Zantrex Blue Ingredients & Drug Interactions
by Zantrex
What is this page for?
First and foremost: checking Zantrex Blue 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
Zantrex Blue is a dietary supplement by Zantrex with 14 active ingredients. Its ingredients are commonly taken for high cholesterol, vitamin b3 deficiency (pellagra), heart health support.Based on those ingredients, 1,599 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Green Tea Leaf Extract, Rhodiola crenulata Root Extract, Asian Ginseng root extract. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Zantrex Blue by Zantrex
Ask about any prescription or over-the-counter medication and we check it for interactions with Zantrex Blue by Zantrex — 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 Zantrex Blue by Zantrex
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
Zantrex Blue contains 14 active ingredients, most of which are plant extracts and stimulants. The main ones are niacin (a B vitamin), green tea leaf extract, guarana seed extract, black tea leaf extract, yerba mate leaf extract, and trimethylxanthine (caffeine in pure form) — all of which contribute significant caffeine or stimulant content.
Also included are maca root extract, black pepper fruit extract (piperine), Asian ginseng root extract, damiana leaf extract, rhodiola crenulata root extract, cacao seed extract, schizonepeta flower extract, and a proprietary blend. The inactive ingredients are gelatin, magnesium stearate, stearic acid, rice flour, microcrystalline cellulose, silicon dioxide, titanium dioxide, and FD&C Blue 1 — these are fillers, binders, and the capsule itself.
Does it work?
Strong evidence
The evidence for most ingredients in Zantrex Blue is limited or absent. Niacin is likely effective for preventing pellagra and possibly effective for managing cholesterol problems in HIV/AIDS-related cases and metabolic syndrome.
Green tea is likely effective for HPV and possibly effective for high cholesterol. Black tea is likely effective for mental alertness and possibly effective for heart health and bone strength.
Caffeine is effective for certain types of newborn breathing problems and postoperative headache, and likely effective for mental alertness and athletic performance. For the others — maca root, black pepper, guarana, Asian ginseng, damiana, rhodiola, cacao, and schizonepeta — the evidence in our data is insufficient to establish whether they work for their intended purposes.
How safe is it?
Well-documented data
Niacin at high doses can cause flushing, stomach upset, liver damage, and (rarely) muscle problems and blood disorders. The data advise against high-dose niacin in pregnancy and caution against it while breastfeeding.
Green tea extract is generally well tolerated but has been linked to rare liver injury at high doses; limit caffeine during pregnancy and breastfeeding. Black tea and yerba mate contain caffeine, which passes into breast milk — moderate intake is usually considered acceptable.
Guarana is high in caffeine and should be avoided in pregnancy. Maca root, damiana, rhodiola, and schizonepeta lack sufficient safety data in pregnancy and breastfeeding — avoid them unless a doctor advises otherwise.
Black pepper is generally safe in food amounts but concentrated supplements need caution. Asian ginseng is generally well tolerated short-term but long-term safety is unclear; avoid in pregnancy and breastfeeding.
Cacao contains caffeine and is generally safe in food amounts. Common side effects across these ingredients include insomnia, nervousness, nausea, and stomach upset — often tied to their caffeine content.
Meds to double-check
Major interaction found
Before taking Zantrex Blue, double-check with your pharmacist if you take: any blood pressure medication (niacin and cacao can lower BP further); ephedrine or ephedra (the caffeine in guarana, green tea, black tea, yerba mate, and caffeine itself can cause dangerous heart and stroke effects); seizure medications like phenytoin, valproate, carbamazepine, or felbamate (caffeine and green tea may reduce their effectiveness); heart medications like nadolol or atorvastatin (green tea reduces their levels); diabetes drugs (niacin and rhodiola may lower blood sugar further); blood thinners like warfarin (niacin and black tea may affect them); gout medications (niacin may interfere); or any drug processed by your liver's enzyme systems. No interactions are documented for the kola seed extract we could not check.
The bottom line
Scorecard at a glanceFormula with limited ingredient disclosure with clinical evidence supporting its stated purpose. Major medication interactions have been identified, and safety information is well characterized.
Zantrex Blue is a multi-ingredient stimulant and botanical blend that interacts with numerous medications, especially blood pressure drugs, seizure medications, heart drugs, and medications affected by enzyme changes in the liver. If you take any prescription medication or over-the-counter drugs regularly, check your exact list with the tool on this page before starting.
Avoid this product if you take ephedrine or have heart disease, high blood pressure, or seizure disorders without talking to your pharmacist first.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 13 of 14 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated May 23, 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
General information
Key facts about Zantrex Blue, straight from the product label.
| Brand | Zantrex |
|---|---|
| Barcode (UPC) | 681168407025 |
| Net contents | 84 Capsule(s) |
| Market status | On market |
| Date entered into DSLD | May 23, 2024 |
| DSLD ID | 308373 |
| Product type | Other Combinations |
| Supplement form | Capsule |
| Dietary claims / uses | All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years), Women (not pregnant or lactating) |
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 Zantrex Blue by Zantrex, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Niacin | 30 mg | 188% |
| Green Tea Leaf Extract | 0 NP | -- |
| Maca Root Extract | 0 NP | -- |
| Black Pepper Fruit Extract | 0 NP | -- |
| Guarana Seed Extract | 0 NP | -- |
| Asian Ginseng root extract | 0 NP | -- |
| Black Tea leaf extract | 0 NP | -- |
| Yerba Mate Leaf Extract | 0 NP | -- |
| Kola seed extract | 0 NP | -- |
| Trimethylxanthine | 0 NP | -- |
| Damiana Leaf Extract | 0 NP | -- |
| Rhodiola crenulata Root Extract | 0 NP | -- |
| Cacao seed extract | 0 NP | -- |
| Zantrex Proprietary Blend | 1160 mg | -- |
| Schizonepeta Flower Extract | 0 NP | -- |
Other ingredients: Gelatin, Magnesium Stearate, Stearic Acid, Rice Flour, Microcrystalline Cellulose, Silicon Dioxide, Titanium Dioxide, FD&C Blue 1
Tap any ingredient to jump to its full detail below.
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
Formulation
Study subjects lost weight without a prescribed diet program While the published clinical trial using the functional compound in Zantrex Blue resulted in significant weight loss without a prescribed diet program, adding a sensible diet to your weight-loss regimen should only enhance its incredible weight-loss power.
Zantrex: Innovative weight-loss solutions backed by our ironclad, 100% satisfaction guarantee. Our guarantee: Because no weight-control product or program will work for everyone, Zantrex Blue is backed by our 100% satisfaction guarantee. Simply stated, if you are not satisfied with your Zantrex Blue, just return it to the place of purchase within 30 days.
Which Zantrex is right for you? Blue Do you want to focus on weight loss or body fat loss? Weight loss How fast do you want to feel energized? Really fast Are you focused on body sculpting? No What is your planned level of physical activity? Minimal Do you plan to change your diet? No What is your gender? Male Female
Study subjects lost an average 11.2 lbs in just 45 days In a published clinical trial, subjects using the key compound in Zantrex Blue experienced a mean weight loss of 11.2 pounds in a little over six weeks.
Rapid weight loss Intense focused energy Ultimate metabolic stimulator
General Statements
With clinically validated ingredients and over a decade of remarkable, proven results, it's no wonder Zantrex is still the high energy, rapid weight-loss winner.
Note for customers of Zantrex Red or Zantrex Black: Zantrex Blue, Zantrex Red, and Zantrex Black are different formulations that work in different ways.
This box was designed in an oversized manner to prevent pilferage. The actual size of the capsule is printed on the front of the box.
Precautions
Note: Limit the use of xanthine-containing (i.e., caffeine and caffeine-like stimulants) supplements, foods, or beverages while consuming this product because stimulants may cause nervousness, irritability, sleeplessness, and occasionally, rapid heartbeat. If you or your health-care provider have any questions, please call: 1-800-898-5153.
International distribution is not allowed without prior written approval. Product resale allowed only through authorized representatives.
Do not exceed 6 capsules in any 24-hour period. Warning: Do not exceed suggested daily serving. This product contains a significantly potent xanthine (i.e., caffeine and caffeine-like stimulants) mixture of about 300 mg per serving. People sensitive to niacin (nicotinic acid) may experience flushing of the skin that is generally mild and transient. Do not use if inner safety seal under the cap is broken or missing. Use only as directed.
Not for use by individuals under the age of 18 years. Keep out of reach of children.
Do not use if pregnant or nursing. Consult your physician before use if you are taking medication, are sensitive to stimulants, or have a medical condition.
Suggested/Recommended/Usage/Directions
For maximum weight-loss effectiveness, take Zantrex Blue every day as directed.
Directions: For weight loss, adults take 2 capsules with a full glass of water 15 minutes before main meals. For a significant energy boost, adults take 1 or 2 capsules as needed. Do not exceed 6 capsules in any 24-hour period. Use in conjunction with any sensible diet and exercise program. Individual results will vary.
Storage
Store at controlled room temperature: 15 degrees-30 degrees C/59 degrees-86 degrees F.
Brand IP Statement(s)
Copyright 2019 All Rights Reserved.
Protected by international patents International patents: Canada: 2312936; Mexico: 257255; Great Britain: 1037644; Spain: 98959104.5
Seals/Symbols
Key Compound is Clinically Validated
FDA Statement of Identity
Dietary Supplement
FDA Disclaimer Statement
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Zantrex Blue by Zantrex 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 Zantrex Blue by Zantrex
These are the 14 active ingredients this product is made of. Select any to open its full monograph.
Serving size1 Capsule(s) Dosage formCapsule Servings per container42 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.
Niacin
Interacts with727 drugs
Niacin (vitamin B3) is an essential nutrient your body needs for energy and metabolism, and deficiency is uncommon in most developed countries. Prescr...
Niacin monograph & interactionsZantrex Proprietary Blend
- › Green Tea Leaf Extract
- › Maca Root Extract
- › Black Pepper Fruit Extract
- › Guarana Seed Extract
- › Asian Ginseng root extract
- › Black Tea leaf extract
- › Yerba Mate Leaf Extract
- › Kola seed extract
- › Trimethylxanthine
- › Damiana Leaf Extract
- › Rhodiola crenulata Root Extract
- › Cacao seed extract
- › Schizonepeta Flower Extract
Other (inactive) ingredients: Gelatin, Magnesium Stearate, Stearic Acid, Rice Flour, Microcrystalline Cellulose, Silicon Dioxide, Titanium Dioxide, FD&C Blue 1. These complete the product’s ingredient list but are not active constituents.
Zantrex Blue by Zantrex Drug Interactions
HelloPharmacist Interaction Report
Zantrex Blue contains 14 ingredients, and several of them interact with medications — most notably through caffeine-related compounds and niacin.
The most serious interactions are Major in severity: green tea extract and guarana seed extract both contain caffeine, which can combine with ephedrine to cause dangerous stimulant effects including heart attack, stroke, and seizure. Black tea leaf extract, yerba mate leaf extract, and trimethylxanthine (another name for caffeine) carry the same Major risk with ephedrine.
Read the full breakdown — every affected drug type, severity by severity
Niacin interacts with blood pressure medications (antihypertensive drugs), blood thinners (anticoagulants and antiplatelet drugs), diabetes medications, cholesterol drugs (statins), gout medications (allopurinol and probenecid), and drugs that lower uric acid (bile acid sequestrants) — all Moderate severity. Green tea extract also reduces the effect of the heart medication nadolol and the cholesterol drug atorvastatin (both Major).
Black pepper fruit extract can increase levels of several drugs including heart medications (propranolol), seizure drugs (phenytoin), and antibiotics (rifampin and nevirapine) — all Moderate.
Guarana, black tea, yerba mate, and caffeine all interact with seizure medications (valproate, felbamate, carbamazepine, phenytoin, ethosuximide) to potentially reduce their anti-seizure effects (Moderate). Asian ginseng root extract, rhodiola crenulata root extract, and schizonepeta flower extract interact with multiple drug-metabolizing enzymes, potentially affecting how your body clears dozens of medications.
Altogether, these interactions span 1,577 individual medications.
We could not check kola seed extract — no data are on file for it. Use the medication checker below with your exact prescriptions before starting this product.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Zantrex Blue?
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 Zantrex Blue interact with 1,599 drugs. Click any drug to see the details.
12 of the 14 ingredients in Zantrex Blue interact with drugs. Each result below shows which ingredient is responsible. Green Tea Leaf Extract Rhodiola crenulata Root Extract Asian Ginseng root extract Yerba Mate Leaf Extract Black Pepper Fruit Extract Schizonepeta Flower Extract Niacin Black Tea leaf extract Cacao seed extract Guarana Seed Extract Trimethylxanthine Damiana Leaf Extract
AcepromazineAtravet
How Acepromazine interacts with Zantrex Blue — through 6 ingredients. Tap an ingredient for the detail:
TrimethylxanthinePhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Trimethylxanthine + Acepromazine interactionBlack Tea Leaf ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Black Tea Leaf Extract + Acepromazine interactionCacao Seed ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Cacao Seed Extract + Acepromazine interactionGreen Tea Leaf ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Green Tea Leaf Extract + Acepromazine interactionGuarana Seed ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Guarana Seed Extract + Acepromazine interactionRhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Acepromazine interactionAminoglutethimideCytadren
How Aminoglutethimide interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Aminoglutethimide interactionAmobarbitalAmytal
How Amobarbital interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Amobarbital interactionAmobarbital, SecobarbitalTuinal
How Amobarbital, Secobarbital interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Amobarbital, Secobarbital interactionAmoxapineAsendin
How Amoxapine interacts with Zantrex Blue — through 2 ingredients. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractAntidepressant Drugs Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with antidepressants.
Read the full Rhodiola Crenulata Root Extract + Amoxapine interactionBlack Tea Leaf ExtractTricyclic Antidepressants (tcas) Minor
Interaction Summary
Theoretically, TCAs might bind with black tea constituents when taken at the same time.
Read the full Black Tea Leaf Extract + Amoxapine interactionBelladonna, OpiumB & O Supprettes
How Belladonna, Opium interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Belladonna, Opium interactionBenactyzine, MeprobamateDeprol
How Benactyzine, Meprobamate interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Benactyzine, Meprobamate interactionBrexanoloneZulresso
How Brexanolone interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants, Antidepressant Drugs Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Brexanolone interactionBupropionAplenzin, Forfivo XL, Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban
How Bupropion interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractAntidepressant Drugs Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with antidepressants.
Read the full Rhodiola Crenulata Root Extract + Bupropion interactionBupropion, NaltrexoneContrave
How Bupropion, Naltrexone interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractAntidepressant Drugs Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with antidepressants.
Read the full Rhodiola Crenulata Root Extract + Bupropion, Naltrexone interactionButabarbital SodiumButisol Sodium, Sarisol #2
How Butabarbital Sodium interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Butabarbital Sodium interactionButorphanolStadol
How Butorphanol interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Butorphanol interactionCarphenazineProketazin
How Carphenazine interacts with Zantrex Blue — through 5 ingredients. Tap an ingredient for the detail:
Green Tea Leaf ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Green Tea Leaf Extract + Carphenazine interactionCacao Seed ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Cacao Seed Extract + Carphenazine interactionGuarana Seed ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Guarana Seed Extract + Carphenazine interactionBlack Tea Leaf ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Black Tea Leaf Extract + Carphenazine interactionTrimethylxanthinePhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Trimethylxanthine + Carphenazine interactionCenobamateXcopri
How Cenobamate interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Cenobamate interactionCetirizineCetirizine, Quzyttir, Zyrtec
How Cetirizine interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Cetirizine interactionChloral HydrateChloral Hydrate
How Chloral Hydrate interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Chloral Hydrate interactionCyamemazineTercian
How Cyamemazine interacts with Zantrex Blue — through 6 ingredients. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Cyamemazine interactionGuarana Seed ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Guarana Seed Extract + Cyamemazine interactionCacao Seed ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Cacao Seed Extract + Cyamemazine interactionGreen Tea Leaf ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Green Tea Leaf Extract + Cyamemazine interactionTrimethylxanthinePhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Trimethylxanthine + Cyamemazine interactionBlack Tea Leaf ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Black Tea Leaf Extract + Cyamemazine interactionDiphenhydramineAllerdryl, Benadryl, Benadryl cream, Benadryl spray, Compoz, Dermamycin cream +9 more
How Diphenhydramine interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Diphenhydramine interactionEsketamineSpravato
How Esketamine interacts with Zantrex Blue — through 2 ingredients. Tap an ingredient for the detail:
Black Tea Leaf ExtractTricyclic Antidepressants (tcas) Minor
Interaction Summary
Theoretically, TCAs might bind with black tea constituents when taken at the same time.
Read the full Black Tea Leaf Extract + Esketamine interactionRhodiola Crenulata Root ExtractAntidepressant Drugs Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with antidepressants.
Read the full Rhodiola Crenulata Root Extract + Esketamine interactionEthotoinPaganone
How Ethotoin interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Ethotoin interactionGabapentinGralise, Neurontin
How Gabapentin interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Gabapentin interactionGabapentin EnacarbilHorizant
How Gabapentin Enacarbil interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Gabapentin Enacarbil interactionGamma Hydroxybutyrate (prescription Drug)GHB
How Gamma Hydroxybutyrate (prescription Drug) interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Gamma Hydroxybutyrate (prescription Drug) interactionGlutethimideDoriden
How Glutethimide interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Glutethimide interactionHeroinHeroin
How Heroin interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Heroin interactionHexobarbitalHexobarbital, Sombulex
How Hexobarbital interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Hexobarbital interactionHydromorphoneDilaudid, Hydromorph Contin, Palladone
How Hydromorphone interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Hydromorphone interactionIndiplonIndiplon
How Indiplon interacts with Zantrex Blue — through 1 ingredient. Tap an ingredient for the detail:
Rhodiola Crenulata Root ExtractCns Depressants Minor
Interaction Summary
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
Read the full Rhodiola Crenulata Root Extract + Indiplon interactionIsopropamide, ProchlorperazineCombid
How Isopropamide, Prochlorperazine interacts with Zantrex Blue — through 5 ingredients. Tap an ingredient for the detail:
TrimethylxanthinePhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Trimethylxanthine + Isopropamide, Prochlorperazine interactionBlack Tea Leaf ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Black Tea Leaf Extract + Isopropamide, Prochlorperazine interactionGuarana Seed ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Guarana Seed Extract + Isopropamide, Prochlorperazine interactionGreen Tea Leaf ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Green Tea Leaf Extract + Isopropamide, Prochlorperazine interactionCacao Seed ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Cacao Seed Extract + Isopropamide, Prochlorperazine interactionIsopropamide, TrifluoperazineStelabid Forte, Stelabid No 1, Stelabid No 2
How Isopropamide, Trifluoperazine interacts with Zantrex Blue — through 5 ingredients. Tap an ingredient for the detail:
Cacao Seed ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Cacao Seed Extract + Isopropamide, Trifluoperazine interactionGuarana Seed ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Guarana Seed Extract + Isopropamide, Trifluoperazine interactionBlack Tea Leaf ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Black Tea Leaf Extract + Isopropamide, Trifluoperazine interactionTrimethylxanthinePhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Trimethylxanthine + Isopropamide, Trifluoperazine interactionGreen Tea Leaf ExtractPhenothiazines Minor
Interaction Summary
Theoretically, phenothiazines might increase the levels and adverse effects of caffeine.
Read the full Green Tea Leaf Extract + Isopropamide, Trifluoperazine interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Zantrex Blue with known interactions, here are the types of medications they can affect. Open any type for the detail — or search your exact drug in the checker above.
Green Tea Leaf Extract
Atorvastatin (Lipitor)
Green tea extract seems to reduce the levels and clinical effects of atorvastatin.
In healthy humans, taking green tea extract 300 mg or 600 mg along with atorvastatin reduces plasma levels of atorvastatin by approximately 24%. The elimination of atorvastatin is not affected. Atorvastatin is a substrate of organic anion-transporting polypeptides (OATPs). Research shows that two of the major catechins found in green tea, epicatechin gallate (ECG) and epigallocatechin gallate (EGCG), inhibit OATPs. Some OATPs are expressed in the small intestine and are responsible for the uptake of drugs and other compounds, which may have resulted in reduced plasma levels of atorvastatin. It is not clear if drinking green tea alters the absorption of atorvastatin.
Ephedrine
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Green tea contains caffeine. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death.
Nadolol (Corgard)
Green tea seems to reduce the levels and clinical effects of nadolol.
Preliminary clinical research shows that green tea consumption reduces plasma concentrations of nadolol. Compared to a control group, both peak levels and total drug exposure (AUC) of nadolol were reduced by approximately 85% in subjects who drank green tea daily for two weeks. Drinking green tea with nadolol also significantly reduced nadolol's systolic blood pressure lowering effect. Other clinical research shows that a single dose of green tea can affect plasma nadolol levels for at least one hour. Green tea catechins have been shown to inhibit organic anion transporting polypeptides (OATP), one of which, OATP1A2, is involved in the uptake of nadolol in the intestine The interaction is thought to be due primarily to the epigallocatechin gallate (EGCG) content of green tea.
5-Fluorouracil
Theoretically, high doses of green tea might increase the effects and side effects of 5-fluorouracil.
Animal research shows that taking green tea in amounts equivalent to about 6 cups daily in humans for 4 weeks prior to receiving a single injection of 5-fluorouracil increases the maximum plasma levels of 5-fluorouracil by about 2.5-fold and the area under the curve by 425%.
Adenosine (Adenocard)
Theoretically, green tea might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Green tea contains caffeine. Caffeine is a competitive inhibitor of adenosine at the cellular level. However, caffeine doesn't seem to affect supplemental adenosine because high interstitial levels of adenosine overcome the antagonistic effects of caffeine. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. However, methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.
Anticoagulant/Antiplatelet Drugs
Theoretically, green tea may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Conflicting reports exist regarding the effect of green tea on bleeding risk when used with anticoagulant or antiplatelet drugs; however, most evidence suggests that drinking green tea in moderate amounts is unlikely to cause a significant interaction. Green tea contains small amounts of vitamin K, approximately 7 mcg per cup. Some case reports have associated the antagonism of warfarin with the vitamin K content of green tea. However, these reports are rare, and very large doses of green tea (about 8-16 cups daily) appear to be needed to cause these effects. Furthermore, the catechins and caffeine in green tea are reported to have antiplatelet activity.
Beta-Adrenergic Agonists
Green tea contains caffeine. Theoretically, concomitant use of large amounts of caffeine might increase cardiac inotropic effects of beta-agonists.
Bortezomib (Velcade)
Theoretically, green tea might interfere with the effects of bortezomib.
In vitro research shows that green tea polyphenols, such as epigallocatechin gallate (EGCG), interact with bortezomib and block its proteasome inhibitory action. This prevents the induction of cell death in multiple myeloma or glioblastoma cancer cell lines. Advise patients taking bortezomib, not to take green tea.
Carbamazepine (Tegretol)
Theoretically, green tea might reduce the effects of carbamazepine and increase the risk for convulsions.
Green tea contains caffeine. Animal research suggests that taking caffeine can lower the anticonvulsant effects of carbamazepine and can induce seizures when taken in doses above 400 mg/kg. Human research has shown that taking caffeine 300 mg in three divided doses along with carbamazepine 200 mg reduces the bioavailability of carbamazepine by 32% and prolongs the plasma half-life of carbamazepine 2-fold in healthy individuals.
Celiprolol (Celicard)
Theoretically, green tea might reduce the levels and clinical effects of celiprolol.
In a small human study, taking green tea daily for 4 days appears to decrease blood and urine levels of celiprolol by at least 98%. This interaction is possibly due to the inhibition of organic anion transporting polypeptide (OATP). Green tea catechins have been shown to inhibit organic anion transporting polypeptides (OATP), one of which, OATP1A2, is found in the intestine The interaction is thought to be due primarily to the epigallocatechin gallate (EGCG) content of green tea.
Cimetidine (Tagamet)
Theoretically, concomitant use might increase the effects and adverse effects of caffeine in green tea.
Green tea contains caffeine. Cimetidine can reduce caffeine clearance by 31% to 42%.
Clozapine (Clozaril)
Theoretically, green tea might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
Animal research suggests that, although green tea extract does not affect the elimination of clozapine, it delays the time to reach peak concentration and reduces the peak plasma levels. Also, concomitant administration of green tea and clozapine might theoretically cause acute exacerbation of psychotic symptoms due to the caffeine in green tea. Caffeine can increase the effects and toxicity of clozapine. Caffeine doses of 400-1000 mg daily inhibit clozapine metabolism. Clozapine is metabolized by cytochrome P450 1A2 (CYP1A2). Researchers speculate that caffeine might inhibit CYP1A2. However, there is no reliable evidence that caffeine affects CYP1A2. There is also speculation that genetic factors might make some patients be more sensitive to the interaction between clozapine and caffeine.
Contraceptive Drugs
Theoretically, concomitant use might increase the effects and adverse effects of caffeine found in green tea.
Green tea contains caffeine. Oral contraceptives can decrease caffeine clearance by 40% to 65%.
Cytochrome P450 1A2 (Cyp1A2) Inhibitors
Theoretically, concomitant use might increase the levels and adverse effects of caffeine.
Green tea contains caffeine. Caffeine is metabolized by cytochrome P450 1A2 (CYP1A2),. Theoretically, drugs that inhibit CYP1A2 may decrease the clearance rate of caffeine from green tea and increase caffeine levels.
Dipyridamole (Persantine)
Theoretically, green tea might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Green tea contains caffeine. Caffeine might inhibit dipyridamole-induced vasodilation. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. Methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.
Disulfiram (Antabuse)
Theoretically, disulfiram might increase the risk of adverse effects from caffeine.
In human research, disulfiram decreases the clearance and increases the half-life of caffeine.
Diuretic Drugs
Theoretically, using green tea with diuretic drugs might increase the risk of hypokalemia.
Green tea contains caffeine. In excessive amounts, caffeine can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also cause lower potassium levels.
Estrogens
Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Green tea contains caffeine. Estrogen inhibits caffeine metabolism.
Ethosuximide (Zarontin)
Theoretically, green tea might reduce the effects of ethosuximide and increase the risk for convulsions.
Green tea contains caffeine. Animal research suggests that caffeine 92.4 mg/kg can decrease the anticonvulsant activity of ethosuximide. However, this effect has not been reported in humans.
Felbamate (Felbatol)
Theoretically, green tea might reduce the effects of felbamate and increase the risk for convulsions.
Green tea contains caffeine. Animal research suggests that a high dose of caffeine 161.7 mg/kg can decreases the anticonvulsant activity of felbamate. However, this effect has not been reported in humans.
Fexofenadine (Allegra)
Green tea can decrease blood levels of fexofenadine.
Clinical research shows that green tea can significantly decrease blood levels and excretion of fexofenadine. Taking green tea extract with a dose of fexofenadine decreased bioavailability of fexofenadine by about 30%. In vitro, green tea inhibits the cellular accumulation of fexofenadine by inhibiting the organic anion transporting polypeptide (OATP) drug transporter. Research shows that two of the major catechins found in green tea, epicatechin gallate (ECG) and epigallocatechin gallate (EGCG), inhibit OATPs, specifically OATP1A2, OATP1B1, and OATP2B1. In addition, green tea has been shown to reduce the absorption of some drugs that are OATP substrates.
Flutamide (Eulexin)
Theoretically, green tea might increase the levels and adverse effects of flutamide.
Green tea contains caffeine. In vitro evidence suggests that caffeine can inhibit the metabolism of flutamide. Theoretically, concomitant use of caffeine and flutamide might increase serum concentrations of flutamide and increase the risk adverse effects.
Fluvoxamine (Luvox)
Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Green tea contains caffeine. Fluvoxamine reduces caffeine metabolism.
Hepatotoxic Drugs
Theoretically, concomitant use might have additive adverse hepatotoxic effects.
Green tea extract supplements have been linked to several cases of hepatotoxicity and might have additive hepatotoxic effects with other drugs..
Imatinib (Gleevec)
Theoretically, green tea might reduce the levels and clinical effects of imatinib.
In animal research, a single dose of green tea extract reduces the area under the curve (AUC) of imatinib by up to approximately 64% and its main metabolite N-desmethyl imatinib by up to approximately 81%. This interaction has not been shown in humans. The mechanism of action is unclear but may involve multiple pathways.
Rhodiola crenulata Root Extract
Antidiabetes Drugs
Theoretically, taking rhodiola with antidiabetes drugs might increase the risk of hypoglycemia.
In vitro and animal research shows that rhodiola extract can decrease blood glucose due to alpha-glucosidase activity.
Antihypertensive Drugs
Theoretically, taking rhodiola with antihypertensive drugs might increase the risk of hypotension.
In vitro and animal research shows that rhodiola extract inhibits angiotensin-converting enzyme (ACE) and might lower blood pressure.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, rhodiola might increase levels of drugs metabolized by CYP2C9.
In vitro research shows that rhodiola inhibits CYP2C9. This effect is highly variable and appears to be dependent on the rhodiola product studied. Also, a clinical study in healthy young males found that taking rhodiola extract 290 mg daily for 14 days reduces the metabolism of losartan, a CYP2C9 substrate, by 21% after 4 hours.
Immunosuppressants
Theoretically, rhodiola use might interfere with immunosuppressive therapy.
In vitro and animal research show that rhodiola has immunostimulatory effects.
Losartan (Cozaar)
Rhodiola might increase the levels and adverse effects of losartan.
A clinical study in healthy young males found that taking rhodiola extract 290 mg daily for 14 days reduces the metabolism of losartan, a CYP2C9 substrate, by 21% after 4 hours.
P-Glycoprotein Substrates
Theoretically, rhodiola might increase levels of P-glycoprotein substrates.
In vitro research shows that rhodiola inhibits P-glycoprotein. Theoretically, using rhodiola with P-glycoprotein substrates might increase drug levels and potentially increase the risk of adverse effects.
Antidepressant Drugs
Theoretically, rhodiola might increase the risk of adverse effects when taken with antidepressants.
A review of adverse event reports in Poland identified cases of tachyarrhythmias, myalgia, arthralgia, gum pain, restless leg syndrome, swallowing disorders, and changes in consciousness when rhodiola was taken in combination with paroxetine, escitalopram, fluoxetine, sertraline, trazodone, and/or duloxetine.
Cns Depressants
Theoretically, rhodiola might increase the risk of adverse effects when taken with CNS depressants.
A review of adverse event reports in Poland identified cases of excessive sedation, myoclonus, hypotension, and hallucinations when rhodiola was taken with haloperidol, diazepam, or alprazolam.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, rhodiola might increase levels of drugs metabolized by CYP1A2.
In vitro research shows that rhodiola inhibits CYP1A2. This effect is highly variable and appears to be dependent on the rhodiola product studied. However, a clinical study in healthy young males found that taking rhodiola extract 290 mg daily for 14 days does not inhibit the metabolism of caffeine, a CYP1A2 substrate.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, rhodiola might increase levels of drugs metabolized by CYP3A4.
In vitro research shows that rhodiola inhibits CYP3A4. This effect is highly variable and appears to be dependent on the rhodiola product studied. However, a clinical study in healthy young males found that taking rhodiola extract 290 mg daily for 14 days does not inhibit the metabolism of midazolam, a CYP3A4 substrate.
Asian Ginseng root extract
Anticoagulant/Antiplatelet Drugs
Although Panax ginseng has shown antiplatelet effects in the laboratory, it is unlikely to increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
In vitro evidence suggests that ginsenoside constituents in Panax ginseng might decrease platelet aggregation. However, research in humans suggests that ginseng does not affect platelet aggregation. Animal research indicates low oral bioavailability of Rb1 and rapid elimination of Rg1, which might explain the discrepancy between in vitro and human research. Until more is known, use with caution in patients concurrently taking anticoagulant or antiplatelet drugs.
Antidiabetes Drugs
Theoretically, taking Panax ginseng with antidiabetes drugs might increase the risk of hypoglycemia.
Clinical research suggests that Panax ginseng might decrease blood glucose levels. Monitor blood glucose levels closely.
Caffeine
Theoretically, taking Panax ginseng with caffeine might increase the risk of adverse stimulant effects.
Panax ginseng has been shown to have stimulant effects. Theoretically, caffeine might have an additive effect on the stimulant effects of Panax ginseng.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Theoretically, Panax ginseng might increase levels of drugs metabolized by CYP2D6. However, research is conflicting.
There is some evidence that Panax ginseng can inhibit the CYP2D6 enzyme by approximately 6%. In addition, in animal research, Panax ginseng inhibits the metabolism of dextromethorphan, a drug metabolized by CYP2D6, by a small amount. However, contradictory research suggests Panax ginseng might not inhibit CYP2D6. Until more is known, use Panax ginseng cautiously in patients taking drugs metabolized by these enzymes.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, Panax ginseng might increase or decrease levels of drugs metabolized by CYP3A4.
Panax ginseng may affect the clearance of drugs metabolized by CYP3A4. One such drug is imatinib. Inhibition of CYP3A4 was believed to be responsible for a case of imatinib-induced hepatotoxicity. In contrast, Panax ginseng has been shown to increase the clearance of midazolam, another drug metabolized by CYP3A4. Clinical research shows that Panax ginseng can reduce midazolam area under the curve by 44%, maximum plasma concentration by 26%, and time to reach maximum plasma concentration by 29%. Midazolam metabolism was also increased in animals given Panax ginseng. Until more is known, use Panax ginseng cautiously in combination with CYP3A4 substrates.
Estrogens
Theoretically, concomitant use of large amounts of Panax ginseng might interfere with hormone replacement therapy.
Laboratory research and some case reports suggest that Panax ginseng can have estrogenic effects due to competition for estrogen receptors. The estrogenic activity is attributed to the ginsenoside constituents of Panax ginseng.
Furosemide (Lasix)
Theoretically, Panax ginseng might reduce the effects of furosemide.
There is some concern that Panax ginseng might contribute to furosemide resistance. There is one case of resistance to furosemide diuresis in a patient taking a germanium-containing ginseng product.
Imatinib (Gleevec)
Theoretically, Panax ginseng might increase the effects and adverse effects of imatinib.
A case of imatinib-induced hepatotoxicity has been reported for a 26-year-old male with chronic myelogenous leukemia stabilized on imatinib for 7 years. The patient took imatinib 400 mg along with a Panax ginseng-containing energy drink daily for 3 months. Since imatinib-associated hepatotoxicity typically occurs within 2 years of initiating therapy, it is believed that Panax ginseng affected imatinib toxicity though inhibition of cytochrome P450 3A4. CYP3A4 is the primary enzyme involved in imatinib metabolism.
Immunosuppressants
Theoretically, Panax ginseng use might interfere with immunosuppressive therapy.
Panax ginseng might have immune system stimulating properties.
Insulin
Theoretically, taking Panax ginseng with insulin might increase the risk of hypoglycemia.
Clinical research suggests that Panax ginseng might decrease blood glucose levels. Insulin dose adjustments might be necessary in patients taking Panax ginseng; use with caution.
Midazolam (Versed)
Theoretically, Panax ginseng may increase the clearance of midazolam.
Midazolam is metabolized by cytochrome P450 3A4 (CYP3A4). Clinical research suggests that Panax ginseng can reduce midazolam area under the curve by 44%, maximum plasma concentration by 26%, and time to reach maximum plasma concentration by 29%. Midazolam metabolism was also increased in animals given Panax ginseng.
Monoamine Oxidase Inhibitors (Maois)
Theoretically, Panax ginseng can interfere with MAOI therapy.
Concomitant use of Panax ginseng with phenelzine (Nardil) is associated with insomnia, headache, tremors, and hypomania.
Nifedipine (Procardia)
Theoretically, taking Panax ginseng with nifedipine might increase serum levels of nifedipine and the risk of hypotension.
Preliminary clinical research shows that concomitant use can increase serum levels of nifedipine in healthy volunteers. This might cause the blood pressure lowering effects of nifedipine to be increased when taken concomitantly with Panax ginseng.
Qt Interval-Prolonging Drugs
Theoretically, Panax ginseng has an additive effect with drugs that prolong the QT interval and potentially increase the risk of ventricular arrhythmias. However, research is conflicting.
Clinical research shows that short-term use of Panax ginseng can increase the QT interval. However, no changes in QT interval have been identified with prolonged use.
Raltegravir (Isentress)
Theoretically, taking Panax ginseng with raltegravir might increase the risk of liver toxicity.
A case report suggests that concomitant use of Panax ginseng with raltegravir can increase serum levels of raltegravir, resulting in elevated liver enzymes levels.
Selegiline (Eldepryl)
Theoretically, Panax ginseng might increase or decrease levels of selegiline, possibly altering the effects and side effects of selegiline.
Animal research shows that taking selegiline with a low dose of Panax ginseng extract (1 gram/kg) reduces selegiline bioavailability, while taking a high dose of Panax ginseng extract (3 grams/kg) increases selegiline bioavailability. More research is needed to confirm these effects.
Stimulant Drugs
Theoretically, taking Panax ginseng with stimulant drugs might increase the risk of adverse stimulant effects.
Panax ginseng has been shown to have stimulant effects.
Warfarin (Coumadin)
Panax ginseng might affect the clearance of warfarin. However, this interaction appears to be unlikely.
There has been a single case report of decreased effectiveness of warfarin in a patient who also took Panax ginseng. However, it is questionable whether Panax ginseng was the cause of this decrease in warfarin effectiveness. Some research in humans and animals suggests that Panax ginseng does not affect the pharmacokinetics of warfarin. However, other research in humans suggests that Panax ginseng might modestly increase the clearance of the S-warfarin isomer. More evidence is needed to determine whether Panax ginseng causes a significant interaction with warfarin.
Fexofenadine (Allegra)
Theoretically, Panax ginseng might decrease blood levels of oral or intravenous fexofenadine.
Animal research suggests that taking Panax ginseng in combination with oral or intravenous fexofenadine may reduce the bioavailability of fexofenadine. Some scientists have attributed this effect to the ability of Panax ginseng to increase the expression of P-glycoprotein.
Lopinavir/Ritonavir (Kaletra)
Although Panax ginseng has demonstrated variable effects on cytochrome P450 3A4 (CYP3A4), which metabolizes lopinavir, Panax ginseng is unlikely to alter levels of lopinavir/ritonavir.
Lopinavir is metabolized by CYP3A4 and is administered with the CYP3A4 inhibitor ritonavir to increase its plasma concentrations. Panax ginseng has shown variable effects on CYP3A4 activity in humans. However, taking Panax ginseng (Vitamer Laboratories) 500 mg twice daily for 14 days did not alter the pharmacokinetics of lopinavir/ritonavir in 12 healthy volunteers.
Yerba Mate Leaf Extract
Ephedrine
Theoretically, the caffeine in yerba mate might increase the risk for stimulant adverse effects when used concomitantly with ephedrine.
Use of ephedrine with caffeine can increase the risk of stimulatory adverse effects. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death.
Adenosine (Adenocard)
Theoretically, the caffeine in yerba mate might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Yerba mate contains caffeine. Some evidence shows that caffeine is a competitive inhibitor of adenosine and can reduce the vasodilatory effects of adenosine in humans. However, other research shows that caffeine does not seem to affect supplemental adenosine because high interstitial levels of adenosine overcome the antagonistic effects of caffeine. Still, some researchers recommend that methylxanthines, such as caffeine, as well as methylxanthine-containing products, should be stopped 24 hours prior to pharmacological stress tests. However, methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.
Anticoagulant/Antiplatelet Drugs
Theoretically, the caffeine in yerba mate may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Yerba mate contains caffeine. Caffeine is reported to have antiplatelet activity. Theoretically, it might increase the risk of bleeding when used concomitantly with these agents; however, this interaction has not been reported in humans.
Benzodiazepines
Theoretically, the caffeine in yerba mate might reduce the efficacy of benzodiazepines.
Yerba mate contains caffeine. Caffeine can antagonize the anxiolytic effects of benzodiazepines.
Beta-Adrenergic Agonists
Theoretically, the caffeine in yerba mate might increase the cardiac inotropic effects of beta-agonists, especially if taken in large amounts.
Yerba mate contains caffeine. Caffeine can increase cardiac inotropic effects of beta-agonists.
Carbamazepine (Tegretol)
Theoretically, the caffeine in yerba mate might reduce the effects of carbamazepine and increase the risk for convulsions.
Yerba mate contains caffeine. Animal research suggests that caffeine can lower the anticonvulsant effects of carbamazepine and can induce seizures when taken in doses above 400 mg/kg. Human research has shown that taking caffeine 300 mg in three divided doses along with carbamazepine 200 mg reduces the bioavailability of carbamazepine by 32% and prolongs the plasma half-life of carbamazepine two-fold in healthy individuals.
Cimetidine (Tagamet)
Theoretically, cimetidine might increase the levels and adverse effects of the caffeine contained in yerba mate.
Yerba mate contains caffeine. Cimetidine decreases caffeine clearance by 31% to 42%.
Clozapine (Clozaril)
Theoretically, the caffeine in yerba mate might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
Yerba mate contains caffeine. Caffeine might increase the effects and toxicity of clozapine. Caffeine doses of 400-1000 mg per day inhibit clozapine metabolism. Clozapine is metabolized by cytochrome P450 1A2 (CYP1A2). Although researchers speculate that caffeine might inhibit CYP1A2, there is no reliable evidence that caffeine affects CYP1A2. There is also speculation that genetic factors might make some patients more sensitive to an interaction between clozapine and caffeine.
Dipyridamole (Persantine)
Theoretically, the caffeine in yerba mate might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Yerba mate contains caffeine. Caffeine inhibits dipyridamole-induced vasodilation. Still, some researchers recommend that methylxanthines, such as caffeine, as well as methylxanthine-containing products, should be stopped 24 hours prior to pharmacological stress. Methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.
Disulfiram (Antabuse)
Theoretically, disulfiram might increase the levels and adverse effects of the caffeine in yerba mate.
Yerba mate contains caffeine. Disulfiram decreases the rate of caffeine clearance.
Diuretic Drugs
Theoretically, the caffeine in yerba mate might increase the risk of hypokalemia when used concomitantly with other diuretics.
Yerba mate contains caffeine. Caffeine, especially in excessive amounts, can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also cause lower potassium levels.
Estrogens
Theoretically, estrogens might increase the levels and adverse effects of the caffeine in yerba mate.
Yerba mate contains caffeine. Estrogen inhibits caffeine metabolism.
Ethosuximide (Zarontin)
Theoretically, the caffeine in yerba mate might reduce the effects of ethosuximide and increase the risk for convulsion.
Yerba mate contains caffeine. Animal research shows that caffeine 92.4 mg/kg can decrease the anticonvulsant activity of ethosuximide. However, this effect has not been reported in humans.
Felbamate (Felbatol)
Theoretically, the caffeine in yerba mate might reduce the effects of felbamate and increase the risk for convulsion.
Yerba mate contains caffeine. Animal research shows that a high dose of caffeine 161.7 mg/kg can decreases the anticonvulsant activity of felbamate. However, this effect has not been reported in humans.
Flutamide (Eulexin)
Theoretically, the caffeine in yerba mate might increase the levels and adverse effects of flutamide.
Yerba mate contains caffeine. In vitro evidence suggests that caffeine can inhibit the metabolism of flutamide. However, this effect has not been reported in humans.
Fluvoxamine (Luvox)
Theoretically, fluvoxamine might increase the levels and adverse effects of the caffeine in yerba mate.
Yerba mate contains caffeine. Fluvoxamine reduces caffeine metabolism.
Lithium
Theoretically, abrupt withdrawal of the caffeine in yerba mate might increase serum lithium levels.
Yerba mate contains caffeine, which has diuretic activity. When abruptly discontinued, it might alter the clearance of lithium. There are two case reports of lithium tremor that worsened upon abrupt coffee withdrawal.
Midazolam (Versed)
Theoretically, use of yerba mate with midazolam might increase midazolam metabolite levels and adverse effects.
In vitro research shows that yerba mate extract containing 6.75% chlorogenic acid significantly inhibits the metabolism of midazolam via inhibition of cytochrome P450 3A4 (CYP3A4).
Monoamine Oxidase Inhibitors (Maois)
Theoretically, the caffeine in yerba mate might increase risk of a hypertensive crisis when used concomitantly with MAOIs.
Yerba mate contains caffeine. Caffeine has been shown to inhibit monoamine oxidase (MAO) A and B in laboratory studies. Concomitant intake of large amounts of caffeine with MAOIs might precipitate a hypertensive crisis. In a case report, a patient that consumed 10-12 cups of caffeinated coffee and took the MAOI tranylcypromine presented with severe hypertension. Hypertension was resolved after the patient switched to drinking decaffeinated coffee.
Nicotine
Theoretically, the caffeine in yerba mate might increase risk of hypertension when used concomitantly with nicotine.
Yerba mate contains caffeine. Concomitant use of caffeine and nicotine has been shown to have additive cardiovascular effects, including increased heart rate and blood pressure. Blood pressure was increased by 10.8/12.4 mmHg when the agents were used concomitantly.
Pentobarbital (Nembutal)
Theoretically, the caffeine in yerba mate might decrease the effects of pentobarbital.
The caffeine in yerba mate might negate the hypnotic effects of pentobarbital.
Phenobarbital (Luminal)
Theoretically, the caffeine in yerba mate might reduce the effects of phenobarbital and increase the risk for convulsions.
Yerba mate contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of phenobarbital. However, the exact mechanism of this interaction is unclear.
Phenylpropanolamine
Theoretically, phenylpropanolamine might increase the risk of hypertension as well as the levels and adverse effects of the caffeine in yerba mate.
Yerba mate contains caffeine. Concomitant use of phenylpropanolamine and caffeine might cause an additive increase in blood pressure. Phenylpropanolamine also seems to increase caffeine serum levels.
Phenytoin (Dilantin)
Theoretically, the caffeine in yerba mate might reduce the effects of phenytoin and increase the risk for convulsions.
Yerba mate contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of phenytoin. The effect does not seem to be related to the seizure threshold-lowering effects of caffeine. However, the exact mechanism of this interaction is unclear.
Pioglitazone (Actos)
Theoretically, the caffeine in yerba mate might increase the levels and clinical effects of pioglitazone.
Yerba mate contains caffeine. Animal research suggests that caffeine can modestly increase the maximum concentration, area under the curve, and half-life of pioglitazone, and also reduce its clearance. This increased the antidiabetic effects of pioglitazone. However, the exact mechanism of this interaction is unclear.
Black Pepper Fruit 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.
Schizonepeta Flower Extract
Cytochrome P450 1A2 (Cyp1A2) Substrates
Animal research suggests that schizonepetin, a monoterpene constituent of schizonepeta, inhibits cytochrome P450 (CYP) 1A2. Theoretically, schizonepeta might increase the effects and side effects of CYP1A2 substrates.
Some substrates of CYP1A2 include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Animal research suggests that schizonepetin, a monoterpene constituent of schizonepeta, inhibits cytochrome P450 (CYP) 2D6. Theoretically, schizonepeta might increase the effects and side effects of CYP2D6 substrates.
Some substrates of CYP2D6 include amitriptyline (Elavil), codeine, desipramine (Norpramin), flecainide (Tambocor), haloperidol (Haldol), imipramine (Tofranil), metoprolol (Lopressor, Toprol XL), ondansetron (Zofran), paroxetine (Paxil), risperidone (Risperdal), tramadol (Ultram), venlafaxine (Effexor), and others.
Cytochrome P450 2E1 (Cyp2E1) Substrates
Animal research suggests that schizonepetin, a monoterpene constituent of schizonepeta, inhibits cytochrome P450 (CYP) 2E1. Theoretically, schizonepeta might increase the effects and side effects of CYP2E1 substrates.
Some substrates of CYP2E1 include acetaminophen, chlorzoxazone (Parafon Forte), ethanol, theophylline, and anesthetics such as enflurane (Ethrane), halothane (Fluothane), isoflurane (Forane), and methoxyflurane (Penthrane).
Cytochrome P450 3A4 (Cyp3A4) Substrates
Animal research suggests that schizonepetin, a monoterpene constituent of schizonepeta, induces cytochrome P450 (CYP) 3A4. Theoretically, schizonepeta might decrease the effects of CYP3A4 substrates.
Some substrates of CYP3A4 include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and numerous others.
Niacin
Alcohol (Ethanol)
Concomitant use of alcohol and niacin might increase the risk of flushing and hepatotoxicity.
Alcohol can exacerbate the flushing and pruritus associated with niacin. Large doses of niacin might also exacerbate liver dysfunction associated with chronic alcohol use. A case report describes delirium and lactic acidosis in a patient taking niacin 3 grams daily who ingested 1 liter of wine. Advise patients to avoid large amounts of alcohol while taking niacin.
Allopurinol (Zyloprim)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as allopurinol.
Large doses of niacin can reduce urinary excretion of uric acid, potentially resulting in hyperuricemia. Doses of uricosurics such as allopurinol might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Anticoagulant/Antiplatelet Drugs
Theoretically, niacin may have additive effects when used with anticoagulant or antiplatelet drugs.
Several cases of clotting factor synthesis deficiency and coagulopathy have been reported in patients taking sustained-release niacin. Also, thrombocytopenia has been reported in patients treated with niacin or niacin plus lovastatin.
Antidiabetes Drugs
Niacin can increase blood glucose levels and may diminish the effects of antidiabetes drugs.
Niacin impairs glucose tolerance in a dose-dependent manner, probably by causing or aggravating insulin resistance and increasing hepatic production of glucose. In diabetes patients, niacin 4.5 grams daily for 5 weeks can increase plasma glucose by an average of 16% and glycated hemoglobin (HbA1c) by 21%. However, lower doses of 1.5 grams daily or less appear to have minimal effects on blood glucose. In some patients, glucose levels increase when niacin is started, but then return to baseline when a stable dose is reached. Up to 35% of patients with diabetes may need adjustments in hypoglycemic therapy when niacin is added.
Antihypertensive Drugs
Theoretically, niacin may increase the risk of hypotension when used with antihypertensive drugs.
The vasodilating effects of niacin can cause hypotension. Furthermore, some clinical evidence suggests that a one-hour infusion of niacin can reduce systolic, diastolic, and mean blood pressure in hypertensive patients. This effect is not observed in normotensive patients.
Bile Acid Sequestrants
Bile acid sequestrants can bind niacin and decrease absorption. Separate administration by 4-6 hours to avoid an interaction.
In vitro studies show that colestipol (Colestid) binds about 98% of available niacin and cholestyramine (Questran) binds 10% to 30%.
Gemfibrozil (Lopid)
Theoretically, concomitant use of niacin and gemfibrozil might increase the risk of myopathy in some patients.
A case of myopathy from concomitant use of niacin and gemfibrozil has been reported. Niacin alone has also been associated with cases of myopathy. Using gemfibrozil with niacin might further increase the risk of developing myopathy.
Hepatotoxic Drugs
Theoretically, concomitant use of niacin and hepatotoxic drugs might increase the risk of hepatotoxicity.
Niacin has been associated with cases of liver toxicity, especially when used in pharmacologic doses. Sustained-release niacin preparations appear to be associated with a higher risk of hepatotoxicity than immediate-release niacin.
Hmg-Coa Reductase Inhibitors ("Statins")
Theoretically, concomitant use of niacin and statins might increase the risk of myopathy and rhabdomyolysis in some patients.
Some case reports have raised concerns that niacin might increase the risk of myopathy and rhabdomyolysis when combined with statins. However, a significantly increased risk of myopathy has not been demonstrated in clinical trials, including those using an FDA-approved combination of lovastatin and niacin (Advicor).
Probenecid (Benemid)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as probenecid.
Large doses of niacin reduce urinary excretion of uric acid, potentially causing hyperuricemia. Doses of uricosurics such as probenecid might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Sulfinpyrazone (Anturane)
Theoretically, niacin might antagonize the therapeutic effects of uricosurics such as sulfinpyrazone.
Large doses of niacin reduce urinary excretion of uric acid, potentially causing hyperuricemia. Doses of uricosurics such as sulfinpyrazone might need to be increased to maintain control of gout in patients who start taking niacin. People who have frequent attacks of gout despite uricosuric therapy should avoid niacin.
Thyroid Hormone
Theoretically, niacin might antagonize the therapeutic effects of thyroid hormones.
Clinical research and case reports suggests that taking niacin can reduce serum levels of thyroxine-binding globulin by up to 25% and moderately reduce levels of thyroxine (T4). Patients taking thyroid hormone for hypothyroidism might need dose adjustments when using niacin.
Transdermal Nicotine (Nicoderm)
Theoretically, concomitant use of niacin and transdermal nicotine might increase the risk of flushing and dizziness.
Niacin and nicotine can both cause flushing and dizziness.
Warfarin (Coumadin)
There is limited evidence that niacin may increase the anticoagulant effects of warfarin.
In a case report, a patient on warfarin developed an elevated international normalized ratio (INR) of 3.9 after taking niacin for two weeks. The patient's INR was previously stable, ranging between 2 and 3 in recent months, and no other medication changes were identified. The elevated INR returned to therapeutic range within 4 days following the discontinuation of niacin.
Aspirin
Large doses of aspirin might alter the clearance of niacin.
Aspirin is often used with niacin to reduce niacin-induced flushing. Doses of 80-975 mg aspirin have been used, but 325 mg appears to be optimal. Aspirin also seems to reduce the clearance of niacin by competing for glycine conjugation. Taking aspirin 1 gram seems to reduce niacin clearance by 45%. This is probably a dose-related effect and not clinically significant with the more common aspirin dose of 325 mg.
Black Tea leaf extract
Ephedrine
Theoretically, concomitant use might increase the risk for simulant adverse effects.
Black tea contains caffeine. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death. Tell patients to avoid taking caffeine with ephedrine and other stimulants.
Adenosine (Adenocard)
Theoretically, black tea might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Black tea contains caffeine. Caffeine is a competitive inhibitor of adenosine at the cellular level. However, caffeine does not seem to affect supplemental adenosine because high interstitial levels of adenosine overcome the antagonistic effects of caffeine. It is recommended that methylxanthines such as caffeine, as well as methylxanthine-containing products, be stopped 24 hours prior to pharmacological stress tests. However, methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.
Anticoagulant/Antiplatelet Drugs
Theoretically, black tea may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Black tea contains caffeine. Caffeine is reported to have antiplatelet activity. Theoretically, the caffeine in black tea might increase the risk of bleeding when used concomitantly with antiplatelet drugs. However, this interaction has not been reported in humans.
Beta-Adrenergic Agonists
Theoretically, concomitant use of large amounts of black tea might increase cardiac inotropic effects of beta-agonists.
Black tea contains caffeine. Caffeine can increase cardiac inotropic effects of beta-agonists.
Carbamazepine (Tegretol)
Theoretically, black tea might reduce the effects of carbamazepine and increase the risk for convulsion.
Black tea contains caffeine. Animal research suggests that caffeine can lower the anticonvulsant effects of carbamazepine and can induce seizures when taken in doses above 400 mg/kg. Human research has shown that taking caffeine 300 mg in three divided doses along with carbamazepine 200 mg reduces the bioavailability of carbamazepine by 32% and prolongs the plasma half-life of carbamazepine 2-fold in healthy individuals.
Cimetidine (Tagamet)
Theoretically, concomitant use might increase the effects and adverse effects of caffeine in black tea.
Black tea contains caffeine. Cimetidine can reduces caffeine clearance by 31% to 42%.
Clozapine (Clozaril)
Theoretically, black tea might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
Concomitant administration of black tea and clozapine might theoretically cause acute exacerbation of psychotic symptoms due to the caffeine in black tea. Caffeine can increase the effects and toxicity of clozapine. Caffeine doses of 400-1000 mg daily inhibit clozapine metabolism. Clozapine is metabolized by cytochrome P450 1A2 (CYP1A2). Researchers speculate that caffeine might inhibit CYP1A2. However, there is no reliable evidence that caffeine affects CYP1A2. There is also speculation that genetic factors might make some patients be more sensitive to the interaction between clozapine and caffeine.
Contraceptive Drugs
Theoretically, concomitant use might increase the effects and adverse effects of caffeine found in black tea.
Black tea contains caffeine. Oral contraceptive drugs can decrease caffeine clearance by 40% to 65%.
Cytochrome P450 1A2 (Cyp1A2) Inhibitors
Theoretically, concomitant use might increase the levels and adverse effects of caffeine.
Black tea contains caffeine. Caffeine is metabolized by CYP1A2,. Theoretically, drugs that inhibit CYP1A2 may decrease the clearance rate of caffeine from black tea and increase caffeine levels.
Dipyridamole (Persantine)
Theoretically, black tea might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Black tea contains caffeine. Caffeine is a methylxanthine that may inhibit dipyridamole-induced vasodilation. It is recommended that methylxanthines such as caffeine, as well as methylxanthine-containing products such as black tea, be stopped 24 hours prior to pharmacological stress tests. Methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.
Disulfiram (Antabuse)
Theoretically, disulfiram might increase the risk of adverse effects from caffeine.
Black tea contains caffeine. In human research, disulfiram decreases the clearance and increases the half-life of caffeine.
Diuretic Drugs
Theoretically, using black tea with diuretic drugs might increase the risk of hypokalemia.
Black tea contains caffeine. Caffeine, especially in excessive amounts, can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also cause lower potassium levels.
Estrogens
Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Black tea contains caffeine. Estrogen inhibits caffeine metabolism.
Ethosuximide (Zarontin)
Theoretically, black tea might reduce the effects of ethosuximide and increase the risk for convulsions.
Black tea contains caffeine. Animal research suggests that caffeine 92.4 mg/kg can decrease the anticonvulsant activity of ethosuximide. However, this effect has not been observed in humans.
Felbamate (Felbatol)
Theoretically, black tea might reduce the effects of felbamate and increase the risk for convulsions.
Black tea contains caffeine. Animal research suggests that a high dose of caffeine 161.7 mg/kg can decrease the anticonvulsant activity of felbamate. However, this effect has not been observed in humans.
Flutamide (Eulexin)
Theoretically, black tea might increase the levels and adverse effects of flutamide.
Black tea contains caffeine. In vitro evidence suggests that caffeine can inhibit the metabolism of flutamide. Theoretically, concomitant use of caffeine and flutamide might increase serum concentrations of flutamide and increase the risk of adverse effects.
Fluvoxamine (Luvox)
Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Black tea contains caffeine. Fluvoxamine reduces caffeine metabolism.
Lithium
Theoretically, abrupt black tea withdrawal might increase the levels and adverse effects of lithium.
Black tea contains caffeine. Abrupt caffeine withdrawal can increase serum lithium levels. Two cases of lithium tremor that worsened with abrupt coffee withdrawal have been reported.
Monoamine Oxidase Inhibitors (Maois)
Theoretically, concomitant use might increase the risk of a hypertensive crisis.
Black tea contains caffeine. Caffeine has been shown to inhibit monoamine oxidase (MAO) A and B in laboratory studies. Concomitant intake of large amounts of caffeine with MAOIs might precipitate a hypertensive crisis. In a case report, a patient that consumed 10-12 cups of caffeinate coffee and took the MAOI tranylcypromine presented with severe hypertension. Hypertension was resolved after the patients switched to drinking decaffeinated coffee.
Nicotine
Theoretically, concomitant use might increase the risk of hypertension.
Black tea contains caffeine. Concomitant use of caffeine and nicotine has been shown to have additive cardiovascular effects, including increased heart rate and blood pressure. Blood pressure was increased by 10.8/12.4 mmHg when the agents were used concomitantly.
Organic Anion-Transporting Polypeptide Substrates (Oatp)
Theoretically, black tea might reduce the absorption of organic anion-transporting polypeptide (OATP) substrates.
In vitro, black tea extract inhibits organic anion-transporting polypeptide (OATP)2B1. OATP2B1 is expressed in the small intestine and liver and is responsible for the uptake of drugs and other compounds. In an animal model, black tea extract was found to inhibit the absorption of rosuvastatin, a substrate of OATP2B1. However, this effect has not been reported in humans.
Pentobarbital (Nembutal)
Theoretically, black tea might decrease the effects of pentobarbital.
Black tea contains caffeine. Theoretically, caffeine might negate the hypnotic effects of pentobarbital.
Phenobarbital (Luminal)
Theoretically, black tea might reduce the effects of phenobarbital and increase the risk for convulsions.
Black tea contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of phenobarbital. The exact mechanism of this interaction is unclear.
Phenylpropanolamine
Theoretically, phenylpropanolamine might increase the risk of hypertension, as well as the levels and adverse effects of caffeine.
Black tea contains caffeine. Concomitant use of phenylpropanolamine and caffeine might cause an additive increase in blood pressure. Phenylpropanolamine also seems to increase caffeine serum levels.
Phenytoin (Dilantin)
Theoretically, black tea might reduce the effects of phenytoin and increase the risk for convulsions.
Black tea contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of phenytoin. The effect does not seem to be related to the seizure threshold-lowering effects of caffeine. However, the exact mechanism of this interaction is unclear.
Cacao seed extract
Ace Inhibitors (Aceis)
Theoretically, taking cocoa with ACEIs might increase the risk of adverse effects.
Human research shows that dark chocolate can inhibit ACE. Additionally, prolonged angioedema in an elderly patient on an ACE inhibitor was precipitated with intake of diabetic chocolate.
Adenosine (Adenocard)
Theoretically, cocoa might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Cocoa contains caffeine. Caffeine is a competitive inhibitor of adenosine at the cellular level. However, caffeine does not seem to affect supplemental adenosine because high interstitial levels of adenosine overcome the antagonistic effects of caffeine. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. However, methylxanthines appear more likely to interfere with dipyridamole than adenosine-induced stress testing.
Alcohol (Ethanol)
Theoretically, concomitant use might increase levels and adverse effects of caffeine.
Cocoa contains caffeine. Alcohol reduces caffeine metabolism. Concomitant use of alcohol can increase caffeine serum concentrations and the risk of caffeine adverse effects.
Anticoagulant/Antiplatelet Drugs
Theoretically, cocoa may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Clinical research shows that intake of cocoa can inhibit platelet adhesion, aggregation, and activity and increase aspirin-induced bleeding time. For patients on dual antiplatelet therapy, cocoa may enhance the inhibitory effect of clopidogrel, but not aspirin, on platelet aggregation.
Antihypertensive Drugs
Theoretically, taking cocoa with antihypertensive drugs might increase the risk of hypotension.
Clinical research shows that cocoa can modestly decrease blood pressure in hypertensive and normotensive patients.
Beta-Adrenergic Agonists
Theoretically, large amounts of cocoa might increase the cardiac inotropic effects of beta-agonists.
Cocoa contains caffeine. Theoretically, large amounts of caffeine might increase cardiac inotropic effects of beta-agonists. A case of atrial fibrillation associated with consumption of large quantities of chocolate in a patient with chronic albuterol inhalation abuse has also been reported.
Cytochrome P450 1A2 (Cyp1A2) Inhibitors
Theoretically, concomitant use might increase the levels and adverse effects of caffeine.
Cocoa contains caffeine. Caffeine is metabolized by cytochrome P450 1A2 (CYP1A2),. Theoretically, drugs that inhibit CYP1A2 may decrease the clearance rate of caffeine from cocoa and increase caffeine levels.
Dipyridamole (Persantine)
Theoretically, cocoa might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Cocoa contains caffeine. Caffeine may inhibit dipyridamole-induced vasodilation. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. Methylxanthines appear more likely to interfere with dipyridamole than adenosine-induced stress testing.
Disulfiram (Antabuse)
Theoretically, disulfiram might increase the risk of adverse effects from caffeine.
Cocoa contains caffeine. In human research, disulfiram decreases the rate of caffeine clearance.
Diuretic Drugs
Theoretically, using cocoa with diuretic drugs might increase the risk of hypokalemia.
Cocoa contains caffeine. In excessive amounts, caffeine can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also cause lower potassium levels.
Ephedrine
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Cocoa contains caffeine. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death.
Estrogens
Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Cocoa contains caffeine. Estrogen inhibits caffeine metabolism.
Flutamide (Eulexin)
Theoretically, cocoa might increase the levels and adverse effects of flutamide.
Cocoa contains caffeine. In vitro evidence suggests that caffeine can inhibit the metabolism of flutamide.
Fluvoxamine (Luvox)
Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Cocoa contains caffeine. Fluvoxamine reduces caffeine metabolism.
Lithium
Theoretically, abrupt cocoa withdrawal might increase the levels and adverse effects of lithium.
Cocoa contains caffeine. There are two case reports of lithium tremor that worsened upon abrupt coffee withdrawal.
Monoamine Oxidase Inhibitors (Maois)
Theoretically, concomitant use might increase the risk of a hypertensive crisis.
Cocoa contains caffeine. Large amounts of caffeine with MAOIs might precipitate a hypertensive crisis.
Nicotine
Theoretically, concomitant use might increase the risk of hypertension.
Cocoa contains caffeine. Concomitant use of caffeine and nicotine has been shown to have additive cardiovascular effects, including increased heart rate and blood pressure. Blood pressure was increased by 10.8/12.4 mmHg when the agents were used concomitantly.
Pentobarbital (Nembutal)
Theoretically, cocoa might decrease the effects of pentobarbital.
Cocoa contains caffeine. Caffeine might negate the hypnotic effects of pentobarbital.
Phenobarbital (Luminal)
Theoretically, cocoa might reduce the effects of phenobarbital and increase the risk for convulsions.
Cocoa contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of phenobarbital. The exact mechanism of this interaction is unclear.
Phenylpropanolamine
Theoretically, phenylpropanolamine might increase the risk of hypertension, as well as the levels and adverse effects of caffeine.
Cocoa contains caffeine. Concomitant use of phenylpropanolamine and caffeine might cause an additive increase in blood pressure. Phenylpropanolamine also seems to increase caffeine serum levels.
Phenytoin (Dilantin)
Theoretically, cocoa might reduce the effects of phenytoin and increase the risk for convulsions.
Cocoa contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of phenytoin. The effect does not seem to be related to the seizure threshold-lowering effects of caffeine. However, the exact mechanism of this interaction is unclear.
Quinolone Antibiotics
Theoretically, quinolone antibiotics might increase the levels and adverse effects of caffeine.
Cocoa contains caffeine. Quinolones (also referred to as fluoroquinolones) decrease caffeine clearance.
Riluzole (Rilutek)
Theoretically, concomitant use might increase the levels and adverse effects of both caffeine and riluzole.
Cocoa contains caffeine. Caffeine and riluzole are both metabolized by cytochrome P450 1A2, and concomitant use might reduce metabolism of one or both agents.
Stimulant Drugs
Theoretically, concomitant use might increase stimulant adverse effects.
Cocoa contains caffeine. Concomitant use might increase the risk of stimulant adverse effects.
Theophylline
Theoretically, cocoa might increase the levels and adverse effects of theophylline.
Cocoa contains caffeine. Large amounts of caffeine might inhibit theophylline metabolism. Caffeine decreases theophylline clearance 23% to 29%.
Guarana Seed Extract
Ephedrine
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Guarana contains caffeine. Use of ephedrine with caffeine can increase the risk of stimulatory adverse effects. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death.
Adenosine (Adenocard)
Theoretically, guarana might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Guarana contains caffeine. Caffeine is a competitive inhibitor of adenosine at the cellular level. However, caffeine does not seem to affect supplemental adenosine because high interstitial levels of adenosine overcome the antagonistic effects of caffeine. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. However, methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.
Anticoagulant/Antiplatelet Drugs
Theoretically, guarana may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
In vitro and animal research suggests that guarana extract can inhibit platelet aggregation. This effect may be due to the caffeine in guarana, which is also reported to have antiplatelet activity. This interaction has not been reported in humans.
Beta-Adrenergic Agonists
Theoretically, concomitant use might increase the clinical effects of beta-adrenergic agonists.
Guarana contains caffeine. Theoretically, concomitant use of large amounts of caffeine might increase cardiac inotropic effects of beta-agonists.
Carbamazepine (Tegretol)
Theoretically, guarana might reduce the effects of carbamazepine and increase the risk for convulsions.
Animal research suggests that taking caffeine can lower the anticonvulsant effects of carbamazepine and can induce seizures when given to animals in doses above 400 mg/kg. Human research has shown that taking caffeine 300 mg in three divided doses along with carbamazepine 200 mg reduces the bioavailability of carbamazepine by 32% and prolongs the plasma half-life of carbamazepine two-fold in healthy individuals.
Cimetidine (Tagamet)
Theoretically, concomitant use might increase the effects and adverse effects of caffeine in guarana.
Guarana contains caffeine. Cimetidine decreases the rate of caffeine clearance by 31% to 42%.
Clozapine (Clozaril)
Theoretically, guarana might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
Guarana contains caffeine. Caffeine can increase the effects and toxicity of clozapine. Caffeine doses of 400-1000 mg per day inhibit clozapine metabolism. Clozapine is metabolized by cytochrome P450 1A2 (CYP1A2). Researchers speculate that caffeine might inhibit CYP1A2. However, there is no reliable evidence that caffeine affects CYP1A2. There is also speculation that genetic factors might make some patients more sensitive to the interaction between clozapine and caffeine.
Dipyridamole (Persantine)
Theoretically, guarana might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Guarana contains caffeine. Caffeine might inhibit dipyridamole-induced vasodilation. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. Methylxanthines appear more likely to interfere with dipyridamole than adenosine-induced stress testing.
Disulfiram (Antabuse)
Theoretically, disulfiram might increase the risk of adverse effects from caffeine.
In human research, disulfiram decreases the clearance and increases the half-life of caffeine.
Diuretic Drugs
Theoretically, using guarana with diuretic drugs might increase the risk of hypokalemia.
Guarana contains caffeine. Caffeine, especially in excessive amounts, can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also lower potassium levels.
Estrogens
Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Guarana contains caffeine. Estrogen inhibits caffeine metabolism.
Ethosuximide (Zarontin)
Theoretically, guarana might reduce the effects of ethosuximide and increase the risk for convulsions.
Guarana contains caffeine. Animal research shows that caffeine 92.4 mg/kg can decrease the anticonvulsant activity of ethosuximide. This effect has not been observed in humans.
Felbamate (Felbatol)
Theoretically, guarana might reduce the effects of felbamate and increase the risk for convulsions.
Guarana contains caffeine. Animal research shows that a high dose of caffeine 161.7 mg/kg can decreases the anticonvulsant activity of felbamate. This effect has not been observed in humans.
Flutamide (Eulexin)
Theoretically, guarana might increase the levels and adverse effects of flutamide.
Guarana contains caffeine. In vitro evidence shows that caffeine can inhibit the metabolism of flutamide. However, this effect has not been reported in humans.
Fluvoxamine (Luvox)
Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Guarana contains caffeine. Fluvoxamine reduces caffeine metabolism.
Lithium
Theoretically, abrupt guarana withdrawal might increase the levels and adverse effects of lithium.
Guarana contains caffeine. Theoretically, abrupt caffeine withdrawal might increase serum lithium levels. There are two case reports of lithium tremor that worsened upon abrupt coffee withdrawal.
Monoamine Oxidase Inhibitors (Maois)
Theoretically, concomitant use might increase the risk of a hypertensive crisis.
Guarana contains caffeine. Caffeine has been shown to inhibit MAO-A and -B in laboratory studies. Concomitant intake of large amounts of caffeine with MAOIs might precipitate a hypertensive crisis. In a case report, a patient that consumed 10-12 cups of caffeinated coffee and took the MAOI tranylcypromine presented with severe hypertension. Hypertension was resolved after the patient switched to drinking decaffeinated coffee.
Nicotine
Theoretically, concomitant use might increase the risk of hypertension.
Guarana contains caffeine. Concomitant use of caffeine and nicotine has been shown to have additive cardiovascular effects, including increased heart rate and blood pressure. Blood pressure was increased by 10.8/12.4 mmHg when the agents were used concomitantly.
Pentobarbital (Nembutal)
Theoretically, guarana might decrease the effects of pentobarbital.
Guarana contains caffeine. In vivo evidence suggests that caffeine can negate the hypnotic effects of pentobarbital in humans. However, animal research suggests that guarana does not alter the hypnotic effect of pentobarbital.
Phenobarbital (Luminal)
Theoretically, guarana might reduce the effects of phenobarbital and increase the risk for convulsions.
Guarana contains caffeine. Animal research shows that caffeine can decrease the anticonvulsant activity of phenobarbital. The exact mechanism of this interaction is unclear.
Phenylpropanolamine
Theoretically, phenylpropanolamine might increase the risk of hypertension, as well as the levels and adverse effects of caffeine.
Guarana contains caffeine. Concomitant use of phenylpropanolamine and caffeine might cause an additive increase in blood pressure. Phenylpropanolamine also seems to increase caffeine serum levels.
Phenytoin (Dilantin)
Theoretically, guarana might reduce the effects of phenytoin and increase the risk for convulsions.
Guarana contains caffeine. Animal research shows that caffeine can decrease the anticonvulsant activity of phenytoin. The effect does not seem to be related to the seizure threshold-lowering effects of caffeine. However, the exact mechanism of this interaction is unclear.
Pioglitazone (Actos)
Theoretically, guarana might increase the levels and clinical effects of pioglitazone.
Guarana contains caffeine. Animal research suggests that caffeine can modestly increase the maximum concentration, area under the curve, and half-life of pioglitazone, and also reduce its clearance. This increased the antidiabetic effects of pioglitazone. However, the exact mechanism of this interaction is unclear.
Riluzole (Rilutek)
Theoretically, concomitant use might increase the levels and adverse effects of both caffeine and riluzole.
Guarana contains caffeine. Caffeine and riluzole are both metabolized by cytochrome P450 1A2 (CYP1A2), and concomitant use might reduce the metabolism of one or both agents.
Stimulant Drugs
Theoretically, concomitant use might increase stimulant adverse effects.
Guarana contains caffeine. Due to the central nervous system (CNS) stimulant effects of caffeine, concomitant use with stimulant drugs can increase the risk of adverse effects.
Trimethylxanthine
Ephedrine
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Use of ephedrine with caffeine can increase the risk of stimulatory adverse effects. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death.
Adenosine (Adenocard)
Theoretically, caffeine might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Some evidence shows that caffeine is a competitive inhibitor of adenosine and can reduce the vasodilatory effects of adenosine in humans. However, other research shows that caffeine does not seem to affect supplemental adenosine because high interstitial levels of adenosine overcome the antagonistic effects of caffeine. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. However, methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.
Anticoagulant/Antiplatelet Drugs
Theoretically, caffeine may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Caffeine is reported to have antiplatelet activity. Theoretically, it might increase the risk of bleeding when used concomitantly with these agents; however, this interaction has not been reported in humans.
Beta-Adrenergic Agonists
Theoretically, large amounts of caffeine might increase the cardiac inotropic effects of beta-agonists.
Carbamazepine (Tegretol)
Theoretically, caffeine might reduce the effects of carbamazepine and increase the risk for convulsions.
Animal research suggests that taking caffeine can lower the anticonvulsant effects of carbamazepine and can induce seizures when taken in doses above 400 mg/kg. Human research has shown that taking caffeine 300 mg in three divided doses along with carbamazepine 200 mg reduces the bioavailability of carbamazepine by 32% and prolongs the plasma half-life of carbamazepine 2-fold in healthy individuals.
Cimetidine (Tagamet)
Theoretically, cimetidine might increase the levels and adverse effects of caffeine.
Cimetidine decreases the rate of caffeine clearance by 31% to 42%.
Clozapine (Clozaril)
Caffeine might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
Caffeine might increase the effects and toxicity of clozapine. Caffeine doses of 400-1000 mg per day inhibit clozapine metabolism. Clozapine is metabolized by cytochrome P450 1A2 (CYP1A2). Although researchers speculate that caffeine might inhibit CYP1A2, there is no reliable evidence that caffeine affects CYP1A2. There is also speculation that genetic factors might make some patients more sensitive to an interaction between clozapine and caffeine. In one case report, severe, life-threatening clozapine toxicity and multiorgan system failure occurred in a patient with schizophrenia stabilized on clozapine who consumed caffeine 600 mg daily.
Dipyridamole (Persantine)
Theoretically, caffeine might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Caffeine inhibits dipyridamole-induced vasodilation. It is recommended that methylxanthines and methylxanthine-containing products be stopped 24 hours prior to pharmacological stress tests. Methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.
Disulfiram (Antabuse)
Theoretically, disulfiram use might increase the levels and adverse effects of caffeine.
Disulfiram decreases the rate of caffeine clearance.
Diuretic Drugs
Theoretically, using caffeine with diuretic drugs might increase the risk of hypokalemia.
Caffeine, especially in excessive amounts, can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also cause lower potassium levels.
Estrogens
Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Estrogen inhibits caffeine metabolism.
Ethosuximide (Zarontin)
Theoretically, caffeine might reduce the effects of ethosuximide and increase the risk for convulsions.
Animal research suggests that caffeine 92.4 mg/kg can decrease the anticonvulsant activity of ethosuximide. However, this effect has not been reported in humans.
Felbamate (Felbatol)
Theoretically, caffeine might reduce the effects of felbamate and increase the risk for convulsions.
Animal research suggests that a high dose of caffeine 161.7 mg/kg can decreases the anticonvulsant activity of felbamate. However, this effect has not been reported in humans.
Flutamide (Eulexin)
Theoretically, caffeine might increase the levels and adverse effects of flutamide.
In vitro evidence suggests that caffeine can inhibit the metabolism of flutamide. However, this effect has not been reported in humans.
Fluvoxamine (Luvox)
Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Fluvoxamine reduces caffeine metabolism.
Lithium
Abrupt caffeine withdrawal might increase the levels and adverse effects of lithium.
Caffeine has diuretic activity. When abruptly discontinued, caffeine may alter the clearance of lithium. There are two case reports of lithium tremor that worsened upon abrupt coffee withdrawal and 6 case reports of elevated serum lithium levels after reducing or eliminating caffeine intake. In one case, a male with schizoaffective disorder stabilized on lithium had an elevated lithium level after reducing his caffeine intake by 87%. At a later date, he increased his caffeine intake by 6-fold, resulting in a subtherapeutic lithium level and a recurrence of psychiatric symptoms.
Monoamine Oxidase Inhibitors (Maois)
Theoretically, concomitant use might increase the risk of a hypertensive crisis.
Caffeine has been shown to inhibit monoamine oxidase (MAO) A and B in laboratory studies. Concomitant intake of large amounts of caffeine with MAOIs might precipitate a hypertensive crisis. In a case report, a patient that consumed 10-12 cups of caffeinated coffee and took the MAOI tranylcypromine presented with severe hypertension. Hypertension was resolved after the patient switched to drinking decaffeinated coffee.
Nicotine
Theoretically, concomitant use might increase the risk of hypertension.
Concomitant use of caffeine and nicotine has been shown to have additive cardiovascular effects, including increased heart rate and blood pressure. Blood pressure was increased by 10.8/12.4 mmHg when the agents were used concomitantly.
Pentobarbital (Nembutal)
Theoretically, caffeine might decrease the effects of pentobarbital.
Caffeine might negate the hypnotic effects of pentobarbital.
Phenobarbital (Luminal)
Theoretically, caffeine might reduce the effects of phenobarbital and increase the risk for convulsions.
Animal research suggests that caffeine can decrease the anticonvulsant activity of phenobarbital. However, the exact mechanism of this interaction is unclear.
Phenylpropanolamine
Theoretically, phenylpropanolamine might increase the risk of hypertension, as well as the levels and adverse effects of caffeine.
Concomitant use of phenylpropanolamine and caffeine might cause an additive increase in blood pressure. Phenylpropanolamine also seems to increase caffeine serum levels.
Phenytoin (Dilantin)
Theoretically, caffeine might reduce the effects of phenytoin and increase the risk for convulsions.
Animal research suggests that caffeine can decrease the anticonvulsant activity of phenytoin. The effect does not seem to be related to the seizure threshold-lowering effects of caffeine. However, the exact mechanism of this interaction is unclear.
Pioglitazone (Actos)
Theoretically, caffeine might increase the levels and clinical effects of pioglitazone.
Animal research suggests that caffeine can modestly increase the maximum concentration, area under the curve, and half-life of pioglitazone, and also reduce its clearance. This increased the antidiabetic effects of pioglitazone. However, the exact mechanism of this interaction is unclear.
Quinolone Antibiotics
Theoretically, quinolone antibiotics might increase the levels and adverse effects of caffeine.
Quinolones (also called fluoroquinolones) can decrease caffeine clearance by inhibiting cytochrome P450 1A2 (CYP1A2) enzyme.
Riluzole (Rilutek)
Theoretically, concomitant use might increase the levels and adverse effects of both caffeine and riluzole.
Caffeine and riluzole are both metabolized by cytochrome P450 1A2 (CYP1A2), and concomitant use might reduce the metabolism of one or both agents.
Damiana Leaf Extract
Antidiabetes Drugs
Theoretically, taking damiana with antidiabetes drugs might increase the risk of hypoglycemia.
Animal research shows that taking damiana lowers blood glucose level.
Brand information
Manufacturer and brand details for Zantrex Blue, from the product label.
Zantrex
See all Zantrex products- Name
- Zoller Laboratories, LLC
- City
- Salt Lake City
- State
- UT
- ZipCode
- 84116
- Web Address
- www.Zantrex3.com
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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 Zantrex Blue’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Niacin
Interacts with 727 drugsNiacin (vitamin B3) is an essential nutrient your body needs for energy and metabolism, and deficiency is uncommon in most developed countries. Prescription-strength niacin has been used to...
Read the full Niacin monograph → Herb & supplement monographGreen Tea
Interacts with 1,293 drugsGreen tea is a popular beverage rich in antioxidants called catechins, and drinking it in normal amounts is considered safe for most people. Concentrated green tea extracts are a different s...
Read the full Green Tea monograph → Herb & supplement monographMaca
Maca is a nutrient-rich Andean root often used for energy, libido, and menopause symptoms. Early studies suggest it may modestly help sexual desire and some menopause symptoms, but the evide...
Read the full Maca 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 → Herb & supplement monographGuarana
Interacts with 655 drugsGuarana is an Amazonian seed that is naturally high in caffeine, which explains most of its stimulant and energy effects. While it may give a short-term boost in alertness and reduce fatigue...
Read the full Guarana monograph → Herb & supplement monographPanax Ginseng
Interacts with 1,130 drugsPanax ginseng is a popular traditional herb used to boost energy, ease stress, and support overall wellness, though scientific evidence is mixed and mostly preliminary. It is generally well...
Read the full Panax Ginseng monograph → Herb & supplement monographBlack Tea
Interacts with 694 drugsBlack tea is a popular caffeinated drink made from the fully oxidized leaves of the Camellia sinensis plant, and it contains caffeine and antioxidant plant compounds. Moderate tea drinking i...
Read the full Black Tea monograph → Herb & supplement monographYerba Mate
Interacts with 1,086 drugsYerba mate is a caffeine-containing herbal beverage from South America that is widely enjoyed for its stimulating, coffee-like effects. While it is rich in antioxidants and is being studied...
Read the full Yerba Mate monograph → Herb & supplement monographCaffeine
Interacts with 655 drugsCaffeine is a natural stimulant found in coffee, tea, and many other plants and products. In moderate amounts it can boost alertness and reduce tiredness for most healthy adults, but too muc...
Read the full Caffeine monograph → Herb & supplement monographDamiana
Interacts with 86 drugsDamiana is a traditional herb most famous as an aphrodisiac and mild mood-lifter, but solid human evidence for any of its uses is very limited. It is generally well tolerated in the small am...
Read the full Damiana monograph → Herb & supplement monographRhodiola
Interacts with 1,271 drugsRhodiola is an herb traditionally used to fight fatigue and help the body cope with stress. Some small studies suggest it may modestly reduce fatigue and improve mood, but the evidence is li...
Read the full Rhodiola monograph → Herb & supplement monographCocoa
Interacts with 661 drugsCocoa is rich in plant compounds called flavanols that may modestly support blood vessel function and blood pressure, but most chocolate products are high in sugar, fat, and calories, which...
Read the full Cocoa monograph → Herb & supplement monographSchizonepeta
Interacts with 797 drugsSchizonepeta is a mint-family herb long used in traditional Chinese medicine, usually as part of combination formulas for colds, fevers, and itchy skin conditions. Modern human evidence is v...
Read the full Schizonepeta monograph →Sources & How We Checked
Zantrex Blue'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 1,142 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.
Niacin 66 references
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- Anon. Inositol hexaniacinate. Altern Med Rev 1998;3:222-3.
- Knodel LC, Talbert RL. Adverse effects of hypolipidaemic drugs. Med Toxicol 1987;2:10-32. PubMed
- Guyton JR, Blazing MA, Hagar J, et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Niaspan-Gemfibrozil Study Group. Arch Intern Med 2000;160:1177-84. PubMed
- Gibbons LW, Gonzalez V, Gordon N, Grundy S. The prevalence of side effects with regular and sustained-release nicotinic acid. Am J Med 1995;99:378-85. PubMed
- Whelan AM, Price SO, Fowler SF, Hainer BL. The effect of aspirin on niacin-induced cutaneous reactions. J Fam Pract 1992;34:165-8.
- Jungnickel PW, Maloley PA, Vander Tuin EL, et al. Effect of two aspirin pretreatment regimens on niacin-induced cutaneous reactions. J Gen Intern Med 1997;12:591-6. PubMed
- Capuzzi DM, Guyton JR, Morgan JM, et al. Efficacy and safety of an extended-release niacin (Niaspan): a long-term study. Am J Cardiol 1998;82:74-81;disc. 85U-6U. PubMed
- Gray DR, Morgan T, Chretien SD, Kashyap ML. Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med 1994;121:252-8. PubMed
- McKenney JM, Proctor JD, Harris S, Chinchili VM. A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients. JAMA 1994;271:672-7. DOI
- Knopp RH, Alagona P, Davidson M, et al. Equivalent efficacy of a time-release form of niacin (Niaspan) given once-a-night versus plain niacin in the management of hyperlipidemia. Metabolism 1998;47:1097-104. PubMed
- Knopp RH. Clinical profiles of plain versus sustained-release niacin (Niaspan) and the physiologic rationale for nighttime dosing. Am J Cardiol 1998;82:24U-28U;discussion 39U-41U. PubMed
- Garg A, Grundy SM. Nicotinic acid as therapy for dyslipidemia in non-insulin-dependent diabetes mellitus. JAMA 1990;264:723-6. DOI
- Leighton RF, Gordon NF, Small GS, et al. Dental and gingival pain as side effects of niacin therapy. Chest 1998;114:1472-4. PubMed
- American Society of Health-System Pharmacists. ASHP Therapeutic Position Statement on the safe use of niacin in the management of dyslipidemias. Am J Health Syst Pharm 1997;54:2815-9. DOI
- Vega GL, Grundy SM. Lipoprotein responses to treatment with lovastatin, gemfibrozil, and nicotinic acid in normolipidemic patients with hypoalphalipoproteinemia. Arch Intern Med 1994;154:73-82. DOI
- Guyton JR, Goldberg AC, Kreisberg RA, et al. Effectiveness of once-nightly dosing of extended-release niacin alone and in combination for hypercholesterolemia. Am J Cardiol 1998;82:737-43.
- 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
- Brown BG, Zhao XQ, Chait A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001;345:1583-93. DOI
- Bays HE, Dujovne CA. Drug interactions of lipid-altering drugs. Drug Saf 1998;19:355-71. PubMed
- Rader JI, Calvert RJ, Hathcock JN. Hepatic toxicity of unmodified and time-release preparations of niacin. Am J Med 1992;92:77-81. PubMed
- Kahn SE, Beard JC, Schwartz MW, et al. Increased B-cell secretory capacity as mechanism for islet adaptation to nicotinic acid-induced insulin resistance. Diabetes 1989;38:562-8.
- Schwartz ML. Severe reversible hyperglycemia as a consequence of niacin therapy. Arch Int Med 1993;153:2050-2. DOI
- Raising HDL and Niacin Use. Pharmacist's Letter/Prescriber's Letter 2004;20(5):200504.
- McKenney J. New perspectives on the use of niacin in the treatment of lipid disorders. Arch Intern Med 2004;164:697-705. PubMed
- Reaven P, Witztum JL. Lovastatin, nicotinic acid and rhabdomyolysis (letter). Ann Int Med 1988;109:597-8. PubMed
- Ito MK. Advances in the understanding and management of dyslipidemia: using niacin-based therapies. Am J Health-Syst Pharm 2003;60(suppl 2):s15-21. PubMed
- Schwab RA, Bachhuber BH. Delirium and lactic acidosis caused by ethanol and niacin coingestion. Am J Emerg Med 1991;9:363-5. PubMed
- Product information: Niaspan. Kos Pharmaceuticals. Cranbury, NJ. 2005. Available at www.niaspan.com/professional/content/pdfs/productinfo.pdf. (Accessed 3 March 2006).
- Ding RW, Kolbe K, Merz B, et al. Pharmacokinetics of nicotinic acid-salicylic acid interaction. Clin Pharmacol Ther 1989;46:642-7. PubMed
- NIH News. NIH stops clinical trial on combination cholesterol treatment. May 26, 2011. http://www.nih.gov/news/health/may2011/nhlbi-26.htm. (Accessed 3 June 2011).
- Dearing BD, Lavie CJ, Lohmann TP, Genton E. Niacin-induced clotting factor synthesis deficiency with coagulopathy. Arch Intern Med. 1992;152(4):861-3. DOI
- O'Brien T, Silverberg JD, Nguyen TT. Nicotinic acid-induced toxicity associated with cytopenia and decreased levels of thyroxine-binding globulin. Mayo Clin Proc. 1992;67(5):465-8. PubMed
- Gadegbeku CA, Dhandayuthapani A, Shrayyef MZ, Egan BM. Hemodynamic effects of nicotinic acid infusion in normotensive and hypertensive subjects. Am J Hypertens. 2003;16(1):67-71. PubMed
- Garnett WR. Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors. Am J Health Syst Pharm. 1995;52(15):1639-45. PubMed
- Litin SC, Anderson CF. Nicotinic acid-associated myopathy: a report of three cases. Am J Med. 1989;86(4):481-3. PubMed
- Dunn RT, Ford MA, Rindone JP, Kwiecinski FA. Low-Dose Aspirin and Ibuprofen Reduce the Cutaneous Reactions Following Niacin Administration. Am J Ther. 1995;2(7):478-480. PubMed
- Cashin-Hemphill L, Spencer CA, Nicoloff JT, et al. Alterations in serum thyroid hormonal indices with colestipol-niacin therapy. Ann Intern Med. 1987;107(3):324-9. PubMed
- Drinka PJ. Alterations in thyroid and hepatic function tests associated with preparations of sustained-release niacin. Mayo Clin Proc. 1992;67(12):1206. PubMed
- Shakir KM, Kroll S, Aprill BS, Drake AJ 3rd, Eisold JF. Nicotinic acid decreases serum thyroid hormone levels while maintaining a euthyroid state. Mayo Clin Proc. 1995;70(6):556-8. PubMed
- Etchason JA, Miller TD, Squires RW, et al. Niacin-induced hepatitis: a potential side effect with low-dose time-release niacin. Mayo Clin Proc. 1991;66(1):23-8. PubMed
- Henkin Y, Johnson KC, Segrest JP. Rechallenge with crystalline niacin after drug-induced hepatitis from sustained-release niacin. JAMA. 1990;264(2):241-3. DOI
- Henkin Y, Oberman A, Hurst DC, Segrest JP. Niacin revisited: clinical observations on an important but underutilized drug. Am J Med. 1991;91(3):239-46. PubMed
- Brown BG, Bardsley J, Poulin D, et al. Moderate dose, three-drug therapy with niacin, lovastatin, and colestipol to reduce low-density lipoprotein cholesterol <100 mg/dl in patients with hyperlipidemia and coronary artery disease. Am J Cardiol. 1997;80(2)
- Goldberg A, Alagona P Jr, Capuzzi DM, et al. Multiple-dose efficacy and safety of an extended-release form of niacin in the management of hyperlipidemia. Am J Cardiol. 2000;85(9):1100-5. PubMed
- Aronov DM, Keenan JM, Akhmedzhanov NM, et al. Clinical trial of wax-matrix sustained-release niacin in a Russian population with hypercholesterolemia. Arch Fam Med. 1996;5(10):567-75. PubMed
- Morgan JM, Capuzzi DM, Guyton JR, et al. Treatment Effect of Niaspan, a Controlled-release Niacin, in Patients With Hypercholesterolemia: A Placebo-controlled Trial. J Cardiovasc Pharmacol Ther. 1996;1(3):195-202. PubMed
- Andersson RG, Aberg G, Brattsand R, Ericsson E, Lundholm L. Studies on the mechanism of flush induced by nicotinic acid. Acta Pharmacol Toxicol (Copenh). 1977 Jul;41(1):1-10. PubMed
- Brown WV. Niacin for lipid disorders. Indications, effectiveness, and safety. Postgrad Med. 1995 Aug;98(2):185-9, 192-3. PubMed
- O'REILLY PO, CALLBECK MJ, HOFFER A. Sustained-release nicotinic acid (nicospan); effect on (1) cholesterol levels and (2) leukocytes. Can Med Assoc J. 1959;80(5):359-62.
- Gharavi AG, Diamond JA, Smith DA, Phillips RA. Niacin-induced myopathy. Am J Cardiol. 1994;74(8):841-2. PubMed
- Litin SC, Anderson CF. Nicotinic acid-associated myopathy: a report of three cases. Am J Med. 1989;86(4):481-3. PubMed
- Fraunfelder FW, Fraunfelder FT, Illingworth DR. Adverse ocular effects associated with niacin therapy. Br J Ophthalmol 1995;79:54-56. PubMed
- Ali EH, McJunkin B, Jubelirer S, Hood W. Niacin induced coagulopathy as a manifestation of occult liver injury. W V Med J. 2013 Jan-Feb;109(1):12-4
- Aramwit P, Srisawadwong R, Supasyndh O. Effectiveness and safety of extended-release nicotinic acid for reducing serum phosphorus in hemodialysis patients. J Nephrol. 2012 May-Jun;25(3):354-62. PubMed
- Bassan M. A case for immediate-release niacin. Heart Lung. 2012 Jan-Feb;41(1):95-8. PubMed
- Davidson MH, Rooney M, Pollock E, Drucker J, Choy Y. Effect of colesevelam and niacin on low-density lipoprotein cholesterol and glycemic control in subjects with dyslipidemia and impaired fasting glucose. J Clin Lipidol. 2013 Sep-Oct;7(5):423-32. PubMed
- Guyton JR, Fazio S, Adewale AJ, Jensen E, Tomassini JE, Shah A, Tershakovec AM. Effect of extended-release niacin on new-onset diabetes among hyperlipidemic patients treated with ezetimibe/simvastatin in a randomized controlled trial. Diabetes Care. 2012 PubMed
- Loebl T, Raskin S. A novel case report: acute manic psychotic episode after treatment with niacin. J Neuropsychiatry Clin Neurosci. 2013 Fall;25(4):E14. PubMed
- Teo KK, Goldstein LB, Chaitman BR, Grant S, Weintraub WS, Anderson DC, Sila CA, Cruz-Flores S, Padley RJ, Kostuk WJ, Boden WE; AIM-HIGH Investigators. Extended-release niacin therapy and risk of ischemic stroke in patients with cardiovascular disease: the
- Goldie C, Taylor AJ, Nguyen P, McCoy C, Zhao XQ, Preiss D. Niacin therapy and the risk of new-onset diabetes: a meta-analysis of randomized controlled trials. Heart. 2016 Feb;102(3):198-203.
- Schandelmaier S, Briel M, Saccilotto R, Olu KK, Arpagaus A, Hemkens LG, Nordmann AJ. Niacin for primary and secondary prevention of cardiovascular events. Cochrane Database Syst Rev. 2017 Jun 14;6:CD009744. PubMed
- Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental vitamins and minerals for CVD prevention and treatment. J Am Coll Cardiol 2018;71(22):2570-84. PubMed
- Song S, Lee CJ, Oh J, Park S, Kang SM, Lee SH. Effect of Niacin on Carotid Atherosclerosis in Patients at Low-Density Lipoprotein-Cholesterol Goal but High Lipoprotein (a) Level: a 2-Year Follow-Up Study. J Lipid Atheroscler. 2019;8(1):58-66. PubMed
- Kimura H, Umemori Y, Yuki D. Anaphylactic shock-like symptoms due to niacin overdose: A case report. J Dermatol 2022;49(8):e287-e288. PubMed
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Green Tea 219 references
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