Herb & supplement monograph

Quassia Drug Interactions, Uses, Effectiveness, Safety & More

Check Quassia against your medication

Add one medication
Quassia
+
Start typing any prescription or over-the-counter drug name.
Reviewed by licensed pharmacists Sourced from Natural Medicines

Quassia 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 Quassia drug interaction appears low for most people, since none of the reported interactions are well documented in humans. No interactions are rated major, and while most carry a moderate rating, every one rests on animal, lab, or theoretical evidence rather than proven human effects.

Interactions deserving the most attention

The combinations worth the closest watch involve medicines where even a small shift matters. Animal research suggests quassia may lower blood sugar, so people taking diabetes medications could face a higher chance of low blood sugar and should keep an eye on their glucose readings. Quassia might also add to the effects of digoxin, a heart medicine with a narrow safety margin, and heavy use could worsen potassium loss in people on potassium-depleting diuretics.

What the rest of the list means

A long list of interacting medications does not mean each combination is harmful. Most entries here are theoretical, and none have been confirmed in human studies. For example, because quassia is thought to raise stomach acid, it is flagged with acid-reducing medicines like antacids, H2-blockers, and PPIs, but only as a possible drop in their effectiveness, not a safety risk.

Check your medications against Quassia

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

Interaction report

Drugs that interact with Quassia

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

2,830 drugs
AcarboseGlucobay, Prandase, Precose› Acetaminophen, Caffeine, PyrilamineMidol Max Strength Menstrual› Acetaminophen, Pamabrom, PyrilamineMidol Max Strength PMS, Pamprin, Pamprin ES› AcetazolamideAk-Zol, Diamox› AcetohexamideDymelor› AlbiglutideTanzeum› AlogliptinNesina› Alogliptin, MetforminKazano› Alogliptin, PioglitazoneOseni› Amiloride, HydrochlorothiazideAmil-Co, Amilzide, Moduret 25, Moduretic› Ammonium ChlorideAmmonium Chloride› Antidiabetes, Dipeptidyl Peptidase-4 (dpp-iv) InhibitorGlyxambi› Atenolol, ChlortalidoneAtenixCo, Tenoret 50, Totaretic› Atenolol, ChlorthalidoneTenoretic› Azilsartan, ChlorthalidoneEdarbyclor› Benazepril, HydrochlorothiazideLotensin HCT› BendroflumethiazideAprinox, Naturetin, Neo-NaClex› Bendroflumethiazide, NadololCorzide› Bendroflumethiazide, PotassiumCentyl K, Neo-NaClex-K› Bendroflumethiazide, Rauwolfia SerpentinaRauzide› BenzthiazideExna› Bisoprolol, HydrochlorothiazideZiac› BumetanideBurinex› Bumetanide, PotassiumBurinex K› Caffeine, Potassium Salicylate, SalicylamideTrim-Elim› CanagliflozinInvokana› Canagliflozin, MetforminInvokamet› Canagliflozin, Metformin HydrochlorideInvokamet XR› Candesartan Cilexetil, HydrochlorothiazideAtacand HCT› Captopril, HydrochlorothiazideAcezide, Capozide›
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 Quassia 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 Quassia affects

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

All 6 drug categories Quassia interacts with
Antidiabetes DrugsDigoxin (lanoxin)Diuretic DrugsAntacidsH2-blockersProton Pump Inhibitors (ppis)
Antidiabetes Drugs

In animals, quassia extract reduced levels of fasting glucose. Theoretically, quassia might have additive effects when used with antidiabetes drugs. This might increase the risk of hypoglycemia in some patients. Monitor blood glucose levels closely.
Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, metformin (Glucophage), pioglitazone (Actos), rosiglitazone (Avandia), and others.

Likelihood Possible Evidence D
Digoxin (Lanoxin)

Theoretically, concomitant use with cardiac medications might increase the risk of therapeutic and adverse effects.

Likelihood Possible Evidence D
Diuretic Drugs

Overuse of quassia might compound diuretic-induced potassium loss. There is some concern that people taking quassia along with potassium depleting diuretics might have an increased risk for hypokalemia. Initiation of potassium supplementation or an increase in potassium supplement dose may be necessary for some patients.
Some diuretics that can deplete potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), and hydrochlorothiazide (HCTZ, Hydrodiuril, Microzide), and others.

Likelihood Possible Evidence D
Antacids

Theoretically, due to reports that quassia increases stomach acid, quassia might decrease the effectiveness of antacids.

Likelihood Possible Evidence D
H2-Blockers

Theoretically, due to reports that quassia increases stomach acid, quassia might decrease the effectiveness of H2-blockers. The H2 blockers include cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid), and famotidine (Pepcid).

Likelihood Possible Evidence D
Proton Pump Inhibitors (Ppis)

Theoretically, due to reports that quassia increases stomach acid, quassia might decrease the effectiveness of PPIs. PPIs include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium).

Likelihood Possible Evidence D
Monograph

Quassia: Uses, Safety & Side Effects

The bottom line

Quassia is a tropical wood known for its very bitter taste, traditionally used as a digestive bitter and as a folk remedy for parasites and head lice. Human evidence for these uses is limited, and high doses may irritate the stomach, so it should be used cautiously and avoided in pregnancy.

Scientific name
Quassia amara
Family
Simaroubaceae
Part used
Wood (bark and stem wood)
Common forms
Dried wood chips, tea/infusion, liquid extract, tincture, capsules, and topical lotions
People commonly use it for
  • Loss of appetite
  • Digestive upset
  • Head lice (topical)
  • Intestinal worms/parasites
  • Bitter tonic

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

Safety at a glance
OverallUse caution

Likely fine in small amounts used in foods, but larger or long-term doses may irritate the digestive tract.

PregnancyLikely Unsafe

When used orally; avoid using. Quassia has cytotoxic and emetic properties. There is insufficient reliable information available about the safety of r...

Read the full pregnancy detail
BreastfeedingLikely Unsafe

When used orally; avoid using. Quassia has cytotoxic and emetic properties. There is insufficient reliable information available about the safety of r...

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

Quassia comes from the wood of Quassia amara, a small tropical shrub or tree in the Simaroubaceae family. It grows in Central and South America. A related tree, Picrasma excelsa (sometimes also called Jamaican quassia), is used in a similar way.

The wood is famous for being intensely bitter, which is where most of its traditional uses come from. People have long used quassia as a digestive "bitter" to stimulate appetite, as a folk remedy for intestinal worms, and applied to the scalp for head lice. It is also used as a natural bittering agent in some foods, drinks, and tonics.

How it works

Quassia contains bitter compounds called quassinoids, including quassin and neoquassin. These give the wood its strong bitter taste.

The bitter taste is thought to trigger taste receptors and increase the flow of saliva and digestive juices, which is the traditional reasoning behind its use as a digestive bitter. In laboratory and animal research, quassinoids have also shown effects against certain insects and parasites. Keep in mind that much of this is based on test-tube and animal studies, so it may not reflect what happens in people.

Effectiveness

Does Quassia work?

Evidence overview · 3 uses evaluated
3 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 Quassia, current evidence isn’t strong enough to rate any specific use. The conditions it has been studied for are listed below.

Also studied for 3 conditions — evidence insufficient to rate
Insufficient Reliable Evidence To Rate Lice
Rating & evidence shown verbatim from Natural Medicines

Preliminary clinical research shows that a single application of quassia tincture can kill head lice. However, the single application of quassia tincture resulted in 0.6% reinfestation rate after a week. Researchers suggest that two applications with a one-week interval between them might be more effective.

Sources Ref 17492
Insufficient Reliable Evidence To Rate Rosacea
Rating & evidence shown verbatim from Natural Medicines

Preliminary clinical research in patients with rosacea shows that applying quassia 4% gel twice daily for 45 days reduces flushing, redness, and telangiectasia by approximately 74%, 56%, and 50%, respectively, compared with baseline. A moderate to complete overall improvement occurred in 89% of patients. The validity of these results is limited by a lack of control group.

Sources Ref 99995
Insufficient Reliable Evidence To Rate Seborrheic dermatitis
Rating & evidence shown verbatim from Natural Medicines

Preliminary clinical research shows that applying quassia 4% gel twice daily for 28 days results in complete remission in 29.4% of patients with seborrheic dermatitis. This response rate is higher than the 5.6% and 7.1% response rate for patients using 1% ciclopirox olamine or 2% ketoconazole. At one-month post-treatment, quassia was more effective than the other two treatments for avoiding relapse. However, the lack of placebo group makes conclusions difficult.

Sources Ref 99994

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

Quassia is generally considered safe in the small amounts used to flavor foods and drinks. Larger amounts taken as supplements or strong teas may irritate the stomach and intestines.

People with stomach ulcers, gastritis, or other digestive conditions should be cautious. Because reliable safety data are limited, it is best to use the smallest effective amount and only for short periods.

Pregnancy: Avoid quassia during pregnancy. It has traditionally been considered unsuitable in pregnancy, and there is not enough safety information.

Breastfeeding: Avoid use while breastfeeding because there is not enough information about its safety for the baby.

Always talk with your pharmacist or doctor before starting quassia, especially if you take medications or have a health condition.

Side effects

When used in small amounts, quassia is usually well tolerated. Larger doses may cause:

  • Stomach upset, nausea, or vomiting
  • Irritation of the digestive tract

Very large amounts of bitter herbs may cause more significant digestive irritation. When used topically for lice, it may rarely cause skin or scalp irritation. If you notice an allergic reaction or severe discomfort, stop using it and seek medical advice.

Quassia: Reported Adverse Effects

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

Orally, quassia can cause mucous membrane irritation, nausea, and vomiting when used in medicinal amounts. Long-term use can cause vision changes and blindness.

Topically, quassia seems to be well tolerated. No adverse effects have been reported.

  1. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
  2. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  3. Ferrari A, Diehl C. Evaluation of the efficacy and tolerance of a topical gel with 4% quassia extract in the treatment of rosacea. J Clin Pharmacol. 2012;52(1):84-8.
Reports by condition
Nausea and vomiting Gastrointestinal

Orally, quassia has been reported to cause mucous membrane irritation, nausea, and vomiting when used in medicinal amounts.

  1. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
  2. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
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 well-established, standardized dose for quassia. Traditional preparations include a bitter tea made from a small amount of wood chips, as well as tinctures and capsules.

Because the strength of products varies and reliable dosing studies are lacking, follow the directions on the product label and use the lowest amount that works. Check with a pharmacist or doctor before use, especially if you are taking other medicines or have a medical condition. Avoid large or long-term doses.

Pregnancy & Breastfeeding

Quassia & Pregnancy

Likely Unsafe

When used orally; avoid using. Quassia has cytotoxic and emetic properties. There is insufficient reliable information available about the safety of rectal or topical use during pregnancy or lactation; avoid using.

  1. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
  2. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  3. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.

Quassia & Breastfeeding

Likely Unsafe

When used orally; avoid using. Quassia has cytotoxic and emetic properties. There is insufficient reliable information available about the safety of rectal or topical use during pregnancy or lactation; avoid using.

  1. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
  2. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  3. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
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.

© 2026 Therapeutic Research Center

Pregnancy & lactation ratings: Natural Medicines, Therapeutic Research Center

References & further reading

The 8 references that drive our Quassia 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. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
  2. Robbers JE, Speedie MK, Tyler VE. Pharmacognosy and Pharmacobiotechnology. Baltimore, MD: Williams & Wilkins, 1996.
  3. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  4. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  5. Jensen O, Nielsen AO, Bjerregaard P. Pediculosis capitis treated with quassia tincture. Acta Derm Venereol 1978;58:557-9. DOI
  6. Diehl C, Ferrari A. Efficacy of topical 4% Quassia amara gel in facial seborrheic dermatitis:a randomized, double-blind, comparative study. J Drugs Dermatol. 2013;12(3):312-5.
  7. Ferrari A, Diehl C. Evaluation of the efficacy and tolerance of a topical gel with 4% quassia extract in the treatment of rosacea. J Clin Pharmacol. 2012;52(1):84-8. PubMed
  8. Husain GM, Singh PN, Singh RK, Kumar V. Antidiabetic activity of standardized extract of Quassia amara in nicotinamide-streptozotocin-induced diabetic rats. Phytother Res. 2011;25(12):1806-12.
Keep reading

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.

© 2021 Therapeutic Research Center, LLC

Pharmacist Counseling Corner

Quassia: Common Questions

What is Quassia used for, and does it work?
People use Quassia 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 Quassia interact with prescription medications?
Yes. We list 198 medications with a known interaction with Quassia. Use the checker above to see how Quassia interacts with a specific drug.
How are Quassia 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 Quassia 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 Quassia 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 Quassia used for?
It is most often used as a bitter digestive tonic to stimulate appetite, and traditionally for intestinal worms and as a topical treatment for head lice. Strong evidence is limited for these uses.
Is Quassia safe to take?
Small amounts used to flavor foods and drinks are generally considered safe, but larger doses can irritate the stomach. Use the smallest amount needed and talk with your pharmacist or doctor first.
Can I use Quassia if I'm pregnant or breastfeeding?
No. It's best to avoid Quassia during pregnancy and breastfeeding because there isn't enough safety information and it has traditionally been considered unsuitable in pregnancy.
Why is Quassia so bitter?
Its wood contains bitter compounds called quassinoids, such as quassin, which are among the most bitter natural substances known. This bitterness is the basis for its use as a digestive bitter.

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

Have a question about Quassia?

Our pharmacists answer your medication & supplement questions — free.

Ask a pharmacist