Interactions on record — worth a quick check against your medications. Check your meds →
Dietary supplement

VSL#3 Unflavored Ingredients & Drug Interactions

by Alfasigma USA

VSL#3 Unflavored label
See full label image
Powder 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 VSL#3 Unflavored 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

VSL#3 Unflavored is a dietary supplement by Alfasigma USA with 3 active ingredients. Its ingredients are commonly taken for hair, skin, and nail health, bone health and osteoporosis, joint and connective tissue support.Based on those ingredients, 182 medications have a known interaction with it, the most serious rated moderate. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

Jump to a section

Check Your Meds Against VSL#3 Unflavored by Alfasigma USA

Ask about any prescription or over-the-counter medication and we check it for interactions with VSL#3 Unflavored by Alfasigma USA — and tell you which ingredient is responsible.

Pharmacist-reviewed data Checks every ingredient Answer in seconds
Prefer a human? Send your question to our licensed pharmacists — free, answered by email within 24 hours.

HelloPharmacist Scorecard of VSL#3 Unflavored by Alfasigma USA

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

From our pharmacy team — supplement deep dive

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

What’s inside

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 0 of its 9 active ingredients.
  • “Lactic Acid Bacteria and Bifidobacteria Blend” is a proprietary blend — the label doesn't break down how much of each component you get.

VSL#3 Unflavored is a powder with nine active probiotic and prebiotic ingredients—strains of Lactobacillus, Bifidobacterium, Streptococcus thermophilus, and a blend of lactic acid bacteria. These are live organisms meant to support your digestive tract.

The product contains no inactive fillers or other ingredients beyond the active strains themselves.

Does it work?

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

Some clinical evidence supports this product's ingredients for its stated purpose, but it isn't conclusive.

Why this rating?
  • The label markets this product for: Digestive health and gut microbiome balance.
  • We looked for evidence on: Antibiotic-associated diarrhea, Diarrhea, Constipation, Colic, Inflammatory bowel disease (IBD), Clostridioides difficile infection — and 4 related terms.
  • The strongest evidence on file: Lactobacillus Acidophilus is rated "Possibly Effective" for Antibiotic-associated diarrhea (Natural Medicines).
  • Also on file: Lactobacillus Acidophilus is rated "Possibly Effective" for Helicobacter pylori, Irritable bowel syndrome (IBS).
  • Also on file: Lactobacillus Acidophilus is rated "Insufficient Reliable Evidence To Rate" for Constipation, Inflammatory bowel disease (IBD), Radiation-induced diarrhea, Lactose intolerance.

The evidence for most of these probiotics is still being worked out. Lactobacillus acidophilus shows possibly effective evidence for irritable bowel syndrome, Helicobacter pylori infection, antibiotic-associated diarrhea, and bacterial vaginosis.

The other strains in this product—Bifidobacterium longum, Lactobacillus delbrueckii bulgaricus, Streptococcus thermophilus, and Bifidobacterium breve—don't yet have enough reliable evidence in our data to rate them for any condition. If you're taking this for a specific digestive concern, talk with your pharmacist about whether the evidence supports your particular use.

The evidence, ingredient by ingredient Silicon Lactic Acid Lactobacillus Acidophilus Bifidobacterium Longum Lactobacillus Delbrueckii Streptococcus Thermophilus Bifidobacterium Breve

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 6 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 6 of 6.
  • General safety write-ups exist for 6 of 6.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

The live bacteria in VSL#3 are generally well tolerated in healthy adults and children. However, the product carries some caution: if you're seriously ill, immune-compromised, or have an indwelling central line, talk with your doctor first.

Rare cases of infection from these bacteria have been reported in critically ill patients and preterm infants. Gastrointestinal side effects—bloating, flatulence, abdominal discomfort, and diarrhea—have been reported uncommonly.

Silicon dioxide in this product is likely safe during pregnancy and breastfeeding; data on the probiotics during pregnancy and breastfeeding are limited, so check with your doctor or pharmacist for personalized advice.

Side effects, ingredient by ingredient Silicon Lactic Acid Lactobacillus Acidophilus Bifidobacterium Longum Lactobacillus Delbrueckii Streptococcus Thermophilus Bifidobacterium Breve

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 6 matched ingredients can interact with medications — Lactobacillus Acidophilus, Bifidobacterium Breve, Bifidobacterium Longum, Lactobacillus Delbrueckii.
  • The most serious interaction on file is rated Moderate.
  • For scale: 182 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.

Antibiotic drugs are the main medication class to watch. Because the live bacteria in VSL#3 can be killed by antibiotics, take them a few hours apart to keep the probiotics working.

Check your exact antibiotic with the tool on this page to confirm timing.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFormula with limited ingredient disclosure with some supporting evidence for its stated purpose. Moderate medication interactions have been identified, and safety information is well characterized.

VSL#3 is a multi-strain probiotic meant to support digestive health, with the strongest evidence for Lactobacillus acidophilus in IBS and antibiotic-associated diarrhea. If you take antibiotics, space them a few hours apart from this supplement.

If you're immune-compromised or seriously ill, talk with your doctor before starting. Run your medications through the checker to be sure.

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

Assessment coverage: 7 of 9 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Oct 24, 2024.

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 VSL#3 Unflavored, straight from the product label.

Brand Alfasigma USA
Barcode (UPC) 745749017802
Net contents 30 Packet(s)
Market status On market
Date entered into DSLD Oct 24, 2024
DSLD ID 315338
Product type Other Combinations
Supplement form Powder
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Adult (18 - 50 Years), Kosher, Halal
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 VSL#3 Unflavored by Alfasigma USA, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
1 Packet(s)
Maximum serving Sizes:
2 Packet(s)
Servings per container
30
UPC/BARCODE
745749017802
IngredientAmount% DV
Silicon Dioxide0 NP--
Lactobacillus acidophilus0 NP--
Bifidobacterium longum infantis0 NP--
Lactobacillus plantarum0 NP--
Bifidobacterium longum0 NP--
Corn Starch0 NP--
Lactobacillus delbrueckii bulgaricus0 NP--
Streptococcus thermophilus0 NP--
Bifidobacterium breve0 NP--
Lactic Acid Bacteria and Bifidobacteria Blend0 NP--

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)

VSL#3 The Living Shield

VSL#3 and The Living Shield are Trademarks of VSL Pharmaceuticals, Inc. Copyright 2019. Alfasigma USA, Inc. All Rights Reserved. VSL Pharmaceuticals Inc.

Formula

All-natural, live, freeze-dried lactic acid bacteria and bifidobacteria 450 billion bacteria per packet

VSL#3 is Kosher & Halal certified.

VSL#3 is Kosher & Halal certified.

Strains of bacteria: Streptococcus thermophilus Bifidobacterium breve Bifidobacterium longum Bifidobacterium infantis Lactobacillus acidophilus Lactobacillus plantarum Lactobacillus paracasei Lactobacillus delbrueckii subsp. bulgaricus Reclassified as B. lactis Reclassified as L. helveticus

450 billion bacteria per packet

Star-K (Kosher)

Suggested/Recommended/Usage/Directions

Directions: Consume as directed by your physician. (Usual adult dosage: 1-2 packets, as needed, up to four times a day). VSL#3 can be mixed into cold water or any cold, non-carbonated beverage and consumed.

Storage

Packets should be refrigerated at 36-46 degrees F (2-8 degrees C). If stored under refrigeration, the product is guaranteed through "Best if used by" date. VSL#3 can be stored at room temperature for up to 2 weeks without adversely affecting potency.

Keep refrigerated at 36-46 degrees F (2-8 degrees C)

Formulation

Product of Italy

For the dietary management of Irritable Bowel Syndrome, Ulcerative Colitis and an Ileal Pouch.

Description: VSL#3 is a medical food for the dietary management of Irritable Bowel Syndrome, Ulcerative Colitis and an Ileal Pouch, that must be used under medical supervision.

General Statements

For more information or the product information sheet visit us at www.VSL3.com or call 1-866-GET VSL3 (438-8753)

FDA Statement of Identity

Probiotic Medical Food

Precautions

VSL#3 is a medical food and must be used under medical supervision.

Do not use if packet is broken or damaged

Description: VSL#3 is a medical food for the dietary management of Irritable Bowel Syndrome, Ulcerative Colitis and an Ileal Pouch, that must be used under medical supervision.

Seals/Symbols

Star-K (Kosher)

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

See for yourself

VSL#3 Unflavored by Alfasigma USA label

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

VSL#3 Unflavored 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 VSL#3 Unflavored by Alfasigma USA

These are the 3 active ingredients this product is made of. Select any to open its full monograph.

Serving size1 Packet(s) Dosage formPowder Servings per container30 Amounts shown are per serving.

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

Silicon Dioxide

No known
interactions
0 NP per serving

Silicon is a trace mineral found in the body and in foods like oats, barley, and certain fruits and vegetables, and it is popular in supplements for h...

Silicon Dioxide monograph & interactions

Corn Starch

0 NP per serving

Lactic Acid Bacteria and Bifidobacteria Blend

No known
interactions
0 NP per serving

Lactic acid is a naturally occurring acid made by the body during exercise and by bacteria that ferment milk and other foods. It is most often used on...

Lactic Acid Bacteria and Bifidobacteria Blend monograph & interactions
Interaction report

VSL#3 Unflavored by Alfasigma USA Drug Interactions

Want to check YOUR meds against VSL#3 Unflavored?

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
182Drugs
182 Moderate

Ingredients driving the most interactions

Individual Drug Interactions

The ingredients in VSL#3 Unflavored interact with 182 drugs. Click any drug to see the details.

0 of the 3 ingredients in VSL#3 Unflavored interact with drugs. Each result below shows which ingredient is responsible.

Each ingredient & the kinds of drugs it affects

For each ingredient in VSL#3 Unflavored with known interactions, here are the types of medications it can affect. Open any type for the detail — or search your exact drug in the checker above.

The maker

Brand information

Manufacturer and brand details for VSL#3 Unflavored, from the product label.

Alfasigma USA

See all Alfasigma USA products
Name
Alfasigma USA, Inc.
City
Covington
State
LA
ZipCode
70433
Phone Number
1-866-438-8753
Web Address
www.vsl3.com
Pharmacist Counseling Corner

VSL#3 Unflavored by Alfasigma USA: Common Questions

Does VSL#3 Unflavored by Alfasigma USA interact with any medications?
Yes. Based on its ingredients, VSL#3 Unflavored has a known interaction with 182 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
VSL#3 Unflavored contains 3 active ingredients, and an interaction can come from any of them. We check every ingredient, combine the results into one list per medication, and show which ingredient and mechanism is responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.
Can I take VSL#3 at the same time as my antibiotic?
No. The antibiotic will kill the live bacteria in VSL#3, making the probiotic less effective. Take them a few hours apart—your pharmacist can help you space them out.
What's actually in VSL#3?
Nine live probiotic strains: Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus delbrueckii bulgaricus, Bifidobacterium longum infantis, Bifidobacterium longum, Bifidobacterium breve, Streptococcus thermophilus, plus silicon dioxide and corn starch.
Does VSL#3 actually work?
Lactobacillus acidophilus in the product shows possibly effective evidence for IBS, Helicobacter pylori, antibiotic-associated diarrhea, and bacterial vaginosis. The other strains don't yet have enough evidence in our data to say whether they work. Talk with your pharmacist about your specific reason for using it.
Are there side effects?
Most people tolerate it well. Bloating, flatulence, abdominal discomfort, and diarrhea have been reported but are uncommon. Rare cases of infection from these bacteria have happened in very ill or immune-compromised patients.
Is it safe during pregnancy or breastfeeding?
Silicon dioxide in the product is likely safe in pregnancy and breastfeeding. Data on the probiotic strains during pregnancy and breastfeeding are limited, so ask your doctor or pharmacist for personalized advice before taking it.
Should I be concerned if I'm seriously ill or immune-compromised?
Yes—talk with your doctor first. Rare cases of infection from these live bacteria have been reported in critically ill patients and those with weakened immune systems.

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

Not sure if VSL#3 Unflavored is safe with your meds?

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Ask a pharmacist

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.

VSL#3 Unflavored label
Go deeper

The Full Monographs Behind VSL#3 Unflavored’s Ingredients

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

Herb & supplement monograph

Silicon

Silicon is a trace mineral found in the body and in foods like oats, barley, and certain fruits and vegetables, and it is popular in supplements for hair, skin, nail, and bone health. Some s...

Read the full Silicon monograph → Herb & supplement monograph

Lactic Acid

Lactic acid is a naturally occurring acid made by the body during exercise and by bacteria that ferment milk and other foods. It is most often used on the skin as an exfoliant and moisturize...

Read the full Lactic Acid monograph → Herb & supplement monograph

Lactobacillus Acidophilus

Interacts with 182 drugs

Lactobacillus acidophilus is a 'friendly' bacterium used as a probiotic to support gut and vaginal health. It is generally well tolerated in healthy people, and there is reasonable evidence...

Read the full Lactobacillus Acidophilus monograph → Herb & supplement monograph

Bifidobacterium Longum

Interacts with 182 drugs

Bifidobacterium longum is a 'friendly' bacterium found naturally in the human gut and used as a probiotic. It is generally well tolerated and is most studied for digestive issues, though evi...

Read the full Bifidobacterium Longum monograph → Herb & supplement monograph

Lactobacillus Delbrueckii

Interacts with 182 drugs

Lactobacillus delbrueckii is a 'friendly' bacterium used in food fermentation and sold as a probiotic, often as part of multi-strain products. It is generally considered safe for healthy peo...

Read the full Lactobacillus Delbrueckii monograph → Herb & supplement monograph

Streptococcus Thermophilus

Streptococcus thermophilus is a friendly bacterium used as a probiotic, often combined with other strains in yogurt and supplements. It is generally well tolerated in healthy people and may...

Read the full Streptococcus Thermophilus monograph → Herb & supplement monograph

Bifidobacterium Breve

Interacts with 182 drugs

Bifidobacterium breve is a 'friendly' gut bacterium taken as a probiotic, most often to support digestion and balance the gut microbiome. Some studies suggest possible benefits for certain d...

Read the full Bifidobacterium Breve monograph →
Sources

Sources & How We Checked

VSL#3 Unflavored'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 115 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.

Silicon 19 references
  1. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  2. Jugdaohsingh R, Anderson SH, Tucker KL, et al. Dietary silicon intake and absorption. Am J Clin Nutr 2002;75:887-93. PubMed
  3. Ichiyanagi O, Sasagawa I, Adachi Y, et al. Silica urolithiasis without magnesium trisilicate intake. Urol Int 1998;61:39-42. PubMed
  4. Levison DA, Crocker PR, Banim S, Wallace DM. Silica stones in the urinary bladder. Lancet 1982;1:704-5. PubMed
  5. Lee MH, Lee YH, Hsu TH, et al. Silica stone--development due to long time oral trisilicate intake. Scand J Urol Nephrol 1993;27:267-9. PubMed
  6. Cruz Guerra, N. A., Gomez Garcia, M. A., Lovaco, Castellano F., Saez Garrido, J. C., Garcia, Cuerpo E., and Escudero, Barrilero A. [Silica urolithiasis: report of a new case]. Actas Urol.Esp 2000;24(2):202-204.
  7. Merget, R., Bauer, T., Kupper, H. U., Philippou, S., Bauer, H. D., Breitstadt, R., and Bruening, T. Health hazards due to the inhalation of amorphous silica. Arch Toxicol. 2002;75(11-12):625-634. PubMed
  8. Khuder, S. A., Peshimam, A. Z., and Agraharam, S. Environmental risk factors for rheumatoid arthritis. Rev Environ Health 2002;17(4):307-315. PubMed
  9. McLaughlin, J. K., Chow, W. H., and Levy, L. S. Amorphous silica: a review of health effects from inhalation exposure with particular reference to cancer. J Toxicol.Environ Health 4-25-1997;50(6):553-566. DOI
  10. Pelucchi, C., Pira, E., Piolatto, G., Coggiola, M., Carta, P., and La, Vecchia C. Occupational silica exposure and lung cancer risk: a review of epidemiological studies 1996-2005. Ann.Oncol. 2006;17(7):1039-1050. PubMed
  11. Gillissen, A., Gessner, C., Hammerschmidt, S., Hoheisel, G., and Wirtz, H. [Health significance of inhaled particles]. Dtsch.Med Wochenschr. 3-24-2006;131(12):639-644.
  12. Hu, J. F., Qu, H., and Wang, J. Z. [Meta analysis for relationship between exposure of free silicon dioxide and lung tumor]. Zhonghua Lao.Dong.Wei Sheng Zhi.Ye.Bing.Za Zhi. 2006;24(7):415-417.
  13. Jugdaohsingh, R. Silicon and bone health. J Nutr Health Aging 2007;11(2):99-110.
  14. Lacasse, Y., Martin, S., Gagne, D., and Lakhal, L. Dose-response meta-analysis of silica and lung cancer. Cancer Causes Control 2009;20(6):925-933. PubMed
  15. McCormic, Z. D., Khuder, S. S., Aryal, B. K., Ames, A. L., and Khuder, S. A. Occupational silica exposure as a risk factor for scleroderma: a meta-analysis. Int Arch Occup.Environ Health 2010;83(7):763-769. PubMed
  16. Haddad, F. S. and Kouyoumdjian, A. Silica stones in humans. Urol.Int 1986;41(1):70-76. PubMed
  17. Tervaert, J. W., Stegeman, C. A., and Kallenberg, C. G. Silicon exposure and vasculitis. Curr Opin.Rheumatol 1998;10(1):12-17. PubMed
  18. Steenland, K. and Stayner, L. Silica, asbestos, man-made mineral fibers, and cancer. Cancer Causes Control 1997;8(3):491-503. PubMed
  19. Boqué N, Valls RM, Pedret A, Puiggrós F, Arola L, Solà R. Relative absorption of silicon from different formulations of dietary supplements: a pilot randomized, double-blind, crossover post-prandial study. Sci Rep 2021;11(1):16479. PubMed

See these in context on the Silicon monograph →

Lactobacillus Acidophilus 15 references
  1. Pierce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: The Stonesong Press, 1999:19.
  2. Begtrup LM, de Muckadell OB, Kjeldsen J, Christensen RD, Jarbøl DE. Long-term treatment with probiotics in primary care patients with irritable bowel syndrome--a randomised, double-blind, placebo controlled trial. Scand J Gastroenterol 2013;48(10):1127-35 PubMed
  3. Chatterjee S, Kar P, Das T, Ray S, Gangulyt S, Rajendiran C, Mitra M. Randomised placebo-controlled double blind multicentric trial on efficacy and safety of Lactobacillus acidophilus LA-5 and Bifidobacterium BB-12 for prevention of antibiotic-associated
  4. Shavakhi A, Tabesh E, Yaghoutkar A, Hashemi H, Tabesh F, Khodadoostan M,Minakari M, Shavakhi S, Gholamrezaei A. The effects of multistrain probiotic compound on bismuth-containing quadruple therapy for Helicobacter pylori infection: a randomized placebo-c
  5. Karamali M, Dadkhah F, Sadrkhanlou M, et al. Effects of probiotic supplementation on glycaemic control and lipid profiles in gestational diabetes: a randomized, double-blind, placebo-controlled trial. Diabetes Metab 2016;42(4):234-41. PubMed
  6. Badehnoosh B, Karamali M, Zarrati M, et al. The effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in gestational diabetes. J Matern Fetal Neonatal Med. 2018 May;31(9):1128-1136.
  7. Kumar S, Kumar R, Rohilla L, Jacob N, Yadav J, Sachdeva N. A high potency multi-strain probiotic improves glycemic control in children with new-onset type 1 diabetes mellitus: A randomized, double-blind, and placebo-controlled pilot study. Pediatr Diabete
  8. Shahriari A, Karimi E, Shahriari M, Aslani N, Khooshideh M, Arab A. The effect of probiotic supplementation on the risk of gestational diabetes mellitus among high-risk pregnant women: A parallel double-blind, randomized, placebo-controlled clinical trial PubMed
  9. Xiao SD, Zhang DZ, Lu H, et al. Multicenter, randomized, controlled trial of heat-killed Lactobacillus acidophilus LB in patients with chronic diarrhea. Adv Ther. 2003;20(5):253-60.
  10. Rossi F, Amadoro C, Gasperi M, Colavita G. Lactobacilli infection case reports in the last three years and safety implications. Nutrients. 2022;14(6):1178. PubMed
  11. Ozer M, Goksu SY, Shahverdiani A, Mustafa M. Lactobacillus acidophilus-induced endocarditis and associated splenic abscess. Case Rep Infect Dis 2020;2020:1382709.
  12. Sadrin S, Sennoune S, Gout B, et al. A 2-strain mixture of Lactobacillus acidophilus in the treatment of irritable bowel syndrome: A placebo-controlled randomized clinical trial. Dig Liver Dis 2020;52(5):534-540. PubMed
  13. Stoffer JN, Slingsby TJ, Giuliari GP. Lactobacillus acidophilus endophthalmitis after intravitreal bevacizumab injection requiring intraocular lens explantation. Can J Ophthalmol 2022;57(1):e21-e22. PubMed
  14. Cukovic-Cavka S, Likic R, Francetic I, Rustemovic N, Opacic M, Vucelic B. Lactobacillus acidophilus as a cause of liver abscess in a NOD2/CARD15-positive patient with Crohn's disease. Digestion 2006;73(2-3):107-10.
  15. Hui J, Ren Y, Wang Y, Han Q. Lactobacillus acidophilus endophthalmitis postcataract operation: A case report with a literature review. Ocul Immunol Inflamm 2023.

See these in context on the Lactobacillus Acidophilus monograph →

Bifidobacterium Longum 21 references
  1. Ha GY, Yang CH, Kim H, Chong Y. Case of sepsis caused by Bifidobacterium longum. J Clin Microbiol 1999;37:1227-8.
  2. Pierce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: The Stonesong Press, 1999:19.
  3. Xiao JZ, Takahashi S, Odamaki T, et al. Antibiotic susceptibility of bifidobacterial strains distributed in the Japanese market. Biosci Biotechnol Biochem. 2010;74(2):336-42. PubMed
  4. Rautava S, Kainonen E, Salminen S, Isolauri E. Maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of eczema in the infant. J Allergy Clin Immunol. 2012;130(6):1355-60. PubMed
  5. Pruccoli G, Silvestro E, Pace Napoleone C, Aidala E, Garazzino S, Scolfaro C. Are probiotics safe? Bifidobacterium bacteremia in a child with severe heart failure. Infez Med. 2019;27(2):175-178.
  6. Pellonperä O, Vahlberg T, Mokkala K, et al. Weight gain and body composition during pregnancy: a randomised pilot trial with probiotics and/or fish oil. Br J Nutr. 2020 Nov 4:1-11. PubMed
  7. Pellonperä O, Mokkala K, Houttu N, et al. Efficacy of fish oil and/or probiotic intervention on the incidence of gestational diabetes mellitus in an at-risk group of overweight and obese women: A randomized, placebo-controlled, double-blind clinical trial PubMed
  8. Shahriari A, Karimi E, Shahriari M, Aslani N, Khooshideh M, Arab A. The effect of probiotic supplementation on the risk of gestational diabetes mellitus among high-risk pregnant women: A parallel double-blind, randomized, placebo-controlled clinical trial PubMed
  9. Esaiassen E, Hjerde E, Cavanagh JP, Simonsen GS, Klingenberg C; Norwegian Study Group on Invasive Bifidobacterial Infections. Bifidobacterium bacteremia: Clinical characteristics and a genomic approach to assess pathogenicity. J Clin Microbiol. 2017;55(7) PubMed
  10. Enomoto T, Sowa M, Nishimori K, et al. Effects of bifidobacterial supplementation to pregnant women and infants in the prevention of allergy development in infants and on fecal microbiota. Allergol Int 2014;63(4):575-85. PubMed
  11. US Food and Drug Administration (FDA). Dear Healthcare Provider Letter: Warning Regarding Use of Probiotics in Preterm Infants. September 2023. Available at: https://www.fda.gov/media/172606/download?attachment. Accessed November 1, 2023.
  12. Pillai A, Tan J, Paquette V, Panczuk J. Does probiotic bacteremia in premature infants impact clinically relevant outcomes? A case report and updated review of literature. Clin Nutr ESPEN. 2020;39:255-259. PubMed
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  19. Tena D, Losa C, Medina MJ, Sáez-Nieto JA. Peritonitis caused by Bifidobacterium longum: case report and literature review. Anaerobe 2014;27:27-30. PubMed
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Lactobacillus Delbrueckii 9 references
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See these in context on the Lactobacillus Delbrueckii monograph →

Streptococcus Thermophilus 21 references
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See these in context on the Streptococcus Thermophilus monograph →

Bifidobacterium Breve 9 references
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  3. Pruccoli G, Silvestro E, Pace Napoleone C, Aidala E, Garazzino S, Scolfaro C. Are probiotics safe? Bifidobacterium bacteremia in a child with severe heart failure. Infez Med. 2019;27(2):175-178.
  4. Ohishi A, Takahashi S, Ito Y, et al. Bifidobacterium septicemia associated with postoperative probiotic therapy in a neonate with omphalocele. J Pediatr. 2010;156(4):679-81. PubMed
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  6. Esaiassen E, Hjerde E, Cavanagh JP, Simonsen GS, Klingenberg C; Norwegian Study Group on Invasive Bifidobacterial Infections. Bifidobacterium bacteremia: Clinical characteristics and a genomic approach to assess pathogenicity. J Clin Microbiol. 2017;55(7) PubMed
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See these in context on the Bifidobacterium Breve monograph →

Lactic Acid 21 references
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  2. Stiller MJ, Bartolone J, Stern R, et al. Topical 8% glycolic acid and 8% L-lactic acid creams for the treatment of photodamaged skin. A double-blind, vehicle-controlled clinical trial. Arch Dermatol 1996;132:631-6.
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  6. Köse O, Özmen I, Arca E. An open, comparative study of 10% potassium hydroxide solution versus salicylic and lactic acid combination in the treatment of molluscum contagiosum in children. J Dermatolog Treat. 2013 Aug;24(4):300-4. PubMed
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  11. Draelos ZD, Hall S, Munsick C. A 14-day Controlled Study Assessing Qualitative Improvement with 15% Lactic Acid and Ceramides in Skin Moisturization and Desquamation. J Clin Aesthet Dermatol 2020;13(8):E54-E58.
  12. Jennings MB, Alfieri D, Ward K, Lesczczynski C. Comparison of salicylic acid and urea versus ammonium lactate for the treatment of foot xerosis. A randomized, double-blind, clinical study. J Am Podiatr Med Assoc 1998;88(7):332-6. PubMed
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  16. US Food and Drug Administration (FDA). Cosmetic Ingredients: Alpha Hydroxy Acids. August 2020. Available at: https://www.fda.gov/cosmetics/cosmetic-ingredients/alpha-hydroxy-acids. Accessed on October 19, 2021.
  17. Diebold R, Schopf B, Stammer H, Mendling W. Vaginal treatment with lactic acid gel delays relapses in recurrent urinary tract infections: results from an open, multicentre observational study. Arch Gynecol Obstet 2021;304(2):409-417. PubMed
  18. Khattar JA, Musharrafieh UM, Tamim H, Hamadeh GN. Topical zinc oxide vs. salicylic acid-lactic acid combination in the treatment of warts. Int J Dermatol 2007;46(4):427-30. PubMed
  19. Emtestam L, Kaaman T, Rensfeldt K. Treatment of distal subungual onychomycosis with a topical preparation of urea, propylene glycol and lactic acid: results of a 24-week, double-blind, placebo-controlled study. Mycoses 2012;55(6):532-40. PubMed
  20. Siskin SB, Quinlan PJ, Finkelstein MS, Marlucci M, Maglietta TG, Gibson JR. The effects of ammonium lactate 12% lotion versus no therapy in the treatment of dry skin of the heels. Int J Dermatol 1993;32(12):905-7. PubMed
  21. Robinson D, Friedmann D, Gordon J, Wortzman M, Nelson D. Efficacy and Tolerability of a Double-Conjugated Retinoid and Alpha Hydroxy Acid Cream in Subjects With Mild to Moderate Blemish-Prone Skin. J Drugs Dermatol 2022;21(1):54-59. DOI

See these in context on the Lactic Acid monograph →

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

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