Drug & supplement interaction

Bitter Orange + Eltrombopag

Eltrombopag brand names: Promacta, Revolade, Alvaiz.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 20, 2026
The bottom line No known interaction

We found no known interaction between Bitter Orange and Eltrombopag in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the label for Eltrombopag states a food rule worth keeping to, and the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

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Interaction report

Bitter Orange and Eltrombopag

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Eltrombopag and Bitter Orange in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Bitter Orange safety at a glance

Bitter Orange overall Use caution Generally limited use may be tolerated, but the synephrine it contains can affect heart rate and blood pressure.
Pregnancy Likely Safe When used orally in the amounts found in foods. Bitter orange has Generally Recognized as Safe (GRAS) status in the US. Read the full pregnancy detail
Breastfeeding Likely Safe When used orally in the amounts found in foods. Bitter orange has Generally Recognized as Safe (GRAS) status in the US. Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center) — the full detail is in the Special populations card below. Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Eltrombopag and Bitter Orange? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Eltrombopag

Interactions in our licensed database are recorded against drug classes, not just single drug names. Eltrombopag is filed under 2 classifications — hepatotoxic drugs, oral drugs. Bitter Orange has documented interactions with 13 drug classes — the most serious being midazolam (versed) (major), monoamine oxidase inhibitors (maois) (major) and antidiabetes drugs (moderate) — and none of Eltrombopag’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Bitter Orange Does Interact With Other Medications

Bitter Orange has 10 major, 876 moderate, 71 minor known drug interactions in our database — Eltrombopag isn’t one of them. If you take anything else, check it against the full list below.

Major 10 Moderate 876 Minor 71 No known interaction 1,873 (incl. Eltrombopag)
Taking anything else?

Check Another of Your Medications Against Bitter Orange

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

What to actually watch for

No Interaction Found — But Data Suggests Bitter Orange and Eltrombopag May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do.

  • Dizziness / Headache Additional detail

    Bitter Orange

    “Dizziness, difficulty in concentrating, memory loss, syncope, seizure, and stroke have been noted in case reports following bitter orange administration. Theoretically, bitter orange may trigger a migraine or cluster headache due to its synephrine and octopamine content. When used as aromatherapy, bitter orange essential oil has also been reported to cause headache in some patients.”

    Bitter Orange · Natural Medicines adverse-effect record, reported in cluster headache.

    5 sources cited
    1. 13091. Bouchard NC, Howland MA, Greller HA, et al. Ischemic stroke associated with use of an ephedra-free dietary supplement containing synephrine. Mayo Clin Proc 2005;80:541-5. PubMed
    2. 13039. Nasir JM, Durning SJ, Ferguson M, et al. Exercise-induced syncope associated with QT prolongation and ephedra-free Xenadrine. Mayo Clin Proc 2004;79:1059-62.. PubMed
    3. 35768. Calapai, G., Firenzuoli, F., Saitta, A., Squadrito, F. R., Arlotta, M., Costantino, G., and Inferrera, G. Antiobesity and cardiovascular toxic effects of Citrus aurantium extracts in the rat: a preliminary report. Fitoterapia 12-1-1999;70(6):586-592. DOI
    4. 104187. Karimzadeh Z, Azizzadeh Forouzi M, Tajadini H, Ahmadinejad M, Roy C, Dehghan M. Effects of lavender and Citrus aurantium on pain of conscious intensive care unit patients: a parallel randomized placebo-controlled trial. J Integr Med 2021:S2095-4964(21)000 PubMed
    5. 95655. Gutiérrez-Hellín J, Salinero JJ, Abían-Vicen J, Areces F, Lara B, Gallo C, et al. Acute consumption of p-synephrine does not enhance performance in sprint athletes.J. Appl Physiol Nutr Metab. 2016;41(1):63-9. doi: 10.1139/apnm-2015-0299.

    Eltrombopag

    Listed in the ADVERSE REACTIONS section of the FDA label for Eltrombopag. Read the label on DailyMed ›

Reported for Bitter Orange but not commonly for Eltrombopag: a heart attack, an irregular heartbeat, a stroke or mini-stroke and severe muscle breakdown.

Effects for Eltrombopag come from the ADVERSE REACTIONS section of its FDA label; effects for Bitter Orange come from the Natural Medicines adverse-effect record, quoted above. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

Special populations

Bitter Orange in Pregnancy & Breastfeeding

Pregnancy And Lactation Likely Safe

When used orally in the amounts found in foods. Bitter orange has Generally Recognized as Safe (GRAS) status in the US.

Pregnancy And Lactation Possibly Unsafe

When used orally for medicinal purposes. There are case reports of cardiotoxicity including tachyarrhythmia, syncope, and myocardial infarction in otherwise healthy adults who have taken bitter orange extract alone or in combination with other stimulants such as caffeine. The effects of bitter orange during lactation are unknown; avoid use.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.© 2026 Therapeutic Research Center

How to take them

Some Eltrombopag Products Have a Food Rule — Bitter Orange Should Not Break It

At least one FDA label for a product containing Eltrombopag says to take it with food. If you take Bitter Orange on an empty stomach out of habit, keep them separate — and take Eltrombopag with a meal where the label says to.

This may not be true of your version. Food instructions belong to the product, not the ingredient: two Eltrombopag products can carry different directions, and extended-release forms often differ from immediate-release ones. The label we read is quoted below — check the directions on your own box or bottle, or ask your pharmacist, for how to take the exact product you were given.

Do not split, chew, or crush tablets and mix with food or liquids.

From the Dosage and Administration section of the FDA label we read for Eltrombopag — where that label names a specific product, the instruction is that product's. Read the label on DailyMed ›

A food rule is not an interaction — it is about how much of the medicine you absorb. The directions that came with your own product, and your pharmacist, outrank anything on this page.

Everything else you take

See Every Supplement That Interacts With Eltrombopag

This page covers Bitter Orange only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Eltrombopag page lists 55 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Beer (major), Siberian Cocklebur (major), Wine (major) and Ashwagandha (moderate).

By severity: 4 major · 42 moderate · 9 minor.

From our pharmacist’s overview on the Eltrombopag page

“Eltrombopag (Promacta, Revolade) boosts platelet production, and because the drug itself can stress the liver, this list warrants genuine care. Thirty-eight of the 55 supplements and herbs here can injure the liver on their own, so combining them stacks risk on an organ your doctor is already watching with blood tests.”

Reviewed by 2 · Jul 18, 2026

Open the Eltrombopag interaction page

One more smart check

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

We hold 1,000 real supplement products containing Bitter Orange, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Bitter Orange. Even though Bitter Orange itself has no known interaction with Eltrombopag, another ingredient on your label might. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Bitter Orange and Eltrombopag 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 Bitter Orange
Top 25%

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

29 days ago today
Medication Eltrombopag
Steady interest

#2,384 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.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Bitter Orange reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 20, 2026. The Bitter Orange and Eltrombopag records this page draws on were last updated July 10, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
Supplement

About Bitter Orange

What is Bitter Orange?

Bitter Orange
  • Weight loss
  • Athletic performance and energy
  • Digestive upset
  • Appetite control
  • Aromatherapy for stress (neroli oil)

Bitter orange is a citrus fruit whose extracts contain synephrine, a mild stimulant often added to weight-loss and energy supplements. Evidence that it works for weight loss or performance is limited, and because it can raise heart rate and blood pressure, people with heart problems, high blood pressure, or who are pregnant should avoid it. Talk to your pharmacist or doctor before using it, especially if you take other stimulants.

Citrus aurantium · Rutaceae · Fruit (especially the dried immature fruit and peel), flowers, and essential oil (neroli) · Capsules, tablets, extracts, dried peel, tea, and essential oil

An interaction check asks whether these two react with each other — it does not ask whether Bitter Orange is a good idea for someone in your situation. Here is what our Bitter Orange record says about it on its own.

Bitter Orange: dosing

There is no well-established, proven dose for bitter orange. Products vary widely, and many are standardized to a certain amount of synephrine and often combined with caffeine or other ingredients.Because of this variability and the potential heart-related risks, it is best to follow the directions on the product label and not exceed them.

From our Bitter Orange monograph — the full record covers uses, side effects and every documented interaction.

Read the full Bitter Orange monograph & all interactions
Medication

About Eltrombopag

What Is Eltrombopag Used For?

Brand names: Promacta, Revolade, Alvaiz

Eltrombopag treats thrombocytopenia (low platelet counts) in several different conditions. It is used for adults and children (age 1 and older, depending on the product) with persistent or chronic immune thrombocytopenia (ITP) — a condition where the immune system destroys platelets — when other treatments like steroids or immunoglobulins haven't worked well enough. It is also used to raise platelet counts in adults with chronic hepatitis C whose low platelet count prevents them from starting or staying on interferon-based antiviral therapy.

Eltrombopag tablets (including Promacta) are also approved — alone or combined with immunosuppressive therapy — for adults and certain children (age 2 and older) with severe aplastic anemia, a serious bone marrow failure condition. Alvaiz (a specific brand) shares most of these uses but has product-specific dosing that is not interchangeable milligram-for-milligram with other eltrombopag products. The oral suspension formulation is approved for ITP and for refractory severe aplastic anemia, but is not approved for first-line severe aplastic anemia in combination with immunosuppressive therapy.

See full Eltrombopag drug information
Keep checking

Other Drugs & Bitter Orange

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

10Major
876Moderate
71Minor
1,872No known interaction
10 Major 876 Moderate 71 Minor 1,872 No interaction
Major

10 interactions

Moderate

876 interactions

Showing 60 of 876 moderate interactions — see all 876 on the Bitter Orange page.

Minor

71 interactions

Showing 60 of 71 minor interactions — see all 71 on the Bitter Orange page.

No interaction 1,872 drugs checked — show the list

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

Showing the 60 most looked-up of 1,872 medications checked with no known interaction — see the full Bitter Orange list.

See the full Bitter Orange interactions page
See every supplement checked against Eltrombopag, ranked by severity
Evidence & sources

Bitter Orange References

The 47 references that drive our Bitter Orange monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Penzak SR, Jann MW, Cold JA, et al. Seville (sour) orange juice: synephrine content and cardiovascular effects in normotensive adults. J Clin Pharmacol 2001;41:1059-63. PubMed
  2. Electronic Code of Federal Regulations. Title 21. Part 182 -- Substances Generally Recognized As Safe. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=182
  3. Calapai G, Firenzuoli F, Saitta A, et al. Antiobesity and cardiovascular toxic effects of Citrus aurantium extracts in the rat: A preliminary report. Fitoterapia 1999;70:586-92. DOI
  4. Keogh AM, Baron DW. Sympathomimetic abuse and coronary artery spasm. Br Med J 1985;291:940.
  5. Malhotra S, Bailey DG, Paine MF, Watkins PB. Seville orange juice-felodipine interaction: comparison with dilute grapefruit juice and involvement of furocoumarins. Clin Pharmacol Ther 2001;69:14-23. PubMed
  6. Pellati F, Benvenuti S, Melegari M, Firenzuoli F. Determination of adrenergic agonists from extracts and herbal products of Citrus aurantium L. var. amara by LC. J Pharm Biomed Anal 2002;29:1113-9. . PubMed
  7. Colker CM, Kalman DS, Torina GC, et al. Effects of Citrus aurantium extract, caffeine, and St. John's wort on body fat loss, lipid levels, and mood states in overweight healthy adults. Curr Ther Res 1999;60:145-153. DOI
  8. Penzak SR, Acosta EP, Turner M, et al. Effect of Seville orange juice and grapefruit juice on indinavir pharmacokinetics. J Clin Pharmacol 2002;42:1165-70. PubMed
  9. Edwards DJ, Fitzsimmons ME, Schuetz EG, et al. 6',7'-Dihydroxybergamottin in grapefruit juice and Seville orange juice: effects on cyclosporine disposition, enterocyte CYP3A4, and P-glycoprotein. Clin Pharmacol Ther 1999;65:237-44. PubMed
  10. Di Marco MP, Edwards DJ, Wainer IW, Ducharme MP. The effect of grapefruit juice and seville orange juice on the pharmacokinetics of dextromethorphan: the role of gut CYP3A and P-glycoprotein. Life Sci 2002;71:1149-60. PubMed
  11. Visentin V, Morin N, Fontana E, et al. Dual action of octopamine on glucose transport into adipocytes: inhibition via beta3-adrenoceptor activation and stimulation via oxidation by amine oxidases. J Pharmacol Exp Ther 2001;299:96-104.
  12. Nykamp DL, Fackih MN, Compton AL. Possible association of acute lateral-wall myocardial infarction and bitter orange supplement. Ann Pharmacother 2004;38:812-6. PubMed
  13. Fugh-Berman A, Myers A. Citrus aurantium, an ingredient of dietary supplements marketed for weight loss: Current status of clinical and basic Research. Exp Biol Med 2004;229:698-704.
  14. Suzuki O, Matsumoto T, Oya M, Katsumata Y. Oxidation of synephrine by type A and type B monoamine oxidase. Experientia 1979;35:1283-4. PubMed
  15. Nasir JM, Durning SJ, Ferguson M, et al. Exercise-induced syncope associated with QT prolongation and ephedra-free Xenadrine. Mayo Clin Proc 2004;79:1059-62.. PubMed

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking Bitter Orange and Eltrombopag Together: Common Questions

Is it safe to take Bitter Orange with Eltrombopag?
We do not list a known interaction between Bitter Orange and Eltrombopag. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
Do Bitter Orange and Eltrombopag have any of the same side effects?
Yes — our sources link each of them separately to 2 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.
Should I take Bitter Orange and Eltrombopag at the same time of day?
At least one FDA label for a product containing Eltrombopag says to take it with food. If you take Bitter Orange on an empty stomach out of habit, keep them separate and take Eltrombopag with a meal where the label says to. Food instructions belong to the product rather than the ingredient — two Eltrombopag products can differ — so check the directions on your own box. This is about absorption, not an interaction.
How was the Bitter Orange and Eltrombopag combination checked?
Interactions in our licensed database are recorded against drug classes. Eltrombopag is filed under 2 classifications, and Bitter Orange has documented interactions with 13 drug classes — none of Eltrombopag's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does Bitter Orange interact with any other medications?
Yes. Bitter Orange has 957 documented drug interactions in our database — Eltrombopag is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Eltrombopag interact with any supplements?
Yes. Eltrombopag has documented interactions with 55 supplements in our database — Bitter Orange is not one of them. The Eltrombopag interaction page linked on this page lists every one, ranked by severity.

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

Where next

Keep Exploring

Bitter Orange monograph Uses, safety profile, and every drug interaction in one place Eltrombopag drug information The full plain-English guide to this medication Eltrombopag supplement interactions Every supplement checked against Eltrombopag, ranked by severity Supplement interaction checker Check any supplement or product against your medications Browse medications A–Z Every drug we’ve checked against herbs & supplements References The 47 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Eltrombopag and Bitter Orange?

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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.