Drug & supplement interaction

Bulbine Natalensis + Anagrelide

Anagrelide brand name: Agrylin.

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

Anagrelide falls into 2 drug categories that Bulbine Natalensis can interact with; the most serious is rated moderate. Theoretically, Bulbine natalensis stem might reduce the levels and clinical effects of CYP1A2 substrates.

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

Bulbine Natalensis and Anagrelide

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

Why Are There 2 Interactions?

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

Moderate

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES

1 of 2

Why this applies to Anagrelide

Anagrelide falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES — the group Bulbine Natalensis interacts with.

Theoretically, Bulbine natalensis stem might reduce the levels and clinical effects of CYP1A2 substrates.
In vitro research shows that Bulbine natalensis stem extract slightly induces CYP1A2 mRNA expression and enzyme activity. Theoretically, this may increase the metabolism of CYP1A2 substrates; however, this has not been studied in humans.
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 anagrelide (Agrylin). Your body relies on a liver enzyme called CYP1A2 to clear this medicine. In lab dish studies, Bulbine natalensis appeared to gently rev up that enzyme. If that happened in a person, your body might break down anagrelide a little faster, which could mean less drug working and your platelet count not staying as well controlled.

I want to be honest about how shaky this is. It comes only from test-tube and animal data, never from real people, so we truly don't know if it matters in everyday life. Still, since anagrelide is keeping your platelets in a safe range, I wouldn't want anything quietly weakening it. Please loop in your doctor or pharmacist before adding this supplement, especially given Bulbine's possible liver concerns.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Husain I, Manda V, Alhusban M, et al. Modulation of CYP3A4 and CYP2C9 activity by Bulbine natalensis and its constituents: An assessment of HDI risk of B. natalensis containing supplements. Phytomedicine 2021;81:153416. PubMed
Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

2 of 2

Anagrelide also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.

Theoretically, combining Bulbine natalensis leaf with drugs that have anticoagulant or antiplatelet activity might increase the risk of bruising and bleeding.
In vitro research shows that Bulbine natalensis ground leaf extract inhibits platelet aggregation.
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 thing to keep in mind: anagrelide already lowers your platelets and can make it harder for your blood to clot. In lab studies, Bulbine natalensis appears to slow platelets from clumping together too. So if you take both, you may be nudging your bleeding risk in the same direction twice over. That could show up as easier bruising, nosebleeds, bleeding gums, or cuts that are slow to stop.

I want to be honest, though: this concern is theoretical, based on test-tube work, not real-world cases. It isn't proven in people. That said, I'd also flag that Bulbine has raised liver and kidney safety questions in animals. Please check with your doctor or pharmacist before pairing it with anagrelide.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Mosa RA, Lazarus GG, Gwala PE, Oyedeji AO, Opoku AR. In Vitro Anti-platelet Aggregation, Antioxidant and Cytotoxic Activity of Extracts of Some Zulu Medicinal Plants. J Nat Prod. 2011;4(2011):136-146.

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

Bulbine Natalensis Also Interacts With Other Medications

Bulbine Natalensis has 918 moderate known drug interactions in our database — the Anagrelide one above is among them. If you take anything else, check it against the full list below.

Moderate 918 No known interaction 1,912 (incl. Anagrelide)
Taking anything else?

Check Another of Your Medications Against Bulbine Natalensis

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

Everything else you take

See Every Supplement That Interacts With Anagrelide

This page covers Bulbine Natalensis only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Anagrelide page lists 265 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Danshen (major), Piracetam (major), Aconite (moderate) and Adrafinil (moderate).

By severity: 3 major · 223 moderate · 39 minor.

From our pharmacist’s overview on the Anagrelide page

“Anagrelide (Agrylin) lowers platelet counts in people whose bone marrow makes too many, so bleeding risk is already the thing being managed, and most of this list pushes on exactly that. The bulk of these ingredients have some blood-thinning or antiplatelet activity of their own, from danshen and piracetam at the serious end down to fa…”

Reviewed by 2 · Jul 18, 2026

Open the Anagrelide interaction page

One more smart check

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

We hold 51 real supplement products containing Bulbine Natalensis, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Bulbine Natalensis. Your product may carry other ingredients that interact with Anagrelide too, on top of Bulbine Natalensis — 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 Bulbine Natalensis and Anagrelide 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 Bulbine Natalensis
Steady interest

#1,114 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Anagrelide
Top 25%

#406 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 Bulbine Natalensis

What is Bulbine Natalensis?

  • Boosting testosterone
  • Improving libido
  • Muscle building and athletic performance
  • General male vitality

Bulbine natalensis is a South African plant marketed mainly as a testosterone-boosting and libido supplement, but the human evidence is essentially absent and most claims come from animal studies. Animal research has also raised concerns about possible liver and kidney harm at higher doses, so caution is warranted. Talk to your pharmacist or doctor before trying it.

Read the full Bulbine Natalensis monograph & all interactions
Medication

About Anagrelide

What Is Anagrelide Used For?

Brand name: Agrylin

Anagrelide — sold as Agrylin and as generic anagrelide capsules — is used to treat thrombocythemia secondary to myeloproliferative neoplasms. That means it's prescribed when a bone marrow disorder causes the body to produce too many platelets, raising the risk of dangerous blood clots.

By bringing platelet counts down to a safer range, anagrelide also helps reduce related symptoms, including bleeding and clotting events (thrombo-hemorrhagic events).

See full Anagrelide drug information
Keep checking

Other Drugs & Bulbine Natalensis

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

0Major
918Moderate
0Minor
1,911No known interaction
918 Moderate 1,911 No interaction
Moderate

918 interactions

Showing 60 of 918 moderate interactions — see all 918 on the Bulbine Natalensis page.

No interaction 1,911 drugs checked — show the list

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

Showing the 60 most looked-up of 1,911 medications checked with no known interaction — see the full Bulbine Natalensis list.

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

Can you take Bulbine Natalensis with Anagrelide?
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 Bulbine Natalensis and Anagrelide?
Anagrelide belongs to more than one drug category, and Bulbine Natalensis 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 Bulbine Natalensis and Anagrelide 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 Anagrelide and Bulbine Natalensis?

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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.