Balance Ingredients & Drug Interactions
by Vali
What is this page for?
First and foremost: checking Balance against your medications. The heart of this page is the interaction checker and the full interaction report — how this product’s ingredients may interact with prescription and over-the-counter medicines you may be taking.
Around that, we add a pharmacist’s high-level view of the product as a whole — what’s inside, the evidence for its stated use, how transparent the label is, and what safety data exists — so you can see the full picture in one place. It’s educational information from our licensed clinical databases and the clinical staff at HelloPharmacist — not medical advice — and we don’t sell or endorse products. Our editorial policy
Balance is a dietary supplement by Vali with 5 active ingredients. Its ingredients are commonly taken for sore throat and cough, heartburn and stomach upset, mouth ulcers and digestive complaints.Based on those ingredients, 1,415 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are St. John's Wort extract, Licorice Root Extract, Black Cohosh Root Extract. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Balance by Vali
Ask about any prescription or over-the-counter medication and we check it for interactions with Balance by Vali — and tell you which ingredient is responsible.
AI summaries are generated from our interaction database for education only — always confirm with your pharmacist. How we use AI
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HelloPharmacist Scorecard of Balance by Vali
Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.
What’s inside
Full disclosure
Balance contains five active herbal extracts: Licorice Root, Black Cohosh Root, Dong Quai Root, Chasteberry Berry, and St. John's Wort.
The capsules also contain inactive ingredients (hydroxypropyl methylcellulose, microcrystalline cellulose, magnesium stearate, and silicon dioxide) that serve as binders and fillers. Each ingredient has been traditionally used for different purposes — licorice for skin conditions, black cohosh and chasteberry for hormonal balance, dong quai in traditional medicine, and St.
John's Wort for mood support. The specific amounts of each extract aren't detailed in our data, so ask the pharmacist if you need those details.
Does it work?
Strong evidence
Our data shows mixed evidence for the ingredients in this blend. Licorice Root is possibly effective for eczema and canker sores, though evidence for Addison disease and asthma is insufficient.
Black Cohosh is possibly effective for menopausal hot flashes but shows insufficient evidence for acne, sexual dysfunction, anxiety, and breast cancer-related symptoms. Dong Quai carries insufficient evidence for anemia, osteoporosis, heart disease, migraine, and eczema.
Chasteberry is possibly effective for premenstrual syndrome and breast tenderness (mastalgia) but possibly ineffective for fracture healing, with insufficient data on aging skin, PMDD, and anxiety. St.
John's Wort is likely effective for depression and possibly effective for somatic symptom disorder and menopausal symptoms, but possibly ineffective for HIV and irritable bowel syndrome. The overall effectiveness of Balance as a combined product isn't established in our data.
If you're considering it for a specific condition, talk with your pharmacist about whether the individual ingredients match your goal.
How safe is it?
Well-documented data
The five ingredients are generally well tolerated at typical doses in the short term. Licorice Root's most common side effects when taken orally are headache, nausea, and vomiting; topically it can cause contact dermatitis.
At high doses or with long-term use, the compound glycyrrhizin in licorice can cause serious problems including potassium loss and fluid retention. Black Cohosh commonly causes breast tenderness, dizziness, headache, gastrointestinal upset, rash, and tiredness, with rare reports of liver toxicity.
Dong Quai is generally well tolerated orally but may cause burping and flatulence; it can increase sun sensitivity. Chasteberry commonly causes diarrhea, fatigue, headache, irregular menstruation, nausea, and stomach upset.
St. John's Wort typically causes diarrhea, dizziness, dry mouth, headache, insomnia, and fatigue; it causes photodermatitis (sun-triggered skin reaction) with chronic use and can trigger mania or psychosis in some people.
Pregnancy and breastfeeding: Licorice is unsafe in pregnancy and should be avoided while breastfeeding. Black Cohosh and Dong Quai are possibly unsafe in pregnancy and should be avoided while breastfeeding.
Chasteberry is possibly unsafe in both pregnancy and lactation. St.
John's Wort is possibly unsafe in pregnancy and may pass into breast milk, so avoid it while breastfeeding. If you are pregnant, planning pregnancy, or nursing, talk with your doctor or pharmacist before taking Balance.
Meds to double-check
Major interaction found
Before taking Balance, check with your pharmacist if you take any of these: digoxin or other heart medications, warfarin or other blood thinners, seizure medications (phenytoin, phenobarbital, mephenytoin), cancer drugs (irinotecan, docetaxel, cisplatin, paclitaxel), HIV protease inhibitors, tacrolimus or other immunosuppressants, metoclopramide, birth control pills or estrogen therapy, antipsychotic medications, antidepressants (especially serotonergic types like sertraline or duloxetine), dopamine agonists, or any drug metabolized by your liver's CYP2B6, CYP2C19, or CYP3A4 enzymes. These represent the major and moderate interactions documented for the ingredients we could check.
The bottom line
Scorecard at a glanceFully disclosed formula with strong clinical evidence behind its ingredients' uses. Major medication interactions have been identified, and safety information is well characterized.
Balance combines five herbal extracts with a long history in traditional medicine, but it carries substantial interactions with many medications and serious concerns in pregnancy and while breastfeeding. If you take any prescription drugs — especially heart or blood-thinning medications, seizure or psychiatric drugs, or cancer treatments — you must check your specific medications against the tool on this page before starting.
Talk with your pharmacist about whether Balance fits your health goals and your personal medication list.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 5 of 5 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Feb 21, 2023.
This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed
General information
Key facts about Balance, straight from the product label.
| Brand | Vali |
|---|---|
| Barcode (UPC) | X002N9SSXD |
| Net contents | 60 Vegetarian Capsule(s) |
| Market status | On market |
| Date entered into DSLD | Feb 21, 2023 |
| DSLD ID | 284127 |
| Product type | Botanical |
| Supplement form | Capsule |
| Dietary claims / uses | All Other, Structure/Function |
| Intended target group(s) | Vegan, Vegetarian, Women (not pregnant or lactating), Adult Female (18 - 50 Years), Menopause, Seniors/Mature (>50 Years) - Women ONLY |
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.
Supplement Facts
The label details for Balance by Vali, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Licorice Root Extract | 280 mg | -- |
| Black Cohosh Root Extract | 150 mg | -- |
| Dong Quai Root Extract | 80 mg | -- |
| Chasteberry Berry Extract, Dried | 325 mg | -- |
| St. John's Wort extract | 125 mg | -- |
Other ingredients: Hydroxypropyl Methylcellulose, Microcrystalline Cellulose, Magnesium Stearate, Silicon Dioxide
Tap any ingredient to jump to its full detail below.
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
Precautions
Warning: Do not exceed recommended dose.
Do not take if pregnant, nursing, or under 18 years old.
Do not take if pregnant, nursing, or under 18 years old.
If you have a medical condition, consult your physician before use. Do not use if safety seal is broken or missing.
Keep out of reach of children.
Manufactured in a facility and equipment that handles: eggs, wheat, milk, tree nuts, peanuts, soybeans, crustacean shellfish, and fish.
Storage
Store in a cool dry place.
Formulation
No Artificial flavors Preservatives Animal products
Suitable for vegetarians Vegan
Made with Non GMO ingredients
Full transparency formula
Menopause relief
Hormonal balance Menopausal support
Made with eco-friendly manufacturing in an FDA registered facility.
Balance and relieve your body and mind
Seals/Symbols
GMP Good Manufacturing Practice Quality Product Made in U.S.A.
Suggested/Recommended/Usage/Directions
Suggested Use: To support menopause symptom relief Take 2 capsules once daily with food. For best results drink plenty of water daily.
FDA Statement of Identity
Dietary Supplement
FDA Disclaimer Statement
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Balance by Vali label
The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.
Label images are published by the NIH Dietary Supplement Label Database for the version of this product on file. Always read your actual product label.
View the full label (PDF)The Ingredients in Balance by Vali
These are the 5 active ingredients this product is made of. Select any to open its full monograph.
Serving size2 Vegetarian Capsule(s) Dosage formCapsule Servings per container30 Amounts shown are per serving.
Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.
Licorice Root Extract
Interacts with1,040 drugs
Licorice root is a traditional remedy used for sore throats, coughs, and digestive complaints, but solid human evidence is limited for most uses. Regu...
Licorice Root Extract monograph & interactionsBlack Cohosh Root Extract
Interacts with652 drugs
Black cohosh is a North American plant most often used to ease menopause symptoms like hot flashes, but the research is mixed and far from settled. It...
Black Cohosh Root Extract monograph & interactionsDong Quai Root Extract
Interacts with163 drugs
Dong Quai is a traditional Chinese herb often called "female ginseng" and is mostly used for menstrual and menopausal complaints. High-quality scienti...
Dong Quai Root Extract monograph & interactionsChasteberry Berry Extract, Dried
Interacts with121 drugs
Vitex (chasteberry) is an herbal remedy most often used for PMS and menstrual cycle problems, and the strongest evidence is for easing some PMS sympto...
Chasteberry Berry Extract, Dried monograph & interactionsSt. John's Wort extract
Interacts with1,143 drugs
St. John's wort is a well-studied herb most often used for mild to moderate depression, and some research suggests it may help with this. However, it...
St. John's Wort extract monograph & interactionsOther (inactive) ingredients: Hydroxypropyl Methylcellulose, Microcrystalline Cellulose, Magnesium Stearate, Silicon Dioxide. These complete the product’s ingredient list but are not active constituents.
Balance by Vali Drug Interactions
HelloPharmacist Interaction Report
Vali Balance is a five-ingredient herbal supplement that carries significant documented interactions with medications.
The most serious concern is with St. John's Wort, which has Major-severity interactions affecting multiple drug classes.
St. John's Wort reduces levels of digoxin (a heart medication), seizure drugs like phenytoin and phenobarbital, cancer medications including irinotecan and docetaxel, HIV protease inhibitors, and the immunosuppressant tacrolimus — potentially causing treatment failure in each case.
Read the full breakdown — every affected drug type, severity by severity
Dong Quai carries a Major-severity interaction with warfarin (a blood thinner), increasing bleeding risk. Licorice Root has Moderate interactions with digoxin and warfarin, loop diuretics, cancer drugs (cisplatin and paclitaxel), and drugs processed by your liver's CYP2B6 and CYP2C19 enzymes.
Black Cohosh interacts Moderately with drugs that raise bleeding risk, hepatotoxic (liver-damaging) medications, liver-metabolized drugs like atorvastatin, cancer therapies, estrogens, and serotonergic antidepressants. Chasteberry has Moderate interactions with metoclopramide, birth control pills, estrogens, antipsychotics, and dopamine agonists.
Altogether, these interactions span 1,394 individual medications. If you take any prescription medication — especially heart drugs, anticoagulants, seizure or psychiatric medications, or cancer treatments — check your exact drugs against the search tool on this page before starting Balance.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Balance?
Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.
Go to the checkerIngredients driving the most interactions
Individual Drug Interactions
The ingredients in Balance interact with 1,415 drugs. Click any drug to see the details.
5 of the 5 ingredients in Balance interact with drugs. Each result below shows which ingredient is responsible. St. John's Wort extract Licorice Root Extract Black Cohosh Root Extract Dong Quai Root Extract Chasteberry Berry Extract, Dried
Ado-trastuzumab EmtansineKadcyla
How Ado-trastuzumab Emtansine interacts with Balance — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Extract + Ado-trastuzumab Emtansine interactionLicorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Ado-trastuzumab Emtansine interactionAbemaciclibVerzenio
How Abemaciclib interacts with Balance — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates Major
Licorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Abemaciclib interactionAbiraterone
How Abiraterone interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates Major
Licorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Abiraterone interactionBlack Cohosh Root ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Abiraterone interactionAbiraterone AcetateYonsa, Zytiga
How Abiraterone Acetate interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates Major
Black Cohosh Root ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Abiraterone Acetate interactionLicorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Abiraterone Acetate interactionAcalabrutinibCalquence
How Acalabrutinib interacts with Balance — through 2 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates, P-glycoprotein Substrates Major
Licorice Root ExtractP-glycoprotein Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the absorption of P-glycoprotein substrates.
Read the full Licorice Root Extract + Acalabrutinib interactionAcetaminophen, Aspirin, CaffeineExcedrin, Excedrin Extra Strength, Excedrin Migraine
How Acetaminophen, Aspirin, Caffeine interacts with Balance — through 4 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Extract + Acetaminophen, Aspirin, Caffeine interactionDong Quai Root ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, dong quai may increase the risk of bleeding when used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Dong Quai Root Extract + Acetaminophen, Aspirin, Caffeine interactionLicorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Acetaminophen, Aspirin, Caffeine interactionBlack Cohosh Root ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Acetaminophen, Aspirin, Caffeine interactionAcetaminophen, Butalbital, CaffeineEsgic, Esgic Plus, Fiogesic, Fioricet, Repan, Tecnal +1 more
How Acetaminophen, Butalbital, Caffeine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Extract + Acetaminophen, Butalbital, Caffeine interactionLicorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Butalbital, Caffeine interactionBlack Cohosh Root ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Acetaminophen, Butalbital, Caffeine interactionAcetaminophen, Butalbital, Caffeine, CodeineEsgic with Codeine, Fioricet w/ Codeine
How Acetaminophen, Butalbital, Caffeine, Codeine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Extract + Acetaminophen, Butalbital, Caffeine, Codeine interactionLicorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Acetaminophen, Butalbital, Caffeine, Codeine interactionBlack Cohosh Root ExtractCytochrome P450 2d6 (cyp2d6) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Some research suggests that black cohosh might inhibit CYP2D6, but there is conflicting evidence.
Read the full Black Cohosh Root Extract + Acetaminophen, Butalbital, Caffeine, Codeine interactionAcetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, PhenylephrineHycomine Compound
How Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Major
Licorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine interactionBlack Cohosh Root ExtractHepatotoxic Drugs, Cytochrome P450 2d6 (cyp2d6) Substrates Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine interactionAcetaminophen, Caffeine, CodeineGesic C15, Gesic C30, Gesic C8, Lenoltec 1, Lenoltec 2, Lenoltec 3 +1 more
How Acetaminophen, Caffeine, Codeine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Extract + Acetaminophen, Caffeine, Codeine interactionBlack Cohosh Root ExtractCytochrome P450 2d6 (cyp2d6) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Some research suggests that black cohosh might inhibit CYP2D6, but there is conflicting evidence.
Read the full Black Cohosh Root Extract + Acetaminophen, Caffeine, Codeine interactionLicorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Acetaminophen, Caffeine, Codeine interactionAcetaminophen, Caffeine, Codeine, SalicylamideCodalan No.1, Codalan No.2, Codalan No.3
How Acetaminophen, Caffeine, Codeine, Salicylamide interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Major
Licorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Caffeine, Codeine, Salicylamide interactionBlack Cohosh Root ExtractCytochrome P450 2d6 (cyp2d6) Substrates, Hepatotoxic Drugs Moderate
Interaction Summary
Some research suggests that black cohosh might inhibit CYP2D6, but there is conflicting evidence.
Read the full Black Cohosh Root Extract + Acetaminophen, Caffeine, Codeine, Salicylamide interactionAcetaminophen, Caffeine, DihydrocodeineDHC Plus, Panlor DC, Panlor SS
How Acetaminophen, Caffeine, Dihydrocodeine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Extract + Acetaminophen, Caffeine, Dihydrocodeine interactionLicorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Acetaminophen, Caffeine, Dihydrocodeine interactionBlack Cohosh Root ExtractHepatotoxic Drugs, Cytochrome P450 2d6 (cyp2d6) Substrates Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Acetaminophen, Caffeine, Dihydrocodeine interactionAcetaminophen, Caffeine, IsomethepteneMigralam
How Acetaminophen, Caffeine, Isometheptene interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Extract + Acetaminophen, Caffeine, Isometheptene interactionBlack Cohosh Root ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Acetaminophen, Caffeine, Isometheptene interactionLicorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Caffeine, Isometheptene interactionAcetaminophen, Caffeine, PyrilamineMidol Max Strength Menstrual
How Acetaminophen, Caffeine, Pyrilamine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Major
Interaction Summary
St.
Read the full St. John's Wort Extract + Acetaminophen, Caffeine, Pyrilamine interactionLicorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Diuretic Drugs +1 Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Acetaminophen, Caffeine, Pyrilamine interactionBlack Cohosh Root ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Acetaminophen, Caffeine, Pyrilamine interactionAcetaminophen, Chlorpheniramine Maleate, Dextromethorphan HbrVicks Formula 44M Cough, Cold & Flu Relief
How Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan Hbr interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractPhotosensitizing Drugs, Cytochrome P450 1a2 (cyp1a2) Substrates +2 Major
Interaction Summary
Theoretically, St.
Read the full St. John's Wort Extract + Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan Hbr interactionLicorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan Hbr interactionBlack Cohosh Root ExtractCytochrome P450 2d6 (cyp2d6) Substrates, Hepatotoxic Drugs +1 Moderate
Interaction Summary
Some research suggests that black cohosh might inhibit CYP2D6, but there is conflicting evidence.
Read the full Black Cohosh Root Extract + Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan Hbr interactionAcetaminophen, Chlorpheniramine, Codeine, PhenylephrineColrex
How Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Serotonergic Drugs +2 Major
Black Cohosh Root ExtractHepatotoxic Drugs, Cytochrome P450 2d6 (cyp2d6) Substrates +1 Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine interactionLicorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine interactionAcetaminophen, Chlorpheniramine, DextromethorphanCoricidin II Extra Strength Cold and Flu
How Acetaminophen, Chlorpheniramine, Dextromethorphan interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates +2 Major
Licorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Chlorpheniramine, Dextromethorphan interactionBlack Cohosh Root ExtractCytochrome P450 2d6 (cyp2d6) Substrates, Serotonergic Drugs +1 Moderate
Interaction Summary
Some research suggests that black cohosh might inhibit CYP2D6, but there is conflicting evidence.
Read the full Black Cohosh Root Extract + Acetaminophen, Chlorpheniramine, Dextromethorphan interactionAcetaminophen, Chlorpheniramine, Dextromethorphan HydrobromideCoricidin HBP Maximum Strength Flu
How Acetaminophen, Chlorpheniramine, Dextromethorphan Hydrobromide interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractPhotosensitizing Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates +2 Major
Interaction Summary
Theoretically, St.
Read the full St. John's Wort Extract + Acetaminophen, Chlorpheniramine, Dextromethorphan Hydrobromide interactionLicorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Acetaminophen, Chlorpheniramine, Dextromethorphan Hydrobromide interactionBlack Cohosh Root ExtractHepatotoxic Drugs, Cytochrome P450 2d6 (cyp2d6) Substrates +1 Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Acetaminophen, Chlorpheniramine, Dextromethorphan Hydrobromide interactionAcetaminophen, Chlorpheniramine, Dextromethorphan, PhenylpropanolamineMulti Symptom Cold Relief
How Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Photosensitizing Drugs +2 Major
Black Cohosh Root ExtractSerotonergic Drugs, Hepatotoxic Drugs +1 Moderate
Interaction Summary
Combining serotonergic drugs with black cohosh might cause additive serotonergic effects.
Read the full Black Cohosh Root Extract + Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine interactionLicorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine interactionAcetaminophen, Chlorpheniramine, Dextromethorphan, PseudoephedrineChildren's Tylenol Cold Plus Cough, Tylenol Cold Ex Strength
How Acetaminophen, Chlorpheniramine, Dextromethorphan, Pseudoephedrine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractSerotonergic Drugs, Photosensitizing Drugs +2 Major
Interaction Summary
Theoretically, St.
Read the full St. John's Wort Extract + Acetaminophen, Chlorpheniramine, Dextromethorphan, Pseudoephedrine interactionLicorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Acetaminophen, Chlorpheniramine, Dextromethorphan, Pseudoephedrine interactionBlack Cohosh Root ExtractCytochrome P450 2d6 (cyp2d6) Substrates, Hepatotoxic Drugs +1 Moderate
Interaction Summary
Some research suggests that black cohosh might inhibit CYP2D6, but there is conflicting evidence.
Read the full Black Cohosh Root Extract + Acetaminophen, Chlorpheniramine, Dextromethorphan, Pseudoephedrine interactionAcetaminophen, Chlorpheniramine, Guaifenesin, Phenylephrine, SalicylamideRhinogesic GG
How Acetaminophen, Chlorpheniramine, Guaifenesin, Phenylephrine, Salicylamide interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Photosensitizing Drugs +2 Major
Licorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Chlorpheniramine, Guaifenesin, Phenylephrine, Salicylamide interactionBlack Cohosh Root ExtractSerotonergic Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Combining serotonergic drugs with black cohosh might cause additive serotonergic effects.
Read the full Black Cohosh Root Extract + Acetaminophen, Chlorpheniramine, Guaifenesin, Phenylephrine, Salicylamide interactionAcetaminophen, Chlorpheniramine, PhenylephrineAlka-Seltzer PLUS, Histex SR, Protid
How Acetaminophen, Chlorpheniramine, Phenylephrine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractSerotonergic Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates +2 Major
Interaction Summary
Theoretically, St.
Read the full St. John's Wort Extract + Acetaminophen, Chlorpheniramine, Phenylephrine interactionBlack Cohosh Root ExtractSerotonergic Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Combining serotonergic drugs with black cohosh might cause additive serotonergic effects.
Read the full Black Cohosh Root Extract + Acetaminophen, Chlorpheniramine, Phenylephrine interactionLicorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Acetaminophen, Chlorpheniramine, Phenylephrine interactionAcetaminophen, Chlorpheniramine, Phenylephrine, SalicylamideRhinogesic, Rhinogesic JR
How Acetaminophen, Chlorpheniramine, Phenylephrine, Salicylamide interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates +2 Major
Licorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Chlorpheniramine, Phenylephrine, Salicylamide interactionBlack Cohosh Root ExtractHepatotoxic Drugs, Serotonergic Drugs Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Acetaminophen, Chlorpheniramine, Phenylephrine, Salicylamide interactionAcetaminophen, Chlorpheniramine, PhenylpropanolamineAlumadrine, Conex, Sinadrin Max Strength, Sinulin
How Acetaminophen, Chlorpheniramine, Phenylpropanolamine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates +2 Major
Licorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Chlorpheniramine, Phenylpropanolamine interactionBlack Cohosh Root ExtractHepatotoxic Drugs, Serotonergic Drugs Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Acetaminophen, Chlorpheniramine, Phenylpropanolamine interactionAcetaminophen, Chlorpheniramine, Phenylpropanolamine, OpiumHista-Derfule
How Acetaminophen, Chlorpheniramine, Phenylpropanolamine, Opium interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractSerotonergic Drugs, Cytochrome P450 1a2 (cyp1a2) Substrates +2 Major
Interaction Summary
Theoretically, St.
Read the full St. John's Wort Extract + Acetaminophen, Chlorpheniramine, Phenylpropanolamine, Opium interactionBlack Cohosh Root ExtractSerotonergic Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Combining serotonergic drugs with black cohosh might cause additive serotonergic effects.
Read the full Black Cohosh Root Extract + Acetaminophen, Chlorpheniramine, Phenylpropanolamine, Opium interactionLicorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Acetaminophen, Chlorpheniramine, Phenylpropanolamine, Opium interactionAcetaminophen, Chlorpheniramine, Phenylpropanolamine, PhenyltoloxamineNorel Plus
How Acetaminophen, Chlorpheniramine, Phenylpropanolamine, Phenyltoloxamine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates +2 Major
Licorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Acetaminophen, Chlorpheniramine, Phenylpropanolamine, Phenyltoloxamine interactionBlack Cohosh Root ExtractSerotonergic Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Combining serotonergic drugs with black cohosh might cause additive serotonergic effects.
Read the full Black Cohosh Root Extract + Acetaminophen, Chlorpheniramine, Phenylpropanolamine, Phenyltoloxamine interactionAcetaminophen, Chlorpheniramine, PseudoephedrineAlka-Seltzer PLUS Liquid Gels, Children's Tylenol Cold, Codimal, Comtrex, Extra Strength Tylenol Allergy Sinus, Lorsin +3 more
How Acetaminophen, Chlorpheniramine, Pseudoephedrine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractSerotonergic Drugs, Photosensitizing Drugs +2 Major
Interaction Summary
Theoretically, St.
Read the full St. John's Wort Extract + Acetaminophen, Chlorpheniramine, Pseudoephedrine interactionLicorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Chlorpheniramine, Pseudoephedrine interactionBlack Cohosh Root ExtractHepatotoxic Drugs, Serotonergic Drugs Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Acetaminophen, Chlorpheniramine, Pseudoephedrine interactionAcetaminophen, DextromethorphanTylenol Cough Ex Strength
How Acetaminophen, Dextromethorphan interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Serotonergic Drugs +1 Major
Interaction Summary
St.
Read the full St. John's Wort Extract + Acetaminophen, Dextromethorphan interactionBlack Cohosh Root ExtractHepatotoxic Drugs, Cytochrome P450 2d6 (cyp2d6) Substrates +1 Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Acetaminophen, Dextromethorphan interactionLicorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Dextromethorphan interactionAcetaminophen, Dextromethorphan, Doxylamine, PseudoephedrineVicks NyQuil
How Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates +1 Major
Licorice Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Read the full Licorice Root Extract + Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine interactionBlack Cohosh Root ExtractHepatotoxic Drugs, Serotonergic Drugs +1 Moderate
Interaction Summary
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
Read the full Black Cohosh Root Extract + Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine interactionAcetaminophen, Dextromethorphan, Guaifenesin, PhenylephrineConar-A
How Acetaminophen, Dextromethorphan, Guaifenesin, Phenylephrine interacts with Balance — through 3 ingredients. Tap an ingredient for the detail:
St. John's Wort ExtractSerotonergic Drugs, Cytochrome P450 3a4 (cyp3a4) Substrates +1 Major
Interaction Summary
Theoretically, St.
Read the full St. John's Wort Extract + Acetaminophen, Dextromethorphan, Guaifenesin, Phenylephrine interactionLicorice Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
Read the full Licorice Root Extract + Acetaminophen, Dextromethorphan, Guaifenesin, Phenylephrine interactionBlack Cohosh Root ExtractCytochrome P450 2d6 (cyp2d6) Substrates, Hepatotoxic Drugs +1 Moderate
Interaction Summary
Some research suggests that black cohosh might inhibit CYP2D6, but there is conflicting evidence.
Read the full Black Cohosh Root Extract + Acetaminophen, Dextromethorphan, Guaifenesin, Phenylephrine interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Balance with known interactions, here are the types of medications they can affect. Open any type for the detail — or search your exact drug in the checker above.
St. John's Wort extract
Alprazolam (Xanax)
St. John's wort increases the clearance of alprazolam and decreases its effects.
Alprazolam, which is used as a probe for cytochrome P450 3A4 (CYP3A4) activity, has a two-fold increase in clearance when given with St. John's wort. St. John's wort reduces the half-life of alprazolam from 12.4 hours to 6 hours.
Contraceptive Drugs
St. John's wort increases the clearance of contraceptive drugs and reduces their clinical effects.
Females taking St. John's wort and oral contraceptives concurrently should use an additional or alternative form of birth control. St. John's wort can decrease norethindrone and ethinyl estradiol levels by 13% to 15%, resulting in breakthrough bleeding, irregular menstrual bleeding, or unplanned pregnancy. Bleeding irregularities usually occur within a week of starting St. John's wort and regular cycles usually return when St. John's wort is discontinued. Unplanned pregnancy has occurred with concurrent use of oral contraceptives and St. John's wort extract. St. John's wort is thought to induce the cytochrome P450 1A2 (CYP1A2), 2C9 (CYP2C9), and 3A4 (CYP3A4) enzymes, which are responsible for metabolism of progestins and estrogens in contraceptives.
Cyclosporine (Neoral, Sandimmune)
St. John's wort reduces the levels and clinical effects of cyclosporine.
Concomitant use can decrease plasma cyclosporine levels by 30% to 70%. Using St. John's wort with cyclosporine in patients with heart, kidney, or liver transplants can cause subtherapeutic cyclosporine levels and acute transplant rejection. This interaction has occurred with a St. John's wort extract standardized to 0.3% hypericin and dosed at 300-600 mg per day. Withdrawal of St. John's wort can result in a 64% increase in cyclosporine levels. St. John's wort induces cytochrome P450 3A4 (CYP3A4) and the multi-drug transporter, P-glycoprotein/MDR-1, which increases cyclosporine clearance.
Cytochrome P450 3A4 (Cyp3A4) Substrates
St. John's wort increases the metabolism and reduces the levels of CYP3A4 substrates.
St. John's wort induces CYP3A4 enzymes and increases metabolism of CYP3A4 substrates. Clinically significant interactions have been reported with St. John's wort products containing hyperforin 1 mg or more.
Digoxin (Lanoxin)
St. John's wort reduces the levels and clinical effects of digoxin.
St. John's wort can reduce the bioavailability, serum levels, and therapeutic effects of digoxin. Taking an extract of St. John's wort 900 mg, containing hyperforin 7.5 mg or more, daily for 10-14 days, can reduce serum digoxin levels by 25% in healthy people. St. John's wort is thought to affect the multidrug transporter, P-glycoprotein, which mediates the absorption and elimination of digoxin and other drugs. St. John's wort products providing less than 7.5 mg of hyperforin daily do not appear to affect digoxin levels.
Docetaxel (Taxotere)
St. John's wort reduces the levels and clinical effects of docetaxel.
Clinical research shows that taking a specific St. John's wort product (Hyperiplant, VSM) 300 mg three times daily for 14 days increases docetaxel clearance by about 14%, resulting in decreased plasma concentrations of docetaxel in cancer patients. This is most likely due to induction of cytochrome P450 3A4 (CYP3A4) by St. John's wort.
Imatinib (Gleevec)
St. John's wort reduces the levels and clinical effects of imatinib.
Taking St. John's wort 900 mg daily for 2 weeks reduces the bioavailability and half-life of a single dose of imatinib and decreases its serum levels by 30% in healthy volunteers. This is most likely due to induction of cytochrome P450 3A4 (CYP3A4) by St. John's wort, which increases clearance of imatinib.
Irinotecan (Camptosar)
St. John's wort reduces the levels and clinical effects of irinotecan.
St. John's wort 900 mg daily for 18 days decreases serum levels of irinotecan by at least 50%. Clearance of the active metabolite of irinotecan, SN-38, is also increased, resulting in a 42% decrease in the area under the concentration-time curve. This is thought to be due to induction of cytochrome P450 3A4 (CYP3A4) by St. John's wort.
Mephenytoin (Mesantoin)
St. John's wort reduces the levels and clinical effects of mephenytoin.
Preliminary clinical research in healthy males shows that taking St. John's wort for 14 days induces cytochrome P450 2C19 (CYP2C19) and significantly increases metabolism of mephenytoin (Mesantoin). In people with wild-type 2C19, metabolism was almost 4-fold greater in subjects who received St. John's wort compared to placebo. In contrast, patients with 2C19*2/*2 and *2/*3 genotypes did not demonstrate a similar increase in metabolism.
Non-Nucleoside Reverse Transcriptase Inhibitors (Nnrtis)
St. John's wort decreases the levels and clinical effects of NNRTIs.
St. John's wort increases the oral clearance of nevirapine (Viramune) by 35%. Subtherapeutic concentrations are associated with therapeutic failure, development of viral resistance, and development of drug class resistance. St. John's wort induces intestinal and hepatic cytochrome P450 3A4 (CYP3A4) and intestinal P-glycoprotein/MDR-1, a drug transporter.
Omeprazole (Prilosec)
St. John's wort decreases the levels and clinical effects of omeprazole.
Taking St. John's wort, 300 mg orally three times daily for 14 days, reduces serum concentrations of omeprazole by inducing its metabolism via cytochrome P450 (CYP) 2C19 and 3A4. The reduction of omeprazole serum levels is dependent on CYP2C19 genotype, with reductions up to 50% in extensive metabolizers and 38% in poor metabolizers.
Oxycodone (Oxycontin)
St. John's wort decreases the levels and clinical effects of oxycodone.
St. John's wort can increase oxycodone metabolism by inducing cytochrome P450 3A4 (CYP3A4), reducing plasma levels and analgesic activity.
P-Glycoprotein Substrates
St. John's wort decreases the levels and clinical effects of P-glycoprotein substrates.
St. John's wort induces P-glycoprotein. P-glycoprotein is a carrier mechanism responsible for transporting drugs and other substances across cell membranes. When P-glycoprotein is induced in the gastrointestinal (GI) tract, it can prevent the absorption of some medications. In addition, induction of p-glycoprotein can decrease entry of drugs into the central nervous system (CNS) and decrease access to other sites of action.
Phenobarbital (Luminal)
St. John's wort decreases the levels and clinical effects of phenobarbital.
St. John's wort may increase the metabolism of phenobarbital. Plasma concentrations of phenobarbital should be monitored carefully. The dose of phenobarbital may need to be increased when St. John's wort is started and decreased when it is stopped.
Phenprocoumon (Marcoumar, Others)
St. John's wort decreases the levels and clinical effects of phenprocoumon.
St. John's wort appears to increase the metabolism of phenprocoumon (an anticoagulant that is not available in the US) by increasing the activity of the cytochrome P450 2C9 (CYP2C9) enzyme. This may result in decreases in the anticoagulant effect and international normalized ratio (INR).
Phenytoin (Dilantin)
St. John's wort decreases the levels and clinical effects of phenytoin.
St. John's wort may increase the metabolism of phenytoin. Plasma concentrations of phenytoin should be monitored closely. The dose of phenytoin may need to be increased when St. John's wort is started and decreased when it is stopped.
Protease Inhibitors (Pis)
St. John's wort reduces the levels and clinical effects of PIs.
In healthy volunteers, St. John's wort can reduce the plasma concentrations of indinavir (Crixivan) by inducing cytochrome P450 3A4 (CYP3A4). This might result in treatment failure and viral resistance. St. John's wort also induces P-glycoprotein, which can result in decreased intracellular protease inhibitor concentrations and increased elimination.
Rivaroxaban (Xarelto)
St. John's wort decreases the levels and clinical effects of rivaroxaban.
A small pharmacokinetic study in healthy volunteers shows that taking a single dose of rivaroxaban 20 mg after using a specific St. John's wort extract (Jarsin, Vifor SA) 450 mg orally twice daily for 14 days reduces the bioavailability of rivaroxaban by 24% and reduces rivaroxaban's therapeutic inhibition of factor Xa by 20%.
Tacrolimus (Prograf)
St. John's wort decreases the levels and clinical effects of tacrolimus.
Taking a St. John's wort extract (Jarsin) 600 mg daily significantly decreases tacrolimus serum levels. Dose increases of 60% may be required to maintain therapeutic tacrolimus levels in patients taking St. John's wort. St. John's wort is thought to lower tacrolimus levels by inducing cytochrome P450 3A4 (CYP3A4) enzymes. A small clinical study in healthy adults also shows that taking St. John's wort 300 mg three times daily for 10 days decreases the total systemic exposure to tacrolimus by 27% and 33% after taking a single 5 mg dose of immediate-release or prolonged-release tacrolimus, respectively.
Warfarin (Coumadin)
St. John's wort decreases the levels and clinical effects of warfarin.
Taking St. John's wort significantly increases clearance of warfarin, including both its R- and S-isomers. This is likely due to induction of cytochrome P450 (CYP) 1A2 and CYP3A4. St. John's wort can also significantly decrease International Normalized Ratio (INR) in people taking warfarin. In addition, taking warfarin at the same time as St. John's wort might reduce warfarin bioavailability. When a dried extract is mixed with warfarin in an aqueous medium, up to 30% of warfarin is bound to particles, reducing its absorption.
Aminolevulinic Acid
St. John's wort might have additive phototoxic effects with aminolevulinic acid.
Concomitant use with St. John's wort extract may cause synergistic phototoxicity. Delta-aminolevulinic acid can cause a burning erythematous rash and severe swelling of the face, neck, and hands when taken with St. John's wort.
Bupropion (Wellbutrin)
St. John's wort might reduce the levels and effects of bupropion.
Clinical research shows that taking St. John's wort 325 mg three times daily for 14 days along with bupropion reduces the area under the concentration-time curve by approximately 14% and increases the clearance of bupropion by approximately 20%. This effect is attributed to the induction of cytochrome P450 2B6 (CYP2B6) by St. John's wort.
Clopidogrel (Plavix)
St. John's wort might increase the levels and effects of clopidogrel.
Taking St. John's wort with clopidogrel seems to increase the activity of clopidogrel. In clopidogrel non-responders, taking St. John's wort seems to induce metabolism of clopidogrel to its active metabolite by cytochrome P450 enzymes 3A4 and 2C19. This leads to increased antiplatelet activity. Theoretically, this might lead to an increased risk of bleeding in clopidogrel responders.
Clozapine (Clozaril)
St. John's wort might decrease the levels and clinical effects of clozapine.
A case report describes a female with schizophrenia controlled on clozapine who had a return of symptoms when she started taking St. John's wort. The plasma concentration of clozapine was reduced, likely because its clearance was increased due to induction of the cytochrome P450 enzymes 3A4, 1A2, 2C9, and 2C19 by St. John's wort.
Cytochrome P450 1A2 (Cyp1A2) Substrates
St. John's wort may increase the metabolism and reduce the levels of CYP1A2 substrates.
Clinical and in vitro research shows that St. John's wort induces CYP1A2, but to a lesser extent than CYP3A4.
Licorice Root Extract
Antihypertensive Drugs
Theoretically, licorice might reduce the effects of antihypertensive drugs.
In human research, licorice increases blood pressure in a dose-dependent manner.
Cisplatin (Platinol-Aq)
Theoretically, licorice might reduce the effects of cisplatin.
In animal research, licorice diminished the therapeutic efficacy of cisplatin.
Corticosteroids
Theoretically, concomitant use of licorice and corticosteroids might increase the side effects of corticosteroids.
Case reports suggest that concomitant use of licorice and oral corticosteroids, such as hydrocortisone, can potentiate the duration of activity and increase blood levels of corticosteroids. Additionally, in one case report, a patient with neurogenic orthostatic hypertension stabilized on fludrocortisone 0.1 mg twice daily developed pseudohyperaldosteronism after recent consumption of large amounts of black licorice.
Cytochrome P450 2B6 (Cyp2B6) Substrates
Theoretically, licorice might increase levels of drugs metabolized by CYP2B6.
In vitro research shows that licorice extract and glabridin, a licorice constituent, inhibit CYP2B6 isoenzymes. Licorice extract from the species G. uralensis seems to inhibit CYP2B6 isoenzymes to a greater degree than G. glabra extract in vitro. Theoretically, these species of licorice might increase levels of drugs metabolized by CYP2B6; however, these interactions have not yet been reported in humans.
Cytochrome P450 2C19 (Cyp2C19) Substrates
Theoretically, licorice might increase levels of drugs metabolized by CYP2C19.
In vitro, licorice extracts from the species G. glabra and G. uralensis inhibit CYP2C19 isoenzymes in vitro. Theoretically, these species of licorice might increase levels of drugs metabolized by CYP2C19; however, this interaction has not yet been reported in humans.
Cytochrome P450 2C8 (Cyp2C8) Substrates
Theoretically, licorice might increase levels of drugs metabolized by CYP2C8.
In vitro, licorice extract from the species G. glabra and G. uralensis inhibits CYP2C8 isoenzymes. Theoretically, these species of licorice might increase levels of drugs metabolized by CYP2C8; however, this interaction has not yet been reported in humans.
Cytochrome P450 2C9 (Cyp2C9) Substrates
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP2C9.
There is conflicting evidence about the effect of licorice on CYP2C9 enzyme activity. In vitro research shows that extracts from the licorice species G. glabra and G. uralensis moderately inhibit CYP2C9 isoenzymes. However, evidence from an animal model shows that licorice extract from the species G. uralensis can induce hepatic CYP2C9 activity. Until more is known, licorice should be used cautiously in people taking CYP2C9 substrates.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Pharmacokinetic research shows that the licorice constituent glycyrrhizin, taken in a dosage of 150 mg orally twice daily for 14 days, modestly decreases the area under the concentration-time curve of midazolam by about 20%. Midazolam is a substrate of CYP3A4, suggesting that glycyrrhizin modestly induces CYP3A4 activity. Animal research also shows that licorice extract from the species G. uralensis induces CYP3A4 activity. However, licorice extract from G. glabra species appear to inhibit CYP3A4-induced metabolism of testosterone in vitro. It is thought that the G. glabra inhibits CYP3A4 due to its constituent glabridin, which is a moderate CYP3A4 inhibitor in vitro and not present in other licorice species. Until more is known, licorice should be used cautiously in people taking CYP3A4 substrates.
Digoxin (Lanoxin)
Theoretically, concomitant use of licorice with digoxin might increase the risk of cardiac toxicity.
Overuse or misuse of licorice with cardiac glycoside therapy might increase the risk of cardiac toxicity due to potassium loss.
Diuretic Drugs
Theoretically, concomitant use of licorice with diuretic drugs might increase the risk of hypokalemia.
Overuse of licorice might compound diuretic-induced potassium loss. In one case report, a 72-year-old male with a past medical history of hypertension, type 2 diabetes, hyperlipidemia, arrhythmia, stroke, and hepatic dysfunction was hospitalized with severe hypokalemia and uncontrolled hypertension due to pseudohyperaldosteronism. This was thought to be provoked by concomitant daily consumption of a product containing 225 mg of glycyrrhizin, a constituent of licorice, and hydrochlorothiazide 12.5 mg for 1 month.
Estrogens
Theoretically, licorice might increase or decrease the effects of estrogen therapy.
Theoretically, licorice might interfere with estrogen therapy due to estrogenic and anti-estrogenic effects.
Loop Diuretics
Theoretically, loop diuretics might increase the mineralocorticoid effects of licorice.
Theoretically, loop diuretics might enhance the mineralocorticoid effects of licorice by inhibiting the enzyme that converts cortisol to cortisone; however, bumetanide (Bumex) does not appear to have this effect.
Midazolam (Versed)
Theoretically, licorice might decrease levels of midazolam.
In humans, the licorice constituent glycyrrhizin appears to moderately induce the metabolism of midazolam. This is likely due to induction of cytochrome P450 3A4 by licorice. Until more is known, licorice should be used cautiously in people taking midazolam.
P-Glycoprotein Substrates
Theoretically, licorice might decrease the absorption of P-glycoprotein substrates.
In vitro research shows that licorice can increase P-glycoprotein activity.
Paclitaxel (Abraxane, Onxol)
Theoretically, licorice might decrease plasma levels and clinical effects of paclitaxel.
Multiple doses of licorice taken concomitantly with paclitaxel might reduce the effectiveness of paclitaxel. Animal research shows that licorice 3 grams/kg given orally for 14 days before intravenous administration of paclitaxel decreases the exposure to paclitaxel and increases its clearance. Theoretically, this occurs because licorice induces cytochrome P450 3A4 enzymes, which metabolize paclitaxel. Notably, a single dose of licorice did not affect exposure or clearance of paclitaxel.
Warfarin (Coumadin)
Theoretically, licorice might decrease plasma levels and clinical effects of warfarin.
Licorice seems to increase metabolism and decrease levels of warfarin in animal models. This is likely due to induction of cytochrome P450 2C9 (CYP2C9) metabolism by licorice. Advise patients taking warfarin to avoid taking licorice.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, licorice might decrease the levels and clinical effects of CYP1A2 substrates.
In vitro research shows that licorice induces CYP1A2 enzymes.
Methotrexate (Trexall, Others)
Theoretically, licorice might increase levels of methotrexate.
Animal research suggests that intravenous administration of glycyrrhizin, a licorice constituent, and high-dose methotrexate may delay methotrexate excretion and increase systemic exposure, leading to transient elevations in liver enzymes and total bilirubin. This interaction has not yet been reported in humans.
Black Cohosh Root Extract
Atorvastatin (Lipitor)
Taking black cohosh with atorvastatin might increase the risk for elevated liver function tests.
In one case report, a patient taking atorvastatin (Lipitor) developed significantly elevated liver function enzymes after starting black cohosh 100 mg four times daily. Liver enzymes returned to normal when black cohosh was discontinued. It is unclear whether the elevated liver enzymes were due to black cohosh itself or an interaction between atorvastatin and black cohosh.
Cisplatin (Platinol-Aq)
Theoretically, black cohosh may reduce the clinical effects of cisplatin.
Animal research suggests that black cohosh might decrease the cytotoxic effect of cisplatin on breast cancer cells.
Cytochrome P450 2D6 (Cyp2D6) Substrates
Some research suggests that black cohosh might inhibit CYP2D6, but there is conflicting evidence.
Some clinical research suggests that black cohosh might modestly inhibit CYP2D6 and increase levels of drugs metabolized by this enzyme. However, contradictory clinical research shows a specific black cohosh product (Remifemin, Enzymatic Therapy) 40 mg twice daily does not significantly inhibit metabolism of a CYP2D6 substrate in healthy study volunteers. Until more is known, use black cohosh cautiously in patients taking drugs metabolized by CYP2D6.
Estrogens
Theoretically, black cohosh may alter the effects of estrogen therapy.
Some research suggests that black cohosh has estrogenic effects. This may enhance or inhibit the effects of estrogen therapy.
Hepatotoxic Drugs
Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
There is concern that black cohosh might be linked to cases of liver failure and autoimmune hepatitis.
Serotonergic Drugs
Combining serotonergic drugs with black cohosh might cause additive serotonergic effects.
Black cohosh might increase the risk of serotonin syndrome when combined with other serotonergic drugs. Black cohosh acts as an agonist at several serotonin receptor subtypes and might interact with other serotonergic medications. In one case, a 55-year-old female who had been on stable treatment with sertraline 50 mg and duloxetine 60 mg daily developed serotonin syndrome after taking black cohosh extract 40 mg daily for 3 days.
Organic Anion-Transporting Polypeptide Substrates (Oatp)
Black cohosh may inhibit one form of OATP, OATP2B1, which could reduce the bioavailability and clinical effects of OATP2B1 substrates.
In vitro research shows that black cohosh modestly inhibits OATP2B1. OATPs are expressed in the small intestine and liver and are responsible for the uptake of drugs and other compounds into the body. Inhibition of OATP may reduce the bioavailability of oral drugs that are substrates of OATP.
Dong Quai Root Extract
Warfarin (Coumadin)
Dong quai may increase the risk of bleeding when used with warfarin.
Case reports suggest that concomitant use of dong quai with warfarin can increase the anticoagulant effects of warfarin and increase the risk of bleeding. In one case, after 4 weeks of taking dong quai 565 mg once or twice daily, the international normalized ratio (INR) increased to 4.9. The INR normalized 4 weeks after discontinuation of dong quai.
Anticoagulant/Antiplatelet Drugs
Theoretically, dong quai may increase the risk of bleeding when used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Animal studies suggest that dong quai has antithrombin activity and inhibits platelet aggregation due to its coumarin components. Additionally, some case reports in humans suggest that dong quai can increase the anticoagulant effects of warfarin. However, clinical research in healthy adults shows that taking 1 gram of dong quai root daily for 3 weeks does not significantly inhibit platelet aggregation or cause bleeding. Until more is known, use dong quai with caution in patients taking antiplatelet/anticoagulant drugs.
Estrogens
Theoretically, dong quai may reduce the effects of estrogens.
Dong quai has estrogenic effects. Theoretically, concomitant use of large amounts of dong quai might interfere with hormone replacement therapy due to competition for estrogen receptors.
Chasteberry Berry Extract, Dried
Antipsychotic Drugs
Theoretically, vitex agnus-castus could interfere with the activity of antipsychotic drugs.
Vitex agnus-castus might interfere with the action of dopamine antagonists such as antipsychotic drugs due to its dopamine agonist effects.
Contraceptive Drugs
Theoretically, vitex agnus-castus could interfere with oral contraceptives.
Vitex agnus-castus might interfere with the efficacy of oral contraceptives due to possible hormone modulating activity.
Dopamine Agonists
Theoretically, vitex agnus-castus could interfere with dopamine agonists.
Vitex agnus-castus might potentiate the actions of dopaminergic agonists due to possible dopaminergic effects.
Estrogens
Theoretically, vitex agnus-castus could interfere with the activity of estrogens.
Vitex agnus-castus has hormone modulating activity that can interfere with the efficacy of hormone replacement therapy.
Metoclopramide (Reglan)
Theoretically, dopaminergic effects of vitex agnus-castus could interfere with metoclopramide.
Vitex agnus-castus might interfere with the action of dopamine antagonists such as metoclopramide due to its possible dopaminergic effects.
Brand information
Manufacturer and brand details for Balance, from the product label.
Vali
See all Vali products- Name
- The BSD Project LLC
- City
- Nashville
- State
- TN
- ZipCode
- 37204
- Phone Number
- (615) 436-3676
- Web Address
- www.valiup.com
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Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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The Full Monographs Behind Balance’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Licorice
Interacts with 1,040 drugsLicorice root is a traditional remedy used for sore throats, coughs, and digestive complaints, but solid human evidence is limited for most uses. Regular licorice contains glycyrrhizin, whic...
Read the full Licorice monograph → Herb & supplement monographBlack Cohosh
Interacts with 652 drugsBlack cohosh is a North American plant most often used to ease menopause symptoms like hot flashes, but the research is mixed and far from settled. It is generally well tolerated for short-t...
Read the full Black Cohosh monograph → Herb & supplement monographDong Quai
Interacts with 163 drugsDong Quai is a traditional Chinese herb often called "female ginseng" and is mostly used for menstrual and menopausal complaints. High-quality scientific evidence that it works for these use...
Read the full Dong Quai monograph → Herb & supplement monographVitex Agnus-castus
Interacts with 121 drugsVitex (chasteberry) is an herbal remedy most often used for PMS and menstrual cycle problems, and the strongest evidence is for easing some PMS symptoms. It is generally well tolerated by ma...
Read the full Vitex Agnus-castus monograph → Herb & supplement monographSt. John's Wort
Interacts with 1,143 drugsSt. John's wort is a well-studied herb most often used for mild to moderate depression, and some research suggests it may help with this. However, it has many serious interactions with presc...
Read the full St. John's Wort monograph →Sources & How We Checked
Balance's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.
- NIH Dietary Supplement Label Database (DSLD) — The official product label on file for this supplement.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference behind the ingredient interaction data.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.
The 354 references behind this product’s interaction data
Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.
Licorice 92 references
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- Attou R, Redant S, Honore PM, Preseau T, Hantson P, De Bels D. Liquorice intoxication can lead to cardiac arrest! Case Rep Emerg Med. 2020;2020:3727682. PubMed
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- Abe K, Higurashi T, Takahashi M, et al. Concomitant Use of High-dose Methotrexate and Glycyrrhizin Affects Pharmacokinetics of Methotrexate, Resulting in Hepatic Toxicity. In Vivo 2021;35(4):2163-2169. PubMed
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- Gatica-Ortega ME, Pastor-Nieto MA. Allergic contact dermatitis to Glycyrrhiza inflata root extract in an anti-acne cosmetic product. Contact Dermatitis 2021;85(4):454-455.
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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.
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