Tri-Metabolic Control Ingredients & Drug Interactions
What is this page for?
First and foremost: checking Tri-Metabolic Control 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
Tri-Metabolic Control is a dietary supplement by Douglas Laboratories with 3 active ingredients. Its ingredients are commonly taken for memory and cognitive support, nerve pain (neuropathy), energy and fatigue.Based on those ingredients, 1,077 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are Piper betle (leaf) extract, Acetyl-L-Carnitine. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Tri-Metabolic Control by Douglas Laboratories
Ask about any prescription or over-the-counter medication and we check it for interactions with Tri-Metabolic Control by Douglas Laboratories — 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 Tri-Metabolic Control by Douglas Laboratories
Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.
What’s inside
Low disclosure
Tri-Metabolic Control contains 3 active ingredients. Acetyl-L-carnitine is an amino acid that your cells use for energy production.
Piper betle (black pepper) extract contributes piperine, which research suggests may affect how your body absorbs and clears certain drugs. The product also includes a proprietary blend labeled LOWAT.
The capsules contain inactive ingredients — microcrystalline cellulose, hydroxypropyl methylcellulose, ascorbyl palmitate, and silica — which are standard binders and fillers.
Does it work?
Moderate evidence
Acetyl-L-carnitine in this product is rated possibly effective for age-related cognitive decline, Alzheimer disease, alcohol use disorder, diabetic neuropathy, and depression. The piper betle extract, however, has insufficient reliable evidence to rate for the conditions studied — hay fever, asthma, athletic performance, headache, depression, and diarrhea.
The data we hold does not establish how well this combination works for any specific condition.
How safe is it?
Well-documented data
Acetyl-L-carnitine is generally well tolerated in the short term, but long-term safety isn't fully established. Common side effects include agitation, dry mouth, headache, insomnia, reduced appetite, nausea, vomiting, diarrhea, and constipation.
A metabolite can cause a fishy odor in urine, breath, and sweat. One safety note in the data advises against it unless your doctor advises otherwise — there isn't enough reliable safety information.
Black pepper extract, when used in food amounts, is generally safe; concentrated supplements should be used more cautiously. It may cause a burning aftertaste, indigestion, or reduced taste perception, and rarely allergic reactions.
Pregnancy safety data for acetyl-L-carnitine isn't on file here, so talk with your doctor or pharmacist for guidance. Black pepper is rated likely safe in pregnancy but likely unsafe while breastfeeding; safety of breastfeeding with acetyl-L-carnitine is unknown.
Meds to double-check
Moderate interaction found
Before taking Tri-Metabolic Control, double-check with your doctor or pharmacist if you're on serotonergic antidepressants (risk of serotonin syndrome), blood thinners like warfarin, thyroid hormone replacement, propranolol or other heart and blood pressure medications, anti-seizure drugs like phenytoin, theophylline for breathing, or nevirapine, rifampin, cyclosporine, atorvastatin, and pentobarbital. All interactions are documented as Moderate severity.
The bottom line
Scorecard at a glanceFormula with limited ingredient disclosure with some supporting evidence behind its ingredients' uses. Moderate medication interactions have been identified, and safety information is well characterized.
This product may help with certain types of cognitive decline and nerve damage, but the evidence is limited. If you take heart medications, blood pressure drugs, anti-seizure drugs, thyroid therapy, antidepressants, or blood thinners, you need to check with your doctor or pharmacist first — the interactions are real and potentially serious.
Talk it over with your own healthcare provider before starting.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 2 of 3 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Feb 25, 2021.
This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed
General information
Key facts about Tri-Metabolic Control, straight from the product label.
| Brand | Douglas Laboratories |
|---|---|
| Barcode (UPC) | 310539977569 |
| Net contents | 120 Vegetarian Capsule(s) |
| Market status | On market |
| Date entered into DSLD | Feb 25, 2021 |
| DSLD ID | 245362 |
| Product type | Other Combinations |
| Supplement form | Capsule |
| Dietary claims / uses | All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years), Gluten Free |
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 Tri-Metabolic Control by Douglas Laboratories, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Acetyl-L-Carnitine | 300 mg | -- |
| Dolichos biflorus (seed) extract | 0 NP | -- |
| Piper betle (leaf) extract | 0 NP | -- |
| LOWAT Proprietary Blend | 300 mg | -- |
Other ingredients: Hydroxypropyl Methylcellulose, Microcrystalline Cellulose, Ascorbyl Palmitate, Silica
Tap any ingredient to jump to its full detail below.
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
Suggested/Recommended/Usage/Directions
Suggested Usage: As a dietary supplement, adults take 2 capsules 30 minutes before a meal, three times daily or as directed by your health professional.
Precautions
Warning: If you are pregnant, nursing, have any health condition or are taking any medication, consult your health professional before using this product.
Keep out of the reach of children.
Use only if safety seal is intact.
Brand IP Statement(s)
LOWAT is a Nutraceuticals trademark
Storage
Store in a cool, dry place.
Formulation
Gluten-free, Non-GMO
Supports metabolic hormones leptin, ghrelin and adiponectin
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.
General Statements
Scan to learn about our manufacturing excellence Contents may not fill bottle in order to accommodate required labeling. Please rely on stated quantity.
FDA Statement of Identity
Dietary Supplement
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Tri-Metabolic Control by Douglas Laboratories 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 Tri-Metabolic Control by Douglas Laboratories
These are the 3 active ingredients this product is made of. Select any to open its full monograph.
Serving size2 Vegetarian Capsule(s) Dosage formCapsule Servings per container60 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.
Acetyl-L-Carnitine
Interacts with203 drugs
Acetyl-L-carnitine is a form of the amino acid carnitine that the body uses to help produce energy in cells. It is most studied for nerve pain and mem...
Acetyl-L-Carnitine monograph & interactionsLOWAT Proprietary Blend
- › Dolichos biflorus (seed) extract
- › Piper betle (leaf) extract
Other (inactive) ingredients: Hydroxypropyl Methylcellulose, Microcrystalline Cellulose, Ascorbyl Palmitate, Silica. These complete the product’s ingredient list but are not active constituents.
Tri-Metabolic Control by Douglas Laboratories Drug Interactions
HelloPharmacist Interaction Report
Tri-Metabolic Control by Douglas Laboratories interacts with medications through its acetyl-L-carnitine and piper betle (black pepper) extract content.
The most serious interactions are Moderate in severity. Acetyl-L-carnitine may increase the risk of serotonin syndrome (a dangerous condition involving excessive serotonin activity) when combined with serotonergic drugs like certain antidepressants, and it might strengthen the blood-thinning effects of warfarin and similar anticoagulants.
It may also reduce how well your body responds to thyroid hormone replacement therapy.
Read the full breakdown — every affected drug type, severity by severity
Black pepper extract raises blood levels of several medications by slowing how your body clears them — including propranolol (a heart and blood pressure drug), phenytoin (an anti-seizure medication), theophylline (a breathing medication), and several others such as nevirapine, rifampin, cyclosporine, atorvastatin, and pentobarbital. In each case, higher drug levels in your bloodstream can increase both effectiveness and side effects.
We could not check Dolichos biflorus seed extract for interactions. Altogether, these interactions span 1,078 individual medications.
Before you start this product, run your complete medication list through the search tool on this page — especially if you take any heart, blood pressure, anti-seizure, thyroid, antidepressant, or blood-thinning medications.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Tri-Metabolic Control?
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 Tri-Metabolic Control interact with 1,077 drugs. Click any drug to see the details.
2 of the 3 ingredients in Tri-Metabolic Control interact with drugs. Each result below shows which ingredient is responsible. Piper betle (leaf) extract Acetyl-L-Carnitine
AxitinibInlyta
How Axitinib interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Axitinib interactionAzelastine Hydrochloride, Fluticasone PropionateDymista
How Azelastine Hydrochloride, Fluticasone Propionate interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Azelastine Hydrochloride, Fluticasone Propionate interactionBazedoxifene Acetate, Conjugated EstrogensDuavee
How Bazedoxifene Acetate, Conjugated Estrogens interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates, P-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Bazedoxifene Acetate, Conjugated Estrogens interactionBeclometasone DipropionateBecotide
How Beclometasone Dipropionate interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of P-glycoprotein substrates.
Read the full Piper Betle (leaf) Extract + Beclometasone Dipropionate interactionBeclomethasoneBeclovent, Vanceril
How Beclomethasone interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates, P-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Beclomethasone interactionBeclomethasone DipropionateQNASL, Qvar
How Beclomethasone Dipropionate interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of P-glycoprotein substrates.
Read the full Piper Betle (leaf) Extract + Beclomethasone Dipropionate interactionBedaquilineSirturo
How Bedaquiline interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Bedaquiline interactionBelinostatBeleodaq
How Belinostat interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractP-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of P-glycoprotein substrates.
Read the full Piper Betle (leaf) Extract + Belinostat interactionBelladonna Alkaloids, Chlorpheniramine, Phenylephrine, PhenylpropanolamineRespa ARM
How Belladonna Alkaloids, Chlorpheniramine, Phenylephrine, Phenylpropanolamine interacts with Tri-Metabolic Control — through 2 ingredients. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Belladonna Alkaloids, Chlorpheniramine, Phenylephrine, Phenylpropanolamine interactionAcetyl-l-carnitineSerotonergic Drugs Moderate
Interaction Summary
Theoretically, acetyl-L-carnitine might increase the risk of serotonergic side effects, including serotonin syndrome and cerebral vasoconstrictive disorders, when taken with serotonergic drugs.
Read the full Acetyl-l-carnitine + Belladonna Alkaloids, Chlorpheniramine, Phenylephrine, Phenylpropanolamine interactionBelladonna Alkaloids, Ergotamine Tartrate, PhenobarbitalBel Tabs, Bellamine-S, Bellaphen-S, Duragal S, Phenarbal S, Spastrin
How Belladonna Alkaloids, Ergotamine Tartrate, Phenobarbital interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Belladonna Alkaloids, Ergotamine Tartrate, Phenobarbital interactionBelladonna, Caffeine, Ergotamine, PentobarbitalMicomp PB
How Belladonna, Caffeine, Ergotamine, Pentobarbital interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates +1 Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Belladonna, Caffeine, Ergotamine, Pentobarbital interactionBelladonna, Ergotamine Tartrate, Phenobarbital
How Belladonna, Ergotamine Tartrate, Phenobarbital interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Belladonna, Ergotamine Tartrate, Phenobarbital interactionBelladonna, Ergotamine, PhenobarbitalBellergal-S
How Belladonna, Ergotamine, Phenobarbital interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Belladonna, Ergotamine, Phenobarbital interactionBellafoline, Caffeine, Ergotamine Tartrate, PentobarbitalCafergot PB
How Bellafoline, Caffeine, Ergotamine Tartrate, Pentobarbital interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Pentobarbital (nembutal) +1 Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Bellafoline, Caffeine, Ergotamine Tartrate, Pentobarbital interactionBelumosudil MesylateRezurock
How Belumosudil Mesylate interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Belumosudil Mesylate interactionBenzhydrocodone, AcetaminophenApadaz
How Benzhydrocodone, Acetaminophen interacts with Tri-Metabolic Control — through 2 ingredients. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Moderate
Interaction Summary
Theoretically, black pepper might decrease levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Piper Betle (leaf) Extract + Benzhydrocodone, Acetaminophen interactionAcetyl-l-carnitineSerotonergic Drugs Moderate
Interaction Summary
Theoretically, acetyl-L-carnitine might increase the risk of serotonergic side effects, including serotonin syndrome and cerebral vasoconstrictive disorders, when taken with serotonergic drugs.
Read the full Acetyl-l-carnitine + Benzhydrocodone, Acetaminophen interactionBenzocaine, DextromethorphanTetra-Formula
How Benzocaine, Dextromethorphan interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Acetyl-l-carnitineSerotonergic Drugs Moderate
Interaction Summary
Theoretically, acetyl-L-carnitine might increase the risk of serotonergic side effects, including serotonin syndrome and cerebral vasoconstrictive disorders, when taken with serotonergic drugs.
Read the full Acetyl-l-carnitine + Benzocaine, Dextromethorphan interactionBepridilVascor
How Bepridil interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Bepridil interactionBerotralstat HydrochlorideOrladeyo
How Berotralstat Hydrochloride interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractP-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of P-glycoprotein substrates.
Read the full Piper Betle (leaf) Extract + Berotralstat Hydrochloride interactionBetamethasoneCelestone, Diprolene AF, Diprosone
How Betamethasone interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractP-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of P-glycoprotein substrates.
Read the full Piper Betle (leaf) Extract + Betamethasone interactionBetamethasone DipropionateSernivo
How Betamethasone Dipropionate interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractP-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of P-glycoprotein substrates.
Read the full Piper Betle (leaf) Extract + Betamethasone Dipropionate interactionBetamethasone Dipropionate, CalcipotrieneEnstilar, Wynzora
How Betamethasone Dipropionate, Calcipotriene interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractP-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of P-glycoprotein substrates.
Read the full Piper Betle (leaf) Extract + Betamethasone Dipropionate, Calcipotriene interactionBetamethasone ValerateLuxiq
How Betamethasone Valerate interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractP-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of P-glycoprotein substrates.
Read the full Piper Betle (leaf) Extract + Betamethasone Valerate interactionBetrixabanBevyxxa
How Betrixaban interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractP-glycoprotein Substrates, Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, black pepper might increase levels of P-glycoprotein substrates.
Read the full Piper Betle (leaf) Extract + Betrixaban interactionBexaroteneTargretin
How Bexarotene interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Bexarotene interactionBictegravir, Emtricitabine, Tenofovir AlafenamideBiktarvy
How Bictegravir, Emtricitabine, Tenofovir Alafenamide interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 3a4 (cyp3a4) Substrates, P-glycoprotein Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
Read the full Piper Betle (leaf) Extract + Bictegravir, Emtricitabine, Tenofovir Alafenamide interactionBisoprololZebeta
How Bisoprolol interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 2d6 (cyp2d6) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP2D6.
Read the full Piper Betle (leaf) Extract + Bisoprolol interactionBisoprolol, HydrochlorothiazideZiac
How Bisoprolol, Hydrochlorothiazide interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractCytochrome P450 2d6 (cyp2d6) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of drugs metabolized by CYP2D6.
Read the full Piper Betle (leaf) Extract + Bisoprolol, Hydrochlorothiazide interactionBivalirudinAngiomax, Angiomax Rtu, Angiox
How Bivalirudin interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, black pepper might increase the risk of bleeding when taken with antiplatelet or anticoagulant drugs.
Read the full Piper Betle (leaf) Extract + Bivalirudin interactionBoceprevirVictrelis
How Boceprevir interacts with Tri-Metabolic Control — through 1 ingredient. Tap an ingredient for the detail:
Piper Betle (leaf) ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, black pepper might increase levels of P-glycoprotein substrates.
Read the full Piper Betle (leaf) Extract + Boceprevir interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Tri-Metabolic Control 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.
Piper betle (leaf) extract
Anticoagulant/Antiplatelet Drugs
Theoretically, black pepper might increase the risk of bleeding when taken with antiplatelet or anticoagulant drugs.
In vitro research shows that piperine, a constituent of black pepper, seems to inhibit platelet aggregation. This has not been reported in humans.
Antidiabetes Drugs
Theoretically, black pepper might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Animal research shows that piperine, a constituent of black pepper, can reduce blood glucose levels. Monitor blood glucose levels closely. Dose adjustments might be necessary.
Atorvastatin (Lipitor)
Theoretically, black pepper might increase blood levels of atorvastatin.
Animal research shows that taking piperine, a constituent of black pepper, 35 mg/kg can increase the maximum serum concentration of atorvastatin three-fold. This has not been reported in humans.
Cyclosporine (Neoral, Sandimmune)
Theoretically, black pepper might increase the effects and side effects of cyclosporine.
In vitro research shows that piperine, a constituent of black pepper, increases the bioavailability of cyclosporine. This has not been reported in humans.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Theoretically, black pepper might increase levels of drugs metabolized by CYP2D6.
In vitro research suggests that some constituents of black pepper inhibit CYP2D6. This has not been reported in humans.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
In vitro research and pharmacokinetic simulation data suggest that piperine, a constituent of black pepper, as well as the pepper fruit seem to inhibit CYP3A4. This has not been reported in humans.
Lithium
Theoretically, black pepper might increase blood levels of lithium due to its diuretic effects. The dose of lithium might need to be reduced.
Black pepper is thought to have diuretic properties.
Nevirapine (Viramune)
Black pepper might increase blood levels of nevirapine.
Clinical research shows that piperine, a constituent of black pepper, increases the plasma concentration of nevirapine. However, no adverse effects were observed in this study.
P-Glycoprotein Substrates
Theoretically, black pepper might increase levels of P-glycoprotein substrates.
In vitro research shows that piperine, a constituent of black pepper, seems to inhibit P-glycoprotein.
Pentobarbital (Nembutal)
Theoretically, black pepper might increase the sedative effects of pentobarbital.
Animal research shows that piperine, a constituent of black pepper, increases pentobarbital-induced sleeping time.
Phenytoin (Dilantin)
Black pepper might increase blood levels of phenytoin.
Clinical research shows that piperine, a constituent of black pepper, seems to increase absorption, slow elimination, and increase levels of phenytoin. Taking a single dose of black pepper 1 gram along with phenytoin seems to double the serum concentration of phenytoin. Consuming a soup with black pepper providing piperine 44 mg/200 mL of soup along with phenytoin also seems to increase phenytoin levels when compared with consuming the same soup without black pepper.
Propranolol (Inderal)
Black pepper might increase blood levels of propranolol.
Clinical research shows that piperine, a constituent of black pepper, seems to increase absorption and slow elimination of propranolol.
Rifampin (Rifadin)
Black pepper might increase blood levels of rifampin.
Clinical research shows that piperine, a constituent of black pepper, seems to increase absorption and serum levels of rifampin.
Theophylline
Black pepper might increase blood levels of theophylline.
Clinical research shows that piperine, a constituent of black pepper, seems to increase absorption and slow elimination of theophylline.
Amoxicillin (Amoxil, Trimox)
Theoretically, black pepper might increase the effects and side effects of amoxicillin.
Animal research shows that taking piperine, a constituent of black pepper, with amoxicillin increases plasma levels of amoxicillin. This has not been reported in humans.
Carbamazepine (Tegretol)
Theoretically, black pepper might increase blood levels of carbamazepine, potentially increasing the effects and side effects of carbamazepine.
One clinical study in patients taking carbamazepine 300 mg or 500 mg twice daily shows that taking a single 20 mg dose of purified piperine, a constituent of black pepper, increases carbamazepine levels. Piperine may increase carbamazepine absorption by increasing blood flow to the GI tract, increasing the surface area of the small intestine, or inhibiting cytochrome P450 3A4 (CYP3A4) in the gut wall. Absorption was significantly increased by 7-10 mcg/mL/hour. The time to eliminate carbamazepine was also increased by 4-8 hours. Although carbamazepine levels were increased, this did not appear to increase side effects. In vitro research also shows that piperine can increase carbamazepine levels by 11% in a time-dependent manner.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, black pepper might decrease levels and clinical effects of drugs metabolized by CYP1A2.
In vitro research suggests that black pepper induces CYP1A2. This has not been reported in humans.
Acetyl-L-Carnitine
Acenocoumarol (Sintrom)
Theoretically, acetyl-L-carnitine might increase the anticoagulant effects of acenocoumarol.
L-carnitine, the parent compound of acetyl-L-carnitine, might enhance the anticoagulant effects of acenocoumarol, an oral anticoagulant that is similar to warfarin, but shorter-acting. There are at least two case reports of INR elevation when L-carnitine was taken with acenocoumarol. In one case, a 33-year-old male with a previously stable INR had an elevated INR of 4.65 after L-carnitine was started and continued for 10 weeks. INR normalized after discontinuation of the L-carnitine-containing product. It is unclear if such an interaction would also occur with acetyl-L-carnitine.
Serotonergic Drugs
Theoretically, acetyl-L-carnitine might increase the risk of serotonergic side effects, including serotonin syndrome and cerebral vasoconstrictive disorders, when taken with serotonergic drugs.
Animal research shows that acetyl-L-carnitine can increase levels of serotonin in the brain.
Thyroid Hormone
Theoretically, acetyl-L-carnitine might decrease the effectiveness of thyroid hormone replacement.
L-carnitine appears to act as a peripheral thyroid hormone antagonist by inhibiting entry of thyroid hormone into the nucleus of cells. Taking L-carnitine also seems to diminish some of the symptoms of hyperthyroidism. It is unclear if such an interaction would occur with acetyl-L-carnitine.
Warfarin (Coumadin)
Theoretically, acetyl-L-carnitine might increase the anticoagulant effects of warfarin.
L-carnitine, the parent compound of acetyl-L-carnitine, might increase the anticoagulant effects of acenocoumarol, a shorter-acting oral anticoagulant similar to warfarin. There is not enough information to know whether this interaction occurs with acetyl-L-carnitine and warfarin.
Brand information
Manufacturer and brand details for Tri-Metabolic Control, from the product label.
Douglas Laboratories
See all Douglas Laboratories products- Name
- Douglas Laboratories
- Street Address
- 600 Boyce Road
- City
- Pittsburgh
- State
- PA
- ZipCode
- 15205
- Phone Number
- 1.800.245.4440
- Web Address
- www.douglaslabs.com
Tri-Metabolic Control by Douglas Laboratories: Common Questions
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Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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Label information is sourced from the NIH Dietary Supplement Label Database and reflects the product version on file; always read your actual product label. This page is for education only and is not a substitute for professional medical advice. Confirm with your pharmacist or doctor before combining supplements and medications.
The Full Monographs Behind Tri-Metabolic Control’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Acetyl-l-carnitine
Interacts with 203 drugsAcetyl-L-carnitine is a form of the amino acid carnitine that the body uses to help produce energy in cells. It is most studied for nerve pain and memory-related conditions, though the evide...
Read the full Acetyl-l-carnitine monograph → Herb & supplement monographBlack Pepper
Interacts with 1,019 drugsBlack pepper is a common kitchen spice that is generally safe in the amounts used in food. Its extract, piperine, is mostly added to supplements to help the body absorb other ingredients (li...
Read the full Black Pepper monograph →Sources & How We Checked
Tri-Metabolic Control'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 51 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.
Acetyl-l-carnitine 22 references
- Thal LJ, Carta A, Clarke WR, et al. A 1-year multicenter placebo-controlled study of acetyl-L-carnitine in patients with Alzheimer's Disease. Neurology 1996;47:705-11. PubMed
- Sano M, Bell K, Cote L, et al. Double-blind parallel design pilot study of acetyl levocarnitine in patients with Alzheimer's Disease. Arch Neurol 1992;49:1137-41. PubMed
- Spagnoli A, Lucca U, Menasce G, et al. Long-term acetyl-L-carnitine treatment in Alzheimer's Disease. Neurology 1991;41:1726-32. PubMed
- Brooks JO 3rd, Yesavage JA, Carta A, Bravi D. Acetyl L-carnitine slows decline in younger patients with Alzheimer's disease: a reanalysis of a double-blind, placebo-controlled study using the trilinear approach. Int Psychoger 1998;10:193-203. PubMed
- Pettegrew JW, Klunk WE, Panchalingam K, et al. Clinical and neurochemical effects of acetyl-L-carnitine in Alzheimer's disease. Neurobiol Aging 1995;16:1-4. PubMed
- Rai G, Wright G, Scott L, et al. Double-blind, placebo controlled study of acetyl-l-carnitine in patients with Alzheimer's dementia. Curr Med Res Opin 1990;11:638-47. PubMed
- Benvenga S, Ruggeri RM, Russo A, et al. Usefulness of L-carnitine, a naturally occurring peripheral antagonist of thyroid hormone action, in iatrogenic hyperthyroidism: a randomized, double-blind, placebo-controlled clinical trial. J Clin Endocrinol Meta
- Montgomery SA, Thal LJ, Amrein R. Meta-analysis of double blind randomized controlled clinical trials of acetyl-L-carnitine versus placebo in the treatment of mild cognitive impairment and mild Alzheimer's disease. Int Clin Psychopharmacol 2003;18:61-71.. PubMed
- Martinez E, Domingo P, Roca-Cusachs A. Potentiation of acenocoumarol action by L-carnitine. J Intern Med 1993;233:94.
- Hudson S, Tabet N. Acetyl-L-carnitine for dementia. Cochrane Database Syst Rev 2003;2:CD003158.. PubMed
- Bachmann HU, Hoffmann A. Interaction of food supplement L-carnitine with oral anticoagulant acenocoumarol. Swiss Med Wkly 2004;134:385. PubMed
- De Grandis D, Minardi C. Acetyl-L-carnitine (levacecarnine) in the treatment of diabetic neuropathy. A long-term, randomised, double-blind, placebo-controlled study. Drugs R D 2002;3:223-31. PubMed
- 12761 Benvenga S, Amato A, Calvani M, Trimarchi F. Effects of carnitine on thyroid hormone action. Ann N Y Acad Sci 2004;1033:158-67. PubMed
- Sima AAF, Calvani M, Mehra M, et al. Acetyl-L-carnitine improves pain, nerve regeneration, and vibratory perception in patients with chronic diabetic neuropathy: An analysis of two randomized, placebo-controlled trials. Diabetes Care 2005;28:89-94.
- Youle, M. and Osio, M. A double-blind, parallel-group, placebo-controlled, multicentre study of acetyl L-carnitine in the symptomatic treatment of antiretroviral toxic neuropathy in patients with HIV-1 infection. HIV.Med. 2007;8(4):241-250.
- Brennan BP, Jensen JE, Hudson JI, Coit CE, Beaulieu A, Pope HG Jr, Renshaw PF, Cohen BM. A placebo-controlled trial of acetyl-L-carnitine and a-lipoic acid in the treatment of bipolar depression. J Clin Psychopharmacol. 2013 Oct;33(5):627-35.
- Ledinek AH, Sajko MC, Rot U. Evaluating the effects of amantadin, modafinil and acetyl-L-carnitine on fatigue in multiple sclerosis--result of a pilot randomized, blind study. Clin Neurol Neurosurg. 2013 Dec;115 Suppl 1:S86-9. PubMed
- Martinotti G, Andreoli S, Reina D, Di Nicola M, Ortolani I, Tedeschi D, Fanella F, Pozzi G, Iannoni E, D'Iddio S, Prof LJ. Acetyl-l-Carnitine in the treatment of anhedonia, melancholic and negative symptoms in alcohol dependent subjects. Prog Neuropsychop PubMed
- Baek SM, Zheng R, Seo EJ, Hwang DY, Kim BH. Pharmacokinetic comparisons of two acetyl-L-carnitine formulations in healthy Korean volunteers. Int J Clin Pharmacol Ther. 2015;53(11):980-6. PubMed
- Goodison G, Overeem K, de Monte V, Siskind D. Mania associated with self-prescribed acetyl-l-carnitine in a man with bipolar I disorder. Australas Psychiatry. 2017;25(1):13-4.
- Bruno A, Pandolfo G, Crucitti M, Lorusso S, Zoccali RA, Muscatello MR. Acetyl-L-Carnitine Augmentation of Clozapine in Partial-Responder Schizophrenia: A 12-Week, Open-Label Uncontrolled Preliminary Study. Clin Neuropharmacol. 2016;39(6):277-80. PubMed
- Veronese N, Stubbs B, Solmi M, Ajnakina O, Carvalho AF, Maggi S. Acetyl-L-Carnitine Supplementation and the Treatment of Depressive Symptoms: A Systematic Review and Meta-Analysis. Psychosom Med. 2018;80(2):154-9. PubMed
Black Pepper 29 references
- Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.
- Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
- Bano G, Amla V, Raina RK, et al. The effect of piperine on pharmacokinetics of phenytoin in healthy volunteers. Planta Med 1987;53:568-9. PubMed
- Bano G, et al. Effect of piperine on bioavailability and pharmacokinetics of propranolol and theophylline in healthy volunteers. Eur J Clin Pharmacol 1991;41;615-7. PubMed
- Cohle SD, Trestrail JD III, Graham MA, et al. Fatal pepper aspiration. Am J Dis Child 1988;142:633-6. PubMed
- Bhardwaj RK, Glaeser H, Becquemont L, et al. Piperine, a major constituent of black pepper, inhibits human P-glycoprotein and CYP3A4. J Pharmacol Exp Ther 2002;302:645-50. PubMed
- Velpandian T, Jasuja R, Bhardwaj RK, et al. Piperine in food: interference in the pharmacokinetics of phenytoin. Eur J Drug Metab Pharmacokinet 2001;26:241-7. PubMed
- Pattanaik S, Hota D, Prabhakar S, et al. Pharmacokinetic interaction of a single dose of piperine with steady-state carbamazepine in epilepsy patients. Phytother Res 2009;23:1281-6.
- Munakata, M., Kobayashi, K., Niisato-Nezu, J., Tanaka, S., Kakisaka, Y., Ebihara, T., Ebihara, S., Haginoya, K., Tsuchiya, S., and Onuma, A. Olfactory stimulation using black pepper oil facilitates oral feeding in pediatric patients receiving long-term en
- Myers, B. M., Smith, J. L., and Graham, D. Y. Effect of red pepper and black pepper on the stomach. Am J Gastroenterol 1987;82(3):211-214.
- Raghavendra, R. H. and Naidu, K. A. Spice active principles as the inhibitors of human platelet aggregation and thromboxane biosynthesis. Prostaglandins Leukot.Essent.Fatty Acids 2009;81(1):73-78. PubMed
- Subehan, Usia, T., Kadota, S., and Tezuka, Y. Mechanism-based inhibition of human liver microsomal cytochrome P450 2D6 (CYP2D6) by alkamides of Piper nigrum. Planta Med 2006;72(6):527-532.
- Kasibhatta, R. and Naidu, M. U. Influence of piperine on the pharmacokinetics of nevirapine under fasting conditions: a randomised, crossover, placebo-controlled study. Drugs R.D. 2007;8(6):383-391. PubMed
- Usia, T., Iwata, H., Hiratsuka, A., Watabe, T., Kadota, S., and Tezuka, Y. CYP3A4 and CYP2D6 inhibitory activities of Indonesian medicinal plants. Phytomedicine. 2006;13(1-2):67-73. PubMed
- Mujumdar, A. M., Dhuley, J. N., Deshmukh, V. K., Raman, P. H., Thorat, S. L., and Naik, S. R. Effect of piperine on pentobarbitone induced hypnosis in rats. Indian J Exp.Biol. 1990;28(5):486-487.
- Panda, S. and Kar, A. Piperine lowers the serum concentrations of thyroid hormones, glucose and hepatic 5'D activity in adult male mice. Horm.Metab Res. 2003;35(9):523-526. PubMed
- Lawless, H. and Stevens, D. A. Effects of oral chemical irritation on taste. Physiol Behav. 1984;32(6):995-998. PubMed
- Hiwale, A. R., Dhuley, J. N., and Naik, S. R. Effect of co-administration of piperine on pharmacokinetics of beta-lactam antibiotics in rats. Indian J Exp.Biol. 2002;40(3):277-281.
- Han, Y., Chin Tan, T. M., and Lim, L. Y. In vitro and in vivo evaluation of the effects of piperine on P-gp function and expression. Toxicol.Appl.Pharmacol. 8-1-2008;230(3):283-289. PubMed
- Sharma, P., Varma, M. V., Chawla, H. P., and Panchagnula, R. In situ and in vivo efficacy of peroral absorption enhancers in rats and correlation to in vitro mechanistic studies. Farmaco 2005;60(11-12):874-883. PubMed
- Aher, S., Biradar, S., Gopu, C. L., and Paradkar, A. Novel pepper extract for enhanced P-glycoprotein inhibition. J Pharm.Pharmacol. 2009;61(9):1179-1186. PubMed
- Zutshi, R. K., Singh, R., Zutshi, U., Johri, R. K., and Atal, C. K. Influence of piperine on rifampicin blood levels in patients of pulmonary tuberculosis. J Assoc.Physicians India 1985;33(3):223-224.
- Marotta, R. B. and Floch, M. H. Diet and nutrition in ulcer disease. Med Clin North Am 1991;75(4):967-979. PubMed
- Subehan, Usia, T., Iwata, H., Kadota, S., and Tezuka, Y. Mechanism-based inhibition of CYP3A4 and CYP2D6 by Indonesian medicinal plants. J Ethnopharmacol. 5-24-2006;105(3):449-455. PubMed
- Gimenez L, Zacharisen M. Severe pepper allergy in a young child. WMJ. 2011 Jun;110(3):138-9.
- Ren T, Yang M, Xiao M, Zhu J, Xie W, Zuo Z. Time-dependent inhibition of carbamazepine metabolism by piperine in anti-epileptic treatment. Life Sci. 2019;218:314-323. PubMed
- Thomas AB, Choudhary DC, Raje A, Nagrik SS. Pharmacokinetics and pharmacodynamic herb-drug interaction of piperine with atorvastatin in rats. J Chromatogr Sci 2021;59(4):371-80. PubMed
- Haron MH, Dale O, Martin K, et al. Evaluation of the Herb-Drug Interaction Potential of Commonly Used Botanicals on the US Market with Regard to PXR- and AhR-Mediated Influences on CYP3A4 and CYP1A2. J Diet Suppl 2022. PubMed
- Lin F, Hu Y, Zhang Y, Zhao L, Zhong D, Liu J. Predicting Food-Drug Interactions between Piperine and CYP3A4 Substrate Drugs Using PBPK Modeling. Int J Mol Sci 2024;25(20):10955. PubMed
Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
© 2021 Therapeutic Research Center, LLC