Drug & supplement interaction

Colocynth + Pioglitazone

Pioglitazone brand name: Actos.

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

Colocynth has a moderate interaction with Pioglitazone. Theoretically, colocynth might increase the risk of hypoglycemia when taken with antidiabetes drugs.

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

Colocynth and Pioglitazone

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

Moderate

ANTIDIABETES DRUGS

Why this applies to Pioglitazone

Pioglitazone falls under ANTIDIABETES DRUGS — the group Colocynth interacts with.

Theoretically, colocynth might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Small clinical studies show that colocynth fruit powder reduces fasting blood glucose levels in patients with type 2 diabetes who are also taking antidiabetes drugs.
Severity Moderate Likelihood Possible Evidence B

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 simple version: colocynth on its own seems to nudge blood sugar lower. Some small studies in people with type 2 diabetes found that colocynth fruit powder dropped their fasting glucose. So if you pair it with pioglitazone (Actos), which already works to lower your blood sugar by making your body more sensitive to insulin, the two could add up and push your sugar down too far.

That means a higher chance of hypoglycemia, with signs like shakiness, sweating, dizziness, a fast heartbeat, or feeling confused. Honestly, the bigger worry with colocynth is that it's quite toxic and can cause severe poisoning, so I'd steer clear of it entirely. Please talk with your pharmacist or doctor before trying anything that contains it.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Li Y, Zheng M, Zhai X, et al. Effect of Gymnema Sylvester, Citrullus colocynthis and Artemisa absinthum on blood glucose and lipid profile in diabetic human. Acta Pol Pharm. 2015;72(5):981-5.
  2. Huseini HF, Darvishzadeh F, Heshmat R, Jafariazar Z, Raza M, Larijani B. The clinical investigation of Citrullus colocynthis (L.) schrad fruit in treatment of Type II diabetic patients: a randomized, double blind, placebo-controlled clinical trial. Phytot

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

Colocynth Also Interacts With Other Medications

Colocynth has 184 moderate known drug interactions in our database — the Pioglitazone one above is one of them. If you take anything else, check it against the full list below.

Moderate 184 No known interaction 2,646 (incl. Pioglitazone)
Taking anything else?

Check Another of Your Medications Against Colocynth

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

Everything else you take

See Every Supplement That Interacts With Pioglitazone

This page covers Colocynth only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Pioglitazone page lists 356 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Beer (major), Grapefruit (major), Siberian Cocklebur (major) and St. John's Wort (major).

By severity: 6 major · 309 moderate · 41 minor.

From our pharmacist’s overview on the Pioglitazone page

“Most of what appears on this pioglitazone (Actos) list shares one trait: the ingredients lower blood sugar on their own, which sounds helpful until you remember pioglitazone already does that job for people with type 2 diabetes. Stacked together, they can push glucose too low, and I would read this list with genuine care.”

Reviewed by 2 · Jul 18, 2026

Open the Pioglitazone interaction page

One more smart check

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

We hold 2 real supplement products containing Colocynth, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Colocynth. Your product may carry other ingredients that interact with Pioglitazone too, on top of Colocynth — 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 Colocynth and Pioglitazone 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 Colocynth
Steady interest

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

29 days ago today
Medication Pioglitazone
Top half

#1,157 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 Colocynth

What is Colocynth?

  • Constipation
  • Digestive complaints
  • Diabetes (traditional use)
  • Joint and nerve pain
  • Skin conditions

Colocynth is a bitter desert gourd used in traditional medicine mainly as a powerful laxative, but it is highly toxic and can cause severe, sometimes deadly poisoning even at small doses. There is not enough good human evidence to support its use, and most pharmacists would advise against taking it. If you are curious about it, talk to a doctor or pharmacist before using any product that contains it.

Read the full Colocynth monograph & all interactions
Medication

About Pioglitazone

What Is Pioglitazone Used For?

Brand name: Actos

Pioglitazone tablets — sold as Actos and under the generic names Pioglitazone and Pioglitazone Hydrochloride — are used to improve blood sugar (glucose) control in adults with type 2 diabetes. They are taken along with diet and exercise, either alone or combined with other diabetes medicines such as a sulfonylurea, metformin, or insulin.

Pioglitazone is not for type 1 diabetes or diabetic ketoacidosis (a serious complication where the blood becomes too acidic). It only works when the body is still producing some of its own insulin.

See full Pioglitazone drug information
Keep checking

Other Drugs & Colocynth

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

0Major
184Moderate
0Minor
2,645No known interaction
184 Moderate 2,645 No interaction
Moderate

184 interactions

Showing 60 of 184 moderate interactions — see all 184 on the Colocynth page.

No interaction 2,645 drugs checked — show the list

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

Showing the 60 most looked-up of 2,645 medications checked with no known interaction — see the full Colocynth list.

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

Can you take Colocynth with Pioglitazone?
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 Colocynth and Pioglitazone 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 Pioglitazone and Colocynth?

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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.