Drug & supplement interaction

Black Horehound + Pramipexole

Pramipexole brand name: Mirapex.

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

Black Horehound has a moderate interaction with Pramipexole. Theoretically, black horehound might have additive effects when used with dopamine agonists.

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

Black Horehound and Pramipexole

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

Moderate

DOPAMINE AGONISTS

Why this applies to Pramipexole

Pramipexole falls under DOPAMINE AGONISTS — the group Black Horehound interacts with.

Theoretically, black horehound might have additive effects when used with dopamine agonists. Some constituents of black horehound bind to dopamine D2 receptors in vitro; however, this has not yet been reported in humans. Some dopamine agonists include bromocriptine (Parlodel), levodopa (Dopar, component of Sinemet), pramipexole (Mirapex), ropinirole (Requip), and others.
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

Here's the gist for pramipexole (Mirapex): this medicine works by acting like dopamine in your brain, switching on dopamine receptors to ease Parkinson's symptoms or restless legs. The concern is that some compounds in black horehound have been shown, in a test tube only, to latch onto those same D2 dopamine receptors. So in theory, stacking the two could nudge dopamine activity higher than intended.

If that played out in real life, you might notice more of pramipexole's usual side effects, things like nausea, dizziness, daytime sleepiness, low blood pressure when standing, or even sudden urges and impulsive behaviors. That said, this is purely a lab-based, theoretical worry with no human reports behind it, so please don't panic. Just loop in your pharmacist or doctor before adding black horehound rather than deciding on your own.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Daels-Rakotoarison DA, Seidel V, Gressier B, et al. Neurosedative and antioxidant activities of phenylpropanoids from Ballota nigra. Arzneimittelforschung 2000;50:16-23. 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

Black Horehound Also Interacts With Other Medications

Black Horehound has 22 moderate known drug interactions in our database — the Pramipexole one above is one of them. If you take anything else, check it against the full list below.

Moderate 22 No known interaction 2,808 (incl. Pramipexole)
Taking anything else?

Check Another of Your Medications Against Black Horehound

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

From our Q&A

Questions About Black Horehound or Pramipexole

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Black Horehound or Pramipexole, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Pramipexole

This page covers Black Horehound only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Pramipexole page lists 21 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Ayahuasca (moderate), Coffee Charcoal (moderate), European Mandrake (moderate) and Glucomannan (moderate).

By severity: 1 major · 11 moderate · 9 minor.

From our pharmacist’s overview on the Pramipexole page

“Activated charcoal is the one entry rated major against pramipexole (Mirapex), and it is where I would start reading. Charcoal binds drugs in the gut and can shrink how much pramipexole actually reaches the bloodstream, and for someone counting on this medicine to steady Parkinson's tremor or calm restless legs, a weakened dose shows u…”

Reviewed by 2 · Jul 18, 2026

Open the Pramipexole interaction page

How much people look this up

Where Black Horehound and Pramipexole 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 Horehound
Top half

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

29 days ago today
Medication Pramipexole
Top half

#943 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 Horehound

What is Black Horehound?

Black Horehound
  • Nausea and vomiting
  • Anxiety and nervous tension
  • Sleep problems
  • Mild digestive upset
  • Coughs and respiratory complaints

Black horehound is a traditional European herb mainly used for nausea, mild anxiety, and digestive upset, but high-quality human studies are lacking, so its effectiveness is largely unproven. It has a strong, unpleasant smell and taste, and its safety has not been well studied, so it should be avoided in pregnancy and breastfeeding and used cautiously by everyone else.

Read the full Black Horehound monograph & all interactions
Medication

About Pramipexole

What Is Pramipexole Used For?

Brand name: Mirapex

Pramipexole tablets (immediate-release) are approved to treat Parkinson's disease and moderate-to-severe primary restless legs syndrome (RLS). Pramipexole dihydrochloride extended-release tablets are approved only for Parkinson's disease.

For Parkinson's disease, pramipexole helps manage the motor symptoms of the condition. For RLS, the immediate-release tablet is taken to relieve the uncomfortable urge-to-move sensations that are the hallmark of the syndrome.

See full Pramipexole drug information
Keep checking

Other Drugs & Black Horehound

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

0Major
22Moderate
0Minor
2,807No known interaction
22 Moderate 2,807 No interaction
Moderate

22 interactions

No interaction 2,807 drugs checked — show the list

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

Showing the 60 most looked-up of 2,807 medications checked with no known interaction — see the full Black Horehound list.

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

Can you take Black Horehound with Pramipexole?
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 Horehound and Pramipexole 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 Pramipexole and Black Horehound?

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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.