Drug & supplement interaction

Peony + Verapamil

Verapamil brand names: Isoptin SR, Verelan, Isoptin, Calan SR, Verelan SR, and others.

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

Verapamil falls into 2 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
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Peony and Verapamil

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Peony interacts with whole categories of medication. Verapamil falls into 2 of those categories, so it can interact with Peony in 2 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 2

Why this applies to Verapamil

Verapamil 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

Here's the gist for verapamil: peony root may gently slow down some of the liver enzymes (like CYP1A2 and CYP3A4) that help clear this medication. If your body breaks verapamil down more slowly, a little more of it can linger in your system. Verapamil isn't a prodrug, so more drug means a stronger effect, which could show up as extra blood pressure lowering, dizziness, lightheadedness, a slower heartbeat, fatigue, or constipation.

That said, this concern comes only from lab studies, not from real people, so it's theoretical at this point. I wouldn't lose sleep over it, but since verapamil affects your heart rhythm, it's worth a quick chat with your pharmacist or doctor before adding peony, especially as a concentrated supplement.

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 2

Verapamil 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

Your body uses an enzyme called CYP3A4 to break down verapamil. Lab and animal studies hint that peony may slow that enzyme a bit. If that happened in real life, verapamil could clear out more slowly and build up in your system, which means a stronger effect than expected. With verapamil, that might show up as feeling dizzy or lightheaded, a slower heartbeat, very low blood pressure, swollen ankles, or constipation.

The good news: this is only a theoretical concern based on test-tube work, not something proven in people, and the blocking effect looks weak. Still, since verapamil affects your heart rate and blood pressure, it is worth a quick chat with your pharmacist or doctor before adding peony. Don't change your verapamil on your own.

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 Verapamil one above is among them. If you take anything else, check it against the full list below.

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

From our Q&A

Questions About Peony or Verapamil

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Peony or Verapamil, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Verapamil

This page covers Peony only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Verapamil page lists 295 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), American Mistletoe (major), Beer (major) and Coleus (major).

By severity: 10 major · 245 moderate · 40 minor.

From our pharmacist’s overview on the Verapamil page

“This is one of the longer interaction lists we publish, and with verapamil (Calan, Verelan) it warrants genuine care, starting with the ten major-rated entries. Verapamil lowers blood pressure and slows the heart, so most of the 295 ingredients on file either push that effect further than intended or change how much of the drug reaches…”

Reviewed by 2 · Jul 18, 2026

Open the Verapamil 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 Verapamil 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 Verapamil 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%

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

29 days ago today
Medication Verapamil
Top 25%

#579 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 Verapamil

What Is Verapamil Used For?

Brand names: Isoptin SR, Verelan, Isoptin, Calan SR, Verelan SR, Calan, Covera HS, Verap, Veramil

Verapamil is used for high blood pressure, angina and some fast heart rhythms. Which uses apply depends on the product.

Immediate-release verapamil tablets are used for angina, certain rhythm problems and high blood pressure. Extended-release tablets and capsules are used for high blood pressure. Verapamil injection is given in a medical setting for fast heart rhythms.

See full Verapamil 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 Verapamil, 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 Verapamil supplement interactions › Every supplement checked against Verapamil, ranked by severity Verapamil 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 Verapamil Together: Common Questions

Can you take Peony with Verapamil?
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 2 interactions listed for Peony and Verapamil?
Verapamil 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 Verapamil 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 Verapamil and Peony?

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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.