Drug & supplement interaction

American Pawpaw + Nivolumab

Nivolumab brand name: Opdivo.

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

American Pawpaw has a minor interaction with Nivolumab. American pawpaw (Asimina triloba) contains Annonacin, a natural compound that has been investigated for its potential anticancer effects.

Read the full interaction report
SeverityMinor
LikelihoodUnlikely
EvidenceC
What do Severity, Likelihood & Evidence mean?
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Interaction report

American Pawpaw and Nivolumab

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

Minor

Antineoplastics

Why this applies to Nivolumab

Nivolumab falls under Antineoplastics — the group American Pawpaw interacts with.

American pawpaw (Asimina triloba) contains Annonacin, a natural compound that has been investigated for its potential anticancer effects. Laboratory studies suggest that Annonacin may inhibit or prevent the growth and spread of tumors or malignant cells by disrupting mitochondrial function, leading to cell death (source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6672878/; https://www.nature.com/articles/s41419-018-0772-x). It is currently unknown how American pawpaw may interact, if at all, with prescription antineoplastic drugs. However, since both Annonacin and antineoplastic drugs can affect cell processes and metabolism, there is a theoretical risk of interactions that could affect treatment efficacy or increase the risk of side effects. Therefore, caution should be exercised when combining pawpaw with prescription antineoplastic drugs, and consulting with a healthcare professional is recommended before making changes to your medication regimen.
Severity Minor Likelihood Unlikely Evidence C

Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans..

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

Here's the honest picture: we don't really know how American pawpaw interacts with nivolumab (Opdivo), and what's on file is mostly a theoretical concern. Pawpaw seeds and bark contain acetogenins like annonacin, which in lab dishes can disrupt how cells make energy. Nivolumab works very differently, it's an immunotherapy that helps your own immune system recognize and attack cancer cells. There's no clear human evidence that pawpaw helps or hurts that process.

The worry is simply that mixing an unproven, potentially toxic plant supplement with a serious cancer treatment could, in theory, affect how well your therapy works or add to side effects. Because you're being treated for cancer, this is a conversation to have directly with your oncology team before taking any pawpaw product. Please don't add or stop anything on your own.

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 Pawpaw Also Interacts With Other Medications

American Pawpaw has 24 minor known drug interactions in our database — the Nivolumab one above is one of them. If you take anything else, check it against the full list below.

Minor 24 No known interaction 2,806 (incl. Nivolumab)
Taking anything else?

Check Another of Your Medications Against American Pawpaw

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

Everything else you take

See Every Supplement That Interacts With Nivolumab

This page covers American Pawpaw only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Nivolumab page lists 1 supplement it has a documented interaction with, worst first, each one explained.

By severity: 1 minor.

From our pharmacist’s overview on the Nivolumab page

“Nivolumab (Opdivo) is an immunotherapy infusion that trains the body's own immune system to recognize and attack cancer cells, the kind of drug you might expect to carry a long list of supplement warnings. It does not.”

Reviewed by 2 · Jul 18, 2026

Open the Nivolumab interaction page

How much people look this up

Where American Pawpaw and Nivolumab 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 Pawpaw
Steady interest

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

29 days ago today
Medication Nivolumab
Top half

#1,199 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 Pawpaw

What is American Pawpaw?

American Pawpaw
  • Anticancer interest
  • Lice and head lice treatment (topical)
  • Traditional digestive remedy
  • General wellness/antioxidant
  • Insecticide (historical seed use)

American pawpaw is a North American fruit tree whose leaves, twigs, and seeds contain compounds called acetogenins that have shown cancer-cell-killing activity in laboratory studies. However, strong human evidence for any health benefit is lacking, and the seeds, bark, and unripe parts can be toxic, so supplements should be used cautiously and only under professional guidance.

Read the full American Pawpaw monograph & all interactions
Medication

About Nivolumab Injection

What Is Nivolumab Injection Used For?

Brand name: Opdivo

Opdivo is a PD-1-blocking antibody used to treat many types of cancer. Sometimes it is used alone. Sometimes it is combined with other cancer medicines such as ipilimumab, cabozantinib or chemotherapy.

The cancers covered include melanoma, non-small cell lung cancer, malignant pleural mesothelioma, renal cell carcinoma (kidney cancer), classical Hodgkin lymphoma, head and neck squamous cell cancer, urothelial carcinoma (bladder and urinary tract cancer), colorectal cancer, hepatocellular carcinoma (liver cancer), esophageal cancer, and gastric (stomach) and gastroesophageal junction cancer. Each use has its own conditions, such as the stage of disease, prior treatments or tumor test results.

See full Nivolumab Injection drug information
Keep checking

Other Drugs & American Pawpaw

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

0Major
0Moderate
24Minor
2,805No known interaction
24 Minor 2,805 No interaction
Minor

24 interactions

No interaction 2,805 drugs checked — show the list

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

Showing the 60 most looked-up of 2,805 medications checked with no known interaction — see the full American Pawpaw list.

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

Can you take American Pawpaw with Nivolumab?
There is only a minor interaction, which is usually not serious. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the American Pawpaw and Nivolumab interaction?
We rate it Minor. This interaction is generally not clinically significant, but it remains worth noting and discussing with your pharmacist.

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

Still Have a Question About Nivolumab and American Pawpaw?

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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.