Ingredients | Amount Per Serving |
---|---|
((90% Solids) Yielding:)
(Cranberry Juice Powder Note: (90% Solids)
Yielding: )
|
400 mg |
Quinic Acid
|
52 mg |
52 mg | |
36 mg |
Vegetable Cellulose, Rice Flour, Vegetable Stearate, Silica
Below is general information about the effectiveness of the known ingredients contained in the product Cranberry. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
Alpha hydroxy acids represent a group of natural chemicals that are used alone or in combination. See specific monographs for effectiveness information.
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
Below is general information about the safety of the known ingredients contained in the product Cranberry. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
Some alpha hydroxy acids are used topically, while others are used orally, intravaginally, or by inhalation. See specific monographs for safety information.
PREGNANCY AND LACTATION:
See specific monographs for safety information.
LIKELY SAFE . .when used orally and appropriately. Cranberry juice up to 300 mL daily and cranberry extracts in doses up to 800 mg twice daily have been safely used in clinical trials (3333,3334,6758,6760,7008,8252,8253,8254,8995,11328) (16415,16720,17100,17126,17176,17210,17524,46379,46388,46389)(46390,46425,46439,46443,46465,46456,46466,46467,46469,46471)(46496,46499,90044,102847,111407).
CHILDREN: LIKELY SAFE
when cranberry juice is consumed in amounts commonly found in the diet (2811,6759,46441,46452,46470,111407).
There is insufficient reliable information available about the safety of cranberry when used in medicinal amounts in children.
PREGNANCY AND LACTATION: LIKELY SAFE
when consumed in amounts commonly found in the diet.
There is insufficient reliable information available about the safety of cranberry when used therapeutically during pregnancy or lactation; avoid using.
LIKELY SAFE ...when used orally in amounts commonly found in foods. Malic acid has Generally Recognized as Safe (GRAS) status in the United States. Allowed maximum levels of malic acid in foods are as follows: 3.4% for nonalcoholic beverages; 3% for chewing gum; 0.8% for gelatins, puddings, and fillings; 6.9% for hard candy; 2.6% for jams and jellies; 3.5% for processed fruits and fruit juices; 3% for soft candy; and 0.7% for all other food categories (26969,95594).
POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts, short-term. Malic acid 1200 mg twice daily has been used with apparent safety for up to 6 months (3262). ...when used topically on oral mucosal surfaces. Specific malic acid combination products (Xeros Dentaid, Dentaid) have been used with apparent safety in spray and lozenge formulations for up to 6 months (92211,92213,95565,104757,104778). There is insufficient reliable information available about the safety of malic acid when used topically on the skin. Historically, malic acid has been used with apparent safety in cosmetics as a pH adjuster or fragrance ingredient, and at concentrations below 2% when used in shampoo, hair styling products, or sun protection products (26868,95595,111742).
PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in amounts commonly found in foods (26969,95594).
There is insufficient reliable information available about the safety of using malic acid in medicinal amounts during pregnancy or lactation.
Below is general information about the interactions of the known ingredients contained in the product Cranberry. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
Theoretically, cranberry might increase levels and adverse effects of atorvastatin.
Details
In one case report, a patient taking atorvastatin experienced upper back pain, rhabdomyolysis, and abnormal liver function after drinking cranberry juice 16 ounces daily for 2 weeks. Theoretically, this may have been caused by inhibition of cytochrome P450 3A4 (CYP3A4) enzymes by cranberry juice, as atorvastatin is a CYP3A4 substrate. Creatinine kinase and liver enzymes normalized within 2 weeks of stopping cranberry juice (90042). Patients taking atorvastatin should avoid large quantities of cranberry juice.
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Theoretically, cranberry might increase the levels and adverse effects of CYP2C9 substrates. However, research is conflicting.
Details
There is contradictory evidence about the effect of cranberry on CYP2C9 enzymes. In vitro evidence suggests that flavonoids in cranberry inhibit CYP2C9 enzymes (10452,11115,90048). However, clinical research shows that cranberry juice does not significantly affect the levels, metabolism, or elimination of the CYP2C9 substrates flurbiprofen or diclofenac (11094,90048). Also, in patients stabilized on warfarin, drinking cranberry juice 250 mL daily for 7 days does not significantly increase the anticoagulant activity of warfarin, a CYP2C9 substrate (15374). Additional pharmacokinetic research shows that cranberry juice does not increase peak plasma concentrations or area under the concentration-time curve of warfarin (15393).
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Theoretically, cranberry might increase the levels and adverse effects of CYP3A4 substrates.
Details
A case of upper back pain, rhabdomyolysis, and abnormal liver function has been reported for a patient taking atorvastatin, a CYP3A4 substrate, in combination with cranberry juice 16 ounces daily for 2 weeks. Creatinine kinase and liver enzymes normalized within 2 weeks of stopping cranberry juice (90042). Also, animal research suggests that cranberry juice, administered intraduodenally 30 minutes prior to nifedipine, a CYP3A4 substrate, inhibits nifedipine metabolism and increases the area under the concentration-time curve by 1.6-fold compared to control (46420).
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Theoretically, cranberry might modestly increase the levels and adverse effects of diclofenac.
Details
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Theoretically, cranberry might increase the levels and adverse effects of nifedipine.
Details
Animal research suggests that cranberry juice, administered intraduodenally 30 minutes prior to nifedipine treatment, inhibits nifedipine metabolism and increases the area under the concentration-time curve by 1.6-fold compared to control (46420). This interaction has not been reported in humans.
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Theoretically, cranberry might increase the levels and adverse effects of warfarin. However, research is conflicting.
Details
There is contradictory evidence about the effect of cranberry juice on warfarin. Case reports have linked cranberry juice consumption to increases in the international normalized ratio (INR) in patients taking warfarin, resulting in severe spontaneous bleeding and excessive postoperative bleeding (10452,12189,12668,21187,21188,21189,46378,46396,46411)(46415,90043). Daily consumption of cranberry sauce for one week has also been linked to an increase in INR in one case report (16816). In a small study in healthy young males, taking a high dose of 3 grams of cranberry juice concentrate capsules, equivalent to 57 grams of fruit daily, for 2 weeks produced a 30% increase in the area under the INR-time curve after a single 25-mg dose of warfarin (16416). However, 3 very small clinical studies in patients stabilized on warfarin reported that cranberry juice 250 mL once or twice daily for 7 days (27% cranberry juice or pure cranberry juice) or 240 mL once daily for 14 days does not significantly increase INR or affect plasma warfarin levels (15374,17124,90045). The reasons for these discrepant findings are unclear. It is possible that the form and dose of cranberry may play a role, as cranberry extracts and juices contain different constituents. Additionally, an in vitro study evaluating 5 different cranberry juices found varying effects, with only a cranberry concentrate, and not diluted cranberry juices, inhibiting CYP2C9. However, this concentrate did not inhibit CYP2C9 activity in humans (108062).
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Theoretically, malic acid might increase the risk of hypotension when taken with antihypertensive drugs.
Details
Animal research shows that malic acid isolated from tagetes roots can reduce mean arterial blood pressure (26970).
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Below is general information about the adverse effects of the known ingredients contained in the product Cranberry. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
General ...Alpha hydroxy acids represent a group of natural chemicals, some of which can cause adverse effects. See specific monographs for safety information.
General
...Orally, cranberry seems to be well tolerated.
Most Common Adverse Effects:
Orally: Diarrhea and gastrointestinal discomfort.
Dermatologic ...Orally, skin redness and itching has been reported in one patient (46389).
Gastrointestinal ...In very large doses, for example 3-4 L per day of juice, cranberry can cause gastrointestinal upset and diarrhea, particularly in young children (46364). There are reports of abdominal and gastrointestinal discomfort after taking cranberry tablets, extracts, and juice in clinical trials (16720,46379,111407). Nausea, vomiting, and diarrhea have also been reported with consumption of lower doses of cranberry juice cocktail, 16 ounces per day, equivalent to about 4 ounces cranberry juice, for several weeks (16415).
Genitourinary ...Vulvovaginal candidiasis has been associated with ingestion of cranberry juice (46374). Clinical research suggests that ingestion of cranberry juice may be associated with vaginal itching and vaginal dryness (46471). One patient in clinical research stopped taking dried cranberry juice due to excessive urination (46437), and an isolated case of nocturia following ingestion of cranberry tablets has been reported (16720).
Hematologic ...Thrombocytopenia has been reported as an adverse event to cranberry juice (46459).
Other ...An isolated case of sensitive swollen nipples after taking cranberry tablets has been reported (16720).
General
...Orally, malic acid seems to be well tolerated.
Topically, malic acid seems to be well tolerated when applied to oral mucosal surfaces. A thorough evaluation of safety outcomes with topical malic acid use on the skin has not been conducted.
Most Common Adverse Effects:
Topical: Eye irritation, skin irritation, and skin peeling.
Dermatologic ...Topically, malic acid may cause moderate to strong skin irritation and peeling (26968,95564,95595). In patients first patch tested with malic acid, next instructed to avoid foods containing malic or citric acid, and then challenged with foods containing high amounts of malic and citric acid, skin reactions including immediate hives and delayed contact dermatitis occurred (26968).
Gastrointestinal ...Orally, diarrhea and nausea have been reported for patients taking a specific combination product (Super Malic) containing malic acid1200 mg and magnesium 300 mg twice daily. However, it is unclear if the adverse effect is due to malic acid, since it is known that magnesium can have a laxative effect at this dose (3262).
Ocular/Otic ...Topically, malic acid might irritate the eyes, especially in formulations containing 2. 27% or more malic acid (26968,95564,95595).