Drug & supplement interaction

Tree Of Heaven + Riociguat

Riociguat brand name: Adempas.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 27, 2026
The bottom line No known interaction

We found no known interaction between Tree Of Heaven and Riociguat in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

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Interaction report

Tree Of Heaven and Riociguat

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Riociguat and Tree Of Heaven in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Tree Of Heaven safety at a glance

Tree Of Heaven overall Use caution Human safety data are limited, and the plant can irritate the stomach and skin.
Pregnancy Avoid Not enough safety information; traditional use for menstrual effects raises concern, so avoid in pregnancy.
Breastfeeding Avoid No reliable safety data during breastfeeding, so it is best avoided.

Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Riociguat and Tree Of Heaven? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Riociguat

Interactions in our licensed database are recorded against drug classes, not just single drug names. Riociguat is filed under 4 classifications — including antihypertensive drugs, p-glycoprotein substrates, cytochrome p450 3a4 (cyp3a4) substrates. Tree Of Heaven has documented interactions with 1 drug class — the most serious being anticoagulant/antiplatelet drugs (moderate) — and none of Riociguat’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Tree Of Heaven Does Interact With Other Medications

Tree Of Heaven has 122 moderate known drug interactions in our database — Riociguat isn’t one of them. If you take anything else, check it against the full list below.

Moderate 122 No known interaction 2,708 (incl. Riociguat)
Taking anything else?

Check Another of Your Medications Against Tree Of Heaven

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

What to actually watch for

No Interaction Found — But Data Suggests Tree Of Heaven and Riociguat May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do.

  • Dizziness / Headache reported in 13.9% of FDA reports for Riociguat Additional detail

    Tree Of Heaven

    “There is currently a limited amount of information available about the safety of tree of heaven. Orally, large amounts of the bark have been reported to cause queasiness, dizziness, headache, limb tingling, and diarrhea (18).”

    Tree Of Heaven · Natural Medicines adverse-effect record, reported in cluster headache.

    1 source cited
    1. 18. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.

    “Orally, large amounts of tree of heaven bark have been reported to cause dizziness, headache, and limb tingling (18).”

    Tree Of Heaven · Natural Medicines adverse-effect record, reported in cluster headache.

    1 source cited
    1. 18. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.

    Riociguat

    Listed in the ADVERSE REACTIONS section of the FDA label for Riociguat, and in voluntary FDA adverse-event reports. Read the label on DailyMed ›

  • Diarrhea / Nausea reported in 11.6% of FDA reports for Riociguat Additional detail

    Tree Of Heaven

    “Orally, large amounts of tree of heaven bark have been reported to cause queasiness and diarrhea (18).”

    Tree Of Heaven · Natural Medicines adverse-effect record, reported in diarrhea.

    1 source cited
    1. 18. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.

    Riociguat

    Listed in the ADVERSE REACTIONS section of the FDA label for Riociguat, and in voluntary FDA adverse-event reports. Read the label on DailyMed ›

Reported for Tree Of Heaven but not commonly for Riociguat: numbness or tingling.

Effects for Riociguat come from the ADVERSE REACTIONS section of its FDA label; effects for Tree Of Heaven come from the Natural Medicines adverse-effect record, quoted above. Where a percentage is shown, it is the share of 32,415 voluntary FDA FAERS reports for Riociguat that mention that effect — a reporting proportion, not an incidence rate and not evidence the drug caused it. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

Everything else you take

See Every Supplement That Interacts With Riociguat

This page covers Tree Of Heaven only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Riociguat page lists 230 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), American Mistletoe (major), Grapefruit (major) and St. John's Wort (major).

By severity: 6 major · 187 moderate · 37 minor.

From our pharmacist’s overview on the Riociguat page

“Riociguat (Adempas) works by relaxing the blood vessels in your lungs, which also lowers blood pressure, so I read this list of 230 supplements and herbs with real concern, and the six rated major are what to understand first. Grapefruit can push riociguat levels up and intensify its effect, while St.”

Reviewed by 2 · Jul 18, 2026

Open the Riociguat interaction page

One more smart check

Taking Tree Of Heaven as Part of a Dietary Supplement Product? Check It for Interactions

We hold 14 real supplement products containing Tree Of Heaven, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Tree Of Heaven. Even though Tree Of Heaven itself has no known interaction with Riociguat, another ingredient on your label might. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Tree Of Heaven and Riociguat 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 Tree Of Heaven
Top half

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

29 days ago today
Medication Riociguat
Steady interest

#2,517 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.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Tree Of Heaven reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 27, 2026. The Tree Of Heaven and Riociguat records this page draws on were last updated July 10, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
Supplement

About Tree Of Heaven

What is Tree Of Heaven?

  • Diarrhea and dysentery
  • Intestinal parasites
  • Menstrual or vaginal complaints
  • Asthma and cough (traditional use)
  • Skin conditions (topical, traditional use)

Tree of Heaven (Ailanthus altissima) is a fast-growing, invasive tree whose bark has been used in traditional medicine, mostly for digestive complaints and parasites. Modern scientific evidence in humans is very limited, and the plant can cause stomach upset and skin reactions, so it should be used cautiously and not without professional guidance.

Ailanthus altissima · Simaroubaceae · Bark (especially root and stem bark), leaves · Dried bark, tinctures, teas/decoctions, traditional herbal preparations

An interaction check asks whether these two react with each other — it does not ask whether Tree Of Heaven is a good idea for someone in your situation. Here is what our Tree Of Heaven record says about it on its own.

Tree Of Heaven: dosing

There is no well-established or standardized dose for Tree of Heaven. Traditional preparations such as bark decoctions varied widely, and they were not measured against modern safety standards.If you choose to use a commercial product, follow the directions on the label and do not exceed them.

From our Tree Of Heaven monograph — the full record covers uses, side effects and every documented interaction.

Read the full Tree Of Heaven monograph & all interactions
Medication

About Riociguat

What Is Riociguat Used For?

Brand name: Adempas

Riociguat — sold as Adempas and under the generic name Riociguat — is used to treat adults with two conditions that cause dangerously high blood pressure in the arteries of the lungs.

  • Chronic Thromboembolic Pulmonary Hypertension (CTEPH): Used after surgical treatment, or when surgery is not an option, to improve exercise capacity and functional class.
  • Pulmonary Arterial Hypertension (PAH): Used to improve exercise capacity, functional class, and to delay the condition from getting worse. It can be used alone or combined with certain other PAH medicines.

Most-Reported Side Effects for Riociguat

From FAERS, the FDA’s public side-effect reporting system (32,415 reports, all brands). Reports are voluntary and are not proof the drug caused the effect.

Dyspnea 5,718 reports
Headache 4,513 reports
Nausea 3,769 reports
Diarrhea 3,533 reports
Dizziness 3,522 reports
See full Riociguat drug information
Keep checking

Other Drugs & Tree Of Heaven

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

0Major
122Moderate
0Minor
2,707No known interaction
122 Moderate 2,707 No interaction
Moderate

122 interactions

Showing 60 of 122 moderate interactions — see all 122 on the Tree Of Heaven page.

No interaction 2,707 drugs checked — show the list

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

Showing the 60 most looked-up of 2,707 medications checked with no known interaction — see the full Tree Of Heaven list.

See the full Tree Of Heaven interactions page
See every supplement checked against Riociguat, ranked by severity
Evidence & sources

Tree Of Heaven References

The 2 references that drive our Tree Of Heaven monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  2. Rahman HMA, Rasool MF, Imran I. Pharmacological Studies Pertaining to Smooth Muscle Relaxant, Platelet Aggregation Inhibitory and Hypotensive Effects of Ailanthus altissima. Evid Based Complement Alternat Med. 2019;2019:1871696.

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking Tree Of Heaven and Riociguat Together: Common Questions

Is it safe to take Tree Of Heaven with Riociguat?
We do not list a known interaction between Tree Of Heaven and Riociguat. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
Do Tree Of Heaven and Riociguat have any of the same side effects?
Yes — our sources link each of them separately to 4 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.
How was the Tree Of Heaven and Riociguat combination checked?
Interactions in our licensed database are recorded against drug classes. Riociguat is filed under 4 classifications, and Tree Of Heaven has documented interactions with 1 drug class — none of Riociguat's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does Tree Of Heaven interact with any other medications?
Yes. Tree Of Heaven has 122 documented drug interactions in our database — Riociguat is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Riociguat interact with any supplements?
Yes. Riociguat has documented interactions with 230 supplements in our database — Tree Of Heaven is not one of them. The Riociguat interaction page linked on this page lists every one, ranked by severity.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Where next

Keep Exploring

Tree Of Heaven monograph Uses, safety profile, and every drug interaction in one place Riociguat drug information The full plain-English guide to this medication Riociguat supplement interactions Every supplement checked against Riociguat, 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 References The 2 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Riociguat and Tree Of Heaven?

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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.