DRUG, VITAMIN, MINERAL, HERB INTERACTIONS

5HTP 5-hydroxytryptophan
5-HTP should be used with caution, if at all, in people taking selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), two types of antidepressant medications. Specifically, the likelihood of developing unpleasant side effects, including serotonin syndrome (characterized by mental status changes, rigidity, hot flashes, rapidly fluctuating vital signs, and possibly coma) is greater if you combine 5-HTP with the drugs sumatriptan, tramadol, trazodone, venlafaxine, and zolpidem. Taking 5-hydroxytryptophan with carbidopa, a medication used to treat Parkinson's disease, has been associated with side effects, including scleroderma-like illness (the skin becomes hard, thick, and inflamed). Using this combination should be avoided except under the supervision of your healthcare provider.

Alpha-Linolenic Acid (ALA)
The combination of alpha-linolenic acid (ALA) and lovastatin may offer benefits to patients on lovastatin therapy. However, additional studies in humans are needed to confirm these findings. You should consult with your healthcare provider before taking ALA if you are currently taking lovastatin.

ALOE VERA
The combination of aloe vera and glyburide, a medication used to treat Type II diabetes, may help control blood sugar and triglyceride levels in the blood. However, you should not use aloe vera in these instances without first consulting with your health care practitioner. Diabetic patients using aloe vera either alone or in combination with other antidiabetic medications need to be monitored closely by health care providers to avoid potential complications from low blood sugar levels. Aloe vera may enhance the effects of hydrocortisone on swelling. Again, consult with your doctor before using aloe with hydrocortisone for conditions involving inflammation or swelling.

Alpha-lipoic acid
In an animal study, alpha-lipoic acid supplements reduced side effects, particularly toxicity to the ear, associated with the antibiotics, amikacin and gentamicin. Additional studies are needed to confirm these effects

in humans. Similarly, the use of alpha-lipoic acid supplements in animals protected against toxic side effects associated with the use of both cisplatin and cyclophosphamide. Consult with your healthcare provider before taking alpha-lipoic acid supplements if you are taking any of these medications. Rats given alpha-lipoic acid supplements had altered thyroid hormone function, but improved cholesterol levels. You would be wise to refrain from using alpha-lipoic acid supplements except under the supervision of a healthcare provider. Blood hormone levels and thyroid function tests should be monitored closely in patients taking thyroid hormones, such as levothyroxine, with alphalipoic acid.

Astragalus
Astragalus may increase the effects of some antiviral medications such as acyclovir and interferon. Astragalus may also counteract the immune-suppressing effects of cyclophosphamide, a medication used to reduce the chances of rejection in transplant recipients.

BETA CAROTENE
People taking the following medications should avoid beta-carotene supplements: Cholestyramine, Colestipol, Probucol Cholestyramine and probucol, medications used to lower cholesterol, can lower blood concentrations of dietary beta carotene by 30% to 40%, according to a 3-year trial in Sweden. Colestipol, a cholesterollowering medication similar to cholestyramin, may also reduce betacarotene levels. Orlistat Beta-carotene and orlistat, a weight loss medication, should not be taken together because orlistat can reduce the absorption of betacarotene by as much as 30%, thereby reducing the amount of this nutrient in the body. Those who must take both orlistat and betacarotene supplements should separate the time between taking the medication and the supplements by at least 2 hours. Other In addition to these medications, mineral oil (used to treat constipation) may lower blood concentrations of beta-carotene and ongoing use of alcohol may interact with beta-carotene, increasing the likelihood of liver damage.

BLACK COHOSH
Although black cohosh may act like the hormone estrogen, no noteworthy interactions (positive or negative) between black cohosh and conventional medications, including hormone replacement therapies, are known to have been reported in the literature to date.

BETAINE AND BILBERRY NO INTERACTIONS KNOWN Brewer's yeast
Brewer's yeast contains a significant amount of tyramine, a substance that should be avoided if you are taking a monoamine oxidase inhibitor (MAOI), a type of antidepressant. Examples of MAOIs are phenelzine, tranylcypromine, pargyline, selegiline, and isocarboxazid. Selegiline is also used for the treatment of Parkinson's disease. Brewer's yeast may also interact with meperidine, a narcotic analgesic, used to treat intense pain. The dangerous interaction between brewer's yeast and these medications may lead to "hypertensive crisis," a rapid and severe increase in blood pressure that is characterized by nausea and vomiting, headache, and irregular heartbeat. This reaction may result in a heart attack or stroke.

BROMELAIN
In a clinical study, the combination of bromelain and amoxicillin increased the levels of this antibiotic in the blood. Studies with bromelain and tetracycline have yielded mixed results regarding whether bromelain increases the body's ability to absorb this antibiotic. More studies are needed to confirm these results. You should consult with your healthcare provider before using bromelain if you are currently taking these antibiotics.

BURDOCK
Although reports have shown that burdock has the ability to lower blood sugar, no noteworthy interactions (positive or negative) between this herb and conventional medications (including antidiabetic medications) are known to have been reported in the literature to date.

CALCIUM
Taking calcium during treatment with the antibiotic gentamicin may increase the potential for toxic effects on the kidneys; therefore, calcium should be used with caution, if at all, in people taking gentamicin. In addition, calcium can interfere with the body's ability to absorb quinolone antibiotics such as ciprofloxacin, as well as tetracyclines, and should not be taken at the same time as these antibiotics. Calcium may also interfere with the absorption of alendronate, a medication used to treat osteoporosis (bone loss). Products containing calcium should be administered at least two hours before or after both alendronate and tetracyclines. Some corticosteroid medications also reduce the absorption of calcium, thereby increasing the risk for osteoporosis over time. Please refer to the depletions monograph on corticosteroids for more information. Two different classes of diuretics interact with calcium in opposite ways—thiazide diuretics such as hydrochlorothiazide can raise calcium levels in the blood, while loop diuretics such as furosemide and bumetanide can decrease calcium levels. In addition, amiloride, a potassium-sparing diuretic, may decrease the amount of calcium excreted in the urine, especially in people with kidney stones; this could raise the levels of calcium levels in the blood. Therefore, taking calcium supplements during treatment with amiloride or thiazide diuretics may not be appropriate or warranted. You should consult with your healthcare provider before adding calcium to your existing medication regimen. Please refer to the depletions monograph on loop diuretics for more information about the effects of reduced calcium levels from these medications. High levels of calcium may increase the likelihood of a toxic reaction to digoxin, a medication used to treat heart conditions, including symptoms of arrhythmia (irregular heartbeat); however, low levels of calcium cause digoxin to be ineffective. People who are taking digoxin should have calcium blood levels monitored closely. Taking calcium with atenolol, a beta-blocker used for the treatment of high blood pressure or heart disorders, may interfere either with blood levels of calcium or this medication; study results are conflicting. Until more is known, individuals taking atenolol should have their blood pressure checked before and after adding calcium antacids or supplements to their medication regimen. Similarly, it has been reported that calcium may reverse the therapeutic effects as well as the side effects of verapamil, a calcium channel blocker often prescribed for the treatment of high blood pressure; there are conflicting reports regarding these results. Again, blood pressure should be monitored closely in patients taking calcium while being treated with verapamil. Consult with your healthcare provider before

adding calcium if you are currently taking atenolol or verapamil. While conjugated estrogens may contribute to an overall increase in calcium blood levels, taking calcium supplements may still be advisable in postmenopausal women on hormone replacement therapy to protect against the risk of developing osteoporosis. For women 51 years or older, the dietary reference intake (DRI) for calcium is 1200 mg/day.

Calendula (Pot Marigold) no interactions CARNITINE
Blood levels of carnitine may be reduced by the anticonvulsant medication valproic acid which might cause carnitine deficiency. Taking carnitine supplements may prevent deficiency and may also reduce the side effects of valproic acid. Please refer to the depletions monograph for more information. In a laboratory study, L-carnitine supplementation protected muscle tissue against toxic side effects from treatment with AZT, a medication used to treat AIDS. Additional studies are needed to confirm whether carnitine would also have this effect in people. Consult with your healthcare practitioner before taking carnitine supplements if you are currently taking AZT. Treatment with carnitine also protected heart cells against the toxic side effects of doxorubicin, a chemotherapy medication, without reducing the effectiveness of the chemotherapy in studies in both animals and children. If you are currently being treated with doxorubicin, consult with your healthcare provider about whether carnitine may be appropriate for you before you start taking these supplements.

Cartilage no interactions CAT’S CLAW
Cat's claw may protect against gastrointestinal damage associated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Consult with your health care provider before using cat's claw if you are currently taking these medications.

CAPSAICAN CREAM
Using capsaicin cream on the skin may increase the risk of cough associated with angiotensin-converting enzyme (ACE) inhibitors, medications used to regulate blood pressure. If you use capsaicin

cream while on these medications and you develop a cough, discontinue use of the cream. In one clinical trial, capsaicin reduced aspirin-induced irritation and damage to the stomach. If you are on chronic aspirin therapy, consult with your health care provider before using capsaicin. Regular use of cayenne may increase the absorption of theophylline, a medication used to treat asthma, thereby increasing the risk of toxicity associated with this medication. You should not use cayenne if you are taking theophylline except on the advice of your health care provider.

CELERY SEED NO INTERACTION Chamomile, German or Roman
No noteworthy interactions

CHROMIUM
Animal studies suggest that antacids may reduce the body's ability to absorb chromium. Although it is unclear how this research relates to humans at this time, it may be advisable to avoid taking chromium supplements at the same time as antacids. Clinical studies have demonstrated that people with Type I or Type II diabetes who take chromium supplements may require lower doses of medications such as insulin, metformin, or sulfonylureas (a class of medications used to treat Type II diabetes that includes glyburide, glimepiride, and others).

Coenzyme Q10
Coenzyme Q10 may help to reduce the toxic effects on the heart of daunorubicin and doxorubicin, two chemotherapy medications that are commonly used to treat a variety of cancers. Consult your healthcare provider before using coenzyme Q10 supplements while you are taking these medications. In a scientific study, supplementation with CoQ10 in patients taking medications for high blood pressure (such as diltiazem, metoprolol, enalapril, and nitrate) resulted in the need for lower doses of these medications. More research is needed to verify these results; therefore, you should consult your healthcare practitioner before adding CoQ10 supplements to your existing medication regimen. There have been reports that coenzyme Q10 may decrease the effectiveness of blood-thinning medications such as warfarin. Therefore, you should not use CoQ10 supplements if you are currently taking warfarin without discussing this with your healthcare

provider. In one study, treatment with CoQ10 in patients using timolol drops, a beta-blocker medication used to treat glaucoma, reduced side effects on the heart without decreasing the effectiveness of the medication. Consult your healthcare provider about whether CoQ10 supplements may be appropriate for you if you are being treated with timolol. Please refer to the consumer depletions monographs for additional information on other medications that may reduce the levels of coenzyme Q10 in the body, such as gemfibrozil, beta-blockers, and tricyclic antidepressant medications, to name a few.

COMFREY NO INTERACTIONS COPPER
Birth control medications can increase blood levels of copper. Therefore, if you are taking birth control medications, copper supplements may not be appropriate or warranted. Consult your healthcare provider before adding copper to your existing medication regimen. Penicillamine, a medication used to treat Wilson's disease and rheumatoid arthritis, reduces copper levels, which may be the intended use, as in the case of Wilson's disease. Allopurinol, a medication used to treat gout, may also reduce copper levels. If you take either of these medications, consult your health care provider before taking copper supplements.

CRANBERRY NO INTERACTION CREATINE
The combined use of caffeine, the herb ephedra, and creatine was associated with at least one report of a stroke in a male weight lifter. Therefore, it would be wise not to take creatine with other herbs or medications that stimulate the central nervous system.

Cysteine
NAC may enhance the blood pressure-lowering effects of angiotensinconverting enzyme (ACE) inhibitors, medications commonly used to treat high blood pressure. You should consult your healthcare provider before adding this supplement to your medication regimen. Treatment with NAC may offer benefits in patients on immunosuppressive therapy with azathioprine, cyclophosphamide, prednisolone, or prednisone. Consult your healthcare provider to determine whether NAC supplements may be appropriate for you.Laboratory studies have

demonstrated that NAC may reduce toxicity associated with both cisplatin and doxorubicin, medications used to treat a variety of cancers. However, scientific studies are needed to confirm these effects in people. Although the combination of NAC with nitroglycerin and isosorbide, medications commonly used to treat angina and chest pain, increases the effects of these medications, it may also increase the chance for unpleasant side effects, particularly headaches, associated with these medications. Consult your healthcare provider before using NAC if you are currently taking either nitroglycerin or isosorbide. Topical applications of NAC may increase the effectiveness of oxiconazole, an antifungal medication. If you are currently taking this medication, you should consult your healthcare provider to determine whether NAC supplements may be appropriate for you.

DANDELIONS
Although the components of dandelion have diuretic effects, no noteworthy interactions (positive or negative) between this herb and diuretic or other medications are known to have been reported in the literature to date. Another species of dandelion, Taraxacum mongolicum, also called Chinese dandelion, may decrease the effectiveness of quinolone antibiotics. It is not known whether Taraxacum officinale, or common dandelion, would interact with these antibiotics in the same way. As a precaution, you should not take dandelion at the same time as these antibiotics.

Dehydroepiandrosterone (DHEA)
In a laboratory study, DHEA increased the effectiveness of AZT against HIV-infected cells. However, scientific studies in humans are needed to confirm these effects. If you are currently taking AZT, consult your healthcare provider before taking DHEA supplements. DHEA may increase the effects of barbiturates, a class of medications often used to treat sleep disorders. You should not take DHEA with these medications unless under the supervision of your healthcare practitioner. An animal study indicates that DHEA may increase the effectiveness of cancer treatments with cisplatin; further studies are needed to confirm these effects in people. Talk to your healthcare provider before adding DHEA to your medication regimen if you are currently being treated with cisplatin. DHEA may also increase the effects of prednisolone, a corticosteroid medication used to treat inflammation and other disorders, when used in combination with this medication. Check with your healthcare practitioner before taking DHEA supplements if you are on prednisolone.

DEVILS CLAW
Devil's claw may interact with warfarin, a blood-thinning medication, resulting in bruising or bleeding disorders. Therefore, devil's claw should not be taken with warfarin.

Docosahexaenoic Acid (DHA)
In combination with aspirin, omega-3 fatty acids could be helpful in the treatment of some forms of coronary artery disease. Consult your healthcare provider about whether this combination would be appropriate for you if you have coronary artery disease. Omega-3 fatty acids may reduce some of the side effects associated with cyclosporine therapy, which is often used to reduce the chances of rejection in transplant recipients. Consult your healthcare provider before adding any new herbs or supplements to your existing medication regimen. In an animal study, omega-3 fatty acids protected the stomach against ulcers induced by reserpine and nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin. Consult your healthcare provider before using omega-3 fatty acids if you are currently taking these medications

Dong Quai
Dong quai may interact with the following medications and herbs: Warfarin Dong quai can increase the potency and, therefore, potential risks of blood-thinning medications, such as warfarin, so it should not be taken with these medicines. Hormone medications Although there is little research on the use of dong quai with hormone medications such as estrogens, progesterones, oral contraceptives, tamoxifen or raloxifene, health practitioners advise against using them together due to the possibility of adverse effects. Blood-thinning herbs Although reported extremely rarely and not published in the scientific literature, combining dong quai with other herbs that thin the blood could possibly increase the risk of bleeding in some people. Herbs with

such potential that should be used only with tremendous caution and supervision when combined with dong quai include feverfew (Tanecetum parthenium), garlic (Allium sativum), ginger (Zingiber officinale), ginkgo (Ginkgo biloba), ginseng (Asian ginseng), licorice (Glycyrrhiza glabra), chinese skullcap (Scutellaria baicalensis), and turmeric (Curcuma longa).

Herbs or medications that cause sun sensitivity Given that dong quai may increase an individual's sensitivity to sunlight, it should not be taken with other medications or herbs (such as St. John's wort) that cause the same reactions.

Echinacea
Two scientific studies have shown that the combination of echinacea and cyclophosphamide, a type of chemotherapy, may support your immune system by negating the immunosuppressive effects associated with chemotherapy. However, you should consult with your health care provider before using echinacea with cyclophosphamide. Echinacea may also be useful in combination with econazole, an antifungal agent used to treat vaginal yeast infections and reduce recurrence of these infections. Consult your health care provider before adding echinacea to your existing medication regimen.

Eicosapentaenoic Acid (EPA)
In combination with aspirin, omega-3 fatty acids could be helpful in the treatment of some forms of coronary artery disease. Consult your healthcare provider about whether this combination would be appropriate for you if you have coronary artery disease. Omega-3 fatty acids may reduce some of the side effects associated with cyclosporine therapy, which is often used to reduce the chances of rejection in transplant recipients. Consult your healthcare provider before adding any new herbs or supplements to your existing medication regimen. In an animal study, omega-3 fatty acids protected the stomach against ulcers induced by reserpine and nonsteroid-al anti-inflammatory drugs (NSAIDs) such as indomethacin. Consult your healthcare provider before using omega-3 fatty acids if you are currently taking these meds. EPA has also been shown to boost the effects of a combination of lowdose etretinate and a topical corticosteroid medication used to treat

severe, chronic psoriasis. Consult your doctor to determine if this combination therapy may be of benefit for you if you suffer from chronic psoriasis.

Ephedra
No noteworthy interactions (positive or negative) between ephedra and conventional medications are known to have been reported in the literature to date. However, the active ingredients of ephedra— ephedrine and pseudoephedrine—are available in a number of overthe-counter and prescription products commonly used for weight loss or nasal decongestion. Ephedrine and pseudoephedrine have been associated with drug interactions. For safety reasons, it is important to assume that interactions associated with the herb ephedra may be similar to those documented for these medications. Side effects such as increased heart rate and nervousness may occur if this herb is taken with: antidepressants that are monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants; blood pressure medications like clonidine and reserpine; theophylline; amphetamine-derivatives; or other preparations that contain ephedrine, pseudoephedrine, caffeine, or phenylpropanolamine as an active ingredient. To minimize the potential for interactions or side effects, consult your healthcare professional before taking ephedra with any of these products or medications.

Ethylenediaminetetraacetic Acid (EDTA)
Animal studies suggest that EDTA may increase the absorption of cefmetazole, an antibiotic; however, further studies in humans are needed to draw definitive conclusions for people. Animal studies suggest that EDTA may increase the absorption of cefmetazole, an antibiotic; however, further studies in humans are needed to draw definitive conclusions for people.

Eucalyptus
In an animal study, topical eucalyptus oil enhanced the absorption of 5-fluorouracil, a medication used to treat cancer that was also applied topically. It is too early to draw conclusions about the usefulness of these findings to humans. Therefore, it would be wise to avoid applying eucalyptus oil topically when using other topical medications. Evening PrimroseIn animal studies, EPO administered during treatment with cyclosporine, a medication used to suppress immune function, may protect against the damage to kidneys that is a possible

side effect of this medication. Consult with your doctor to determine whether EPO supplementation may be appropriate for you. If you are taking a class of medications called phenothiazines to treat schizophrenia, you should not take EPO because it may interact with these medications and increase the risk of seizures.

Feverfew
Although specific interactions between feverfew and conventional medications have not been adequately researched, a potential interaction with non-steroidal anti-inflammatory drugs (NSAIDs) has been identified and may result in decreased effectiveness of these medications. Therefore, you should not take feverfew if you are currently taking NSAIDs such as ibuprofen.

FIBER
Taking psyllium with carbamazepine, which is used to treat seizure disorders, may decrease the absorption and effectiveness of this medication. If you use psyllium while on carbamazepine, your blood levels of this medication should be monitored closely. Consult with your healthcare provider before adding any new supplements to your existing medication regimen. Combining psyllium with cholestyramine or colestipol may be beneficial in lowering cholesterol levels. Consult with your healthcare practitioner about whether this may be an option for you. However, taking fiber in the form of pectin (from fruit) and oat bran reportedly reduces the body's ability to absorb lovastatin, a cholesterol-lowering medication, and could lead to decreased effectiveness of this medication. Psyllium may lower lithium levels in the blood, reducing the effectiveness of the medication. Consult your healthcare provider before using psyllium with lithium. If both are used, take them at least one hour apart, preferably two. Lithium levels should be monitored very closely, particularly with any change in intake of fiber. Fiber supplements may reduce the body's ability to absorb digoxin, a medication used to regulate heart function. Therefore, you should not take fiber supplements at the same time as this medication; it would be best to take them either two hours before or after your dose of digoxin. While fiber supple-ments may help to regulate blood sugar levels, they may also interfere with the absorption of your antidiabetic medications, specifically glyburide and

metformin. Therefore, you should not take fiber supplements at the same time as your antidiabet-ic medications. Your blood sugar levels should be monitored closely. In one study, taking the fiber supplement guar gum with penicillin reduced the blood levels of this medication. Therefore, it would be best not to take penicillin at the same time as fiber supplements. Similarly, increasing dietary fiber led to decreased blood levels and effectiveness of tricyclic antidepressant medications such as amitriptyline, doxepin, and imipramine in three patients. Reduced dietary fiber intake increased the blood levels and improved the conditions of these patients. If you are currently taking these medications, it would be best not to increase your fiber intake, but if you do, consult with your healthcare provider so that the blood levels of these medications can be monitored closely. In general, taking psyllium or other fiber supplements with any medications may reduce or delay the absorption of these medications. It is best to refrain from taking these supplements at the same time as these other medications; take them at least 1 to 2 hours apart.

FLAXSEED AND OILS NO INTERACTIONS Gamma-Linolenic Acid (GLA)
GLA may increase the effectiveness of ceftazidime, an antibiotic, against a variety of bacterial infections. If you are currently taking this medication, consult your healthcare provider to determine whether this combination is appropriate for you. GLA may also increase the effects of anti-cancer treatments, such as doxorubicin, cisplatin, carboplatin, idarubicin, mitoxantrone, tamoxifen, vincristine, and vinblastine. Your healthcare provider can tell you whether taking GLA may benefit you if you are currently undergoing chemotherapy with any of these medications.

GARLIC
There have been reports of a possible interaction between garlic and warfarin that could increase your risk of bleeding. Therefore, if you are taking anticoagulant (blood-thinning) medications such as aspirin, warfarin, dipyridamole, and indomethacin, you should refrain from consuming large amounts of garlic, either fresh or commercially processed.

GINGER

No noteworthy interactions (positive or negative) between ginger and conventional medications are known to have been reported in the literature to date. Although ginger may interfere with blood clotting, there have been no reports of interactions between ginger and anticoagulants (blood-thinning medications). However, patients taking ginger while on anticoagulants should be monitored closely for signs of bleeding disorders.

Ginkgo Biloba
Ginkgo has blood-thinning properties and therefore should not be used if you are taking anticoagulant (blood-thinning) medications, such as aspirin, clopidogrel, dipyridamole, heparin, ticlopidine, or warfarin. High doses of Ginkgo biloba could decrease the effectiveness of anticonvulsant therapy in patients taking carbamazepine or valproic acid to control seizures. If you are taking these medications, you should not use gingko without consulting your health care provider. Ginkgo biloba may be beneficial during treatment with cyclosporine because of its ability to protect cell membranes from damage. If you are currently taking cyclosporine, you should consult your doctor before adding any new herbs or supplements to your existing medication regimen. The combination of papaverine and ginkgo may be effective for the treatment of erectile dysfunction in patients who do not respond to papaverine alone. Consult with your doctor about whether this is an appropriate treatment option for you. Although there has been one literature report of increased blood pressure associated with the use of ginkgo during treatment with thiazide diuretics, this interaction has not been verified by clinical trials. Nevertheless, you should consult with your healthcare provider before using ginkgo if you are taking thiazide diuretics. Additionally, there has been a report of an adverse interaction between ginkgo and trazodone, an antidepressant medication, that resulted in an elderly patient going into a coma. Therefore, you should not take ginkgo if you are taking trazodone for depression without consulting with your doctor first.

GINSENG
There have been reports of a possible interaction between ginseng and the antidepressant medication, phenelzine, resulting in symptoms ranging from manic-like episodes to headache and tremulousness.

Therefore, you should not use ginseng with phenelzine. There have been reports that American ginseng may possibly decrease the effectiveness of the blood-thinning medication, warfarin. If you are currently on warfarin therapy, you should refrain from taking American ginseng. One study reported that ginseng may increase the effects of digoxin, a medication used to treat heart conditions. You should consult with your doctor before using ginseng with digoxin in order to assure that it is appropriate for you to combine the two. There have been reports of a possible interaction between ASIAN ginseng and the antidepressant medication, phenelzine, resulting in symptoms ranging from manic-like episodes to headache and tremulousness. Therefore, you should not use ginseng with phenelzine. There have been reports that Asian ginseng may possibly decrease the effectiveness of the blood-thinning medication, warfarin. If you are currently on warfarin therapy, you should refrain from taking Asian ginseng. Ginseng may block the effects of analgesic medications such as morphine. You should not use ginseng with morphine except on the advice of your doctor. There has been a report that Siberian ginseng increased levels of digoxin in the blood but did not cause toxic effects. However, you should consult with your health care provider before using Siberian ginseng if you are currently taking digoxin

Glucosamine
Glucosamine may increase the anti-inflammatory activity of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. This interaction may result in the need for lower doses of these medications. Consult your doctor to determine whether adding glucosamine supplements may be appropriate for you.

Glutamine
Glutamine may increase the effectiveness and reduce the side effects of chemotherapy treatments with doxorubicin, methotrexate, and 5fluorouracil. Consult your healthcare provider to determine if glutamine supplements may be appropriate for you during treatment with any of these medications.

GOLDENROD OR GOLDENSEAL NO INTERACTIONS GOTU KOLA

There have been no reports documenting negative interactions between gotu kola and medications to date. Since high doses of gotu kola can cause sedation, individuals should refrain from taking this herb with

GRAPE SEED EXTRACT NO INTERACTIONS GREEN TEA
Green tea may increase the effectiveness of beta-lactam antibiotics by reducing bacterial resistance to treatment. Consult your healthcare provider before using green tea if you are currently taking these antibiotics. The combination of green tea and chemotherapy medications, specifically doxorubicin and tamoxifen, increased the effectiveness of these medications in laboratory studies. These results have not yet been demonstrated in studies with human subjects. You should consult with your healthcare provider before using green tea if you are currently being treated with either doxorubicin or tamoxifen. Green tea should not be taken with warfarin, a blood-thinning medication. Green tea contains vitamin K, which diminishes the effects of warfarin. There has been at least one report of an interaction between these substances that decreased the effectiveness of warfarin. If you are currently taking warfarin, you have probably been counseled to minimize your intake of substances containing vitamin K, including green tea.

HAWTHORNE
Although hawthorne reportedly enhances the activity of digoxin, a medication used to treat heart conditions, there are no known reports of interactions between hawthorn and digoxin identified in the literature to date. In a laboratory study, an alcoholic extract of hawthorn fruit counteracted the effects of phenylephrine, a medication that constricts blood vessels and is commonly found in nasal decongestant products. However, this interaction has not been studied in humans; therefore, the relevance of this interaction to people is unknown at this time.

HORSETAIL
Although there have been reports that horsetail acts as a diuretic, no noteworthy interactions (positive or negative) between horsetail and conventional medications are known to have been reported in the literature to date.

IODINE
Although no noteworthy interactions (positive or negative) between iodine and conventional medications are known to have been reported in the literature to date, iodine should be used with caution in people taking thyroid medications

IRON
The cholesterol-lowering medications cholestyramine and colestipol as well as the antibiotic tetracycline decrease the absorption of iron. This effect also occurs when taking medications such as omeprazole, lansoprazole, ranitidine, cimetidine, or antacids that are often prescribed for the treatment of ulcers and other stomach problems. Iron decreases the absorption of tetracyclines and quinolones (antibiotics that include ciprofloxacin, norfloxacin, ofloxacin, and levofloxacin). Iron also decreases the absorption of ACE inhibitors (such as captopril, enalapril, and lisinopril), a class of medications used for the treatment of high blood pressure. Effective levels of carbidopa and levodopa, medications used to treat Parkinson's disease, may be reduced by iron supplements if taken at the same time as these medications. Iron supplements should not be taken at the same time as any of the medications above. It is best to take them at least two hours before or after taking any of these medications to avoid interference with absorption. Iron may decrease the effectiveness of levothyroxine, a thyroid replacement hormone used to treat an underactive thyroid. Thyroid function should be monitored in patients taking iron while on this medication. Birth control medications may increase iron levels in women. Therefore, iron supplementation may not be warranted or appropriate. Consult with your healthcare professional before taking iron supplements if you use birth control medications.

JAMAICA DOGWOOD
No noteworthy interactions (positive or negative) between Jamaica dogwood and conventional medications are known to have been reported in the literature to date.

KAVA

Kava may enhance the effects of substances such as barbiturates and other psychopharmacological agents (psychoactive medications). In addition, kava may increase the risk of unpleasant side effects if taken with phenothiazine medications (often used for the treatment of schizophrenia). There has been a case report of an interaction between alprazolam and kava that resulted in coma. Therefore, it is best not to take kava with these medications. There has been at least one report that kava may reduce the effectiveness of levodopa, a medication used to treat Parkinson's disease. Therefore, you should not take this herb if you are taking any medications containing levodopa.

LACTOBACILLUS ACIDOPHILUS
A laboratory study suggests that Lactobacillus acidophilus may interfere with the body's ability to use sulfasalazine, a medication used to treat ulcerative colitis. The significance of this information is unknown at this time.

LAVENDER AND LEMON BALM NO INTERACTIONS LICORICE
If you are taking angiotensin-converting enzyme (ACE) inhibitors or diuretics (except potassium-sparing diuretics) to regulate blood pressure, do not use licorice products. Licorice could interfere with the effectiveness of these medications or could worsen possible side effects. Because licorice may dangerously increase the risk of toxic effects from digoxin, this herb should not be taken with this medication.Licorice may increase the effects of corticosteroid medications. You should consult with your doctor before using licorice with any corticosteroids. There have been reports of women developing high blood pressure and low potassium levels when they took licorice while on oral contraceptives. Therefore, you should avoid licorice if you are taking birth control medications.

LINDEN NO INTERACTIONS LIPASE
Using lipase supplements while taking orlistat will render them ineffective. Orlistat is a medication used to treat obesity that blocks the ability of lipase to break down fats; this interferes with the body's ability to absorb fats.

LOBELIA NO INTERACTION LYSINE NO INTERACTIONS MAGNESIUM
Magnesium may increase the likelihood of negative side effects (such as dizziness, nausea, and leg swelling) from calcium channel blockers, particularly nifedipine, that are used to control blood pressure. Pregnancy increases the likelihood of this inter-action. Magnesium may interfere with absorption of tiludronate, a medication similar to alendronate that is used for the treatment of osteoporosis. This interaction has not been reported with alendronate specifically. Magnesium supplements or magnesium-containing antacids should be taken at least two hours before or after taking these medications to minimize potential interference with absorption. Magnesium tends to decrease during menopause; studies suggest, though, that hormone replacement therapy may lessen the loss of magnesium. If you are postmenopausal, on hormone replacement or not, talk to your healthcare provider about whether magnesium supplementation would be beneficial. Magnesium hydroxide, commonly found in antacids, may increase the absorption of glipizide and glyburide, medications used to control blood sugar levels. Similarly, magnesium supplements improved the secretion of and sensitivity to insulin. Consult your healthcare provider to determine whether magnesium supplements are appropriate for you if you have diabetes and are current-ly taking any of these medications. The absorption of quinolone and tetracycline anti-biotics as well as nitrofurantoin is diminished when taken with magnesium supplem-ents. Therefore, magnesium should be taken two to four hours before or after taking these medications to avoid interference with absorption. Penicillamine, a medication used for the treatment of Wilson's disease and rheumatoid arthritis, can inactivate magnesium, particularly when high doses are used over a long period of time. Howev-er, supplementation with magnesium and other nutrients in patients on penicillamine therapy reduced the occurrence of side effects. Consult your healthcare practitioner to determine whether magnesium supplements may be appropriate for you. Aminoglycoside antibiotics (such as gentamicin and tobramycin), thiazide diuretics (such as hydrochlorothiazide), loop diuretics (such as furosemide and bumetanide), amphotericin B, corticosteroids, antacids, insulin, and digoxin may lower magnesium levels. Although adequate levels of magnesium can increase the effectiveness of both insulin and digoxin specifically, consult your healthcare provider before

taking mag-nesium supplements. Please refer to the depletions monographs on some of these medications for more information.

MANGANESE
There has been at least one case report of an interaction between haloperidol and manganese that resulted in neuropsychiatric side effects. Therefore, it would be wise to refrain from taking manganese if you are currently taking haloperidol. Your healthcare provider should monitor blood levels of both haloperidol and manganese closely. Reserpine, a medication used to treat high blood pressure, may decrease manganese levels.

MARSHMALLOW NO INTERACTIONS

Melatonin
Melatonin may reduce the effectiveness of blood pressure medications like methoxamine and clonidine. Consult your healthcare provider before using melatonin if you take these medications.In an animal study, melatonin supplements reduced the antidepressant effects of desipramine and fluoxetine. More research is needed to determine whether these effects would occur in humans. Until more is known, it may be wise to refrain from using melatonin supplements while you are on these medica-tions. The combination of melatonin and triazolam, a benzodiazepine medication used for the treatment of anxiety and sleep disorders, improved sleep quality in one study. In addition, there has been at least one report that melatonin supplements enabled a patient to cease long-term benzodiazepine therapy. If you are currently being treated with benzodiazepine medications, consult your healthcare practitioner to determine whether melatonin supplementation may be appropriate for you. Preliminary research suggests that the combination of tamoxifen and melatonin may benefit patients with certain cancers. More research is needed to confirm these results. Therefore, you should consult with your healthcare provider before using melatonin supplements if you are currently taking tamoxifen. Long-term use of beta-blockers (medications used to treat high blood pressure) may reduce the production of melatonin by the body. However, this effect has not been shown to affect sleep patterns (melatonin helps to regulate the body's sleep cycles). Please refer to the depletions monograph on betablockers for additional information. Non-steroidal anti-inflammatory

drugs (NSAIDs) like ibuprofen may reduce the levels of melatonin in the blood. Reduced melatonin levels could alter sleep patterns; consult your healthcare provider before taking melatonin supplements if you are taking these medications. For additional information, please refer to the depletions monograph on NSAIDs

MILK THISTLE
Milk thistle may protect the kidneys against toxic side effects associated with chemotherapy treatment with cisplatin; however, a laboratory study revealed that the anticancer effect of cisplatin and ifosfamide was reduced in the presence of milk thistle. Therefore, you should consult with your healthcare provider before adding any new herbs or supplements to your existing medication regimen, especially if you are undergoing chemotherapy. Milk thistle may also impact the effectiveness of cyclosporine. Consult with your healthcare provider before using milk thistle if you are currently being treated with cyclosporine.

Omega-3 fatty acids
Omega-3 fatty acids may increase the blood-thinning effects of aspirin. While this combination may be helpful in the treatment of some diseases, you should only take omega-3 fatty acids under the guidance and supervision of your healthcare provider. Taking omega-3 fatty acids during cyclosporine therapy may reduce toxic side effects associated with this medication in transplant patients. Use of omega-3 fatty acids with cyclosporine should only be done with the approval of your healthcare provider. In a scientific study, the addition of omega-3 fatty acids, specifically EPA, to a regimen of etretinate and topical corticosteroids to treat psoriasis, resulted in improvement of symptoms. Consult your healthcare provider about whether omega-3 supplementation would be of benefit to you. In an animal study, treatment with omega-3 fatty acids protected against the possibility of ulcers from nonsteroidal antiinflammatory drugs (NSAIDs). More research is needed to evaluate whether omega-3 fatty acids would have the same effects in people. Until more is known, you should consult with your doctor before taking omega-3 supplements if you are currently taking NSAIDs.

Omega-6 fatty acids
Taking omega-6 fatty acids during therapy with cyclosporine, a medication used to suppress the immune system, may increase the immunosuppressive effects of this medication. Consult your healthcare provider before using omega-6 fatty acids during cyclosporine therapy.

PASSIONFLOWER
An animal study has demonstrated that passionflower enhances the effects of pentobarbital, a medication used to promote sleep. Caution is advised when taking passionflower with sedatives because the herb may increase the effects of these substances. Examples of medications with sedative properties include most antihistamines and therapies for anxiety and insomnia.

PAU D’ARCO NO INTERACTIONS PEPPERMINT OIL
In an animal study, topical peppermint oil increased the absorption of 5-fluorouracil, a medication used to treat cancer that was also applied topically. It is too early to draw conclusions about the usefulness of these findings to humans. Therefore, it would be wise to avoid applying peppermint oil topically when using other topical medications.

PHENYLALANINE
The absorption of baclofen, a medication used to relieve muscle spasms, may be reduced by phenylalanine. Therefore, it is best to avoid taking this medication with a meal, especially one that is high in protein content, or with phenylalanine supplements. Phenylalanine may reduce the effectiveness of levodopa, a medication used to treat Parkinson's disease; therefore, phenylalanine should not be taken at the same time as levodopa.

PHOSPHORUS
No noteworthy interactions (positive or negative) between phosphorus and conventional medications are known to have been reported in the literature to date. High doses of insulin may decrease blood levels of phosphorus!!!.

POTASSIUM
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may raise levels of potassium in the blood, particularly in patients with

decreased kidney function. If you are taking these medications, you should avoid using potassium supplements. ACE inhibitors (such as captopril, enalapril, and lisinopril) can also increase blood levels of potassium, particularly when taken with NSAIDs, potassium-sparing diuretics (such as spironolactone, triamterene, or amiloride), or salt substitutes. A rise in potassium from ACE inhibitors may also be more likely in cases of decreased kidney function and diabetes. You should consult your healthcare provider before adding potassium supplements to your existing medication regimen. Heparin, cyclosporine, trimethoprim, and beta-blockers (such as metoprolol and propranolol that are used to treat high blood pressure) may also raise blood levels of potassium. Consult your healthcare provider before adding potassium supplements if you are taking any of these medications. Corticosteroids, amphotericin B, antacids, insulin, loop diuretics (such as furosemide and bumetanide), and thiazide diuretics (such as Hydrochloro-thiazide) can lower potassium levels. Please refer to the depletions monographs related to these medications for additional information. You should consult with your healthcare practitioner to determine whether you should take potassium supplements if you are also taking these medications. Lower blood levels of potassium increase the likelihood of toxic effects from digoxin, a medication used to treat heart conditions. Normal levels of potassium should be maintained during digoxin treatment; consult your healthcare provider to determine if you should take potassium supplements while on this medication.

PSYLLIUM
Taking psyllium with carbamazepine, which is used to treat seizure disorders, may decrease the absorption and effectiveness of this medication. If you use psyllium while on carbamazepine, your blood levels of this medication should be monitored closely. Consult with your healthcare provider before adding any new supplements to your existing medication regimen. Combining psyllium with cholestyramine or colestipol may be beneficial in lowering cholesterol levels. Consult with your healthcare practitioner about whether this may be an option for you. However, taking fiber in the form of pectin (from fruit) and oat bran reportedly reduces the body's ability to absorb lovastatin, a cholesterol-lowering medication, and could lead to decreased effectiveness of this medication. Psyllium may lower lithium levels in the blood, reducing the effectiveness of the medication. Consult your healthcare provider before using psyllium with lithium. If both are used, take them at least one hour apart, preferably two. Lithium levels should be monitored very closely, particularly with any change in

intake of fiber. In general, taking psyllium or other fiber supplements with any medications may reduce or delay the absorption of these medications. It is best to refrain from taking these supplements at the same time as these other medications; take them at least 1 to 2 hours apart.

QUERCETIN
Quercetin may increase the effects of adriamycin and cisplatin, two chemotherapy medications. More research is needed to determine if quercetin should be taken in conjunction with chemotherapy

RED YEAST RICE
Red yeast rice should not be taken with cholesterol-lowering (statin) medications known as HMG-CoA reductase inhibitors (such as atorvastatin, lovastatin, fluvastatin, simvastatin, pravastatin, cerivastatin), because it may enhance the effect of these medications, thereby increasing the risk of liver damage. Grapefruit Juice When grapefruit or grapefruit juice is taken with HMG-CoA reductase inhibitors such as atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin, and simvastatin, they enhance the effects of the medications and cause a significant increase in blood levels of these synthetic drugs, leading to a greater chance of side effects and liver damage. Because red yeast rice appears to act in much the same way as these cholesterol-lowering drugs, it would be wise to avoid drinking grapefruit juice or eating grapefruit or grapefruit products such as marmalade while taking red yeast rice.

ROSEMARY
In a laboratory study, rosemary extract increased the effectiveness of doxorubicin in treating human breast cancer cells. The relevance of these findings is not known; additional clinical studies are needed to confirm these effects in people. If you are currently being treated with doxorubicin, consult with your health care practitioner before adding rosemary to your treatment regimen.

S-Adenosylmethionine (SAMe)
SAM-e may interact with certain antidepressant medications and increase the potential for side effects including headache, irregular or

accelerated heart rate, anxiety, and restlessness. Consult your healthcare provider before using this supplement if you are taking antidepressant medications

SAW PALMETTO
No noteworthy interactions (positive or negative) between saw palmetto and conventional medications are known to have been reported in the literature to date. However, because the way that saw palmetto works in the body is similar to the way finasteride works, it has been recommended that this herb not be used in combination with finasteride or other medications used to treat BPH.

SELENIUM
Selenium may reduce toxic side effects associated with cisplatin and doxorubicin, two forms of chemotherapy

SKULLCAP
While no noteworthy interactions (positive or negative) between skullcap and conventional medications are known to have been reported in the literature to date, skullcap does possess sedative properties. Therefore, use skullcap with caution, if at all, if you are taking benzodiazepines (anti-anxiety medications), barbiturates (medications often prescribed for sleep disorders), or other sedative medications such as antihistamines

SLIPPERY ELM NO INTERACTIONS SULFUR NO INTERACTIONS SPIRULINA NO INTERACTIONS St. JOHN’S WORT
Using St. John's wort with antiviral agents such as indinavir and other protease inhibitors is not recommended. There is the possibility that this herb could reduce the effectiveness of these particular antiviral medications. It is not clear whether St. John's wort may also interact with other antiviral medications. You should consult with your doctor

before using St. John's wort if you are undergoing treatment for HIV or AIDs. St. John's wort may interact with antidepressant medications that are used to treat depression or other mood disorders. Therefore, do not take this herb with any such medications. St. John's wort may also interfere with reserpine, a medication used to regulate high blood pressure, rendering the medication ineffective. You should not use St. John's wort if you are taking reserpine. You should not use St. John's wort if you are taking digoxin because of a potentially dangerous interaction that could result in reduced effectiveness of this medication. You should not take St. John's wort with immunosuppressive medications such as cyclosporine because it may reduce the effectiveness of these medications. There have been reports of bleeding in women taking St. John's wort with birth control medications. The interaction between St. John's wort and birth control medications may result in decreased effectiveness of these medications. There has also been a report of a possible interaction between St. John's wort and loperamide, a medication used for the treatment of diarrhea; therefore, this herb should not be taken with this medication. If you are being treated for asthma with theophylline, you should not use St. John's wort. There has been a report of an interaction between St. John's wort and theophylline that resulted in a lack of effectiveness of the medication due to low blood levels. Additionally, there have been reports that St. John's wort interferes with the anticoagulant medication, warfarin, requiring adjustments in doses of this medication. You should not use St. John's wort if you are taking warfarin. Consult your healthcare provider before adding any new herbs or supplements to your existing medication regimen.

STINGING NETTLE
In a scientific study of patients with acute arthritis, stewed stinging nettle leaves enhanced the anti-inflammatory effect of diclofenac, a nonsteroidal anti-inflammatory medication (NSAID). Although the combination of stinging nettle and NSAIDs may be beneficial for the treatment of arthritic conditions, you should consult with your health care provider before adding this herb to your existing medication regimen.

TURMERIC NO INTERACTIONS TYROSINE
Levodopa, a medication used to treat Parkinson's disease, may interfere with the absorption of tyrosine and could reduce tyrosine

levels in the blood. Therefore, tyrosine should not be taken at the same time as levodopa. L-tyrosine increased the appetite-suppressant effects of phenylpropanolamine, ephedrine, and amphetamine in rats. More research is needed to determine whether L-tyrosine would produce similar results in people. Although the application for humans is unclear, animal studies suggest that tyrosine increases the painrelieving effects of morphine.

UVA URSI
Based upon animal studies, uva ursi may increase the antiinflammatory effects of corticosteroid medications and nonsteroidal antiinflammatory drugs (NSAIDs) such as dexamethasone, prednisolone, and indomethacin. Additional studies are needed to confirm whether uva ursi could increase the effects of these medications in people

VALERIAN
While no noteworthy interactions (positive or negative) between valerian and conventional medications are known to have been reported in the literature to date, valerian is a sedative herb that may increase the effects of alcohol and medications for anxiety and insomnia. Therefore, use valerian with caution, if at all, if you are taking benzodiazepines (anti-anxiety medications), barbiturates (medications often prescribed for sleep disorders), or other sedative medications (such as antihistamines

VANADIUM
In experiments, vanadium increased the effects of heparin, a medication used to prevent blood clotting. Therefore, it would be wise to refrain from taking vanadium supplements while on heparin therapy

VITAMIN A RETINOL
The cholesterol-lowering medications cholestyramine and colestipol may reduce the body's ability to absorb vitamin A. Please refer to the consumer depletions monographs for these medications for more information. However, another class of cholesterol-lowering medications called HMG-CoA reductase inhibitors or statins (including atorvastatin, fluvastatin, and lovastatin, among others) may actually increase vitamin A levels in the blood. One study suggests that the combination of vitamin A and antacids may be more effective than antacids alone in healing ulcers.

Neomycin, an antibiotic, may reduce vitamin A absorption, especially when delivered in a large dose. The significance of this interaction on daily supplementation with vitamin A is unknown. Omeprazole may influence the absorption and effectiveness of beta-carotene supplements. It is not known whether this medication affects the absorption of beta-carotene from foods. As mentioned above, betacarotene is the precursor form of vitamin A. Birth control medications increase the levels of vitamin A in women. Therefore, it may not be appropriate for women taking birth control medications to take vitamin A supplements. You should discuss this situation with your healthcare provider.

VITAMIN B1
Diuretics, particularly furosemide, may reduce the levels of thiamine in the body. When furosemide is combined with digoxin (a medication used to treat heart conditions) and taken for long periods of time, the ability of thiamine to benefit the heart may be reduced. Please refer to the depletions monographs on loop diuretics and cardiac glycosides for more information. Taking vitamin B1 supplements may improve treatment with antidepressants such as nortriptyline, especially in elderly patients. However, you should check with your healthcare practitioner before adding new supplements to your existing medication regimen. Thiamine may help reduce some of the side effects associated with scopolamine, a medication commonly used to treat motion sickness. Thiamine should not be taken at the same time as tetracycline, an antibiotic, because it interferes with the absorption and effectiveness of this medication. Thiamine either alone or in combination with other B vitamins should be taken at different times from tetracycline.

vitamin B12
The body's ability to absorb vitamin B12 is decreased when taking medications such as omeprazole, lansoprazole, ranitidine, cimetidine, or antacids that are often used to treat ulcers. This interference is most likely to result from prolonged use of these medications more than a year. Vitamin B12 should not be taken at the same time as tetracycline, an antibiotic, because it interferes with the absorption and effectiveness of this medication. Vitamin B12 either alone or in combination with other B vitamins should be taken at different times from tetracycline. Blood levels of vitamin B12 may also be reduced when taking metformin for diabetes or chemotherapy medications for cancer, particularly methotrexate. Long-term treatment with

phenobarbital and phenytoin may interfere with the body's ability to use vitamin B12.

RIBOFLAVIN
Poor dietary habits in combination with birth control medications can interfere with the body's ability to use riboflavin. Riboflavin can reduce the effectiveness of sulfa-containing medications (antibiotics used to treat bacterial infections). Riboflavin may reduce the effectiveness of medications taken for malaria (such as chloroquine, mesloquine). Riboflavin interacts with selegiline, a medication used for Parkinson's disease. Riboflavin may interact with doxorubicin, a medication used for the treatment of certain cancers. Methotrexate, a medication used to treat cancer, can prevent the body from making riboflavin (as well as other essential vitamins). Phenytoin, a medication used to control epileptic seizures, may affect riboflavin levels in children. Psychotherapeutic medications called phenothiazines (such as chlorpro-mazine) may lower riboflavin levels. Tricyclic antidepressants (imipramine, amitriptyl-ine) also reduce levels of riboflavin in the body. Please refer to the depletions monogr-aphs for these medications for more information.Taking riboflavin may improve treat-ment with antidepressants such as nortriptyline, especially in elderly patients. Howev-er, you should check with your healthcare provider before adding new supplements to your existing medication regimen. Riboflavin should not be taken at the same time as tetracycline, an antibiotic, because it interferes with the absorption and effectiveness of this medication. Vitamin B complex supplements should be taken at different times from tetracycline.

NIACIN
Taking aspirin before taking niacin may reduce the flushing associated with niacin. However, large doses of aspirin may prolong the length of time that niacin is in the body. If you experience "niacin flush," consult your healthcare provider about whether you should use aspirin to reduce this reaction. Niacin binds bile-acid sequestrants (cholesterollowering medications such as colestipol and cholestyramine) and may decrease their effectiveness; therefore, niacin and these medications should be taken at different times of the day. When niacin is taken at the same time as another class of cholesterol-lowering medications, called HMG-CoA reductase inhibitors or statins, the likelihood for serious side effects, such as muscle inflammation or liver toxicity, is increased. Doses of niacin that are high enough to reduce cholesterol levels may raise blood sugar and lead to a loss of blood sugar control. However, one study suggests that niacin may actually benefit patients

with recent onset of Type I diabetes. People taking insulin, metformin, glyburide, glipizide, or other similar medications used to treat high blood sugar levels should monitor their blood sugar levels closely. Niacin should not be taken at the same time as tetracycline, an antibiotic, because it interferes with the absorption and effectiveness of this medication. Niacin either alone or in combination with other B vitamins should be taken at different times from tetracycline. When niacin is taken with certain blood pressure medications (such as prazosin, doxazosin, and guanabenz), the likelihood of side effects from these medications is increased. The use of nicotine patches with niacin may increase the chances of or worsen the flushing reactions associated with this supplement.

VITAMIN B5 PANTOTHENIC ACID
No noteworthy interactions (positive or negative) between pantothenic acid and conventional medications are known to have been reported in the literature to date.

VITAMIN B6
Vitamin B6 supplements taken during chemotherapy with 5-fluorouracil may reduce certain side effects (namely, palmar-plantar erythrodysesthesia, a potentially debilitating skin condition) without affecting the chemotherapy. Vitamin B6 decreases the effectiveness of hydralazine, a medication used to treat high blood pressure, and should, therefore, not be taken with this medication. Vitamin B6 reduces the effect of levodopa, a medication used to treat Parkinson's disease. Pyridoxine supplements should not be taken with levodopa. Taking vitamin B6 supplements may improve treatment with antidepressants such as nortriptyline, especially in elderly patients. However, you should check with your healthcare practitioner before adding new supplements to your existing medication regimen. Taking vitamin B6 during treatment with phenytoin, an anticonvulsant medication, may decrease the effectiveness of this medication. You should consult with your healthcare professional before using vitamin B6 if you are on phenytoin therapy. B complex vitamins may interfere with the body's ability to absorb tetracycline; these vitamins should not be taken at the same time as this medication. Antituberculosis medications such as isoniazid (INH) and cycloserine (used for resistant forms of tuberculosis) reduce the levels of vitamin B6 in the blood. For this reason, it is recommended that you take vitamin B6 if you are taking these medications, and that your healthcare provider closely monitor you for signs of vitamin B6 deficiency. Erythropoietin therapy

used for severe anemia may decrease vitamin B6 levels in red blood cells. Therefore, taking vitamin B6 supplements may be warranted. You should consult with your doctor if you are currently being treated with this medication. Penicillamine (used in the treatment of Wilson's disease and rheumatoid arthritis) may decrease levels of vitamin B6. Long-term penicillamine therapy may warrant monitoring of vitamin B6 levels in the blood. Long-term treatment with theophylline for asthma may reduce blood levels of vitamin B6. Taking supplements may be warranted, but you should check with your healthcare provider first. Birth control medications and monoamine oxidase inhibitors (MAOIs), medications such as phenelzine and tranylcypromine that are used to treat depress-ion, may reduce blood levels of vitamin B6.

FOLIC ACID VITAMIN B9
Birth control medications, anticonvulsants (such as phenytoin), and cholesterol lower-ing medications, particularly cholestyramine, may reduce the levels of folic acid in the blood as well as the body's ability to use this vitamin. Please refer to the consumer depletions monographs for these medications for additional information. Sulfasala-zine, a medication used for ulcerative colitis and Crohn's disease, may reduce the absorption of folic acid, leading to lower levels in the blood. Methotrexate, a medica-tion used to treat cancer and resistant rheumatoid arthritis, increases the body's need for folic acid. Folic acid reduces the side effects of methotrexate without decreasing its effectiveness. Consult your healthcare provider to determine whether taking folic acid may be appropriate for you if you are undergoing treatment with methotrexate. Folic acid should not be taken at the same time as tetracycline, an antibiotic, because it interferes with the absorption and effectiveness of this medication. Folic acid alone or as part of a vitamin B complex supplement should be taken at different times from tetracycline. When taken for long periods of time, aspirin, ibuprofen, acetaminophen, and other anti-inflammatory medications can also increase the body's need for folic acid. Please refer to the depletions monographs for these medications for more information.

VITAMIN C
Vitamin C taken with aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) may protect the stomach and intestines against injury from these medications. However, high doses of vitamin C (equal to or greater than 500 mg per day) may raise the blood levels of aspirin and other acidic medications. Vitamin C may decrease excretion of

acetaminophen in the urine, which may increase blood levels of this medication. Vitamin C may also affect the levels of furosemide, a diuretic, and propranolol, a beta-blocker; therefore, vitamin C supplements should not be taken at the same time as these medications. Vitamin C can increase levels of estradiol, an ingredient in some birth control medications and hormone replacement therapies. However, vitamin C may offer antioxidant benefits to women taking birth control medications. You should consult your healthcare provider before using vitamin C supplements if you are taking estradiol. Cyclosporine, a medication used for the treatment of cancer, may reduce blood levels of vitamin C. The combination of vitamin C with nitroglycerin and nitrate medications (isosorbide dinitrate and isosorbide mononitrate), used to treat heart disease, reduces the occurrence of nitrate tolerance, an effect by which the body becomes accustomed to the medicine and then requires a brief break from it for it to work properly. For ex-ample, people taking nitrate-containing medications generally take the medicine for 12 hours and then have a 12-hour time period without the medicine. Apparently, vita-min C makes nitrate tolerance less likely to happen which may, upon further investig-ation, translate into greater effectiveness of the nitrate medication. Taking vitamin C with tetracycline, an antibiotic, may increase the levels of this medication. More res-earch is needed to confirm these effects. Patients taking warfarin, a blood-thinning medication, should not exceed the RDA for vitamin C. There is a remote possibility that vitamin C could interfere with the effectiveness of this medication.

VITAMIN D
Isoniazid (INH), cholestyramine, antacids, calcium channel blockers, anticonvulsants, and thiazide diuretics all interfere with vitamin D. INH, a medication used to treat tuberculosis, may raise blood levels of this vitamin. Cholestyramine, a cholesterol-lowering medication, interferes with the absorption of vitamin D (as well as other fat soluble vitamins). Calcium-channel blockers (such as verapamil) that are used to treat high blood pressure and heart conditions may decrease the production of vitamin D by the body. Phenobarbital, phenytoin, and other anticonvulsant medications increase the body's use of vitamin D. Please refer to the consumer depletions monographs on phenobarbital and phenytoin for additional information. Thiazide diuretics increase

the activity of vitamin D and could lead to higher calcium levels. Hormone replacement therapy with estrogen appears to increase vitamin D levels in the blood; this may be a beneficial effect on calcium and bone metabolism. However, this benefit may be lost with the addition of progesterone. The hormonal form of vitamin D may enhance the effects of doxorubicin, a medication used to treat a variety of cancers. Taking some antacids for long periods of time may alter the levels, metabolism, and availability of vitamin D.

VITAMIN E
Taking vitamin E at the same time as warfarin, a blood-thinning medication, increases the risk of abnormal bleeding, especially in vitamin K-deficient individuals. A study evaluating the effects of vitamin E and aspirin suggests that the combination appears to be safe and may benefit patients at risk for stroke. Consult your healthcare provid-er before taking this supplement. Cholesterol-lowering medications such as colestipol and cholestyramine, called bile-acid sequestrants, decrease the absorption of vitamin E. Gemfibrozil, a different type of cholesterol-lowering medication, may also reduce vitamin E levels. Although statins, another class of medications used to lower cholest-erol levels, may reduce the antioxidant activity of vitamin E, there may be other bene-fits derived from the combination of vitamin E and these medications. Consult your healthcare practitioner to determine whether it would be appropriate for you to take vitamin E supplements if you are taking any of these medications. Vitamin E may interact with cyclosporine, a medication used to treat cancer, reducing the effective-ness of both the supplement and the medication. However, there appears to be some controversy regarding the nature of this interaction; another study suggests that the combination of vitamin E and cyclosporine may actually increase the effects of the medication. More research is needed to know for certain if it is safe to take the two together. Vitamin E may affect the levels and effectiveness of a variety of medications such as chloroquine, chlorpromazine, desipramine, and propranolol. Vitamin E supplements may benefit women taking hormone replacement therapy by improving lipid profiles. It may also provide antioxidant benefits to women taking birth control medications. Vitamin E may protect against toxicity from AZT, a medication used to treat AIDS. If you are taking AZT, consult your healthcare provider to determine whether vitamin E supplements may be appropriate for you

VITAMIN H(Biotin)

Although no noteworthy interactions (positive or negative) between biotin and conventional medications are known to have been reported in the literature to date, there are some medications that may deplete biotin levels. Long-term use of anticonv-ulsant medications such as phenytoin, primidone, carbamezepine, and phenobarbital reduce blood levels of biotin; this effect is not only responsible for the anti-seizure activity of these medications, but it is also responsible for their side effects. Please refer to the appropriate depletions monographs for additional information

Vitamin K
Vitamin K reduces the effects of the blood-thinning medication warfarin, rendering the medication ineffective. When taking this medication, do not take vitamin K supplements and avoid foods with high quantities of this nutrient unless instructed to do otherwise by your healthcare provider. Antibiotics, particularly a class known as cephalosporins, reduce the absorption of vitamin K. This is particularly a problem for people who already have low levels of vitamin K or are at risk for deficiency (such as those who are malnourished, elderly, or taking warfarin). The cholesterol-lowering medication cholestyramine may also reduce the absorption of vitamin K. Phenytoin interferes with the body's ability to use vitamin K. Taking anticonvulsants (such as phenytoin) during pregnancy or while breastfeeding may deplete vitamin K in new-borns; consult your obstetrician and/or pediatrician for advice on nutrient replacement therapy

WILD YAM
An animal study indicated that the active component of wild yam, diosgenin, may interact with estradiol. You should consult with your doctor before using wild yam if you are currently taking this medication

YARROW NO INTERACTIONS ZINC
Zinc decreases the absorption of oral quinolones, a class of antibiotics that includes ciprofloxacin, norfloxacin, ofloxacin, and levofloxacin, as well as tetracycline anti-biotics. Similarly, zinc interacts with nonsteroidal anti-inflammatory drugs (NSAIDs), and could reduce the absorption and effectiveness of these medications. If you take NSAIDs and are considering taking zinc supplements, talk with your healthcare provider first. Penicillamine, a medication used to treat Wilson's disease and rheumatoid arthritis, decreases zinc levels. Since zinc

supports immune function, it should not be taken with corticosteroids, cyclosporine, or other medications intended to suppress the immune system. Hormone replacement therapy consisting of estrogen and progesterone derivatives may reduce loss of zinc in the urine, particularly in women with osteoporosis. There has been at least one report of an interaction between zinc and hydralazine, a medication used to treat high blood pressure, which resulted in a lupuserythematosus-like syndrome (characterized by a facial butterfly rash, fever, leg and mouth ulcers, and abdominal distress). It would be wise to refrain from using zinc supplements with hydralazine

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