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Appendix I. Drug – Nutrient Interactions

Nutraceutical/
Botanical Significant Concern Theoretical/Minor Concern
Vitamin D • Steroids, phenobarbital and dilantin can interfere with vitamin D metabolism
• Orlistat and cholestyramine may interfere with vitamin D absorption
Vitamin A • Warfarin activity may be • Retinoid medications and other products containing vitamin A may interact with
affected by Vitamin A each other
• Neomycin, orlistat, and cholestyramine may interfere with vitamin A absorption
Vitamin C • Warfarin activity may be • Vitamin C may increase aluminum absorption from antacids
affected by Vitamin C • Vitamin C may decrease exogenous estrogen metabolism
• Vitamin C may decrease fluphenazine concentrations
• Large doses of vitamin C may reduce half-life of HIV protease inhibitors
Zinc • Zinc may decrease absorption of some antibiotics when taken at same time
• Zinc may increase side effects of cisplatin
• Zinc may decrease the absorption of penicillamine
• Amiloride may increase amount of zinc in body
Melatonin • Possible interactions with warfarin, nifedipine and immune suppressing drugs.
Quercetin • Quercetin may affect • Quercetin may decrease the effectiveness of some antibiotics
medications metabolized by • Quercetin may increase concentrations of cyclosporine
CYP2C8, CYP2D6, CYP3A4,
and P-glycoprotein
substrates
Fish Oil • Fish oil may slow blood clotting, taking with other blood thinners may increase
chances for bruising and bleeding
N-Acetyl Cysteine • Caution in those with a sulfur sensitivity
Glutathione • Caution in those with a sulfur sensitivity
Astragalus • Astragalus may decrease the effectiveness of cyclophosphamide and other
immune suppressants
• Astragalus may decrease the excretion of lithium
Andrographis • Andrographis may decrease blood pressure, taking with blood pressure
medications may cause hypotension
• Andrographis may decrease the effectiveness of immune suppressing medications
• Andrographis may slow blood clotting, taking with other blood thinners may
increase chances for bruising and bleeding
Reishi • Reishi may decrease blood pressure, taking with blood pressure medications may
cause hypotension
• High doses of reishi may slow blood clotting, taking with other blood thinners
may increase chances for bruising and bleeding
Berberine • Berberine may decrease • Berberine may affect medications metabolized by CYP3A4
metabolism of cyclosportine
Baicalin • Baicalin may decrease the effects of exogenous estrogen
• Baicalin may decrease the excretion of lithium
Echinacea • Echinacea might decrease caffeine metabolism
• Echinacea may affect medications metabolized by CYP3A4 and CYP1A2
• Echinacea may decrease the effectiveness of immune suppressing medications
Goldenseal • Goldenseal may decrease cyclosporine metabolism
• Goldenseal may increase digoxin levels
• Goldenseal may affect medications metabolized by CYP2D6, CYP3A4, and
P-Glycoprotein substrates.
Curcurmin • Curcumin may slow blood clotting, taking with other blood thinners may
increase chances for bruising and bleeding
Bromelain • Bromelain might increase levels of amoxicillin
• Bromelain may change levels of tetracyclines
• Bromelain may slow blood clotting, taking with other blood thinners may
increase chances for bruising and bleeding.
Resveratrol • Resveratrol may affect medications metabolized by CYP3A4.
• Resveratrol may slow blood clotting, taking with other blood thinners may
increase chances for bruising and bleeding.
Sulforaphane • Sulforaphane may affect medications metabolized by CYP1A2
Boswellia • None known

26 Integrative Medicine • Vol. 19, No. S1 • Epub Ahead of Print Yanuck—Immuno-physiological Approach to COVID-19