Is it safe to take black cohosh, vitamin D with K2, and fish oil with Lamictal (lamotrigine) and Viibryd (vilazodone) simultaneously?

Safety of Taking Black Cohosh, Vitamin D with K2, and Fish Oil with Lamictal and Viibryd

Black cohosh should not be taken with Lamictal (lamotrigine) and Viibryd (vilazodone) due to potential risk of serotonin toxicity and rhabdomyolysis. 1

Potential Drug-Supplement Interactions

Black Cohosh

• High Risk: Recent case reports document serotonin toxicity and rhabdomyolysis when black cohosh is combined with serotonergic medications like Viibryd (vilazodone) 1
• Black cohosh has been associated with liver toxicity in some cases 2
• Clinical guidelines indicate that black cohosh has shown limited efficacy for menopausal symptoms and may pose safety concerns 3
• The 2017 NCCN guidelines specifically note that "randomized data in breast cancer survivors show no benefit" for black cohosh for vasomotor symptoms 3

Vitamin D with K2

• Low Risk: No significant interactions documented with Lamictal or Viibryd
• Generally considered safe to take with most medications
• May provide health benefits for bone health when taken at appropriate doses

Fish Oil (Omega-3 Fatty Acids)

• Moderate Risk: May have minor interactions with medications
• Can potentially increase bleeding risk, but this is primarily a concern with anticoagulants, not with Lamictal or Viibryd 3
• International Society for Nutritional Psychiatry Research notes that omega-3 supplements are generally safe but recommends monitoring certain parameters when using higher doses 3

Medication-Specific Concerns

Lamictal (Lamotrigine)

• Primary metabolism is through glucuronidation, not through CYP450 pathways
• Limited evidence for significant interactions with the supplements you're taking
• However, any supplement that affects liver function could theoretically impact lamotrigine metabolism

Viibryd (Vilazodone)

• Metabolized primarily by CYP3A4
• Has serotonergic properties that could potentially interact with black cohosh 1
• The combination with black cohosh specifically has been documented to cause serotonin toxicity 1

Recommendations

1. Discontinue black cohosh immediately due to documented risk of serotonin toxicity and rhabdomyolysis when combined with serotonergic medications like Viibryd 1

2. Vitamin D with K2 can be continued as there are no documented significant interactions with your medications

3. Fish oil can be continued with monitoring for any unusual bleeding or bruising

4. Take supplements at least 2 hours apart from medications to minimize any potential absorption interactions

5. Monitor for symptoms of serotonin toxicity including:

   • Agitation or restlessness
   • Confusion
   • Rapid heart rate
   • Dilated pupils
   • Muscle rigidity
   • Elevated temperature

Important Considerations

• Always inform all healthcare providers about all supplements you are taking
• The quality and purity of supplements vary widely as they are not regulated as strictly as prescription medications
• If you experience any unusual symptoms after taking supplements with your medications, discontinue the supplements and contact your healthcare provider

Remember that while vitamin D with K2 and fish oil are generally considered safe with your medications, black cohosh poses a significant risk when combined with Viibryd due to its serotonergic properties and should be avoided.