If your health routine includes both prescription medication and a supplement regimen, you’re certainly not alone. According to the latest statistics from the Centers for Disease Control and Prevention, nearly 70 percent of adults between the ages of 40 and 79 take at least one prescription drug. Meanwhile, a 2020 survey conducted by the Council for Responsible Nutrition reveals that approximately 75 percent of Americans take dietary supplements.
However, while the goal of supplementing is to boost your health and wellness, it’s possible that some of your supplements and medications may not mix well.
“Many people mistakenly believe that supplements will not interact with their prescription (or even over-the-counter) medications,” says Jessica Nouhavandi, Pharm.D., co-founder of online pharmacy Honeybee Health. “While supplements taken on their own can be perfectly fine, some interfere with prescription drugs.”
For this reason, you should always inform your doctor of your regular supplement intake and establish a relationship with your local pharmacist. “We are trained to make sure you are taking the right things and taking them properly, and to help you get the most out of your medicines and supplements,” she explains.
If you take any of the following six commonly-prescribed medications, you’ll want to avoid certain supplements. The good news: There are safer supplement alternatives.
If your doctor prescribes you this common cholesterol medication, you should avoid the cholesterol support supplement red yeast rice. Red yeast rice contains a small amount of an inhibitor of the naturally-occurring enzyme HMG-CoA reductase; popular lipid-lowering statins also contain enzyme blockers.
“A patient taking both this medicine and supplement would be placed at risk for symptoms of HMG-CoA reductase toxicity, which includes muscle damage, muscle pain, and liver dysfunction,” Nouhavandi says.
Black cohosh, which belongs to the buttercup family and may help with menopausal symptoms and menstrual cramps, per the National Institutes of Health (NIH), may also increase the likelihood of suffering from liver disease when paired with statins, she adds.
Safer Sub: Another popular cardiovascular support supplement is CoQ10. A meta-analysis published in Journal of the American Heart Association indicates that the antioxidant CoQ10 can benefit patients experiencing statin-induced muscle damage. Plus, a study published in Cardiovascular Pharmacology: Open Access concluded that CoQ10 has “significant potential” in promoting heart health, whether on its own or as an adjunct therapy to traditional meds.
If you take a diuretic for high blood pressure, avoid potassium supplements. You see, potassium-sparing diuretics preserve the potassium excreted through the kidneys, putting patients at risk of hyperkalemia (a condition in which blood potassium levels are higher than normal) should they supplement.
“If a patient were to add a potassium supplement, the additive potassium accumulation could cause dangerous heart rhythms,” says Nouhavandi.
“Although not currently recommended by hypertension guidelines [from the American Pharmacists Association, American College of Cardiology, and American Heart Association], some evidence suggests that these supplements can support healthy blood pressure when used in combination with a patient’s medication,” Nouhavandi says.
A 2020 review published in the journal Experimental and Therapeutic Medicine further confirmed that garlic supplements, in particular, may help support healthy blood pressure with limited (or no) side effects.
If taking prescription insulin to manage diabetes, avoid chewable or gummy vitamins, as well as any other supplements that contain sugar. Sugar may show up on ingredient lists as anything from dextrose to fruit juice concentrate.
“Any supplements containing sugar will defeat the usefulness of the diabetes medication,” says Anita Gupta, D.O., Pharm.D., M.P.P, an adjunct assistant professor of anesthesiology and critical care medicine and pain medicine at the Johns Hopkins University School of Medicine.
A probiotic may also be beneficial, since diabetes can cause problems within the digestive system. “Probiotics and a balanced diet in coordination with healthcare provider recommendations can help maintain a healthy gut and balance of blood glucose,” Gupta explains.
4) Asthma Inhalers
If you use an asthma inhaler regularly, avoid supplements containing caffeine (such as some green tea extracts, energy-boosters, and performance enhancers).
Bronchodilator inhalers, like Albuterol, are designed to relax the muscles in the lungs and open the lungs’ airways. With that, though, they may also cause a faster heart rate and heart palpitations—the same possible side effects of caffeine, Nouhavandi says. This means, taking both an inhaler and caffeine may increase your risk of experiencing tachycardia (a heart rate of over 100 beats per minute) or palpitations.
Safer Sub: Eucalyptus oil may be a great addition to your doctor-prescribed asthma care plan. A 2020 review published in the peer-reviewed journal Advances in Therapy found that inhaling cineole, the active chemical in eucalyptus oil, can be one form of adjunctive therapy for asthma.
5) A Synthetic Thyroid Hormone
When taking medications for hypothyroidism (a condition in which the thyroid gland is underactive), beware of supplements containing iron, calcium, aluminum, and magnesium. You’ll also want to look out for iron and folate. When taken within four hours of the hormone replacement treatment medicine levothyroxine, these nutrients can decrease its absorption, Nouhavandi explains.
The ATA currently recommends against the use of dietary supplements, nutraceuticals, and over-the-counter products for the treatment of hypothyroidism, Nouhavandi stresses.
“While the amino acid tyrosine helps with the synthesis of thyroid hormones, there are no clinical studies that prove its efficacy,” she explains. If you’d like to add any supplements to your health regimen, talk with your doctor first.
6) SSRI and SNRI Antidepressants
Avoid any supplement containing the amino acid tyramine, as well as the 5-hydroxytryptophan (a.k.a. 5-HTP), a chemical the body makes from tryptophan, when taking SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors). This is because they can impact related brain chemicals, such as serotonin and dopamine.
“These types of supplements can increase the risk of serotonin syndrome,” states Gupta. In serotonin syndrome, medications cause high levels of serotonin, according to the Mayo Clinic.
“Serotonin syndrome is a serious condition, which may include symptoms such as irritability, confusion, hallucinations, increased heart rate, fever, excessive sweating, nausea, vomiting, and diarrhea,” she adds.
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Additionally, those on antidepressants should be cautious of taking valerian root. “The supplement commonly used for anxiety and insomnia may increase side effects like dizziness, drowsiness, and difficulty concentrating when combined with SSRIs or SNRIs,” says Nouhavandi.
Safer Sub: A solid fish oil or omega-3 supplement is a great option for SSRI or SNRI users. “Some studies have found that polyunsaturated fatty acids can support the activity of the SSRI,” says Nouhavandi. A review published in the Journal of Integrative Neuroscience also suggests that, in conjunction with standard therapy, fish oil can be beneficial for those on antidepressants.
Editor’s Note: This is not a complete list of medications that interact with supplements. Always consult with your doctor when you add a new supplement to your health routine.