Drug & supplement interaction

Puravive + Nintedanib Esylate

Nintedanib Esylate brand name: Ofev.

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

Nintedanib Esylate falls into 3 drug categories that Puravive can interact with; the most serious is rated moderate. Puravive, a dietary supplement, contains several ingredients that may interact with anticoagulant drugs due to their potential mild anticoagulant effects.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions3
EvidenceC
What do Severity, Likelihood & Evidence mean?
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Interaction report

Puravive and Nintedanib Esylate

These two interact in 3 distinct ways. Each one is explained separately below.

Why Are There 3 Interactions?

Puravive interacts with whole categories of medication. Nintedanib Esylate falls into 3 of those categories, so it can interact with Puravive in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

Anticoagulant/Antiplatelet Drugs

1 of 3

Why this applies to Nintedanib Esylate

Nintedanib Esylate falls under Anticoagulant/Antiplatelet Drugs — the group Puravive interacts with.

Puravive, a dietary supplement, contains several ingredients that may interact with anticoagulant drugs due to their potential mild anticoagulant effects. These ingredients include Kudzu, Panax ginseng, Phellodendron, and Propolis. Ginsenosides in Panax ginseng may decrease platelet aggregation in lab studies, but human studies have not confirmed this effect. Animal studies suggest low oral bioavailability of certain compounds in ginseng, which could explain differences between lab and human research. Propolis water extract and caffeic acid phenethyl ester, found in propolis, have also been shown to inhibit platelet aggregation in lab studies. Additionally, in an animal model, propolis taken with warfarin reduced the effectiveness of warfarin, suggesting a potential interaction with anticoagulant drugs. Lastly, Phellodendron contains berberine, which studies show may inhibit platelet aggregation.
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 something many folks don't realize about Ofev (nintedanib): one of its known side effects is a small increase in bleeding risk, separate from how it's processed by your body. So this isn't about Puravive speeding up or slowing down how you clear the drug. It's about adding two things that can each nudge bleeding in the same direction.

Several Puravive ingredients (ginseng, propolis, phellodendron's berberine) have shown mild blood-thinning effects, mostly in lab dishes rather than confirmed in people, so this is a fairly weak, theoretical concern. Still, stacked on top of nintedanib, you'd want to watch for easy bruising, nosebleeds, bleeding gums, or cuts that are slow to stop. Please run this combination by your pharmacist or doctor before starting Puravive, especially since IPF and SSc-ILD are serious conditions.

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

Cytochrome P450 3A4 (Cyp3A4) Substrates

2 of 3

Nintedanib Esylate 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 situation with Ofev (nintedanib) and Puravive. The reason Puravive even comes up is that it contains Panax ginseng, which may tinker with CYP3A4, one of the enzymes that helps process nintedanib. The catch is that ginseng's effect on this enzyme is inconsistent in studies. In some cases it seemed to block the enzyme (which could let a drug build up), and in others it sped it up (which could weaken a drug). So we honestly can't predict which way it would push your nintedanib.

Good news is this is rated a minor, theoretical concern based on weak evidence. Still, nintedanib can already cause diarrhea, nausea, and liver enzyme changes, so before starting Puravive, run it by your pharmacist or your IPF specialist.

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

P-Glycoprotein Substrates

3 of 3

Nintedanib Esylate also falls under P-Glycoprotein Substrates.

Puravive contains quercetin. Theoretically, concurrent use of quercetin and P-glycoprotein substrates might alter the effects and adverse effects of the drugs. There is preliminary evidence suggesting that quercetin inhibits the P-glycoprotein efflux pump in the gastrointestinal tract. This inhibition could potentially increase the bioavailability and serum levels of drugs transported by this pump. For example, a small study in healthy volunteers found that pretreatment with quercetin increased bioavailability and plasma levels following a single dose of cyclosporine (Neoral, Sandimmune) (source: https://pubmed.ncbi.nlm.nih.gov/15581264/). However, other small studies have shown that quercetin might decrease the absorption of talinolol, another substrate of the gastrointestinal P-glycoprotein efflux pump. Interestingly, several days of quercetin treatment did not significantly affect the pharmacokinetics of saquinavir (Invirase) in another small study (source: https://pubmed.ncbi.nlm.nih.gov/16945047/). The reason for these discrepancies is not entirely clear. Until more is known, it is advisable to use quercetin cautiously in combination with P-glycoprotein substrates.
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 situation with Puravive and your Ofev (nintedanib). Puravive contains quercetin, which may block a gut transporter called P-glycoprotein. Nintedanib relies on that same pump, and it is an active drug, not a prodrug. So if quercetin slows the pump, a little more nintedanib could get absorbed into your bloodstream. That could nudge up its common side effects, mainly diarrhea, nausea, stomach upset, and changes in your liver tests.

I want to be honest about the evidence though. This interaction is mostly theoretical, and quercetin has acted inconsistently in studies, sometimes raising drug levels and sometimes lowering them. It's rated minor. Still, before adding Puravive, please run it by your pharmacist or pulmonary team so they can keep an eye on you.

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 Nintedanib Esylate 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. Nintedanib Esylate)
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 Nintedanib Esylate

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 Nintedanib Esylate, 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 Nintedanib Esylate

This page covers Puravive only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Nintedanib Esylate page lists 285 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Danshen (major), Grapefruit (major), Piracetam (major) and St. John's Wort (major).

By severity: 5 major · 240 moderate · 40 minor.

From our pharmacist’s overview on the Nintedanib Esylate page

“You take Ofev (nintedanib) to slow lung scarring, and this page deserves a careful read before any supplement joins it. Of the 285 ingredients here, the biggest cluster, over 200, can add to bleeding risk, a real concern since nintedanib itself can make you bleed more easily.”

Reviewed by 2 · Jul 18, 2026

Open the Nintedanib Esylate interaction page

How much people look this up

Where Puravive and Nintedanib Esylate 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

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

29 days ago today
Medication Nintedanib Esylate
Steady interest

#1,495 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 Nintedanib

What Is Nintedanib Used For?

Brand name: Ofev

Nintedanib capsules are approved for adults with idiopathic pulmonary fibrosis (IPF) — a chronic, progressive scarring of the lungs — and for adults with chronic fibrosing interstitial lung diseases (ILDs) with a progressive phenotype, meaning fibrosing lung diseases that continue to worsen over time despite treatment.

Nintedanib capsules (including Ofev) are also indicated to slow the rate of decline in lung function in adults with systemic sclerosis-associated interstitial lung disease (SSc-ILD), a lung complication of the autoimmune condition systemic sclerosis (scleroderma). Note that the Nintedanib esylate capsule product is approved for IPF and chronic fibrosing ILDs with a progressive phenotype, but SSc-ILD approval is carried by Ofev and other nintedanib capsule products — always confirm with your prescriber which product you have been prescribed.

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

Can you take Puravive with Nintedanib Esylate?
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 3 interactions listed for Puravive and Nintedanib Esylate?
Nintedanib Esylate 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 Nintedanib Esylate 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.