Drug & supplement interaction

European Mandrake + Maralixibat

Maralixibat brand name: Livmarli.

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

European Mandrake has a moderate interaction with Maralixibat. Theoretically, concurrent use might increase absorption of some drugs because of inhibited gastrointestinal (GI) motility caused by European mandrake.

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

European Mandrake and Maralixibat

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

Moderate

ORAL DRUGS

Why this applies to Maralixibat

Maralixibat falls under ORAL DRUGS — the group European Mandrake interacts with.

Theoretically, concurrent use might increase absorption of some drugs because of inhibited gastrointestinal (GI) motility caused by European mandrake.
Severity Moderate Likelihood Probable Evidence D

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

First and most important: please don't take European mandrake at all. It's a genuinely poisonous plant, and we don't recommend it in any amount. Setting that aside, here's the idea behind this specific interaction with Maralixibat (Livmarli). Mandrake's tropane alkaloids (like atropine and scopolamine) slow down the movement of your gut. When the gut moves more slowly, an oral medicine can sit there longer and potentially get absorbed more than usual.

For Maralixibat, this is only a theoretical concern based on how these chemicals work, not something proven in studies. Maralixibat is meant to work mostly inside your intestines, so more absorption could mean more side effects like diarrhea, belly pain, or nausea. Bottom line: skip the mandrake, and check with your pharmacist or doctor about anything you take with Livmarli.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. McEvoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.

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

European Mandrake Also Interacts With Other Medications

European Mandrake has 2,041 moderate known drug interactions in our database — the Maralixibat one above is one of them. If you take anything else, check it against the full list below.

Moderate 2,041 No known interaction 789 (incl. Maralixibat)
Taking anything else?

Check Another of Your Medications Against European Mandrake

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

Everything else you take

See Every Supplement That Interacts With Maralixibat

This page covers European Mandrake only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Maralixibat page lists 17 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Coffee Charcoal (moderate), Glucomannan (moderate), Guar Gum (moderate) and Gum Arabic (moderate).

By severity: 1 major · 7 moderate · 9 minor.

From our pharmacist’s overview on the Maralixibat page

“Maralixibat (Livmarli) relieves the severe itching caused by rare childhood liver diseases like Alagille syndrome, and since it does its job inside the intestine, this list warrants genuine vigilance, not a shrug. All 17 supplement entries share one mechanism, ingredients that trap or slow drugs in the gut and change how much of a dose…”

Reviewed by 2 · Jul 18, 2026

Open the Maralixibat interaction page

How much people look this up

Where European Mandrake and Maralixibat 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 European Mandrake
Top 25%

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

29 days ago today
Medication Maralixibat
Steady interest

#1,933 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 European Mandrake

What is European Mandrake?

European Mandrake
  • Insomnia (traditional)
  • Pain relief (historical)
  • Anxiety or depression (folk use)
  • Gout and aches (traditional)
  • Sedation or anesthesia (historical)

European mandrake is a highly toxic plant from the nightshade family that was used in ancient and medieval times as a sedative and pain reliever. It contains powerful poisons that can cause serious harm or death, and there is no proof it safely treats any condition. We strongly recommend you do not consume mandrake in any form.

Read the full European Mandrake monograph & all interactions
Medication

About Maralixibat

What Is Maralixibat Used For?

Brand name: Livmarli

Livmarli (maralixibat) is used to treat cholestatic pruritus (intense itching caused by bile acid buildup in the body) in two rare liver conditions. It is approved for patients aged 3 months and older with Alagille syndrome (ALGS), and for patients aged 12 months and older with progressive familial intrahepatic cholestasis (PFIC).

There is an important limitation for PFIC: Livmarli is not recommended for a specific subgroup of PFIC type 2 patients who have certain gene variants (ABCB11 variants) that result in a non-functional or completely absent bile salt export pump (BSEP) protein.

See full Maralixibat drug information
Keep checking

Other Drugs & European Mandrake

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

0Major
2,041Moderate
0Minor
788No known interaction
2,041 Moderate 788 No interaction
Moderate

2,041 interactions

Showing 60 of 2,041 moderate interactions — see all 2,041 on the European Mandrake page.

No interaction 788 drugs checked — show the list

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

Showing the 60 most looked-up of 788 medications checked with no known interaction — see the full European Mandrake list.

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

Can you take European Mandrake with Maralixibat?
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 European Mandrake and Maralixibat 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 Maralixibat and European Mandrake?

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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.