Peony + Relugolix, Estradiol, Norethindrone Acetate
Relugolix, Estradiol, Norethindrone Acetate brand name: Myfembree.
Relugolix, Estradiol, Norethindrone Acetate 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 reportPeony and Relugolix, Estradiol, Norethindrone Acetate
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. Relugolix, Estradiol, Norethindrone Acetate 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).
CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES
1 of 3Why this applies to Relugolix, Estradiol, Norethindrone Acetate
Relugolix, Estradiol, Norethindrone Acetate 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.
Here's the situation with Myfembree (relugolix, estradiol, and norethindrone) and peony root. Peony has been shown in lab dishes to mildly slow down a liver enzyme called CYP1A2, which helps process the estradiol part of this combo pill. In theory, slowing that enzyme could let estrogen levels drift a little higher, which might add to side effects like breast tenderness, headaches, nausea, bloating, or mood changes.
I want to be honest though: this is based only on test-tube and animal research, not real people, so it's very theoretical and may not happen at all. Food amounts are unlikely to matter, but concentrated supplements are less predictable. Since Myfembree already carries a clotting warning, please run peony by 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
ESTROGENS
2 of 3Relugolix, Estradiol, Norethindrone Acetate 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.
Myfembree is a combination pill that includes estradiol, a form of estrogen, along with relugolix and norethindrone. Here's the wrinkle with peony: lab and animal studies suggest peony has mild estrogen-like activity, meaning it can act a bit like estrogen in the body. In theory, layering concentrated peony supplements on top of the estrogen in Myfembree could add to estrogen-related effects.
What might that look like? Things like breast tenderness, bloating, headaches, mood changes, or spotting. I want to be honest though, this concern is theoretical and based only on test-tube and animal research, not real patient cases. Everyday culinary or small herbal amounts are unlikely to matter, but if you're using strong peony supplements, please check with your pharmacist or doctor first.
- 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
3 of 3Relugolix, Estradiol, Norethindrone Acetate 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.
Myfembree is a combination pill (relugolix with estradiol and norethindrone) used for heavy periods from fibroids or for endometriosis pain. The relugolix part is broken down in your body partly by an enzyme called CYP3A4. Peony has shown, in lab dish studies only, a mild ability to slow that enzyme down. In theory, that could let a little more of the drug build up.
What that might look like in real life: slightly stronger side effects such as hot flashes, headaches, mood changes, or spotting. I want to be honest though, this is based purely on test-tube research and has never been seen in people, so it's a low-level concern. Don't change anything on your own. Just mention the peony to your pharmacist or doctor so they can keep an eye on you.
- 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 Relugolix, Estradiol, Norethindrone Acetate 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 Relugolix, Estradiol, Norethindrone Acetate
This page covers Peony only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Relugolix, Estradiol, Norethindrone Acetate page lists 219 supplements it has a documented interaction with, worst first, each one explained.
The most serious there right now: Activated Charcoal (major), American Hellebore (major), Arsenic (major), Cesium (major) and Ephedra (major).
By severity: 8 major · 174 moderate · 37 minor.
From our pharmacist’s overview on the Relugolix, Estradiol, Norethindrone Acetate page
“Grapefruit is where I would start on this page. Myfembree (relugolix, estradiol, and norethindrone acetate) depends on the CYP3A4 enzyme to be cleared, and grapefruit juice blocks that enzyme, raising drug levels and side effect risk.”
Reviewed by 2 · Jul 18, 2026
Open the Relugolix, Estradiol, Norethindrone Acetate interaction page
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 Relugolix, Estradiol, Norethindrone Acetate 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 Relugolix, Estradiol, Norethindrone Acetate 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.
#213 of 1,452 supplements looked up here in the last 7 days
#1,159 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.
About Relugolix, Estradiol, and Norethindrone
What Is Relugolix, Estradiol, and Norethindrone Used For?
Brand name: Myfembree
Myfembree is approved for two conditions in premenopausal women: managing heavy menstrual bleeding caused by uterine fibroids (non-cancerous growths in the uterus), and managing moderate to severe pain caused by endometriosis (a condition where tissue similar to the uterine lining grows outside the uterus).
Treatment with Myfembree should not exceed 24 months because of the risk of ongoing bone loss that may not fully reverse after stopping the medication.
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 ›
- Hydroxyurea ›
- Valacyclovir ›
- Tirzepatide ›
- Methamphetamine ›
- Semaglutide ›
- Sumatriptan ›
- Lisdexamfetamine ›
- Metformin ›
- Lisinopril ›
- Amoxicillin ›
- Bupropion ›
- Acyclovir ›
- Methotrexate ›
- Doxycycline ›
- Fluoxetine ›
- Amphetamine ›
- Pregabalin ›
- Lamotrigine ›
- Azithromycin ›
- Gabapentin ›
- Isotretinoin ›
- Dextroamphetamine ›
- Methylene Blue ›
- Duloxetine ›
- Ciprofloxacin ›
- Bisoprolol ›
- Levothyroxine, Liothyronine ›
- Candesartan Cilexetil ›
- Cephalexin ›
- Cyclopentolate ›
- Acetaminophen, Dextromethorphan, Doxylamine ›
- Roxithromycin ›
- Mannitol ›
- Levetiracetam ›
- Pegunigalsidase Alfa-iwxj ›
- Ezetimibe ›
- Levothyroxine Sodium ›
- Daptomycin ›
- Amoxicillin, Clavulanate Potassium ›
- Dexmethylphenidate ›
- Mitomycin ›
- Valsartan ›
- Spironolactone ›
- Hexobarbitone ›
- Thyroid Hormone ›
- Phentermine, Topiramate ›
- Carbidopa, Levodopa ›
- Factor 7a ›
- Levodopa ›
- Minoxidil ›
- Cefaclor ›
- Hethylphenidate Hcl ›
- Venlafaxine ›
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
Relugolix, Estradiol, Norethindrone Acetate Is Linked to Lower Levels of 5 Nutrients
Natural Medicines records Relugolix, Estradiol, Norethindrone Acetate 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 Relugolix, Estradiol, Norethindrone Acetate 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 Relugolix, Estradiol, Norethindrone Acetate Together: Common Questions
Can you take Peony with Relugolix, Estradiol, Norethindrone Acetate?
Why are there 3 interactions listed for Peony and Relugolix, Estradiol, Norethindrone Acetate?
How serious is the Peony and Relugolix, Estradiol, Norethindrone Acetate 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.