Drug-Herb Interactions Database

	A	B	C	D	E	F	G	H	I	J	K	L	M
1	Drug	Herb or constituent (dose)	Nature of Interaction	Reference	Recommendation	Study type	Population	Sample size	Duration	Single/ multi drug dose	Pharmaco- kinetic only?	Herb product and/or extract	Other notes

2	5-Fluorouracil	Withania somnifera root extract (2 g tid)	Decreased fatigue vs. no treatment	Biswal 2013	Beneficial to combine	ONR	Malaysian women with breast cancer	100	18 weeks	Multi	No	Himalaya Drug Company, New Dehli, India
3	5-Fluorouracil + oxaliplatin + folinic acid (FOLFOX)	Curcumin (2000 mg qd)	Safe to combine, some preliminary indication of improved efficacy	James 2015	Beneficial to combine	ONR	British adults with metastatic colon cancer	12	24 weeks	Multi	No
4	5-Fluorouracil + oxaliplatin + folinic acid (FOLFOX), some + bevacizumab	Curcumin (2000 mg qd)	Safe to combine, some preliminary indication of improved efficacy	Howells 2019	Beneficial to combine	ORN	British adults with metastatic colon cancer	27	113 days (mean)	Multi	No	Curcumin C3 Complex, Sabinsa Corporation, Piscataway, NJ (containing ∼80% curcumin and 20% demethoxycurcumin and bisdemethoxycurcumin)	Four patients in control group and 8 patients in curcumin group also got bevacizumab treatment (see separate entry)
5	Acetaminophen (paracetamol)	Andrographis paniculata extract (520 mg with 30 mg andrographolides tid)	Reduces risk of progression of disease, duration of disease, speeds virus clearance, reduces days of hospitalization, and accelerates symptomatic recovery significantly, when combined with acetaminophen, vs. placebo.	Ratiani 2022	Beneficial to combine	DBPCR	Georgian adults with mild CoVid-19	86	14 days	Multi	No	Kan Jang/Nergocov, Swedish Herbal Institute
6	Acetaminophen (paracetamol)	Curcuminoids (4 g) + piperine (24 mg)	No interaction	Volak 2013	Fine to combine without dose adjustments	OPRCX	Healthy American adults (6 White, 1 Black, 1 Arab)	8	1 day	Single	Yes	Sabinsa Corporation, Piscataway, NJ
7	Acetaminophen (paracetamol)	Eleutherococcus senticosus root extract (37 mg tid)	Reduces risk of progression of disease, duration of disease, speeds virus clearance, reduces days of hospitalization, and accelerates symptomatic recovery significantly, when combined with acetaminophen, vs. placebo.	Ratiani 2022	Beneficial to combine	DBPCR	Georgian adults with mild CoVid-19	86	14 days	Multi	No	Kan Jang/Nergocov, Swedish Herbal Institute
8	Alprazolam	Eleutherococcus senticosus root extract (485 mg bid)	No interaction	Donovan 2003	Fine to combine without dose adjustments	ONR	Healthy American adults	12	12 days	Single	Yes		CYP3A4 probe drug
9	Alprazolam	Glycyrrhiza glabra, deglycyrrhizinated or DGL (75 mg bid)	No significant interaction	Liu 2023	Fine to combine without dose adjustment	ONR	Healthy American women	19	14 days	Multie	Yes	Natural Remedies (Bangalore, India)	CYP3A4 probe drug
10	Alprazolam	Valeriana officinalis (1 g hs, standardized to 11 mg valerienic acid)	No significant interaction	Donovan 2004	Fine to combine without dose adjustment	ORN	Healthy American adults	12	14 days	Multie	Yes	Dr. Willmar Schwabe GmbH and Co. (Karlsruhe, Germany)	CYP3A4 probe drug
11	Ambrisentan	Hypericum perforatum aerial parts extract (300 mg tid)	Slight reduction in absorption, no clinically-relevant interaction (regardless of CYP2C19 genotype)	Markert 2015	Fine to combine without dose adjustments	ORCX	Healthy German adults	20	20 days	Multi	Yes	Jarsin300 (LI 160), Lichtwer Pharma, Berlin, Germany	CYP2C19 substrate
12	Amitriptyline	Hypericum perforatum aerial parts extract (900 mg qd)	Significant reduction in serum amitriptyline and metabolites within 3 days, but no obvious interference with antidepressant efficacy	Johne 2001	Combine cautiously, may require higher amitriptyline dose, monitor carefully	ORN	German adults with depression	11	14–16 days	Multi	No	Jarsin300 (LI 160), Lichtwer Pharma, Berlin, Germany	Note strange once-daily dosing of Hypericum extract.
13	Amoxicillin	Glycyrrhiza glabra root extract (380 mg bid)	Improved eradication of Helicobacter pylori and resolution of peptic ulcer or dyspepsia	Hajiagha- mohammadi 2016	Beneficial to combine	ORN	Iranian adults with H. pylori and peptic ulcer or dyspepsia	108	14 days	Multi	No	D-Reglis, Iran Sanduc Pharmacy Company
14	Amoxicillin	Glycyrrhiza glabra root extract (500 mg tid)	Improved eradication of Helicobacter pylori and resolution of peptic ulcer	Rahnama 2013	Beneficial to combine	DBACR	Iranian adults with H. pylori and peptic ulcer	40	30 days	Multi	No	Not stated
15	Antibiotics (multiple), decongestant	Sambucus nigra (elder) flowers 2 parts, Verbena officinalis (vervain) herb 2 parts, Rumex acetosa (sour dock) herb 2 parts, Primula veris (cowslip) flowers 2 parts, Gentiana lutea (gentian) 1 part	Herbal formula + drugs led to much better symptomatic and radiographic improvement compared to placebo + drugs.	Neubauer 1994	Beneficial to combine	DBPCR	German adults with acute bacterial sinusitis	160		Multi	No	Sinupret, Bionorica, Neumarkt, Germany
16	Apixaban	artemisinin (>100 mg qd)	Apixaban absorption reduced		May require apixaban dose increaes	Theory							This is a likely interaction based on apixaban being a CYP3A4 substrate and artemisinin inducing this enzymes in the intestines. Use of whole Artemisia annua, except at very high doses, is unlikely to be a problem.
17	Aspirin	Allium sativum bulb powder tablet (400 mg w/ 1.2 mg allicin bid)	No interaction	Mahdavi-Roshan 2016	Fine to combine without dose adjustments	DBPCR	Iranian adults with severe coronary artery disease	56	12 weeks	Multi	No	Not stated	Patients were also all taking clopidogrel and atorvastatin
18	Aspirin	Angelica sinensis root extract (~1 g tid)	Signifcant reduction in cardiac mortality, nonfatal recurrent MI, ischemia-drive revascularization, stroke, or CHF; significant but slight improvment in eGFR	Zhang 2020b	Beneficial to combine	ORN	Chinese adults recovering from myocardial infarction (s/p angioplasty) and CKD G2–3b	426	6 mon	Multi	No	Fufang Chuanng Capsule (Shandong Phoenix Pharmaceutical Co., Ltd., Dongying City, Shandong Province, China)
19	Aspirin	Angelica sinensis root extract (1 g qd)	No interaction. Two volunteers reported heavier menses while taking dong quai, but this could have due to hormonal effects of herbs (there was no sign of changes in any coagulation parameters in either woman).	Fung 2017	Fine to combine without dose adjustments	DBPCR	Healthy Chinese adults	25	3 weeks	Multi	No	GNC Herbal Plus Turmeric Curcumin by Nutra Manufacturing (Pittsburgh, PA, USA)	Aspirin 100 mg per day
20	Aspirin	Curcumin (500 mg qd)	No interaction	Fung 2017	Fine to combine without dose adjustments	DBPCR	Healthy Chinese adults	25	3 weeks	Multi	No	GNC Ginseng Gold Korean White Ginseng Root by Nutra Manufacturing (Pittsburgh, PA, USA)	Aspirin 100 mg per day
21	Aspirin	Curcumin phosholipid complex (1 g qd)	No interaction	Hu 2018	Fine to combine without dose adjustments	ONR (?)	Italian adults with cardiovascular disease	18	10 days	Multi	No	Meriva, Indena SpA, Milan, Italy	The methodology used (in terms of whether or not subjects were randomly assigned to active drug alone or drug + curcumin-phospholipid complex, whether there was any blinding) was not described
22	Aspirin	Ginkgo biloba extract	see separate review in the Articles section (Ginkgo and Anticoagulants)		Fine to combine without dose adjustments
23	Aspirin	Ligusticum chuanxiong root (~1 g tid)	Signifcant reduction in cardiac mortality, nonfatal recurrent MI, ischemia-drive revascularization, stroke, or CHF; significant but slight improvment in eGFR	Zhang 2020b	Beneficial to combine	ORN	Chinese adults recovering from myocardial infarction (s/p angioplasty) and CKD G2–3b	426	6 mon	Multi	No	Fufang Chuanng Capsule (Shandong Phoenix Pharmaceutical Co., Ltd., Dongying City, Shandong Province, China)
24	Aspirin	Panax ginseng root extract (1 g qd)	No interaction	Fung 2017	Fine to combine without dose adjustments	DBPCR	Healthy Chinese adults	25	3 weeks	Multi	No	GNC Herbal Plus ® Fingerprinted Dong Quai by Nutra Manufacturing (Pittsburgh, PA, USA)	Aspirin 100 mg per day
25	Aspirin	Panax notoginseng root extract (100 mg tid)	Improved neurological recovery with no changes in blood clotting or any other adverse effects	He 2011	Beneficial to combine	DBPCR	Chinese adults recovering from ischemic strokes	140	30 days	Multi	No		Note use of low-dose aspirin (50 mg)
26	Aspirin	Panax quinquefolius leaf/stem (~1 g tid)	Signifcant reduction in cardiac mortality, nonfatal recurrent MI, ischemia-drive revascularization, stroke, or CHF; significant but slight improvment in eGFR	Zhang 2020b	Beneficial to combine	ORN	Chinese adults recovering from myocardial infarction (s/p angioplasty) and CKD G2–3b	426	6 mon	Multi	No	Xinyue Capsule (Jilin Jian Yisheng Pharmaceutical Co., Ltd., Jian City, Jilin Province, China)
27	Aspirin	Phyllanthus emblica extract (500 mg bid)	No interaction	Fatima 2014	Fine to combine without dose adjustments	ORCX	Indian adults with type 2 diabetes mellitus	10	14 days	Multi	No	Capros, Natreon, New Brunswick, NJ (standardized to 60% low molecular weight hydrolyzable tannins)	Phyllanthus emblica (amla) extract by itself did induce significant anticoagulation, combined with 75 mg aspirin the level of anticoagulation was no different than aspirin alone. There were no spontaneous bleeding events.
28	Aspirin	Pueraria montana ssp lobata root granulation (225 mg bid)	mild synergistic effects, mild increase in aspirin systemic exposure, no increase in GI or other bleeding	Zhang 2020a	Beneficial to combine	ONRCX	Healthy Chinese men	14	5 days	Multi	No	Nong's Concentrate Chinese Medicine Granules, PuraPharm Internatinoal Limited (Hong Kong)
29	Aspirin	Quercetin phytosome (100 mg bid)	No change in bleeding time	Riva 2019	Fine to combine without dose adjustments	ONR	Italian adults requiring antiplatelet therapy	10	10 days	Multi	No
30	Aspirin	Salvia miltiorrhiza root granulation (525 mg bid)	mild synergistic effects, mild increase in aspirin systemic exposure, no increase in GI or other bleeding	Zhang 2020a	Beneficial to combine	ONRCX	Healthy Chinese men	14	5 days	Multi	No	Nong's Concentrate Chinese Medicine Granules, PuraPharm Internatinoal Limited (Hong Kong)
31	Atorvastatin	Allium sativum bulb powder tablet (400 mg w/ 1.2 mg allicin bid)	No interaction	Mahdavi-Roshan 2016	Fine to combine without dose adjustments	DBPCR	Iranian adults with severe coronary artery disease	56	12 weeks	Multi	No	Not stated	Patients were also all taking aspirin and clopidogrel
32	Atorvastatin	Ginkgo biloba extract (120 mg every 3rd day)	Slight reduction in absorption, no clinically-relevant interaction	Guo 2012	Fine to combine without dose adjustments	ORCX	Healthy Chinese adults	16	14 days	Single	No	Dr. Willmar Schwabe extract
33	Atorvastatin	Hypericum perforatum extract (300 mg bid)	LDL and total cholesterol levels were significantly higher with Hypericum compared to the multivitamin.	Andrén 2007	Do not combine without increasing atorvastatin dose	ORCX (multivitamin control)	Swedish adults with hypercholesterolemia	16	4 weeks	Multi	No	Movina	Hypericum was underdosed (more usual to give 300 mg tid)
34	Atorvastatin	Salvia officinalis leaf ethanol extract (500 mg tid)	Lowers LDL and total cholesterol, glucose levels	Kianbakht 2016	Beneficial to combine	DBPCR	Iranian adults with DM2 and dyslipidemia	100	2 mon	Multi	No	made by the researchers	Absolute magnitude of effect was small (TC 10 point drop, LDL 1 point drop, HDL 1 point gain, HgbA1c 0.2% drop, 2h PPG 5 mg/dl drop compared to baseline (but all significantly better than placebo).
35	Atorvastatin	silymarin 60–80% 105 mg + Berberis aristata 588 mg providing berberine 500 mg	Allows for 50% statin dose reduction with no loss of efficacy and with additional improvements in glucose control	Derosa 2015	Beneficial to combine	DBRPC	Italian adults with dyslipidemia not tolerating high-dose statin	163	6 mon	Multi	No	Berberol (PharmaExtract, Pontenure, Italy)
36	Azithromycin	Echinacea spp root tincture (5 ml tid)	Reduced frequency and severity of tonsillitis episodes vs. no treatment or azithromycin alone	Awad 2020	Beneficial to combine	ONR	Egyptian children with recurrent tonsillitis	300	6 days/mon for 6 mon	Multi	No	Not stated
37	Bevacizumab	Curcumin (2000 mg qd)	Safe to combine, some indication of improved efficacy	Howells 2019	Beneficial to combine	ORN	British adults with metastatic colon cancer	12	113 days (mean)	Multi	No	Curcumin C3 Complex, Sabinsa Corporation, Piscataway, NJ (containing ∼80% curcumin and 20% demethoxycurcumin and bisdemethoxycurcumin)	see entry under 5-fluorouracil + oxaliplatin + folinic acid (FOLFOX) for more details
38	Boceprevir	Hypericum perforatum	No clinically-relevant changes in the drug or its metabolites	Jackson 2014	Fine to combine without dose adjustments	ORCX	Healthy British adults	17	14 days	Multi	Yes
39	Buproprion	Hypericum perforatum extract (325 mg tid)	Mild decrease in buproprion absorption, questionable clinical relevance	Lei 2010	Likely fine to combine, monitor treatment efficacy	ONR?	Healthy Chinese men	18	14 days	Single	Yes
40	Caffeine	Ginkgo biloba extract (120 mg bid or 240 mg qd)	No interaction	Zadoyan 2012	Fine to combine without dose adjustments	OPRCX	Healthy German adults	18	8 days	Single	Yes	EGb 761
41	Capecitabine	Prunus mume ethanol extract (100 mg qd)	Reduces diarrhea significantly vs placebo	Xing 2018	Beneficial to combine	PCR	Chinese women with breast cancer	208	6 weeks	Multi	No
42	Carbamazepine	Hypericum perforatum extract (300 mg tid)	No interaction	Burstein 2000	Fine to combine without dose adjustments	ONR	Healthy American adults	8	14 days	Multi	Yes
43	Carbamazepine	Piperine (20 mg)	Increased absorption only at carbamazepine 500 mg bid dose, not 300 mg bid (dose sparing)	Pattanaik 2009	Combine cautiously, reduce phenytoin dose, monitor serum levels carefully if combined	ONR (not clearly stated)	Indian adults with epilepsy	20	1 dose	Single	Yes	Synthite Pharma (Kerala, India)
44	Chlorpromazine	Silybum marianum extract silymarin (800 mg qd)	Decreased oxidative hepatic damage compared to placebo	Palasciano 1994	Beneficial to combine	DBPCR	Italian women with schizophrenia	60	3 mon	Multi	No	not stated
45	Cilostazol	Ginkgo biloba extract	see separate review in the Articles section (Ginkgo and Anticoagulants)		Fine to combine without dose adjustments								One smaller study found the combination prolonged bleeding times, while a larger study could not confirm this finding.
46	Citalopram	Lepidium meyenii (3 g qd)	Reduced sexual side effects.	Dording 2008	Beneficial to combine	DBR	American adults with low-libido due to SSRI	16	12 weeks	Multi	No	A Healthy Alternative (Long Island, NY)
47	Clarithromycin	Glycyrrhiza glabra root extract (380 mg bid)	Improved eradication of Helicobacter pylori and resolution of peptic ulcer or dyspepsia	Hajiagha- mohammadi 2016	Beneficial to combine	ORN	Iranian adults with H. pylori and peptic ulcer or dyspepsia	108	14 days	Multi	No	D-Reglis, Iran Sanduc Pharmacy Company
48	Clonazepam	Curcumin (250–750 mg bid)	No interaction	Kanchanatawan 2018	Fine to combine without dose adjustments	DBPRC	Depressed Thai adults	16	16 weeks	Multi	No	Government Pharmaceutical Organization (Bangkok, Thailand)
49	Clopidogrel	Allium sativum bulb powder tablet (400 mg w/ 1.2 mg allicin bid)	No interaction	Mahdavi-Roshan 2016	Fine to combine without dose adjustments	DBPCR	Iranian adults with severe coronary artery disease	56	12 weeks	Multi	No	Not stated	Patients were also all taking aspirin and atorvastatin
50	Clopidogrel	Angelica sinensis root extract (~1 g tid)	Signifcant reduction in cardiac mortality, nonfatal recurrent MI, ischemia-drive revascularization, stroke, or CHF; significant but slight improvment in eGFR	Zhang 2020b	Beneficial to combine	ORN	Chinese adults recovering from myocardial infarction (s/p angioplasty) and CKD G2–3b	426	6 mon	Multi	No	Fufang Chuanng Capsule (Shandong Phoenix Pharmaceutical Co., Ltd., Dongying City, Shandong Province, China)
51	Clopidogrel	Citrus x paradisi juice (200 ml tid)	Interferes with activation of clopidogrel	Holmberg 2014	Do not combine large doses	ORCX	Healthy Finnish adults	14	3 days	Single	No	Valio greippitäysmehu (Valio, Helsinki, Finland)	Note extremely high GFJ dose
52	Clopidogrel	Curcumin phosholipid complex (1 g qd)	No interaction	Hu 2018	Fine to combine without dose adjustments	ONR (?)	Italian adults with cardiovascular disease	10	10 days	Multi	No	Meriva, Indena SpA (Milan, Italy)	The methodology used (in terms of whether or not subjects were randomly assigned to active drug alone or drug + curcumin-phospholipid complex, whether there was any blinding) was not described
53	Clopidogrel	Ginkgo biloba	see separate review in the Articles section (Ginkgo and Anticoagulants)		Fine to combine without dose adjustments
54	Clopidogrel	Hypericum perforatum extract (300 mg tid)	Enhances activity (by increasing activation of this prodrug) in initial non-responders to the drug	Lau 2011	Beneficial to combine in hyporesponders to clopidogrel	DBRPC	American adults s/p coronary artery stenting, clopidogrel hyporesponders	20	14 days	Multi	No
55	Clopidogrel	Hypericum perforatum extract (300 mg tid)	Enhances activity (by increasing activation of this prodrug) in initial non-responders to the drug	Trana 2013	Beneficial to combine in hyporesponders to clopidogrel	ORN	Belgian adults with stable angina, s/p PCI, clopidogrel hyporesponders	23	14 days	Multi	No
56	Clopidogrel	Ligusticum chuanxiong root (~1 g tid)	Signifcant reduction in cardiac mortality, nonfatal recurrent MI, ischemia-drive revascularization, stroke, or CHF; significant but slight improvment in eGFR	Zhang 2020b	Beneficial to combine	ORN	Chinese adults recovering from myocardial infarction (s/p angioplasty) and CKD G2–3b	426	6 mon	Multi	No	Fufang Chuanng Capsule (Shandong Phoenix Pharmaceutical Co., Ltd., Dongying City, Shandong Province, China)
57	Clopidogrel	Panax quinquefolius leaf/stem (~1 g tid)	Signifcant reduction in cardiac mortality, nonfatal recurrent MI, ischemia-drive revascularization, stroke, or CHF; significant but slight improvment in eGFR	Zhang 2020b	Beneficial to combine	ORN	Chinese adults recovering from myocardial infarction (s/p angioplasty) and CKD G2–3b	426	6 mon	Multi	No	Xinyue Capsule (Jilin Jian Yisheng Pharmaceutical Co., Ltd., Jian City, Jilin Province, China)
58	Clopidogrel	Phyllanthus emblica extract (500 mg bid)	No interaction	Fatima 2014	Fine to combine without dose adjustments	ORCX	Indian adults with type 2 diabetes mellitus	10	14 days	Multi	No	Capros, Natreon, New Brunswick, NJ (standardized to 60% low molecular weight hydrolyzable tannins)	Phyllanthus emblica (amla) extract by itself did induce significant anticoagulation, combined with 75 mg clopidogrel the level of anticoagulation was no different than clopidogrel alone. There were no spontaneous bleeding events.
59	Clopidogrel	Quercetin phytosome (100 mg bid)	No change in bleeding time	Riva 2019	Fine to combine without dose adjustments	ONR	Italian adults requiring antiplatelet therapy	10	10 days	Multi	No
60	Clozapine	Withania somnifera root extract (400 mg tid)	Reduced fasting blood glucose and triglyceride levels vs placebo	Agnihotri 2013	Beneficial to combine	DBRPC	Indian adults with schizophrenia	30	30 days	Multi	No	Cap Strelaxin, M/s Pharmanza Herbal Pvt. Ltd (Gujarat, India)
61	Clozapine	Berberis vulgaris root (500 mg tid)	Slightly offset weight gain	Rostami 2023	Fine to combine without dose adjustments	DBRPC	Iranian adults with schizophrenia	88	3 mon	Multi	No	Crude powder purchased in Khorasan, Iran, encapsulated at Ahvaz Medicinal Plants Research Center
62	Corticosteroids	Curcumin nano-micellar extract (160 mg qd)	No interaction	Hassaniazid 2021	Fine to combine without dose adjustments	DBPCR	Iranian adults with CoVid-19	40 (variable)	14 days	Multi	No	SinaCurcumin, Exir Nano Sina, Tehran, Iran	This was not explicitly designed to assess for interactions, but many patients were taking the drug at the same time as the curcumin.
63	Cyclosphosphamide	Withania somnifera root extract (2 g tid)	Decreased fatigue vs. no treatment	Biswal 2013	Beneficial to combine	ONR	Malaysian women with breast cancer	100	18 weeks	Multi	No	Himalaya Drug Company, New Dehli, India
64	Cyclosporin	Allium sativum (1 raw clove garlic chewed qd)	Nephroprotective without interfering with cyclosporin	Jabbari 2005	Beneficial to combine, monitor therapy	ORCX	Iranian adults with kidney transplants	44	60 days	Multi	No
65	Cyclosporin	Berberine (200 mg tid)	Signficantly increases absorption of cyclosporin (dose sparing), ~25–30%	Wu 2005	Beneficial to combine, reduce cyclosporin dose, monitor therapy	ORN	Chinese adults with kidney transplants	52	90 days	Multi	No		Additionally 6 subjects were monitored for 12 days while taking berberine + cyclosporin to look at pharmacokinetic interactions in detail. Mean AUC increased 34.5%, tmax 1.7 h, t1/2 2.7 h
66	Cyclosporin	Berberine (300 mg bid)	Signficantly increases absorption of cyclosporin (dose sparing)	Xin 2006	Beneficial to combine, reduce cyclosporin dose, monitor therapy	ONR	Healthy Chinese men	6	10 days	Single	Yes
67	Cyclosporin	Citrus maxima (pomelo) juice (240 ml)	Significantly but mildly increased absorption	Grenier 2006	Beneficial to combine, reduce cyclosporin dose, monitor therapy	ORCX	Healthy Canadian men	12	1 dose	Single	Yes
68	Cyclosporin	Citrus tangerina (tangerine) juice (250 ml)	No interaction	Sorkhi 2008	Fine to combine without dose adjustments	ORCX	Iranian child kidney transplant recipients	10	1 dose	Single	Yes
69	Cyclosporin	Citrus tangerina (tangerine) juice (250 ml)	No interaction	Sorkhi 2007	Fine to combine without dose adjustments	ORCX	Iranian adult kidney transplant recipients	10	1 dose	Single	Yes
70	Cyclosporin	Citrus x sinensis (orange) juice (250 ml)	No interaction	Sorkhi 2009	Fine to combine without dose adjustments	ORCX	Iranian child kidney transplant recipients	10	1 dose	Single	Yes
71	Cyclosporin	Citrus x sinensis (orange) juice (250 ml)	No interaction	Sorkhi 2007	Fine to combine without dose adjustments	ORCX	Iranian adult kidney transplant recipients	10	1 dose	Single	Yes
72	Cyclosporin	Glycyrhizin from Glycyrrhiza spp (5–10 mg/kg qd, a very high dose)	Glyycrrhizin significantly enhanced the efficacy and reduced the toxicity (nausea, vomiting, liver damage) of the drug	Ren 2013	Beneficial to combine, monitor therapy	ORN	Chinese adults with mild aplastic anemia	68	4 mon	Multi	No	not stated	Directly contradicts animal research that suggested glycyrrhizin would interfere with absorption of cyclosporine (Hou YC, Lin SP, Chao PD (2012) "Liquorice reduced cyclosporine bioavailability by activating P-glycoprotein and CYP 3A" Food Chem 135(4):2307–12.)
73	Cyclosporin	Hypericum perforatum extract (300 mg tid)	Decreased absorption significantly	Dresser 2003	Do not combine		Healthy American adults	21	12.5 days	Multi	Yes
74	Cyclosporin	Hypericum perforatum extracts (300 mg tid, high or low hyperforin contents)	High-hyperforin (but now low-hyperforin) extracts significantly reduced absorption and required significant dose increases	Mai 2004	Do not combine (low-hyperforin extract fine to combine)	RC	German kidney transplant recipients	10	14 days	Multi	Yes
75	Cyclosporin	Hypericum perforatum extracts (600 mg qd)	Significantly reduced absorption, causing need to increase dose of cyclosporin (60% on average) to maintain therapeutic serum levels	Bauer 2003	Do not combine	ONR	German kidney transplant recipients	11	14 days	Multi	No	Jarsin300, Lichtwer Pharma, Berlin, Germany	Onset of reduced absorption within 72 hours. Took more than 2 weeks to return to baseline in most patients
76	Cyclosporin	Silybum marianum extract silibinin (20 mg/kg IV qd)	No interference with drug, lowered HCV viral loads significantly compared to placebo	Rendina 2014	Beneficial to combine	DBPCR	Italian adults with hepatitis C status-post liver transplant	20	14 days	Multi	No	Legalon Sil, Madaus, Germany
77	Cyclosporin	Vaccinium macrocarpon juice (240 ml)	No interaction	Grenier 2006	Fine to combine without dose adjustments	ORCX	Healthy Canadian men	12	1 dose	Single	Yes
78	Dabigatran	Curcumin phosholipid complex (1 g qd)	No interaction	Hu 2018	Fine to combine without dose adjustments	ONR (?)	Italian adults with cardiovascular disease	16	10 days	Multi	No	Meriva, Indena SpA, Milan, Italy	The methodology used (in terms of whether or not subjects were randomly assigned to active drug alone or drug + curcumin-phospholipid complex, whether there was any blinding) was not described
79	Dabigatran	Quercetin phytosome (100 mg bid)	No change in INR or platelet count	Riva 2019	Fine to combine without dose adjustments	ONR	Italian adults requiring anticoagulant therapy	10	20 days	Multi	No
80	Darunavir	Echinacea purpurea root extract (500 mg qid)	No interaction	Moltó 2011	Fine to combine without dose adjustments	ONR	HIV+ Spanish adults	15	14 days	Multi	Yes	Arkocápsulas Echinácea, Arkopharma, Madrid, Spain
81	Darunavir	Silymarin (150 mg tid)	No interaction	Moltó 2012b	Fine to combine without dose adjustments	ONR	HIV+ Spanish adults	15	14 days	Multi	Yes	Arkocápsulas Echinácea, Arkopharma, Madrid, Spain
82	Desferrioxamine	Silymarin 80% (140 mg tid)	Significantly enhanced its iron-chelating properties compared to placebo. Also significantly lowers serum transaminase levels compared to placebo	Moayedi 2013	Beneficial to combine	DBPCR	Iranian adults with β-thalassemia major	97	9 mon	Multi	No
83	Dextromethorphan	Valeriana officinalis (1 g hs, standardized to 11 mg valerienic acid)	No significant interaction	Donovan 2004	Fine to combine without dose adjustment	ORN	Healthy American adults	12	14 days	Multie	Yes	Dr. Willmar Schwabe GmbH and Co. (Karlsruhe, Germany)	CYP2D6 probe drug
84	Dextromethorphan	Eleutherococcus senticosus root extract (485 mg bid)	No interaction	Donovan 2003	Fine to combine without dose adjustments	ONR	Healthy American adults	12	12 days	Single	Yes		CYP2D6 probe drug
85	Dextromethorphan	Ginkgo biloba leaf extract (120 mg bid or 240 mg qd)	No interaction	Zadoyan 2012	Fine to combine without dose adjustments	OPRCX	Healthy German adults	18	8 days	Single	Yes	EGb 761	CYP2D6 probe drug
86	Dextromethorphan	Glycyrrhiza glabra, deglycyrrhizinated or DGL (75 mg bid)	No significant interaction	Liu 2023	Fine to combine without dose adjustment	ONR	Healthy American women	19	14 days	Multie	Yes	Natural Remedies (Bangalore, India)	CYP2D6 probe drug
87	Diclofenac	Curcumin + volatile oil of Curcuma longa 500 mg bid	Improved pain control in knee osteoarthritis and reduced adverse effects	Shep 2020	Beneficial to combine	ORN	Indian adults with knee OA	140	28 days	Multi	No	BCM-95, Arjuna Natural Pvt. Ltd, India
88	Digoxin	Actaea racemosa extract 2.5% triterpenoids (20 mg bid)	No interaction	Gurley 2006	Fine to combine without dose adjustments	ONR	Healthy American adults	16	14 days	Multi	Yes	Enzymatic Therapy, Green Bay, WI
89	Digoxin	Echinacea angustifolia root extract (72 mg tid)	No interaction	Gurley 2008	Fine to combine without dose adjustments	ORN	Healthy American adults, daily cannabis users	18	14 days	Single	Yes	Gaia Herbs, combined with Echinacea purpurea leaf, root and seed 195 mg tid
90	Digoxin	Echinacea purpurea leaf, root, seed extract (195 mg tid)	No interaction	Gurley 2008	Fine to combine without dose adjustments	ORN	Healthy American adults, daily cannabis users	18	14 days	Single	Yes	Gaia Herbs, combined with Echinacea angustifolia root extract 72 mg tid
91	Digoxin	Ginkgo biloba extract (80 mg tid)	No interaction	Mauro 2003	Fine to combine without dose adjustments	ORCX	Healthy American adults	8	14 days	Single	Yes
92	Digoxin	Hypericum perforatum (multiple products and extracts)	Only products and extracts with hyperforin significantly reduced absorption of digoxin compard to placebo; clinical effects of the drug not assessed	Mueller 2004	Do not combine (low-hyperforin extract fine to combine)	PCR	Healthy German adults	96	14 days	Multi	Yes	Ze117 , LI 160, powder, tea, juice, oil	Supports that Hypericum perforatum and specifically hyperforin upregulates Pgp (likely secondary to PXR upregulation).
93	Digoxin	Hypericum perforatum extract (300 mg tid)	Significantly reduced digoxin absorption	Gurley 2008	Do not combine (low-hyperforin extract fine to combine)	ORN	Healthy American adults, daily cannabis users	18	14 days	Single	Yes	WS 5572
94	Digoxin	Hypericum perforatum extract (300 mg tid)	After 10 days of SJW use, digoxin absorption was significantly reduced compared to placebo; clinical effects of the drug not assessed	Johne 1999	Do not combine (low-hyperforin extract fine to combine)	SBPCR	Healthy German adults	25	15 days	Multi	Yes	LI 160 (Kira, Lichtwer Pharma, Berlin, Germany)	Supports that Hypericum perforatum upregulates Pgp (likely secondary to PXR upregulation).
95	Digoxin	Hypericum perforatum extract (300 mg tid)	Mild decrease in absorption, roughly 18% (not clearly clinically relavant)	Dürr 2000	Do not combine (low-hyperforin extract fine to combine)		Healthy Swiss men	8	14 days	Single	Yes		Supports that Hypericum induces intestinal P-glycoprotein
96	Digoxin	Silybum marianum extract 80% silymarin (300 mg tid)	No significant changes but statistical trend toward lowering absorption	Gurley 2006	Fine to combine without dose adjustments (monitor serum levels)	ONR	Healthy American adults	16	14 days	Multi	Yes	Enzymatic Therapy, Green Bay, WI
97	Diphenhydramine	Curcumin nano-micellar extract (160 mg qd)	No interaction	Hassaniazid 2021	Fine to combine without dose adjustments	DBPCR	Iranian adults with CoVid-19	40 (variable)	14 days	Multi	No	SinaCurcumin, Exir Nano Sina, Tehran, Iran	This was not explicitly designed to assess for interactions, but many patients were taking the drug at the same time as the curcumin.
98	Docetaxel	Curcumin (6,000 mg qd for 4 days before and 2 days after drug infusion)	No interaction	Bayet-Robert 2010	Fine to combine without dose adjustments	ONR	French women with breast cancer	14	126 days	Multi	Yes		Note that toxic effects were sufficiently bad at 8 g per day that they stopped dose escalation at that point; 6 g per day was the maximum safe dose
99	Docetaxel	Curcumin (6,000 mg qd for 4 days before and 2 days after drug infusion)	Improved short-term clinical outcomes (improved PSA levels)	Mahammedi 2016	Beneficial to combine	ONR	French men with progressive, castration-resistant prostate cancer	30	126 days	Multi	No
100	Docetaxel	Echinacea purpurea aerial parts 95% and root 5% tincture (20 drops tid)	No change in pharmacokinetics or side effects of doceetaxel	Goey 2013	Fine to combine without dose adjustments	ONR	Dutch adults with cancer	10	21 days	Single	Yes	A. Vogel Echinaforce, Biohorma BV, Elburg, the Netherlands	Docetaxel is normally given as a single intravenous dose once every three weeks so this study's methodology was fairly sound though it was a single dose trial.