Provitalize With Levothyroxine, Valacyclovir, and Citalopram

Thank you for trusting HelloPharmacist with your question! For all our readers in the United States, Eltroxin is a brand name for the drug levothyroxine, a thyroid hormone medication.

Provitalize is a probiotic blend (strains like B. breve and L. gasseri) combined with turmeric root extract, black pepper extract (Bioperine), moringa, lecithin, and curry leaf.

There is no interaction here that outright rules out taking it with your three medications, but a couple of things are worth taking a closer look at.

Moringa, Timing, and Your Levothyroxine (Eltroxin)

As mentioned, Eltroxin is a brand of levothyroxine, a replacement form of the thyroid hormone T4.

The moringa in Provitalize is the ingredient to know about here.

Animal research suggests that moringa aqueous leaf extract might reduce serum triiodothyronine (T3) concentrations by inhibiting the peripheral conversion of thyroxine (T4) to T3. This hasn't been shown in humans, so it is a theoretical concern, but because thyroid dosing is sensitive and adjusted based on your labs, it is worth mentioning to your doctor and keeping up with your routine thyroid blood work after starting the supplement. You can read more about the interaction on our dedicated webpage for it: Moringa and Levothyroxine Interaction: Severity & What to Do | HelloPharmacist

Just as important is how you space things out.

Levothyroxine should be taken by itself, first thing in the morning on an empty stomach, at least 30 to 60 minutes before food, other medications, and supplements, since even small changes in its absorption can shift your thyroid levels (if you were prescribed to take it differently than this, of course continue to take it as prescribed).

The easiest approach is to take your Eltroxin as you do now and take Provitalize later in the day with a meal (turmeric is actually absorbed better with some food).

Turmeric and Black Pepper with Citalopram

Citalopram is an SSRI antidepressant that is partly broken down by a liver enzyme called CYP3A4, and lab studies suggest turmeric (curcumin) and the piperine in black pepper extract can inhibit that enzyme.

In one study, curcumin showed a competitive type of inhibition towards CYP1A2, CYP3A4 and CYP2B6, and separate research found that piperine inhibits both the drug transporter P-glycoprotein and the major drug-metabolizing enzyme CYP3A4.

In theory, this could nudge citalopram levels up, though this hasn't been demonstrated in people at typical supplement doses. It's a possible, moderate-level interaction rather than a proven one, so the practical advice is to watch for anything that feels like more citalopram effect than usual, such as increased drowsiness, nausea, or dizziness, and to let your prescriber know you've added the supplement.

Valacyclovir and the Probiotic Ingredients

Valacyclovir is the reassuring one on your list. Per its FDA labeling, no clinically significant drug-drug or drug-food interactions with valacyclovir tablets are known, and nothing in Provitalize would be expected to change that. Likewise, the probiotic strains and lecithin in the supplement aren't known to interact with any of your three medications.

Final words

Overall, Provitalize can usually be taken alongside these medications with a little care, such as keeping your Eltroxin by itself in the morning. You also want to monitor how you're feeling and let your doctor know you're considering taking Provitalize so they can assess its safety with citalopram. 

Thanks again for reaching out!