Interactions with IBD medications
Consolidated for the Five; the individual product cards carry the cautions for the rest. Three general rules first, then the specifics.
Rule 1, the calcineurin inhibitors
Tacrolimus and cyclosporine have narrow therapeutic windows and are cleared by CYP3A4 and P-glycoprotein. Several polyphenols in this guide inhibit both in laboratory studies. If you are on either drug, every new supplement goes past your prescriber first.
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| Entry | Mesalamine / sulfasalazine | Thiopurines, methotrexate | Corticosteroids | Tacrolimus, cyclosporine | Biologics, JAK inhibitors | Other notable |
|---|---|---|---|---|---|---|
| A-01 Curcumin | Co-administered in every UC trial; no problem seen | — | — | Caution, CYP3A4/P-gp inhibition in vitro; may raise levels | — | Anticoagulants (additive); iron absorption ↓ |
| A-02 Quercetin | — | — | — | Caution, CYP3A4/P-gp inhibition; may raise levels | — | Anticoagulants (additive); some quinolone antibiotics |
| A-03 Omega-3 | — | — | — | — | — | Anticoagulants/antiplatelets (additive); antihypertensives (mild) |
| A-04 SBI | No known interaction (no dedicated study). EnteraGam's maker reports no significant drug interactions and no need to separate doses; SBI acts inside the gut and isn't absorbed. Follow your mesalamine's own instructions. | — | — | — | Added on top of biologics in the case series | Beef allergy, alpha-gal syndrome |
| A-05 Vitamin D3 | — | — | Steroids raise vitamin D need and bone loss | — | — | Cholestyramine (absorption ↓, separate by hours); thiazides (calcium ↑) |
"—" means no interaction has been documented, not that one has been ruled out. Sources: the trial reports cited in each entry and standard interaction references.
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