Drug & supplement interaction

Rauvolfia Vomitoria + Amitriptyline, Perphenazine

Amitriptyline, Perphenazine brand names: Triavil, Etrafon, Etrafon-A, Etrafon-Forte.

Major Interaction
Medically reviewed by · Updated September 2026
The bottom line Major

Amitriptyline, Perphenazine falls into 4 drug categories that Rauvolfia Vomitoria can interact with; the most serious is rated major. Theoretically, concomitant use might increase the risk of adverse effects.

Read the full interaction report
SeverityMajor
LikelihoodProbable
Interactions4
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Rauvolfia Vomitoria and Amitriptyline, Perphenazine

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

Why Are There 4 Interactions?

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

Major

ANTIPSYCHOTIC DRUGS

1 of 4

Why this applies to Amitriptyline, Perphenazine

Amitriptyline, Perphenazine falls under ANTIPSYCHOTIC DRUGS — the group Rauvolfia Vomitoria interacts with.

Theoretically, concomitant use might increase the risk of adverse effects.
Concomitant use of neuroleptics with Rauvolfia vomitoria may potentiate the effects of these drugs and the rauwolfia alkaloids.
Severity Major Likelihood Probable Evidence D

Interaction 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..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

This combination pill pairs amitriptyline (an older antidepressant) with perphenazine (an antipsychotic). The perphenazine part is the piece that overlaps with Rauvolfia vomitoria. Both this herb's alkaloids (like reserpine) and perphenazine dial down the same brain chemicals and can lower blood pressure, so stacking them may push those effects too far. The concern here is mostly theoretical, based on how the drugs work rather than firm studies, but the potential is taken seriously.

In real life, that could mean stronger drowsiness, dizziness, lightheadedness when you stand up, very low blood pressure, or a worsening of mood. Please don't start or stop anything on your own. Run this past your pharmacist or doctor first so they can weigh it safely for you.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.
  2. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
Moderate

CNS DEPRESSANTS

2 of 4

Amitriptyline, Perphenazine also falls under CNS DEPRESSANTS.

Theoretically, taking Rauvolfia vomitoria might cause additive sedative effects.
Rauvolfia vomitoria has sedative effects in animal research.
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

Triavil combines two medicines that already make many people drowsy: amitriptyline (a sedating antidepressant) and perphenazine (an antipsychotic). Rauvolfia vomitoria has its own calming, sedative-type effects in lab and animal studies. Put them together and the worry is simply that the sleepiness could stack up, leaving you more groggy, foggy, dizzy, or off-balance than usual.

I'll be honest with you: this concern is theoretical, based on how these things work rather than strong human studies, so don't panic if you've taken both. Still, both contain real blood-pressure and nervous-system actions, so it's worth a quick chat. Please check with your pharmacist or doctor before pairing them, and don't change your Triavil on your own.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Ekong MB, Peter AI, Edagha IA, et al. Rauwolfia vomitoria inhibits olfaction and modifies olfactory bulb cells. Brain Res Bull 2016;124:206-13. PubMed
  2. Amole OO, Yemitan OK, Oshikoya KA. Anticonvulsant activity of Rauvol?a Vomitoria (Afzel). Afr J Pharmacy Pharmacol 2009;3:319-322.
  3. Campbell JI, Mortensen A, Mølgaard P. Tissue lipid lowering-effect of a traditional Nigerian anti-diabetic infusion of Rauwolfia vomitoria foilage and Citrus aurantium fruit. J Ethnopharmacol 2006;104:379-86. PubMed
Moderate

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES

3 of 4

Amitriptyline, Perphenazine also falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES.

Theoretically, Rauvolfia vomitoria might increase the levels and clinical effects of CYP2D6 substrates.
Rauvolfia vomitoria contains small amounts of the drug yohimbine. In vitro research shows that yohimbine inhibits CYP2D6 enzyme activity.
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

This combination pill pairs amitriptyline (a tricyclic antidepressant) with perphenazine (an antipsychotic). Both of these are cleared from your body in part by a liver enzyme called CYP2D6. Rauvolfia vomitoria contains a little yohimbine, and lab studies suggest yohimbine can slow that same enzyme down. If CYP2D6 is blocked, these two drugs could clear more slowly and build up.

If levels climb, you might notice more of their usual side effects: heavy drowsiness, dry mouth, constipation, blurred vision, dizziness on standing, fast or irregular heartbeat, or muscle stiffness. Keep in mind this is based only on lab data, not human studies, so it's theoretical. Still, please talk with your pharmacist or doctor before mixing these, since reserpine itself also affects mood and blood pressure.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. VandenBrink, B. M., Foti, R. S., Rock, D. A., Wienkers, L. C., and Wahlstrom, J. L. Prediction of CYP2D6 drug interactions from in vitro data: evidence for substrate-dependent inhibition. Drug Metab Dispos. 2012;40(1):47-53. PubMed
Moderate

TRICYCLIC ANTIDEPRESSANTS (TCAs)

4 of 4

Amitriptyline, Perphenazine also falls under TRICYCLIC ANTIDEPRESSANTS (TCAs).

Theoretically, concomitant use might alter the effects of Rauvolfia vomitoria and increase the risk for adverse effects.
A small clinical study in patients taking TCAs for at least 4 weeks shows that receiving doses of intravenous yohimbine, a constituent of Rauvolfia vomitoria, 2.5-20 mg daily for up to 7 days precipitates severe anxiety, agitation, and tremor. Also, concomitant use of TCAs with Rauvolfia vomitoria may decrease the effects of rauwolfia alkaloids.
Severity Moderate Likelihood Probable Evidence D

Interaction 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..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Your medicine combines amitriptyline (a tricyclic antidepressant) with perphenazine (an antipsychotic). The concern here is mostly about one piece of Rauvolfia vomitoria called yohimbine. In a small study, people already taking tricyclics who got yohimbine ran into severe anxiety, agitation, and tremor. Since you're on a tricyclic, that's worth taking seriously, even though this is based more on theory and limited data than strong proof.

There's also a flip side: combining these can blunt the blood pressure lowering effect the rauwolfia alkaloids are known for. Bottom line, this is a potent plant, not a casual supplement. Please don't start it without checking with your doctor or pharmacist first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. McEvoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.
  2. Schmauss M, Laakmann G, Dieterle D. Effects of alpha 2-receptor blockade in addition to tricyclic antidepressants in therapy-resistant depression. J Clin Psychopharmacol. 1988;8(2):108-11.

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

Rauvolfia Vomitoria Also Interacts With Other Medications

Rauvolfia Vomitoria has 229 major, 523 moderate, 87 minor known drug interactions in our database — the Amitriptyline, Perphenazine one above is among them. If you take anything else, check it against the full list below.

Major 229 Moderate 523 Minor 87 No known interaction 1,991 (incl. Amitriptyline, Perphenazine)
Taking anything else?

Check Another of Your Medications Against Rauvolfia Vomitoria

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

Everything else you take

See Every Supplement That Interacts With Amitriptyline, Perphenazine

This page covers Rauvolfia Vomitoria only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Amitriptyline, Perphenazine page lists 311 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: 1,4-butanediol (major), Activated Charcoal (major), American Hellebore (major), Arsenic (major) and Beer (major).

By severity: 19 major · 235 moderate · 57 minor.

From our pharmacist’s overview on the Amitriptyline, Perphenazine page

“Alcohol is the risk I'd flag first for anyone taking amitriptyline with perphenazine (Triavil, Etrafon). Beer and wine both carry major ratings here, and 78 of the 311 ingredients on file deepen the drowsiness this antidepressant and antipsychotic combination already causes, sometimes to the point of slowed breathing.”

Reviewed by 2 · Jul 18, 2026

Open the Amitriptyline, Perphenazine interaction page

One more smart check

Taking Rauvolfia Vomitoria as Part of a Dietary Supplement Product? Check It for Interactions

We hold 17 real supplement products containing Rauvolfia Vomitoria, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Rauvolfia Vomitoria. Your product may carry other ingredients that interact with Amitriptyline, Perphenazine too, on top of Rauvolfia Vomitoria — 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 Rauvolfia Vomitoria and Amitriptyline, Perphenazine 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 Rauvolfia Vomitoria
Steady interest

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

29 days ago today
Medication Amitriptyline, Perphenazine
Top half

#1,070 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 Rauvolfia Vomitoria

What is Rauvolfia Vomitoria?

  • High blood pressure
  • Anxiety and agitation
  • Sleep problems
  • Mental health symptoms (traditional use)
  • Fever and general ailments

Rauvolfia vomitoria is an African shrub whose root contains powerful alkaloids, including reserpine, that have historically been used for high blood pressure and agitation. Because these compounds can strongly affect blood pressure, mood, and the nervous system, the plant can cause serious side effects and is not a casual supplement. Always talk to a doctor or pharmacist before using it.

Read the full Rauvolfia Vomitoria monograph & all interactions
Keep checking

Other Drugs & Rauvolfia Vomitoria

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

229Major
523Moderate
87Minor
1,990No known interaction
229 Major 523 Moderate 87 Minor 1,990 No interaction
Major

229 interactions

Showing 60 of 229 major interactions — see all 229 on the Rauvolfia Vomitoria page.

Moderate

523 interactions

Showing 60 of 523 moderate interactions — see all 523 on the Rauvolfia Vomitoria page.

Minor

87 interactions

Showing 60 of 87 minor interactions — see all 87 on the Rauvolfia Vomitoria page.

No interaction 1,990 drugs checked — show the list

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

Showing the 60 most looked-up of 1,990 medications checked with no known interaction — see the full Rauvolfia Vomitoria list.

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

Can you take Rauvolfia Vomitoria with Amitriptyline, Perphenazine?
This is rated a major interaction, so the combination is best avoided unless your doctor or pharmacist has specifically told you otherwise. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 4 interactions listed for Rauvolfia Vomitoria and Amitriptyline, Perphenazine?
Amitriptyline, Perphenazine belongs to more than one drug category, and Rauvolfia Vomitoria 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 Rauvolfia Vomitoria and Amitriptyline, Perphenazine interaction?
We rate it Major. This is a clinically significant combination that is generally best avoided, or used only under the direct supervision of your physician or pharmacist.

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.