Evodia + Ethinyl Estradiol, Norethindrone
Ethinyl Estradiol, Norethindrone brand names: Femhrt, Loestrin 21, Ovcon 35 21, Ovcon 50 28, Necon 0.5 35 21, and others.
Ethinyl Estradiol, Norethindrone falls into 4 drug categories that Evodia can interact with; the most serious is rated moderate. Evodia might reduce the levels and clinical effects of CYP1A2 substrates through induction of CYP1A2.
Read the full interaction reportEvodia and Ethinyl Estradiol, Norethindrone
These two interact in 4 distinct ways. Each one is explained separately below.
Why Are There 4 Interactions?
Evodia interacts with whole categories of medication. Ethinyl Estradiol, Norethindrone falls into 4 of those categories, so it can interact with Evodia in 4 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES
1 of 4Why this applies to Ethinyl Estradiol, Norethindrone
Ethinyl Estradiol, Norethindrone falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES — the group Evodia interacts with.
Evodia extract and the evodia constituent rutaecarpine induce hepatic CYP1A2 enzyme activity. Evodia decreases levels of theophylline and caffeine, CYP1A2 substrates, by about 70% in animal models.
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..
Here's the gist for your birth control pill: the estrogen part (ethinyl estradiol) is partly broken down by a liver enzyme called CYP1A2. Evodia appears to speed that enzyme up, so in theory it could clear the estrogen a little faster and lower its levels in your body. With a combination pill, anything that weakens hormone levels raises the worry of less reliable protection, breakthrough bleeding, or spotting.
That said, this is based only on test tube and animal research, not real people taking Evodia with the pill, so the actual effect in humans is unknown. I wouldn't panic, but I also wouldn't gamble with contraception. Please check with your pharmacist or doctor before combining them, and ask about backup protection if you do.
- Ueng YF, Tsai TH, Don MJ, et al. Alteration of the pharmacokinetics of theophylline by rutaecarpine, an alkaloid of the medicinal herb Evodia rutaecarpa, in rats. J Pharm Pharmacol 2005;57:227-32.
- Ueng YF, Jan WC, Lin LC, et al. The alkaloid rutaecarpine is a selective inhibitor of cytochrome P450 1A in mouse and human liver microsomes. Drug Metab Dispos 2002;30:349-53. PubMed
- Tsai TH, Chang CH, Lin LC. Effects of Evodia rutaecarpa and rutaecarpine on the pharmacokinetics of caffeine in rats. Planta Med 2005;71:640-5.
- Lee SK, Kim NH, Lee J, et al. Induction of cytochrome P450s by rutaecarpine and metabolism of rutaecarpine by cytochrome P450s. Planta Med 2004;70:753-7. PubMed
CYTOCHROME P450 3A4 (CYP3A4) INHIBITORS
2 of 4Ethinyl Estradiol, Norethindrone also falls under CYTOCHROME P450 3A4 (CYP3A4) INHIBITORS.
Animal research shows that concomitant administration of ketoconazole, a known CYP3A4 inhibitor, with the alkaloid constituents of evodia significantly increases the area under the curve (AUC), maximum concentration (Cmax), and half-life of these constituents.
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.
Here's the thing to keep straight: this interaction works the other way around from what people often assume. Your birth control pill, the ethinyl estradiol with norethindrone combo, has mild blocking activity on a liver enzyme called CYP3A4. Evodia happens to be broken down by that same enzyme. So in theory, the pill could slow how fast your body clears evodia, letting the herb build up a bit more than expected.
I want to be honest about how soft this evidence is. It comes from test tube and animal work only, not real patients, so we're talking theoretical. Your pill itself shouldn't become weaker or stronger from this. Still, since evodia isn't well studied in people, I'd loop in your pharmacist or doctor before combining them.
- Zhang W, Guo J, Wang D, et al. Effect of CYP3A inducer/inhibitor on pharmacokinetics of five alkaloids in Evodiae Fructus. Chem Biol Interact 2020;327:109146. PubMed
CYTOCHROME P450 1A2 (CYP1A2) INHIBITORS
3 of 4Ethinyl Estradiol, Norethindrone also falls under CYTOCHROME P450 1A2 (CYP1A2) INHIBITORS.
The evodia constituent rutaecarpine is metabolized by CYP1A2.
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.
Here is the key thing to know about this particular pairing: the concern flows toward the Evodia, not your birth control pill. The estrogen part of your pill (ethinyl estradiol) can act as a mild blocker of a liver enzyme called CYP1A2. That same enzyme breaks down rutaecarpine, one of the active compounds in Evodia. So in theory, taking them together could let Evodia build up a bit higher and have stronger effects than expected.
I want to be honest about how soft this evidence is. It comes only from test tube and animal studies, not from people, so the real-world effect is likely small. Your contraceptive protection and side effects (like nausea or breast tenderness) shouldn't change. Still, it's worth running Evodia by your pharmacist or doctor before starting it.
- Lee SK, Kim NH, Lee J, et al. Induction of cytochrome P450s by rutaecarpine and metabolism of rutaecarpine by cytochrome P450s. Planta Med 2004;70:753-7. PubMed
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
4 of 4Ethinyl Estradiol, Norethindrone also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
In vitro research shows that evodia extract inhibits hepatic CYP3A4. This effect has not been reported in humans.
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.
Your birth control pill, which combines ethinyl estradiol with norethindrone, is processed in the liver by an enzyme called CYP3A4. Lab studies suggest evodia may slow that enzyme down. In theory, that could let more of the hormones build up in your body, which might mean more of the usual estrogen-related effects like nausea, breast tenderness, headaches, or bloating.
Here's the honest part: this has only been seen in test tube research, never in actual people, so it's a theoretical concern rather than a proven one. I wouldn't lose sleep over it, but since evodia hasn't been well studied in humans and you're relying on this pill, it's worth a quick chat with your pharmacist or doctor before combining them.
- Iwata H, Tezuka Y, Kadota S, et al. Mechanism-based inactivation of human liver microsomal CYP3A4 by rutaecarpine and limonin from Evodia fruit extract. Drug Metab Pharmacokinet 2005;20:34-45. PubMed
What These Ratings Mean
Every interaction above is graded three ways — here’s the key to each label.
Clinically significant. Avoid the combination, or use only under close professional supervision.
Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.
Generally not serious. Be aware of it and mention it to your pharmacist.
- 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.
- 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.
Evodia Also Interacts With Other Medications
Evodia has 949 moderate known drug interactions in our database — the Ethinyl Estradiol, Norethindrone one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Evodia
We haven’t checked that one against Evodia yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Evodia. Pick one to open its full report.
See Every Supplement That Interacts With Ethinyl Estradiol, Norethindrone
This page covers Evodia only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ethinyl Estradiol, Norethindrone page lists 240 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 · 196 moderate · 38 minor.
From our pharmacist’s overview on the Ethinyl Estradiol, Norethindrone page
“If you take a birth control pill or hormone therapy containing ethinyl estradiol and norethindrone (Loestrin, Femhrt, and others), a few supplements can genuinely undermine it, so read this page with care. Six of the 240 ingredients on file are rated major, and those six come first.”
Reviewed by 2 · Jul 18, 2026
Taking Evodia as Part of a Dietary Supplement Product? Check It for Interactions
We hold 182 real supplement products containing Evodia, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Evodia. Your product may carry other ingredients that interact with Ethinyl Estradiol, Norethindrone too, on top of Evodia — and those would not show on this page. Find your product and we’ll check every ingredient on its label:
Where Evodia and Ethinyl Estradiol, Norethindrone 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.
#430 of 1,452 supplements looked up here in the last 7 days
#450 of 2,830 medications looked up here in the last 7 days
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.
About Evodia
What is Evodia?
- Digestive upset and nausea
- Headaches
- Menstrual cramps
- Abdominal pain
- Diarrhea
Evodia is a fruit used in traditional Chinese medicine, most often for digestive complaints, headaches, and menstrual pain. Human evidence for these uses is very limited, and it is mostly studied in laboratory and animal research. Talk with a pharmacist or doctor before using it, and avoid it during pregnancy and breastfeeding.
Other Drugs & Evodia
Browse every other medication we’ve checked against Evodia — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
949 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Theophylline ›
- Nifedipine ›
- Ibuprofen ›
- Metronidazole ›
- Aspirin ›
- Hydrocortisone ›
- Naproxen ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Lidocaine ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Triazolam ›
- Zopiclone ›
- Ciprofloxacin ›
- Colchicine ›
- Fentanyl ›
- Oxybutynin ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Dipyridamole ›
- Doxorubicin ›
- Fluticasone ›
- Miconazole ›
- Procainamide ›
- Trimipramine ›
- Acetaminophen ›
- Buprenorphine ›
- Conjugated Estrogens ›
- Diazepam ›
- Everolimus ›
- Griseofulvin ›
- Ivabradine ›
- Ketoprofen ›
- Lofepramine ›
- Medroxyprogesterone ›
- Medroxyprogesterone Acetate ›
- Nortriptyline ›
- Rifampin ›
- Sotalol ›
- Sumatriptan Succinate ›
- Testosterone Undecanoate ›
- Aripiprazole ›
Showing 60 of 949 moderate interactions — see all 949 on the Evodia page.
No interaction 1,880 drugs checked — show the list
We also checked Evodia against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Methylphenidate ›
- Metoprolol ›
- Ivermectin ›
- Rosuvastatin ›
- Valacyclovir ›
- Docusate ›
- Hydroxyurea ›
- Methamphetamine ›
- Semaglutide ›
- Tirzepatide ›
- Lisdexamfetamine ›
- Bupropion ›
- Metformin ›
- Acyclovir ›
- Amoxicillin ›
- Lisinopril ›
- Doxycycline ›
- Lamotrigine ›
- Methotrexate ›
- Gabapentin ›
- Pregabalin ›
- Amphetamine ›
- Isotretinoin ›
- Dextroamphetamine ›
- Methylene Blue ›
- Duloxetine ›
- Bisoprolol ›
- Levothyroxine, Liothyronine ›
- Cyclopentolate ›
- Candesartan Cilexetil ›
- Mannitol ›
- Cephalexin ›
- Pegunigalsidase Alfa-iwxj ›
- Acetaminophen, Dextromethorphan, Doxylamine ›
- Daptomycin ›
- Hexobarbitone ›
- Dexmethylphenidate ›
- Valsartan ›
- Levothyroxine Sodium ›
- Levetiracetam ›
- Mitomycin ›
- Minoxidil ›
- Cefaclor ›
- Factor 7a ›
- Thyroid Hormone ›
- Carbidopa, Levodopa ›
- Ezetimibe ›
- Levodopa ›
- Vancomycin ›
- Phenylephrine ›
- Spironolactone ›
- Dirithromycin ›
- Hethylphenidate Hcl ›
- Azelaic Acid ›
- Phentermine, Topiramate ›
- Bentoquatam ›
- Amoxicillin, Clavulanate Potassium ›
- Digoxin ›
- Codeine Sulfate ›
Showing the 60 most looked-up of 1,880 medications checked with no known interaction — see the full Evodia list.
Sources & How We Checked
Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for vitamins, herbs and supplements — the basis for our interaction data.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for the medication overviews.
- NIH Dietary Supplement Label Database (DSLD) — Official supplement product labels.
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
Ethinyl Estradiol, Norethindrone Is Linked to Lower Levels of 7 Nutrients
Natural Medicines records Ethinyl Estradiol, Norethindrone as a medicine that can lower these. This is not an interaction with Evodia — it is a separate effect of the medicine, and it is a reason some people are advised to supplement rather than to avoid one:
Read the full Ethinyl Estradiol, Norethindrone nutrient depletion report ›
Depletion records come from the licensed Natural Medicines database. Do not start a supplement on the strength of this page — ask your pharmacist or doctor whether it applies to you.
Taking Evodia and Ethinyl Estradiol, Norethindrone Together: Common Questions
Can you take Evodia with Ethinyl Estradiol, Norethindrone?
Why are there 4 interactions listed for Evodia and Ethinyl Estradiol, Norethindrone?
How serious is the Evodia and Ethinyl Estradiol, Norethindrone interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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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.