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Supplements
Supplements are pharmacologically active substances — even if they are 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 drugs, and cause toxicity.
When to Use This Section
- A patient asks: “Can I take this with my meds?”
- Unexplained LFT elevation, INR instability, CK elevation, or BP changes
- A patient using supplements for weight loss, sleep, libido, pain, or “immune boosting”
High-Risk Supplements (Clinically Important)
These frequently interact with prescription medications:
- Kava → Hepatotoxicity risk (monitor LFTs)
- Kratom → Opioid-like effects; interacts with Opioids
- Red Yeast Rice → Contains lovastatin analog → similar risks as Statins
- High-dose Biotin → Interferes with troponin, TSH, thyroid panels
- Yohimbine → Sympathomimetic; interacts with Adrenergic Agents and Beta Blockers
Supplement Categories
1) Metabolic / Weight Loss
Commonly used alongside or instead of:
Common supplements:
- Berberine (AMPK activation similar to metformin)
- Cinnamon
- Chromium
- Green tea extract
- Garcinia cambogia
- Fiber (psyllium)
2) Cardiovascular / Lipids / Blood Pressure
Often taken alongside:
Common supplements:
- Omega-3 fatty acids (EPA/DHA)
- Red yeast rice
- CoQ10
- Garlic
- Beetroot/nitrates
- Magnesium
3) Sleep / Anxiety / Mood
Often combined with:
Common supplements:
- Melatonin
- Valerian
- L-theanine
- Ashwagandha
- 5-HTP (serotonergic risk with SSRIs/SNRIs)
- Kava (hepatotoxicity risk)
4) Pain / Inflammation
Often used instead of or in addition to:
Common supplements:
- Turmeric / curcumin
- Omega-3 fatty acids
- Glucosamine / chondroitin
- Capsaicin (topical)
- Boswellia
- Willow bark (salicylate-like → NSAID-like)
→ Pain & Inflammation Supplements
5) Immune / “Cold & Flu”
Often used during infection while on:
Common supplements:
- Vitamin C
- Zinc
- Elderberry
- Echinacea
- Vitamin D
6) GI / Microbiome
May interact with:
Common supplements:
- Probiotics
- Peppermint oil
- Ginger
- Fiber
- Digestive enzymes
7) Sexual Health / Testosterone / Performance
Often used alongside:
Common supplements:
- DHEA
- Tribulus
- Tongkat ali
- L-arginine / citrulline
- Yohimbine
8) Vitamins & Minerals (Deficiency-Driven)
Often used in conjunction with:
- Calcium Channel Blockers (interaction relevance)
- Diuretics (electrolyte shifts)
Common supplements:
- Vitamin D
- Iron
- B12 / folate
- Magnesium
- Calcium
- Zinc