← 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.
P
Paclitaxel
Trade names Taxol, others
Originally derived from the Pacific yew plant, now synthesized. Used for cancers of various organs (ovaries, breast, lung, cervix, pancreas and also for Kaposi’s sarcoma). See also Abraxane for a slightly different formulation. Primarily metabolized via CYP3A4, so physician consult needed before adding Golden Paste.
Paracetamol: see Acetaminophen
PEA
Also known as: PALMITOYLETHANOLAMIDE
PEA is an endogenous fatty acid amide, belonging to the class of nuclear factor agonists. PEA has been studied in in vitro and in vivo systems using exogenously added or dosed compound; there is evidence that it binds to a nuclear receptor, through which it exerts a variety of biological effects, some related to chronic inflammation and pain.
A main target of PEA is proposed to be the peroxisome proliferator-activated receptor alpha (PPAR-α). PEA also has affinity to cannabinoid-like G-coupled receptors GPR55 and GPR119. PEA cannot strictly be considered a classic endocannabinoid because it lacks affinity for the cannabinoid receptors CB1 and CB2. However, primary research supports the conclusion that the presence of PEA (or other structurally related N-acylethanolamines) enhances anandamide activity by an “entourage effect“.
More detail and references
Some primary research reports support the conclusion that PEA levels are altered and that the endocannabinoid system (ECS) is “imbalanced” in acute and chronic inflammation. A primary research article, for instance, has reported that the deregulation of cannabinoid receptors and their endogenous ligands accompanies the development and progression of β-amyloid-induced neuroinflammation.
In some primary research studies, PEA has been shown to have anti-inflammatory, anti-nociceptive, neuroprotective, and anticonvulsant properties.
https://en.wikipedia.org/wiki/Palmitoylethanolamide
Okay with Golden Paste.
Pentosan Polysulfate
Trade name Elmiron
Pentosan is a semi-synthetic low-molecular weight compound that has some of the characteristics of heparin. Testing revealed no additional anticoagulation along with warfarin (unchanged INR with and without the addition of pentosan). However, caution with other anticoagulants was recommended. Use with Golden Paste only with physician approval.
An interesting note–pentosan polysulfate was one of the few drugs found to be effective against prion diseases in humans, such as Jakob-Kreuzfeldt Disease, Gerstmann-Straussler-Scheinker Syndrome and Kuru, and in animal diseases such as bovine spongiform encephalopathy (mad cow disease), scrapie (in sheep) and chronic wasting disease (in ungulates like deer). However, it has to be injected directly into the brain, as it does not cross the blood-brain barrier.
Pentoxiphylline
Pentoxiphylline actually IS a blood thinner. It reduces blood viscosity. It’s also a vasodilator and reduces platelet adhesion. It reduces fibrinogen production, so it has a dual anti-clotting mechanism. It inhibits tumor necrosis factor-alpha, just as turmeric does, and also inhibits some of the same interleukins (1,2,6 and 8). So it’s not incompatible with turmeric, but care would be important to make sure the patient wasn’t getting too much of a good thing, so to speak. It’s often prescribed for someone with peripheral artery disease, who has decreased circulation. Recently it has also been used as an effective antifungal.
Sources:
More detail and references
http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/018631s039lbl.pdf
Perindopril
Trade names Coversyl, Coversum, Aceon
Perindopril is an ACE inhibitor for blood pressure. It’s available as perindopril arginine (sold as Coversyl and Coversum) and perindopril erbumine (sold as Aceon). The two forms are therapeutically identical, but the dosage is different. It is cleared via CYP3A4, but there does not appear to be any significant increase in blood serum levels. Golden Paste should not be a problem with it.
Phenobarbital, Phenobarbitone
Trade names Phenoleptil, Luminal
A barbiturate commonly prescribed for seizures. Works by reducing the inhibitory activity of GABA. It’s metabolized primarily via CYP2C19, so Golden Paste will not have a significant interaction with it. However, CBD is a potent CYP2V19 inhibitor and would slow phenobarbital’s clearance. Considering how often people are now using CBD for seizures, that’s a risk that needs to be mentioned if CBD usage is reported.
Phenobarbital is a CYP3A4 and CYP2A1 inducer, which could possibly have some effect on the metabolism of the curcumin in turmeric, but is probably not going to be significant.
More detail and references
DrugBank: https://www.drugbank.ca/drugs/DB01174
Phenothiazine
Phenothiazine is not a specific medication, but a class of antipsychotic drugs. Included are chlorpromazine, promazine, triflupromazine, levomepromazine (methotrimeprazine in the US), mesoridazine, thioridazine, fluphenazine, perphenazine, prochlorperazine and trifluoperazine. Each of those is sold under a variety of trade names, which are listed with the individual medication entries.
Phenoxybenzamine
Trade name Dibenzyline
Phenoxybenzamine is a non-selective irreversible alpha blocker, used for blood pressure control. It’s specific for hypertension caused by pheochromocytoma. Shouldn’t be a problem with Golden Paste.
Phenylpropanolamine
Trade names Propalin, Proin, Rinexin, others
This has been taken off the market for human use in much of the world, but is still used for urinary incontinence in dogs. It’s a psychoactive drug similar to norephedrine. Generally okay with Golden Paste.
Pimobendan
Trade names Vetmedin, Acardi, Heartmedin
A veterinary medication for mitral valve disease or dilated cardiomyopathy. Acardi is also approved for human use in Japan. Often prescribed along with an ACE inhibitor. Okay with Golden Paste.
Piriton: see Chlorpheniramine
Piroxicam
Trade names Feldene, Mobilis, others
Piroxicam is another of the NSAIDs, okay with Golden Paste
Pizotifen
Trade name Sandomigran
Prescribed to reduce the frequency of migraines, though it is not as effective as other medications for the purpose, and is usually prescribed only if migraines have not responded to the more usual drugs. Also prescribed for anxiety, depression and social phobia. It is a serotonin antagonist and an anticholinergic. Physician consult required for use with Golden Paste, since both turmeric and black pepper act in opposition to its mechanisms. Their effect may not be significant, but given individual metabolism, it would be best to check first.
Plaquenil: see Hydroxychloroquine
Plavix: see Clopidogrel bisulphate
Potassium Bromide
Trade names Bromav, Dibro-BE, Epilease, Libromide
Potassium bromide is an ionic salt of bromine(KBr) that has wide veterinary use to reduce seizure activity in dogs (not prescribed for cats). It is not approved for human use in the US, but is still prescribed for humans in Germany. It is not affected by Golden Paste and there would be no restrictions on its use with Golden Paste. However, it does have a very narrow therapeutic range and can itself cause seizures in overdoses.
Note: bromide is sometimes combined with other anti-epileptic medications.
Crisax – bromocamphor and phenobarbital, sold in France
Influen Bronquial – Dextromethorphan, Chlorphenamine and Sodium Bromide,, sold in Paraguay
Tussyl – Dextromethorphan, Bromhexine and Sodium Bromide, sold in Paraguay
Pramipexole
Trade names Mirapex, Mirapexin, Sifrol
Pramipexole is a dopamine agonist, meaning it will increase dopamine levels in the bloodstream. Turmeric and pepper, as MAO inhibitors, do the same thing. The issues are not the same as in serotonin syndrome, but overdosing on dopamine can cause, anxiety, nausea, hyperactivity and other neurological side effects. The greater problem for someone on dopamine for Parkinsons is that longterm use of supplemental dopamine can cause cognitive problems. Anything that increases the amount of dopamine in the system over an extended period is likely to make that worse. So the patient’s doctor should be asked.
Prednisolone
Trade names macrolone, prednil, others
A steroid, generally okay with Golden Paste.
Pregabalin
Trade names Lyrica, Alzain
A pain medication often prescribed for nerve pain. This is a reformulation of gabapentin, which the original manufacturer came up with in order to have a brand-name (and more expensive) product on the market when the brand protection ran out on gabapentin. It will normally be okay with Golden Paste.
Prepulsid, Propulsid: see Cisapride
Prevacid: see Lansoprazole
Prilactone: see Spironolactone
Pristiq: see Desvenlafaxine
Prochlorperazine
Trade names Stemetil, Stemzine, Buccastem, Compazine, Phenotil, others
A dopamine-receptor antagonist, potent anti-psychotic, metabolized via CYP2D6 and CYP3A4. Not a good combination with Golden Paste. Physician approval required. At one time it was widely used as a sedative in the emergency setting, especially in psych wards.
Profemin: see Furosemide
Proin: see Phenylpropalamine
Prolet: see Carprofen
Promolut-Nor: see Norethisterone acetate
Propalin: see Phenylpropalamine
Propecia: see Finasteride
Propentofylline
Trade names Vivitonin, others
Like pentoxyfylline, this actually is a blood thinner. It’s prescribed mainly for dementia in dogs. Should be okay with Golden Paste.
Propentophylline
Trade name Canergy
A phosphodiesterase inhibitor that is a strong vasodilator. Prescribed in veterinary practice for cognitive dysfunction in dogs and cats. It is a TNF-alpha inhibitor like turmeric, and shares some of turmeric’s anti-inflammatory benefits. However, as a xanthine derivative, its clearance can be slowed by turmeric. Probably still okay with Golden Paste.
Proscar: see Finasteride
Prothiaden: see Dosulepin
Prozac: see Fluoxetine
Purinethol: see Mercaptopurine
Q
Quellin: see Carprofen
Qvar: see Beclometasone
R
Ranexa: see Ranolazine
Ranolazine
Trade name Ranexa
Ranolazine is prescribed for chronic angina. It’s a potent vasodilator. It is a CYP3A4 substrate and a CYP2D6 inhibitor, and its clearance will be affected by any CYP3A4 inhibitor like turmeric and pepper. Doctor consult required.
Rasagiline
Trade name Azilect
An irreversible MAO-B inhibitor used to treat Parkinson’s. Given that both turmeric and pepper are non-selective MAO inhibitors, this is not a good combination with Golden Paste. The manufacturer states explicitly not to prescribe if MAO inhibitors are in use. That refers to prescription MAO’s, which are far more potent than either turmeric or pepper, but the caution is still important. Physician consult required.
Reaptan: see Perindopril and Amlodipine
Reclast: see Zolendronic acid
Relentus: see Tizanidine
Reproval: see Carprofen
Rifampin
Also known as: Rifampicin, Rifabutin, Rifapentine, Rifamixin
A semisynthetic derivative of the rifamycin class. Antbiotic, effective against many forms of mycobacteria, typically prescribed for tuberculosis, leprosy and mycobacterium avium complex (MAC). Okay with Golden Paste BUT–it is a potent inducer of CYP3A4. So the turmeric in Golden Paste may be cleared faster than would be the norm, in spite of the pepper. Rifampicin is one of the standard test compounds used as a benchmark for CYP3A4 induction (just as ketoconazole is for CYP3A4 inhibition).
Sources:
More detail and references
DrugBank: https://www.drugbank.ca/drugs/DB01045
PubChem: https://pubchem.ncbi.nlm.nih.gov/compound/5381226
Stockley’s: Chapter 1, Page 6, Table 1.4
Rilexine: see Cephalexin
Rimadyl: see Carprofen
Rimifin: see Carprofen
Rinexin: see Phenylpropalamine
Risperidone
Mechanism of Action: Has high affinity for serotonin type 2 (5-HT2) receptors; binds to dopamine D2 receptors with 20 times lower affinity than that for 5-HT2 receptors; antagonizes alpha1-adrenergic, alpha2-adrenergic, and histaminergic receptors; has moderate affinity for serotonin type 1 (5-HT1C, 5-HT1D, 5-HT1A) receptors; has weak affinity for dopamine D1 receptors; has no affinity for muscarinic, beta1-adrenergic, and beta2-adrenergic receptors. Absorption: Peak plasma time, steady-state: 4-6 hr (SC)
Peak plasma concentration: 6.33-10.9 ng/mL (risperidone, 9-hydroxyrisperidone)
AUC: 2262-3891 ng·hr/mL
Bioavailability: 70%
Peak plasma time: Extensive metabolizers, 3 hr; poor metabolizers, 17 hr
More detail and references
Metabolized in liver by CYP2D6
Metabolite: 9-hydroxyrisperidone (paliperidone)
Elimination: Half-life: Extensive metabolizers, 3 hr (parent and metabolite combined); poor metabolizers, 20 hr (parent and metabolite combined); prolonged in renal impairment; free fraction increase in hepatic disease. Half-life: 8-9 days (9-hydroxyrisperidone and total active moiety) Excretion: Urine (70%), feces (14%)
Physician consult recommended, given its potent interactions with many other medications. Whole turmeric and black pepper are unlikely to affect its clearance (and thus its serum levels) significantly. However, both curcumin extracts and CBD are moderate to potent CYP2D6 inhibitors and would likely be a problem along with risperidone.
Ritalin: see Methylfenidate
Rivaroxaban
Trade name Xarelto
Mechanism of Action: anticoagulant. Factor Xa inhibitor that inhibits platelet activation by selectively blocking the active site of factor Xa without requiring a cofactor (eg, antithrombin III) for activity
Blood coagulation cascade is dependent on the activation of factor X to factor Xa via the intrinsic and extrinsic pathways, which play a central role in the blood coagulation cascade
Dose-dependent inhibition of factor Xa activity observed; antifactor Xa activity is also influenced by rivaroxaban; prolongs PT and aPTT and HepTest
Turmeric is also anticoagulant and this effect needs medical monitoring.
Unlike some of the antiplatelet medications, it is possible to obtain INR times for rivaroxaban, though not PTT. In addition, there is now an antidote for the Factor Xa inhibitors (both rivaroxaban and apixaban). Andexanet alfa (trade name Ondexxya) is available in the US and has received a conditional approval in the EU.
Rivotril: see Clonazepam
Rizatriptan
Trade name Maxalt
5HT1 receptor agonist, metabolized by monoamine oxidase, therefore not a good fit with turmeric and pepper. However, it’s not normally used on a regular basis (generally prescribed for migraines). A person who has some warning of an impending migraine might be able to stop the Golden Paste in advance and not take it again for roughly 24 hours (rizatriptan has a half-life of 2-3 hours, so would be cleared within 15-17 hours).
More detail and references
Robax Platinum
Also known as: methocarbamol and ibuprofen, see methocarbamol
We don’t have detailed notes on this medication yet. Ask Dr Doug if you need to know.
Robaxacet
Also known as: methocarbamol and acetaminophen, see methocarbamol
We don’t have detailed notes on this medication yet. Ask Dr Doug if you need to know.
Robaxin: see Methocarbamol
Robaxisal
Also known as: methocarbamol and aspirin, except that in Spain it refers to the combination of methocarbamol and acetaminophen, see methocarbamol
We don’t have detailed notes on this medication yet. Ask Dr Doug if you need to know.
Robenacoxib
Trade name Onsior
An NSAID formulated for veterinary use. Should be okay with Golden Paste.
Rofeniflex: see Carprofen
Ronaxan: see Doxycycline
Rosemide: see Furosemide
Rosiglitazone
Trade name Avandia
A diabetic medication that works as an insulin sensitizer. Because of the high incidence of adverse side effects (mostly the increased risk of heart attacks), rosiglitazone has been taken off the market in Europe, the UK, India, New Zealand and South Africa. It is still available in the US. It’s metabolized via CYP2C8, a pathway which doesn’t involve turmeric or pepper. Generally okay with Golden Paste, with a caution to the user that turmeric also increases insulin sensitivity and can thus also result in reduced blood sugar.
Rosuvastatin
Sold as Cavstat, Crestor and others
Rosuvastatin is another of the ubiquitous statins, prescribed for high LDL cholesterol levels. It’s metabolized primarily by CYP2C9 and CYP2C19, meaning that it’s unlikely to be a problem with Golden Paste. However, the use of curcumin extracts could slow its clearance.
Rovera: see Carprofen
Ruside: see Furosemide
Ruta 6
This is a homeopathic preparation, and because of that, not something that would normally even be included here. However, there is one very interesting trial that suggested its efficacy against brain cancer. No idea whether this journal is a reputable one, or what bona fides the authors have, but if valid, the results were impressive. It doesn’t appear that there would be any interaction with Golden Paste.
References:
More detail and references
International Journal of Oncology: http://www.sciencedirect.com/science/article/pii/S0041134503003774
Rycarfa: see Carprofen
S
Salix: see Furosemide
Sarafem: see Fluoxetine
Scanodyl: see Carprofen
Selegiline Hydrochloride
Trade name Anipryl
Mechanism of Action: Selective MAO-B inhibitor; may increase dopaminergic activity by interfering with dopamine reuptake at the synapse.
Pharmacokinetics: Peak plasma time: (conventional) 0.5-0.9 hr; (ODT) 15-40 mi
Half-life elimination: 10 hr (PO); 18-25hr (TD)
Onset of action: Within 1 hr; Duration: 24-72hr (PO); Bioavailability: 10%
Metabolism: cytochrome P-450 enzymes
Metabolites: L-amphetamine, L-desmethylselegiline, L-methamphetamine. Excretion: Urine
Selegiline hydrochloride is used for control of symptoms in canine cognitive dysfunction syndrome (CDS) and uncomplicated canine pituitary dependent hyperadrenocorticism (PDH). There has been one mention of it being prescribed for a dog with lymphoma (not sure why). We’ve occasionally seen it mentioned as a human medication as well.
More detail and references
Here is the manufacturer’s statement about its use with several classes of drugs:
Concurrent use of ANIPRYL with ephedrine, opioids, phenylpropanolamine, other MAO inhibitors (such as amitraz), and several classes of antidepressants is not recommended. Do not use in dogs with known hypersensitivity to the drug. In clinical studies, the most common adverse events were vomiting, diarrhea or changes in behavior, such as hyperactivity or restlessness.
Best to consult with the doctor or vet on this one.
Selokeen: see Metoprolol
Semintra: see Telmisartan
Serc: see Betahistine dihydrochloride
Sertraline
Sold as Zoloft
An SSRI metabolized via CYP3A4 and multiple others. So its clearance would be slowed by Golden Paste and even more by CBD. in addition to the elevation of serotonin via the MAO inhibition effect of both turmeric and pepper. The other metabolic pathways are CYP2D6, CYP2C19 and CYP2B6, all of which are affected moderately to potently by CBD.
Sevikar, Sevikar HCT: see Olmesartan
Sildenafil
Trade name Viagra
Sildenafil is best known for its effect on erectile dysfunction. But it is also prescribed for pulmonary hypertension. It may be prescribed in combination with ambritensin for that purpose. Its major metabolic route is CY3A4, and should therefore not be combined with Golden Paste without a doctor’s consult
Sources:
More detail and references
DrugBank: https://www.drugbank.ca/drugs/DB00203
Singulair: see Montelukast
Sirdalud: see Tizanidine
Skelaxin: see Metaxalone
Sodium Valproate
Trade names Epilim, Depakote
Anticonvulsant for epilepsy, and also now used increasingly often for bipolar disorder. May be prescribed also for migraines. It’s cleared by one of the pathways that both the pepper and the turmeric in Golden Paste inhibit. Physician consult needed, as it has a long list of toxic side effects that would be worsened by slower clearance and higher plasma levels.
Sofril: see Pramipexole
Solifenacin Succinate
Trade names Vesicare and others
Primarily metabolized via CYP3A4, doctor should be consulted before adding Golden Paste
Sotalol
Also known as: Betapace, Betapace AF, Sorine
Antiarrhythmic: Class II (beta blockade) and class III (action potential prolongation) properties.
Has adrenoceptor-blocking effect and markedly prolongs action potential and repolarization.
Half life 12 hours and excreted unchanged with no metabolism. Should be okay with Golden Paste.
Sovel: see Norethisterone acetate
Spacol T/S: see Hyoscyamine
Spironolactone
Trade name Aldactone
A potassium-sparing loop diuretic primarily prescribed for hypertension. Also prescribed for heart failure, hyperaldosteronism, adrenal hyperplasia, hypertension, and nephrotic syndrome. Because of its androgenic properties, it has been prescribed off label for hirsutism, female pattern hair loss, and adult acne vulgaris. It is also used in medical gender transition. It has a minor interaction with CYP3A4, but is generally okay along with Golden Paste.
Spironolactone
Trade names Prilactone and others
We don’t have detailed notes on this medication yet. Ask Dr Doug if you need to know.
Stemetil: see Prochlorperazine
Stemzine: see Prochlorperazine
Stenerh: see Ursodeoxycholic acid
Styptyn: see Norethisterone acetate
Sunitinib
Sold as Sutent
Sunitinib is a multiple receptor tyrosine kinase inhibitor, with many actions similar to that of turmeric (VEGF inhibitor, CD-17 inhibitor, and others). Because of its similarity to turmeric, it’s also cleared via some of the same metabolic pathways, notably CYP3A4. It’s probably going to be okay with Golden Paste, but the patient needs to get their doctor’s consent.
Sutent: see Sunitinib
Symadine: see Amantadine
Symax: see Hyoscyamine
Symmetrel: see Amantadine
Synapause: see Estriol (Synapause is estriol succinate)
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
