Peony + Norelgestromin, Ethinyl Estradiol
Norelgestromin, Ethinyl Estradiol brand names: Ortho Evra, Evra.
Norelgestromin, Ethinyl Estradiol falls into 4 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 reportPeony and Norelgestromin, Ethinyl Estradiol
These two interact in 4 distinct ways. Each one is explained separately below.
Why Are There 4 Interactions?
Peony interacts with whole categories of medication. Norelgestromin, Ethinyl Estradiol falls into 4 of those categories, so it can interact with Peony in 4 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES
1 of 4Why this applies to Norelgestromin, Ethinyl Estradiol
Norelgestromin, Ethinyl Estradiol falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES — the group Peony interacts with.
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.
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.
Your Ortho Evra patch delivers two active hormones, a progestin (norelgestromin) and an estrogen (ethinyl estradiol). Part of how your body clears the estrogen runs through a liver enzyme called CYP1A2. In lab and animal studies, peony seems to gently slow that enzyme down. In theory, that could let estrogen linger a little longer in your system, which might bump up familiar side effects like nausea, breast tenderness, headaches, bloating, or spotting.
Here's the honest part: this is only test-tube and animal data, and it has never been shown to happen in real people. So I wouldn't lose sleep over it. Still, since the patch is a medicine you really want working steadily, it's worth a quick chat with your pharmacist or doctor before adding peony.
- 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
ESTROGENS
2 of 4Norelgestromin, Ethinyl Estradiol also falls under ESTROGENS.
In vitro and animal research shows that peony extract has estrogenic activity. Theoretically, peony might compete for estrogen receptors and/or cause additive estrogenic effects.
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.
Your Ortho Evra patch delivers two hormones, an estrogen (ethinyl estradiol) and a progestin (norelgestromin). The concern here is pretty mild and mostly on paper. In lab dishes and animal studies, peony seems to act a little like estrogen, latching onto the same receptors your body's estrogen uses. So in theory, taking large, concentrated peony supplement doses alongside your patch could add a bit to the estrogen-like activity or nudge how it works.
What that might look like in real life is uncertain, but possible estrogen-related effects include breast tenderness, nausea, headaches, or breakthrough spotting. This is theoretical, and small culinary amounts are unlikely to matter. Before adding a peony supplement, please run it by your pharmacist or doctor.
- Xu Y, Li X, Chen T, et al. Radix Paeoniae Alba increases serum estrogen level and up-regulates estrogen receptor expression in uterus and vagina of immature/ovariectomized mice. Phytother Res. 2019;33(1):117-29. [RETRACTED].
CONTRACEPTIVE DRUGS
3 of 4Norelgestromin, Ethinyl Estradiol also falls under CONTRACEPTIVE DRUGS.
In vitro and animal research shows that peony extract has estrogenic activity. Concomitant use might also increase the risk for estrogen-related adverse effects.
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.
The Ortho Evra patch delivers two hormones, a progestin (norelgestromin) and an estrogen (ethinyl estradiol), to prevent pregnancy. The concern here is that peony root has shown estrogen-like activity in lab dishes and animal studies. In theory, peony's plant compounds could compete at estrogen receptors and add to the estrogen effect from your patch.
Honestly, this is a theoretical worry only, based on test-tube and animal data, not real people. If anything happened, it might mean a slightly higher chance of estrogen-related effects like breast tenderness, nausea, bloating, or mood changes. It is not a strong, proven interaction, and I would not want you to panic. Still, it is worth a quick chat with your pharmacist or doctor before starting peony, especially since the patch is something you rely on.
- Xu Y, Li X, Chen T, et al. Radix Paeoniae Alba increases serum estrogen level and up-regulates estrogen receptor expression in uterus and vagina of immature/ovariectomized mice. Phytother Res. 2019;33(1):117-29. [RETRACTED].
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
4 of 4Norelgestromin, Ethinyl Estradiol also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
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.
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.
The patch you're using (Ortho Evra) delivers two active hormones, norelgestromin and ethinyl estradiol, and your body partly clears the estrogen using a liver enzyme called CYP3A4. In lab dishes, peony seems to gently slow that same enzyme. In theory, that could let a little more of the hormone hang around, which might bump up typical side effects like nausea, breast tenderness, headaches, or breakthrough spotting.
Here's the honest part: this is only based on test-tube and animal work, never confirmed in actual people, and the effect looks weak. These are not prodrugs, so they don't get switched on by the enzyme. I wouldn't lose sleep over it, but since reliable birth control matters, just mention the peony to your pharmacist or doctor before combining them.
- 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.
Clinically significant. Avoid the combination, or use only under close professional supervision.
Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.
Generally not serious. Be aware of it and mention it to your pharmacist.
- 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.
- 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.
Peony Also Interacts With Other Medications
Peony has 810 moderate known drug interactions in our database — the Norelgestromin, Ethinyl Estradiol one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Peony
We haven’t checked that one against Peony yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Peony. Pick one to open its full report.
See Every Supplement That Interacts With Norelgestromin, Ethinyl Estradiol
This page covers Peony only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Norelgestromin, Ethinyl Estradiol page lists 203 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), Activated Charcoal (moderate) and Adrafinil (moderate).
By severity: 2 major · 168 moderate · 33 minor.
From our pharmacist’s overview on the Norelgestromin, Ethinyl Estradiol page
“St. John's wort is the first entry to check if you wear the Ortho Evra patch (norelgestromin and ethinyl estradiol).”
Reviewed by 2 · Jul 18, 2026
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 Norelgestromin, Ethinyl Estradiol 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:
Where Peony and Norelgestromin, Ethinyl Estradiol 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.
#227 of 1,452 supplements looked up here in the last 7 days
#1,981 of 2,830 medications looked up here in the last 7 days
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.
About Peony
What is 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.
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.
No drugs match “”.
810 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Theophylline ›
- Nifedipine ›
- Ibuprofen ›
- Aspirin ›
- Hydrocortisone ›
- Naproxen ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Lidocaine ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Triazolam ›
- Zopiclone ›
- Colchicine ›
- Fentanyl ›
- Oxybutynin ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Dipyridamole ›
- Doxorubicin ›
- Fluticasone ›
- Miconazole ›
- Acetaminophen ›
- Buprenorphine ›
- Conjugated Estrogens ›
- Diazepam ›
- Everolimus ›
- Ivabradine ›
- Ketoprofen ›
- Lofepramine ›
- Medroxyprogesterone ›
- Medroxyprogesterone Acetate ›
- Nortriptyline ›
- Rifampin ›
- Testosterone Undecanoate ›
- Aripiprazole ›
- Bendamustine ›
- Bivalirudin ›
- Caffeine (otc Drug) ›
- Ciclesonide ›
- Clonazepam ›
- Cyclobenzaprine ›
- Dapsone ›
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.
- Levothyroxine ›
- Methylphenidate ›
- Ivermectin ›
- Metoprolol ›
- Rosuvastatin ›
- Escitalopram ›
- Docusate ›
- Tirzepatide ›
- Hydroxyurea ›
- Valacyclovir ›
- Methamphetamine ›
- Semaglutide ›
- Sumatriptan ›
- Lisdexamfetamine ›
- Metformin ›
- Amoxicillin ›
- Lisinopril ›
- Bupropion ›
- Methotrexate ›
- Amphetamine ›
- Acyclovir ›
- Isotretinoin ›
- Doxycycline ›
- Fluoxetine ›
- Pregabalin ›
- Lamotrigine ›
- Azithromycin ›
- Gabapentin ›
- Dextroamphetamine ›
- Methylene Blue ›
- Duloxetine ›
- Ciprofloxacin ›
- Bisoprolol ›
- Levothyroxine, Liothyronine ›
- Candesartan Cilexetil ›
- Acetaminophen, Dextromethorphan, Doxylamine ›
- Cyclopentolate ›
- Cephalexin ›
- Mannitol ›
- Roxithromycin ›
- Amoxicillin, Clavulanate Potassium ›
- Levetiracetam ›
- Ezetimibe ›
- Levothyroxine Sodium ›
- Pegunigalsidase Alfa-iwxj ›
- Phentermine, Topiramate ›
- Dexmethylphenidate ›
- Spironolactone ›
- Thyroid Hormone ›
- Daptomycin ›
- Valsartan ›
- Carbidopa, Levodopa ›
- Mitomycin ›
- Hexobarbitone ›
- Levodopa ›
- Venlafaxine ›
- Hethylphenidate Hcl ›
- Factor 7a ›
- Minoxidil ›
- Bentoquatam ›
Showing the 60 most looked-up of 2,019 medications checked with no known interaction — see the full Peony list.
Sources & How We Checked
Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for vitamins, herbs and supplements — the basis for our interaction data.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for the medication overviews.
- NIH Dietary Supplement Label Database (DSLD) — Official supplement product labels.
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
Norelgestromin, Ethinyl Estradiol Is Linked to Lower Levels of 7 Nutrients
Natural Medicines records Norelgestromin, Ethinyl Estradiol as a medicine that can lower these. This is not an interaction with Peony — it is a separate effect of the medicine, and it is a reason some people are advised to supplement rather than to avoid one:
Read the full Norelgestromin, Ethinyl Estradiol nutrient depletion report ›
Depletion records come from the licensed Natural Medicines database. Do not start a supplement on the strength of this page — ask your pharmacist or doctor whether it applies to you.
Taking Peony and Norelgestromin, Ethinyl Estradiol Together: Common Questions
Can you take Peony with Norelgestromin, Ethinyl Estradiol?
Why are there 4 interactions listed for Peony and Norelgestromin, Ethinyl Estradiol?
How serious is the Peony and Norelgestromin, Ethinyl Estradiol interaction?
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.