Herb & supplement monograph

Peony Drug Interactions, Uses, Effectiveness, Safety & More

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS ·Updated July 2026

What is this page for?

First and foremost: how Peony interacts with medications. The heart of this page is the interaction list — every drug Peony is known to interact with, and how serious each one is.

But these pages have grown well beyond that into a full monograph — what Peony is, what people use it for and how strong the evidence is, its safety and side effects, and answers to the questions we’re asked most — written and reviewed by the clinical staff at HelloPharmacist. It’s educational information from our licensed clinical databases, not medical advice, and we don’t sell or endorse products. Our editorial policy

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On this page

Peony Drug Interactions: The Bottom Line

From the HelloPharmacist Editorial Team · Updated July 2026

Based on the available evidence, the overall risk of a clinically significant Peony drug interaction appears low for most people. None of the listed interactions are rated major, and nearly all rest on lab or animal research rather than effects actually seen in people.

Interactions deserving the most attention

The best-documented concern is phenytoin, a seizure medicine: animal studies show peony may lower its levels, and steady levels matter for seizure control, though one small human study found peony did not change levels of a drug cleared the same way. Lab findings also suggest peony could add to the effects of anticoagulant or antiplatelet drugs, creating a theoretical bleeding risk. Because peony has shown estrogen-like activity in lab and animal research, it could in theory interfere with contraceptives or hormone therapy.

What the rest of the list means

Most medicines on this long list appear because lab studies suggest peony might slow enzymes the body uses to clear them. Findings like that often do not translate into meaningful changes in people, and so far these predicted effects have not been reported in humans.

Check your medications against Peony

Based on HelloPharmacist’s Peony interaction data and reviewed under our editorial standards.

Interaction report

Drugs that interact with Peony

813 medications have a known interaction with Peony, graded by severity. Select any drug for the full evidence-based detail.

Don’t want to scroll the list? Just ask.

Tell us the medications you take and we’ll check each one against Peony using our pharmacist-reviewed interaction data.

AI summaries are generated from our Peony interaction data for education only — always confirm with your pharmacist. How we use AI

2,830 drugs

Read The List Like a Pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
Probable. Interaction 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.
Possible. 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
Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
Each drug listed above links to the full report for that exact Peony combination — clinical detail, likelihood, evidence level, and citations.
Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

The big picture

The kinds of drugs Peony affects

Every type of medication (drug category) Peony is known to interact with. Open any category for the detail — or search your exact drug in the checker above.

All 7 drug categories Peony interacts with

Anticoagulant/antiplatelet DrugsClozapine (clozaril)Contraceptive DrugsCytochrome P450 1a2 (cyp1a2) SubstratesCytochrome P450 3a4 (cyp3a4) SubstratesEstrogensPhenytoin (dilantin)

Anticoagulant/Antiplatelet Drugs

Theoretically, combining peony with anticoagulant or antiplatelet drugs might increase the risk of bleeding.
In vitro research suggests that peony might have antiplatelet, anticoagulant, and antithrombotic effects.

Likelihood Possible Evidence D

Clozapine (Clozaril)

Theoretically, peony might increase the levels and clinical effects of clozapine.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on cytochromes P450 (CYP) 1A2 and CYP3A4. This effect has not been reported in humans.

Likelihood Possible Evidence D

Contraceptive Drugs

Theoretically, peony might interfere with contraceptive drugs due to competition for estrogen receptors.
In vitro and animal research shows that peony extract has estrogenic activity. Concomitant use might also increase the risk for estrogen-related adverse effects.

Likelihood Possible Evidence D

Cytochrome P450 1A2 (Cyp1A2) Substrates

Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. This effect has not been reported in humans.

Likelihood Possible Evidence D

Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. This effect has not been reported in humans.

Likelihood Possible Evidence D

Estrogens

Theoretically, concomitant use of large amounts of peony might interfere with hormone replacement therapy and/or increase the risk for estrogen-related adverse effects.
In vitro and animal research shows that peony extract has estrogenic activity. Theoretically, peony might compete for estrogen receptors and/or cause additive estrogenic effects.

Likelihood Possible Evidence D

Phenytoin (Dilantin)

Theoretically, peony might reduce the levels and clinical effects of phenytoin.
Animal research shows that taking peony root reduces levels of phenytoin. Some researchers suggest that peony root might affect cytochrome P450 (CYP) 2C9, which metabolizes phenytoin. However, preliminary research in humans shows that peony root does not alter levels of losartan (Cozaar), which is also metabolized by CYP2C9.

Likelihood Probable Evidence D

Monograph

Peony: Uses, Safety & Side Effects

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS · Reviewed July 2026 ·

The bottom line

Peony root is a traditional Chinese medicine herb often used for menstrual problems, cramps, and inflammation, frequently as part of combination formulas. Human evidence for most uses is limited or preliminary, so it should not replace proven treatments. Talk to your pharmacist or doctor before using it, especially if you are pregnant, breastfeeding, or taking other medicines.

Scientific name: Paeonia lactiflora
Family: Paeoniaceae
Part used: Root (and sometimes the root bark, flower, and seeds)
Common forms: Dried root, powders, capsules, tinctures, teas, and combination herbal formulas

People commonly use it for

Menstrual cramps and irregular periods
Muscle cramps and spasms
Anxiety and stress
Inflammation and pain
Polycystic ovary syndrome (PCOS)

Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.

Safety at a glance

OverallUse caution

Generally considered well tolerated for short-term use, but high-quality safety data are limited.

PregnancyPossibly Unsafe

When used orally. Preliminary research suggests that peony can cause uterine contractions. However, other preliminary research suggests a combination...

Read the full pregnancy detail

BreastfeedingInsufficient reliable information

Insufficient reliable information available; avoid using.

Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

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Overview

Peony is a flowering plant in the genus Paeonia. The plants are native to parts of Asia, Europe, and western North America and are known for their large, showy flowers in colors like white, pink, and red. In herbal medicine, the root is the part most often used, though the flower and seeds are sometimes used too.

Different types of peony are used in traditional Chinese medicine and go by names like Bai Shao (white peony) and Chi Shao (red peony). It has a long history of use for menstrual problems, cramps, pain, and inflammation. Peony is often combined with other herbs rather than taken alone, such as in well-known formulas used for women's health.

How it works

Peony root contains several plant compounds that researchers have studied. The most discussed is paeoniflorin, along with related compounds and antioxidants. Red peony also contains tannins and other substances.

In laboratory and animal studies, these compounds appear to have anti-inflammatory, antioxidant, and muscle-relaxing effects, and they may influence hormone levels and immune activity. Some research suggests paeoniflorin may affect the nervous system in ways that could relate to its traditional use for stress and cramps.

It is important to know that most of this information comes from test-tube and animal research. How well these effects translate to people taking peony is still not well established.

Effectiveness

Does Peony work?

Here’s what the research actually shows for each use — graded by Natural Medicines and reviewed by Dr. Brian Staiger, PharmD.

Evidence overview · 31 uses evaluated

31 Insufficient evidence

How to read these evidence grades

Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.

1EffectiveStrong, consistent evidence it works.

2Likely EffectiveGood evidence, though not yet conclusive.

3Possibly EffectiveSome evidence suggests a benefit.

4Possibly IneffectiveSome evidence it may not help.

5Likely IneffectiveFairly strong evidence it doesn’t help.

6IneffectiveStrong evidence it doesn’t work.

7Insufficient Reliable Evidence to RateToo little research to say either way.

For Peony, current evidence isn’t strong enough to rate any specific use. The conditions it has been studied for are listed below.

Also studied for 31 conditions — evidence insufficient to rate

Insufficient Reliable Evidence To Rate Aging skin