Drug & supplement interaction

Puravive + Bosentan

Bosentan brand name: Tracleer.

Moderate Interaction
Medically reviewed by · Updated February 2024
The bottom line Moderate

Bosentan falls into 4 drug categories that Puravive can interact with; the most serious is rated moderate. Puravive contains quercetin, which has been shown in studies to mildly inhibit the CYP2C9 metabolizing enzyme.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions4
EvidenceC
What do Severity, Likelihood & Evidence mean?
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Interaction report

Puravive and Bosentan

These two interact in 4 distinct ways. Each one is explained separately below.

Why Are There 4 Interactions?

Puravive interacts with whole categories of medication. Bosentan falls into 4 of those categories, so it can interact with Puravive in 4 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

Cytochrome P450 2C9 (Cyp2C9) Substrates

1 of 4

Why this applies to Bosentan

Bosentan falls under Cytochrome P450 2C9 (Cyp2C9) Substrates — the group Puravive interacts with.

Puravive contains quercetin, which has been shown in studies to mildly inhibit the CYP2C9 metabolizing enzyme. This inhibition could potentially increase the risk of side effects from drugs. A small clinical trial with healthy volunteers found that taking 500 mg of quercetin twice daily for 10 days before using diclofenac, a drug metabolized by CYP2C9, increased diclofenac plasma levels by 75% and extended its half-life by 32.5% (source: https://pubmed.ncbi.nlm.nih.gov/29168292/). Combining quercetin with drugs metabolized by CYP2C9 could increase the risk of side effects, so caution is advised.
Severity Moderate Likelihood Possible Evidence C

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 simple version. Your body uses an enzyme called CYP2C9 to help break down and clear bosentan from your system. Puravive contains quercetin, which can mildly slow that same enzyme down. When the enzyme works slower, bosentan can clear out a little less efficiently, so more of it may linger in your blood. With bosentan that could mean a bigger chance of its usual side effects, like headache, flushing, swelling in your legs or ankles, low blood pressure, or feeling unusually tired.

I want to be honest about the strength of this: the evidence comes from a quercetin study using a different drug, so it's a possible concern rather than a proven one. Concentrated supplement doses matter more than food amounts. Since bosentan needs regular liver monitoring anyway, please check with your pharmacist or doctor before pairing these.

Contact Dr. Brian directly if you have additional questions on this interaction
Minor

Cytochrome P450 3A4 (Cyp3A4) Substrates

2 of 4

Bosentan also falls under Cytochrome P450 3A4 (Cyp3A4) Substrates.

Puravive contains Panax ginseng. Panax ginseng has the potential to affect the breakdown of drugs that are metabolized by an enzyme called CYP3A4. One example of such a drug is imatinib. There was a case where imatinib was thought to have caused liver damage, and it was believed that this might have been due to Panax ginseng inhibiting CYP3A4, which is involved in imatinib's metabolism (https://pubmed.ncbi.nlm.nih.gov/20332334/). On the other hand, Panax ginseng has been found to increase the breakdown of another drug called midazolam, which is also metabolized by CYP3A4 (https://pubmed.ncbi.nlm.nih.gov/21646440/), suggesting Panax ginseng induces CYP3A4 in some cases (i.e., makes more potent). Given these contradictory findings, it is important to use Panax ginseng cautiously if you are taking medications that are metabolized by CYP3A4, as the interaction between Panax ginseng and these drugs is not fully understood.
Severity Minor 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 honest picture: Puravive contains Panax ginseng, which can nudge a liver enzyme called CYP3A4. Your bosentan (Tracleer) is partly cleared by that same enzyme. The tricky part is that ginseng has shown mixed results in studies, sometimes slowing this enzyme and sometimes speeding it up, so we can't say with confidence which way things would tip for bosentan.

If ginseng slowed clearance, bosentan could build up and you might notice more flushing, headache, swelling in the legs, or low blood pressure. If it sped clearance up, bosentan might work less well at controlling your lung pressure. Both directions are theoretical and rated minor, but since PAH is serious, please run Puravive past your pharmacist or doctor before starting it.

Contact Dr. Brian directly if you have additional questions on this interaction
Minor

Antihypertensive Drugs

3 of 4

Bosentan also falls under Antihypertensive Drugs.

Puravive contains quercetin, which has been found to slightly reduce blood pressure in individuals with mild hypertension (https://pubmed.ncbi.nlm.nih.gov/17951477/). There is a theoretical possibility that it could enhance the blood pressure-lowering effects of antihypertensive medications.
Severity Minor Likelihood Possible Evidence C

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 simple version. One ingredient in Puravive, called quercetin, has shown a mild blood pressure lowering effect in a small study of people with mild hypertension. Since Bosentan can also relax blood vessels as part of treating the high pressure in your lung arteries, there is a theoretical chance the two together could nudge your blood pressure down a little more than expected.

If that happened, you might feel lightheaded, dizzy, or unusually tired, especially when standing up. To be honest, this is a weak, possible interaction based on limited evidence, not something proven with Bosentan specifically. Still, before adding Puravive, check with your pharmacist or doctor, since people on Bosentan are already being watched closely.

Contact Dr. Brian directly if you have additional questions on this interaction
Minor

Organic Anion-Transporting Polypeptide Substrates (Oatp)

4 of 4

Bosentan also falls under Organic Anion-Transporting Polypeptide Substrates (Oatp).

Puravive contains quercetin. The simultaneous use of quercetin and OATP substrates (the drug in question in this interaction is reported to be an OATP substrate) may theoretically enhance their effects and adverse effects. In vitro studies indicate that quercetin can inhibit the uptake of estrone-3-sulfate and pravastatin, which are transported by OATP 1B1. Clinical research in healthy males demonstrates that co-administration of quercetin and pravastatin increases the area under the curve (AUC) of pravastatin by 24%, prolongs its half-life by 14%, and reduces its apparent clearance by 18% (source: https://pubmed.ncbi.nlm.nih.gov/22114872/). Overall, quercetin may increase the risk of side effects of drugs that are OATP substrates when taken together.
Severity Minor Likelihood Possible Evidence C

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 Bosentan (Tracleer). One ingredient in Puravive, quercetin, can mildly slow down a transporter called OATP that helps move bosentan into the liver. If that uptake is blocked a bit, slightly more bosentan can hang around in your bloodstream, which could nudge up its usual side effects, things like headache, flushing, swelling in the legs or feet, or a bit more fatigue.

Honestly, this is a minor, mostly theoretical concern based on lab data and a small study using a different drug, not bosentan itself. Bosentan is not a prodrug, so it isn't weakened here. Food amounts of quercetin almost certainly don't matter, but a concentrated supplement is worth mentioning. Since bosentan is closely monitored, just run Puravive by your pharmacist or doctor first.

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

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

Puravive Also Interacts With Other Medications

Puravive has 356 moderate, 881 minor known drug interactions in our database — the Bosentan one above is among them. If you take anything else, check it against the full list below.

Moderate 356 Minor 881 No known interaction 1,593 (incl. Bosentan)
Taking anything else?

Check Another of Your Medications Against Puravive

Covers the 2,830 medications we’ve checked against Puravive. Pick one to open its full report.

From our Q&A

Questions About Puravive or Bosentan

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Puravive or Bosentan, 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 Bosentan

This page covers Puravive only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Bosentan page lists 266 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), Apple (major) and Beer (major).

By severity: 11 major · 216 moderate · 39 minor.

Open the Bosentan interaction page

How much people look this up

Where Puravive and Bosentan 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 Puravive
Top half

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

29 days ago today
Medication Bosentan
Steady interest

#1,462 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 Puravive

What is Puravive?

Puravive
  • Weight management
  • Metabolism support
  • Energy levels
  • General wellness
  • Stress and brain health

Puravive is a branded, multi-ingredient capsule marketed mainly for weight loss by claiming to boost brown fat activity, but there is no published, independent clinical research showing the product itself works for this purpose. Some individual ingredients have been studied in laboratory or small human studies, but those results do not prove the finished blend is safe or effective. Talk to a pharmacist or doctor before trying it, especially if you have health conditions or take medications.

Read the full Puravive monograph & all interactions
Medication

About Bosentan

What Is Bosentan Used For?

Brand name: Tracleer

Bosentan is used to treat pulmonary arterial hypertension (PAH) — high blood pressure in the arteries of the lungs. In adults, it helps improve the ability to exercise and slows how quickly the disease gets worse.

In children aged 3 years and older with idiopathic (no known cause) or congenital (present from birth) PAH, bosentan is used to lower resistance in the lung blood vessels, which is expected to improve exercise ability. Tracleer is one brand approved for both adults and pediatric patients with PAH.

See full Bosentan drug information
Keep checking

Other Drugs & Puravive

Browse every other medication we’ve checked against Puravive — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
356Moderate
881Minor
1,592No known interaction
356 Moderate 881 Minor 1,592 No interaction
Moderate

356 interactions

Showing 60 of 356 moderate interactions — see all 356 on the Puravive page.

Minor

881 interactions

Showing 60 of 881 minor interactions — see all 881 on the Puravive page.

No interaction 1,592 drugs checked — show the list

We also checked Puravive against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 1,592 medications checked with no known interaction — see the full Puravive list.

See the full Puravive interactions page
See every supplement checked against Bosentan, 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
Puravive monograph › Uses, safety, and every drug interaction in one place Bosentan supplement interactions › Every supplement checked against Bosentan, ranked by severity Bosentan 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 Puravive and Bosentan Together: Common Questions

Can you take Puravive with Bosentan?
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 4 interactions listed for Puravive and Bosentan?
Bosentan belongs to more than one drug category, and Puravive 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 Puravive and Bosentan 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

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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.