| Insulin and sulfonylureas | Monitor | Chromium, allulose, glucomannan | Three ingredients act on glucose through different routes. The combined effect is modest, but for a patient on hypoglycemia-prone therapy, monitor glucose when starting rather than assuming Ozzi is inert. |
| Levothyroxine | Separate | Glucomannan, chromium | Both fiber and chromium can reduce levothyroxine absorption. Levothyroxine is usually taken fasting in the morning and Ozzi after meals, so usual timing already keeps them apart. Worth confirming with the patient. |
| Oral drugs with a narrow therapeutic range | Separate | Glucomannan | Examples include warfarin, digoxin, lithium and antiepileptics. Viscous fiber can delay or reduce absorption of oral drugs taken at the same time. General guidance for soluble fiber is to take oral medications at least 1 hour before, or a few hours after. |
| Injectable GLP-1 receptor agonists | Consider | Glucomannan, allulose | No known pharmacological interaction. These patients often have delayed gastric emptying and GI side effects, and fiber plus allulose may add to nausea or bloating. Starting at 1 stick after dinner is sensible. |
| Oral GLP-1 receptor agonist tablets | Timing | All | These tablets have strict fasting administration requirements before any food, drink or other medication. Ozzi taken after a later meal doesn't conflict, but it shouldn't be taken in that pre-dose window. |
| Metformin | Theoretical | Ursolic acid, chromium | Ursolic acid acts through AMPK, as metformin does, and chromium supports insulin response. No interaction is documented. Mentioned because the mechanisms overlap. |
| HDAC-inhibitor oncology therapy | Theoretical | Butyrate | Butyrate is itself an HDAC inhibitor. No interaction is documented at supplement doses, but defer to the treating oncologist. |
| Everything else | Low | | No caffeine or stimulants, so no concern with blood pressure or cardiac medications on that front. No berberine, which is common in this category and carries real CYP interaction potential. |