Drug & supplement interaction

Sage + Warfarin Sodium

Warfarin Sodium brand names: Coumadin, Panwarfin, Sofarin.

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

Warfarin Sodium falls into 3 drug categories that Sage can interact with; the most serious is rated moderate. Theoretically, sage might increase the levels and clinical effects of drugs metabolized by CYP2C19.

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

Sage and Warfarin Sodium

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. Warfarin Sodium 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

CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES

1 of 3

Why this applies to Warfarin Sodium

Warfarin Sodium falls under CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES — the group Sage interacts with.

Theoretically, sage might increase the levels and clinical effects of drugs metabolized by CYP2C19.
In vitro evidence suggests that aqueous extracts of sage can inhibit CYP2C19. 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 for warfarin. Sage may slow down one of the liver enzymes (CYP2C19) that helps clear warfarin. In theory, if warfarin clears more slowly, it could build up a bit and thin your blood more than intended. With a drug like warfarin, even small shifts matter, because too much can mean easy bruising, nosebleeds, or more serious bleeding.

The good news: this concern comes only from lab studies, not from real people, so it's more of a caution than a proven problem. Sprinkling sage on dinner is unlikely to do much. Concentrated sage extracts or capsules are where I'd be careful. If you take warfarin, check with your pharmacist or doctor before adding sage supplements, and keep up with your INR checks.

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
Moderate

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES

2 of 3

Warfarin Sodium also falls under CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES.

Theoretically, sage might increase the levels and clinical effects of drugs metabolized by CYP2C9.
In vitro evidence suggests that aqueous extracts of sage can inhibit CYP2C9. 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: your body relies on an enzyme called CYP2C9 to break warfarin down and clear it out. In lab tests, sage extracts seem to slow that enzyme. If that happened in real life, warfarin could build up and act more strongly, which means a higher chance of bleeding problems, things like easy bruising, nosebleeds, bleeding gums, or blood in the urine or stool.

I want to be honest about the strength of this, though. This is only test-tube evidence, and it has not actually been reported in people. Since warfarin is a finicky drug where small shifts matter, I'd still loop in your doctor or pharmacist before using concentrated sage supplements or sage oil. A little sage on your dinner is very unlikely to cause trouble.

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
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

3 of 3

Warfarin Sodium 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 for warfarin. Lab studies suggest sage can slow down an enzyme called CYP3A4, which is one of the routes your body uses to clear warfarin. In theory, if that pathway is blocked, warfarin could build up a bit and thin your blood more than intended. With warfarin, even small shifts matter, so that could mean easier bruising, nosebleeds, bleeding gums, or more serious bleeding.

The honest part: this is only a theoretical concern from test-tube work, and it hasn't actually been seen in people. A sprinkle of sage on dinner is very unlikely to do anything. Concentrated sage extracts or capsules are where I'd be more cautious. Before adding any sage supplement, check with your pharmacist or doctor, since your INR may need a closer look.

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.

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 Warfarin Sodium 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. Warfarin Sodium)
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.

From our Q&A

Questions About Sage or Warfarin Sodium

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Sage or Warfarin Sodium, 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 Warfarin Sodium

This page covers Sage only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Warfarin Sodium page lists 361 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Alfalfa (major), American Ginseng (major), Beer (major) and Cannabis (major).

Open the Warfarin Sodium 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 Warfarin Sodium 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 Warfarin Sodium 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%

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

29 days ago today
Medication Warfarin Sodium
Top 1%

#20 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
Medication

About Warfarin

What Is Warfarin Used For?

Brand names: Coumadin, Panwarfin, Sofarin

Warfarin sodium tablets and Jantoven tablets are both used to prevent and treat venous thrombosis (blood clots in the veins) and pulmonary embolism (a clot in the lungs). They are also used to prevent clot-related complications in people with atrial fibrillation (an irregular heart rhythm) or who have had a heart valve replaced.

In people who have had a heart attack, warfarin is used to reduce the risk of death, another heart attack, stroke, or other clotting events. It does not dissolve an existing clot, but it helps prevent the clot from growing and stops new dangerous clots from forming.

See full Warfarin drug information
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 Warfarin Sodium, 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 Warfarin Sodium supplement interactions › Every supplement checked against Warfarin Sodium, ranked by severity Warfarin 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 Sage and Warfarin Sodium Together: Common Questions

Can you take Sage with Warfarin Sodium?
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 Warfarin Sodium?
Warfarin Sodium 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 Warfarin Sodium 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 Warfarin Sodium and Sage?

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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.