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.

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”

High-Risk Supplements (Clinically Important)

St. John’s Wort → CYP induction → ↓ efficacy of SSRIs, SNRIs, TCAs, Oral Contraceptives, Transplant Immunosuppressants
Kava → hepatotoxicity risk (consider LFT monitoring)
Kratom → opioid-like effects; dependence/withdrawal risk (see Opioids)
Red Yeast Rice → statin-like (lovastatin analog) → similar risks as Statins and myopathy risk with Atorvastatin / Rosuvastatin
High-dose Biotin → interferes with Thyroid labs and troponin interpretation
Yohimbine / Stimulant blends → HTN, tachycardia, anxiety; arrhythmia risk (caution in Hypertension and with Beta Blockers)

Supplement Categories

1) Metabolic / Weight Loss

Often used alongside diabetes/obesity pharmacology:

Diabetes
Metformin
SGLT2 Inhibitors (e.g., Empagliflozin, Dapagliflozin)
Sulfonylureas (e.g., Glipizide, Glimepiride)
TZDs (e.g., Pioglitazone)
Insulin
GLP-1 Receptor Agonists (e.g., Semaglutide, Liraglutide)
Dual GLP-1/GIP Agonists (e.g., Tirzepatide)

Common supplements:

→ Weight Loss Supplements

2) Cardiovascular / Lipids / Blood Pressure

Commonly taken with:

Statins (e.g., Atorvastatin, Rosuvastatin)
Hypertension
Beta Blockers (e.g., Metoprolol)
RAAS (ACEi/ARB/ARNI)

Common supplements:

→ Cardiovascular Supplements

3) Sleep / Anxiety / Mood

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

Common supplements:

→ Sleep & Mood Supplements

4) Pain / Inflammation

Often used instead of or alongside:

Common supplements:

→ Pain & Inflammation Supplements

5) Immune / “Cold & Flu”

Common supplements:

Relevant medication considerations:

→ Immune Supplements

6) GI / Microbiome

Common supplements:

Related PharmAtlas area:

Gastroenterology

Common co-medications:

→ GI Supplements

7) Sexual Health / Testosterone / “Performance”

Often used alongside:

PDE-5 Inhibitors

Common supplements:

→ Sexual Health Supplements

8) Vitamins & Minerals

Common supplements:

Often relevant in patients with:

→ Vitamins & Minerals