Drug & supplement interaction

Neem + Sirolimus (albumin bound)

Sirolimus (albumin bound) brand name: Fyarro.

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

Sirolimus (albumin bound) falls into 3 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 P-glycoprotein substrates.

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

Neem and Sirolimus (albumin bound)

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. Sirolimus (albumin bound) 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

P-GLYCOPROTEIN SUBSTRATES

1 of 3

Why this applies to Sirolimus (albumin bound)

Sirolimus (albumin bound) falls under P-GLYCOPROTEIN SUBSTRATES — the group Neem interacts with.

Theoretically, neem leaf extract might increase the levels and clinical effects of P-glycoprotein substrates.
In vitro research shows that neem leaf methanol extract inhibits renal P-glycoprotein transport activity. 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 Fyarro (albumin-bound sirolimus) and neem. Sirolimus relies partly on a cellular pump called P-glycoprotein to move it out of cells. In test-tube studies, neem leaf extract seems to slow that pump down. If that happened in your body, sirolimus could build up and reach higher levels than expected, which may mean more side effects like mouth sores, low blood counts, infections, swelling, high blood sugar, or high cholesterol.

I want to be honest about the strength here: this is only based on lab research, and it has not been seen in real patients. Still, sirolimus is a powerful cancer medicine with a narrow safety window, so I'd loop in your oncology team or pharmacist before adding any neem product.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Amaeze O, Marques ES, Wei W, et al. Evaluation of Nigerian Medicinal Plants Extract on Human P-glycoprotein and Cytochrome P450 Enzyme Induction: Implications for Herb-drug Interaction. Curr Drug Metab. 2021;22(14):1103-1113. PubMed
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

2 of 3

Sirolimus (albumin bound) also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.

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 for Fyarro (albumin-bound sirolimus): your liver and gut rely on an enzyme called CYP3A4 to break this drug down. Lab studies suggest neem leaf extract may slow that enzyme. If that happens in the body, sirolimus could clear more slowly and build up, which means more of its effects and side effects, things like mouth sores, low blood counts, infections, fatigue, swelling, and trouble with wound healing.

I want to be honest with you, though: this is only based on test-tube research, and it has not been seen in real people. Sirolimus is a drug where small changes in level matter, so it's worth a quick conversation with your oncology team or pharmacist before adding neem in any form.

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

3 of 3

Sirolimus (albumin bound) 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. Your Fyarro (albumin-bound sirolimus) works by calming and blocking certain signals that tell tumor cells to grow, and it also dampens the immune system. In animal studies, neem seemed to do the opposite, giving the immune system a little nudge to be more active. On paper, that push could work against what sirolimus is trying to do, so the worry is reduced effectiveness rather than more side effects.

I want to be honest about how thin this evidence is. It comes from lab and animal research only, not from people taking this medication. Still, since sirolimus is treating a serious cancer, I wouldn't risk it. Please check with your oncology team or pharmacist before using any neem product.

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 Sirolimus (albumin bound) 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. Sirolimus (albumin bound))
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 Sirolimus (albumin bound)

This page covers Neem only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Sirolimus (albumin bound) page lists 171 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 · 142 moderate · 27 minor.

From our pharmacist’s overview on the Sirolimus (albumin bound) page

“Fyarro, the albumin-bound form of sirolimus used to treat advanced malignant PEComa, a rare cancer, is a medication I would guard carefully from supplement interference, and the 171 ingredients on this page show why. Most of them (121 through the CYP3A4 enzyme, 37 through the P-glycoprotein transporter) can shift how much sirolimus act…”

Reviewed by 2 · Jul 18, 2026

Open the Sirolimus (albumin bound) 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 Sirolimus (albumin bound) 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 Sirolimus (albumin bound) 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 Sirolimus (albumin bound)
Steady interest

#2,322 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 Sirolimus (with albumin) Injection

What Is Sirolimus (with albumin) Injection Used For?

Brand name: Fyarro

Fyarro (sirolimus with albumin) injection is approved to treat adult patients with locally advanced unresectable or metastatic malignant perivascular epithelioid cell tumor (PEComa) — a rare type of soft-tissue tumor. This includes tumors that cannot be surgically removed or that have spread to other parts of the body.

See full Sirolimus (with albumin) Injection 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 Sirolimus (albumin bound), 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 Sirolimus (albumin bound) supplement interactions › Every supplement checked against Sirolimus (albumin bound), ranked by severity Sirolimus (with albumin) Injection 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 Sirolimus (albumin bound) Together: Common Questions

Can you take Neem with Sirolimus (albumin bound)?
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 Sirolimus (albumin bound)?
Sirolimus (albumin bound) 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 Sirolimus (albumin bound) 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 Sirolimus (albumin bound) 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.