Herb & supplement monograph

Pu-erh Tea 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 Pu-erh Tea interacts with medications. The heart of this page is the interaction list — every drug Pu-erh Tea is known to interact with, and how serious each one is.

But these pages have grown well beyond that into a full monograph — what Pu-erh Tea 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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Pu-erh Tea Drug Interactions: The Bottom Line

From the HelloPharmacist Editorial Team · Updated July 2026

Because pu-erh tea contains caffeine, the overall risk of a clinically significant Pu-erh Tea drug interaction is moderate for most people, and it depends heavily on which medicines are involved and how much tea is consumed. A small number of interactions are rated major, most are rated moderate, and nearly all trace back to the tea's caffeine content.

Interactions deserving the most attention

The pairing that concerns us most is ephedrine, since combining it with caffeine has been linked to serious problems like dangerously high blood pressure, heart attack, and stroke. Cimetidine clearly slows the body's clearance of caffeine, which can amplify effects like jitteriness and a racing heart; fluvoxamine, disulfiram, and estrogens can act similarly. Caffeine may also raise levels of clozapine, and combining pu-erh tea with other stimulant medicines can add to side effects on the heart and nervous system.

What the rest of the list means

Most of the remaining interactions on the list are theoretical, predicted from caffeine's possible effects on an enzyme the body uses to process many medicines, or from animal studies. Several of these predicted effects, including weakened seizure medicines and extra bleeding risk with blood thinners, have not been shown to cause meaningful problems in people. A long list does not mean every combination is harmful in practice.

Check your medications against Pu-erh Tea

Based on HelloPharmacist’s Pu-erh Tea interaction data and reviewed under our editorial standards.

Interaction report

Drugs that interact with Pu-erh Tea

667 medications have a known interaction with Pu-erh Tea, graded by severity. Select any drug for the full evidence-based detail.

9 major interactions. These combinations can be clinically significant — best avoided, or used only with close professional supervision. Always check with your pharmacist before combining them with Pu-erh Tea.

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

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

AI summaries are generated from our Pu-erh Tea 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 Pu-erh Tea 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 Pu-erh Tea affects

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

All 42 drug categories Pu-erh Tea interacts with

Cimetidine (tagamet)EphedrineAdenosine (adenocard)Anticoagulant/antiplatelet DrugsBeta-adrenergic AgonistsCarbamazepine (tegretol)Clozapine (clozaril)Cytochrome P450 1a2 (cyp1a2) InhibitorsDipyridamole (persantine)Disulfiram (antabuse)EstrogensEthosuximide (zarontin)Felbamate (felbatol)Flutamide (eulexin)Fluvoxamine (luvox)LithiumMonoamine Oxidase Inhibitors (maois)NicotinePentobarbital (nembutal)Phenobarbital (luminal)PhenylpropanolaminePhenytoin (dilantin)Pioglitazone (actos)Riluzole (rilutek)Stimulant DrugsTheophyllineValproateVerapamil (calan, Others)Alcohol (ethanol)Antidiabetes DrugsContraceptive DrugsDiuretic DrugsFluconazole (diflucan)Metformin (glucophage)Methoxsalen (oxsoralen)Mexiletine (mexitil)PhenothiazinesQuinolone AntibioticsTerbinafine (lamisil)Tiagabine (gabitril)Ticlopidine (ticlid)Tricyclic Antidepressants (tcas)

Cimetidine (Tagamet)

Theoretically, concomitant use might increase the effects and adverse effects of caffeine in pu-erh tea.
Pu-erh tea contains caffeine. Cimetidine can reduce caffeine clearance by 31% to 42%.

Likelihood Likely Evidence B

Ephedrine

Theoretically, concomitant use might increase the risk for simulant adverse effects.
Pu-erh tea contains caffeine. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death.

Likelihood Probable Evidence D

Adenosine (Adenocard)

Theoretically, pu-erh tea might decrease the vasodilatory effects of adenosine and interfere with its use prior to stress testing.
Pu-erh tea contains caffeine. Caffeine is a competitive inhibitor of adenosine at the cellular level. However, caffeine does not seem to affect supplemental adenosine because high interstitial levels of adenosine overcome the antagonistic effects of caffeine. It is recommended that methylxanthines, such as caffeine, be stopped 24 hours prior to pharmacological stress tests. However, methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.

Likelihood Possible Evidence B

Anticoagulant/Antiplatelet Drugs

Theoretically, pu-erh tea may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Pu-erh tea contains caffeine. Caffeine is reported to have antiplatelet activity. Theoretically, the caffeine in pu-erh tea might increase the risk of bleeding when used concomitantly with antiplatelet drugs. However, this interaction has not been reported in humans.

Likelihood Possible Evidence D

Beta-Adrenergic Agonists

Theoretically, concomitant use of large amounts of pu-erh tea might increase cardiac inotropic effects of beta-agonists.
Pu-erh tea contains caffeine. Caffeine can increase cardiac inotropic effects of beta-agonists.

Likelihood Probable Evidence D

Carbamazepine (Tegretol)

Theoretically, pu-erh tea might reduce the effects of carbamazepine and increase the risk for convulsions.
Pu-erh tea contains caffeine. Animal research suggests that taking caffeine can lower the anticonvulsant effects of carbamazepine and can induce seizures when taken in doses above 400 mg/kg. Human research has shown that taking caffeine 300 mg in three divided doses along with carbamazepine 200 mg reduces the bioavailability of carbamazepine by 32% and prolongs the plasma half-life of carbamazepine 2-fold in healthy individuals.

Likelihood Possible Evidence D

Clozapine (Clozaril)

Theoretically, pu-erh tea might increase the levels and adverse effects of clozapine and acutely exacerbate psychotic symptoms.
Pu-erh tea contains caffeine. Caffeine can increase the effects and toxicity of clozapine. Caffeine doses of 400-1000 mg daily inhibit clozapine metabolism. Clozapine is metabolized by cytochrome P450 1A2 (CYP1A2). Researchers speculate that caffeine might inhibit CYP1A2. However, there is no reliable evidence that caffeine affects CYP1A2. There is also speculation that genetic factors might make some patients be more sensitive to the interaction between clozapine and caffeine.

Likelihood Possible Evidence B

Cytochrome P450 1A2 (Cyp1A2) Inhibitors

Theoretically, concomitant use might increase the levels and adverse effects of caffeine.
Pu-erh tea contains caffeine. Caffeine is metabolized by CYP1A2. Theoretically, drugs that inhibit CYP1A2 may decrease the clearance rate of caffeine from pu-erh tea and increase caffeine levels.

Likelihood Possible Evidence D

Dipyridamole (Persantine)

Theoretically, pu-erh tea might decrease the vasodilatory effects of dipyridamole and interfere with its use prior to stress testing.
Pu-erh tea contains caffeine. Caffeine is a methylxanthine that may inhibit dipyridamole-induced vasodilation. It is recommended that methylxanthines such as caffeine, as well as methylxanthine-containing products such as pu-erh tea, be stopped 24 hours prior to pharmacological stress tests. Methylxanthines appear more likely to interfere with dipyridamole (Persantine) than adenosine-induced stress testing.

Likelihood Probable Evidence B

Disulfiram (Antabuse)

Theoretically, disulfiram might increase the risk of adverse effects from caffeine.
Pu-erh tea contains caffeine. In human research, disulfiram decreases the clearance and increases the half-life of caffeine.

Likelihood Probable Evidence D

Estrogens

Theoretically, estrogens might increase the levels and adverse effects of caffeine.
Pu-erh tea contains caffeine. Estrogen inhibits caffeine metabolism.

Likelihood Probable Evidence B

Ethosuximide (Zarontin)

Theoretically, pu-erh tea might reduce the effects of ethosuximide and increase the risk for convulsions.
Pu-erh tea contains caffeine. Animal research suggests that caffeine 92.4 mg/kg can decrease the anticonvulsant activity of ethosuximide. However, this effect has not been observed in humans.

Likelihood Possible Evidence D

Felbamate (Felbatol)

Theoretically, pu-erh tea might reduce the effects of felbamate and increase the risk for convulsions.
Pu-erh tea contains caffeine. Animal research suggests that a high dose of caffeine 161.7 mg/kg can decrease the anticonvulsant activity of felbamate. However, this effect has not been observed in humans.

Likelihood Possible Evidence D

Flutamide (Eulexin)

Theoretically, pu-erh tea might increase the levels and adverse effects of flutamide.
Pu-erh tea contains caffeine. In vitro evidence suggests that caffeine can inhibit the metabolism of flutamide. Theoretically, concomitant use of caffeine and flutamide might increase serum concentrations of flutamide and increase the risk of adverse effects.

Likelihood Possible Evidence D

Fluvoxamine (Luvox)

Theoretically, fluvoxamine might increase the levels and adverse effects of caffeine.
Pu-erh tea contains caffeine. Fluvoxamine reduces caffeine metabolism.

Likelihood Probable Evidence D

Lithium

Theoretically, abrupt pu-erh tea withdrawal might increase the levels and adverse effects of lithium.
Pu-erh tea contains caffeine. Abrupt caffeine withdrawal can increase serum lithium levels. Two cases of lithium tremor that worsened with abrupt coffee withdrawal have been reported.

Likelihood Probable Evidence D

Monoamine Oxidase Inhibitors (Maois)

Theoretically, concomitant use might increase the risk of a hypertensive crisis.
Pu-erh tea contains caffeine. Caffeine has been shown to inhibit monoamine oxidase (MAO) A and B in laboratory studies. Concomitant intake of large amounts of caffeine with MAOIs might precipitate a hypertensive crisis. In a case report, a patient that consumed 10-12 cups of caffeinated coffee and took the MAOI tranylcypromine presented with severe hypertension. Hypertension was resolved after the patients switched to drinking decaffeinated coffee.

Likelihood Possible Evidence D

Nicotine

Theoretically, concomitant use might increase the risk of CNS effects or hypertension.
Pu-erh tea contains caffeine. Concomitant use of caffeine and nicotine has been shown to have additive CNS effects or cardiovascular effects, including increased heart rate and blood pressure. In one study, blood pressure was increased by 10.8/12.4 mmHg when the agents were used concomitantly.

Likelihood Probable Evidence D

Pentobarbital (Nembutal)

Theoretically, pu-erh tea might decrease the effects of pentobarbital.
Pu-erh tea contains caffeine. Theoretically, caffeine might negate the hypnotic effects of pentobarbital.

Likelihood Possible Evidence B

Phenobarbital (Luminal)

Theoretically, pu-erh tea might reduce the effects of phenobarbital and increase the risk for convulsions.
Pu-erh tea contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of phenobarbital. The exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D

Phenylpropanolamine

Theoretically, phenylpropanolamine might increase the risk of hypertension, as well as the levels and adverse effects of caffeine.
Pu-erh tea contains caffeine. Concomitant use of phenylpropanolamine and caffeine might cause an additive increase in blood pressure. Phenylpropanolamine also seems to increase caffeine serum levels.

Likelihood Probable Evidence B

Phenytoin (Dilantin)

Theoretically, pu-erh tea might reduce the effects of phenytoin and increase the risk for convulsions.
Pu-erh tea contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of phenytoin. The effect does not seem to be related to the seizure threshold-lowering effects of caffeine. However, the exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D

Pioglitazone (Actos)

Theoretically, caffeine might increase the levels and clinical effects of pioglitazone.
Pu-erh tea contains caffeine. Animal research suggests that caffeine can modestly increase the maximum concentration, area under the curve, and half-life of pioglitazone, and also reduce its clearance. This increased the antidiabetic effects of pioglitazone. However, the exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D

Riluzole (Rilutek)

Theoretically, concomitant use might increase the levels and adverse effects of both caffeine and riluzole.
Pu-erh tea contains caffeine. Caffeine and riluzole are both metabolized by cytochrome P450 1A2 (CYP1A2), and concomitant use might reduce metabolism of one or both agents.

Likelihood Possible Evidence D

Stimulant Drugs

Theoretically, concomitant use might increase stimulant adverse effects.
Pu-erh tea contains caffeine. Due to the central nervous system (CNS) stimulant effects of caffeine, concomitant use with stimulant drugs can increase the risk of adverse effects.

Likelihood Probable Evidence C

Theophylline

Theoretically, pu-erh tea might increase the levels and adverse effects of theophylline.
Pu-erh tea contains caffeine, which can increase theophylline levels.

Likelihood Probable Evidence D

Valproate

Theoretically, pu-erh tea might reduce the effects of valproate and increase the risk for convulsions.
Pu-erh tea contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of valproate. However, the exact mechanism of this interaction is unclear.

Likelihood Possible Evidence D

Verapamil (Calan, Others)

Theoretically, concomitant use might increase the levels and adverse effects of caffeine.
Pu-erh tea contains caffeine. Verapamil increases plasma caffeine concentrations by 25%.

Likelihood Possible Evidence D

Alcohol (Ethanol)

Theoretically, alcohol might increase the levels and adverse effects of caffeine.
Pu-erh tea contains caffeine. Alcohol reduces caffeine metabolism. Concomitant use of alcohol and caffeine can increase caffeine serum concentrations and the risk of caffeine adverse effects.

Likelihood Possible Evidence D

Antidiabetes Drugs

Theoretically, taking pu-erh tea with antidiabetes drugs might interfere with blood glucose control.
Pu-erh tea contains caffeine. Reports claim that caffeine might increase or decrease blood sugar levels.

Likelihood Unlikely Evidence B

Contraceptive Drugs

Theoretically, concomitant use might increase the effects and adverse effects of caffeine found in pu-erh tea.
Pu-erh tea contains caffeine. Oral contraceptive drugs can decrease caffeine clearance by 40% to 65%.

Likelihood Possible Evidence B

Diuretic Drugs

Theoretically, using pu-erh tea with diuretic drugs might increase the risk of hypokalemia.
Pu-erh tea contains caffeine. Caffeine, especially in excessive amounts, can reduce potassium levels due to stimulation of the sodium-potassium pump. Diuretics can also cause lower potassium levels.

Likelihood Possible Evidence D

Fluconazole (Diflucan)

Theoretically, fluconazole might increase the levels and adverse effects of caffeine.
Pu-erh tea contains caffeine. Fluconazole decreases caffeine clearance by approximately 25%.

Likelihood Possible Evidence B

Metformin (Glucophage)

Theoretically, metformin might increase the levels and adverse effects of caffeine.
Pu-erh tea contains caffeine. Animal research suggests that metformin can reduce caffeine metabolism. Theoretically, concomitant use can increase caffeine serum concentrations and the risk of caffeine adverse effects.

Likelihood Possible Evidence D

Methoxsalen (Oxsoralen)

Theoretically, methoxsalen might increase the levels and adverse effects of caffeine.
Pu-erh tea contains caffeine. Methoxsalen can reduce caffeine metabolism. Concomitant use can increase caffeine serum concentrations and the risk of caffeine adverse effects.

Likelihood Possible Evidence D

Mexiletine (Mexitil)

Theoretically, mexiletine might increase the levels and adverse effects of caffeine.
Pu-erh tea contains caffeine. Mexiletine can decrease caffeine elimination by 50%.

Likelihood Possible Evidence B

Phenothiazines

Theoretically, phenothiazines might increase the levels and adverse effects of caffeine. Also, pu-erh tea may bind to phenothiazines and reduce their absorption.
Pu-erh tea contains caffeine. Phenothiazines can reduce the metabolism of caffeine by inhibiting cytochrome P450 1A2 (CYP1A2). Additionally, the tannins in pu-erh tea may bind to phenothiazines in the gastrointestinal tract and reduce their absorption.

Likelihood Possible Evidence D

Quinolone Antibiotics

Theoretically, quinolone antibiotics might increase the levels and adverse effects of caffeine.
Pu-erh tea contains caffeine. Concomitant use of caffeine and quinolones can decrease caffeine clearance and increase effects and risk of adverse effects.

Likelihood Possible Evidence B

Terbinafine (Lamisil)

Theoretically, terbinafine might increase the levels and adverse effects of caffeine.
Pu-erh tea contains caffeine. Terbinafine decreases the clearance of intravenous caffeine by 19%.

Likelihood Possible Evidence B

Tiagabine (Gabitril)

Theoretically, pu-erh tea might increase the levels and adverse effects of tiagabine.
Pu-erh tea contains caffeine. Animal research suggests that chronic caffeine administration can increase the serum concentrations of tiagabine. However, concomitant use does not seem to reduce the antiepileptic effects of tiagabine.

Likelihood Possible Evidence D

Ticlopidine (Ticlid)

Theoretically, ticlopidine might increase the levels and adverse effects of caffeine.
Pu-erh tea contains caffeine. In vitro evidence suggests that ticlopidine can inhibit caffeine metabolism. However, this effect has not been reported in humans.

Likelihood Possible Evidence D

Tricyclic Antidepressants (Tcas)

Theoretically, TCAs might bind with pu-erh tea constituents when taken at the same time.
In vitro research suggests that the tannins in pu-erh tea might cause precipitation of TCAs. However, this effect has not been reported in humans.

Likelihood Possible Evidence D

Monograph

Pu-erh Tea: Uses, Safety & Side Effects

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

The bottom line

Pu-erh tea is a fermented, aged form of tea made from the same plant as green and black tea. It is enjoyed worldwide as a beverage and is sometimes promoted for weight loss, cholesterol, and digestion, but human evidence for these uses is limited. As a normal drink it is generally well tolerated, though it does contain caffeine.

Scientific name: Camellia sinensis
Family: Theaceae
Part used: Leaves (fermented/aged)
Common forms: Loose-leaf tea, compressed tea cakes, tea bags, capsules, extracts

People commonly use it for

Weight management
Cholesterol and heart health
Digestion after meals
Mental alertness
General antioxidant support

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

Safety at a glance

OverallUse caution

Generally safe as a beverage, but it contains caffeine and concentrated supplements are less studied.

PregnancyPossibly Safe

When used orally in moderate amounts. Due to the caffeine content of pu-erh tea, intake should be closely monitored during pregnancy to ensure moderat...

Read the full pregnancy detail

BreastfeedingPossibly Safe

When used orally in moderate amounts. Due to the caffeine content of pu-erh tea, caffeine intake should be closely monitored. Breast milk concentratio...

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.

Jump to a section

Overview

Pu-erh tea (sometimes spelled puer or pu'er) is a type of tea made from the leaves of the Camellia sinensis plant — the same plant used to make green, black, and oolong tea. What makes pu-erh different is how it is processed. The leaves go through a microbial fermentation and aging process, which can take months to many years. This gives pu-erh its dark color and rich, earthy flavor.

Pu-erh comes mainly from Yunnan province in China, where it has been produced and traded for centuries. It is often pressed into cakes, bricks, or other shapes for storage and aging. People usually drink it as a brewed tea, but it is also sold as capsules and extracts marketed as supplements.

How it works

Pu-erh contains many of the same compounds found in other teas, including caffeine, polyphenols (such as catechins and their fermentation byproducts called theabrownins), and other plant antioxidants. The fermentation and aging process changes some of these compounds, which is thought to give pu-erh its unique properties.

Laboratory and animal studies suggest that compounds in pu-erh may affect how the body handles fats and sugars and may have antioxidant activity. The caffeine content can stimulate the nervous system and mildly increase metabolism. It is important to know that much of this research is preliminary and based on cells or animals, so it does not prove the same effects happen in people drinking the tea.

Effectiveness

Does Pu-erh Tea work?

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

Evidence overview · 6 uses evaluated

6 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 Pu-erh Tea, current evidence isn’t strong enough to rate any specific use. The conditions it has been studied for are listed below.

Also studied for 6 conditions — evidence insufficient to rate

Insufficient Reliable Evidence To Rate Cognitive function

Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral pu-erh tea for cognitive function, there is insufficient reliable information about the clinical effects of pu-erh for this purpose.

Insufficient Reliable Evidence To Rate Diabetes

Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral pu-erh tea for diabetes, there is insufficient reliable information about the clinical effects of pu-erh tea for this purpose.

Insufficient Reliable Evidence To Rate Hyperlipidemia

Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral pu-erh tea for hyperlipidemia, there is insufficient reliable information about the clinical effects of pu-erh tea for this purpose.

Insufficient Reliable Evidence To Rate Mental alertness

Rating & evidence shown verbatim from Natural Medicines

It is unclear if oral pu-erh tea is beneficial for improving mental alertness.

Insufficient Reliable Evidence To Rate Nonalcoholic steatohepatitis (NASH)

Rating & evidence shown verbatim from Natural Medicines

Although there has been interest in using oral pu-erh tea for NASH, there is insufficient reliable information about the clinical effects of pu-erh tea for this purpose.

Insufficient Reliable Evidence To Rate Obesity

Rating & evidence shown verbatim from Natural Medicines

It is unclear if oral pu-erh tea is beneficial for improving weight loss.

Source & disclaimer. Effectiveness ratings and evidence summaries are provided by Natural Medicines (Therapeutic Research Center) and shown as licensed. Where Natural Medicines hasn’t rated a use, HelloPharmacist’s pharmacists may add their own reviewed rating and evidence (each such entry is labeled). This is educational information, not medical advice — talk with your pharmacist or doctor before starting, stopping, or changing a supplement.

Safety & precautions

As a beverage, pu-erh tea is generally considered safe for most healthy adults when consumed in normal amounts. The main thing to keep in mind is its caffeine content, which can affect sleep, anxiety, heart rate, and blood pressure in sensitive people.

People with heart conditions, anxiety disorders, acid reflux, or trouble sleeping should be cautious with caffeinated teas. Concentrated pu-erh supplements and extracts are not well studied, so their long-term safety is unknown.

Pregnancy: Caffeine crosses the placenta, and high intake during pregnancy is generally discouraged. If you are pregnant, limit caffeine and check with your doctor before drinking large amounts of pu-erh or using extracts.

Breastfeeding: Caffeine passes into breast milk and may affect some infants. Moderate tea intake is usually considered acceptable, but avoid concentrated extracts and talk to your healthcare provider.

Always tell your pharmacist or doctor about any teas, herbs, or supplements you use, especially if you take medications or have a health condition.

Side effects

Most side effects from pu-erh tea are related to its caffeine content. These can include trouble sleeping, jitteriness, a faster heartbeat, anxiety, headache, and stomach upset, especially with large amounts.

Drinking tea on an empty stomach may cause nausea in some people. Tea can also interfere with iron absorption when taken with meals. Very high or long-term intake of strong concentrated extracts is not well studied. If you notice an irregular heartbeat, severe stomach pain, or other concerning symptoms, stop using it and seek medical advice.

Pu-erh Tea: Reported Adverse Effects

Documented safety reports on Pu-erh Tea from the evidence-graded Natural Medicines (TRC Healthcare) database, shown word-for-word from the licensed record.

Orally, pu-erh tea is well tolerated when consumed as a beverage in moderate amounts.

Most Common Adverse Effects:

Orally: Many of the adverse effects of pu-erh tea can be attributed to its caffeine content, such as diuresis, gastric irritation, insomnia, nausea, nervousness, restlessness, tachycardia, tachypnea, tremors, and vomiting.

Serious Adverse Effects (Rare):

Orally: Many of the severe adverse effects of pu-erh tea can be attributed to its caffeine content, such as arrhythmia, chest pain, convulsions, delirium, premature heartbeat, and respiratory alkalosis. Large doses of caffeine can cause massive catecholamine release and subsequent sinus tachycardia, metabolic acidosis, hyperglycemia, and ketosis.

Reports by condition

Allergic rhinitis (hay fever) Immunologic

Pu-erh tea contains caffeine. Caffeine can cause anaphylaxis in sensitive individuals, although true IgE-mediated caffeine allergy seems to be relatively rare.

Infante S, Baeza ML, Calvo M, et al. Anaphylaxis due to caffeine. Allergy 2003;58:681-2.

Anemia Endocrine

Pu-erh tea contains caffeine. Some evidence has found that caffeine is associated with fibrocystic breast disease, breast cancer, and endometriosis; however, this is controversial since findings are conflicting. Restricting caffeine in those with fibrocystic breast conditions doesn't seem to affect breast nodularity, swelling, or pain. A population analysis of the Women's Health Initiative observational study has found no association between consumption of caffeine-containing beverages and the incidence of invasive breast cancer in models adjusted for demographic, lifestyle, and reproductive factors. Also, a dose-response analysis of 2 low-quality observational studies has found that high consumption of caffeine is not associated with an increased risk of breast cancer.

In infants, tea may cause microcytic anemia.

Anxiety Neurologic/CNS

Pu-erh tea contains caffeine. Orally, caffeine can cause insomnia, nervousness, headache, anxiety, agitation, jitteriness, restlessness, ringing in the ears, tremors, delirium, and convulsions. Caffeine may also exacerbate sleep disturbances in patients with acquired immunodeficiency syndrome (AIDS).

There is some concern that stopping regular use of caffeine may cause withdrawal symptoms such as headache, tiredness and fatigue, decreased energy, alertness, and attentiveness, drowsiness, depressed mood, difficulty concentrating, and irritability. Other symptoms such as delirium, nervousness, restlessness, and anxiety have been described. However, these symptoms may be from nonpharmacological factors related to knowledge and expectation of effects.

Schechter MD, Timmons GD. Objectively measured hyperactivity--II. Caffeine and amphetamine effects. J Clin Pharmacol 1985;25:276-80..
Institute of Medicine. Caffeine for the Sustainment of Mental Task Performance: Formulations for Military Operations. Washington, DC: National Academy Press, 2001. Available at: http://books.nap.edu/books/0309082587/html/index.html.
Holmgren P, Norden-Pettersson L, Ahlner J. Caffeine fatalities--four case reports. Forensic Sci Int 2004;139:71-3.
Leson CL, McGuigan MA, Bryson SM. Caffeine overdose in an adolescent male. J Toxicol Clin Toxicol 1988;26:407-15.
Dreher HM. The effect of caffeine reduction on sleep quality and well-being in persons with HIV. J Psychosom Res 2003;54:191-8..
Juliano LM, Griffiths RR. A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology (Berl) 2004;176:1-29.
Dews PB, Curtis GL, Hanford KJ, O'Brien CP. The frequency of caffeine withdrawal in a population-based survey and in a controlled, blinded pilot experiment. J Clin Pharmacol 1999;39:1221-32.
Dews PB, O'Brien CP, Bergman J. Caffeine: behavioral effects of withdrawal and related issues. Food Chem Toxicol 2002;40:1257-61.

Arrhythmia Cardiovascular

Pu-erh tea contains caffeine. Although acute consumption of caffeine can cause increased blood pressure, regular consumption does not seem to increase either blood pressure or pulse, even in mildly hypertensive patients. Epidemiological research suggests there is no association of caffeine consumption with incidence of hypertension. Some evidence suggests chronic consumption of pu-erh tea may reduce the risk of hypertension.

Epidemiological research has found that regular caffeine intake of up to 400 mg daily, or approximately 4 cups of tea, is not associated with an increased incidence of atrial fibrillation, atherosclerosis, cardiac ectopy, stroke, ventricular arrhythmia, and cardiovascular disease in general.

Bone loss Musculoskeletal

Pu-erh tea contains caffeine. Some epidemiological research has found that caffeine may be associated with an increased risk of osteoporosis, but conflicting evidence exists. Caffeine can increase urinary excretion of calcium. Females with a genetic variant of the vitamin D receptor appear to be at an increased risk for the detrimental effect of caffeine on bone mass. However, moderate caffeine intake of less than 400 mg daily, or about 4 cups of tea, does not seem to significantly increase osteoporosis risk in most postmenopausal adults with normal calcium intake.

Some researchers believe that stopping regular use of caffeine may cause withdrawal symptoms such as muscle tension and muscle pains. However, these symptoms may be from nonpharmacological factors related to knowledge and expectation of effects.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Adverse-effects data: Natural Medicines, Therapeutic Research Center

Dosing

There is no official or standardized dose of pu-erh tea for any health condition. Most people simply drink it as a brewed beverage, often one to several cups per day.

For supplement capsules or extracts, follow the directions on the product label, since strength varies between products. Because these concentrated forms are not well studied, it is wise to start low and check with a pharmacist or doctor before using them, particularly if you are sensitive to caffeine, are pregnant or breastfeeding, or take other medications.

Pregnancy & Breastfeeding

Pu-erh Tea & Pregnancy

Possibly Safe

When used orally in moderate amounts. Due to the caffeine content of pu-erh tea, intake should be closely monitored during pregnancy to ensure moderate consumption. Fetal blood concentrations of caffeine approximate maternal concentrations. Use of caffeine in pregnancy is controversial; however, moderate consumption has not been associated with clinically important adverse fetal effects. In some studies, consuming caffeine in amounts over 200 mg daily is associated with a significantly increased risk of miscarriage. This increased risk may be most likely to occur in those with genotypes that confer a slow rate of caffeine metabolism. According to a review by Health Canada, and a subsequent large meta-analysis conducted in the US, most healthy pregnant adults can safely consume caffeine doses up to 300 mg daily without an increased risk of spontaneous abortion, stillbirth, preterm birth, fetal growth retardation, or congenital malformations. Advise keeping caffeine consumption below 300 mg daily during pregnancy. This is similar to the amount of caffeine found in about 3 cups of tea.

Briggs GB, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1998.
The National Toxicology Program (NTP). Caffeine. Center for the Evaluation of Risks to Human Reproduction (CERHR). Available at: http://cerhr.niehs.nih.gov/common/caffeine.html.
Klebanoff MA, Levine RJ, DerSimonian R, et al. Maternal serum paraxanthine, a caffeine metabolite, and the risk of spontaneous abortion. N Engl J Med 1999;341:1639-44.
Eskenazi B. Caffeine—filtering the facts. N Engl J Med 1999;341:1688-9.
Fernandes O, Sabharwal M, Smiley T, et al. Moderate to heavy caffeine consumption during pregnancy and relationship to spontaneous abortion and abnormal fetal growth: a meta-analysis. Reprod Toxicol 1998;12:435-44.
Bracken MB, Triche EW, Belanger K, et al. Association of maternal caffeine consumption with decrements in fetal growth. Am J Epidemiol 2003;157:456-66..
Wikoff D, Welsh BT, Henderson R, et al. Systematic review of the potential adverse effects of caffeine consumption in healthy adults, pregnant women, adolescents, and children. Food Chem Toxicol 2017;109:585-648.
Weng X, Odouli R, Li DK. Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study. Am J Obstet Gynecol 2008;198:279.e1-8.
Greenwood, D. C., Alwan, N., Boylan, S., Cade, J. E., Charvill, J., Chipps, K. C., Cooke, M. S., Dolby, V. A., Hay, A. W., Kassam, S., Kirk, S. F., Konje, J. C., Potdar, N., Shires, S., Simpson, N., Taub, N., Thomas, J. D., Walker, J., White, K. L., and
Nawrot P, Jordan S, Eastwood J, et al. Effects of caffeine on human health. Food Addit Contam 2003;20:1-30.

Possibly Unsafe

When used orally in large amounts. Caffeine from pu-erh tea crosses the placenta, producing fetal blood concentrations similar to maternal levels. Consumption of caffeine in amounts over 300 mg daily is associated with a significantly increased risk of miscarriage in some studies. Advise keeping caffeine consumption from all sources below 300 mg daily during pregnancy. This is similar to the amount of caffeine in about 3 cups of tea. High intake of caffeine throughout pregnancy has resulted in symptoms of caffeine withdrawal in newborn infants. High doses of caffeine have also been associated with spontaneous abortion, premature delivery, and low birth weight. In a study that included 2 large cohorts of mother/infant pairs, the first cohort with a median maternal plasma caffeine level of 168.5 ng/mL (range 29.5-650.5 ng/mL) during pregnancy, suggests birth weights and lengths were lower in the 4th quartile of caffeine intake compared with the 1st. By age 7, heights and weights were lower by 1.5 cm and 1.1 kg respectively. In the second cohort of mother/infant pairs with higher maternal pregnancy plasma caffeine levels, median 625.5 ng/mL (range 86.2 to 1994.7 ng/mL), heights at age 8 were 2.2 cm lower, but there was no difference in weights.

Pu-erh Tea & Breastfeeding

Possibly Safe

When used orally in moderate amounts. Due to the caffeine content of pu-erh tea, caffeine intake should be closely monitored. Breast milk concentrations of caffeine are thought to be approximately 50% of maternal serum concentrations and caffeine peaks in milk approximately 1-2 hours after consumption. POSSIBLY UNSAFE...when used orally in large amounts. Consumption of pu-erh tea might cause irritability and increased bowel activity in nursing infants. Large doses or excessive intake of pu-erh tea should be avoided during lactation.

Pregnancy & lactation ratings: Natural Medicines, Therapeutic Research Center

References & further reading

The 135 references that drive our Pu-erh Tea 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.

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Caldeira D, Martins C, Alves LB, Pereira H, Ferreira JJ, Costa J. Caffeine does not increase the risk of atrial fibrillation: a systematic review and meta-analysis of observational studies. Heart. 2013;99(19):1383-9. doi: 10.1136/heartjnl-2013-303950. Re PubMed
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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.

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.

Pharmacist Counseling Corner

Pu-erh Tea: Common Questions

What is Pu-erh Tea used for, and does it work?

People use Pu-erh Tea for a range of reasons, but according to the Natural Medicines database the current clinical evidence is insufficient to confirm it works for the specific conditions it has been studied for. See the graded list on this page, and talk to your pharmacist or doctor before relying on it for any condition.

Does Pu-erh Tea interact with prescription medications?

Yes. We list 667 medications with a known interaction with Pu-erh Tea, including 9 rated major. Use the checker above to see how Pu-erh Tea interacts with a specific drug.

How are Pu-erh Tea interactions rated?

Each interaction is graded major, moderate, or minor based on how clinically significant it is and the strength of the evidence behind it. Major interactions are the most serious and are best avoided, or used only under close professional supervision.

Is it safe to take Pu-erh Tea with my medications?

It depends on the specific medication. Some combinations are fine, while others call for monitoring, timing changes, or should be avoided. Check your exact drug above and confirm with your pharmacist or doctor before starting, stopping, or changing anything.

Where does this Pu-erh Tea interaction information come from?

Our interaction data is built on the Natural Medicines database — an evidence-graded reference for vitamins, herbs, and supplements — and is reviewed by licensed HelloPharmacist pharmacists, who may add clinical context.

What is Pu-erh Tea used for?

People commonly drink Pu-erh Tea for weight management, cholesterol and heart health, digestion after meals, and alertness. However, strong human evidence for most of these uses is limited, so it is best thought of as an enjoyable beverage.

Does Pu-erh Tea contain caffeine?

Yes. Like green and black tea, pu-erh is made from the Camellia sinensis plant and naturally contains caffeine, which can affect sleep, anxiety, and heart rate in sensitive people.

Can Pu-erh Tea help me lose weight?

Some early lab, animal, and small human studies hint at possible effects on fat metabolism, but the evidence is weak and inconsistent. Pu-erh is not a proven weight-loss treatment, and a healthy diet and exercise matter far more.

Is Pu-erh Tea safe during pregnancy?

Because it contains caffeine, it is best to limit pu-erh during pregnancy and talk to your doctor. Avoid concentrated extracts, which are not well studied.

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

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Pu-erh Tea Drug Interactions, Uses, Effectiveness, Safety & More

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Pu-erh Tea Drug Interactions: The Bottom Line

Drugs that interact with Pu-erh Tea

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What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

Likelihood — How Well It’s Documented

Where This Data Comes From

The kinds of drugs Pu-erh Tea affects

Pu-erh Tea: Uses, Safety & Side Effects

Overview

How it works

Does Pu-erh Tea work?

Safety & precautions

Side effects

Pu-erh Tea: Reported Adverse Effects

Dosing

Pu-erh Tea & Pregnancy

Pu-erh Tea & Breastfeeding

References & further reading

Pu-erh Tea: Common Questions

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