6 Supplements Pharmacists Would Never Recommend to Women Over 60

The world of supplements can be tricky. There’s a million options. And they all make claims that seem too good to be true (and many are.) But that’s not to say all supplements are just marketing schemes.

Many have actual benefits. You just need to make sure you’re choosing the right supplement from a reputable brand that actually puts in the the ingredients that they claim to put in. 

To go one step deeper, the supplements that are safest for you (and your gender and age) may not be safe for someone else. And vice versa. Age, the prescriptions you’re taking, and your body’s changing ability to clear compounds all shift the equation. For women over 60 the stakes climb pretty quickly.

Things like drug interactions multiply. Your tissues hold onto fat-soluble vitamins longer. And many of the most aggressively marketed supplements have never been tested in older-adult populations at all. Kind of a yikes. So how can you manage this maze of products?

We put together this short list of what you should watch out for. Keeping in mind, this is not exhaustive. These six supplements that pharmacists raise eyebrows at when a woman over 60 mentions she’s taking them, organized by what the research actually shows.

If you want the companion piece on what to take, see 9 Best Vitamins and Supplements for Women in Their 60s.

Pharmacists’ Six-Item Watchlist for Women 60+

And a quick note on pharmacists. A lot of people don’t use their pharmacist for advice as much as they could. They are right there and it’s like having access to a medical professional that is free of charge. Feel free to ask one at your local pharmacy the next time you’re there.

What to take instead is covered with each one below.

1. High-Dose Vitamin E

Vitamin E is widely sold at most stores as an antioxidant and heart-health supplement. At low doses, it’s generally safe. At high doses — 400 IU or more per day — it can start to become problematic.

A 2005 meta-analysis from Johns Hopkins, published in Annals of Internal Medicine, pooled nineteen randomized trials covering more than 135,000 participants. Specifically, high-dose vitamin E supplementation was associated with a small but statistically significant increase in all-cause mortality — enough that the authors concluded such doses “should be avoided.”

Vitamin E also has blood-thinning properties, which is important to be very aware of. For women over 60 who take aspirin, warfarin, or any direct oral anticoagulant, that interaction is a meaningful bleeding-risk multiplier.

Most older adults already get adequate vitamin E through diet without supplementing, which is why geriatricians tend to treat the high-dose pill aisle as low-hanging fruit in a “stop taking this” conversation. Or at least think twice before jumping in. And as always, ask your medical professional before adding any of this to you regimen.

2. Iron Supplements (Without a Diagnosed Deficiency)

Let’s start out by saying one important thing: Don’t self diagnose! Iron is one of those easy things to assume. If you’re tired, then you probably are low on iron. So we find that a lot of the people who start their own iron supplement self-diagnosed themselves based on how tired they are.

But that’s not always the case at all. And having that assumption be wrong can have some significantly negative consequences. And let’s be honest, are we all a little tired most of the time.

Life is hectic! Having gotten that out of the way, iron deficiency is common in premenopausal women. After menopause, the picture flips.

Without monthly blood loss, most women over 60 don’t need supplemental iron and can accumulate too much. Importantly, excess iron is stored in tissue, not excreted.

Longitudinal cohort data from eastern Finland (the long-running Kuopio Ischaemic Heart Disease study) and others have linked high body-iron stores to oxidative stress and elevated cardiovascular risk, and iron overload is a well-established driver of liver damage.

The best thing to do (as always) is to get some simple bloodwork done to see where your iron levels actually are. Supplements shouldn’t be an easy way out. And if you don’t know your bloodwork you’re flying blind.

As Dr. Victoria Maizes, MD, executive director of the Andrew Weil Center for Integrative Medicine at the University of Arizona, puts it: “Excess iron can increase the risk of heart disease, diabetes and various kinds of organ damage.” Many standard multivitamins still contain iron because they’re formulated for the broader adult population.

If you’re over 60 and not iron-deficient, look specifically for a senior or 50+ formulation that lists no iron — and don’t supplement iron without a blood test (ferritin is the most informative single number) confirming you actually need it. Self-prescribed iron is one of the few supplements where “more” can be actively damaging.

3. Kava

There’s one trope in the supplement world that we’d like to put an end to. And that is people typically think “natural means safe.”

That is not the case (remember, uranium is natural and you wouldn’t take an “All-Natural Uranium” supplement.) Kava is marketed for stress and anxiety relief and does have real pharmacological effects: it produces sedation and reduces anxiety in clinical trials.

But there’s also an important caveat. It has a pretty well documented risk of serious liver toxicity. In 2002, the U.S. Food and Drug Administration issued a consumer advisory after reports of liver damage — including at least one case requiring a liver transplant — were associated with kava-containing supplements.

The risk around kava is basically dose-dependent. Moderate kava intake has been associated with severe hepatoxicity. And the problem for women over 60 is they are more likely to be on meds that metabolize through the same liver pathways that kava.

This is why kava lands on a lot of pharmacist’s “don’t” lists. If you’re looking for a sleep aid of some kind, most medical professionals would recommend a 200-400 mg dose of magnesium glycinate at bed time. It’s been studied a ton.

4. DHEA

DHEA is a hormone precursor that is sold over the counter as an anti-aging supplement. It’s usually marketed for energy, mood, bone density, and libido.

The problem is what happens inside the body: DHEA converts to estrogen and testosterone through pathways that aren’t tightly regulated, so the same daily dose can shift hormone levels meaningfully in some women and barely at all in others.

Which is why you really should consult a medical professional before taking a new supplement. We don’t mean to be a broken record, but while these supplements can be beneficial, they can also cause serious harm. As Rachel Pope, MD, an OB/GYN and certified menopause practitioner at University Hospitals, puts it:

For women with a personal or family history of hormone-sensitive cancers — breast, ovarian, endometrial — that unpredictability is a meaningful concern. The Mayo Clinic (you’ve probably heard of it) advises that anyone with a hormone-sensitive cancer should not use DHEA, and notes that quality control on the supplement is often poor.

We wish they would put this type of information on every bottle For those on prescribed hormone replacement therapy, over-the-counter DHEA can confound the dose their physician is carefully titrating. So pharmacists are firm on this one: skip it unless your endocrinologist or OB-GYN has specifically recommended it and is monitoring your labs.

5. St. John’s Wort

Ok, this one is really worth noting. St. John’s Wort is one of the most-studied herbal supplements for mild depression. We hgave probably known someone who has tried SJW at some point in their lives thinking it was a natural alternative to Prozac or SSRIs. But the catch?

It is also one of the most dangerous drug-interactors on the market. It induces a liver enzyme called CYP3A4 — meaning it ramps up the enzyme’s activity and speeds the breakdown of other drugs, which can quietly drop their levels below the dose you were prescribed.

CYP3A4 helps metabolize a large share of prescription drugs in use today. So talk to your doctor! The National Center for Complementary and Integrative Health, part of the NIH, names St. John’s Wort as a potent inducer that interferes with drugs including blood thinners (warfarin), the heart-rhythm drug digoxin, immunosuppressants, oral contraceptives, and antidepressants; the broader pharmacology literature adds statins and some chemotherapy drugs to that list.

The average woman over 60 in the United States takes 3.5 prescriptions. The problem is St. John’s Wort can have negative side effect (from causing real problems to just making your prescriptions less effective.) on many of them.

The fact that SJW is sold near daily multivitamins and has the word “natural” all over the labels, most folks assume is safe and probably benign.

One of those products that “can’t hurt” so you think the downside is low. But as we’ve learned here that’s not the case at all. If you want help navigating the supplement and vitamin aisle, check out our pharmacist’s guide to reading a supplement label.

6. High-Dose Calcium Supplements

Calcium is another one that most people feel “more equals better” about. We all know we lose bone density as we age, so the more calcium we take the stronger our bones will be, right? Well, not so fast. Calcium supplementation had been the default women’s-health recommendation for decades.

But recently the evidence has gotten more complicated. In a 2010 study calcium supplements — not dietary calcium — were associated with roughly a 30% relative increase in heart-attack risk among people taking calcium without co-administered vitamin D. 30% is a very large number!

More recent studies have honed the risks more carefully. Most of the cardiovascular risk concentrates around high single doses (above 500 mg at once), without vitamin D, on a baseline of already-adequate dietary calcium. Calcium is one of those minerals where you probably don’t need a supplement for a few reasons.

First, it’s available in a lot of foods. And a small diet change can really have an impact on how much calcium you’re ingesting. And second, and most importantly, we typically recommend gewttig your vitamins and minerals from food whenever possible.

Food intake almost always triumphs over the supplement intake. It’s more natural and the body usually processes it better. So do your best to up calcium-rich foods and you should be pretty good to go. “I tell my patients to make sure they’re getting adequate amounts of calcium from their diets,” says Dr. Rhanderson Cardoso, a cardiologist at Harvard-affiliated Brigham and Women’s Hospital. The pharmacist’s translation is the same: get calcium from food where possible; if you supplement, cap each dose at 500 mg, pair with vitamin D3 and magnesium, and don’t double up on calcium-fortified products without realizing it.

Now would be a good time to audit your medicine cabinet (or wherever you keep your supplements.) Which ones do you have on this list? How often do you take them? And have you ever talked to a medical professional about any of them. Easy answers to some pretty important questions.

And remember, “natural” is not the same as “safe at any age.” Each of the six supplements above has a defensible use case in certain demographics and populations. But these nuances matter. A lot! Just not, on the available evidence, in women over 60 who are also taking prescription medications without medical supervision.

The simpler version: Just take five minutes to check with your local pharmacist before starting anything new, make sure you eat food first whenever the math allows, and check out our companion pieces on what to take in your 60s, your 70s, and how to make 65–85 your healthiest years yet when you’re building a stack rather than pruning one.

The six at a glance, with safer alternatives

Anthony Fanucci, Pharm.D.

Anthony is a licensed pharmacist and freelance medical writer. He received his Doctor of Pharmacy at Wilkes University, where he graduated Magna Cum Laude. He is also a JD candidate at Penn State Dickinson Law school. Anthony writes, edits, and reviews content for a large number of clients within the medical and health industries. From individual practitioners to medical startups, Anthony’s clients rely on him for accurate information that will ultimately benefit patients and consumers.