Other medication classes with documented supplement interactions
43 documented interactions24 supplements1 major
Read this first. This page is educational reference material, not medical advice, and it is not a substitute for a pharmacist’s review of your own medication list. It cannot know your kidney function, your doses, your other prescriptions, or why you were put on them. Bring the actual bottle to the pharmacist who fills your prescriptions, or to your prescriber, before you start or stop anything. In an emergency call 911 (US) or your local emergency number.
These classes have fewer documented supplement interactions than the big ones, so rather than fragment them into thin pages they are collected here in full — thyroid medication, lithium, anti-seizure drugs, antidepressants, NSAIDs, sedatives, nitrates and PDE5 inhibitors, acid reducers, bisphosphonates and more. Every entry carries the same citation and the same routing as the rest of the hub.
Below is every interaction Magellan documents for this class — 43 entries across 24 supplements, each with the mechanism as the cited reference states it, how serious that reference treats it, and where to take the question next.
One caveat on how to weigh them. 6 of the 43 entries below are marked class-level caution: the source flags a broad group of drugs that share a metabolic pathway — usually CYP3A4 — rather than reporting a finding about a named medicine. Those are weaker than the entries that name a specific drug, and they are labelled so you can tell the difference rather than being quietly padded in.
Check your own listMagellan’s Medication Safety Check runs entirely on your device — type the medicines you take and it flags every documented interaction in this dataset. Nothing you type is sent anywhere.
Open the Medication Safety Check → Prescription lithium
Medicines in this group include: Lithium (Lithobid, Eskalith).
Moderate ACE inhibitors and ARBs (e.g., lisinopril, valsartan)
Documented for Low-dose lithium (lithium orotate)
Direction of the risk: Drug levels — the source describes a change in how much of the medicine ends up in the blood.These blood pressure medications can raise lithium blood levels by reducing renal excretion; documented for therapeutic-dose lithium, extrapolated cautiously to low-dose orotate.
Source: 7 Common Drugs Linked To Dangerous Lithium Interactions ↗
What to do: Prescription lithium is dosed to a narrow blood level. Any change in fluid balance, kidney handling, or co-medication can move that level — talk to the prescriber who monitors it before adding anything, and ask whether a lithium level is due.
Moderate Diuretics, especially thiazides (e.g., hydrochlorothiazide)
Documented for Low-dose lithium (lithium orotate)
Direction of the risk: Drug levels — the source describes a change in how much of the medicine ends up in the blood.Thiazide and loop diuretics decrease lithium clearance by the kidneys, increasing lithium levels and toxicity risk.
Source: 7 Common Drugs Linked To Dangerous Lithium Interactions ↗
What to do: Prescription lithium is dosed to a narrow blood level. Any change in fluid balance, kidney handling, or co-medication can move that level — talk to the prescriber who monitors it before adding anything, and ask whether a lithium level is due.
Moderate NSAIDs (ibuprofen, naproxen, meloxicam, etc.)
Documented for Low-dose lithium (lithium orotate)
Direction of the risk: Drug levels — the source describes a change in how much of the medicine ends up in the blood.NSAIDs reduce renal clearance of lithium, raising blood lithium levels and toxicity risk. This is well-established for prescription lithium carbonate; there is no dedicated interaction study for 5mg lithium orotate, but because it delivers the same lithium ion, the same caution is reasonable at a lower magnitude.
Source: 7 Common Drugs Linked To Dangerous Lithium Interactions ↗
What to do: Prescription lithium is dosed to a narrow blood level. Any change in fluid balance, kidney handling, or co-medication can move that level — talk to the prescriber who monitors it before adding anything, and ask whether a lithium level is due.
Moderate Serotonergic drugs (SSRIs, SNRIs, MAOIs, triptans, tramadol)
Documented for Low-dose lithium (lithium orotate)
Direction of the risk: Additive serotonergic effect — the source describes a documented risk of serotonin syndrome.Lithium itself has serotonergic activity; combining with other serotonergic medications carries a documented risk of serotonin syndrome, again established at prescription dosing.
Source: 7 Common Drugs Linked To Dangerous Lithium Interactions ↗
What to do: Prescription lithium is dosed to a narrow blood level. Any change in fluid balance, kidney handling, or co-medication can move that level — talk to the prescriber who monitors it before adding anything, and ask whether a lithium level is due.
Minor NSAIDs, ACE inhibitors/ARBs, and diuretics (via the microdose lithium component)
Documented for NOVOS Core (multi-ingredient formula)
Direction of the risk: Drug levels — the source describes a change in how much of the medicine ends up in the blood.These drug classes are documented to raise lithium blood levels at prescription lithium-carbonate dosing by reducing renal clearance. This product contains only a microdose of lithium, so the magnitude of risk is far lower than with prescription lithium, but the mechanism is the same and worth flagging for users on these medications.
Source: 7 Common Drugs Linked To Dangerous Lithium Interactions ↗
What to do: Prescription lithium is dosed to a narrow blood level. Any change in fluid balance, kidney handling, or co-medication can move that level — talk to the prescriber who monitors it before adding anything, and ask whether a lithium level is due.
Thyroid medication (levothyroxine)
Medicines in this group include: Levothyroxine (Synthroid, Levoxyl), Liothyronine (Cytomel), Desiccated thyroid (Armour thyroid, Np thyroid).
Minor Thyroid hormone replacement (e.g., levothyroxine)
Documented for Carnitine (L-carnitine and acetyl-L-carnitine) — specifically Acetyl-L-Carnitine (ALCAR)
Direction of the risk: Opposing — may work against what the medicine was prescribed to do, which is a different (and easily missed) danger from an additive one.L-carnitine (and acetyl-L-carnitine) can act as a peripheral antagonist of thyroid hormone action, which could theoretically blunt the effectiveness of thyroid medication.
Source: Carnitine | Memorial Sloan Kettering Cancer Center ↗
What to do: Take levothyroxine on an empty stomach and separate any mineral-containing supplement by several hours. Ask about a TSH recheck roughly six weeks after any change — that is the interval a thyroid dose is normally judged on.
Moderate Thyroid hormone medication (e.g., levothyroxine, for hypothyroidism)
Documented for Alpha-lipoic acid (ALA)
Mayo Clinic advises against using alpha-lipoic acid together with thyroid hormone medication, as the supplement might affect how well the thyroid medicine works.
Source: Diabetic neuropathy: Can dietary supplements help? - Mayo Clinic ↗
What to do: Take levothyroxine on an empty stomach and separate any mineral-containing supplement by several hours. Ask about a TSH recheck roughly six weeks after any change — that is the interval a thyroid dose is normally judged on.
Moderate Levothyroxine and quinolone antibiotics (via calcium alpha-ketoglutarate component)
Documented for NOVOS Core (multi-ingredient formula)
Direction of the risk: Absorption and timing — taken together, less of one of the two is absorbed. The entry below says which, and separating the doses is usually the fix.Calcium reduces absorption of levothyroxine and quinolone antibiotics (e.g., ciprofloxacin); dosing should be separated by several hours.
Timing the source specifies: Dosing should be separated by several hours.
Source: Calcium - Health Professional Fact Sheet ↗
What to do: Take levothyroxine on an empty stomach and separate any mineral-containing supplement by several hours. Ask about a TSH recheck roughly six weeks after any change — that is the interval a thyroid dose is normally judged on.
Anti-seizure medications
Medicines in this group include: Phenytoin (Dilantin), Carbamazepine (Tegretol), Valproic acid (Depakote, Valproate), Phenobarbital (Luminal), Levetiracetam (Keppra), Lamotrigine (Lamictal), Gabapentin (Neurontin), Topiramate (Topamax).
Moderate Anticonvulsants (valproic acid, phenobarbital, phenytoin, carbamazepine)
Documented for Carnitine (L-carnitine and acetyl-L-carnitine) — specifically L-Carnitine
Direction of the risk: Nutrient level — this entry is at least partly about what happens to your own level of a vitamin or mineral, not only to the drug.These anticonvulsants reduce blood carnitine levels; valproic acid in particular can cause carnitine-related hepatotoxicity/hyperammonemia, and IV L-carnitine is sometimes used clinically to treat valproate toxicity.
Source: Carnitine - Health Professional Fact Sheet ↗
What to do: Seizure medicines are dosed to a blood level and to seizure control. Do not add or stop anything without the prescriber who manages them, and ask whether drug-level testing is warranted.
Moderate Antiepileptic drugs (phenytoin, carbamazepine, valproate; also barbiturates)
Documented for L-methylfolate (5-MTHF)
Direction of the risk: Nutrient level — this entry is at least partly about what happens to your own level of a vitamin or mineral, not only to the drug.These medications can lower serum folate levels, while folate supplementation can in turn lower blood levels of the antiepileptic drug itself, potentially reducing seizure control; patients on these drugs should consult their provider before taking folate/methylfolate supplements.
Source: Folate - Health Professional Fact Sheet ↗
What to do: Seizure medicines are dosed to a blood level and to seizure control. Do not add or stop anything without the prescriber who manages them, and ask whether drug-level testing is warranted.
Minor Drugs metabolized via cytochrome P450 pathways (antidepressants, antiseizure drugs, blood thinners, statins) class-level caution
Documented for Taurine
Direction of the risk: Drug levels — the source describes a change in how much of the medicine ends up in the blood.Taurine may interfere with cytochrome P450 enzymes used to metabolize these drug classes at supplemental (not typical energy-drink) doses, though this is a general mechanism-based caution rather than itemized per-drug clinical data.
Source: Taurine Benefits and Side Effects ↗
What to do: Seizure medicines are dosed to a blood level and to seizure control. Do not add or stop anything without the prescriber who manages them, and ask whether drug-level testing is warranted.
Antidepressants (SSRIs and SNRIs)
Medicines in this group include: Sertraline (Zoloft), Fluoxetine (Prozac), Escitalopram (Lexapro), Citalopram (Celexa), Paroxetine (Paxil), Venlafaxine (Effexor), Duloxetine (Cymbalta), Desvenlafaxine (Pristiq), Bupropion (Wellbutrin), Mirtazapine (Remeron), Trazodone (Desyrel).
Minor Other CYP2C9/CYP2D6-metabolized drugs (e.g., NSAIDs like ibuprofen/celecoxib, fluoxetine, tramadol)
Documented for Pomegranate ellagitannins
Direction of the risk: Drug levels — the source describes a change in how much of the medicine ends up in the blood.Pomegranate may inhibit CYP2C9 and CYP2D6 enzymes, potentially raising blood levels of drugs metabolized by these pathways.
Source: Pomegranate: Health Benefits, Side Effects, Uses, Dose & Precautions ↗
What to do: Tell your prescriber before adding this. Do not stop a prescribed antidepressant on your own; changes are tapered for a reason.
Minor Antidepressants (e.g., imipramine, escitalopram)
Documented for NAC and GlyNAC
Direction of the risk: Additive — pushes in the same direction as the medicine, so the combined effect can overshoot.Animal studies suggest NAC may increase the effects of these antidepressants, but clinical relevance in humans has not been established.
Source: N-Acetylcysteine | Memorial Sloan Kettering Cancer Center ↗
What to do: Tell your prescriber before adding this. Do not stop a prescribed antidepressant on your own; changes are tapered for a reason.
Moderate Antidepressants (via Rhodiola rosea component)
Documented for NOVOS Core (multi-ingredient formula)
Rhodiola's MAO-inhibiting activity has a documented case of tachyarrhythmia when combined with a prescription antidepressant.
Source: Rhodiola ↗
What to do: Tell your prescriber before adding this. Do not stop a prescribed antidepressant on your own; changes are tapered for a reason.
NSAID pain relievers
Medicines in this group include: Ibuprofen (Advil, Motrin), Naproxen (Aleve, Naprosyn), Meloxicam (Mobic), Celecoxib (Celebrex), Diclofenac (Voltaren, Cataflam), Indomethacin (Indocin).
Minor NSAIDs (aspirin, ibuprofen, naproxen)
Documented for MSM (methylsulfonylmethane)
Direction of the risk: Bleeding risk — stacked on top of a drug that already reduces the blood's ability to clot.Possible additive effect on bleeding/GI risk when combined with regular NSAID use; documentation is limited compared to other supplement-anticoagulant interactions.
Source: What Is MSM (Methylsulfonylmethane)? Uses and Risks ↗
What to do: Mention it to your pharmacist, particularly if you use NSAIDs regularly rather than occasionally, and more so if you also take a blood thinner, have reduced kidney function, or have a history of stomach ulcers.
Sedatives and sleep medications
Medicines in this group include: Trazodone (Desyrel), Alprazolam (Xanax), Lorazepam (Ativan), Clonazepam (Klonopin), Diazepam (Valium), Zolpidem (Ambien), Eszopiclone (Lunesta), Temazepam (Restoril), Buspirone (Buspar).
Moderate Drugs metabolized by CYP3A4 and other CYP450 enzymes class-level caution
Documented for Resveratrol
Direction of the risk: Drug levels — may change the medicine's level or its effect; the source does not commit to a single direction.At higher doses resveratrol can systemically inhibit cytochrome P450 enzymes, potentially attenuating or altering the activity of drugs that rely on these pathways; a 2020 literature review flags this as a real but understudied interaction risk.
Source: Potential Adverse Effects of Resveratrol: A Literature Review ↗
What to do: Do not combine without telling your prescriber, and do not drive or operate machinery until you know how the combination affects you.
Minor CYP3A4-metabolized medications class-level caution
Documented for Grape seed extract
Direction of the risk: Drug levels — may change the medicine's level or its effect; the source does not commit to a single direction.Grape seed extract inhibits the CYP3A4 enzyme in vitro and may alter blood levels of drugs metabolized through this pathway; clinical relevance has not been determined.
Source: Grape Seed | Memorial Sloan Kettering Cancer Center ↗
What to do: Do not combine without telling your prescriber, and do not drive or operate machinery until you know how the combination affects you.
Moderate Sedative/CNS depressant medications
Documented for Saffron extract
Direction of the risk: Additive sedation — more drowsiness, and slower reactions, than either would cause alone.Saffron may cause drowsiness; combined with sedative medications it could increase sleepiness and the risk of slowed breathing.
Source: Saffron: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews ↗
What to do: Do not combine without telling your prescriber, and do not drive or operate machinery until you know how the combination affects you.
Minor Medications metabolized by CYP3A4 class-level caution
Documented for Beetroot and dietary nitrate
Direction of the risk: Drug levels — may change the medicine's level or its effect; the source does not commit to a single direction.Beet may alter how quickly the liver metabolizes CYP3A4-substrate drugs, potentially changing their effectiveness or side effects.
Source: Beet - Uses, Side Effects, and More ↗
What to do: Do not combine without telling your prescriber, and do not drive or operate machinery until you know how the combination affects you.
Minor Sedatives / sleep medications (e.g., benzodiazepines, zolpidem) - via L-theanine component
Documented for NOVOS Core (multi-ingredient formula)
Direction of the risk: Additive sedation — more drowsiness, and slower reactions, than either would cause alone.L-theanine may increase drowsiness when combined with prescription sedative-hypnotics; patients on these medications should discuss use with their provider.
Source: L-Theanine ↗
What to do: Do not combine without telling your prescriber, and do not drive or operate machinery until you know how the combination affects you.
Minor Drugs metabolized by CYP3A4, CYP2C9, or CYP2D6 class-level caution
Documented for DaVinci Labs Phyto Benefits
Direction of the risk: Drug levels — may change the medicine's level or its effect; the source does not commit to a single direction.Individual polyphenols in this class of supplement (resveratrol-type and quercetin-type compounds) have documented in-vitro/in-vivo inhibition of these cytochrome P450 enzymes; combining several such polyphenols in one blend raises the theoretical risk of additively altered blood levels for CYP3A4/2C9/2D6-metabolized prescription drugs.
Source: Resveratrol ↗
What to do: Do not combine without telling your prescriber, and do not drive or operate machinery until you know how the combination affects you.
PDE5 inhibitors (sildenafil, tadalafil)
Medicines in this group include: Sildenafil (Viagra, Revatio), Tadalafil (Cialis, Adcirca), Vardenafil (Levitra).
Major PDE5 inhibitors (sildenafil, tadalafil) and nitrate drugs (nitroglycerin)
Documented for Beetroot and dietary nitrate
Direction of the risk: Additive — pushes in the same direction as the medicine, so the combined effect can overshoot.Dietary nitrate from beetroot is converted to nitric oxide in the body; combining nitric-oxide-raising intake with PDE5 inhibitors or nitrate medications produces additive vasodilation that can cause a dangerous drop in blood pressure, the same well-documented mechanism behind the pharmaceutical nitric-oxide-plus-sildenafil interaction.
Source: Nitric Oxide and Viagra (Sildenafil) Drug Interactions ↗
What to do: Never combine a nitrate medicine with a PDE5 inhibitor. If you take either, tell the prescriber before adding anything that lowers blood pressure or raises nitric oxide.
Nitrate vasodilators (nitroglycerin)
Medicines in this group include: Nitroglycerin (Nitrostat, Nitro-dur), Isosorbide mononitrate (Imdur), Isosorbide dinitrate (Isordil).
Moderate Nitroglycerin and other nitrate vasodilators
Documented for NAC and GlyNAC
Direction of the risk: Additive — pushes in the same direction as the medicine, so the combined effect can overshoot.NAC combined with nitroglycerin produces an added vasodilation effect, which in human use has caused severe headaches and can further lower blood pressure.
Source: N-Acetylcysteine | Memorial Sloan Kettering Cancer Center ↗
What to do: Never combine a nitrate medicine with a PDE5 inhibitor such as sildenafil or tadalafil. Tell the prescriber who manages your nitrate before adding anything that also widens blood vessels.
Moderate Blood pressure medications (antihypertensives)
Documented for Beetroot and dietary nitrate
Direction of the risk: Additive — pushes in the same direction as the medicine, so the combined effect can overshoot.Beetroot/dietary nitrate itself has a blood-pressure-lowering effect; combined with antihypertensive medications it may cause additive blood pressure lowering, warranting monitoring, especially at supplement (vs. dietary) doses.
Source: Beet - Uses, Side Effects, and More ↗
What to do: Never combine a nitrate medicine with a PDE5 inhibitor such as sildenafil or tadalafil. Tell the prescriber who manages your nitrate before adding anything that also widens blood vessels.
Proton pump inhibitors (acid reducers)
Medicines in this group include: Omeprazole (Prilosec), Esomeprazole (Nexium), Lansoprazole (Prevacid), Pantoprazole (Protonix), Rabeprazole (Aciphex).
Moderate Proton pump inhibitors (e.g. esomeprazole, lansoprazole, omeprazole)
Documented for Magnesium
Direction of the risk: Nutrient level — this entry is at least partly about what happens to your own level of a vitamin or mineral, not only to the drug.Prolonged PPI use (typically over a year) can independently cause low serum magnesium (hypomagnesemia); the FDA advises considering magnesium level checks before long-term PPI therapy, which is relevant context for anyone also taking magnesium supplements.
Source: Magnesium: Fact Sheet for Health Professionals ↗
What to do: Mention it at your next visit or refill. If you have been on an acid reducer long-term, ask whether the labs that are normally followed in that situation are up to date.
Minor Omeprazole and other CYP-metabolized medications
Documented for Berberine
Direction of the risk: Drug levels — may change the medicine's level or its effect; the source does not commit to a single direction.Berberine may alter the metabolism of drugs processed through similar liver enzyme pathways, including omeprazole, though clinical significance appears limited.
Source: Berberine: What It Is, Benefits & Side Effects ↗
What to do: Mention it at your next visit or refill. If you have been on an acid reducer long-term, ask whether the labs that are normally followed in that situation are up to date.
Bisphosphonates (osteoporosis drugs)
Medicines in this group include: Alendronate (Fosamax), Risedronate (Actonel), Ibandronate (Boniva), Zoledronic acid (Reclast, Zometa).
Moderate Oral bisphosphonates (e.g. alendronate)
Documented for Magnesium
Direction of the risk: Absorption and timing — taken together, less of one of the two is absorbed. The entry below says which, and separating the doses is usually the fix.Magnesium can bind bisphosphonates in the gut and reduce their absorption; separate doses by at least 2 hours before or after the bisphosphonate.
Timing the source specifies: Separate doses by at least 2 hours before or after the bisphosphonate.
Source: Magnesium: Fact Sheet for Health Professionals ↗
What to do: Bisphosphonates already have strict dosing rules — on waking, with plain water, upright, nothing else by mouth for 30–60 minutes. Keep the supplement well outside that window and confirm the interval with your pharmacist.
Moderate Bisphosphonates and tetracycline/quinolone antibiotics (via magnesium malate component) class-level caution
Documented for NOVOS Core (multi-ingredient formula)
Direction of the risk: Absorption and timing — taken together, less of one of the two is absorbed. The entry below says which, and separating the doses is usually the fix.Magnesium reduces absorption of oral bisphosphonates (e.g., alendronate) and forms insoluble complexes with tetracycline and quinolone antibiotics, reducing their effectiveness; dosing should be separated by 2+ hours.
Timing the source specifies: Dosing should be separated by 2+ hours.
Source: Magnesium - Health Professional Fact Sheet ↗
What to do: Bisphosphonates already have strict dosing rules — on waking, with plain water, upright, nothing else by mouth for 30–60 minutes. Keep the supplement well outside that window and confirm the interval with your pharmacist.
Acetaminophen (paracetamol)
Medicines in this group include: Acetaminophen (Tylenol, Paracetamol).
Moderate Other hepatotoxic drugs (e.g., acetaminophen) / use in people with liver disease
Documented for Green tea EGCG extract
Direction of the risk: Liver strain — the documented concern is additive stress on the liver rather than a change in drug levels.NCCIH notes liver injury has been reported in some people using concentrated green tea extract products (tablets/capsules), with a genetic susceptibility affecting an estimated 5-15% of Americans; caution is warranted when combined with other drugs that stress the liver or in people with existing liver conditions.
Source: Green Tea: Usefulness and Safety | NCCIH ↗
What to do: Keep a running total of all acetaminophen-containing products, including combination cold and pain remedies, and tell your clinician what else you take regularly.
Minor Acetaminophen
Documented for Glucosamine and chondroitin — specifically D-Glucosamine Sulfate
Direction of the risk: Opposing — may work against what the medicine was prescribed to do, which is a different (and easily missed) danger from an additive one.Taking glucosamine sulfate and acetaminophen together might reduce the effectiveness of both the supplement and the medication.
Source: Glucosamine ↗
What to do: Keep a running total of all acetaminophen-containing products, including combination cold and pain remedies, and tell your clinician what else you take regularly.
Minor Acetaminophen (Tylenol)
Documented for Glucosamine and chondroitin — specifically Osteo Bi-Flex Triple Strength (Glucosamine Chondroitin + Joint Shield) and Glucosamine Chondroitin MSM (with OptiMSM)
Direction of the risk: Opposing — may work against what the medicine was prescribed to do, which is a different (and easily missed) danger from an additive one.Taking glucosamine sulfate together with acetaminophen may reduce the effectiveness of both the supplement and the medication.
Source: Glucosamine - Mayo Clinic ↗
What to do: Keep a running total of all acetaminophen-containing products, including combination cold and pain remedies, and tell your clinician what else you take regularly.
Orlistat (fat-absorption blocker)
Medicines in this group include: Orlistat (Xenical, Alli).
Minor Orlistat (Xenical, Alli)
Documented for Omega-3 (EPA/DHA fish oil)
Direction of the risk: Absorption and timing — taken together, less of one of the two is absorbed. The entry below says which, and separating the doses is usually the fix.Orlistat can reduce absorption of the fatty acids in fish oil; Mayo Clinic recommends taking the supplement and drug about two hours apart.
Timing the source specifies: Mayo Clinic recommends taking the supplement and drug about two hours apart.
Source: Fish oil - Mayo Clinic (Drugs & Supplements) ↗
What to do: Fat-soluble vitamins and orlistat should be separated by at least a couple of hours; your pharmacist can fit that into your routine.
Moderate Orlistat
Documented for Vitamin D3
Direction of the risk: Nutrient level — this entry is at least partly about what happens to your own level of a vitamin or mineral, not only to the drug.Orlistat, especially combined with a reduced-fat diet, reduces absorption of vitamin D from food and supplements, which can lower blood 25(OH)D levels.
Source: Vitamin D - Health Professional Fact Sheet ↗
What to do: Fat-soluble vitamins and orlistat should be separated by at least a couple of hours; your pharmacist can fit that into your routine.
Caffeine
Minor Caffeine
Documented for Saffron extract
Direction of the risk: Drug levels — the source describes a change in how much of the medicine ends up in the blood.Saffron may slow how quickly the body breaks down caffeine, potentially increasing caffeine's effects and side effects.
Source: Saffron: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews ↗
What to do: Track your real caffeine total — coffee, tea, energy drinks, and pre-workout together — and raise it with your clinician if you notice palpitations, tremor, or poor sleep.
Minor Caffeine (high intake)
Documented for Creatine monohydrate
Mayo Clinic notes taking caffeine together with creatine might reduce how well creatine works, though more research is needed; a study in Parkinson's disease patients also flagged faster disease progression in those combining high-dose caffeine with creatine, but this needs further investigation.
Source: Creatine - Mayo Clinic (Drugs & Supplements) ↗
What to do: Track your real caffeine total — coffee, tea, energy drinks, and pre-workout together — and raise it with your clinician if you notice palpitations, tremor, or poor sleep.
Corticosteroids (e.g. prednisone)
Medicines in this group include: Prednisone (Deltasone), Prednisolone (Orapred, Millipred), Dexamethasone (Decadron), Hydrocortisone (Cortef), Methylprednisolone (Medrol).
Moderate Corticosteroids (e.g., prednisone)
Documented for Vitamin D3
Direction of the risk: Nutrient level — this entry is at least partly about what happens to your own level of a vitamin or mineral, not only to the drug.Corticosteroids can reduce calcium absorption and impair vitamin D metabolism; vitamin D deficiency is roughly twice as common among long-term steroid users, so vitamin D needs and status should be monitored.
Source: Vitamin D - Health Professional Fact Sheet ↗
What to do: Tell the prescriber managing your steroid course, particularly if it is long-term, and ask which monitoring they normally do.
Raloxifene
Medicines in this group include: Raloxifene (Evista).
Minor Raloxifene (osteoporosis medication)
Documented for Green tea EGCG extract
A study found an interaction between green tea and raloxifene, a drug used to treat osteoporosis.
Source: Green Tea: Usefulness and Safety | NCCIH ↗
What to do: Mention it to the prescriber who manages your bone health and ask about dose separation.
Penicillamine
Medicines in this group include: Penicillamine (Cuprimine, Depen).
Moderate Penicillamine
Documented for Zinc
Direction of the risk: Absorption and timing — taken together, less of one of the two is absorbed. The entry below says which, and separating the doses is usually the fix.Zinc can reduce the absorption and effectiveness of penicillamine (used for rheumatoid arthritis and Wilson disease); doses should be separated by at least 1 hour.
Timing the source specifies: Doses should be separated by at least 1 hour.
Source: Zinc - Health Professional Fact Sheet, Office of Dietary Supplements ↗
What to do: Penicillamine is dosed away from food and minerals for a reason. Confirm the exact timing with your pharmacist before you add anything.
Sulfasalazine
Medicines in this group include: Sulfasalazine (Azulfidine).
Minor Sulfasalazine
Documented for L-methylfolate (5-MTHF)
Direction of the risk: Nutrient level — this entry is at least partly about what happens to your own level of a vitamin or mineral, not only to the drug.Sulfasalazine inhibits intestinal absorption of folate and can contribute to folate deficiency; this is generally a reason clinicians may recommend folate rather than a dangerous interaction, but patients should discuss supplementation with their provider.
Source: Folate - Health Professional Fact Sheet ↗
What to do: Tell the prescriber who manages your sulfasalazine and ask whether the labs they normally follow should be repeated.
Pyrimethamine
Medicines in this group include: Pyrimethamine (Daraprim).
Moderate Pyrimethamine
Documented for L-methylfolate (5-MTHF)
Direction of the risk: Opposing — may work against what the medicine was prescribed to do, which is a different (and easily missed) danger from an additive one.Folic acid/folate can interfere with pyrimethamine's effectiveness; since pyrimethamine is used for malaria prevention/treatment and toxoplasmosis, this interaction is considered clinically significant.
Source: Folate (folic acid) - Mayo Clinic ↗
What to do: This is a specialist-managed medicine. Do not add or change anything around it without the prescribing specialist.
Prescription medicines generally
Minor Oral medications generally (absorption timing)
Documented for Inulin prebiotic fibre
Direction of the risk: Absorption and timing — taken together, less of one of the two is absorbed. The entry below says which, and separating the doses is usually the fix.Inulin may affect the absorption of some medicines; general advice is to take other medications a couple of hours apart from a fiber supplement and disclose all medications to a healthcare provider before use.
Timing the source specifies: General advice is to take other medications a couple of hours apart from a fiber supplement and disclose all medications to a healthcare provider before use.
Source: Inulin - Uses, Side Effects, and More ↗
What to do: Bring the actual bottle to your pharmacist and ask them to run your full list. That review is free at almost every pharmacy and it is the single highest-yield thing you can do.
Minor General - all prescription medications
Documented for Milk thistle (silymarin)
NCCIH does not name a specific well-established drug pairing on its consumer safety page, but explicitly cautions that milk thistle can interact with medicines in harmful ways and advises anyone on any medication to talk with their health care provider before use; it also flags that some milk thistle products are inconsistent in silymarin content or contaminated with pesticides/mycotoxins.
Source: Milk Thistle: Usefulness and Safety | NCCIH ↗
What to do: Bring the actual bottle to your pharmacist and ask them to run your full list. That review is free at almost every pharmacy and it is the single highest-yield thing you can do.
When to seek care urgently
These are the warning signs that go with the medication classes on this page. They are general safety-netting, not a prediction that any supplement will cause them.
- Bleeding that will not stop, black or tarry stools, blood in urine, vomit that looks like coffee grounds, coughing up blood, a sudden severe headache, or any head injury while you are on a blood thinner — these need emergency assessment, not a next-available appointment.
- Fainting, chest pain, or severe dizziness after combining anything that widens blood vessels needs emergency assessment. Nitrate medicines and PDE5 inhibitors (sildenafil, tadalafil) must never be taken together.
- Lithium toxicity is a medical emergency: a coarse tremor, vomiting or diarrhoea, unsteady walking, slurred speech, or new confusion. Stop and seek care the same day, and mention every supplement you have started.
- Agitation, fever, heavy sweating, muscle twitching or rigidity and a racing heart after adding something to a serotonergic medicine can indicate serotonin syndrome — that is an emergency.
If something feels seriously wrong, do not wait for an appointment. Call 911 (US) or your local emergency number.
How to read a severity label
- Major — the source describes a clinically significant risk — treat this as a combination to clear with a clinician before you start, not after.
- Moderate — a real, documented interaction that usually calls for monitoring, separating the doses, or a prescriber-led dose change.
- Minor — documented but usually low-impact, or based on mechanism and animal data rather than human events — still worth naming to your pharmacist.
Severity describes the interaction as the cited reference frames it, not how a specific person will react. A “minor” entry in someone with kidney disease, on five other drugs, can matter more than a “major” one in someone on nothing else.
What this page does not tell you
This is a curated set of interactions with citations — not an exhaustive pharmacology database. An interaction that is absent here has not been ruled out; it may simply not be documented in the references Magellan curates from. Supplements are also not batch-tested for identity or contamination the way prescription drugs are, so what is on the label is a claim rather than a guarantee. And most of these entries come from case reports and mechanistic work rather than randomized trials, which is exactly why the sensible response is a pharmacist review rather than either alarm or dismissal.
Supplements documented in this class
Zinc3 documented interactions in total.
Taurine1 documented interaction in total · covered on the hub.
Questions people actually ask
Which supplements interact with other drug classes?
Omega-3 (EPA/DHA fish oil), Magnesium, Berberine, Vitamin D3, Zinc, Green tea EGCG extract, Resveratrol, Pomegranate ellagitannins, Grape seed extract, Saffron extract, Carnitine (L-carnitine and acetyl-L-carnitine), Alpha-lipoic acid (ALA), L-methylfolate (5-MTHF), Low-dose lithium (lithium orotate), Glucosamine and chondroitin, MSM (methylsulfonylmethane), NAC and GlyNAC, Beetroot and dietary nitrate, Inulin prebiotic fibre, NOVOS Core (multi-ingredient formula), DaVinci Labs Phyto Benefits, Creatine monohydrate, Taurine, Milk thistle (silymarin) — 43 documented entries in total (1 major, 22 moderate, 20 minor). Each entry on this page names the reference it came from.
Which drugs count as other drug classes?
In this dataset the class includes Lithium, Levothyroxine, Liothyronine, Desiccated thyroid, Phenytoin, Carbamazepine and others. Brand names are mapped to their generic ingredient inside the Medication Safety Check, so typing the name on your bottle works.
Does an interaction mean I have to stop the supplement?
Usually not. Most entries here call for one of three things: separating the doses by a few hours, monitoring a lab value or a home reading for a couple of weeks, or a prescriber-led dose adjustment. The decision belongs to the clinician who manages the prescription — what this page is for is making sure the conversation happens before you start rather than after something goes wrong.
Who compiles this. Magellan Longevity is written and edited by Gabriel Radu, DO — a physiatrist (New York license 275110, NPI 1376861765). Interaction entries are curated from clinical references — the NIH Office of Dietary Supplements, NCCIH, MedlinePlus, Mayo Clinic and Memorial Sloan Kettering’s About Herbs among them — and every entry links to the reference it came from so you can check it yourself. Magellan earns affiliate commission on some products; nothing on a safety page is softened, delayed, or omitted because of it. Where a supplement we sell carries a major documented interaction, that is the first thing on the page.