Drug & supplement interaction

Evodia + Olodaterol Hydrochloride, Tiotropium Bromide

Olodaterol Hydrochloride, Tiotropium Bromide brand name: Stiolto Respimat.

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

Olodaterol Hydrochloride, Tiotropium Bromide falls into 2 drug categories that Evodia can interact with; the most serious is rated moderate. Theoretically, evodia might have an additive effect with drugs that prolong the QT interval, potentially increasing the risk of ventricular arrhythmias.

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

Evodia and Olodaterol Hydrochloride, Tiotropium Bromide

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

Why Are There 2 Interactions?

Evodia interacts with whole categories of medication. Olodaterol Hydrochloride, Tiotropium Bromide falls into 2 of those categories, so it can interact with Evodia in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

QT INTERVAL-PROLONGING DRUGS

1 of 2

Why this applies to Olodaterol Hydrochloride, Tiotropium Bromide

Olodaterol Hydrochloride, Tiotropium Bromide falls under QT INTERVAL-PROLONGING DRUGS — the group Evodia interacts with.

Theoretically, evodia might have an additive effect with drugs that prolong the QT interval, potentially increasing the risk of ventricular arrhythmias.
Evodia has demonstrated dose-dependent activity as a proarrhythmic agent in animal and in vitro studies. Evodia infusion in animals extends the action duration potential and induces prolongation of the QT interval and Torsade de pointes.
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

Stiolto Respimat combines olodaterol with tiotropium, two inhaled medicines that help open your airways in COPD. The olodaterol part is a long-acting beta-agonist, and like other drugs in that family it can slightly nudge your heart's electrical rhythm in a way doctors call QT prolongation. Evodia, in lab and animal studies, has shown a similar ability to stretch that same electrical signal.

So the concern here is simply additive. On paper, pairing them could raise the odds of an irregular heartbeat, with symptoms like a fluttering or racing heart, dizziness, or feeling faint. That said, this is theoretical and based only on test tube and animal research, not real patient reports, so I don't want you to panic. Just loop in your pharmacist or doctor before adding an Evodia supplement, especially if you have heart concerns.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Baburin I, Varkvisser R, Schramm A, et al. Dehydroevodiamine and hortiamine, alkaloids from the traditional Chinese herbal drug Evodia rutaecarpa, are IKr blockers with proarrhythmic effects in vitro and in vivo. Pharmacol Res. 2018 May;131:150-163. DOI
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

2 of 2

Olodaterol Hydrochloride, Tiotropium Bromide also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.

Theoretically, evodia might increase the levels and clinical effects of CYP3A4 substrates.
In vitro research shows that evodia extract inhibits hepatic CYP3A4. This effect has not been reported in humans.
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 quick picture with Stiolto Respimat (olodaterol plus tiotropium). Lab studies hint that evodia can slow down a liver enzyme called CYP3A4. The olodaterol part of your inhaler is partly handled by that enzyme, so in theory, blocking it could let a bit more olodaterol linger in your body. That might nudge up the usual side effects of this long-acting bronchodilator, things like a faster or pounding heartbeat, jittery or shaky feelings, headache, or a dry mouth.

That said, this is only seen in test-tube research, not in real people, and most of olodaterol is breathed in and stays local in your lungs. So I wouldn't lose sleep over it. Still, it's worth a quick word with your pharmacist or doctor before adding evodia, especially if you notice your heart racing.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. 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.

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

Evodia Also Interacts With Other Medications

Evodia has 949 moderate known drug interactions in our database — the Olodaterol Hydrochloride, Tiotropium Bromide one above is among them. If you take anything else, check it against the full list below.

Moderate 949 No known interaction 1,881 (incl. Olodaterol Hydrochloride, Tiotropium Bromide)
Taking anything else?

Check Another of Your Medications Against Evodia

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

Everything else you take

See Every Supplement That Interacts With Olodaterol Hydrochloride, Tiotropium Bromide

This page covers Evodia only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Olodaterol Hydrochloride, Tiotropium Bromide page lists 171 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: American Hellebore (major), Arsenic (major), Cesium (major), Ephedra (major) and Grapefruit (major).

By severity: 9 major · 133 moderate · 29 minor.

Open the Olodaterol Hydrochloride, Tiotropium Bromide interaction page

One more smart check

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 Olodaterol Hydrochloride, Tiotropium Bromide 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:

How much people look this up

Where Evodia and Olodaterol Hydrochloride, Tiotropium Bromide 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 Evodia
Top half

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

29 days ago today
Medication Olodaterol Hydrochloride, Tiotropium Bromide
Steady interest

#2,051 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 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.

Read the full Evodia monograph & all interactions
Keep checking

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.

0Major
949Moderate
0Minor
1,880No known interaction
949 Moderate 1,880 No interaction
Moderate

949 interactions

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.

Showing the 60 most looked-up of 1,880 medications checked with no known interaction — see the full Evodia list.

See the full Evodia interactions page
See every supplement checked against Olodaterol Hydrochloride, Tiotropium Bromide, 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
Evodia monograph › Uses, safety, and every drug interaction in one place Olodaterol Hydrochloride, Tiotropium Bromide supplement interactions › Every supplement checked against Olodaterol Hydrochloride, Tiotropium Bromide, 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 Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Evodia and Olodaterol Hydrochloride, Tiotropium Bromide Together: Common Questions

Can you take Evodia with Olodaterol Hydrochloride, Tiotropium Bromide?
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 Evodia and Olodaterol Hydrochloride, Tiotropium Bromide?
Olodaterol Hydrochloride, Tiotropium Bromide belongs to more than one drug category, and Evodia 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 Evodia and Olodaterol Hydrochloride, Tiotropium Bromide 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

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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.