Drug & supplement interaction

Black Hellebore + Dirithromycin

Dirithromycin brand name: Dynabac.

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

Black Hellebore has a moderate interaction with Dirithromycin. Theoretically, concomitant use of macrolide antibiotics and black hellebore might increase risk of cardiac glycoside toxicity.

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

Black Hellebore and Dirithromycin

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

Moderate

MACROLIDE ANTIBIOTICS

Why this applies to Dirithromycin

Dirithromycin falls under MACROLIDE ANTIBIOTICS — the group Black Hellebore interacts with.

Theoretically, concomitant use of macrolide antibiotics and black hellebore might increase risk of cardiac glycoside toxicity. Some of these drugs include erythromycin, azithromycin, and clarithromycin.
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

First things first: black hellebore is a genuinely toxic plant, and I wouldn't recommend taking it at all. It contains compounds that act on the heart much like digoxin does, and even small amounts can trigger dangerous heart rhythm problems on their own.

Here's the concern when you pair it with Dirithromycin (Dynabac), a macrolide antibiotic. Macrolides can slow how the body handles these heart-active chemicals, so the worry is that the hellebore's glycoside-like effects could build up and become stronger. That could mean an irregular or dangerously slow heartbeat, nausea, or feeling faint. To be fair, this is a theoretical interaction based on how these compounds behave, not strong human data. Still, since the supplement itself is unsafe, please skip it and talk with your pharmacist or doctor first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Ellenhorn MJ, et al. Ellenhorn's Medical Toxicology: Diagnoses and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams & Wilkins, 1997.

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

Black Hellebore Also Interacts With Other Medications

Black Hellebore has 132 moderate known drug interactions in our database — the Dirithromycin one above is one of them. If you take anything else, check it against the full list below.

Moderate 132 No known interaction 2,698 (incl. Dirithromycin)
Taking anything else?

Check Another of Your Medications Against Black Hellebore

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

Everything else you take

See Every Supplement That Interacts With Dirithromycin

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

The most serious there right now: Activated Charcoal (major), Oleander (major), Bacillus Coagulans (moderate), Bacillus Subtilis (moderate) and Bifidobacterium Animalis Subsp. Lactis (moderate).

By severity: 2 major · 43 moderate · 10 minor.

From our pharmacist’s overview on the Dirithromycin page

“Activated charcoal is the pairing I would stop first with dirithromycin (Dynabac). It can soak up the antibiotic in the gut and cut how much reaches the bloodstream, and it is one of only two major-rated entries among the 55 supplements on this page.”

Reviewed by 2 · Jul 18, 2026

Open the Dirithromycin interaction page

One more smart check

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

We hold 1 real supplement products containing Black Hellebore, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Black Hellebore. Your product may carry other ingredients that interact with Dirithromycin too, on top of Black Hellebore — 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 Black Hellebore and Dirithromycin 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 Black Hellebore
Top half

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

29 days ago today
Medication Dirithromycin
Top 5%

#89 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 Black Hellebore

What is Black Hellebore?

Black Hellebore
  • Constipation (historical purgative)
  • Mental and nervous disorders (historical)
  • Worm and parasite expulsion (historical)
  • Fluid retention (historical)
  • Heart conditions (historical, dangerous)

Black Hellebore is a highly toxic plant that was used in old folk medicine but has no proven, safe modern use. Because even small amounts can cause severe poisoning and dangerous heart rhythm problems, it should not be taken as a supplement. Talk to a doctor or pharmacist before considering any product that contains it.

Read the full Black Hellebore monograph & all interactions
Keep checking

Other Drugs & Black Hellebore

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

0Major
132Moderate
0Minor
2,697No known interaction
132 Moderate 2,697 No interaction
Moderate

132 interactions

Showing 60 of 132 moderate interactions — see all 132 on the Black Hellebore page.

No interaction 2,697 drugs checked — show the list

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

Showing the 60 most looked-up of 2,697 medications checked with no known interaction — see the full Black Hellebore list.

See the full Black Hellebore interactions page
See every supplement checked against Dirithromycin, 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
Black Hellebore monograph › Uses, safety, and every drug interaction in one place Dirithromycin supplement interactions › Every supplement checked against Dirithromycin, 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 Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Black Hellebore and Dirithromycin Together: Common Questions

Can you take Black Hellebore with Dirithromycin?
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 Black Hellebore and Dirithromycin 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 Dirithromycin and Black Hellebore?

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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.