Many people take supplements to help with health conditions or improve
their well-being. Vitamins, minerals, herbs, and probiotics are all
types of supplements that may aid health. You might even take a combination of supplements. But there are
certain combinations that shouldn't be taken. Supplements might interact
not only with each other, but also with medications you may be taking.
That's why knowing the potential interactions of supplements is
important.
Supplements can have health benefits, but they may also have health
risks. For example, sometimes the ingredients in certain supplements can
alter lab tests or have negative effects during surgery. The risks that may come with taking supplements can be increased
if you take more than one supplement. Here are some supplement
combinations that you should talk to a healthcare provider about—and
what you what you might need to do if you take both.
Magnesium is a mineral that is needed to help with hundreds of your
body's processes, including muscle and nerve function, blood sugar
control, and blood pressure regulation. It is found in food like green,
leafy vegetables as well as in legumes, nuts, seeds, and whole grains.
It is also available in a variety of supplement forms, though taking
them might not be advised .
Having low levels of magnesium has been associated with heart disease,
diabetes, and osteoporosis (brittle bones). Too-low levels of magnesium
is rare, but it is more likely among those who :
- Have alcoholism
- Have a gastrointestinal disease or surgery that causes your body to not properly absorb nutrients
- Have type 2 diabetes
- Are older
Calcium is another mineral important for bone health. It can be found in
foods like milk, yogurt, and cheese. In the US, calcium is
under-consumed by 30% of men and 60% of women . A supplement may be called for if there is insufficient dietary
intake of the mineral. Not getting enough calcium can lead to reduced
bone strength and osteoporosis.
Taking both minerals together can result in a decreased absorption of
magnesium if you take very high doses of calcium (2600mg daily). It's
recommended that people at high risk for magnesium deficiency who take
calcium supplements take the calcium at bedtime instead of during a
meal. That's because taking the calcium supplement during a meal could
negatively affect how much dietary magnesium is being taken in .
Vitamin C helps create collagen, a protein that helps your wounds heal.
People take vitamin C supplements for various reasons, including to help
fight infection, reduce pain after surgery, or lower blood pressure.
The mineral copper is involved in energy production and helps create
your connective tissue, which gives structure to the body. People with
cardiovascular disease may take copper supplements as they have been
shown to help change blood lipid levels, lowering the risk for
atherosclerotic cardiovascular disease. The supplement has also been
used in Alzheimer's disease since copper deficiency has been seen among
those with the condition.
There is some evidence that taking high amounts of vitamin C (over
1,500mg) can reduce copper absorption. The finding was based on research
completed among young men, and it is likely that it only affects people
whose intake of copper is low .
Iron is a mineral that is an essential part of red blood cells that
transfers oxygen from the lungs to the tissues. Iron supplements are
typically recommended for people who have iron-deficiency anemia,
cancer, and certain gastrointestinal disorders, as well as for those who
are pregnant (NIH, 2022).
Green tea has become popularto sip on and to take as an extract. It's been touted to help improve
mental alertness, alleviate digestive symptoms and headaches, and
protect against cancer and heart disease.
Taking green tea with iron can reduce the absorption of the mineral.
While the effect might not be significant for most people, if you take
both, you can still consider taking them at separate times.
Certain dietary supplements can change absorption, metabolism, or
excretion of a medication. If that happens, it can affect the potency of
your medication, which means you may get either too much or too little
of the medication you need. Here are several common vitamins and supplements and which medications they may interact with.
Ashwagandha is an adaptogen, which is an herb that's used in traditional
Chinese medicine and Ayurvedic medicine. Ashwagandha—a small evergreen
shrub found in dry areas like India, the Middle East, and parts of
Africa—is touted to help the body fight stress and insomnia. But taking ashwagandha might interact with a variety of medications including:
Drugs for people with diabetes
Taking ashwagandha with antidiabetes drugs meant to lower blood sugar
levels could increase the risk of low blood sugar (hypoglycemia). Some herbs have been shown to help in the management of
diabetes, but taking them on top of drugs that do that too can
potentially lead to blood sugar that is too low.
Drugs for high blood pressure
There is animal research that suggests that ashwagandha may lower
systolic and diastolic blood pressure, putting people who take blood
pressure-lowering medication at risk for hypotension, blood pressure
that is too low.
Immunosuppressants
Human research has shown that ashwagandha can stimulate the immune
system. In addition, animal research has shown that ashwagandha can
decrease the effectiveness of the immunosuppression caused by
cyclophosphamide, a drug used to treat cancer and nephrotic syndrome.
Zinc is a mineral that has numerous roles, including in immunity,
protein creation, wound healing, DNA creation, and sense of taste and
smell. But zinc can interact with numerous medications including:(NIH, 2022)
Antibiotics
Certain antibiotics—specifically quinolone antibiotics (like Cipro) and
tetracycline antibiotics (like Achromycin and Sumycin)—interact with
zinc in the gastrointestinal tract and don't allow the absorption of
both the zinc and the antibiotic. If you need to take both, take the
antibiotic at least two hours before or four to six hours after taking
the zinc supplements.
Penicillamine
Zinc decreased the absorption and action of penicillamine, which is used
to treat rheumatoid arthritis. If you need to take both, zinc
supplements should be taken at least two hours before or after taking
penicillamine.
Melatonin is a hormone your brain produces when it's dark. It helps with
the timing of your internal clock (circadian rhythm) and with sleep.
Some ppeople take melatonin supplements to help with sleep or jet lag. Melatonin may interact with several medications, including:
Blood thinners
Also known as anticoagulants, these drugs prevent blood clots from forming. There
are some case reports of minor bleeding and decreased production of the
protein prothrombin (one of many factors that help your blood clot) in
people taking melatonin with warfarin.
Anticonvulsants
An anticonvulsant is a type of medicine given to individuals who may
experience seizures. It is believed that melatonin may reduce the
effectiveness of anticonvulsants. There is also some clinical research
that suggests that melatonin can increase the frequency of seizures,
especially children with neurological impairment.
Contraceptives
Some research suggests that oral contraceptives can increase the levels
of melatonin, thereby increasing the effects and possible adverse
effects of melatonin supplements . Potential adverse effects of melatonin include headache, dizziness, nausea, and sleepiness.
This popular supplement is a plant native to Europe that has yellow,
star-shaped flowers. The supplement tends to be taken to help with
mental health conditions like depression. However, St. John's wort has
been associated with potentially serious interactions with certain drugs.
Taking St. John's wort with certain antidepressants can lead to an
increase in serotonin levels that can be life threatening. Symptoms can
appear within minutes or hours and can include diarrhea, agitation, fast
heartbeat, high blood pressure, and hallucination.
St. John's wort can also weaken antidepressants. Other medications that St. John's wort can weaken include
- Birth control pills
- Cyclosporine (a drug used to prevent the body from rejecting organ transplants)
- Digoxin (a heart failure medication)
- Oxycodone (a pain medication)
- Some HIV drugs, like indinavir
- Some cancer medications, like irinotecan
- Warfarin (a blood thinner)
If you are taking any type of supplement or supplement combination and
experience any negative side effects, you should stop using the
supplement and see a healthcare provider. Potential serious reactions can include:
- Itchy skin, rash, or hives
- Swelling of the throat, lips, or tongue
- Wheezing or shortness of breath
- Fainting
- Chest pain or irregular heartbeat
- Nausea, vomiting, or diarrhea
- Difficulty urinating, decreased urination, or dark urine
- Blood in urine, stool, vomit, or sputum
- Abnormal bleeding from the nose or gums
- Fatigue
- Loss of appetite
- Yellowing of the skin or eyes
- Severe joint, muscle, or abdominal pain
If you are unsure about the combination of supplements or the
combination of supplements and medicines you are taking, you should have
a healthcare provider assess the combination for any potential dangers.
And if you are thinking of starting a supplement, you should consult
with a healthcare provider as well, letting them know what other
supplements and medications you take. This is especially true for people
who are pregnant or breastfeeding, as well as for children, as these
groups might be more susceptible to potential harms.
You should also talk to your provider about the supplements you take if
you recently had or will soon be having surgery. Some supplements can
have negative interactions with medications you need to take before,
after, or during surgery and your regimen might need to be changed for
the time being (FDA, 2022).
Taking a supplement that claims to help with certain health conditions
can be as easy as buying something from online or your local health and
wellness store. However, if you take more than one or take a supplement
while on a medication, there might be a risk for negative interactions.
Symptoms of negative interactions can include fatigue, yellowing of the
skin, and severe muscle pain. If you experience any adverse reaction
while taking a supplement, you should see a healthcare provider. If
you're thinking about starting a new supplement, you should visit a
healthcare provider to figure out what's best for you, letting them know
of any other supplements or medications you take.