Drug & supplement interaction

Sage + Conjugated Estrogens, Medroxyprogesterone Acetate

Conjugated Estrogens, Medroxyprogesterone Acetate brand names: Prempro, Premplus.

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

Conjugated Estrogens, Medroxyprogesterone Acetate falls into 3 drug categories that Sage can interact with; the most serious is rated moderate. Theoretically, sage might increase levels of drugs transported by P-glycoprotein.

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

Sage and Conjugated Estrogens, Medroxyprogesterone Acetate

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

Why Are There 3 Interactions?

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

Moderate

P-GLYCOPROTEIN SUBSTRATES

1 of 3

Why this applies to Conjugated Estrogens, Medroxyprogesterone Acetate

Conjugated Estrogens, Medroxyprogesterone Acetate falls under P-GLYCOPROTEIN SUBSTRATES — the group Sage interacts with.

Theoretically, sage might increase levels of drugs transported by P-glycoprotein.
In vitro research suggests that common sage (Salvia officinalis) can inhibit the multi-drug transporter protein, P-glycoprotein. 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 with Prempro (the estrogen and progestin combo). In lab dish studies, sage seems to block a cellular pump called P-glycoprotein, which helps move certain medicines around and out of the body. If that pump slows down, a little more of a hormone medicine could theoretically stick around. That might mean slightly stronger hormone effects, like breast tenderness, bloating, nausea, headaches, or spotting.

The big caveat: this has only been seen in test tubes, never in real people, so it's very much theoretical. Everyday cooking amounts of sage are not a concern. Concentrated sage extracts or the essential oil are where I'd be more cautious. If you take those regularly, just mention it to your pharmacist or doctor so they can keep an eye on things.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Hellum, B. H. and Nilsen, O. G. In vitro inhibition of CYP3A4 metabolism and P-glycoprotein-mediated transport by trade herbal products. Basic Clin Pharmacol Toxicol. 2008;102(5):466-475.
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

2 of 3

Conjugated Estrogens, Medroxyprogesterone Acetate also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.

Theoretically, sage might increase the levels and clinical effects of drugs metabolized by CYP3A4.
In vitro evidence suggests that aqueous extracts of sage can inhibit CYP3A4. So far, this interaction 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 with Prempro (conjugated estrogens plus medroxyprogesterone). Your body uses a liver enzyme called CYP3A4 to help clear these hormones. In test-tube studies, sage appears to slow that enzyme down a bit. If that happened in real life, hormone levels could nudge upward, which in theory might mean more estrogen-related effects like breast tenderness, bloating, nausea, headaches, or spotting.

I want to be honest about how shaky this is. The evidence is lab-only, and this has never actually been reported in people. Cooking with sage almost certainly won't matter. Concentrated sage extracts or the essential oil are where I'd be a little more careful. If you're using a daily sage supplement, just run it by your pharmacist or doctor so they can keep an eye on things.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Foster BC, Vandenhoek S, Hana J, et al. In vitro inhibition of human cytochrome P450-mediated metabolism of marker substrates by natural products. Phytomedicine 2003;10:334-42.. PubMed
  2. Hellum, B. H. and Nilsen, O. G. In vitro inhibition of CYP3A4 metabolism and P-glycoprotein-mediated transport by trade herbal products. Basic Clin Pharmacol Toxicol. 2008;102(5):466-475.
Moderate

ESTROGENS

3 of 3

Conjugated Estrogens, Medroxyprogesterone Acetate also falls under ESTROGENS.

Theoretically, sage might interfere with hormone therapy.
In vitro evidence suggests that geraniol, a constituent of Spanish sage (Salvia lavandulaefolia), exerts estrogenic activity. The clinical significance of this effect is unclear.
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 honest picture with Prempro, which combines conjugated estrogens with the progestin medroxyprogesterone. The concern is purely theoretical. In lab dish studies, a compound called geraniol found in Spanish sage showed mild estrogen-like activity. The idea is that sage could, in theory, add a little to the estrogen signal your hormone therapy already provides. We have no human data showing this actually happens, so I wouldn't lose sleep over it.

The amount of sage you'd use in cooking is very unlikely to matter at all. Concentrated sage extracts or essential oil taken daily are where I'd be more cautious. If you take Prempro and want to use sage regularly, just run it by your pharmacist or doctor first so it fits your situation.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Perry, N. S., Houghton, P. J., Sampson, J., Theobald, A. E., Hart, S., Lis-Balchin, M., Hoult, J. R., Evans, P., Jenner, P., Milligan, S., and Perry, E. K. In-vitro activity of S. lavandulaefolia (Spanish sage) relevant to treatment of Alzheimer's diseas

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

Sage Also Interacts With Other Medications

Sage has 1,295 moderate known drug interactions in our database — the Conjugated Estrogens, Medroxyprogesterone Acetate one above is among them. If you take anything else, check it against the full list below.

Moderate 1,295 No known interaction 1,535 (incl. Conjugated Estrogens, Medroxyprogesterone Acetate)
Taking anything else?

Check Another of Your Medications Against Sage

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

Everything else you take

See Every Supplement That Interacts With Conjugated Estrogens, Medroxyprogesterone Acetate

This page covers Sage only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Conjugated Estrogens, Medroxyprogesterone Acetate page lists 187 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Grapefruit (major), St. John's Wort (major), Acacia Rigidula (moderate) and Adrafinil (moderate).

By severity: 3 major · 152 moderate · 32 minor.

From our pharmacist’s overview on the Conjugated Estrogens, Medroxyprogesterone Acetate page

“St. John's wort tops my list of concerns for anyone on Prempro (conjugated estrogens plus medroxyprogesterone), the combination hormone therapy for menopause symptoms.”

Reviewed by 2 · Jul 18, 2026

Open the Conjugated Estrogens, Medroxyprogesterone Acetate interaction page

One more smart check

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

We hold 718 real supplement products containing Sage, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Sage. Your product may carry other ingredients that interact with Conjugated Estrogens, Medroxyprogesterone Acetate too, on top of Sage — 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 Sage and Conjugated Estrogens, Medroxyprogesterone Acetate 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 Sage
Top 25%

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

29 days ago today
Medication Conjugated Estrogens, Medroxyprogesterone Acetate
Top half

#893 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 Sage

What is Sage?

Sage
  • Sore throat and mouth irritation
  • Digestive upset
  • Excessive sweating
  • Memory and thinking
  • Menopause symptoms (hot flashes)
  • General antioxidant support

Sage is a common kitchen herb that is generally safe in food amounts and is traditionally used for sore throats, digestion, sweating, and memory. Some early research is encouraging for sore throat and menopausal hot flashes, but most uses are not well proven. Concentrated extracts and the essential oil should be used carefully because high doses contain a compound called thujone, which can be harmful.

Read the full Sage monograph & all interactions
Keep checking

Other Drugs & Sage

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

0Major
1,295Moderate
0Minor
1,534No known interaction
1,295 Moderate 1,534 No interaction
Moderate

1,295 interactions

Showing 60 of 1,295 moderate interactions — see all 1,295 on the Sage page.

No interaction 1,534 drugs checked — show the list

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

Showing the 60 most looked-up of 1,534 medications checked with no known interaction — see the full Sage list.

See the full Sage interactions page
See every supplement checked against Conjugated Estrogens, Medroxyprogesterone Acetate, 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
Sage monograph › Uses, safety, and every drug interaction in one place Conjugated Estrogens, Medroxyprogesterone Acetate supplement interactions › Every supplement checked against Conjugated Estrogens, Medroxyprogesterone Acetate, 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 Sage and Conjugated Estrogens, Medroxyprogesterone Acetate Together: Common Questions

Can you take Sage with Conjugated Estrogens, Medroxyprogesterone Acetate?
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 Sage and Conjugated Estrogens, Medroxyprogesterone Acetate?
Conjugated Estrogens, Medroxyprogesterone Acetate belongs to more than one drug category, and Sage 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 Sage and Conjugated Estrogens, Medroxyprogesterone Acetate 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.