Drug & supplement interaction

Fever Bark + Moclobemide

Moclobemide brand names: Moclobemide, Manerix.

Major Interaction
The bottom line Major

Moclobemide falls into 2 drug categories that Fever Bark can interact with; the most serious is rated major. Concomitant use of MAOIs with fever bark can result in additive effects.

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

Fever Bark and Moclobemide

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

Why Are There 2 Interactions?

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

Major

MONOAMINE OXIDASE INHIBITORS (MAOIs)

1 of 2

Why this applies to Moclobemide

Moclobemide falls under MONOAMINE OXIDASE INHIBITORS (MAOIs) — the group Fever Bark interacts with.

Concomitant use of MAOIs with fever bark can result in additive effects.
Yohimbine, a constituent of fever bark, has MAO inhibitory effects. At high doses, yohimbine is a non-selective inhibitor of MAO. It is not known if this would occur with fever bark.
Severity Major Likelihood Likely Evidence D

Well-controlled human studies have demonstrated the likely existence of this interaction.

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

Here's the concern with pairing these two. Moclobemide is itself a reversible MAO inhibitor (it's a true MAOI antidepressant). Fever bark contains a yohimbine-like alkaloid that, at high amounts, can also block MAO. Stacking two things that work the same way can add up, and that's where trouble starts.

When MAO is blocked too much, certain brain chemicals can pile up. That raises the risk of things like a spike in blood pressure, racing heartbeat, headache, sweating, agitation, or in a serious case, serotonin-type symptoms. I'll be honest: this warning is mostly theoretical, based on how these chemicals behave rather than solid human studies, and we don't even know if fever bark blocks MAO at normal doses. Still, because the consequences can be serious, please don't combine them without checking with your doctor or pharmacist first.

References
  1. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.
  2. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
Moderate

CYTOCHROME P450 2D6 (CYP2D6) INHIBITORS

2 of 2

Moclobemide also falls under CYTOCHROME P450 2D6 (CYP2D6) INHIBITORS.

Theoretically, CYP2D6 inhibitors might increase the levels and clinical effects of yohimbine, a constituent of fever bark.
In vitro and clinical research shows that the fever bark constituent, yohimbine, is metabolized by CYP2D6 isoenzymes.
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 keep in mind with this pairing. Moclobemide can block an enzyme called CYP2D6, and that same enzyme is what your body uses to break down yohimbine, one of the active alkaloids in fever bark. So in theory, moclobemide could slow the clearance of that yohimbine and let it build up, pushing its effects stronger than expected.

Why that matters: yohimbine can raise blood pressure, speed up your heart, and trigger anxiety, jitteriness, or trouble sleeping. On top of that, moclobemide is itself an MAO inhibitor, and combining it with stimulating compounds like these isn't a great idea. The good news is this concern is theoretical, based on how the chemicals behave, not on real-world reports. Still, I'd avoid fever bark here and check with your pharmacist or doctor first.

References
  1. Le Corre P, Parmer RJ, Kailasam MT, et al. Human sympathetic activation by alpha2-adrenergic blockade with yohimbine: Bimodal, epistatic influence of cytochrome P450-mediated drug metabolism. Clin Pharmacol Ther. 2004;76(2):139-53.
  2. Mueller-Schoell A, Michelet R, Weinelt F, Kloft C, Mikus G. CYP2D6 phenotype explains reported yohimbine concentrations in four severe acute intoxications. Arch Toxicol. 2021. PubMed
  3. Bharucha AE, Skaar T, Andrews CN, et al Relationship of cytochrome P450 pharmacogenetics to the effects of yohimbine on gastrointestinal transit and catecholamines in healthy subjects. Neurogastroenterol Motil. 2008;20(8):891-9. 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

Fever Bark Also Interacts With Other Medications

Fever Bark has 39 major, 674 moderate, 87 minor known drug interactions in our database — the Moclobemide one above is among them. If you take anything else, check it against the full list below.

Taking anything else?

Check Another of Your Medications Against Fever Bark

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

Everything else you take

See Every Supplement That Interacts With Moclobemide

This page covers Fever Bark only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Moclobemide page lists 94 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Beer (major), Bitter Orange (major), Brewer's Yeast (major) and Cowhage (major).

By severity: 13 major · 67 moderate · 14 minor.

Open the Moclobemide interaction page

How much people look this up

Where Fever Bark and Moclobemide 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 Fever Bark
Steady interest

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

29 days ago today
Medication Moclobemide
Top half

#1,148 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 Fever Bark

What is Fever Bark?

Fever Bark
  • Fever
  • Diarrhea
  • Malaria (traditional)
  • Digestive complaints
  • Bitter tonic

Fever bark is the bark of the Australian tree Alstonia constricta, used in traditional medicine for fever, diarrhea, and infections. There is very little reliable human research to support these uses, and the bark contains potent alkaloids that may cause serious side effects. It is best avoided unless used under direct medical supervision.

Read the full Fever Bark monograph & all interactions
Keep checking

Other Drugs & Fever Bark

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

39Major
674Moderate
87Minor
2,029No known interaction
Major

39 interactions

Moderate

674 interactions

Showing 60 of 674 moderate interactions — see all 674 on the Fever Bark page.

Minor

87 interactions

Showing 60 of 87 minor interactions — see all 87 on the Fever Bark page.

No interaction 2,029 drugs checked — show the list
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

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Pharmacist Counseling Corner

Taking Fever Bark and Moclobemide Together: Common Questions

Can you take Fever Bark with Moclobemide?
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 Fever Bark and Moclobemide?
Moclobemide belongs to more than one drug category, and Fever Bark 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 Fever Bark and Moclobemide 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

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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.