Medications That May Interact With Callumae

Drug Interactions with Picrorhiza

Major

Avoid these drugs

None.

Moderate

Be cautious with these drugs

Immunosuppressants – Because picrorhiza is known to boost different aspects of the immune system, it may interact with drugs that suppress the immune system by lowering their efficacies. Therefore, it should be used with caution when taking immunosuppressants used in the treatment of autoimmune diseases.

Such immunosuppressants include corticosteroids, prednisone, tacrolimus (Prograf), cyclosporine, azathioprine, basiliximab (Simulect) and mycophenolate (CellCept).

Drug Interactions with Ginkgo Biloba

Major

Avoid these drugs

None.

Moderate

Be cautious with these drugs

Xanax – Ginkgo can block the effect of alprazolam (Xanax). Therefore, callumae may make Xanax less effective.

HIV medications – Ginkgo can decrease the effectiveness of certain antiviral drugs used in the treatment of HIV. One good example is Efavirenz (Sustiva).

Prozac – The combination of Prozac and herbal mixtures containing ginkgo and St. John’s wort is known to cause hypomania. This presents as irritability, hyperexcitability, and nervousness. While it is not clear whether this reaction is due to ginkgo or another herb in those herbal mixtures, the combination of Prozac and Callumae should still be taken with caution.

Ibuprofen – Both ginkgo and ibuprofen are blood thinners. Therefore, the combination of both medicinal agents may increase the risk of bleeding.

Anticoagulants – The same anticoagulant property of ginkgo means that Callumae should also be used cautiously with other drugs that slow down blood clotting. These include aspirin, indomethacin, warfarin, and heparin.

Drugs metabolized by the members of the liver enzyme family known as Cytochrome P450 including CYP1A2, CYP2C19, CYP2C9, CYP2D6, and CYP3A4 – Ginkgo speeds up the activities of CYP2C19 but slows down the other enzymes. Therefore, it affects the rate at which the liver removes these drugs.

These interactions with liver enzymes can reduce the efficacies of certain drugs or make some of them too efficacious and, therefore, increase their side effects.

Drugs affected include theophylline, haloperidol, propranolol, amitriptyline, diazepam, omeprazole, warfarin, diclofenac, ibuprofen, methadone, codeine, tramadol, and estrogens.

Medications that may cause seizures – One of the rare side effects of ginkgo is seizures. Therefore, it should be used cautiously with medications that may also cause seizures. Such drugs are listed in the table below.

Drugs that may cause seizures

• Antibiotics such as penicillin, amphotericin, and cephalosporin
• Antidepressants
• Antihistamines
• Antiarrhythmics
• Anesthetics
• Narcotics and stimulants
• Immunosuppressants

Anticonvulsants – Because ginkgo may cause seizures, it can decrease the effectiveness of anticonvulsants. Therefore, care should be taken when combining it with drugs that may prevent seizures. These include phenobarbital, carbamazepine, gabapentin, and phenytoin.

Trazodone – Trazodone (Desyrel) significantly influences the balance of brain chemicals. The combination of this drug with ginkgo has been linked with at least one case of a coma. Therefore, trazodone should be avoided while taking Callumae.

Minor

Be watchful of this medication

Hydrochlorothiazide – Used to reduce edematous swelling and control blood pressure, the combination of this drug and ginkgo may increase blood pressure. Therefore, be mindful of your blood pressure when using hydrochlorothiazide with Callumae.

Drug Interactions with Khella

Major

Avoid these drugs

None.

Moderate

Be cautious with these drugs

Digoxin – While digoxin increases the rate of heartbeat, khella slows it down. Therefore, khella may decrease the effectiveness of digoxin. For this reason, Callumae should not be combined with digoxin.

Hepatotoxic Drugs – Because khella can overwork the liver, it should not be combined with drugs with known hepatotoxic effects. Such drugs include acetaminophen (Tylenol), carbamazepine (Tegretol), isoniazid, methotrexate, methyldopa, fluconazole, erythromycin, phenytoin, lovastatin, simvastatin, and pravastatin.

Photosensitizing Drugs – Khella can increase the sensitivity of the skin to sunlight. Therefore, taking it along with photosensitizing drugs can significantly increase the risks of sunburn, rashes and blistering in the exposed areas of the skin.

To reduce this risk, make sure to wear sunblock and protective clothing when you are out in the sun.

Examples of photosensitizing drugs to avoid are antibiotics such as ciprofloxacin, ofloxacin, levofloxacin, norfloxacin, sparfloxacin, tetracycline, and trimethoprim/sulfamethoxazole. Other photosensitizing drugs include amitriptyline and psoralen drugs.

Drug Interactions with L-Phenylalanine

Major

Avoid these drugs

None.

Moderate

Be cautious with these drugs

MAOIs – Monoamine oxidase inhibitors which are mostly first-generation antidepressants should not be combined with L-phenylalanine. The combination of the amino acid with these drugs can cause a significant increase in blood pressure and also increase the risks of heart attack and stroke.

Examples of MAOIs are phenelzine, isocarboxazid, and tranylcypromine.

Baclofen – Baclofen is a muscle relaxant used for relieving muscle spasms. Phenylalanine can reduce the effectiveness of baclofen by lowering its absorption.

Levodopa – Phenylalanine also interferes with levodopa in the same way as baclofen. Phenylalanine reduces the absorption of levodopa and, therefore, its effectiveness in the treatment of Parkinson’s disease.

Selegiline – Selegiline is also a monoamine oxidase inhibitor. However, besides the possible interaction with MAOIs mentioned above, selegiline can also strengthen the antidepressant effects of L-phenylalanine.

Therefore, both medications should not be combined as the combination may increase the risk of mania.

Antipsychotic Drugs – L-phenylalanine worsens a particular side effect of antipsychotics known as tardive kinesis. Therefore, the combination of this amino acid with drugs in this class may cause involuntary twitching of the face, limbs, and trunk.

Examples of antipsychotics are phenytoin, carbamazepine, and valproic acid.

Drug Interactions with Alpha Lipoic Acid

Major

Avoid these drugs

None.

Moderate

Be cautious with these drugs

Diabetes Drugs – Because alpha-lipoic acid can lower blood sugar levels, taking it along with diabetes drugs can drastically lower blood sugar levels and increase the risk of hypoglycemia. Therefore, speak with your doctor before adding Callumae to your diabetes drugs.

However, it is still possible to take this combination as long as you closely monitor your blood sugar level.

In addition, your doctor may need to adjust the dose of the diabetes medication you are currently taking to account for the hypoglycemic effect of alpha-lipoic acid.

Chemotherapy Drugs – Drugs used in the treatment of cancer can also be affected by alpha-lipoic acid. Therefore, consult your doctor before taking Callumae if you are currently receiving chemotherapy.

Levothyroxine and other Thyroid Drugs – Alpha-lipoic acid lowers the levels of the hormones released from the thyroid gland.

Therefore, you need to regularly take thyroid function tests and monitor the blood levels of thyroid hormones when taking Callumae with thyroid medications.

Drug Interactions with Vitamin B6

Major

Avoid this drug

Phenytoin – Phenytoin (Dilantin) is used to treat seizures. However, vitamin B6 speeds up the breakdown of phenytoin and reduces its efficacy. Therefore, the combination of phenytoin and high doses of vitamin B6 may increase the risk of seizures.

This is an important interaction because Callumae contains 1500% of the recommended daily intake of vitamin B6. It is, therefore, important not to combine Callumae with phenytoin.

Moderate

Be cautious with these drugs

Amiodarone – Amiodarone increases the sensitivity of the skin to sunlight. When combined with vitamin B6, there is a significant risk of photosensitivity.

In order to prevent sunburn and blistering in the areas of the skin exposed to sunlight, make sure to wear sunblock and protective clothing while taking amiodarone (Cordarone) and Callumae.

Phenobarbital – Vitamin B6 speeds up the breakdown of phenobarbital and, therefore, promotes the clearance of the drug from the body.

This means that Callumae can reduce the effectiveness of phenobarbital. Therefore, your doctor may need to recommend a dosage adjustment of phenobarbital to accommodate this interaction.

Minor

Watch out for this drug interaction

Levodopa – Vitamin B6 also speeds up the breakdown and clearance of levodopa from the body. However, unlike the cases described above, this interaction is only significant when taking only levodopa.

Because levodopa is more frequently prescribed along with carbidopa, this interaction is not as significant.

Carbidopa prevents vitamin B6 from breaking down levodopa. Therefore, Callumae can be safely used with levodopa/carbidopa combination.

Drug Interactions with Folic Acid

Major

Avoid these drugs

None.

Moderate

Be cautious with these drugs

5-Fluorouracil – Combining high doses of folic acid with this medication can worsen its side effects. Therefore, you may need to discuss the combination of Callumae with 5-fluorouracil especially if you already suffer from gastrointestinal symptoms while placed on the latter.

Capecitabine (Xeloda) – There is the same concern that large doses of folic acid can worsen the gastrointestinal side effects of this drug.

Fosphenytoin (Cerebyx) – Folic acid increases the rate at which the body breaks down fosphenytoin. Therefore, the vitamin reduces its therapeutic effects. Because fosphenytoin is used to control seizures, this interaction may increase the risk of seizures.

Methotrexate – Methotrexate acts by inhibiting the activities of folic acid in the cells of the body. And vice versa. Therefore, taking more folic acid can reduce the effectiveness of methotrexate.

Phenobarbital – Folic acid interferes with phenobarbital in the same way that vitamin B6 interferes with the drug.

Therefore, Callumae may reduce the effectiveness of this drug and, therefore, increase the frequency of seizures among those taking phenobarbital.

Phenytoin and Primidone – Folic acid affects phenytoin and primidone in the same way as phenobarbital. These drugs are also used to control seizures. Therefore, folic acid can lower the effectiveness of both drugs and increase the risks of seizures.

Pyrimethamine – This is a drug used in the treatment of malaria. Folic acid is known to reduce its efficacy against the parasites responsible for malaria.

Drug Interactions with Vitamin B12

Major

Avoid these drugs

Chloramphenicol – Chloramphenicol reduces the production of new blood cells while vitamin B12 is used to produce more of these cells. When combined, chloramphenicol can reduce the efficacy of vitamin B12.

Therefore, do not combine chloramphenicol with Callumae. If you must, do not take chloramphenicol for too long.

Moderate

Be cautious with these drugs

Folic Acid – Large doses of folic acid can mask vitamin B12 deficiency. Therefore, it is important to ensure that you have optimal vitamin B12 levels before starting on folic acid.

This interaction is unlikely to be serious with Callumae because the supplement contains optimal doses of both vitamins.

Potassium – Potassium can reduce the absorption of vitamin B12. To avoid vitamin B12 deficiency, potassium supplements should be used while taking vitamin B12.