Pharmacy & Floor Reference · Confidential, internal use only
Spectrum Health Portfolio Safety Reference
Dosing, paediatric, pregnancy and lactation, renal and hepatic, G6PD, drug interactions, and other cautions across the Spectrum Health portfolio. A quick reference for pharmacists and floor staff when recommending a product. For any Orange or Red position, defer to the pharmacist or physician before recommending.
Legend & rules
Risk tiers
βNot recommended / absolute contraindication
RxConsult HCP / Pharmacist judgement after case review
π©ΊSpecialist advice. Physician or specialist oversight required
β³Dose-adjustment required
βStandard use at labelled dose, no specific concern
Product
Highlight tier
| Product | Adult dose | Child 6-12 yrs | Child 2-6 yrs | Child <2 yrs | Pregnancy | Lactation | Renal / hepatic | G6PD | Drug interactions | Other cautions |
|---|---|---|---|---|---|---|---|---|---|---|
Bromelain Gemedy Bromelain Support daily inflammation balance | βMaintenance: 1 sachet OD before a meal. Acute: 2 sachets OD, titrate up to 2 sachets BD (max 4 sachets/day) until symptoms ease, then step down. | β³Half-sachet OD. | RxNo published mg/kg dose for ages 2-6. Bromelain-POS (URSAPHARM, Germany) is the closest paediatric reference, used in the Braun 2005 sinusitis trial in children under 11.Braun 2005 Β· Locci 2024 | β | βTheoretical uterotonic and bleeding risk at supplement dose. NCCIH Β· Pavan 2012 | β | π©ΊSevere impairment. | βNo documented G6PD trigger signal. | π©ΊAnticoagulants / antiplatelets (warfarin, DOACs, aspirin, clopidogrel): not without physician oversight.π©ΊNSAIDs: monitor for additive bleeding.RxAntibiotics (amoxicillin, tetracyclines): space dosing. | βPineapple or bromelain allergy: absolute contraindication.RxPre-surgery or dental: stop at least 2 weeks prior. |
Bromecap Gemedy Bromecap Targeted support for intense inflammation | βMaintenance: 1 cap OD before a meal. Acute: 2 caps OD, titrate up to 2 caps BD (max 4 caps/day) until symptoms ease, then step down. | β | β | β | β | β | π©ΊSevere impairment. | βNo documented G6PD trigger signal. | π©ΊSame as Gemedy Bromelain | — |
 Cozey Support women's health, balance and relaxation | β1 sachet OD in 150ml room temperature water. Best taken 30 mins before sleep for sleep disturbances or poor sleep quality. Max 1 sachet BD (monitor for dizziness). | RxHalf-sachet at pharmacist discretion only where clinically indicated, e.g. paediatric ADHD where saffron 20-30 mg/day carries RCT support. Not for general wellness use in this age group. See ingredient-level paediatric evidence. | β | β | βSaffron uterotonic at high doses. | β | π©ΊSevere impairment. | βNo documented G6PD trigger signal. | π©ΊPsychoactive drugs (SSRI, SNRI, MAOI, tricyclics, benzodiazepines, Z-drugs, prescription sedatives, lithium): avoid concomitant use. Saffron has a SSRI-like serotonergic mechanism; sedative-class stacking carries additive risk. Consult HCP on spacing if patient needs to step down from prescribed psychoactive therapy.π©ΊSt John's wort: avoid (serotonergic stacking).π©ΊAnticoagulants or antiplatelets: theoretical additive bleeding via saffron. | βAllergies: saffron, melon, kombucha.π©ΊBipolar disorder: consult psychiatrist before use. Theoretical mood-switch risk via serotonergic mechanism. |
Glyzempic Glyzempic Daily GLP-1 support for metabolic balance | β1 sachet OD before a main meal. | βUnder 18 yrs not studied. | β | β | βBitter melon has documented abortifacient activity. Bitter Melon LiverTox | β | π©ΊSevere impairment. | βAvoid in known G6PD deficiency. Bitter melon contains vicine and convicine, the same glycosides that drive favism in fava beans. Documented haemolysis case report.Case report Β· Vicine mechanism | β³Antidiabetics (metformin, SU, DPP-4i, SGLT2i, GLP-1 agonists, insulin): additive glucose-lowering. Self-monitor 4 to 6 weeks.RxWarfarin: theoretical CYP3A4 modulation via citrus flavonoids, monitor. | βCitrus or bitter melon allergy: contraindicated. |
Caltivate Caltivate Support bone strength and mobility | β1 sachet OD after meal in 150ml room temperature water. | β³Β½ to 1 sachet OD at HCP discretion within range. | RxOnly where clinically indicated, e.g. confirmed low serum calcium or 25-OH vitamin D. | β | RxCa and D3 routinely supplemented (Malaysia RNI: Ca 1,000 mg/day, vit D 600 IU/day). MK-7 has limited published pregnancy data.CRN MK-7 Β· Malaysia RNI Ca | RxVitamin K LactMed | π©ΊSevere renal or ESKD: hypercalcaemia and ectopic calcification risk. | βNo documented G6PD trigger signal. | βAnticoagulants: warfarin and vitamin K antagonists. Discuss with prescriber before initiation. DOACs unaffected.RxChelation-sensitive medications (levothyroxine, bisphosphonates, tetracyclines, fluoroquinolones, iron): space 4 hoursRxHypercalcaemia risk: thiazide diuretics, digoxin. | π©ΊHypercalcaemia history, primary hyperparathyroidism, sarcoidosis, active nephrolithiasis: specialist oversight.βMarine algae or yeast allergy: contraindicated. |
TMM Advance TMM Advance Respiratory and immunity support | β2 sachets OD. | β1 sachet OD. | β³Half sachet OD. | β | π©ΊLignosus rhinocerus has favourable rat developmental data (NOAEL 3,400 mg/kg/day). Wellmune is EFSA-reviewed with no pregnancy concern signal at supplement dose. Lingzhi (Ganoderma) has no human pregnancy data.Lee 2017 Β· Wellmune EFSA | π©Ί | π©ΊSevere hepatic, renal, or immune disorders. | βNo documented G6PD trigger signal. | βImmunosuppressants (cyclosporine, tacrolimus, mycophenolate, methotrexate, azathioprine, immunosuppressive corticosteroids): theoretical antagonism via Ξ²-glucan immune priming. Avoid unless specialist oversight.βAutoimmune disease (RA, SLE, IBD, MS, etc.): avoid unless specialist oversight.RxAnticoagulants: theoretical additive bleeding via Lingzhi. | βMushroom or yeast allergy: contraindicated. |
Isolyte Isolyte Rehydrate and restore energy | β1 sachet in 200 ml water as needed. Acute GI: 1 per episode, max 5/24h. Sports or heat: 1 post-activity, repeat every 60 min during prolonged activity. Daily wellness: 1 to 2/day. Alcohol hangover: 1 before alcohol, 1 after. | β³Half sachet in 100 ml water per episode, max 4/24h. | β | β | RxNo anticipated safety concern at standard doses.Electrolyte review Β· EFSA isomaltulose | Rx | π©ΊSevere renal or ESKD: specialist oversight required (Na/K load). | βNo documented G6PD trigger signal. | π©ΊACE inhibitors, ARBs, K-sparing diuretics (spironolactone, eplerenone, amiloride): additive potassium load. Serum K monitoring required for daily repeated use. π©ΊLithium: keep sodium intake consistent. Why: lithium clearance competes with sodium renally. A sudden sodium spike can drop lithium below therapeutic range; a sudden sodium drop can push lithium toward toxicity.RxDigoxin: keep potassium intake consistent. Why: Digoxin is highly sensitive to potassium imbalance. Low potassium increases digoxin toxicity risk, while excessive potassium intake may contribute to hyperkalaemia. | RxUncontrolled hypertension: caution at daily repeated use.βHyperkalaemia: contraindicated.βSevere dehydration: may needs IV resuscitation, not oral rehydration. |
ReLeaf ReLeaf Support digestive balance and comfort | β1 sachet OD in 150 ml room temperature water. Max 1 sachet BD for short-course acute relief. | β³Half sachet OD, dissolved in proportionally less water. | π©ΊFirst-line consultation required. | β | π©ΊInulin and acacia gum generally safe at standard doses. The 34-botanical complexity warrants oversight.Inulin in pregnancy Β· BCM-95 safety | π©Ί | RxCaution use with HCP oversight. | βNo documented G6PD trigger signal across the actives. | RxAll oral medications and supplements: separate by at least 2 hrs (fibre reduces absorption).π©ΊWarfarin: cruciferous, garlic, turmeric, and green tea can affect INR. Keep intake consistent, flag anticoagulant clinic. | βBowel obstruction or suspected obstruction: absolute contraindication.π©ΊActive IBD flare: specialist advice required.RxAllergies: pineapple, acacia, multiple botanicals (garlic, onion, broccoli, tomato, citrus in Mitogreens), turmeric or curcumin. |
Footnotes
Cozey paediatric reasoning
Cozey 6β12 yrs: Consult HCP. This framing is based on practical pharmacy use, where half-sachet use may be considered only at HCP discretion.
The full Cozey formulation has no paediatric RCT, but the individual actives have some paediatric evidence at single-ingredient doses:
Saffron 30 mg/day : Paediatric ADHD RCTs used 20β30 mg/day in ages 6β17. Short-term safety was acceptable, with adverse-event frequency similar to methylphenidate. Long-term data not established. Systematic review
Lemon balm 300 mg: Studied in infant colic and adolescent PMS. Generally well-tolerated in paediatric populations. Review
L-theanine 200 mg: ADHD-sleep RCT in boys aged 8β12 used 400 mg/day for 6 weeks and showed improved sleep quality. Short-term safety was clean; long-term data not established. Lyon 2011
Overall, βConsult HCPβ reflects case-by-case HCP judgement, not a paediatric label endorsement.
G6PD Position Summary
Among the 8 Spectrum Health SKUs, only Glyzempic carries a documented G6PD concern, due to bitter melonβs vicine and convicine glycosides, the same trigger mechanism linked to fava bean favism.
The other 7 SKUs have no documented G6PD signal at supplement dose.