Safety Reference
Drug-Supplement Interactions & Medication Audit
Check every supplement against your medications before starting. Review this chart with your physician.
AVOID Never combine
HIGH Serious risk, separate timing
MODERATE Time apart, monitor
LOW Monitor only
Supplement-Drug Interactions
| Supplement | Do NOT Combine With | Risk | Severity | Timing | Monitor |
|---|---|---|---|---|---|
| 5-HTP | SSRIs, SNRIs, MAOIs, Tramadol, Triptans | Serotonin syndrome — potentially fatal | AVOID | Take evening, with food | Watch for agitation, rapid heartbeat, high temperature |
| St. John's Wort | SSRIs, birth control, blood thinners, cyclosporine | CYP3A4 induction reduces drug levels | AVOID | Take with food. Wash out 2+ weeks | Monitor breakthrough bleeding, INR |
| Ginkgo Biloba | Blood thinners, NSAIDs | Increased bleeding risk | HIGH | Take with food, morning/noon. Stop 2 weeks before surgery | Watch for unusual bruising |
| NAC | Nitroglycerin, activated charcoal | Potentiates vasodilation | HIGH | Empty stomach, separate from nitroglycerin 4+ hours | Monitor blood pressure |
| Iron | Thyroid medication, antibiotics, antacids | Chelation reduces absorption | HIGH | Empty stomach with vitamin C, separate from thyroid 4 hours | Retest ferritin at 3 months |
| Magnesium | Fluoroquinolones, tetracyclines, bisphosphonates | Chelation reduces antibiotic efficacy | MODERATE | Separate from antibiotics 2+ hours | Watch for loose stools >400mg |
| Omega-3 (high dose) | Blood thinners, pre-surgery | Additive anticoagulant at >3g/day | MODERATE | With fat-containing meal | Watch for easy bruising at high doses |
| Vitamin D | Thiazide diuretics, digoxin | Hypercalcemia risk | MODERATE | With fat, morning preferred | Monitor serum calcium |
| Alpha Lipoic Acid | Diabetes medications | Additive blood sugar lowering | MODERATE | Empty stomach, 30 min before meals | Monitor blood glucose more frequently |
| Ashwagandha | Thyroid medications, immunosuppressants, sedatives | May increase thyroid hormone levels | MODERATE | With food, start low 300mg | Recheck thyroid labs 6 weeks |
| Methylene Blue | SSRIs, SNRIs, MAOIs, Tramadol, Buspirone | MAO-A inhibitor — serotonin syndrome risk | AVOID | Only pharmaceutical-grade USP, off serotonergic meds 2+ weeks | Watch for agitation, hyperthermia |
Medications That Cause Brain Fog
Important: Never discontinue medications without medical guidance. Discuss alternatives with your prescriber if you suspect medication-induced brain fog.
| Medication | Class | Mechanism | Risk | Alternative |
|---|---|---|---|---|
| Diphenhydramine (Benadryl) | 1st-gen antihistamine | Blocks acetylcholine | HIGH | Switch to cetirizine/loratadine |
| Oxybutynin (Ditropan) | Anticholinergic | Blocks muscarinic receptors in hippocampus | AVOID | Discuss mirabegron (Myrbetriq) |
| Zolpidem (Ambien) | Z-drug sleep aid | Same GABA pathways as benzos, amnesia | HIGH | CBT-I first, then low-dose trazodone |
| Metoprolol / Atenolol | Beta-blocker | Lipophilic, crosses BBB, dampens norepinephrine | MODERATE | Discuss hydrophilic alternatives |
| SSRIs | Antidepressant | "Emotional blunting" in 40-60% of patients | MODERATE | Discuss bupropion or dose reduction |
| Alprazolam / Lorazepam | Benzodiazepine | Dampens working to long-term memory transfer | AVOID | Buspirone, hydroxyzine, or CBT |
| Gabapentin / Pregabalin | Anticonvulsant | Calcium channel modulation, cognitive dulling | MODERATE | Discuss dose reduction or alternatives |
| Omeprazole / Pantoprazole | PPI | Long-term B12 and magnesium depletion | MODERATE | Step down to H2 blockers if possible |
A Note on Statins
Recent large-scale evidence has shifted the consensus — statins are now considered potentially neuroprotective. They should not be discontinued for cognitive concerns without discussing with your prescriber.
Bring this reference to your next doctor's appointment
How to Talk to Your Doctor →Not medical advice. Consult your pharmacist and physician.