Drug & supplement interaction

Puravive + Romidepsin

Romidepsin brand name: Istodax.

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

Romidepsin falls into 3 drug categories that Puravive can interact with; the most serious is rated moderate. Puravive contains Panax ginseng. Panax ginseng is thought to have an additive effect with drugs that prolong the QT interval, potentially increasing the risk of ventricular arrhythmias.

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

Puravive and Romidepsin

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. Romidepsin 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

Qt Interval-Prolonging Drugs

1 of 3

Why this applies to Romidepsin

Romidepsin falls under Qt Interval-Prolonging Drugs — the group Puravive interacts with.

Puravive contains Panax ginseng. Panax ginseng is thought to have an additive effect with drugs that prolong the QT interval, potentially increasing the risk of ventricular arrhythmias. However, research findings on this matter are conflicting. Clinical studies indicate that short-term use of Panax ginseng can increase the QT interval (source: https://pubmed.ncbi.nlm.nih.gov/27240158/). However, no changes in the QT interval have been observed with prolonged use (source: https://pubmed.ncbi.nlm.nih.gov/11978148/).
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 connection worth knowing about. Romidepsin (Istodax) can stretch out the heart's electrical recovery time, something we call QT prolongation. Puravive contains Panax ginseng, which some short-term studies suggest may also lengthen the QT interval a little. Stacking two things that push in the same direction could, in theory, raise the chance of an irregular heartbeat.

I want to be honest about the evidence here: it's mixed. Some studies showed a small effect from ginseng, while longer use showed no change at all, so this is more of a caution than a sure thing. Still, since romidepsin is a serious cancer therapy with real heart-rhythm risks, please loop in your oncology team or pharmacist before adding Puravive. Don't change your romidepsin on your own.

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

Cytochrome P450 3A4 (Cyp3A4) Substrates

2 of 3

Romidepsin 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 deal with combining Puravive and your romidepsin (Istodax) infusions. Puravive contains Panax ginseng, and your liver uses an enzyme called CYP3A4 to help clear romidepsin from your body. The tricky part is that ginseng has pulled in both directions in studies, sometimes slowing this enzyme down and sometimes speeding it up, so we genuinely can't predict which way it would push your romidepsin levels.

If levels crept up, you could see more of the usual side effects like nausea, fatigue, low blood counts, or heart rhythm changes. If levels dropped, the treatment might work less well. The good news is this is rated a minor, possible interaction built on weak, conflicting evidence. Still, since romidepsin is serious chemotherapy, please run any supplement past your oncologist or pharmacist before starting it.

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

P-Glycoprotein Substrates

3 of 3

Romidepsin 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 gist: Puravive contains quercetin, and your romidepsin (Istodax) is carried around the body by a transporter pump called P-glycoprotein. In lab and small human studies, quercetin can block that pump. If it does, a bit more romidepsin could stay in your system than expected, which in theory might mean stronger side effects like nausea, fatigue, low blood counts, or changes on a heart tracing (EKG). Romidepsin is not a prodrug, so blocking the pump leans toward more drug effect, not less.

The honest truth is that this is mostly theoretical and rated minor, and the human studies are mixed. But since romidepsin is a serious chemotherapy given by infusion, please run any supplement past your oncology team or pharmacist before starting it.

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 Romidepsin 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. Romidepsin)
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 Romidepsin

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 Romidepsin, 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 Romidepsin

This page covers Puravive only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Romidepsin page lists 135 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: American Hellebore (major), Arsenic (major), Cesium (major), Ephedra (major) and Grapefruit (major).

By severity: 7 major · 100 moderate · 28 minor.

Open the Romidepsin interaction page

How much people look this up

Where Puravive and Romidepsin 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

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

29 days ago today
Medication Romidepsin
Steady interest

#2,273 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 Romidepsin Injection

What Is Romidepsin Injection Used For?

Brand name: Istodax

Romidepsin injection is approved to treat cutaneous T-cell lymphoma (CTCL) — a cancer that starts in white blood cells and primarily affects the skin — in adult patients who have already received at least one prior systemic (whole-body) therapy.

It is given intravenously (through a vein) in a clinical or infusion-center setting. It is not approved or recommended for peripheral T-cell lymphoma.

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

Can you take Puravive with Romidepsin?
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 Romidepsin?
Romidepsin 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 Romidepsin 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 Romidepsin and Puravive?

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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.