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Possible side effects

• Side effects may include dizziness, headache, insomnia, and either dry mouth or excessive saliva production.
• Rhodiola is possibly safe for up to 12 weeks.

Avoid or ask a doctor first if

• Little is known about safety during pregnancy or breastfeeding.
• People who have or may have depression, or have a family member who may, should consult a health care provider.

Medication interactions

• Interactions between rhodiola and losartan, a blood pressure drug, have been reported.
• People taking any medicine should talk with a health care provider before using an herbal product, since some herbs and medicines interact in harmful ways.

Possible side effects

• Stomach upset, loose stools, nausea, and drowsiness are listed as common side effects, and ODS calls them mild.
• NCCIH says some people may get drowsiness, stomach upset, diarrhea, and vomiting.
• Increased heart rate variability has been reported.

Serious risks

• There are a few reports of more serious side effects, including effects on liver function.
• In reported liver injury cases, people's conditions improved over time after they stopped the supplement, and some also received medical treatment.
• NCCIH describes liver injury cases linked to ashwagandha supplements and calls them rare.
• Three case reports describe thyrotoxicosis in women taking ashwagandha extract.
• In all three thyrotoxicosis cases, stopping ashwagandha resolved the symptoms.

Avoid or ask a doctor first if

• Some experts advise pregnant women not to use ashwagandha, because some reports suggest it could cause spontaneous abortion.
• NCCIH says to avoid ashwagandha during pregnancy and not to use it while breastfeeding.
• NCCIH does not recommend it before surgery or for people with autoimmune or thyroid disorders.
• People with hormone-sensitive prostate cancer should avoid it because it may raise testosterone.

Medication interactions

• Ashwagandha might interact with thyroid hormone medications.
• It might also interact with antidiabetes drugs, antihypertensives, immunosuppressants, and sedatives.
• NCCIH lists diabetes, high blood pressure, immunosuppressant, sedative, anti-seizure, and thyroid hormone medications.

Possible side effects

• About 3 g/day of carnitine supplements can cause nausea, vomiting, abdominal cramps, diarrhea, and a fishy body odor.

Serious risks

• Some research indicates gut bacteria turn unabsorbed carnitine into TMAO and gamma-butyrobetaine, which might increase CVD risk; the implications are not well understood.
• Carnitine can cause seizures in people with seizure disorders.

Avoid or ask a doctor first if

• People with uremia can get muscle weakness, and people with seizure disorders can have seizures, from carnitine.

Medication interactions

• Several types of medications have the potential to interact with carnitine supplements.
• People taking medications regularly should discuss their carnitine intake with their healthcare providers.

Possible side effects

• The most common complaints are diarrhea, nausea, abdominal cramps, and other digestive upset.

Serious risks

• High intakes may raise urinary oxalate and uric acid, which could contribute to kidney stones, especially in people with renal disorders.
• The best evidence that vitamin C contributes to kidney stones is in patients who already have hyperoxaluria.
• In people with hereditary hemochromatosis, long-term high doses could worsen iron overload and cause tissue damage.
• A few in vitro studies suggested that supplemental oral vitamin C, acting as a pro-oxidant, could cause chromosomal or DNA damage and possibly contribute to cancer.
• In postmenopausal women with diabetes in the Iowa Women's Health Study, supplemental vitamin C of at least 300 mg/day was significantly associated with a higher risk of dying from CVD.

Avoid or ask a doctor first if

• People with hereditary hemochromatosis face a concern about iron overload with chronic high doses.
• The upper limits do not apply to people receiving vitamin C as medical treatment, who should be under a physician's care.
• Infants should get vitamin C only from formula and food.

Medication interactions

• Vitamin C supplements may interact with radiation therapy and with medications, including chemotherapy drugs and statins.
• People taking these medications regularly should talk with their health care providers about vitamin C intake.

Serious risks

• No adverse effects have been reported from high thiamin intakes, but the FNB noted that excessive intakes could still have adverse effects.

Avoid or ask a doctor first if

• People who take certain medications regularly should talk with their health care providers about their thiamin status.

Medication interactions

• Thiamin isn't known to interact with any medications, but certain medications can have an adverse effect on thiamin levels.

Serious risks

• The Food and Nutrition Board set no upper limit for B12 because its potential for toxicity is low.

Avoid or ask a doctor first if

• People who regularly take certain medications are told to talk with their health care providers about their B12 status.

Medication interactions

• B12 supplements may interact with some medications. Gastric acid inhibitors and metformin may affect B12 levels.
• Several types of medications might adversely affect B12 levels.

Possible side effects

• Some people taking large doses of pantothenic acid supplements develop mild diarrhea and gastrointestinal distress. The cause is not known.

Serious risks

• The FNB found no reports of pantothenic acid toxicity in humans at high intakes.

Medication interactions

• Pantothenic acid is not known to have clinically relevant interactions with medications.

Possible side effects

• High blood calcium from vitamin D toxicity can lead to nausea, vomiting, muscle weakness, and other symptoms.

Serious risks

• Toxicity can cause high blood and urine calcium. In extreme cases it may lead to kidney failure, soft tissue calcification, heart rhythm problems, and death.
• Toxicity is almost always caused by taking too much vitamin D through supplements.

Avoid or ask a doctor first if

• The source says people on regular medications should talk with their health care providers about vitamin D intake and status.

Medication interactions

• Vitamin D supplements may interact with orlistat, statins, steroids, and thiazide diuretics.
• Taking calcium supplements with vitamin D supplements may raise the risk of certain adverse effects.