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supplements:start [2026/02/14 18:39] – andrew2393cnssupplements:start [2026/02/14 18:57] (current) – [4) Pain / Inflammation] andrew2393cns
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 ====== Supplements ====== ====== Supplements ======
  
-Supplements are pharmacologically active substances — even if they are sold over-the-counter.+Supplements are pharmacologically active substances — even when sold over-the-counter.
  
-This section integrates supplement physiology with drug mechanisms, interactions, and clinical decision-making.+If it changes physiology, it can change labs, interact with medications, and cause toxicity.
  
-If it changes physiology, it can change labs, interact with drugs, and cause toxicity.+This section connects supplement mechanisms to PharmAtlas drug classes and clinical decision-making.
  
 ---- ----
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   * A patient asks: “Can I take this with my meds?”   * A patient asks: “Can I take this with my meds?”
-  * Unexplained LFT elevation, INR instability, CK elevation, or BP changes +  * Unexplained LFT elevation, CK elevation, INR instability, or blood pressure changes 
-  * A patient using supplements for weight loss, sleep, libido, pain, or “immune boosting”+  * A patient stacking supplements for weight loss, sleep, libido, pain, or “immune boosting”
  
 ---- ----
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 ===== High-Risk Supplements (Clinically Important) ===== ===== High-Risk Supplements (Clinically Important) =====
  
-These frequently interact with prescription medications: +  * [[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]] 
- +  * [[supplements:kava|Kava]] → hepatotoxicity risk (consider LFT monitoring) 
-  * **St. John’s Wort** → CYP induction → ↓ efficacy of many drugs including [[drug_classes:statins|Statins]], [[psychiatry:ssri|SSRIs]], [[psychiatry:snri|SNRIs]], oral contraceptives, and transplant meds +  * [[supplements:kratom|Kratom]] → opioid-like effects; dependence/withdrawal risk (see [[neuro:opioids:start|Opioids]]) 
-  * **Kava** → Hepatotoxicity risk (monitor LFTs) +  * [[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]] 
-  * **Kratom** → Opioid-like effects; interacts with [[drug_classes:opioids|Opioids]] +  * [[supplements:biotin|High-dose Biotin]] → interferes with [[endocrine:thyroid:start|Thyroid]] labs and troponin interpretation 
-  * **Red Yeast Rice** → Contains lovastatin analog → similar risks as [[drug_classes:statins|Statins]] +  * [[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** → Interferes with troponin, TSH, thyroid panels +
-  * **Yohimbine** → Sympathomimetic; interacts with [[cardio:adrenergic_agonists|Adrenergic Agents]] and [[cardio:beta_blockers|Beta Blockers]]+
  
 ---- ----
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 ==== 1) Metabolic / Weight Loss ==== ==== 1) Metabolic / Weight Loss ====
  
-Commonly used alongside or instead of:+Often used alongside diabetes/obesity pharmacology:
  
-  * [[endocrine:glp1_agonists|GLP-1 Receptor Agonists]] +  * [[endocrine:diabetes:start|Diabetes]] 
-  * [[endocrine:sglt2_inhibitors|SGLT2 Inhibitors]] +  * [[endocrine:biguanides:metformin|Metformin]] 
-  * [[endocrine:metformin|Metformin]]+  * [[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: Common supplements:
-  * Berberine (AMPK activation similar to metformin) +  * [[supplements:berberine|Berberine]] 
-  * Cinnamon +  * [[supplements:cinnamon|Cinnamon]] 
-  * Chromium +  * [[supplements:chromium|Chromium]] 
-  * Green tea extract +  * [[supplements:green_tea_extract|Green Tea Extract]] 
-  * Garcinia cambogia +  * [[supplements:garcinia_cambogia|Garcinia cambogia]] 
-  * Fiber (psyllium)+  * [[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 / Blood Pressure ==== ==== 2) Cardiovascular / Lipids / Blood Pressure ====
  
-Often taken alongside:+Commonly taken with:
  
-  * [[drug_classes:statins|Statins]] +  * [[cardio:lipids:statins|Statins]] (e.g., [[cardio:lipids:atorvastatin|Atorvastatin]], [[cardio:lipids:rosuvastatin|Rosuvastatin]]) 
-  * [[cardio:antihypertensives:start|Antihypertensives]] +  * [[cardio:hypertension:start|Hypertension]] 
-  * [[drug_classes:antiplatelets|Antiplatelet Agents]] +  * [[cardio:beta_blockers:start|Beta Blockers]] (e.g., [[cardio:beta_blockers:metoprolol|Metoprolol]]) 
-  * [[drug_classes:anticoagulants|Anticoagulants]]+  * [[cardio:raas:start|RAAS]] (ACEi/ARB/ARNI)
  
 Common supplements: Common supplements:
-  * Omega-3 fatty acids (EPA/DHA) +  * [[supplements:omega_3_fatty_acids|Omega-3 fatty acids]] 
-  * Red yeast rice +  * [[supplements:red_yeast_rice|Red Yeast Rice]] 
-  * CoQ10 +  * [[supplements:coq10|CoQ10]] 
-  * Garlic +  * [[supplements:garlic|Garlic]] 
-  * Beetroot/nitrates +  * [[supplements:beetroot|Beetroot / nitrates]] 
-  * Magnesium+  * [[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 ====
  
-Often combined with:+Often combined with (interaction risk when stacking sedating agents):
  
   * [[psychiatry:ssri|SSRIs]]   * [[psychiatry:ssri|SSRIs]]
   * [[psychiatry:snri|SNRIs]]   * [[psychiatry:snri|SNRIs]]
   * [[psychiatry:tca|TCAs]]   * [[psychiatry:tca|TCAs]]
-  * [[psychiatry:benzodiazepines|Benzodiazepines]] 
-  * [[psychiatry:sedative_hypnotics|Sedative-Hypnotics]] 
  
 Common supplements: Common supplements:
-  * Melatonin +  * [[supplements:melatonin|Melatonin]] 
-  * Valerian +  * [[supplements:valerian|Valerian]] 
-  * L-theanine +  * [[supplements:l_theanine|L-theanine]] 
-  * Ashwagandha +  * [[supplements:ashwagandha|Ashwagandha]] 
-  * 5-HTP (serotonergic risk with SSRIs/SNRIs) +  * [[supplements:5_htp|5-HTP]] 
-  * Kava (hepatotoxicity risk)+  * [[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 ====
  
-Often used instead of or in addition to:+Often used instead of or alongside:
  
 +  * [[pain_management:drug_classes:start|Pain Management Drug Classes]]
   * [[drug_classes:nsaids|NSAIDs]]   * [[drug_classes:nsaids|NSAIDs]]
   * [[drug_classes:opioids|Opioids]]   * [[drug_classes:opioids|Opioids]]
-  * [[psychiatry:tca|TCAs]] (neuropathic pain) 
-  * [[psychiatry:snri|SNRIs]] (neuropathic pain) 
  
 Common supplements: Common supplements:
-  * Turmeric / curcumin +  * [[supplements:kratom|Kratom]] 
-  * Omega-3 fatty acids +  * [[supplements:turmeric_curcumin|Turmeric / curcumin]] 
-  * Glucosamine / chondroitin +  * [[supplements:omega_3_fatty_acids|Omega-3 fatty acids]] 
-  * Capsaicin (topical) +  * [[supplements:glucosamine|Glucosamine]] / [[supplements:chondroitin|Chondroitin]] 
-  * Boswellia +  * [[supplements:capsaicin|Capsaicin]] 
-  * Willow bark (salicylate-like → NSAID-like)+  * [[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” ====
  
-Often used during infection while on:+Common supplements: 
 +  * [[supplements:vitamin_c|Vitamin C]] 
 +  * [[supplements:zinc|Zinc]] 
 +  * [[supplements:elderberry|Elderberry]] 
 +  * [[supplements:echinacea|Echinacea]] 
 +  * [[supplements:vitamin_d|Vitamin D]]
  
 +Relevant medication considerations:
   * [[drug_classes:antibiotics|Antibiotics]]   * [[drug_classes:antibiotics|Antibiotics]]
-  * [[drug_classes:corticosteroids|Corticosteroids]] +  * [[endocrine:drug_classes:corticosteroids|Corticosteroids]]
- +
-Common supplements: +
-  * Vitamin C +
-  * Zinc +
-  * Elderberry +
-  * Echinacea +
-  * Vitamin D+
  
 → [[supplements:immune:start|Immune Supplements]] → [[supplements:immune:start|Immune Supplements]]
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 ==== 6) GI / Microbiome ==== ==== 6) GI / Microbiome ====
  
-May interact with:+Common supplements: 
 +  * [[supplements:probiotics|Probiotics]] 
 +  * [[supplements:peppermint_oil|Peppermint oil]] 
 +  * [[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:proton_pump_inhibitors|Proton Pump Inhibitors]]
   * [[drug_classes:laxatives|Laxatives]]   * [[drug_classes:laxatives|Laxatives]]
-  * [[drug_classes:antidiarrheals|Antidiarrheals]] 
- 
-Common supplements: 
-  * Probiotics 
-  * Peppermint oil 
-  * Ginger 
-  * Fiber 
-  * Digestive enzymes 
  
 → [[supplements:gi:start|GI Supplements]] → [[supplements:gi:start|GI Supplements]]
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 ---- ----
  
-==== 7) Sexual Health / Testosterone / Performance ====+==== 7) Sexual Health / Testosterone / “Performance” ====
  
 Often used alongside: Often used alongside:
- 
   * [[drug_classes:pde5_inhibitors|PDE-5 Inhibitors]]   * [[drug_classes:pde5_inhibitors|PDE-5 Inhibitors]]
-  * [[endocrine:testosterone_replacement|Testosterone Replacement]] 
  
 Common supplements: Common supplements:
-  * DHEA +  * [[supplements:dhea|DHEA]] 
-  * Tribulus +  * [[supplements:tribulus|Tribulus]] 
-  * Tongkat ali +  * [[supplements:tongkat_ali|Tongkat ali]] 
-  * L-arginine / citrulline +  * [[supplements:l_arginine|L-arginine]] / [[supplements:l_citrulline|L-citrulline]] 
-  * Yohimbine+  * [[supplements:yohimbine|Yohimbine]]
  
 → [[supplements:sexual_health:start|Sexual Health Supplements]] → [[supplements:sexual_health:start|Sexual Health Supplements]]
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 ---- ----
  
-==== 8) Vitamins & Minerals (Deficiency-Driven) ====+==== 8) Vitamins & Minerals ====
  
-Often used in conjunction with:+Common supplements: 
 +  * [[supplements:vitamin_d|Vitamin D]] 
 +  * [[supplements:iron|Iron]] 
 +  * [[supplements:vitamin_b12|Vitamin B12]] / [[supplements:folate|Folate]] 
 +  * [[supplements:magnesium|Magnesium]] 
 +  * [[supplements:calcium|Calcium]] 
 +  * [[supplements:zinc|Zinc]]
  
-  * [[drug_classes:iron_supplements|Iron Therapy]] +Often relevant in patients with: 
-  * [[endocrine:vitamin_d|Vitamin D]] +  * [[endocrine:diabetes:start|Diabetes]] 
-  * [[drug_classes:calcium_channel_blockers|Calcium Channel Blockers]] (interaction relevance) +  * [[cardio:hypertension:start|Hypertension]] 
-  * [[cardio:diuretics:start|Diuretics]] (electrolyte shifts) +  * [[cardio:diuretics:start|Diuretics]]
- +
-Common supplements: +
-  * Vitamin D +
-  * Iron +
-  * B12 / folate +
-  * Magnesium +
-  * Calcium +
-  * Zinc+
  
 → [[supplements:vits_minerals:start|Vitamins & Minerals]] → [[supplements:vits_minerals:start|Vitamins & Minerals]]
- 
----- 
- 
-===== Drug–Supplement Interaction Quick Links ===== 
- 
-  * [[drug_classes:statins|Statins]] 
-  * [[drug_classes:anticoagulants|Anticoagulants]] 
-  * [[drug_classes:antiplatelets|Antiplatelet Agents]] 
-  * [[psychiatry:ssri|SSRIs]] 
-  * [[psychiatry:snri|SNRIs]] 
-  * [[drug_classes:opioids|Opioids]] 
-  * [[endocrine:diabetes_drugs:start|Diabetes Medications]] 
-  * [[cardio:antihypertensives:start|Antihypertensives]] 
  
 ---- ----
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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.1771094341.txt.gz · Last modified: by andrew2393cns