Experts explain how three common supplements can interfere with medications or cause unwanted side effects after 60, plus what to check before taking them.
Reviewed by Dietitian Casey Wing, RD, CD
Key Points
- Red yeast rice may cause harmful side effects, especially if you take statins or have liver issues.
- St. John’s wort can interfere with medications for heart health, blood clots and depression.
- Melatonin may disrupt sleep cycles and cause drowsiness, especially in older adults.
From sleep gummies to capsules promising better heart health, there seems to be a supplement for every ailment out there. And while some can help meet a specific medical need, others may actually do more harm than good.
After 60, deciding what supplements you include in your routine usually means looking at your health conditions, prescriptions and the reason you’re taking each product in the first place. Age alone doesn’t make a supplement unsafe, and you shouldn’t stop a prescribed supplement because it appears on an avoid list. With this in mind, we asked health professionals which products warrant caution after 60. Here are three to discuss with your health care provider before starting or continuing.
Red Yeast Rice
Red yeast rice is often marketed as a natural way to lower cholesterol. But Danielle Oncer, Pharm.D.cautions against it for people over 60. Red yeast rice contains the same active substance as a prescription statin. Called monacolin K, it is chemically identical to lovastatin and can cause similar side effects, including muscle, liver and kidney damage. The amount varies between products and generally isn’t listed on the label, making it difficult to know what dose you’re taking.
There’s also no guarantee the product you buy will lower your cholesterol. In a randomized trial of adults with elevated cardiovascular risk, researchers compared a low-dose statin with several supplements. After 28 days, the red yeast rice product didn’t lower LDL (low density lipoprotein, or “bad”) cholesterol significantly more than a placebo, while the statin did.
Oncer advises avoiding red yeast rice if you already take a statin or have kidney or liver disease. If you’re looking for an alternative because your cholesterol medication causes side effects, discuss that with your prescriber. Red yeast rice can carry the same risks that prompted you to seek another option in the first place.
St. John’s Wort
St. John’s wort is commonly taken for depression, but Reshma Kapadia Patel, Pharm.D.cautions against adding it without checking your medications first. Although research supports its use for mild to moderate depression, it can interfere with prescriptions used to manage heart conditions, prevent blood clots and treat depression.
One concern is that St. John’s wort speeds up the breakdown of certain medications, leaving less available in your body. It can weaken the effects of warfarin, a blood thinner, and digoxin, a heart medication. With some antidepressants, combining them with St. John’s wort can cause a dangerous increase in serotonin-related effects. These interactions make it especially concerning if you take several prescriptions. “I wouldn’t assume a lower dose eliminates the interaction risk,” Patel says. “The specific medication combination matters.”
Patel recommends discussing persistent depression or anxiety with your health care provider so treatment can account for your other medications. If you already take St. John’s wort, ask your health care provider to review it before changing your routine, including stopping it.
Melatonin
Sleep can become increasingly interrupted as you get older. Pain, medications and conditions such as sleep apnea can make it harder to get a full night’s rest. That can make a melatonin supplement appealing, but Patel recommends checking what’s disrupting your sleep before making it a nightly habit. “In an older adult, I want to know why they’re not sleeping and what else they’re taking first,” she says.
Melatonin helps regulate your sleep-wake cycle, but it may stay active longer in older adults, leaving you drowsy the next day. Patel recommends particular caution if you already take medications that cause drowsiness or have balance problems. People taking blood thinners or living with epilepsy also need medical supervision when using melatonin, she adds.
Even the amount you’re taking can be hard to pin down. Researchers tested 25 melatonin gummy products and found that 22 were inaccurately labeled. One particular product tested contained nearly three and a half times the melatonin listed on the bottle.
Melatonin may be useful for certain sleep-timing problems, but its long-term safety remains uncertain. If you regularly struggle to sleep, Patel recommends reviewing possible causes, including pain or medication side effects. Ask about cognitive behavioral therapy for insomnia, or CBT-I, a recommended treatment that addresses habits and thought patterns that interfere with sleep.
Other Safety Tips for Taking Supplements
Before starting a supplement, Robin Arends, D.N.P., CNP, FNP-BC, PMHNP-BCrecommends discussing why you want to take it and which medications you already use with your health care provider. These tips can help you prepare for that conversation and make informed choices about what supplements to take.
- Discuss your complete routine. Patel recommends including prescriptions, over-the-counter medications and supplements you take, even if only occasionally. Record each product’s dose and frequency so your health care provider can assess potential interactions.
- Look for independent testing. Arends recommends USP Verified or NSF certification. These programs assess product quality, including label accuracy and contaminants, but don’t guarantee that a supplement is effective or safe for you.
- Set a review date. Oncer recommends identifying the intended benefit and deciding when to assess whether the product is helping or not.
Our Expert Take
After 60, supplements taken for sleep, mood or cholesterol can complicate treatment for the same conditions you’re trying to manage. Red yeast rice may cause the same side effects as the statin you hoped to avoid, while St. John’s wort can make certain prescriptions less effective. Even a familiar product like melatonin can cause unwanted daytime drowsiness.
Before adding a supplement, discuss what you want it to do and what you already take with your pharmacist or prescriber. If you’re trying to manage persistent sleep problems or low mood, finding the cause can help you choose a treatment that is more likely to help.