Drug & supplement interaction

Siberian Cocklebur + Ixazomib Citrate

Ixazomib Citrate brand name: Ninlaro.

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

Siberian Cocklebur has a major interaction with Ixazomib Citrate. Siberian cocklebur can adversely affect the liver.

Read the full interaction report
SeverityMajor
LikelihoodLikely
EvidenceB
What do Severity, Likelihood & Evidence mean?
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Interaction report

Siberian Cocklebur and Ixazomib Citrate

Here is the interaction we found between these two, with the evidence behind it.

Major

HEPATOTOXIC DRUGS

Why this applies to Ixazomib Citrate

Ixazomib Citrate falls under HEPATOTOXIC DRUGS — the group Siberian Cocklebur interacts with.

Siberian cocklebur can adversely affect the liver. It has been linked to many cases of hepatotoxicity and some cases of liver failure. Theoretically, concomitant use with other potentially hepatotoxic drugs might increase the risk of developing liver damage. Some of these drugs include acarbose (Precose, Prandase), amiodarone (Cordarone), atorvastatin (Lipitor), azathioprine (Imuran), carbamazepine (Tegretol), cerivastatin (Baycol), diclofenac (Voltaren), felbamate (Felbatol), fenofibrate (TriCor), fluvastatin (Lescol), gemfibrozil (Lopid), isoniazid, itraconazole, (Sporanox), ketoconazole (Nizoral), leflunomide (Arava), lovastatin (Mevacor), methotrexate (Rheumatrex), nevirapine (Viramune), niacin, nitrofurantoin (Macrodantin), pioglitazone (Actos), pravastatin (Pravachol), pyrazinamide, rifampin (Rifadin), ritonavir (Norvir), rosiglitazone (Avandia), simvastatin (Zocor), tacrine (Cognex), tamoxifen, terbinafine (Lamisil), valproic acid, and zileuton (Zyflo).
Severity Major Likelihood Likely Evidence B

Well-controlled human studies have demonstrated the likely existence of this interaction.

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

Here's the concern with pairing Siberian cocklebur and ixazomib (Ninlaro). The cocklebur fruit contains natural compounds that can be hard on the liver, and it has been tied to real cases of liver injury and even liver failure. Ixazomib, your multiple myeloma medicine, can also stress the liver on its own. Stacking two things that strain the same organ may raise your risk of liver problems, like fatigue, nausea, yellowing of the skin or eyes, dark urine, or abnormal liver blood tests.

This isn't about ixazomib being a prodrug or one canceling the other out. It's a simple additive burden on the liver. Given how serious cocklebur poisoning can be, I'd steer clear of it and check with your oncology team or pharmacist before adding any herbal product.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Gurley ES, Rahman M, Hossain MJ, et al. Fatal outbreak from consuming Xanthium strumarium seedlings during time of food scarcity in northeastern Bangladesh. PLoS One 2010 Mar 18;5(3):e9756. PubMed
  2. Turgut M, Alhan CC, Gurgoze M, et al. Carboxyatractyloside poisoning in humans. Ann Trop Paediatr 2005;25(2):125-34. PubMed
  3. Karabiber H, Almis H, Selimoglu MA, Yakinci C, Yilmaz S. Xanthium strumarium poisoning requiring liver transplantation. J Pediatr Gastroenterol Nutr. 2014;58(1):e6-9.

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

Siberian Cocklebur Also Interacts With Other Medications

Siberian Cocklebur has 663 major, known drug interactions in our database — the Ixazomib Citrate one above is one of them. If you take anything else, check it against the full list below.

Major 663 No known interaction 2,167 (incl. Ixazomib Citrate)
Taking anything else?

Check Another of Your Medications Against Siberian Cocklebur

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

Everything else you take

See Every Supplement That Interacts With Ixazomib Citrate

This page covers Siberian Cocklebur only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ixazomib Citrate page lists 168 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), St. John's Wort (major) and Wine (major).

By severity: 6 major · 124 moderate · 38 minor.

From our pharmacist’s overview on the Ixazomib Citrate page

“Anyone taking ixazomib citrate (Ninlaro) for multiple myeloma should give this list real weight, because a supplement that shifts this chemotherapy's blood level can shift how well it works against the cancer. Of the 168 ingredients on file, 121 act on CYP3A4, the enzyme that clears ixazomib.”

Reviewed by 2 · Jul 18, 2026

Open the Ixazomib Citrate interaction page

One more smart check

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

We hold 84 real supplement products containing Siberian Cocklebur, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Siberian Cocklebur. Your product may carry other ingredients that interact with Ixazomib Citrate too, on top of Siberian Cocklebur — 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 Siberian Cocklebur and Ixazomib Citrate 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 Siberian Cocklebur
Top half

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

29 days ago today
Medication Ixazomib Citrate
Steady interest

#1,585 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 Siberian Cocklebur

What is Siberian Cocklebur?

  • Nasal congestion and sinus problems
  • Allergic rhinitis (hay fever)
  • Headache
  • Skin conditions and itching
  • Joint and muscle discomfort

Siberian cocklebur is a fruit used in traditional Chinese and other Asian herbal medicine, mainly for nasal congestion, sinus issues, and allergies. Human evidence is very limited, and the plant contains naturally toxic compounds that can cause serious poisoning, so it should only be used under expert guidance, if at all.

Read the full Siberian Cocklebur monograph & all interactions
Medication

About Ixazomib

What Is Ixazomib Used For?

Brand name: Ninlaro

Ninlaro (ixazomib) is used to treat multiple myeloma — a cancer of plasma cells in the bone marrow. It is not used alone; it is always taken together with two other medicines, lenalidomide and dexamethasone. This combination is for adults who have already received at least one prior treatment for their myeloma.

Ninlaro is not recommended for use as maintenance therapy or in newly diagnosed multiple myeloma patients on a lenalidomide and dexamethasone regimen outside of controlled clinical trials.

See full Ixazomib drug information Ixazomib NDC codes and packages
Keep checking

Other Drugs & Siberian Cocklebur

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

663Major
0Moderate
0Minor
2,166No known interaction
663 Major 2,166 No interaction
Major

663 interactions

Showing 60 of 663 major interactions — see all 663 on the Siberian Cocklebur page.

No interaction 2,166 drugs checked — show the list

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

Showing the 60 most looked-up of 2,166 medications checked with no known interaction — see the full Siberian Cocklebur list.

See the full Siberian Cocklebur interactions page
See every supplement checked against Ixazomib Citrate, 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
Siberian Cocklebur monograph › Uses, safety, and every drug interaction in one place Ixazomib Citrate supplement interactions › Every supplement checked against Ixazomib Citrate, ranked by severity Ixazomib drug information › The full plain-English guide to this medication Ixazomib NDC codes and packages › Every package, labeler and price in the FDA directory 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 Siberian Cocklebur and Ixazomib Citrate Together: Common Questions

Can you take Siberian Cocklebur with Ixazomib Citrate?
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.
How serious is the Siberian Cocklebur and Ixazomib Citrate 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

Still Have a Question About Ixazomib Citrate and Siberian Cocklebur?

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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.