Drug & supplement interaction

Peony + Prasterone (prescription drug)

Prasterone (prescription drug) brand name: Intrarosa.

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

Peony has a moderate interaction with Prasterone (prescription drug). Theoretically, concomitant use of large amounts of peony might interfere with hormone replacement therapy and/or increase the risk for estrogen-related adverse effects.

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

Peony and Prasterone (prescription drug)

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

Moderate

ESTROGENS

Why this applies to Prasterone (prescription drug)

Prasterone (prescription drug) falls under ESTROGENS — the group Peony interacts with.

Theoretically, concomitant use of large amounts of peony might interfere with hormone replacement therapy and/or increase the risk for estrogen-related adverse effects.
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.
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 thing with Intrarosa (vaginal prasterone): it's a hormone your body converts into estrogen and testosterone locally in the vaginal tissue, which helps ease the dryness and painful intercourse that come with menopause. Peony root has shown some estrogen-like activity in lab and animal studies, so the concern is mostly theoretical. In plain terms, large amounts of peony might add to estrogen effects or compete at estrogen receptors.

This is a low-strength, theory-only worry, not something proven in people. Still, if you're using peony in concentrated supplement doses, it's worth mentioning to your pharmacist or doctor, especially if you notice things like breast tenderness or unusual vaginal bleeding. Occasional culinary or tea amounts are far less likely to matter.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. 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].

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 Prasterone (prescription drug) 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. Prasterone (prescription drug))
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 Prasterone (prescription drug)

This page covers Peony only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Prasterone (prescription drug) page lists 63 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Grapefruit (major), Aletris (moderate), Alfalfa (moderate), Androstenediol (moderate) and Androstenedione (moderate).

By severity: 1 major · 56 moderate · 6 minor.

From our pharmacist’s overview on the Prasterone (prescription drug) page

“Grapefruit is the single major-rated interaction on prasterone's (Intrarosa) list, and it earns that spot. It blocks the enzyme that clears estrogens, so estrogen levels can climb, and side effects with them.”

Reviewed by 2 · Jul 18, 2026

Open the Prasterone (prescription drug) 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 Prasterone (prescription drug) 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 Prasterone (prescription drug) 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 Prasterone (prescription drug)
Top 10%

#146 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 Prasterone Vaginal

What Is Prasterone Vaginal Used For?

Brand name: Intrarosa

Intrarosa (prasterone) vaginal insert is used to treat moderate to severe dyspareunia — that is, pain during sex — which is a symptom of vulvar and vaginal atrophy (thinning and drying of vaginal tissues) caused by menopause.

See full Prasterone Vaginal 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 Prasterone (prescription drug), 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 Prasterone (prescription drug) supplement interactions › Every supplement checked against Prasterone (prescription drug), ranked by severity Prasterone Vaginal 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 Prasterone (prescription drug) Together: Common Questions

Can you take Peony with Prasterone (prescription drug)?
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 Prasterone (prescription drug) 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 Prasterone (prescription drug) 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.