The 5 Supplements Pharmacists Would Never Take

It's your pharmacist's job to know the ins and outs of every medication in the drug store. But they're also a wealth of knowledge when it comes to vitamins and supplements — including the potential risks or downsides you should be aware of.

In fact, there may be some supplements on the drugstore shelf that the pharmacist might recommend avoiding, especially if you haven't consulted with your doctor first. At the top of the list: These five popular picks.

The traditional Ayurvedic herb is a favorite among health influencers for its potential to relieve stress and anxiety, enhance sleep and support energy levels.

"There is a lot of evidence to support its use; however, the amount in which each individual is able to tolerate varies, and there is not enough research with randomized controlled trials to know exactly how much each person can tolerate," says Sonia Amin Thomas, PharmD, BCOP, interim co-chair of the Department of Pharmacy Practice at PCOM Georgia.

That's problematic because ashwagandha often shows up in products like teas and latte blends, protein powders and even multivitamins — but we just don't have good data on the long-term safety of ashwagandha, Thomas says. And in rare instances, it's been shown to have negative effects on liver and thyroid function, according to the National Institutes of Health (NIH).

That's not to say you need to avoid ashwagandha completely. But it's important to have a conversation with your health care provider about whether it's a healthy choice for you.

"This is a great supplement when used the correct way and under the proper guidance of a health care professional, but routine use without knowing too much about it should be done with caution," Thomas says.

Kava powders, tinctures, concentrates and pills abound, with many products claiming this herbal remedy can help ease feelings of anxiety. And indeed, there's some evidence to support that — but kava has also been linked to some harmful side effects, including severe liver toxicity according to the National Center for Complementary and Integrative Health (NCCIH).

That's why Katy Dubinsky, PharmD, CEO of Vitalize, recommends steering clear. "Kava's compounds actively harm liver cells, with the danger growing when one combines them with alcohol or medications that the liver also metabolizes," she says. "In spite of its calming effects, the potential for liver damage is considered a high-risk option."

Some people turn to licorice root tea for help managing GI problems like bloating or nausea, or to support recovery for bacterial and viral infections. Problem is, "many people buy herbal teas over the counter and don't realize the amount of licorice that might be in each one," Thomas says. And consuming large quantities of licorice for long periods can cause harmful side effects like elevated blood pressure, according to the NCCIH.

Like ashwagandha, supplements with licorice root don't have to be a complete no-go. But you should discuss your use with your doctor first and decide together on how much to take, Thomas says. "My recommendation is to check the ingredients and know exactly how many milligrams you are ingesting," she adds.

Some people try this herbal remedy as a way to manage mild depression, and it can potentially be effective, notes the Mayo Clinic.

But St. John's wort also has the potential to interact with many types of medications, which could set the stage for harmful side effects, Dubinsky says. Those meds include birth control pills, chemotherapy drugs, cyclosporine, narcotics, heart medications like digoxin and blood thinners like warfarin.

"Birth control pills, blood thinners and chemotherapy drugs can experience reduced effectiveness," when taken alongside St. John' wort, Dubinsky warns.

You also shouldn't take St. John's wort if you're already on antidepressants. The combination could increase your risk for serotonin syndrome, a life-threatening condition that occurs when the brain's levels of the neurotransmitter serotonin get too high and cause symptoms like high blood pressure and rapid heartbeat, warns the NCCIH.

Sometimes touted as a natural cholesterol-lowering alternative to statins, red yeast rice comes with some serious health concerns, Dubinsky says. It's thought to potentially contain monacolin K, which is the same active ingredient in the prescription drug lovastatin. As such, red yeast rice may pose similar side effects to statins, like liver damage and muscle disorders, notes the Mayo Clinic. The risk for liver damage is higher if you drink alcohol or grapefruit juice (or eat grapefruit), according to Mount Sinai.

Monacolin K may also interact with other meds you might be taking, "such as certain antibiotics, the antidepressant nefazodone and drugs for fungal infections as well as HIV infections, along with other cholesterol-lowering medications," Dubinsky says.

Many supplements can be a part of a healthy diet. But it's important to be thoughtful about what you take. Herbal remedies have different effects at different dosages and on different people. That's paired with the fact that you don't always know what you're actually getting from a given product, say Thomas and Dubinsky.

To reap the benefits of supplements while staying safe, you should:

• ‌Get the green light from your doctor first.‌ You can talk about the benefits and drawbacks of a given supplement with your current health and medical history in mind. Your doctor may also have recommendations for a specific product or brand that they know is high-quality.
  
• ‌Buy certified products.‌ Look for the seal of a third-party certifier like NSF or the United States Pharmacopeia (USP), recommends the Council for Responsible Nutrition (CRN). Verification can indicate that the product has met specific manufacturing standards and contains the ingredients and ingredient amounts listed on its label.
  
• ‌Stick with big-name brands from big-name retailers.‌ Major brands sold by long-established vendors (like GNC or The Vitamin Shoppe) are more likely to stand behind their products than some lesser-known brands or retailers.