Safety Concerns with Common Supplements

5-HTP

Serotonergic

Beta-Carotene

Increases Cardiovascular Mortality

Bitter Orange

Stimulant

Black Cohosh

Hepatotoxic

Caffeine

Increases Blood Pressure

Increases Heart Rate

Chondroitin

Increases Bleeding Risk

Dong Quai

Increases Bleeding Risk

Garlic

Increases Bleeding Risk

Discontinue prior to surgery

Ginger

Increases Bleeding Risk

Discontinue prior to surgery

Ginkgo

Increases Bleeding Risk

Discontinue prior to surgery

Ginseng

Increases Bleeding Risk

Discontinue prior to surgery

Glucosamine

Increases Bleeding Risk

Discontinue prior to surgery

Hawthorn

Positive Inotrope (Avoid use with other inotropes like digoxin)

Kava

Hepatotoxin

Omega-3 Fatty Acids

Increases Bleeding Risk with high doses

Potassium

Fatal Arrhythmias: Dose based on measured levels

Probiotics

Concern that live bacteria in immunocompromised states could cause an infection

Red Yeast Rice

Do not use with statins

SAMe

Serotonergic

St. John’s Wort

Serotonergic

Photosensitivity

Many DDIs due to CYP induction

Valerian

Sedation

Vitamin C

Nephrolithiasis

Vitamin E

Increases Bleeding Risk

Supplements that Increase Bleeding Risk

Chondroitin

Dong Quai

Vitamin E

Fish Oils (Omega-3 Fatty Acids)

Garlic

Ginger

Ginkgo

Ginseng

Glucosamine

Willow Bark

Supplements with Risk of Liver Toxicity

Black Cohosh

Kava