Drug & supplement interaction

Neem + Amiodarone

Amiodarone brand names: Pacerone, Cordarone.

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

Amiodarone falls into 2 drug categories that Neem can interact with; the most serious is rated moderate. Theoretically, neem leaf extract might increase the levels and clinical effects of CYP3A4 substrates.

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

Neem and Amiodarone

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

Why Are There 2 Interactions?

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

Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

1 of 2

Why this applies to Amiodarone

Amiodarone falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group Neem interacts with.

Theoretically, neem leaf extract might increase the levels and clinical effects of CYP3A4 substrates.
In vitro research shows that neem leaf methanol extract inhibits CYP3A4 enzymes. So far, this reaction 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 gist with neem and amiodarone. Your body uses a liver enzyme called CYP3A4 to help clear amiodarone. In test-tube studies, neem leaf extract seems to slow that enzyme down. If that happened in real life, more amiodarone could linger in your system, which in theory could mean stronger effects and a higher chance of side effects like a very slow heartbeat, dizziness, fatigue, or changes in your QT interval (a heart rhythm measurement).

I want to be honest though: this is only lab-based evidence and has not been seen in actual people. Still, amiodarone is a touchy drug where small shifts matter, so please check with your pharmacist or doctor before adding neem rather than guessing.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Amaeze O, Eng H, Horlbogen L, Varma MVS, Slitt A. Cytochrome P450 Enzyme Inhibition and Herb-Drug Interaction Potential of Medicinal Plant Extracts Used for Management of Diabetes in Nigeria. Eur J Drug Metab Pharmacokinet. 2021;46(3):437-450. PubMed
Moderate

CYTOCHROME P450 2C8 (CYP2C8) SUBSTRATES

2 of 2

Amiodarone also falls under CYTOCHROME P450 2C8 (CYP2C8) SUBSTRATES.

Theoretically, neem leaf extract might increase the levels and clinical effects of CYP2C8 substrates.
In vitro research shows that neem leaf methanol extract inhibits CYP2C8 enzymes. So far, this reaction 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 gist for amiodarone (Pacerone, Cordarone): your body partly relies on an enzyme called CYP2C8 to break this drug down. In lab tests, neem leaf extract slowed that same enzyme. If that happened in a real person, amiodarone could build up a bit more than expected, which might mean stronger effects like a slower heart rate, dizziness, fatigue, or worsening of its known side effects over time.

I want to be honest about the evidence, though. This is only seen in test-tube studies, never reported in actual patients, so it's theoretical. Still, amiodarone is a powerful heart-rhythm drug where small shifts matter, so please check with your pharmacist or doctor before adding neem.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Amaeze O, Eng H, Horlbogen L, Varma MVS, Slitt A. Cytochrome P450 Enzyme Inhibition and Herb-Drug Interaction Potential of Medicinal Plant Extracts Used for Management of Diabetes in Nigeria. Eur J Drug Metab Pharmacokinet. 2021;46(3):437-450. 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

Neem Also Interacts With Other Medications

Neem has 1,013 moderate known drug interactions in our database — the Amiodarone one above is among them. If you take anything else, check it against the full list below.

Moderate 1,013 No known interaction 1,817 (incl. Amiodarone)
Taking anything else?

Check Another of Your Medications Against Neem

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

From our Q&A

Questions About Neem or Amiodarone

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

This page covers Neem only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Amiodarone 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 · 163 moderate · 36 minor.

From our pharmacist’s overview on the Amiodarone page

“Amiodarone (Pacerone, Cordarone) treats dangerous heart rhythms, and this is one supplement list I would genuinely be careful with. Of the 210 ingredients on file, 11 carry a major rating, and the everyday one is grapefruit, which blocks the liver enzyme that clears amiodarone and can push the drug's level higher than intended.”

Reviewed by 2 · Jul 18, 2026

Open the Amiodarone interaction page

One more smart check

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

We hold 288 real supplement products containing Neem, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Neem. Your product may carry other ingredients that interact with Amiodarone too, on top of Neem — 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 Neem and Amiodarone 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 Neem
Top half

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

29 days ago today
Medication Amiodarone
Top half

#1,028 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 Neem

What is Neem?

Neem
  • Skin conditions
  • Dental and gum health
  • Antimicrobial and antiparasitic
  • Digestive upset
  • Blood sugar support
  • Insect repellent/pesticide

Neem is a tree from India used for centuries in traditional medicine, especially for skin, dental, and antimicrobial purposes. Some small studies are promising for oral health and skin, but high-quality human evidence is limited for most uses. Neem oil and seed extracts can be toxic if swallowed, especially in children, so use with caution and talk to your pharmacist or doctor first.

Read the full Neem monograph & all interactions
Medication

About Amiodarone

What Is Amiodarone Used For?

Brand names: Pacerone, Cordarone

Amiodarone treats dangerous rhythm problems that start in the lower chambers of the heart: ventricular fibrillation and hemodynamically unstable ventricular tachycardia. In both, the heart beats so abnormally that blood pressure and blood flow can drop.

The tablets (including Pacerone) are for adults with documented, life-threatening, recurrent episodes who have not responded to other antiarrhythmics or cannot tolerate them. The IV injection (including Nexterone) is for starting treatment and preventing frequently recurring episodes in patients who are refractory to other therapy. Injection can also be used when someone needs oral amiodarone but cannot take medicine by mouth.

See full Amiodarone drug information
Keep checking

Other Drugs & Neem

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

0Major
1,013Moderate
0Minor
1,816No known interaction
1,013 Moderate 1,816 No interaction
Moderate

1,013 interactions

Showing 60 of 1,013 moderate interactions — see all 1,013 on the Neem page.

No interaction 1,816 drugs checked — show the list

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

Showing the 60 most looked-up of 1,816 medications checked with no known interaction — see the full Neem list.

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

Can you take Neem with Amiodarone?
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 Neem and Amiodarone?
Amiodarone belongs to more than one drug category, and Neem 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 Neem and Amiodarone 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 Amiodarone and Neem?

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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.