What bodybuilding supplements can predispose to intracranial hemorrhage (ICH)?

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Last updated: June 17, 2025View editorial policy

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From the FDA Drug Label

ADVERSE REACTIONS ... NERVOUS SYSTEM Cerebral Hemorrhage 1 (2.2) 0 (0.0)

The caffeine supplement can predispose to Intracranial Hemorrhage (ICH), as evidenced by the reported case of Cerebral Hemorrhage in the drug label 1.

  • Key points:
    • Caffeine is a bodybuilding supplement that may increase the risk of ICH.
    • The drug label reports a case of Cerebral Hemorrhage associated with caffeine use.

From the Research

Bodybuilding supplements that can predispose to intracranial hemorrhage (ICH) include those containing stimulants like ephedra, yohimbine, and high doses of caffeine, as well as supplements with blood-thinning properties such as fish oil, vitamin E, ginkgo biloba, and garlic extracts. The most recent and highest quality study 2 found that caffeine consumption, coffee consumption, lifting heavy weights, minor head trauma, sexual activity, straining for defecation, and vigorous exercise can increase the risk of ICH. Some key points to consider include:

  • Pre-workout formulations with multiple stimulants pose particular danger due to their combined effects on blood pressure.
  • Anabolic steroids and SARMs (selective androgen receptor modulators) can contribute to ICH risk by increasing blood pressure, altering cholesterol levels, and potentially causing liver damage that affects clotting factors.
  • Supplements create risk through various mechanisms including hypertension, altered blood vessel integrity, reduced platelet function, and changes to normal clotting mechanisms.
  • A case report 3 documented a healthy 25-year-old male who experienced a bilateral cerebellar hemorrhagic stroke occurring shortly after taking a supplement named Animal Rage XL, which contains ingredients that can cause hypertension, tachycardia, and vasospasm.
  • Another study 4 reported a case of cerebral haemorrhage potentially associated with Ginkgo biloba leaf extract. Anyone using these supplements should be aware of warning signs like severe headache, confusion, weakness on one side of the body, vision changes, or difficulty speaking, which require immediate medical attention.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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