Drug & supplement interaction

Peony + Ivacaftor, Lumacaftor

Ivacaftor, Lumacaftor brand name: Orkambi.

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

Peony has a moderate interaction with Ivacaftor, Lumacaftor. Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.

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

Peony and Ivacaftor, Lumacaftor

Here is the interaction we found between these two, with the evidence behind it.

Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Why this applies to Ivacaftor, Lumacaftor

Ivacaftor, Lumacaftor falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group Peony interacts with.

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

Here's the gist with Orkambi (lumacaftor/ivacaftor): the ivacaftor part is cleared from your body largely by a liver enzyme called CYP3A4. Peony, at least in test-tube studies, seems to gently slow that same enzyme down. If that happened in people, ivacaftor could build up a little, which in theory might mean more side effects like headache, stomach upset, dizziness, or a rash.

I want to be honest about the strength of this, though. This is based only on lab work, not on real patients, so it's quite theoretical and rated as moderate. Lumacaftor actually nudges CYP3A4 the other way, which muddies things further. Please don't change your Orkambi or stop peony on your own. Just run it past your CF team or pharmacist 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

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 812 moderate known drug interactions in our database — the Ivacaftor, Lumacaftor one above is one of them. If you take anything else, check it against the full list below.

Moderate 812 No known interaction 2,018 (incl. Ivacaftor, Lumacaftor)
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 Ivacaftor, Lumacaftor

This page covers Peony only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ivacaftor, Lumacaftor page lists 153 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Grapefruit (major), St. John's Wort (major), Acacia Rigidula (moderate) and Adrafinil (moderate).

By severity: 3 major · 110 moderate · 40 minor.

From our pharmacist’s overview on the Ivacaftor, Lumacaftor page

“Ivacaftor with lumacaftor (Orkambi) only works against cystic fibrosis if its blood level stays steady, and most of the supplements on this page can tug that level up or down through a shared liver pathway called CYP3A4. Grapefruit can push the level higher, St.”

Reviewed by 2 · Jul 18, 2026

Open the Ivacaftor, Lumacaftor 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 Ivacaftor, Lumacaftor 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 Ivacaftor, Lumacaftor 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%

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

29 days ago today
Medication Ivacaftor, Lumacaftor
Top 5%

#126 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
Medication

About Lumacaftor and Ivacaftor

What Is Lumacaftor and Ivacaftor Used For?

Brand name: Orkambi

Lumacaftor and ivacaftor (Orkambi) treats cystic fibrosis (CF) in people aged 1 year and older who are homozygous for the F508del mutation in the CFTR gene. Homozygous means you inherited the mutation from both parents.

If your genetic makeup is unknown, an FDA-cleared CF mutation test is used to check for the mutation on both copies of the gene. Orkambi has not been shown to be safe or effective in people with CF who do not have two copies of F508del.

See full Lumacaftor and Ivacaftor drug information
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
812Moderate
0Minor
2,017No known interaction
812 Moderate 2,017 No interaction
Moderate

812 interactions

Showing 60 of 812 moderate interactions — see all 812 on the Peony page.

No interaction 2,017 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 2,017 medications checked with no known interaction — see the full Peony list.

See the full Peony interactions page
See every supplement checked against Ivacaftor, Lumacaftor, 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 Ivacaftor, Lumacaftor supplement interactions › Every supplement checked against Ivacaftor, Lumacaftor, ranked by severity Lumacaftor and Ivacaftor 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 Peony and Ivacaftor, Lumacaftor Together: Common Questions

Can you take Peony with Ivacaftor, Lumacaftor?
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.
How serious is the Peony and Ivacaftor, Lumacaftor 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 Ivacaftor, Lumacaftor and Peony?

Our pharmacists answer your medication & supplement questions — free.

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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.