Drug & supplement interaction

Black Hellebore + Tigecycline

Tigecycline brand name: Tygacil.

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

Tigecycline falls into 2 drug categories that Black Hellebore can interact with; the most serious is rated moderate. Theoretically, concomitant use of macrolide antibiotics and black hellebore might increase risk of cardiac glycoside toxicity.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Black Hellebore and Tigecycline

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

Why Are There 2 Interactions?

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

Moderate

MACROLIDE ANTIBIOTICS

1 of 2

Why this applies to Tigecycline

Tigecycline 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, the big picture: Black Hellebore is genuinely toxic and shouldn't be taken as a supplement at all, so this isn't a combo you'd ever want to set up on purpose. The concern on file is that it contains heart-acting compounds that behave like cardiac glycosides (think digoxin-style chemicals), and pairing those with certain antibiotics may raise the odds of dangerous heart rhythm changes.

Now, a fair note on Tigecycline (Tygacil): it's actually a tetracycline-type antibiotic given by IV in the hospital, not a macrolide, so this particular warning fits the category more than the exact drug. It's also not a prodrug, so there's no enzyme being flipped here. The flag is theoretical, based on pharmacology rather than real cases. Still, since Black Hellebore can trigger irregular heartbeats and severe stomach upset on its own, please clear anything containing it with your doctor or pharmacist 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.
Moderate

TETRACYCLINE ANTIBIOTICS

2 of 2

Tigecycline also falls under TETRACYCLINE ANTIBIOTICS.

Theoretically, concomitant use of tetracyclic antibiotics and black hellebore might increase the risk of cardiac glycoside toxicity.
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 genuinely toxic and isn't something I'd ever recommend taking, no matter what else you're on. With Tigecycline specifically, the concern here is theoretical. Tigecycline is given as an IV infusion in the hospital for serious infections, and it isn't a prodrug, so the antibiotic itself doesn't need activating to work.

The worry is that Black Hellebore contains compounds that behave a bit like heart medicines (cardiac glycosides), and there's a thought that combining it with tetracycline-type antibiotics could nudge up the risk of heart rhythm trouble. This comes from pharmacology reasoning, not solid studies. Honestly, the bigger issue is the hellebore itself. Please talk with your doctor or pharmacist before going near any product containing it.

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 Tigecycline one above is among them. If you take anything else, check it against the full list below.

Moderate 132 No known interaction 2,698 (incl. Tigecycline)
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 Tigecycline

This page covers Black Hellebore only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Tigecycline page lists 98 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Oleander (major), Para-aminobenzoic Acid (paba) (major), Acerola (moderate), Alfalfa (moderate) and Alpha-lipoic Acid (moderate).

By severity: 2 major · 88 moderate · 8 minor.

From our pharmacist’s overview on the Tigecycline page

“Tigecycline (Tygacil) is an intravenous antibiotic usually reserved for serious or resistant infections, and its supplement list deserves real attention. The two major-rated entries come first: oleander, a heart-toxic plant whose compounds may build to dangerous levels with certain antibiotics on board, and PABA, which can blunt the an…”

Reviewed by 2 · Jul 18, 2026

Open the Tigecycline 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 Tigecycline 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 Tigecycline 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

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

29 days ago today
Medication Tigecycline
Steady interest

#2,548 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
Medication

About Tigecycline Injection

What Is Tigecycline Injection Used For?

Brand name: Tygacil

Tygacil (tigecycline for injection) is approved for adults 18 and older to treat three types of serious bacterial infections: complicated skin and skin structure infections, complicated intra-abdominal (stomach and intestinal) infections, and community-acquired bacterial pneumonia (pneumonia caught outside a hospital).

It is not approved for diabetic foot infections or for pneumonia caught in a hospital setting, including ventilator-associated pneumonia — clinical trials showed it did not work well enough for those uses and was associated with higher mortality in patients with ventilator-associated pneumonia.

See full Tigecycline Injection drug information
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 Tigecycline, 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 Tigecycline supplement interactions › Every supplement checked against Tigecycline, ranked by severity Tigecycline 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 Black Hellebore and Tigecycline Together: Common Questions

Can you take Black Hellebore with Tigecycline?
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.
Why are there 2 interactions listed for Black Hellebore and Tigecycline?
Tigecycline belongs to more than one drug category, and Black Hellebore 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 Black Hellebore and Tigecycline 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 Tigecycline 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.