Drug & supplement interaction

Ephedra + Tamoxifen Citrate

Tamoxifen Citrate brand names: Nolvadex, Soltamox.

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

Tamoxifen Citrate falls into 2 drug categories that Ephedra can interact with; the most serious is rated major. Theoretically, ephedra might have an additive effect with drugs that prolong the QT interval.

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

Ephedra and Tamoxifen Citrate

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

Why Are There 2 Interactions?

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

Major

QT INTERVAL-PROLONGING DRUGS

1 of 2

Why this applies to Tamoxifen Citrate

Tamoxifen Citrate falls under QT INTERVAL-PROLONGING DRUGS — the group Ephedra interacts with.

Theoretically, ephedra might have an additive effect with drugs that prolong the QT interval.
Even in healthy volunteers, EKG changes including prolonged QT interval and premature atrial contractions have been reported with ingestion of recommended doses of ephedra. Ephedra may have an additive effect with drugs that prolong the QT interval. This may increase the risk of ventricular arrhythmias.
Severity Major Likelihood Probable Evidence B

Interaction 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..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the concern with pairing ephedra and tamoxifen. Tamoxifen can stretch out the heart's electrical reset time, something doctors call QT prolongation. Ephedra, which contains stimulants like ephedrine, can do the same thing and also speeds up and stresses the heart. Stacking the two together may add up and raise the risk of a dangerous, irregular heart rhythm.

This isn't about ephedra changing tamoxifen's cancer-fighting power. It's about two things that each affect heart rhythm landing at once. On top of that, ephedra is banned from U.S. supplements because of strokes and deaths. Please don't start or stop anything on your own, and talk with your pharmacist or doctor about safer choices.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Jenkins DJ, Wesson V, Wolever TM, et al. Wholemeal versus wholegrain breads: proportion of whole or cracked grain and the glycaemic response. BMJ 1988;297:958-60. PubMed
  2. McBride BF, Karapanos AK, Krudysz A, et al. Electrocardiographic and hemodynamic effects of a multicomponent dietary supplement containing ephedra and caffeine: a randomized controlled trial. JAMA 2004;291:216-21. PubMed
  3. Gardner SF, Franks AM, Gurley BJ, et al. Effect of a multicomponent, ephedra-containing dietary supplement (Metabolife 356) on Holter monitoring and hemostatic parameters in healthy volunteers. Am J Cardiol 2003;91:1510-3, A9. PubMed
  4. Gardner, S. F., Franks, A. M., Gurley, B. J., Haller, C. A., Singh, B. K., and Mehta, J. L. Effect of a multicomponent, ephedra-containing dietary supplement (Metabolife 356) on Holter monitoring and hemostatic parameters in healthy volunteers. Am J Card PubMed
Moderate

HEPATOTOXIC DRUGS

2 of 2

Tamoxifen Citrate also falls under HEPATOTOXIC DRUGS.

Theoretically, concomitant use might have additive adverse hepatotoxic effects.
There are numerous cases of liver toxicity from ephedra-containing supplements.
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 concern with pairing ephedra and tamoxifen. Both can be tough on the liver. Tamoxifen, while doing important work against breast cancer, is known to occasionally raise liver enzymes or, rarely, cause fatty liver or more serious liver problems. Ephedra-containing products have their own track record of liver injury. Put them together and the worry is that the strain on your liver could add up.

To be clear, this is a theoretical caution based on how each affects the liver, not something proven from people taking both. Still, ephedra is banned in U.S. supplements for good reason, so I wouldn't use it at all. Please talk with your oncologist or pharmacist about safer choices before adding anything new.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Nadir A, Agrawal S, King PD, Marshall JB. Acute hepatitis associated with the use of a Chinese herbal product, ma-huang. Am J Gastroenterol 1996;91:1436-8.
  2. Borum, M. L. Fulminant exacerbation of autoimmune hepatitis after the use of ma huang. Am J Gastroenterol. 2001;96(5):1654-1655. PubMed
  3. Vigano, M., Lampertico, P., and Colombo, M. Acute hepatitis following assumption of a herbal remedy. Eur.J.Gastroenterol.Hepatol. 2008;20(4):364-365. PubMed
  4. Neff, G. W., Reddy, K. R., Durazo, F. A., Meyer, D., Marrero, R., and Kaplowitz, N. Severe hepatotoxicity associated with the use of weight loss diet supplements containing ma huang or usnic acid. J Hepatol. 2004;41(6):1062-1064. PubMed
  5. Bajaj J, Knox JF, Komorowski R, Saeian K. The irony of herbal hepatitis: Ma-Huang-induced hepatotoxicity associated with compound heterozygosity for hereditary hemochromatosis. Dig Dis Sci. 2003;48(10):1925-8.
  6. Charalampopoulos A, Karatsourakis T, Tsiodra P. Acute hepatitis associated with the use of Ma-huang in a young adult. Eur J Intern Med. 2007;18(1):81. PubMed
  7. Skoulidis F, Alexander GJ, Davies SE. Ma huang associated acute liver failure requiring liver transplantation. Eur J Gastroenterol Hepatol. 2005;17(5):581-4. PubMed
  8. Drug record: Ma huang. U.S. National Library of Medicine: Livertox Database. https://livertox.nlm.nih.gov/Ephedra.htm. Updated October 16, 2017. Accessed November 1, 2017.

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

Ephedra Also Interacts With Other Medications

Ephedra has 336 major, 496 moderate known drug interactions in our database — the Tamoxifen Citrate one above is among them. If you take anything else, check it against the full list below.

Major 336 Moderate 496 No known interaction 1,998 (incl. Tamoxifen Citrate)
Taking anything else?

Check Another of Your Medications Against Ephedra

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

From our Q&A

Questions About Ephedra or Tamoxifen Citrate

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Ephedra or Tamoxifen Citrate, 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 Tamoxifen Citrate

This page covers Ephedra only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Tamoxifen Citrate page lists 210 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), Arsenic (major), Beer (major) and Cesium (major).

By severity: 11 major · 166 moderate · 33 minor.

From our pharmacist’s overview on the Tamoxifen Citrate page

“Tamoxifen (Nolvadex, Soltamox) often stands between a breast cancer patient and a recurrence, so the stakes on this page run higher than usual. Eleven of the 210 supplements and herbs on file carry a major rating, and those eleven deserve your attention ahead of everything else.”

Reviewed by 2 · Jul 18, 2026

Open the Tamoxifen Citrate interaction page

One more smart check

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

We hold 37 real supplement products containing Ephedra, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Ephedra. Your product may carry other ingredients that interact with Tamoxifen Citrate too, on top of Ephedra — 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 Ephedra and Tamoxifen Citrate 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 Ephedra
Top half

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

29 days ago today
Medication Tamoxifen Citrate
Top 25%

#399 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 Ephedra

What is Ephedra?

Ephedra
  • Weight loss
  • Nasal and sinus congestion
  • Asthma and breathing problems
  • Boosting energy and athletic performance
  • Allergies

Ephedra (ma huang) contains powerful stimulants like ephedrine that affect the heart and nervous system. Because it has been linked to serious harms including high blood pressure, stroke, and death, it is banned for use in dietary supplements in the U.S. and many other countries. We do not recommend using ephedra-containing supplements; talk to your pharmacist or doctor about safer, approved options.

Read the full Ephedra monograph & all interactions
Medication

About Tamoxifen

What Is Tamoxifen Used For?

Brand names: Nolvadex, Soltamox

Tamoxifen is used to treat estrogen receptor-positive metastatic breast cancer in both women and men, and as follow-up (adjuvant) therapy after surgery for early-stage breast cancer in women. It also reduces the occurrence of cancer in the opposite breast when used as adjuvant therapy.

In women with ductal carcinoma in situ (DCIS — an early, non-invasive breast change) following surgery and radiation, tamoxifen lowers the risk of developing invasive breast cancer. It is also approved to reduce the risk of breast cancer in women who are at high risk but have not yet been diagnosed. Both Tamoxifen Citrate tablets and Soltamox oral solution share these indications.

See full Tamoxifen drug information
Keep checking

Other Drugs & Ephedra

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

336Major
496Moderate
0Minor
1,997No known interaction
336 Major 496 Moderate 1,997 No interaction
Major

336 interactions

Showing 60 of 336 major interactions — see all 336 on the Ephedra page.

Moderate

496 interactions

Showing 60 of 496 moderate interactions — see all 496 on the Ephedra page.

No interaction 1,997 drugs checked — show the list

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

Showing the 60 most looked-up of 1,997 medications checked with no known interaction — see the full Ephedra list.

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

Can you take Ephedra with Tamoxifen Citrate?
This is rated a major interaction, so the combination is best avoided unless your doctor or pharmacist has specifically told you otherwise. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for Ephedra and Tamoxifen Citrate?
Tamoxifen Citrate belongs to more than one drug category, and Ephedra 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 Ephedra and Tamoxifen Citrate interaction?
We rate it Major. This is a clinically significant combination that is generally best avoided, or used only under the direct supervision of your physician or pharmacist.

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

Still Have a Question About Tamoxifen Citrate and Ephedra?

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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.