← Medication interactions guide · A · B–C · D–L · M–O · P–S · T–Z
General information for discussion with your doctor, pharmacist or vet. It is not medical or veterinary advice. Never stop or change a medication without talking to your prescriber.
M
Marbofloxacin
Veterinary oral fluoroquinolone antibiotic effective against a variety of bacterial pathogens; prohibited for extra-label use in food animals in the United States.
Contraindications include hypersensitivity to fluoroquinolones, cats younger than 12 months, and immature dogs during the rapid growth phase.
Caution: Hepatic or renal insufficiency, seizure patients, or dehydration
Adverse effects include GI distress; marbofloxacin has not been proven to cause ocular toxicity in cats or predispose to Streptococcus canis necrotizing fasciitis.
Many drug interactions and not ok with turmeric because turmeric reduces the action of the antibiotic (dampens the ‘oxidative burst’ that the fluroquinolones employ to kill pathogens).
Maxalt: see Rizatriptan
Meclizine
Also known as: see Antivert, Antrizine, Bonamine, Bonine, Meni-D
Meclizine is an antihistamine for motion sickness. It should be okay with Golden Paste.
Medroxyprogesterone Acetate
Trade name Depo-Provera
Birth control pill. Most online references refer to it only as Medoxyprogesterone, but that is just the ‘Provera’ part of it. Should be okay with Golden Paste.
Meloxicam
Trade names Mobic, others
Commonly prescribed NSAID, usually sold as meloxicam in veterinary use, often as Mobic for human use. Like all the NSAIDs, it’s cleared via CYP3A4, the same pathway that pepper inhibits. Clinical experience suggests that in most cases this isn’t a problem with the Golden Paste. The concentration of meloxicam in synovial fluid runs about 2.5 times higher than in blood plasma, which may account for it being particularly effective with joint inflammation and pain.
Melphalan
Extensive research within the last decade in cell culture and in rodents has revealed that curcumin can sensitize tumors to different chemotherapeutic agents including doxorubicin, 5-FU, paclitaxel, vincristine, melphalan, butyrate, cisplatin, celecoxib, vinorelbine, gemcitabine, oxaliplatin, etoposide, sulfinosine, thalidomide, and bortezomib. Chemosensitization has been observed in cancers of the breast, colon, pancreas, gastric, liver, blood, lung, prostate, bladder, cervix, ovary, head and neck, and brain and in multiple myeloma, leukemia, and lymphoma. Similar studies have also revealed that this agent can sensitize a variety of tumors to gamma radiation including glioma, neuroblastoma, cervical carcinoma, epidermal carcinoma, prostate cancer, and colon cancer. How curcumin acts as a chemosensitizer and radiosensitizer has also been studied extensively.
Memantine
Trade names Abixa, Adaxor, Admed, Akatinol, Alceba, Alios, Almenta, Alois, Alzant, Alzer, Alzia, Alzinex, Alzixa, Alzmenda, Alzmex, Axura, Biomentin, Carrier, Cogito, Cognomem, Conexine, Cordure, Dantex, Demantin, Demax, Dementa, Dementexa, Ebitex, Ebixa, Emantin, Emaxin, Esmirtal, Eutebrol, Evy, Ezemantis, Fentina, Korint, Lemix, Lindex, Lindex, Lucidex, Manotin, Mantine, Mantomed, Marbodin, Mardewel, Marixino, Maruxa, Maxiram, Melanda, Memabix, Memamed, Memando, Memantin, Memantina, Memantine, Mémantine, Memantinol, Memantyn, Memanvitae, Memanxa, Memanzaks, Memary, Memax, Memexa, Memigmin, Memikare, Memogen, Memolan, Memorel, Memorix, Memotec, Memox, Memxa, Mentikline, Mentium, Mentixa, Merandex, Merital, Mexia, Mimetix, Mirvedol, Modualz, Morysa, Namenda, Nemdatine, Nemdatine, Nemedan, Neumantine, Neuro-K, Neuroplus, Noojerone, Polmatine, Prilben, Pronervon, Ravemantine, Talentum, Timantila, Tingreks, Tonibral, Tormoro, Valcoxia, Vilimen, Vivimex, Witgen, Xapimant, Ymana, Zalatine, Zemertinex, Zenmem, Zenmen, and Zimerz
An NMDA antagonist that has been prescribed for Alzheimer’s. It is not widely used, as it has not proven as beneficial as AChE inhibitors, but is sometimes used for people who are intolerant of the AChE inhibitors. Its ability to bind with NMDA receptors has not been proven to slow the progression of Alzheimers. It is also a non-competitive antagonist at the 5-HT3 (serotonin) receptor. It is a dopamine agonist, which may have significance for its use along with Golden Paste. Physician consult recommended, but unless a person is particularly sensitive to dopamine levels (and many are), Golden Paste probably will be okay.
Mercaptopurine
Trade name Purinethol
A cancer medication. It’s cleared via xanthine oxidase, and turmeric is an XO inhibitor. Physician consult required.
Mesalamine
Also known as: Mesalazine, Balsalazide, Olsalazine, Pentasa, Sulfasalazine
This is an aminosalicylate (in the same class of drugs as aspirin). It’s widely used in the treatment of Crohn’s, ulcerative colitis, IBD and other similar conditions. It works (as far as its mechanism is understood) by inhibiting production of prostaglandin E2 and the various leukotrienes. It is different from the medications classed as NSAIDs in that they also affect the cycloxygenase enzymes (primarily COX-1 and/or COX-2). People who are sensitive to NSAIDs may be able to tolerate mesalamine better.
Sulfasalazine is the older formulation. It contains sulphonamide, which many people are sensitive to. Mesalamine and the other more recent formulations do not contain sulphonamide, so are more suitable for many people. In any case, the newer formulations are being prescribed almost exclusively nowadays.
More detail and references
Mesalamine (or mesalazine) is the one most often prescribed for upper intestinal conditions because when taken orally, it’s almost entirely absorbed into the bloodstream before reaching the lower intestinal tract. The other formulations are more likely to be prescribed for conditions affecting the colon or lower intestines, as they are not broken down so fast.
At least one trial indicated that the curcumin in turmeric would increase the plasma concentration of sulphasalazine (the base drug of which mesalamine is a metabolite). The trial used a single 2000mg dose of 95% curcumin, so it may be that the whole turmeric in Golden Paste would not be a problem. But it’s too iffy for us to say it’s okay.
Metaxalone
Sold as Skelaxin
This is a central nervous system depressant that is used as a muscle relaxer (though it does not act directly on the muscles). It appears to be a potent MAO inhibitor–there are reports of patients abusing or deliberately overdosing on tramadol and metaxalone and having a near-fatal serotonin syndrome reaction. Since both turmeric and pepper are MAO inhibitors (though modest ones in comparison), there would be a double caution for anyone who’s on an anti-depressant or anti-psychotic medication, or a painkiller like tramado that contains an SSRI. Metaxalone is not a CYP3A4 substrate, so metabolic interactions are not an issue.
References:
More detail and references
Drugbank: https://www.drugbank.ca/drugs/DB00660
DailyMed: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f06f2b96-3684-483c-89f7-6c9201fd4664
PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4252289/
Metformin
Trade names Diaformin, Glucophage, others
An oral diabetes drug, works by decreasing the liver’s glucose production and increasing insulin sensitivity. Turmeric also reduces insulin resistance, so they work in a similar way in that regard. Generally okay with Golden Paste with the caution that anyone on diabetes meds should be monitoring their blood glucose.
Methadone
Trade name Dolophine and others
An opioid used to treat pain and also to help people wean off opioid addiction. Unlike many of the other opioids that have short enough half-lives to be alternated with Golden Paste, methadone has a half-life from 15-55 hours. So it would not be appropriate with Golden Paste without physician approval.
References:
More detail and references
Drugbank: https://www.drugbank.ca/drugs/DB00333
Methimazole
Also known as: THIAMAZOLE
Widely used to treat hyperthroidism in cats, and also prescribed for human use for hyperthyroidism, Graves disease and non-iodine-deficiency goiter. it is a moderate to potent inhibitor of all the common cytochrome p450 pathways, including CYP3A4. Because of its effect on thyroid hormones, the use of Golden Paste with hyperthyroidism would be a caution to begin with, but methimazole’s inhibition of CYP3A4 is going to extend and enhance the effect of the piperine in black pepper. Vet or doctor advice required.
References:
More detail and references
Drugbank: https://www.drugbank.ca/drugs/DB00763
Drug Metabolism and Disposition: http://dmd.aspetjournals.org/content/25/3/390.long
Methocarbamol
Trade names Robaxin, Robaxacet, Robax Platinum, Robaxisal
A central muscle relaxer used to treat back muscle spasms. Generally okay with Golden Paste. However, it is reported that there is an increase in the risk and severity of side effects when used along with CBD.
Drug Interactions
The following drug interactions have either been reported or are theoretical in humans or animals receiving methocarbamol and may be of significance in veterinary patients. Unless otherwise noted, use together is not necessarily contraindicated, but weigh the potential risks and perform additional monitoring when appropriate.
- ANTICHOLINERGICS (eg, atropine): Methocarbamol may potentiate the effect of anticholinergic drugs.
- BUPRENORPHINE: Methocarbamol may enhance the CNS depressant effect of buprenorphine.
- CNS DEPRESSANTS, OTHER: Additive depression may occur when methocarbamol is given with other CNS depressant agents.
- MIRTAZAPINE: Methocarbamol may enhance the CNS depressant effect of mirtazapine.
- PYRIDOSTIGMINE: Methocarbamol may diminish the therapeutic effect of pyridostigmine.
- SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs): Methocarbamol may enhance the adverse/toxic effects of SSRIs.
More detail and references
Methocarbamol is one of the few muscle relaxers that is okay with Golden Paste.
Methotrexate
An immunosuppressant prescribed for psoriasis, Crohn’s and other autoimmune conditions. It’s metabolized in part via CYP3A4, but has been used by many group members along with Golden Paste without any reported problems.
Methylcobalamin
Trade names Neuro-Forte
A form of vitamin B12 (not a prescription drug). Okay with Golden Paste
Methylfenidate
Trade names Concerta, Metadate, Ritalin
A psycho-stimulant used to treat ADHD, and also now for bipolar disorder and major depressive disorder. The manufacturer’s FDA submission cautions not to use it with an MAO inhibitor, so it would be contraindicated with Golden Paste without a doctor’s approval.
References:
More detail and references
https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/021121s014lbl.pdf
Metoprolol
Trade names Lopressor, Toprol-XL, Selokeen, Minax, Betaloc
Metoprolol is a beta blocker prescribed primarily for hypertension. Those are normally okay with both turmeric and pepper. Metoprolol succinate is the longer-acting form, sold as Toprol.
Metronidazole
Trade name Flagyl
An antibiotic and antiprotozoal drug used for a wide variety of human and veterinary conditions. It’s the drug of choice for protozoal infections such as giardiasis and trichomoniasis, and is widely used for other intestinal upsets, especially when the specific pathogen isn’t known for certain. It’s metabolized via several of the CYP3A sub-families (CYP3A5 and CYP3A7), and also by UGT1A1 (which is inhibited by black pepper). It would not typically be (and has not been) a problem along with Golden Paste, but might be with a curcumin extract.
Mirabegron
Trade names Myrbetriq, Betmiga
A beta-3 adrenergic receptor agonist used for the treatment for ‘overactive bladder.’ It has minimal clearance via CYP3A4, probably not enough to worry about. It’s primary metabolic path is via glucoronidation, which is also inhibited by the pepper in Golden Paste, but is still not likely to be an issue.
Mirtazapine
Original brand name Remeron, now sold primarily in generic form
Mirtazapine is an atypical antidepressant (meaning it doesn’t fit into the more usual category of SSRI or SNRI or tricyclic, etc.). It does not inhibit serotonin or norepinephrine reuptake, but it does affect serotonin levels in other ways. For that reason, it would carry the same cautions as any other antidepressant. In addition, it’s a CYP3A4 substrate, so its clearance would be affected by piperine.
Unlike most other antidepressants, mirtazapine carries a warning from its original manufacturer not to be given within two weeks of any MAO-inhibitor use. Turmeric and pepper are both MAO inhibitors, though less potent than the prescription MAO-I’s. There is still sufficient risk to be cautious and tell people to consult their doctors first.
Mitoxantrone
Good with turmeric.
Curcumin augments the cytostatic and anti-invasive effects of mitoxantrone on carcinosarcoma cells in vitro
Marcin Luty 1, Edyta Kwiecień 1, Magdalena Firlej 2, Anna Łabędź-Masłowska 1, Milena Paw 1, Zbigniew Madeja 1, Jarosław Czyż 1
Abstract: Numerous adverse effects limit the applicability of mitoxantrone for the treatment of drug-resistant tumors, including carcinosarcoma. Here, we estimated the additive effects of mitoxantrone and curcumin, a plant-derived biomolecule isolated from Curcuma longa, on the neoplastic and invasive potential of carcinosarcoma cells in vitro. Curcumin augmented the cytostatic, cytotoxic and anti-invasive effects of mitoxantrone on the Walker-256 cells. It also strengthened the inhibitory effects of mitoxantrone on the motility of drug-resistant Walker-256 cells that had retained viability after a long-term mitoxantrone/curcumin treatment. Thus, curcumin reduces the effective doses of mitoxantrone and augments its interference with the invasive potential of drug-resistant carcinosarcoma cells.
Mometasone Furoate
Trade name Nasonex
Mometasone furoate is a corticosteroid used to reduce airway inflammation and sometimes for itching. It’s available in nasal spray form. It is often combined with other drugs (mometasone and fumotorol–Dulera–is one commonly prescribed formulation). Mometasone is metabolized via CYP3A4, but the therapeutic index is relatively wide and few instances of advere effects with other CYP3A4 inhibitors/inducers have been reported. Should be okay with Golden Paste.
Sources:
More detail and references
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21858255
DrugBank: https://www.drugbank.ca/drugs/DB00764/biointeractions
PharmGKB: https://www.pharmgkb.org/chemical/PA450541#tabview=tab2&subtab=31
Montelukast
Trade name Singulair
A leukotriene receptor antagonist prescribed for asthma. Minor CYP3A4 interaction, okay with Golden Paste. This has actually been trialled with curcumin, against gastric ulcers, and curcumin improved its performance.
More detail and references
Mycophenolate
Trade name Cellcept
An immunosuppressant often used after organ transplantation and for auto-immune diseases. We’ve had several anecdotal reports of people’s vets saying it was okay with Golden Paste. But it is cleared via both of the pathways that are inhibited by turmeric and pepper. In addition, the curcumin in turmeric has the same effect on T-cell production as mycophenolate. The small amount of curcumin in Golden Paste is probably not significant in terms of having the same effect as mycophenolate. But the effect on its clearance from pepper’s inhibition of UGT-1A1 may be. So physician/veterinarian consult should still be recommended.
N
Naltrexone
Mechanism of Action: Opioid competitive receptor antagonist; shows highest affinity for mu r Absorption
96% absorbed from gastrointestinal tract, but because of first-pass metabolism, only 5-40% reaches systemic circulation
Bioavailability: 5-40% Onset: 15-30 min Duration: 24 hr Peak plasma time: PO tablet, 1 hr; PO solution, 0.6 hr
Metabolized in liver Metabolites: 6-β-naltrexol (major), 2-hydroxy-3-methoxy-6-β-naltrexol (HMN), 2-hydroxy-3-metho-xynaltrexone, noroxymorphone, 3-methoxy-6-β-naltrexol
Half-life: PO, 4 hr; 6-β-naltrexol, 13 hr; IM and 6-β-naltrexol and IM: 5-10 days
Excretion: Urine (mainly) eceptors; congener of oxymorphone
Low Dose Naltrexone (LDN) is typically dosed at a very small fraction of naltrexone itself, and has not been a problem with Golden Paste
Nasonex: see Mometasome furoate
Neoquess: see Hyoscyamine
Neuro-Forte: see Methocobalamin
Nexiclon: see Clonidine
Nicorol: see Furosemide
Nicotinamide Nitrate
Trade name Nicorandil and others
Nicotinic acid and nicotinamde have been used as cholesterol-lowering drugs since the 1980’s. Nicotinamide nitrate, sold as Nicorandil, is a relatively new derivative prescribed for high blood pressure and angina. It’s a potent inhibitor of CYP3A4, so is probably okay with Golden Paste. However, it’s likely that anyone on Nicorandil will be on a list of other drugs too, whose dosage may have been adjusted to compensate for the CYP3A4 inhibition. So they need to be taken into account. It’s a good guess that most people will need to be referred to their doctors, not because of the Nicorandil itself but because of the potential interaction of Golden Paste with other meds being taken with the Nicorandil.
Nifedipine
Trade names Adalat, others
A blood pressure medication also used for angina and to halt premature labor. There are multiple toxic side effects, and a narrow therapeutic range. It’s metabolized via CYP3A4, so physician consult is strongly recommended.
Nitrofurantoin
Trade names Furadantin, Macrobid, Macrodantin
An antibiotic typically prescribed for urinary tract infections. Golden Paste should be okay with it. It’s a substrate for PgP, but that appears to be minor.
Norco: see Codeine
Nordip: see Amlodipine
Norethisterone Acetate
Also called Norethindrone acetate, trade names Promolut-Nor, Aygestin, Gestakadin, Milligynon, Monogest, Norlutate, Sovel, Styptin and others
A progesterone which is half of a contraceptive called Estalis-Sequi. This product is composed of estradiol in one package and a combination of estradiol and norethisterone acetate in the other. So basically an estrogen/progesterone combination. Should be okay with Golden Paste.
Norlutate: see Norethisterone acetate
Norocarp: see Carprofen
Norodyl: see Carprofen
Nortriptyline
Mechanism of Action
Neurotransmitter (especially norepinephrine and serotonin) reuptake inhibitor; increases concentration of neurotransmitters in the CNS
Absorption: Onset of action: 1-3 weeks; Peak plasma time: 7-8.5 hr; Steady-state therapeutic plasma concentration: 50-150 ng/mL; Distribution: Protein bound: 93-95%
Needs care with turmeric and pepper both of which are non-selective MAO inhibitors that also increase serotonin levels. Talk to prescribing doctor.
Abrupt discontinuation or interruption of antidepressant therapy has been associated with a discontinuation syndrome, which may include vomiting, diarrhea, headaches, dizziness, chills, tremors, paresthesias, somnolence, fatigue, and sleep disturbances
Norvasc: see Amlodipine
Novocox: see Carprofen
Nuflor: see Florfenicol
Nulev: see Hyoscyamine
Nurofen Plus: see Codeine
O
Odemase: see Furosemide
Oedemex: see Furosemide
Oestriol: see Estriol
Olmesartan
Trade name Benicar, see notes for Benicar HCT, Benitec H, Sevikar, WinBP, Olmy, Olvance, Olsar, Olmetec
An angiotensin II receptor antagonist for hypertension, generally not a problem with Golden Paste. However, one of its uncommon side effects is severe gastrointestinal irritation.
Note: olmesartan is frequently combined with other hypertension drugs and/or diuretics–Sevikar is a combination of olmesartan and amlodipine; Sevikar HCT adds hydrochlorothiazide. Sevikar HCT is also sold as WinBP, Olmy, Olvance, Olsar and Olmetec, depending on country.
Omeprazole
Trade names Acimax, others
We don’t have detailed notes on this medication yet. Ask Dr Doug if you need to know.
Oncept
A so-called ‘vaccine’ for canine melanoma. There is a fair amount of controversy surrounding its use. It does not have FDA approval, since it was trialed only in dogs, but is approved by the USDA. This is actually a weakened form of human tyrosinase, the enzyme that limits production of melanin in the skin. Since turmeric is a tyrosinase inhibitor, Golden Paste would not be appropriate with it.
Orphenadrine
Trade name Norflex
An anticholinergic related to diphenhydramine (Benadryl). It has been prescribed as a muscle relaxer as well as for motor control in Parkinson’s. It’s used much less now than in the past, as it has been superseded by more effective drugs. It’s a CYP3A4 substrate as well as an anticholinergic, so unlikely to be a good combination with Golden Paste. Physician consult required.
Oxcarbazepine
Trade name Trileptal
An anti-epileptic drug also prescribed for bipolar disorder. Its effects are primarily from its 10-monohydroxy metabolite (MHD), though its mechanism of action has not been well characterized. MHD is further metabolized via glucuronidation, so the pepper in Golden Paste could extend its bloodstream presence and levels. It has a wide range of side effects, including Stevens-Johnson syndrome and toxic epidermal necrosis. It is both an inducer and an inhibitor of CYP3A4, but inhibition was observed only at high dosages. it is a potent inhibitor of CYP2C19, not an issue for Golden Paste, but if CBD (also a CYP2C19 inhibitor) is also being given, their combined effect could be an issue for the metabolism of other drugs in use. Because of the potential for slower clearance from inhibition of glucuronication, and the wide range of serious side effects, a physician consult is recommended before adding Golden Paste.
More detail and references
Drugbank.ca: https://www.drugbank.ca/drugs/DB00776
FDA prescriber information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/21014s012,21285s007lbl.pdf
Oxytetracycline
Trade name Oxycare
A broad-spectrum tetracycline antibiotic effective against a wide range of organisms, including Helicobacter pylori (which cause stomach ulcers), Haemophilus influenzae (bacterial pneumonia), Chlamydia trachomatis (the chest infection psittacosis, the eye infection Trachoma and the genital infection usually referred to just as Chlamydia), and Borellia burgdorferii (Lyme disease). No problems with Golden Paste.
Can’t find your medication? Ask Dr Doug and it may be added to the guide. A · B–C · D–L · M–O · P–S · T–Z
