Drug & supplement interaction

Diosmin + Ibrutinib

Ibrutinib brand name: Imbruvica.

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

Ibrutinib falls into 2 drug categories that Diosmin can interact with; the most serious is rated moderate. Theoretically, diosmin might inhibit the metabolism of CYP3A4 substrates.

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

Diosmin and Ibrutinib

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

Why Are There 2 Interactions?

Diosmin interacts with whole categories of medication. Ibrutinib falls into 2 of those categories, so it can interact with Diosmin 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 3A4 (CYP3A4) SUBSTRATES

1 of 2

Why this applies to Ibrutinib

Ibrutinib falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group Diosmin interacts with.

Theoretically, diosmin might inhibit the metabolism of CYP3A4 substrates.
Laboratory research is conflicting with respect to the effects of diosmin on CYP3A4. Some research suggests that diosmin does not affect CYP3A4 activity. However, other research suggests that diosmin alters the metabolism of carbamazepine, a CYP3A4 substrate. Laboratory and animal research show that oral administration of diosmin for 7 days prior to oral administration of carbamazepine increases plasma concentrations of carbamazepine, decreases the clearance of carbamazepine, and decreases the formation of carbamazepine's active metabolite. Additionally, pharmacokinetic research in healthy male subjects shows that taking diosmin (Venex) 500 mg daily for 10 days prior to oral administration of carbamazepine 200 mg increases blood levels of carbamazepine by approximately 58% and decreases carbamazepine clearance by 42%. It is speculated that diosmin reduces the metabolism of carbamazepine by inhibiting CYP3A4. Diosmetin, a metabolite of diosmin, may also inhibit CYP3A4.
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 gist: your body clears ibrutinib mainly through a liver enzyme called CYP3A4. Diosmin may put the brakes on that same enzyme. If it does, ibrutinib could clear out of your system more slowly and build up to higher levels than intended. Since ibrutinib is an active drug (not a prodrug that needs switching on), higher levels generally mean stronger effects and a greater chance of side effects like bruising, bleeding, diarrhea, low blood counts, or heart rhythm changes.

I want to be honest about the evidence though. This is mostly theoretical, and lab studies even disagree on whether diosmin really affects CYP3A4. The clearest signal comes from a different drug, carbamazepine. Because ibrutinib is a serious cancer medicine, please don't add diosmin without first checking with your oncology team or pharmacist.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Bedada SK, Neerati P. Modulation of CYP3A enzyme activity by diosmin and its consequence on carbamazepine pharmacokinetics in rats. Naunyn Schmiedebergs Arch Pharmacol. 2018;391(2):115-21. PubMed
  2. Burkina V, Zlabek V, Halsne R, Ropstad E, Zamaratskaia G. In vitro effects of the citrus flavonoids diosmin, naringenin and naringin on the hepatic drug-metabolizing CYP3A enzyme in human, pig, mouse and fish. Biochem Pharmacol. 2016;110-111:109-16 PubMed
  3. Bedada SK, Boga PK. Influence of diosmin on the metabolism and disposition of carbamazepine in healthy subjects. Xenobiotica. 2017;47(10):879-84. PubMed
Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

2 of 2

Ibrutinib also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.

Theoretically, diosmin may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
A case of spontaneous intraventricular hemorrhage has been reported for a 77-year-old female after 6 weeks of warfarin therapy, despite an international normalized ratio (INR) of only 1.8. The patient had also been taking aspirin and diosmin for several years. Experts speculate that chronic intake of diosmin predisposed the patient to spontaneous intraventricular hemorrhage by inducing chronic microcirculatory hypertension and inhibiting platelet aggregation. The presence of aspirin was also thought to play a role in this event.
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 know about ibrutinib (Imbruvica): on its own it can raise your risk of bleeding and bruising. That's actually one of its well-known side effects, since it affects how platelets stick together. Diosmin, the citrus flavonoid used for vein and hemorrhoid issues, has also been linked (in rare reports) to a mild increase in bleeding tendency. So the worry here is that putting the two together could nudge that bleeding risk a little higher.

I want to be honest about the strength of this: it's mostly theoretical, based on a single case report involving warfarin and aspirin, not ibrutinib. Still, with a medicine like ibrutinib, I'd play it safe. Watch for easy bruising, nosebleeds, blood in urine or stool, or unusual bleeding, and check with your oncologist or pharmacist before adding diosmin.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Kumar RM, Van Gompel JJ, Bower R, Rabinstein AA. Spontaneous intraventricular hemorrhage associated with prolonged diosmin therapy. Neurocrit Care. 2011 Jun;14(3):438-40. 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

Diosmin Also Interacts With Other Medications

Diosmin has 883 moderate known drug interactions in our database — the Ibrutinib one above is among them. If you take anything else, check it against the full list below.

Moderate 883 No known interaction 1,947 (incl. Ibrutinib)
Taking anything else?

Check Another of Your Medications Against Diosmin

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

Everything else you take

See Every Supplement That Interacts With Ibrutinib

This page covers Diosmin only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ibrutinib page lists 282 supplements it has a documented interaction with, worst first, each one explained.

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

By severity: 5 major · 236 moderate · 41 minor.

From our pharmacist’s overview on the Ibrutinib page

“Ibrutinib (Imbruvica) treats blood cancers such as chronic lymphocytic leukemia, and because the drug itself makes bruising and bleeding more likely, adding the wrong supplement here can carry real consequences. Most of the entries below have blood-thinning or antiplatelet activity that stacks on top of that built-in bleeding risk.”

Reviewed by 2 · Jul 18, 2026

Open the Ibrutinib interaction page

One more smart check

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

We hold 121 real supplement products containing Diosmin, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Diosmin. Your product may carry other ingredients that interact with Ibrutinib too, on top of Diosmin — 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 Diosmin and Ibrutinib 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 Diosmin
Top half

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

29 days ago today
Medication Ibrutinib
Top half

#766 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 Diosmin

What is Diosmin?

  • Chronic venous insufficiency
  • Hemorrhoids
  • Leg swelling and heaviness
  • Varicose veins
  • Spider veins

Diosmin is a citrus-derived flavonoid most often used for vein-related problems such as chronic venous insufficiency and hemorrhoids, and it is usually combined with a related flavonoid called hesperidin. Some studies suggest it may help relieve leg swelling and hemorrhoid symptoms, but quality varies. Talk to your pharmacist or doctor before starting it, especially if you are pregnant or breastfeeding.

Read the full Diosmin monograph & all interactions
Medication

About Ibrutinib

What Is Ibrutinib Used For?

Brand name: Imbruvica

Imbruvica (ibrutinib) is used in adults to treat chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL), including cases with a specific genetic change called 17p deletion. It is also used in adults to treat Waldenström's macroglobulinemia (WM), a rare type of slow-growing blood cancer.

Imbruvica is also approved for adults and children aged 1 year and older with chronic graft-versus-host disease (cGVHD) — a serious immune complication that can occur after a stem cell or bone marrow transplant — when at least one prior treatment has not worked.

See full Ibrutinib drug information
Keep checking

Other Drugs & Diosmin

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

0Major
883Moderate
0Minor
1,946No known interaction
883 Moderate 1,946 No interaction
Moderate

883 interactions

Showing 60 of 883 moderate interactions — see all 883 on the Diosmin page.

No interaction 1,946 drugs checked — show the list

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

Showing the 60 most looked-up of 1,946 medications checked with no known interaction — see the full Diosmin list.

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

Can you take Diosmin with Ibrutinib?
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 Diosmin and Ibrutinib?
Ibrutinib belongs to more than one drug category, and Diosmin 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 Diosmin and Ibrutinib 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 Ibrutinib and Diosmin?

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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.