Drug & supplement interaction

Atractylodes + Nirmatrelvir, Ritonavir

Nirmatrelvir, Ritonavir brand name: Paxlovid.

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

Atractylodes has a minor interaction with Nirmatrelvir, Ritonavir. Theoretically, atractylodes might increase the levels of CYP3A4 substrates.

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

Atractylodes and Nirmatrelvir, Ritonavir

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

Minor

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Why this applies to Nirmatrelvir, Ritonavir

Nirmatrelvir, Ritonavir falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group Atractylodes interacts with.

Theoretically, atractylodes might increase the levels of CYP3A4 substrates.
In animals, atractylodes administered at high doses has been shown to inhibit CYP3A1 activity, which is a homolog to the human CYP3A4 enzyme. This effect has not been shown in humans.
Severity Minor 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 gist with Paxlovid (nirmatrelvir plus ritonavir). The nirmatrelvir part is cleared by a liver enzyme called CYP3A4, and that's actually why ritonavir is added on purpose, to slow that enzyme down and keep nirmatrelvir levels high enough to work. In lab and animal studies, atractylodes has shown a mild blocking effect on this same enzyme. In theory, that could nudge nirmatrelvir levels a little higher, which might mean more of its usual side effects like an altered or metallic taste, diarrhea, nausea, or higher blood pressure.

I want to be honest about the strength here. This is theoretical and based only on animal data, never confirmed in people, and rated minor. Paxlovid is also a short 5-day course. Still, since it already has many real interactions, please run any supplement past your pharmacist or doctor first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Muhamad N, Plengsuriyakarn T, Na-Bangchang K. Atractylodes lancea for cholangiocarcinoma: Modulatory effects on CYP1A2 and CYP3A1 and pharmacokinetics in rats and biodistribution in mice. PLoS One 2022;17(11):e0277614. 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

Atractylodes Also Interacts With Other Medications

Atractylodes has 127 moderate, 673 minor known drug interactions in our database — the Nirmatrelvir, Ritonavir one above is one of them. If you take anything else, check it against the full list below.

Moderate 127 Minor 673 No known interaction 2,030 (incl. Nirmatrelvir, Ritonavir)
Taking anything else?

Check Another of Your Medications Against Atractylodes

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

Everything else you take

See Every Supplement That Interacts With Nirmatrelvir, Ritonavir

This page covers Atractylodes only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Nirmatrelvir, Ritonavir page lists 176 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Beer (major), Grapefruit (major), Siberian Cocklebur (major) and St. John's Wort (major).

By severity: 6 major · 134 moderate · 36 minor.

From our pharmacist’s overview on the Nirmatrelvir, Ritonavir page

“Paxlovid (nirmatrelvir and ritonavir) deserves genuine care around supplements, mostly because its ritonavir component strongly blocks the liver enzyme CYP3A4. The bulk of this list is made up of ingredients that enzyme normally clears, so their levels can climb unpredictably during the five-day course.”

Reviewed by 2 · Jul 18, 2026

Open the Nirmatrelvir, Ritonavir interaction page

One more smart check

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

We hold 691 real supplement products containing Atractylodes, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Atractylodes. Your product may carry other ingredients that interact with Nirmatrelvir, Ritonavir too, on top of Atractylodes — 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 Atractylodes and Nirmatrelvir, Ritonavir 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 Atractylodes
Top 25%

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

29 days ago today
Medication Nirmatrelvir, Ritonavir
Top half

#972 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 Atractylodes

What is Atractylodes?

Atractylodes
  • Digestive upset and poor appetite
  • Bloating and fluid retention
  • General fatigue or 'weakness'
  • Diarrhea
  • Support within traditional formulas

Atractylodes is a root used for centuries in traditional Chinese, Japanese, and Thai medicine, mostly for digestive complaints and fatigue, often as part of multi-herb formulas. Modern research is still early and mostly from lab and animal studies, so its true benefits in people are not well proven. If you want to try it, talk with a pharmacist or doctor first, and avoid it during pregnancy and breastfeeding.

Read the full Atractylodes monograph & all interactions
Medication

About Nirmatrelvir and Ritonavir

What Is Nirmatrelvir and Ritonavir Used For?

Brand name: Paxlovid

Paxlovid is approved to treat mild-to-moderate COVID-19 in adults who are at high risk of progressing to severe disease — meaning hospitalization or death. It is intended for people who already have symptoms and a confirmed COVID-19 diagnosis.

Paxlovid is not approved to prevent COVID-19 before or after exposure. It is a treatment, not a preventive medication.

See full Nirmatrelvir and Ritonavir drug information
Keep checking

Other Drugs & Atractylodes

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

0Major
127Moderate
673Minor
2,029No known interaction
127 Moderate 673 Minor 2,029 No interaction
Moderate

127 interactions

Showing 60 of 127 moderate interactions — see all 127 on the Atractylodes page.

Minor

673 interactions

Showing 60 of 673 minor interactions — see all 673 on the Atractylodes page.

No interaction 2,029 drugs checked — show the list

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

Showing the 60 most looked-up of 2,029 medications checked with no known interaction — see the full Atractylodes list.

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

Can you take Atractylodes with Nirmatrelvir, Ritonavir?
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 Atractylodes and Nirmatrelvir, Ritonavir 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 Nirmatrelvir, Ritonavir and Atractylodes?

Our pharmacists answer your medication & supplement questions — free.

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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.