====== Supplements ======

Supplements are pharmacologically active substances — even when sold over-the-counter.

If it changes physiology, it can change labs, interact with medications, and cause toxicity.

This section connects supplement mechanisms to PharmAtlas drug classes and clinical decision-making.

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===== When to Use This Section =====

  * A patient asks: “Can I take this with my meds?”
  * Unexplained LFT elevation, CK elevation, INR instability, or blood pressure changes
  * A patient stacking supplements for weight loss, sleep, libido, pain, or “immune boosting”

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===== High-Risk Supplements (Clinically Important) =====

  * [[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)
  * [[supplements:kratom|Kratom]] → opioid-like effects; dependence/withdrawal risk (see [[neuro:opioids:start|Opioids]])
  * [[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]]
  * [[supplements:biotin|High-dose Biotin]] → interferes with [[endocrine:thyroid:start|Thyroid]] labs and troponin interpretation
  * [[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]])

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===== Supplement Categories =====

==== 1) Metabolic / Weight Loss ====

Often used alongside diabetes/obesity pharmacology:

  * [[endocrine:diabetes:start|Diabetes]]
  * [[endocrine:biguanides: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:
  * [[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]]

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==== 2) Cardiovascular / Lipids / Blood Pressure ====

Commonly taken with:

  * [[cardio:lipids:statins|Statins]] (e.g., [[cardio:lipids:atorvastatin|Atorvastatin]], [[cardio:lipids:rosuvastatin|Rosuvastatin]])
  * [[cardio:hypertension:start|Hypertension]]
  * [[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]]

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==== 3) Sleep / Anxiety / Mood ====

Often combined with (interaction risk when stacking sedating agents):

  * [[psychiatry:ssri|SSRIs]]
  * [[psychiatry:snri|SNRIs]]
  * [[psychiatry:tca|TCAs]]

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]]

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==== 4) Pain / Inflammation ====

Often used instead of or alongside:

  * [[pain_management:drug_classes:start|Pain Management Drug Classes]]
  * [[drug_classes:nsaids|NSAIDs]]
  * [[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]]

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==== 5) Immune / “Cold & Flu” ====

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]]
  * [[endocrine:drug_classes:corticosteroids|Corticosteroids]]

→ [[supplements:immune:start|Immune Supplements]]

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==== 6) GI / Microbiome ====

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:laxatives|Laxatives]]

→ [[supplements:gi:start|GI Supplements]]

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==== 7) Sexual Health / Testosterone / “Performance” ====

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]]

→ [[supplements:sexual_health:start|Sexual Health Supplements]]

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==== 8) Vitamins & Minerals ====

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]]

Often relevant in patients with:
  * [[endocrine:diabetes:start|Diabetes]]
  * [[cardio:hypertension:start|Hypertension]]
  * [[cardio:diuretics:start|Diuretics]]

→ [[supplements:vits_minerals:start|Vitamins & Minerals]]

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