Drug & supplement interaction

Alkanna + Telotristat Etiprate

Telotristat Etiprate brand name: Xermelo.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Alkanna has a moderate interaction with Telotristat Etiprate. Hepatotoxic pyrrolizidine alkaloids (PAs) are substrates of cytochrome P450 3A4 (CYP3A4).

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Alkanna and Telotristat Etiprate

Here is the interaction we found between these two, with the evidence behind it.

Moderate

CYTOCHROME P450 3A4 (CYP3A4) INDUCERS

Why this applies to Telotristat Etiprate

Telotristat Etiprate falls under CYTOCHROME P450 3A4 (CYP3A4) INDUCERS — the group Alkanna interacts with.

Hepatotoxic pyrrolizidine alkaloids (PAs) are substrates of cytochrome P450 3A4 (CYP3A4). Theoretically, drugs that induce CYP3A4 might increase the conversion of PAs to toxic metabolites. Some drugs that induce CYP3A4 include carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin, rifabutin (Mycobutin), and others.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the concern with combining Alkanna and Xermelo (telotristat). Alkanna root can contain pyrrolizidine alkaloids, which are compounds the liver turns into harmful byproducts using an enzyme called CYP3A4. Telotristat is known to nudge that same enzyme into working faster (it's a mild CYP3A4 inducer). The theory is that by speeding up CYP3A4, telotristat could increase how much of Alkanna's toxic metabolites get formed, which may add stress to your liver.

I want to be honest about the evidence here: this is theoretical, based on how these compounds behave on paper, not on real patient reports. Still, oral Alkanna isn't recommended anyway because of its liver toxicity. The safest move is to skip oral Alkanna and run any use, even topical, past your pharmacist or doctor first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Chojkier M. Hepatic sinusoidal-obstruction syndrome: toxicity of pyrrolizidine alkaloids. J Hepatol 2003;39:437-46. PubMed
  2. Wang YP, Yan J, Fu PP, Chou MW. Human liver microsomal reduction of pyrrolizidine alkaloid N-oxides to form the corresponding carcinogenic parent alkaloid. Toxicol Lett 2005;155:411-20. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Alkanna Also Interacts With Other Medications

Alkanna has 86 moderate known drug interactions in our database — the Telotristat Etiprate one above is one of them. If you take anything else, check it against the full list below.

Moderate 86 No known interaction 2,744 (incl. Telotristat Etiprate)
Taking anything else?

Check Another of Your Medications Against Alkanna

Covers the 2,830 medications we’ve checked against Alkanna. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Telotristat Etiprate

This page covers Alkanna only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Telotristat Etiprate page lists 36 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Alpine Ragwort (moderate), Boneset (moderate), Borage (moderate) and Butterbur (moderate).

By severity: 1 major · 26 moderate · 9 minor.

From our pharmacist’s overview on the Telotristat Etiprate page

“Telotristat etiprate (Xermelo) works in the gut to calm the severe diarrhea of carcinoid syndrome, and the lone major-rated interaction among its 36 flagged supplements strikes at that point. Activated charcoal can soak up the drug before it reaches the bloodstream, and 17 of the entries, mostly bulking fibers and charcoal products, ca…”

Reviewed by 2 · Jul 18, 2026

Open the Telotristat Etiprate interaction page

One more smart check

Taking Alkanna as Part of a Dietary Supplement Product? Check It for Interactions

We hold 1 real supplement products containing Alkanna, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Alkanna. Your product may carry other ingredients that interact with Telotristat Etiprate too, on top of Alkanna — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Alkanna and Telotristat Etiprate Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Alkanna
Top half

#690 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Telotristat Etiprate
Steady interest

#2,635 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Alkanna

What is Alkanna?

Alkanna
  • Wound healing
  • Burns and skin ulcers
  • Natural red dye for foods and cosmetics
  • Skin irritation
  • Traditional remedy for diarrhea

Alkanna is a Mediterranean plant whose red root has long been used as a dye and as a folk skin remedy for wounds and burns. Human evidence for any health benefit is very limited, and because the plant can contain liver-toxic pyrrolizidine alkaloids, oral use is not recommended. If you use it at all, use it externally and check with a pharmacist or doctor first.

Read the full Alkanna monograph & all interactions
Medication

About Telotristat

What Is Telotristat Used For?

Brand name: Xermelo

Xermelo (telotristat) tablets are approved to treat carcinoid syndrome diarrhea in adults. Carcinoid syndrome is a set of symptoms caused by certain tumors — called neuroendocrine tumors — that release excess serotonin into the body, triggering frequent, often severe diarrhea.

Xermelo is used in combination with somatostatin analog (SSA) therapy — a class of injected medications commonly used to control carcinoid syndrome — in patients whose diarrhea is still not adequately controlled by SSA therapy alone.

See full Telotristat drug information
Keep checking

Other Drugs & Alkanna

Browse every other medication we’ve checked against Alkanna — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
86Moderate
0Minor
2,743No known interaction
86 Moderate 2,743 No interaction
Moderate

86 interactions

Showing 60 of 86 moderate interactions — see all 86 on the Alkanna page.

No interaction 2,743 drugs checked — show the list

We also checked Alkanna against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,743 medications checked with no known interaction — see the full Alkanna list.

See the full Alkanna interactions page
See every supplement checked against Telotristat Etiprate, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Alkanna monograph › Uses, safety, and every drug interaction in one place Telotristat Etiprate supplement interactions › Every supplement checked against Telotristat Etiprate, ranked by severity Telotristat drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Alkanna and Telotristat Etiprate Together: Common Questions

Can you take Alkanna with Telotristat Etiprate?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Alkanna and Telotristat Etiprate interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Telotristat Etiprate and Alkanna?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.