Drug-Supplement Interactions

Drug-Supplement Interactions & Medication Audit

Check every supplement against your medications before starting. Review this chart with your physician.

Severity Legend

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

Key Rules

Serotonergic combinations — Never combine 5-HTP, St. John's Wort, or Methylene Blue with SSRIs/SNRIs
Blood thinners — Watch Ginkgo, high-dose Omega-3, and vitamin E
Thyroid medication — Always take first, separate from iron, calcium, and coffee by 4+ hours
Anticholinergic burden — Cumulative effect from multiple meds (antihistamines, bladder meds, tricyclics)

This information is for educational purposes only. Always consult with your healthcare provider before making any changes to medications or supplements.