxocobalamin in healthy volunteers in a randomized, placebo-controlled study. Clin Toxicol (Phila) 2006;44 Suppl 1:17-28. PubMed
  10. Borron, S. W., Baud, F. J., Barriot, P., Imbert, M., and Bismuth, C. Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation. Ann Emerg.Med 2007;49(6):794-801, 801. PubMed
  11. Borron, S. W., Baud, F. J., Megarbane, B., and Bismuth, C. Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation. Am J Emerg.Med 2007;25(5):551-558. PubMed
  12. Lewis, J. G. Gout, Steatorrhoea, and Megaloblastic Anaemia. Ann Rheum.Dis 1962;21(3):284-286. PubMed
  13. Tal, S., Shavit, Y., Stern, F., and Malnick, S. Association between vitamin B12 levels and mortality in hospitalized older adults. J Am Geriatr.Soc 2010;58(3):523-526. PubMed
  14. Baztan, J. J., Gavidia, J. J., Gomez-Pavon, J., Esteve, A., and Ruiperez, I. High vitamin B12 levels and in-hospital mortality. J Am Geriatr.Soc 2010;58(11):2237-2238. PubMed
  15. Omboni, E., Checchini, M., and Longoni, F. [Hypopotassemia and megaloblastic anemia. Presentation of a case]. Minerva Med 8-31-1987;78(16):1255-1257.
  16. Aalfs As, Scholvinck LH, Horvath B. Acneiform eruption in a 5-year old due to vitamin B12 supplementation. Eur J Dermatol 2013;23(5):726-7. PubMed
  17. Balta I, Ozuguz P. Vitamin B12-induced acneiform eruption. Cutan Ocul Toxicol 2014;33(2):94-5. PubMed
  18. Carman KB, Belgemen T, Yis U. Involuntary movements misdiagnosed as seizure during vitamin B12 treatment. Pediatr Emerg Care 2013;29(11):1223-4. PubMed
  19. Djuric V, Bogic M, Popadic AP, et al. Anaphylactic reaction to hydroxycobalamin with tolerance to cyanocobalamin. Ann Allergy Asthma Immunol 2012;108(3):207-8. PubMed
  20. Kartel O, Gulec M, Demirel F, et al. Vitamin B12 allergy and successful desensitization with cyanocobalamin: A case report. Allergol Immunopath (Madr) 2012;40(5):324-5.
  21. Patiroglu T, Unal E, Yildirim S. Infantile tremor syndrome associated with cobalamin therapy: A case report. Clin Neurol Neurosurg 2013;115(9):1903-5. PubMed
  22. Schulte S, Barkema LW, Kardaun SH. Long-lasting atypical acneiform eruption with prominent comedones induced by hydroxocobalamin (vitamin B12). J Dtsch Dermatol Ges 2014;12(6):502-3.
  23. Zanus C, Alberini E, Costa P, et al. Involuntary movements after correction of vitamin B12 deficiency: A video-case report. Epileptic Disord 2012;14(2):174-80. PubMed
  24. Fanidi A, Carreras-Torres R, Larose TL, et al. Is high vitamin B12 status a cause of lung cancer? Int J Cancer. 2019 Sep 15;145(6):1499-1503. PubMed
  25. Fujita Y, Mizukami T, Maya Y, et al. Vitamin B12 allergy manifesting as lymphomatoid contact dermatitis. Eur J Dermatol. 2020;30(3):304-305. PubMed
  26. Dépret F, Hoffmann C, Daoud L, et al. Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study. Crit Care. 2019;23(1):421. PubMed
  27. Khairan P, Sobue T, Eshak ES, et al. Association of dietary intakes of vitamin B12, vitamin B6, folate, and methionine with the risk of esophageal cancer: the Japan Public Health Center-based (JPHC) prospective study. BMC Cancer 2021;21(1):982. PubMed
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Marshmallow 5 references
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  2. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.
  3. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  4. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  5. Hage-Sleiman R, Mroueh M, Daher CF. Pharmacological evaluation of aqueous extract of Althaea officinalis flower grown in Lebanon. Pharm Biol 2011;49(3):327-33.

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Proteolytic Enzymes (proteases) 3 references
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Lipase 1 reference
  1. Casper C, Hascoet JM, Ertl T, et al. Recombinant bile salt-stimulated lipase in preterm infant feeding: A randomized phase 3 study. PLoS One. 2016;11(5):e0156071. PubMed

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Slippery Elm 3 references
  1. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
  2. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  3. Czarnecki D, Nixon R, Bekhor P, and et al. Delayed prolonged contact urticaria from the elm tree. Contact Dermatitis 1993;28:196-197. PubMed

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Papaya 14 references
  1. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
  2. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.
  3. Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Saf 1997;17:342-56.
  4. Mansfield LE, Ting S, Haverly RW, Yoo TJ. The incidence and clinical implications of hypersensitivity to papain in an allergic population, confirmed by blinded oral challenge. Ann Allergy 1985;55:541-3.
  5. Blanco C, Diaz-Perales A, Collada C, et al. Class I chitinases as potential panallergens involved in the latex-fruit syndrome. J Allergy Clin Immunol 1999;103(3 Pt 1):507-13. PubMed
  6. Diaz-Perales A, Collada C, Blanco C, et al. Cross-reactions in the latex-fruit syndrome: A relevant role of chitinases but not of complex asparagine-linked glycans. J Allergy Clin Immunol 1999;104:681-7. PubMed
  7. Castillo, R., Delgado, J., Quiralte, J., Blanco, C., and Carrillo, T. Food hypersensitivity among adult patients: epidemiological and clinical aspects. Allergol.Immunopathol.(Madr.) 1996;24(3):93-97.
  8. Oderinde, O., Noronha, C., Oremosu, A., Kusemiju, T., and Okanlawon, O. A. Abortifacient properties of aqueous extract of Carica papaya (Linn) seeds on female Sprague-Dawley rats. Niger.Postgrad.Med J 2002;9(2):95-98. DOI
  9. Danese, C., Esposito, D., D'Alfonso, V., Cirene, M., Ambrosino, M., and Colotto, M. Plasma glucose level decreases as collateral effect of fermented papaya preparation use. Clin Ter. 2006;157(3):195-198.
  10. Iliev, D. and Elsner, P. Generalized drug reaction due to papaya juice in throat lozenges. Dermatology 1997;194(4):364-366. PubMed
  11. Andersen HA, Bernatz PE, Grindlay JH. Perforation of the esophagus after use of a digestant agent: report of case and experimental study. Ann Otol Rhinol Laryngol 1959;68:890-6. PubMed
  12. Deiana L, Marini S, Mariotti S. Ingestion of large amounts of papaya fruit and impaired effectiveness of levothyroxine therapy. Endocr Pract 2012;18(1):98-100. PubMed
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See these in context on the Papaya monograph →

Mastic 5 references
  1. Kaliora, A. C., Stathopoulou, M. G., Triantafillidis, J. K., Dedoussis, G. V., and Andrikopoulos, N. K. Chios mastic treatment of patients with active Crohn's disease. World J Gastroenterol. 2-7-2007;13(5):748-753. PubMed
  2. Dabos, K. J., Sfika, E., Vlatta, L. J., and Giannikopoulos, G. The effect of mastic gum on Helicobacter pylori: a randomized pilot study. Phytomedicine. 2010;17(3-4):296-299. PubMed
  3. Dabos, K. J., Sfika, E., Vlatta, L. J., Frantzi, D., Amygdalos, G. I., and Giannikopoulos, G. Is Chios mastic gum effective in the treatment of functional dyspepsia? A prospective randomised double-blind placebo controlled trial. J Ethnopharmacol. 2-3-20 PubMed
  4. Hazan Z, Adamsky K, Lucassen A, Levin LA. A first-in-human phase 1 randomized single and multiple ascending dose study of RPh201 in healthy volunteers. Clin Pharmacol Drug Dev. 2020;9(3):366-74. PubMed
  5. Moraschini V, Kischinhevsky ICC, Calasans-Maia MD, et al. Ineffectiveness of ozone therapy in nonsurgical periodontal treatment: a systematic review and metaanalysis of randomized clinical trials. Clin Oral Investig 2020;24(6):1877-1888. PubMed

See these in context on the Mastic monograph →

Parts of this content are provided by the Therapeutic Research Center, LLC.

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

© 2021 Therapeutic Research Center, LLC

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