Drug & supplement interaction

Neem + Ciclesonide

Ciclesonide brand names: Omnaris, Alvesco, Zetonna.

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

Ciclesonide 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 Ciclesonide

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. Ciclesonide 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 Ciclesonide

Ciclesonide 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 your Alvesco or Omnaris (ciclesonide). Ciclesonide is actually a prodrug, meaning your body switches it on into its active form once it reaches the lungs or nasal lining. After that, the enzyme CYP3A4 helps clear it out. Lab studies (in test tubes, not people) suggest neem leaf extract may slow that enzyme down a bit, which in theory could let a little more active drug hang around.

Honestly, this is very speculative and has never been seen in real patients. Because inhaled and nasal ciclesonide barely reach the bloodstream, I wouldn't lose sleep over it. If you ever notice things like a hoarse voice, mouth thrush, or other steroid side effects, just check in with your pharmacist or doctor.

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

IMMUNOSUPPRESSANTS

2 of 2

Ciclesonide also falls under IMMUNOSUPPRESSANTS.

Theoretically, neem might decrease the effectiveness of immunosuppressants.
Animal research suggests that neem might have immunostimulant effects.
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 idea behind this one: in animal studies, neem seemed to give the immune system a little nudge, so on paper it could work against medicines that calm the immune system down. Ciclesonide (Alvesco, Omnaris, Zetonna) is an inhaled or nasal corticosteroid, and steroids do quiet inflammation, so neem could in theory blunt how well it controls your asthma or nasal swelling.

I want to keep this in perspective, though. This concern comes only from lab and animal research, not from real people, so it's quite weak. Inhaled ciclesonide also acts mostly right where you spray it, with little reaching the rest of the body. Still, if you notice more wheezing, chest tightness, or congestion after starting neem, mention it to your pharmacist or doctor before changing anything.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Upadhyay SN, Dhawan S, Garg S, Talwar GP. Immunomodulatory effects of neem (Azadirachta indica) oil. Int J Immunopharmacol 1992;14:1187-93. 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 1,012 moderate known drug interactions in our database — the Ciclesonide one above is among them. If you take anything else, check it against the full list below.

Moderate 1,012 No known interaction 1,818 (incl. Ciclesonide)
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.

Everything else you take

See Every Supplement That Interacts With Ciclesonide

This page covers Neem only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ciclesonide page lists 166 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Grapefruit (major), St. John's Wort (major), Acacia Rigidula (moderate), Active Hexose Correlated Compound (ahcc) (moderate) and Adrafinil (moderate).

By severity: 2 major · 134 moderate · 30 minor.

From our pharmacist’s overview on the Ciclesonide page

“Ciclesonide (Alvesco, Omnaris, Zetonna) is a corticosteroid for asthma and nasal allergies, and even though it is inhaled rather than swallowed, its supplement list warrants genuine care. The body clears it through the CYP3A4 enzyme, and 121 of the 166 ingredients on file nudge that pathway one way or the other.”

Reviewed by 2 · Jul 18, 2026

Open the Ciclesonide 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 Ciclesonide 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 Ciclesonide 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 25%

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

29 days ago today
Medication Ciclesonide
Top half

#1,177 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 Ciclesonide Oral Inhalation

What Is Ciclesonide Oral Inhalation Used For?

Brand names: Omnaris, Alvesco, Zetonna

Alvesco (ciclesonide) inhaler is approved for the maintenance treatment of asthma as a preventive therapy in adults and children 12 years of age and older. It is taken regularly to reduce airway inflammation and help prevent asthma symptoms — not to relieve a sudden attack.

Alvesco is not a rescue inhaler and should not be used to treat sudden wheezing or acute asthma episodes. It is also not approved for children under 12.

See full Ciclesonide Oral Inhalation 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
1,012Moderate
0Minor
1,817No known interaction
1,012 Moderate 1,817 No interaction
Moderate

1,012 interactions

Showing 60 of 1,012 moderate interactions — see all 1,012 on the Neem page.

No interaction 1,817 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 1,817 medications checked with no known interaction — see the full Neem list.

See the full Neem interactions page
See every supplement checked against Ciclesonide, 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 Ciclesonide supplement interactions › Every supplement checked against Ciclesonide, ranked by severity Ciclesonide Oral Inhalation 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 Ciclesonide Together: Common Questions

Can you take Neem with Ciclesonide?
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 Ciclesonide?
Ciclesonide 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 Ciclesonide 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.