Drug & supplement interaction

Neem + rosiglitazone, glimepiride

rosiglitazone, glimepiride brand name: Avandaryl.

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

rosiglitazone, glimepiride falls into 3 drug categories that Neem can interact with; the most serious is rated moderate. Neem might increase the risk of hypoglycemia when taken with antidiabetes drugs.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions3
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Neem and rosiglitazone, glimepiride

These two interact in 3 distinct ways. Each one is explained separately below.

Why Are There 3 Interactions?

Neem interacts with whole categories of medication. rosiglitazone, glimepiride falls into 3 of those categories, so it can interact with Neem in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

ANTIDIABETES DRUGS

1 of 3

Why this applies to rosiglitazone, glimepiride

rosiglitazone, glimepiride falls under ANTIDIABETES DRUGS — the group Neem interacts with.

Neem might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Some clinical research shows that neem can lower blood glucose levels in adults with type 2 diabetes, including those already taking metformin.
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

Avandaryl combines two diabetes medicines: rosiglitazone and glimepiride. Both work to bring your blood sugar down, and glimepiride in particular can already cause low blood sugar (hypoglycemia) on its own. Neem appears to have its own mild blood-sugar-lowering effect, so stacking it on top of this medicine could push your numbers lower than you want.

If your blood sugar dips too far, you might feel shaky, sweaty, dizzy, confused, or unusually hungry. To be clear, this concern comes mostly from lab and animal work plus some small human studies, so it is a possible interaction rather than a sure thing. Still, if you want to try neem, please check with your pharmacist or doctor first and keep an eye on your readings.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Biswas K, Chattopadhyay I, Banerjee RK, Bandyopadhyay U. Biological activities and medicinal properties of neem (Azadirachta indica). Curr Sci 2002;82:1336-45.
  2. Pingali U, Ali MA, Gundagani S, Nutalapati C. Evaluation of the effect of an aqueous extract of Azadirachta indica (neem) leaves and twigs on glycemic control, endothelial dysfunction and systemic inflammation in subjects with type 2 diabetes mellitus - a
Moderate

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES

2 of 3

rosiglitazone, glimepiride also falls under CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES.

Theoretically, neem leaf extract might increase the levels and clinical effects of CYP2C9 substrates.
In vitro research shows that neem leaf methanol extract inhibits CYP2C9 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

Avandaryl combines two diabetes medicines: rosiglitazone and glimepiride. Both are partly cleared by a liver enzyme called CYP2C9. In lab studies (test tube only, not in people), neem leaf extract appears to slow down this enzyme. If that happened in your body, these medicines could clear a bit slower and build up, which would push their effects, and their side effects, a little higher.

The one to watch most is glimepiride, since stronger effect there can mean low blood sugar (shakiness, sweating, dizziness, confusion). Rosiglitazone could add a bit more fluid retention or weight gain. Honestly though, this is only a theoretical concern and hasn't been seen in real patients. Just keep your pharmacist or doctor in the loop before adding neem supplements.

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

3 of 3

rosiglitazone, glimepiride 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

Avandaryl combines two diabetes medicines, and rosiglitazone in particular leans on a liver enzyme called CYP2C8 to be broken down. In a lab setting, neem leaf extract appeared to slow that same enzyme. If that happened in your body, rosiglitazone could clear more slowly and build up, which might push its blood sugar lowering effect a little stronger. The glimepiride part already lowers sugar on its own, so the bigger practical worry is low blood sugar (shakiness, sweating, dizziness, confusion) or extra fluid retention and swelling.

Here's the honest part: this is only a test-tube finding and has never been reported in real people. So it's a theoretical caution, not a proven problem. Still, since blood sugar matters, just give your pharmacist or doctor a heads-up 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 1,012 moderate known drug interactions in our database — the rosiglitazone, glimepiride 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. rosiglitazone, glimepiride)
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 rosiglitazone, glimepiride

This page covers Neem only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the rosiglitazone, glimepiride page lists 308 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Siberian Cocklebur (major), Acai (moderate), Adrafinil (moderate) and African Wild Potato (moderate).

By severity: 2 major · 258 moderate · 48 minor.

From our pharmacist’s overview on the rosiglitazone, glimepiride page

“Siberian cocklebur worries me most on this page. Its seeds have caused severe, worsening drops in blood sugar in people, and rosiglitazone with glimepiride (Avandaryl) already pulls glucose down through two separate mechanisms, so these pairings deserve real vigilance.”

Reviewed by 2 · Jul 18, 2026

Open the rosiglitazone, glimepiride 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 rosiglitazone, glimepiride 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 rosiglitazone, glimepiride 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%

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

29 days ago today
Medication rosiglitazone, glimepiride
Top half

#1,312 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
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 rosiglitazone, glimepiride, 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 rosiglitazone, glimepiride supplement interactions › Every supplement checked against rosiglitazone, glimepiride, 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 Neem and rosiglitazone, glimepiride Together: Common Questions

Can you take Neem with rosiglitazone, glimepiride?
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 3 interactions listed for Neem and rosiglitazone, glimepiride?
rosiglitazone, glimepiride 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 rosiglitazone, glimepiride 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 rosiglitazone, glimepiride 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.