Sage + Ethinyl Estradiol, Ethynodiol Diacetate
Ethinyl Estradiol, Ethynodiol Diacetate brand names: Demulen 1/35, Zovia 1/35, Demulen Compack, Demulen 1/50, Zovia 1/50, and others.
Ethinyl Estradiol, Ethynodiol Diacetate 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 reportSage and Ethinyl Estradiol, Ethynodiol Diacetate
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. Ethinyl Estradiol, Ethynodiol Diacetate 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).
P-GLYCOPROTEIN SUBSTRATES
1 of 3Why this applies to Ethinyl Estradiol, Ethynodiol Diacetate
Ethinyl Estradiol, Ethynodiol Diacetate falls under P-GLYCOPROTEIN SUBSTRATES — the group Sage interacts with.
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.
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.
Here's the situation with your birth control pill (a combination of ethinyl estradiol and ethynodiol diacetate) and sage. In lab dish studies, sage appears to slow down a cellular pump called P-glycoprotein, which helps move certain medicines in and out of your body. The thinking is that if this pump is blocked, slightly more of the hormone could stay in your system. In theory, that might mean a touch more of the usual estrogen-related effects, like nausea, breast tenderness, bloating, or headache.
I want to be honest though: this has only been seen in a test tube, never in real people, so it's mostly theoretical. Everyday cooking amounts of sage are very unlikely to matter. If you're using concentrated sage extracts or the essential oil regularly, just give your pharmacist or doctor a quick heads-up so they can keep an eye on things.
- 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.
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
2 of 3Ethinyl Estradiol, Ethynodiol Diacetate also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
In vitro evidence suggests that aqueous extracts of sage can inhibit CYP3A4. So far, this interaction has not been reported in humans.
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.
Your birth control pill, with ethinyl estradiol and ethynodiol diacetate, gets processed in your body partly by a liver enzyme called CYP3A4. In lab studies, water-based sage extracts seemed to slow this enzyme down a bit. If that happened in a person, estrogen levels could nudge upward, which might mean more of the usual estrogen-related effects like nausea, breast tenderness, bloating, or headaches.
Here is the reassuring part: this is only a test tube finding, and it has never actually been reported in real people. Everyday cooking amounts of sage are very unlikely to matter at all. If you are regularly using concentrated sage extracts or the essential oil, just give your pharmacist or doctor a heads-up so they can keep an eye on things.
- 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
- 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.
ESTROGENS
3 of 3Ethinyl Estradiol, Ethynodiol Diacetate also falls under ESTROGENS.
In vitro evidence suggests that geraniol, a constituent of Spanish sage (Salvia lavandulaefolia), exerts estrogenic activity. The clinical significance of this effect is unclear.
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.
Your pill (Demulen, Zovia, Kelnor) is a combination birth control pill made of an estrogen and a progestin. The concern here with sage is very mild and mostly theoretical. In lab dishes, a compound found in Spanish sage called geraniol showed weak estrogen-like activity. That's a long way from proving anything happens in real people.
What this could theoretically mean is a small added estrogen-like nudge on top of your pill, but honestly, the evidence is too thin to predict any real effect on your cycle, breakthrough bleeding, or your pill's reliability. Sage used as a kitchen herb is not a worry at all. If you're thinking about concentrated sage extracts or capsules regularly, just run it by your pharmacist or doctor first.
- 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.
Clinically significant. Avoid the combination, or use only under close professional supervision.
Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.
Generally not serious. Be aware of it and mention it to your pharmacist.
- 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.
- 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.
Sage Also Interacts With Other Medications
Sage has 1,295 moderate known drug interactions in our database — the Ethinyl Estradiol, Ethynodiol Diacetate one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Sage
We haven’t checked that one against Sage yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Sage. Pick one to open its full report.
See Every Supplement That Interacts With Ethinyl Estradiol, Ethynodiol Diacetate
This page covers Sage only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ethinyl Estradiol, Ethynodiol Diacetate page lists 239 supplements it has a documented interaction with, worst first, each one explained.
The most serious there right now: Activated Charcoal (major), Beer (major), Grapefruit (major), Siberian Cocklebur (major) and St. John's Wort (major).
By severity: 6 major · 195 moderate · 38 minor.
From our pharmacist’s overview on the Ethinyl Estradiol, Ethynodiol Diacetate page
“The stakes here are pregnancy prevention, so I read this list with genuine seriousness. Ethinyl estradiol with ethynodiol diacetate (Zovia, Demulen, Kelnor) is a combined birth control pill, and the interactions that concern me most are the ones that can quietly weaken it.”
Reviewed by 2 · Jul 18, 2026
Open the Ethinyl Estradiol, Ethynodiol Diacetate interaction page
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 Ethinyl Estradiol, Ethynodiol Diacetate 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:
Where Sage and Ethinyl Estradiol, Ethynodiol Diacetate 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.
#253 of 1,452 supplements looked up here in the last 7 days
#1,513 of 2,830 medications looked up here in the last 7 days
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.
About Sage
What is 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.
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.
No drugs match “”.
1,295 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Nifedipine ›
- Ibuprofen ›
- Diphenhydramine ›
- Hydrocortisone ›
- Insulin (rdna) ›
- Naproxen ›
- Doxycycline ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Tetracycline ›
- Lidocaine ›
- Ranitidine ›
- Hydrochlorothiazide ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Flurazepam ›
- Glyburide ›
- Glycopyrrolate ›
- Insulin (pork) ›
- Triazolam ›
- Zopiclone ›
- Colchicine ›
- Fentanyl ›
- Flurbiprofen ›
- Oxybutynin ›
- Oxycodone ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Triamcinolone ›
- Apomorphine ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Doxorubicin ›
- Fluticasone ›
- Formoterol ›
- Hydralazine ›
- Indomethacin ›
- Insulin (human) ›
- Ipratropium ›
- Miconazole ›
- Morphine Sulfate ›
- Nitrazepam ›
- Procainamide ›
- Trimipramine ›
- Acetaminophen ›
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.
- Levothyroxine ›
- Methylphenidate ›
- Aspirin ›
- Rosuvastatin ›
- Escitalopram ›
- Docusate ›
- Valacyclovir ›
- Hydroxyurea ›
- Sumatriptan ›
- Amoxicillin ›
- Bupropion ›
- Bendamustine ›
- Acyclovir ›
- Methotrexate ›
- Azithromycin ›
- Isotretinoin ›
- Methylene Blue ›
- Ciprofloxacin ›
- Levothyroxine, Liothyronine ›
- Cephalexin ›
- Cyclopentolate ›
- Roxithromycin ›
- Pegunigalsidase Alfa-iwxj ›
- Ezetimibe ›
- Daptomycin ›
- Levothyroxine Sodium ›
- Dexmethylphenidate ›
- Mitomycin ›
- Amoxicillin, Clavulanate Potassium ›
- Hexobarbitone ›
- Thyroid Hormone ›
- Carbidopa, Levodopa ›
- Factor 7a ›
- Levodopa ›
- Hethylphenidate Hcl ›
- Lenvatinib ›
- Cefaclor ›
- Azelaic Acid ›
- Phenylephrine ›
- Hydroxychloroquine ›
- Tenecteplase ›
- Dirithromycin ›
- Vancomycin ›
- Pizotifen ›
- Triptorelin ›
- Bentoquatam ›
- Acetylsalicylic Acid ›
- Ribavirin Aerosol ›
- Dextrothyroxine ›
- Ropinirole ›
- Tocainide ›
- Rocuronium ›
- Mitomycin C ›
- Lomustine ›
- Digitoxin ›
- Salbutamol Sulfate ›
- Chenodiol ›
- Gestodene ›
- Desflurane ›
- Caspofungin ›
Showing the 60 most looked-up of 1,534 medications checked with no known interaction — see the full Sage list.
Sources & How We Checked
Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for vitamins, herbs and supplements — the basis for our interaction data.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for the medication overviews.
- NIH Dietary Supplement Label Database (DSLD) — Official supplement product labels.
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
Ethinyl Estradiol, Ethynodiol Diacetate Is Linked to Lower Levels of 7 Nutrients
Natural Medicines records Ethinyl Estradiol, Ethynodiol Diacetate as a medicine that can lower these. This is not an interaction with Sage — it is a separate effect of the medicine, and it is a reason some people are advised to supplement rather than to avoid one:
Read the full Ethinyl Estradiol, Ethynodiol Diacetate nutrient depletion report ›
Depletion records come from the licensed Natural Medicines database. Do not start a supplement on the strength of this page — ask your pharmacist or doctor whether it applies to you.
Taking Sage and Ethinyl Estradiol, Ethynodiol Diacetate Together: Common Questions
Can you take Sage with Ethinyl Estradiol, Ethynodiol Diacetate?
Why are there 3 interactions listed for Sage and Ethinyl Estradiol, Ethynodiol Diacetate?
How serious is the Sage and Ethinyl Estradiol, Ethynodiol Diacetate interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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