Drug & supplement interaction

Cowhage + Apremilast

Apremilast brand name: Otezla.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 20, 2026
The bottom line No known interaction

We found no known interaction between Cowhage and Apremilast in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

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Interaction report

Cowhage and Apremilast

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Apremilast and Cowhage in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Cowhage safety at a glance

Cowhage overall Use caution It contains L-dopa, an active drug-like compound, so it should be used carefully and with professional guidance.
Pregnancy Avoid Not enough safety data and its dopamine effects make it best avoided during pregnancy.
Breastfeeding Avoid L-dopa can lower prolactin and reduce milk supply, so avoid while breastfeeding.

Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Apremilast and Cowhage? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Apremilast

Interactions in our licensed database are recorded against drug classes, not just single drug names. Apremilast is filed under 2 classifications — cytochrome p450 3a4 (cyp3a4) substrates, oral drugs. Cowhage has documented interactions with 8 drug classes — the most serious being levodopa (major), methyldopa (aldomet) (major) and monoamine oxidase inhibitors (maois) (major) — and none of Apremilast’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Cowhage Does Interact With Other Medications

Cowhage has 17 major, 176 moderate known drug interactions in our database — Apremilast isn’t one of them. If you take anything else, check it against the full list below.

Major 17 Moderate 176 No known interaction 2,637 (incl. Apremilast)
Taking anything else?

Check Another of Your Medications Against Cowhage

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

What to actually watch for

No Interaction Found — But Data Suggests Cowhage and Apremilast May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do.

  • Diarrhea reported in 16.9% of FDA reports for Apremilast Additional detail

    Cowhage

    “Orally, cowhage has been reported to cause flatulence, diarrhea, and dry mouth. Orally, a specific powdered cowhage seed extract (Zandopa, formerly HP-200; Zandu Pharmaceuticals) has been reported to cause nausea, abdominal distention, and vomiting in clinical research when taken in amounts of 22.5-67.5 grams divided into 2-5 doses per day.”

    Cowhage · Natural Medicines adverse-effect record, reported in diarrhea.

    3 sources cited
    1. 7021. Infante ME, Perez AM, Simao MR, et al. Outbreak of acute toxic psychosis attributed to Mucuna pruriens. Lancet 1990;336:1129. PubMed
    2. 7203. Vaidya AB, Rajagopalan TG, Mankodi NA, et al. Treatment of Parkinson's disease with the cowhage plant-Mucuna pruriens Bak. Neurol India 1978;26:171-6.
    3. 7020. HP-200 in Parkinson's Disease study group. An alternative medicine treatment for Parkinson's disease: Results of a multicenter clinical trial. J Alt Comp Med 1995;1:249-55. DOI

    Apremilast

    Listed in the ADVERSE REACTIONS section of the FDA label for Apremilast, and in voluntary FDA adverse-event reports. Read the label on DailyMed ›

  • Trouble sleeping / Headache reported in 12.3% of FDA reports for Apremilast Additional detail

    Cowhage

    “Orally, cowhage has been reported to cause headaches. Orally, insomnia has been reported in clinical research in about 3% of patients taking a specific powdered cowhage seed extract (Zandopa, formerly HP-200; Zandu Pharmaceuticals) 22.5 grams to 67.5 grams divided into 2-5 doses daily.”

    Cowhage · Natural Medicines adverse-effect record, reported in insomnia.

    3 sources cited
    1. 7021. Infante ME, Perez AM, Simao MR, et al. Outbreak of acute toxic psychosis attributed to Mucuna pruriens. Lancet 1990;336:1129. PubMed
    2. 7203. Vaidya AB, Rajagopalan TG, Mankodi NA, et al. Treatment of Parkinson's disease with the cowhage plant-Mucuna pruriens Bak. Neurol India 1978;26:171-6.
    3. 7020. HP-200 in Parkinson's Disease study group. An alternative medicine treatment for Parkinson's disease: Results of a multicenter clinical trial. J Alt Comp Med 1995;1:249-55. DOI

    Apremilast

    Listed in the ADVERSE REACTIONS section of the FDA label for Apremilast, and in voluntary FDA adverse-event reports. Read the label on DailyMed ›

  • Nausea / Vomiting reported in 15.2% of FDA reports for Apremilast Additional detail

    Cowhage

    Recorded for Cowhage in the same Natural Medicines adverse-effect record shown under Diarrhea above.

    Apremilast

    Listed in the ADVERSE REACTIONS section of the FDA label for Apremilast, and in voluntary FDA adverse-event reports. Read the label on DailyMed ›

  • A skin rash Additional detail

    Cowhage

    Recorded for Cowhage in the same Natural Medicines adverse-effect record shown under Diarrhea above.

    Apremilast

    Listed in the ADVERSE REACTIONS section of the FDA label for Apremilast. Read the label on DailyMed ›

Reported for Cowhage but not commonly for Apremilast: liver problems, trouble passing urine, hallucinations and muscle pain.

Effects for Apremilast come from the ADVERSE REACTIONS section of its FDA label; effects for Cowhage come from the Natural Medicines adverse-effect record, quoted above. Where a percentage is shown, it is the share of 145,481 voluntary FDA FAERS reports for Apremilast that mention that effect — a reporting proportion, not an incidence rate and not evidence the drug caused it. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

Everything else you take

See Every Supplement That Interacts With Apremilast

This page covers Cowhage only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Apremilast page lists 138 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Grapefruit (major), St. John's Wort (major), Acacia Rigidula (moderate) and Adrafinil (moderate).

By severity: 3 major · 94 moderate · 41 minor.

From our pharmacist’s overview on the Apremilast page

“St. John's wort is the first thing I would rule out for anyone taking apremilast (Otezla) for psoriasis, psoriatic arthritis, or Behçet's mouth sores.”

Reviewed by 2 · Jul 18, 2026

Open the Apremilast interaction page

One more smart check

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

We hold 1,218 real supplement products containing Cowhage, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Cowhage. Even though Cowhage itself has no known interaction with Apremilast, another ingredient on your label might. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Cowhage and Apremilast 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 Cowhage
Top 25%

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

29 days ago today
Medication Apremilast
Top half

#1,155 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.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Cowhage reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 20, 2026. The Cowhage and Apremilast records this page draws on were last updated July 11, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
Supplement

About Cowhage

What is Cowhage?

  • Parkinson's disease symptoms
  • Male fertility and libido
  • Mood and stress support
  • Traditional aphrodisiac
  • General energy and vitality

Cowhage (Mucuna pruriens) is a tropical legume best known as a natural source of L-dopa, the compound the body turns into dopamine. It is most studied for Parkinson's disease symptoms and male fertility, but evidence is still limited and the L-dopa content makes it potentially powerful and risky—talk to your doctor or pharmacist before using it.

Mucuna pruriens · Fabaceae · Seeds (and seed hairs from the pods) · Capsules, powder, standardized extracts

An interaction check asks whether these two react with each other — it does not ask whether Cowhage is a good idea for someone in your situation. Here is what our Cowhage record says about it on its own.

Cowhage: dosing

There is no official, standardized dose of cowhage. Products vary widely in how much L-dopa they contain, which makes safe dosing difficult. Some supplements are standardized to a percentage of L-dopa, but this is not consistent across brands.Because of these differences and the drug-like effects of L-dopa, you should not guess at a dose.

From our Cowhage monograph — the full record covers uses, side effects and every documented interaction.

Read the full Cowhage monograph & all interactions
Medication

About Apremilast

What Is Apremilast Used For?

Brand name: Otezla

Otezla (apremilast) is used to treat active psoriatic arthritis and plaque psoriasis in adults and in children 6 years of age and older who weigh at least 20 kg. For plaque psoriasis, it is prescribed when phototherapy or systemic treatment is appropriate. Otezla is also approved to treat oral ulcers associated with Behçet's Disease in adults.

Dosing for children depends on body weight. Otezla is approved for pediatric patients weighing at least 20 kg. Otezla is not approved for children with Behçet's Disease.

Most-Reported Side Effects for Apremilast

From FAERS, the FDA’s public side-effect reporting system (145,481 reports, all brands). Reports are voluntary and are not proof the drug caused the effect.

Diarrhea 24,624 reports
Nausea 22,177 reports
Psoriasis 20,585 reports
Headache 17,913 reports
Abdominal discomfort 8,234 reports
See full Apremilast drug information
Keep checking

Other Drugs & Cowhage

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

17Major
176Moderate
0Minor
2,636No known interaction
17 Major 176 Moderate 2,636 No interaction
Major

17 interactions

Moderate

176 interactions

Showing 60 of 176 moderate interactions — see all 176 on the Cowhage page.

No interaction 2,636 drugs checked — show the list

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

Showing the 60 most looked-up of 2,636 medications checked with no known interaction — see the full Cowhage list.

See the full Cowhage interactions page
See every supplement checked against Apremilast, ranked by severity
Evidence & sources

Cowhage References

The 12 references that drive our Cowhage monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. McEvoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.
  2. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  3. Anon. Epidemiological notes and reports: Mucuna pruriens-associated pruritus--New Jersey. MMWR Morb Mortal Wkly Rep 1985;34:732-3.
  4. HP-200 in Parkinson's Disease study group. An alternative medicine treatment for Parkinson's disease: Results of a multicenter clinical trial. J Alt Comp Med 1995;1:249-55. DOI
  5. Infante ME, Perez AM, Simao MR, et al. Outbreak of acute toxic psychosis attributed to Mucuna pruriens. Lancet 1990;336:1129. PubMed
  6. Vaidya AB, Rajagopalan TG, Mankodi NA, et al. Treatment of Parkinson's disease with the cowhage plant-Mucuna pruriens Bak. Neurol India 1978;26:171-6.
  7. Vadivel V, Janardhanan K. Nutritional and anti-nutritional composition of velvet bean: an under-utilized food legume in south India. Int J Food Sci Nutr 2000;51:279-87. PubMed
  8. Akhtar MS, Qureshi AQ, Iqbal J. Antidiabetic evaluation of Mucuna pruriens, Linn seeds. J Pak Med Assoc 1990;40:147-50.
  9. Prakash, D., Niranjan, A., and Tewari, S. K. Some nutritional properties of the seeds of three Mucuna species. Int.J.Food Sci.Nutr. 2001;52(1):79-82.
  10. Vadivel, V. and Janardhanan, K. Nutritional and antinutritional characteristics of seven South Indian wild legumes. Plant Foods Hum.Nutr 2005;60(2):69-75. PubMed
  11. Creapure (Creatine Monohydrate). Toxicological Datasheet. Degussa BioActives. Available at: https://www.fda.gov/ohrms/DOCKETS/.../95s-0316-rpt0154-54-Ref-50-vol112.pdf.
  12. Pulikkalpura H, Kurup R, Mathew PJ, Baby S. Levodopa in Mucuna pruriens and its degradation. Sci Rep 2015;5:11078. PubMed

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking Cowhage and Apremilast Together: Common Questions

Is it safe to take Cowhage with Apremilast?
We do not list a known interaction between Cowhage and Apremilast. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
Do Cowhage and Apremilast have any of the same side effects?
Yes — our sources link each of them separately to 6 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.
How was the Cowhage and Apremilast combination checked?
Interactions in our licensed database are recorded against drug classes. Apremilast is filed under 2 classifications, and Cowhage has documented interactions with 8 drug classes — none of Apremilast's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does Cowhage interact with any other medications?
Yes. Cowhage has 193 documented drug interactions in our database — Apremilast is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Apremilast interact with any supplements?
Yes. Apremilast has documented interactions with 138 supplements in our database — Cowhage is not one of them. The Apremilast interaction page linked on this page lists every one, ranked by severity.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Where next

Keep Exploring

Cowhage monograph Uses, safety profile, and every drug interaction in one place Apremilast drug information The full plain-English guide to this medication Apremilast supplement interactions Every supplement checked against Apremilast, 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 References The 12 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Apremilast and Cowhage?

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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.