Drug & supplement interaction

Oleander + Retapamulin

Retapamulin brand names: Altabax, Altargo.

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

Retapamulin falls into 2 drug categories that Oleander can interact with; the most serious is rated major. Theoretically, macrolide antibiotics may increase the risk of oleander toxicity.

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

Oleander and Retapamulin

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

Why Are There 2 Interactions?

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

Major

MACROLIDE ANTIBIOTICS

1 of 2

Why this applies to Retapamulin

Retapamulin falls under MACROLIDE ANTIBIOTICS — the group Oleander interacts with.

Theoretically, macrolide antibiotics may increase the risk of oleander toxicity.
Macrolide antibiotics reduce levels of bacteria in the gut that break down digoxin to inactive metabolites, increasing digoxin bioavailability. Theoretically, this same process could increase the bioavailability of cardiac glycosides in oleander, increasing its toxicity.
Severity Major Likelihood Probable Evidence D

Interaction 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..

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

First things first: I'd steer you away from oleander entirely. It's a genuinely poisonous plant, and there's no safe at-home dose. With that said, let's talk about how it lines up with Retapamulin (Altabax). The interaction on file applies to macrolide antibiotics taken by mouth, where they shift gut bacteria and let more of oleander's heart-active compounds get absorbed, raising the risk of toxicity.

Here's the reassuring part for you: Retapamulin is a topical ointment you rub on the skin for impetigo. Almost none of it gets into your bloodstream or gut, so this gut-bacteria mechanism really doesn't apply the way it would for a swallowed antibiotic. The bigger danger by far is the oleander itself. Please skip the oleander and check with your pharmacist or doctor.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Ellenhorn MJ, et al. Ellenhorn's Medical Toxicology: Diagnoses and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams & Wilkins, 1997.
Major

TETRACYCLINE ANTIBIOTICS

2 of 2

Retapamulin also falls under TETRACYCLINE ANTIBIOTICS.

Theoretically, tetracycline antibiotics may increase the risk of oleander toxicity.
Tetracycline antibiotics reduce levels of bacteria in the gut that break down digoxin to inactive metabolites, increasing digoxin bioavailability. Theoretically, this same process might increase the bioavailability of cardiac glycosides in oleander, increasing its toxicity.
Severity Major Likelihood Probable Evidence D

Interaction 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..

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

First, a big caveat: I never recommend oleander in any form. It is genuinely poisonous, and people have died from teas and extracts made from it. The interaction we have on file is theoretical, based on how certain antibiotics work in the gut, not on solid studies.

Here is the wrinkle with Retapamulin (Altabax), though. The concern was written for tetracycline pills that get swallowed and change gut bacteria, which can let more of oleander's heart toxins get absorbed. Retapamulin is a topical ointment you smear on skin for impetigo. Almost none of it reaches your gut or bloodstream, so it really would not drive that gut-bacteria effect. The bottom line stays the same: skip oleander entirely, and check with your pharmacist or doctor before mixing any supplement with your medicines.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Ellenhorn MJ, et al. Ellenhorn's Medical Toxicology: Diagnoses and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams & Wilkins, 1997.

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

Oleander Also Interacts With Other Medications

Oleander has 132 major, 23 moderate known drug interactions in our database — the Retapamulin one above is among them. If you take anything else, check it against the full list below.

Major 132 Moderate 23 No known interaction 2,675 (incl. Retapamulin)
Taking anything else?

Check Another of Your Medications Against Oleander

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

Everything else you take

See Every Supplement That Interacts With Retapamulin

This page covers Oleander only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Retapamulin page lists 81 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Para-aminobenzoic Acid (paba) (major), Acerola (moderate), Alpha-lipoic Acid (moderate), Bacillus Coagulans (moderate) and Bacillus Subtilis (moderate).

By severity: 2 major · 71 moderate · 8 minor.

Open the Retapamulin interaction page

How much people look this up

Where Oleander and Retapamulin 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 Oleander
Steady interest

#1,134 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Retapamulin
Steady interest

#1,899 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 Oleander

What is Oleander?

  • Heart failure (traditional)
  • Cancer (investigational)
  • Skin conditions
  • Asthma (folk use)
  • Pain relief (folk use)

Oleander is a highly poisonous ornamental plant, and every part of it can cause life-threatening heart and nervous system effects, even in small amounts. There is no proven safe dose for self-use, and serious poisonings and deaths have occurred from teas, extracts, and accidental ingestion. We strongly advise against using oleander as a supplement.

Read the full Oleander monograph & all interactions
Medication

About Retapamulin

What Is Retapamulin Used For?

Brand names: Altabax, Altargo

  • Retapamulin is used to treat impetigo (a skin infection caused by bacteria) in children and adults. Retapamulin is in a class of medications called antibacterials. It works by killing and stopping the growth of bacteria on the skin.

See full Retapamulin drug information
Keep checking

Other Drugs & Oleander

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

132Major
23Moderate
0Minor
2,674No known interaction
132 Major 23 Moderate 2,674 No interaction
Major

132 interactions

Showing 60 of 132 major interactions — see all 132 on the Oleander page.

Moderate

23 interactions

No interaction 2,674 drugs checked — show the list

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

Showing the 60 most looked-up of 2,674 medications checked with no known interaction — see the full Oleander list.

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

Can you take Oleander with Retapamulin?
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 Oleander and Retapamulin?
Retapamulin belongs to more than one drug category, and Oleander 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 Oleander and Retapamulin 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.