Drug & supplement interaction

Peony + Esomeprazole, Naproxen

Esomeprazole, Naproxen brand name: Vimovo.

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

Esomeprazole, Naproxen falls into 3 drug categories that Peony can interact with; the most serious is rated moderate. Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.

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

Peony and Esomeprazole, Naproxen

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

Why Are There 3 Interactions?

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

Moderate

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES

1 of 3

Why this applies to Esomeprazole, Naproxen

Esomeprazole, Naproxen falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES — the group Peony interacts with.

Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. This effect 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

Vimovo combines naproxen (an anti-inflammatory pain reliever) with esomeprazole (an acid blocker that protects your stomach). The thinking here is that peony root may gently slow the CYP1A2 enzyme that helps break naproxen down. If that happens, a little more naproxen could linger in your body, which might nudge up side effects like stomach upset, heartburn, fluid retention, or higher blood pressure.

I'll be honest with you though: this is based only on lab and animal testing, mostly looking at a different drug (clozapine). It has never been shown to be a real problem in people, and neither of these is a prodrug, so don't be alarmed. Still, if you plan to use peony regularly, run it by your pharmacist or doctor first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Wang W, Tian DD, Zheng B, et al. Peony-glycyrrhiza decoction, an herbal preparation, inhibits clozapine metabolism via cytochrome P450s, but not flavin-containing monooxygenase in in vitro models. Drug Metab Dispos 2015;43(7):1147-53. PubMed
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

2 of 3

Esomeprazole, Naproxen also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.

Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. This effect 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

Vimovo combines two medicines: esomeprazole (a stomach acid reducer) and naproxen (an anti-inflammatory pain reliever). The idea here is that peony root might gently slow down a liver enzyme called CYP3A4 that helps clear certain drugs. If that enzyme slows, those drug levels could creep up a bit, which in theory could mean stronger effects or more side effects, like stomach upset, heartburn, or in naproxen's case a higher chance of stomach irritation.

That said, I want to keep this in perspective. This concern comes only from lab and animal studies, not from people, so it's very theoretical. Neither drug is a prodrug, so the direction is straightforward. Still, before adding peony, check in with your pharmacist or doctor.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Wang W, Tian DD, Zheng B, et al. Peony-glycyrrhiza decoction, an herbal preparation, inhibits clozapine metabolism via cytochrome P450s, but not flavin-containing monooxygenase in in vitro models. Drug Metab Dispos 2015;43(7):1147-53. PubMed
Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

3 of 3

Esomeprazole, Naproxen also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.

Theoretically, combining peony with anticoagulant or antiplatelet drugs might increase the risk of bleeding.
In vitro research suggests that peony might have antiplatelet, anticoagulant, and antithrombotic 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

Vimovo combines two medicines: naproxen, an anti-inflammatory pain reliever (NSAID), and esomeprazole, a stomach acid blocker that's added to protect your stomach. The part that matters here is the naproxen. Like other NSAIDs, naproxen makes platelets a little less sticky, so it already nudges up your bleeding risk and can irritate the stomach lining.

Peony root, in lab and animal studies, also seems to make blood clot a bit slower and platelets less active. So the worry is that stacking peony on top of naproxen could add to that bleeding tendency, things like easy bruising, nosebleeds, or stomach bleeding. I'll be honest: this is theoretical and only based on test-tube and animal work, not human studies. Still, before combining them, please check with your pharmacist or doctor.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Koo YK, Kim JM, Koo JY, et al. Platelet anti-aggregatory and blood anti-coagulant effects of compounds isolated from Paeonia lactiflora and Paeonia suffruticosa. Pharmazie 2010;65(8):624-8.

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

Peony Also Interacts With Other Medications

Peony has 810 moderate known drug interactions in our database — the Esomeprazole, Naproxen one above is among them. If you take anything else, check it against the full list below.

Moderate 810 No known interaction 2,020 (incl. Esomeprazole, Naproxen)
Taking anything else?

Check Another of Your Medications Against Peony

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

Everything else you take

See Every Supplement That Interacts With Esomeprazole, Naproxen

This page covers Peony only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Esomeprazole, Naproxen page lists 348 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Asarabacca (major), Beer (major), Danshen (major) and Grapefruit (major).

By severity: 9 major · 283 moderate · 56 minor.

From our pharmacist’s overview on the Esomeprazole, Naproxen page

“Bleeding risk is the thread running through nearly this whole page. Vimovo pairs naproxen, an anti-inflammatory that already makes stomach bleeding more likely, with esomeprazole on board to shield the gut, and most of the supplements flagged here could push that bleeding risk higher still.”

Reviewed by 2 · Jul 18, 2026

Open the Esomeprazole, Naproxen interaction page

One more smart check

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

We hold 71 real supplement products containing Peony, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Peony. Your product may carry other ingredients that interact with Esomeprazole, Naproxen too, on top of Peony — 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 Peony and Esomeprazole, Naproxen 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 Peony
Top 25%

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

29 days ago today
Medication Esomeprazole, Naproxen
Steady interest

#1,667 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 Peony

What is Peony?

Peony
  • Menstrual cramps and irregular periods
  • Muscle cramps and spasms
  • Anxiety and stress
  • Inflammation and pain
  • Polycystic ovary syndrome (PCOS)

Peony root is a traditional Chinese medicine herb often used for menstrual problems, cramps, and inflammation, frequently as part of combination formulas. Human evidence for most uses is limited or preliminary, so it should not replace proven treatments. Talk to your pharmacist or doctor before using it, especially if you are pregnant, breastfeeding, or taking other medicines.

Read the full Peony monograph & all interactions
Keep checking

Other Drugs & Peony

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

0Major
810Moderate
0Minor
2,019No known interaction
810 Moderate 2,019 No interaction
Moderate

810 interactions

Showing 60 of 810 moderate interactions — see all 810 on the Peony page.

No interaction 2,019 drugs checked — show the list

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

Showing the 60 most looked-up of 2,019 medications checked with no known interaction — see the full Peony list.

See the full Peony interactions page
See every supplement checked against Esomeprazole, Naproxen, 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
Peony monograph › Uses, safety, and every drug interaction in one place Esomeprazole, Naproxen supplement interactions › Every supplement checked against Esomeprazole, Naproxen, 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 Peony and Esomeprazole, Naproxen Together: Common Questions

Can you take Peony with Esomeprazole, Naproxen?
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 Peony and Esomeprazole, Naproxen?
Esomeprazole, Naproxen belongs to more than one drug category, and Peony 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 Peony and Esomeprazole, Naproxen 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.