Drug & supplement interaction

Zizyphus + Ethotoin

Ethotoin brand name: Paganone.

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

Zizyphus has a moderate interaction with Ethotoin. Theoretically, zizyphus might cause additive sedative effects when taken with CNS depressants.

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

Zizyphus and Ethotoin

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

Moderate

CNS DEPRESSANTS

Why this applies to Ethotoin

Ethotoin falls under CNS DEPRESSANTS — the group Zizyphus interacts with.

Theoretically, zizyphus might cause additive sedative effects when taken with CNS depressants.
Some animal research has found that various parts of zizyphus have sedative effects. However, other animal research shows that zizyphus plant extract does not alter sleep parameters when used in combination with pentobarbital.
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 simple version for ethotoin (Paganone), which is an older seizure medicine. Like many anti-seizure drugs, it can make you feel drowsy or a little foggy on its own. Zizyphus (jujube) has been used traditionally as a calming, sleep-friendly remedy, and some early animal studies hint it may have a mild sedative effect.

So the concern here is simply adding two things that can both make you sleepy. Together they might leave you feeling more tired, lightheaded, or slow to react than usual. I want to be honest, though: this is a theoretical concern based on lab and animal data, not strong human evidence, and even those animal results were mixed. The fruit eaten as food is unlikely to matter much. Concentrated supplements are more of a question mark. Just loop in your pharmacist or doctor before pairing them.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Adzu, B., Amos, S., Dzarma, S., Wambebe, C., and Gamaniel, K. Effect of Zizyphus spina-christi Willd aqueous extract on the central nervous system in mice. J Ethnopharmacol. 2002;79(1):13-16.
  2. Morishita, S., Mishima, Y., Hirai, Y., Saito, T., and Shoji, M. Pharmacological studies of water extract of the Zizyphus seed and the Zizyphus seed containing drug. Gen Pharmacol 1987;18(6):637-641. PubMed
  3. Watanabe, I., Saito, H., and Takagi, K. Pharmacological studies of Zizyphus seeds. Jpn J Pharmacol 1973;23(4):563-571. DOI
  4. Wu, S. X., Zhang, J. X., Xu, T., Li, L. F., Zhao, S. Y., and Lan, M. Y. [Effects of seeds, leaves and fruits of Ziziphus spinosa and jujuboside A on central nervous system function]. Zhongguo Zhong Yao Za Zhi 1993;18(11):685-4.
  5. Hajhashemi V, Safaei A. Hypnotic effect of Coriandrum sativum, Ziziphus jujuba, Lavandula angustifolia and Melissa officinalis extracts in mice. Res Pharm Sci. 2015 Nov-Dec;10(6):477-84.

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

Zizyphus Also Interacts With Other Medications

Zizyphus has 468 moderate known drug interactions in our database — the Ethotoin one above is one of them. If you take anything else, check it against the full list below.

Moderate 468 No known interaction 2,362 (incl. Ethotoin)
Taking anything else?

Check Another of Your Medications Against Zizyphus

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

Everything else you take

See Every Supplement That Interacts With Ethotoin

This page covers Zizyphus only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ethotoin page lists 105 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: 1,4-butanediol (major), Activated Charcoal (major), Beer (major), Gamma-hydroxybutyrate (ghb) (major) and Kava (major).

By severity: 7 major · 82 moderate · 16 minor.

From our pharmacist’s overview on the Ethotoin page

“Ethotoin (Paganone) is a seizure medicine, which raises the stakes for this list of 105 interacting supplements and herbal ingredients, seven of them rated major. Most of the page, 78 ingredients, layers extra sedation onto a drug that already slows the nervous system.”

Reviewed by 2 · Jul 18, 2026

Open the Ethotoin interaction page

How much people look this up

Where Zizyphus and Ethotoin 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 Zizyphus
Steady interest

#1,273 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Ethotoin
Steady interest

#2,695 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 Zizyphus

What is Zizyphus?

Zizyphus
  • Sleep problems and insomnia
  • Anxiety and stress
  • Digestive support
  • General nutrition (vitamin C and fiber)
  • Constipation

Zizyphus (jujube) is an edible fruit and traditional remedy used mainly for sleep, anxiety, and digestion. The fruit is a nutritious food, but human evidence for its medicinal benefits is limited and mostly preliminary. If you want to try a supplement form, talk with your pharmacist or doctor first, especially if you are pregnant, breastfeeding, or taking other medicines.

Read the full Zizyphus monograph & all interactions
Keep checking

Other Drugs & Zizyphus

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

0Major
468Moderate
0Minor
2,361No known interaction
468 Moderate 2,361 No interaction
Moderate

468 interactions

Showing 60 of 468 moderate interactions — see all 468 on the Zizyphus page.

No interaction 2,361 drugs checked — show the list

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

Showing the 60 most looked-up of 2,361 medications checked with no known interaction — see the full Zizyphus list.

See the full Zizyphus interactions page
See every supplement checked against Ethotoin, 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
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Pharmacist Counseling Corner

Taking Zizyphus and Ethotoin Together: Common Questions

Can you take Zizyphus with Ethotoin?
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.
How serious is the Zizyphus and Ethotoin 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 Ethotoin and Zizyphus?

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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.