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supplements:start [2026/02/14 18:36] – created andrew2393cnssupplements:start [2026/02/14 18:57] (current) – [4) Pain / Inflammation] andrew2393cns
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 ====== Supplements ====== ====== Supplements ======
  
-Supplements are everywhere — and patients assume they are “safe” because they’re sold over-the-counter.+Supplements are pharmacologically active substances — even when sold over-the-counter.
  
-This section is built to answer the clinical questions that actually matter:+If it changes physiology, it can change labs, interact with medications, and cause toxicity.
  
-  * What does it do (mechanism)? +This section connects supplement mechanisms to PharmAtlas drug classes and clinical decision-making.
-  * Does it work (evidence)? +
-  * What are the risks (toxicity + interactions)? +
-  * Who should avoid it (special populations)? +
-  * What labs/monitoring matter?+
  
 ---- ----
  
-===== How to Use This Section =====+===== When to Use This Section =====
  
-**Start here when:** +  * A patient asks: “Can I take this with my meds?” 
-  * A patient asks “Can I take this with my meds?” +  * Unexplained LFT elevation, CK elevation, INR instability, or blood pressure changes 
-  * You see abnormal labs and suspect supplement toxicity (liver, kidney, thyroid, INR changes) +  * A patient stacking supplements for weight loss, sleep, libido, pain, or “immune boosting”
-  * A patient is taking “stacked” supplements for weight loss, energy, sleep, pain, libido, or immunity +
- +
-**Quick Rule:**   +
-If it has a physiologic effect, it can have side effects and drug interactions.+
  
 ---- ----
  
-===== High-Risk Supplements (Clinical Watchlist) ===== +===== High-Risk Supplements (Clinically Important) =====
- +
-These come up constantly and are associated with meaningful adverse effects or drug interactions:+
  
-  * St. John’s Wort (CYP induction; ↓ efficacy of many drugs) +  * [[supplements:st_johns_wort|St. John’s Wort]] → CYP induction → ↓ efficacy of [[psychiatry:ssri|SSRIs]], [[psychiatry:snri|SNRIs]], [[psychiatry:tca|TCAs]], [[drug_classes:oral_contraceptives|Oral Contraceptives]], [[drug_classes:transplant_immunosuppressants|Transplant Immunosuppressants]] 
-  * Kava (hepatotoxicity) +  * [[supplements:kava|Kava]] → hepatotoxicity risk (consider LFT monitoring) 
-  * Kratom (dependence, withdrawal, seizures; opioid-like effects) +  * [[supplements:kratom|Kratom]] → opioid-like effects; dependence/withdrawal risk (see [[neuro:opioids:start|Opioids]]) 
-  * Yohimbine (HTN, anxiety, tachyarrhythmias) +  * [[supplements:red_yeast_rice|Red Yeast Rice]] → statin-like (lovastatin analog) → similar risks as [[cardio:lipids:statins|Statins]] and myopathy risk with [[cardio:lipids:atorvastatin|Atorvastatin]] / [[cardio:lipids:rosuvastatin|Rosuvastatin]] 
-  * “Fat burners” / stimulant blends (tachycardia, HTN, anxiety) +  * [[supplements:biotin|High-dose Biotin]] → interferes with [[endocrine:thyroid:start|Thyroid]] labs and troponin interpretation 
-  * Red yeast rice (statin-like; myopathy/hepatotoxicity) +  * [[supplements:yohimbine|Yohimbine]] / [[supplements:stimulant_blends|Stimulant blends]] → HTN, tachycardia, anxiety; arrhythmia risk (caution in [[cardio:hypertension:start|Hypertension]] and with [[cardio:beta_blockers:start|Beta Blockers]])
-  * High-dose biotin (false lab results: thyroid, troponin, etc.)+
  
 ---- ----
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 ==== 1) Metabolic / Weight Loss ==== ==== 1) Metabolic / Weight Loss ====
-  * Berberine + 
-  * Cinnamon +Often used alongside diabetes/obesity pharmacology: 
-  * Chromium + 
-  * Green tea extract +  * [[endocrine:diabetes:start|Diabetes]] 
-  * Garcinia cambogia +  * [[endocrine:biguanides:metformin|Metformin]] 
-  * Fiber (psyllium, glucomannan)+  * [[endocrine:sglt2:start|SGLT2 Inhibitors]] (e.g., [[endocrine:sglt2:empagliflozin|Empagliflozin]], [[endocrine:sglt2:dapagliflozin|Dapagliflozin]]) 
 +  * [[endocrine:sulfonylureas:start|Sulfonylureas]] (e.g., [[endocrine:sulfonylureas:glipizide|Glipizide]], [[endocrine:sulfonylureas:glimepiride|Glimepiride]]) 
 +  * [[endocrine:tzds:start|TZDs]] (e.g., [[endocrine:tzds:pioglitazone|Pioglitazone]]) 
 +  * [[endocrine:insulin:start|Insulin]] 
 +  * [[endocrine:glp1:start|GLP-1 Receptor Agonists]] (e.g., [[endocrine:glp1:semaglutide|Semaglutide]], [[endocrine:glp1:liraglutide|Liraglutide]]) 
 +  * [[endocrine:glp1_gip:dual_glp-1_gip_incretin_agonists|Dual GLP-1/GIP Agonists]] (e.g., [[endocrine:incretin:tirzepatide|Tirzepatide]]) 
 + 
 +Common supplements: 
 +  * [[supplements:berberine|Berberine]] 
 +  * [[supplements:cinnamon|Cinnamon]] 
 +  * [[supplements:chromium|Chromium]] 
 +  * [[supplements:green_tea_extract|Green Tea Extract]] 
 +  * [[supplements:garcinia_cambogia|Garcinia cambogia]] 
 +  * [[supplements:psyllium|Psyllium]] / [[supplements:glucomannan|Glucomannan]]
  
 → [[supplements:weight_loss:start|Weight Loss Supplements]] → [[supplements:weight_loss:start|Weight Loss Supplements]]
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 ---- ----
  
-==== 2) Cardiovascular / Lipids / BP ==== +==== 2) Cardiovascular / Lipids / Blood Pressure ==== 
-  * Omega-3 fatty acids (EPA/DHA) + 
-  * Red yeast rice +Commonly taken with: 
-  * CoQ10 + 
-  * Garlic +  * [[cardio:lipids:statins|Statins]] (e.g., [[cardio:lipids:atorvastatin|Atorvastatin]], [[cardio:lipids:rosuvastatin|Rosuvastatin]]) 
-  * Beetroot / nitrates +  * [[cardio:hypertension:start|Hypertension]] 
-  * Magnesium+  * [[cardio:beta_blockers:start|Beta Blockers]] (e.g., [[cardio:beta_blockers:metoprolol|Metoprolol]]) 
 +  * [[cardio:raas:start|RAAS]] (ACEi/ARB/ARNI) 
 + 
 +Common supplements: 
 +  * [[supplements:omega_3_fatty_acids|Omega-3 fatty acids]] 
 +  * [[supplements:red_yeast_rice|Red Yeast Rice]] 
 +  * [[supplements:coq10|CoQ10]] 
 +  * [[supplements:garlic|Garlic]] 
 +  * [[supplements:beetroot|Beetroot / nitrates]] 
 +  * [[supplements:magnesium|Magnesium]]
  
 → [[supplements:cardio:start|Cardiovascular Supplements]] → [[supplements:cardio:start|Cardiovascular Supplements]]
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 ==== 3) Sleep / Anxiety / Mood ==== ==== 3) Sleep / Anxiety / Mood ====
-  * Melatonin + 
-  * Valerian +Often combined with (interaction risk when stacking sedating agents): 
-  * L-theanine + 
-  * Magnesium +  * [[psychiatry:ssri|SSRIs]] 
-  * Ashwagandha +  * [[psychiatry:snri|SNRIs]] 
-  * Kava (high risk) +  * [[psychiatry:tca|TCAs]] 
-  * 5-HTP / tryptophan (serotonergic interactions)+ 
 +Common supplements: 
 +  * [[supplements:melatonin|Melatonin]] 
 +  * [[supplements:valerian|Valerian]] 
 +  * [[supplements:l_theanine|L-theanine]] 
 +  * [[supplements:ashwagandha|Ashwagandha]] 
 +  * [[supplements:5_htp|5-HTP]] 
 +  * [[supplements:kava|Kava]]
  
 → [[supplements:sleep_mood:start|Sleep & Mood Supplements]] → [[supplements:sleep_mood:start|Sleep & Mood Supplements]]
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 ==== 4) Pain / Inflammation ==== ==== 4) Pain / Inflammation ====
-  * Turmeric / curcumin + 
-  * Omega-3 fatty acids +Often used instead of or alongside: 
-  * Glucosamine / chondroitin + 
-  * Capsaicin (topical) +  * [[pain_management:drug_classes:start|Pain Management Drug Classes]] 
-  * Boswellia +  * [[drug_classes:nsaids|NSAIDs]] 
-  * Willow bark (salicylate-like)+  * [[drug_classes:opioids|Opioids]] 
 + 
 +Common supplements: 
 +  * [[supplements:kratom|Kratom]] 
 +  * [[supplements:turmeric_curcumin|Turmeric / curcumin]] 
 +  * [[supplements:omega_3_fatty_acids|Omega-3 fatty acids]] 
 +  * [[supplements:glucosamine|Glucosamine]] / [[supplements:chondroitin|Chondroitin]] 
 +  * [[supplements:capsaicin|Capsaicin]] 
 +  * [[supplements:boswellia|Boswellia]] 
 +  * [[supplements:willow_bark|Willow bark]]
  
 → [[supplements:pain_inflammation:start|Pain & Inflammation Supplements]] → [[supplements:pain_inflammation:start|Pain & Inflammation Supplements]]
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 ==== 5) Immune / “Cold & Flu” ==== ==== 5) Immune / “Cold & Flu” ====
-  * Vitamin C + 
-  * Zinc +Common supplements: 
-  * Elderberry +  * [[supplements:vitamin_c|Vitamin C]] 
-  * Echinacea +  * [[supplements:zinc|Zinc]] 
-  * Vitamin D+  * [[supplements:elderberry|Elderberry]] 
 +  * [[supplements:echinacea|Echinacea]] 
 +  * [[supplements:vitamin_d|Vitamin D]] 
 + 
 +Relevant medication considerations: 
 +  * [[drug_classes:antibiotics|Antibiotics]] 
 +  * [[endocrine:drug_classes:corticosteroids|Corticosteroids]]
  
 → [[supplements:immune:start|Immune Supplements]] → [[supplements:immune:start|Immune Supplements]]
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 ==== 6) GI / Microbiome ==== ==== 6) GI / Microbiome ====
-  * Probiotics + 
-  * Peppermint oil +Common supplements: 
-  * Ginger +  * [[supplements:probiotics|Probiotics]] 
-  * Fiber +  * [[supplements:peppermint_oil|Peppermint oil]] 
-  * Digestive enzymes+  * [[supplements:ginger|Ginger]] 
 +  * [[supplements:psyllium|Fiber (psyllium)]] 
 +  * [[supplements:digestive_enzymes|Digestive enzymes]] 
 + 
 +Related PharmAtlas area: 
 +  * [[gastroenterology:start|Gastroenterology]] 
 + 
 +Common co-medications: 
 +  * [[drug_classes:proton_pump_inhibitors|Proton Pump Inhibitors]] 
 +  * [[drug_classes:laxatives|Laxatives]]
  
 → [[supplements:gi:start|GI Supplements]] → [[supplements:gi:start|GI Supplements]]
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 ==== 7) Sexual Health / Testosterone / “Performance” ==== ==== 7) Sexual Health / Testosterone / “Performance” ====
-  * DHEA 
-  * Tribulus 
-  * Tongkat ali 
-  * L-arginine / citrulline 
-  * Yohimbine (high risk) 
  
-→ [[supplements:sexual_health:start|Sexual Health Supplements]]+Often used alongside: 
 +  * [[drug_classes:pde5_inhibitors|PDE-5 Inhibitors]]
  
-----+Common supplements: 
 +  * [[supplements:dhea|DHEA]] 
 +  * [[supplements:tribulus|Tribulus]] 
 +  * [[supplements:tongkat_ali|Tongkat ali]] 
 +  * [[supplements:l_arginine|L-arginine]] / [[supplements:l_citrulline|L-citrulline]] 
 +  * [[supplements:yohimbine|Yohimbine]]
  
-==== 8) Vitamins & Minerals (Deficiency-Driven Use) ==== +→ [[supplements:sexual_health:start|Sexual Health Supplements]]
-  * Vitamin D +
-  * Iron +
-  * B12 / folate +
-  * Magnesium +
-  * Calcium +
-  * Zinc +
- +
-→ [[supplements:vits_minerals:start|Vitamins & Minerals]]+
  
 ---- ----
  
-===== Drug–Supplement Interaction Quick Links =====+==== 8) Vitamins & Minerals ====
  
-  * [[supplements:interactions:anticoagulants_antiplatelets|Anticoagulants / Antiplatelets]] +Common supplements: 
-  * [[supplements:interactions:statins|Statins]] +  * [[supplements:vitamin_d|Vitamin D]] 
-  * [[supplements:interactions:ssri_snri_tca_maoi|Serotonergic Drugs]] +  * [[supplements:iron|Iron]] 
-  * [[supplements:interactions:bp_meds|Blood Pressure Meds]] +  * [[supplements:vitamin_b12|Vitamin B12]] / [[supplements:folate|Folate]] 
-  * [[supplements:interactions:diabetes_meds|Diabetes Meds]] +  * [[supplements:magnesium|Magnesium]] 
-  * [[supplements:interactions:transplant_immunosuppression|Immunosuppression / Transplant]]+  * [[supplements:calcium|Calcium]] 
 +  * [[supplements:zinc|Zinc]]
  
-----+Often relevant in patients with: 
 +  * [[endocrine:diabetes:start|Diabetes]] 
 +  * [[cardio:hypertension:start|Hypertension]] 
 +  * [[cardio:diuretics:start|Diuretics]]
  
-===== Evidence & Safety Legend ===== +→ [[supplements:vits_minerals:start|Vitamins & Minerals]]
- +
-^ Label ^ Meaning ^ +
-| **Effective** | Good evidence for a clinically meaningful benefit | +
-| **Maybe** | Mixed evidence, small effect, or benefit only in specific populations | +
-| **Not proven** | No convincing benefit in high-quality studies | +
-| **High risk** | Significant adverse effects, contamination risk, or major drug interactions |+
  
 ---- ----
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 ===== Related ===== ===== Related =====
  
-  * [[drug_classes:start|Drug Classes]]+  * [[office_hours:start|Office Hours]]
   * [[lectures:start|Full Lecture Series]]   * [[lectures:start|Full Lecture Series]]
   * [[start|PharmAtlas Home]]   * [[start|PharmAtlas Home]]
supplements/start.1771094214.txt.gz · Last modified: by andrew2393cns