Drug & supplement interaction

American Mistletoe + Treprostinil

Major Interaction
Medically reviewed by · Updated February 2024
The bottom line Major

Treprostinil falls into 2 drug categories that American Mistletoe can interact with; the most serious is rated major. American mistletoe contains phoratoxin, a compound toxic to humans that induces smooth muscle contraction and vasoconstriction, potentially increasing blood pressure and heart rate.

Read the full interaction report
SeverityMajor
LikelihoodProbable
Interactions2
EvidenceC
What do Severity, Likelihood & Evidence mean?
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Interaction report

American Mistletoe and Treprostinil

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

American Mistletoe interacts with whole categories of medication. Treprostinil falls into 2 of those categories, so it can interact with American Mistletoe in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Major).

Major

Antihypertensive Drugs

1 of 2

Why this applies to Treprostinil

Treprostinil falls under Antihypertensive Drugs — the group American Mistletoe interacts with.

American mistletoe contains phoratoxin, a compound toxic to humans that induces smooth muscle contraction and vasoconstriction, potentially increasing blood pressure and heart rate. Case reports of cardiotoxicity have been documented with American mistletoe, and it should not be used with antihypertensive drugs or by individuals with cardiac conditions. American mistletoe is uncommon in dietary supplements, and formulations containing it are generally homeopathic. European mistletoe, which lacks phoratoxin, is more commonly used.
Severity Major Likelihood Probable Evidence C

Interaction 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..

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

Here's the concern with these two together. Treprostinil (Orenitram) is used to treat pulmonary arterial hypertension, and a big part of how it helps is by relaxing and widening blood vessels to lower the pressure in your lungs. American mistletoe pulls in the opposite direction. Its phoratoxin can tighten blood vessels and bump up blood pressure and heart rate, which could work against what your treprostinil is trying to do.

This isn't fully proven in people, but there are real case reports of mistletoe causing heart problems, so it's taken seriously. American mistletoe is also genuinely toxic and we don't recommend it at all. If you've come across it in any product, please check with your pharmacist or doctor before using it alongside treprostinil.

Contact Dr. Brian directly if you have additional questions on this interaction
Major

Vasodilators

2 of 2

Treprostinil also falls under Vasodilators.

American mistletoe contains phoratoxin, a compound toxic to humans that induces smooth muscle contraction and vasoconstriction, potentially increasing blood pressure and heart rate. Taking dietary supplements containing American mistletoe may counteract the effects of vasodilator drugs, such as hydralazine. It is important to note that American mistletoe is uncommon in dietary supplements. More commonly, European mistletoe is used as it does not contain phoratoxin.
Severity Major Likelihood Probable Evidence C

Interaction 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..

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

Here's the concern with these two together. Treprostinil (Orenitram) is a vasodilator that works by widening your blood vessels and easing the pressure in your lungs, which is exactly what your body needs in pulmonary hypertension. American mistletoe pulls in the opposite direction. It contains a toxin called phoratoxin that can tighten blood vessels and may push your blood pressure and heart rate up.

So the worry is that mistletoe could fight against the very effect treprostinil is trying to achieve, leaving your symptoms less controlled. The good news is that this is based mostly on lab and animal findings, and true American mistletoe is rarely found in supplements. Still, I wouldn't take it. Please check with your doctor or pharmacist before adding anything new.

Contact Dr. Brian directly if you have additional questions on this interaction

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

American Mistletoe Also Interacts With Other Medications

American Mistletoe has 189 major, known drug interactions in our database — the Treprostinil one above is among them. If you take anything else, check it against the full list below.

Major 189 No known interaction 2,641 (incl. Treprostinil)
Taking anything else?

Check Another of Your Medications Against American Mistletoe

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

Everything else you take

See Every Supplement That Interacts With Treprostinil

This page covers American Mistletoe only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Treprostinil page lists 291 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), Danshen (major), Piracetam (major) and Tyramine (major).

By severity: 6 major · 258 moderate · 27 minor.

Open the Treprostinil interaction page

How much people look this up

Where American Mistletoe and Treprostinil 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 American Mistletoe
Steady interest

#1,039 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Treprostinil
Steady interest

#2,270 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 American Mistletoe

What is American Mistletoe?

American Mistletoe
  • Traditional folk remedies
  • Digestive complaints
  • Decorative holiday plant

American mistletoe is a parasitic plant that is best known as a holiday decoration, not a proven medicine. It contains toxins that can harm the heart, gut, and blood vessels, and it has little reliable evidence to support any health use. We do not recommend taking it, and all parts should be kept away from children and pets.

Read the full American Mistletoe monograph & all interactions
Medication

About Treprostinil

What Is Treprostinil Used For?

Treprostinil treats pulmonary arterial hypertension (PAH; WHO Group 1) — high blood pressure in the arteries of the lungs. Depending on the product and route, it is used to improve exercise ability, delay disease progression, or reduce symptoms tied to physical activity. Remodulin and treprostinil injection products are also indicated for patients who need to transition away from another PAH medicine called epoprostenol.

Tyvaso, Tyvaso DPI, and Yutrepia (inhaled forms) are additionally approved to treat pulmonary hypertension associated with interstitial lung disease (PH-ILD; WHO Group 3) — lung-pressure problems caused by scarring or inflammation in the lung tissue itself. Orenitram (extended-release oral tablet) is specifically indicated to delay disease progression and improve exercise capacity in PAH.

See full Treprostinil drug information
Keep checking

Other Drugs & American Mistletoe

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

189Major
0Moderate
0Minor
2,640No known interaction
189 Major 2,640 No interaction
Major

189 interactions

Showing 60 of 189 major interactions — see all 189 on the American Mistletoe page.

No interaction 2,640 drugs checked — show the list

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

Showing the 60 most looked-up of 2,640 medications checked with no known interaction — see the full American Mistletoe list.

See the full American Mistletoe interactions page
See every supplement checked against Treprostinil, 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
American Mistletoe monograph › Uses, safety, and every drug interaction in one place Treprostinil supplement interactions › Every supplement checked against Treprostinil, ranked by severity Treprostinil 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 American Mistletoe and Treprostinil Together: Common Questions

Can you take American Mistletoe with Treprostinil?
This is rated a major interaction, so the combination is best avoided unless your doctor or pharmacist has specifically told you otherwise. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for American Mistletoe and Treprostinil?
Treprostinil belongs to more than one drug category, and American Mistletoe interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the American Mistletoe and Treprostinil interaction?
We rate it Major. This is a clinically significant combination that is generally best avoided, or used only under the direct supervision of your physician or pharmacist.

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

Still Have a Question About Treprostinil and American Mistletoe?

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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.