Essiac Tonic Ingredients & Drug Interactions
by Herbs, Etc
What is this page for?
First and foremost: checking Essiac Tonic 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
Essiac Tonic is a dietary supplement by Herbs, Etc with 4 active ingredients. Its ingredients are commonly taken for skin conditions like acne and eczema, digestive support, diuretic ('detox') and blood purifier.Based on those ingredients, 2,130 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are Slippery Elm Inner Bark Extract, Chinese Rhubarb Root Extract, Sheep Sorrel herb extract. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
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HelloPharmacist Scorecard of Essiac Tonic by Herbs, Etc
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
Low disclosure
Essiac Tonic is a liquid blend of four active herbal extracts. Burdock root extract and sheep sorrel herb extract are traditional digestive and detoxifying herbs.
Slippery elm inner bark extract contains a soothing mucilage that has been used for throat and digestive comfort. Chinese rhubarb root extract serves as a stimulant laxative.
The product also contains alcohol, purified water, and glycerin as inactive ingredients.
Does it work?
Moderate evidence
The evidence for these ingredients is limited. Burdock, sheep sorrel, and slippery elm all lack sufficient reliable evidence to rate their effectiveness for conditions like acne, skin aging, cough, inflammatory bowel disease, and constipation.
Rhubarb has some evidence suggesting it may be possibly effective for pancreatitis and menopausal symptoms, but data for constipation and other uses remain insufficient.
How safe is it?
Well-documented data
Burdock is likely safe as a food and for short-term use in healthy adults, though human safety data are limited. Avoid medicinal amounts during pregnancy due to possible effects on the uterus, and avoid while breastfeeding.
Sorrel is generally safe in food amounts but contains oxalates; high or concentrated doses can concern the kidneys. It is possibly safe in pregnancy, but avoid medicinal amounts while breastfeeding.
Slippery elm is generally well tolerated short-term but lacks high-quality safety data; sources caution against pregnancy use, and there is too little information on breastfeeding safety. Rhubarb root (not the stalks) can cause cramping and should not be used long-term; the medicinal form is possibly unsafe in pregnancy because it may stimulate the uterus, and medicinal use should be avoided while breastfeeding.
All four ingredients may rarely cause allergic reactions. Rhubarb overuse can lead to potassium loss and kidney or liver damage.
Meds to double-check
Moderate interaction found
Before taking Essiac Tonic, double-check these medication types with your doctor or pharmacist: blood thinners and antiplatelet drugs (from burdock, sorrel, and rhubarb); antihistamines like fexofenadine (from sorrel); any oral medications (slippery elm may slow their absorption); nephrotoxic and hepatotoxic drugs (from rhubarb); corticosteroids and diuretics (rhubarb may worsen potassium loss); digoxin (Lanoxin) and cyclosporine (from rhubarb). Rhubarb's strong laxative effect is a particular concern if you take heart or kidney medications.
The bottom line
Scorecard at a glanceFormula with limited ingredient disclosure with some supporting evidence behind its ingredients' uses. Moderate medication interactions have been identified, and safety information is well characterized.
Essiac Tonic is marketed as a traditional herbal blend, but its ingredients have limited evidence for effectiveness and carry Moderate-severity interactions with common medications—especially blood thinners, heart drugs, kidney medications, and potassium-affecting drugs. If you take any prescription medication, check with your doctor or pharmacist before starting this product.
Pregnant or breastfeeding individuals should discuss its use with their healthcare provider first.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 4 of 4 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Dec 14, 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 Essiac Tonic, straight from the product label.
| Brand | Herbs, Etc |
|---|---|
| Net contents | 2 Fluid Ounce(s); 59 mL |
| Market status | On market |
| Date entered into DSLD | Dec 14, 2023 |
| DSLD ID | 299994 |
| Product type | Botanical |
| Supplement form | Liquid |
| Dietary claims / uses | All Other, Structure/Function |
| Intended target group(s) | Vegan, Vegetarian, Adult (18 - 50 Years), Women (not pregnant or lactating), Gluten Free, Dairy Free |
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 Essiac Tonic by Herbs, Etc, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Proprietary Extract Blend | 1 mL | -- |
| Burdock Root Extract | 0 NP | -- |
| Sheep Sorrel herb extract | 0 NP | -- |
| Slippery Elm Inner Bark Extract | 0 NP | -- |
| Chinese Rhubarb Root Extract | 0 NP | -- |
Other ingredients: Alcohol, Water, Purified, Glycerin
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.
Formulation
Herbal medicine
Gluten free No artificial preservatives.
Vegan
Made in Santa Fe, NM.
Formula
Traditional four herb Ojibwa cleanse
Essiac Tonic stays true to the traditional four herb Ojibwa cleanse formula.
FDA Statement of Identity
Herbal Supplement
General Statements
We apply our company philosophy to Essiac Tonic, as we do to all of our herbal medicines. That philosophy is to do what's right, which extends to choosing the right herbs, using the right processes and making the right formulations that support your health needs.
Suggested/Recommended/Usage/Directions
Suggested use: Take 40 drops in water twice a day on an empty stomach.
Precautions
Caution: Do not use during pregnancy.
FDA Disclaimer Statement
This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
Brand IP Statement(s)
We do all of this to bring you herbal medicines made right.
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Essiac Tonic by Herbs, Etc 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 Essiac Tonic by Herbs, Etc
These are the 4 active ingredients this product is made of. Select any to open its full monograph.
Serving size40 Drop(s) Dosage formLiquid Servings per container59 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.
Proprietary Extract Blend
Other (inactive) ingredients: Alcohol, Water, Purified, Glycerin. These complete the product’s ingredient list but are not active constituents.
Essiac Tonic by Herbs, Etc Drug Interactions
HelloPharmacist Interaction Report
Essiac Tonic by Herbs, Etc contains four active ingredients—burdock root extract, sheep sorrel herb extract, slippery elm inner bark extract, and Chinese rhubarb root extract—that together interact with medications.
The most serious concern involves rhubarb's interaction with blood thinners like warfarin (Coumadin); overuse may increase bleeding risk because rhubarb's laxative effects can cause diarrhea, which boosts warfarin's potency.
Read the full breakdown — every affected drug type, severity by severity
Burdock and sheep sorrel both interact with blood thinners (anticoagulants and antiplatelet drugs) with Moderate severity, theoretically raising bleeding risk through effects on platelet function. Sheep sorrel also affects how the body absorbs certain antihistamines and other drugs through organic anion-transporting polypeptides (OATP); notably, it may reduce the effectiveness of fexofenadine (Allegra).
Slippery elm may slow the absorption and reduce blood levels of any oral medication you take by interfering with how drugs move through your digestive tract.
Rhubarb carries several other Moderate-severity interactions. It may worsen kidney damage if taken with nephrotoxic drugs, increase liver injury risk with hepatotoxic drugs, and compound potassium loss when combined with corticosteroids, diuretics, or stimulant laxatives.
It may also reduce levels of the heart medication cyclosporine (Neoral, Sandimmune) and increase digoxin (Lanoxin) toxicity through potassium depletion.
Altogether, these interactions span 2,131 individual medications. Check your exact medications with the search tool on this page before you start.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Essiac Tonic?
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 Essiac Tonic interact with 2,130 drugs. Click any drug to see the details.
4 of the 4 ingredients in Essiac Tonic interact with drugs. Each result below shows which ingredient is responsible. Slippery Elm Inner Bark Extract Chinese Rhubarb Root Extract Sheep Sorrel herb extract Burdock Root Extract
Adalimumab-bwwdHadlima
How Adalimumab-bwwd interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Adalimumab-bwwd interactionAdefovirHepsera
How Adefovir interacts with Essiac Tonic — through 2 ingredients. Tap an ingredient for the detail:
Chinese Rhubarb Root ExtractNephrotoxic Drugs Moderate
Interaction Summary
Theoretically, long-term use of anthraquinones from rhubarb might increase the risk of nephrotoxicity when used with nephrotoxic drugs.
Read the full Chinese Rhubarb Root Extract + Adefovir interactionSlippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Adefovir interactionAdenosineATP Tablets
How Adenosine interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Adenosine interactionAfatinib DimaleateGilotrif
How Afatinib Dimaleate interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Afatinib Dimaleate interactionAgomelatineValdoxan
How Agomelatine interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Agomelatine interactionAlbendazoleAlbenza
How Albendazole interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Albendazole interactionAlbuterolProAir HFA, Proventil, Ventolin (U.S.), Volmax
How Albuterol interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Albuterol interactionAlcuroniumAlcuronium
How Alcuronium interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alcuronium interactionAldesleukinProleukin
How Aldesleukin interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Chinese Rhubarb Root ExtractNephrotoxic Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, long-term use of anthraquinones from rhubarb might increase the risk of nephrotoxicity when used with nephrotoxic drugs.
Read the full Chinese Rhubarb Root Extract + Aldesleukin interactionAlectinib HydrochlorideAlecensa
How Alectinib Hydrochloride interacts with Essiac Tonic — through 2 ingredients. Tap an ingredient for the detail:
Chinese Rhubarb Root ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of rhubarb with potentially hepatotoxic drugs might increase the risk of developing liver damage.
Read the full Chinese Rhubarb Root Extract + Alectinib Hydrochloride interactionSlippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alectinib Hydrochloride interactionAlemtuzumabCampath
How Alemtuzumab interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alemtuzumab interactionAlendronateBinosto, Fosamax
How Alendronate interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alendronate interactionAlendronate Sodium
How Alendronate Sodium interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alendronate Sodium interactionAlendronate Sodium, CholecalciferolFosamax Plus D
How Alendronate Sodium, Cholecalciferol interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alendronate Sodium, Cholecalciferol interactionAlfentanilAlfenta
How Alfentanil interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alfentanil interactionAlfuzosinUroxatral
How Alfuzosin interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alfuzosin interactionAlginic Acid, Aluminum HydroxideRafton
How Alginic Acid, Aluminum Hydroxide interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alginic Acid, Aluminum Hydroxide interactionAliskirenTekturna
How Aliskiren interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Aliskiren interactionAlitretinoinPanretin
How Alitretinoin interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alitretinoin interactionAllopurinolCaplenal, Cosuric, Rimapurinol, Zyloprim, Zyloric
How Allopurinol interacts with Essiac Tonic — through 2 ingredients. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Allopurinol interactionChinese Rhubarb Root ExtractNephrotoxic Drugs, Hepatotoxic Drugs Moderate
Interaction Summary
Theoretically, long-term use of anthraquinones from rhubarb might increase the risk of nephrotoxicity when used with nephrotoxic drugs.
Read the full Chinese Rhubarb Root Extract + Allopurinol interactionAlmotriptanAlmogran, Axert
How Almotriptan interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Almotriptan interactionAlogliptinNesina
How Alogliptin interacts with Essiac Tonic — through 2 ingredients. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alogliptin interactionChinese Rhubarb Root ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of rhubarb with potentially hepatotoxic drugs might increase the risk of developing liver damage.
Read the full Chinese Rhubarb Root Extract + Alogliptin interactionAlogliptin, MetforminKazano
How Alogliptin, Metformin interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alogliptin, Metformin interactionAlogliptin, PioglitazoneOseni
How Alogliptin, Pioglitazone interacts with Essiac Tonic — through 2 ingredients. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alogliptin, Pioglitazone interactionChinese Rhubarb Root ExtractHepatotoxic Drugs Moderate
Interaction Summary
Theoretically, concomitant use of rhubarb with potentially hepatotoxic drugs might increase the risk of developing liver damage.
Read the full Chinese Rhubarb Root Extract + Alogliptin, Pioglitazone interactionAlosetronLotronex
How Alosetron interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alosetron interactionAlpelisibPiqray
How Alpelisib interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alpelisib interactionAlpha 1-proteinaseZemaira
How Alpha 1-proteinase interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alpha 1-proteinase interactionAlprazolamNiravam, Xanax
How Alprazolam interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alprazolam interactionAlteplase, TpaActilyse, Activase
How Alteplase, Tpa interacts with Essiac Tonic — through 3 ingredients. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Alteplase, Tpa interactionBurdock Root ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, taking burdock with anticoagulant or antiplatelet drugs might increase the risk of bleeding.
Read the full Burdock Root Extract + Alteplase, Tpa interactionSheep Sorrel Herb ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, sorrel might cause additive effects and side effects when used with anticoagulant or antiplatelet drugs.
Read the full Sheep Sorrel Herb Extract + Alteplase, Tpa interactionAltretamineHexalen
How Altretamine interacts with Essiac Tonic — through 1 ingredient. Tap an ingredient for the detail:
Slippery Elm Inner Bark ExtractOral Drugs Moderate
Interaction Summary
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Read the full Slippery Elm Inner Bark Extract + Altretamine interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Essiac Tonic 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.
Slippery Elm Inner Bark Extract
Oral Drugs
Theoretically, slippery elm may slow the absorption and reduce serum levels of oral drugs.
Slippery elm inner bark contains mucilage, which may interfere with the absorption of orally administered drugs.
Chinese Rhubarb Root Extract
Corticosteroids
Theoretically, frequent and high doses of rhubarb might increase the risk of hypokalemia when taken with corticosteroids.
Rhubarb has stimulant laxative effects. Overuse of rhubarb might compound corticosteroid-induced potassium loss.
Cyclosporine (Neoral, Sandimmune)
Theoretically, taking rhubarb with cyclosporine might reduce cyclosporine levels.
Animal research shows that co-administration of rhubarb decoction 0.25 or 1 gram/kg with cyclosporine 2.5 mg/kg, decreases cyclosporine maximum plasma concentration and overall exposure levels when compared with taking cyclosporine alone. The authors theorize that rhubarb might reduce cyclosporine bioavailability by inducing of P-glycoprotein and/or cytochrome P450 3A4. However, since rhubarb was administered as a single oral dose and enzyme induction usually occurs after multiple doses, it is possible that cyclosporine absorption was actually reduced via rhubarb's stimulant laxative effects. Also, the composition of the rhubarb decoction was not described.
Digoxin (Lanoxin)
Theoretically, overuse of rhubarb might increase the risk of adverse effects when taken with digoxin.
Rhubarb has stimulant laxative effects. Overuse of rhubarb might cause potassium depletion, increasing the risk of digoxin toxicity.
Diuretic Drugs
Theoretically, frequent and high doses of rhubarb might increase the risk of hypokalemia.
Rhubarb has stimulant laxative effects. Overuse of rhubarb might cause potassium depletion and compound diuretic-induced potassium loss.
Hepatotoxic Drugs
Theoretically, concomitant use of rhubarb with potentially hepatotoxic drugs might increase the risk of developing liver damage.
Some animal research suggests that anthraquinones in rhubarb might have hepatotoxic effects. Also, rhubarb use has been linked to at least 24 cases of liver injury, although details on the dose of rhubarb and duration of use in these cases is unclear.
Nephrotoxic Drugs
Theoretically, long-term use of anthraquinones from rhubarb might increase the risk of nephrotoxicity when used with nephrotoxic drugs.
The anthraquinone constituents of rhubarb have been shown to induce nephrotoxicity in animal research. Additionally, in a case report, a 23-year old female presented with kidney failure after taking 6 tablets of a proprietary slimming agent (found to contain the anthraquinones emodin and aloe-emodin from rhubarb) daily for 6 weeks and then adding diclofenac 25 mg 4 times daily for 2 days. The authors postulate that the anthraquinone constituents of rhubarb contributed to the renal dysfunction, and the addition of diclofenac, a nephrotoxic drug, led to renal failure. Until more is known, advise patients to avoid taking rhubarb if they are taking other potentially nephrotoxic drugs.
Stimulant Laxatives
Theoretically, rhubarb might increase the risk for fluid and electrolyte loss when taken with other stimulant laxatives.
Rhubarb has stimulant laxative effects. Concomitant use with stimulant laxatives might compound fluid and electrolyte loss.
Warfarin (Coumadin)
Theoretically, excessive use of rhubarb might increase the risk of bleeding when taken with warfarin.
Rhubarb has stimulant laxative effects and can cause diarrhea. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. Advise patients who take warfarin not to take excessive amounts of rhubarb.
Sheep Sorrel herb extract
Anticoagulant/Antiplatelet Drugs
Theoretically, sorrel might cause additive effects and side effects when used with anticoagulant or antiplatelet drugs.
In vitro, sorrel has been shown to inhibit platelet aggregation. However, this effect has not been reported in humans.
Fexofenadine (Allegra)
Sorrel might reduce the effectiveness of fexofenadine by reducing its absorption from the gut.
In vitro research shows that an ethanol extract of sorrel inhibits organic anion-transporting polypeptide 1A2 (OATP1A2), which transports fexofenadine from the intestine into cells. In rats, concomitant administration of sorrel extract with fexofenadine reduces oral absorption of fexofenadine and the area under the plasma concentration-time curve (AUC).
Organic Anion-Transporting Polypeptide Substrates (Oatp)
Sorrel might reduce the effectiveness of OATP substrates by reducing their absorption from the gut.
In vitro research shows that sorrel inhibits OATP1A2. Theoretically it may inhibit other OATPs. The OATPs are expressed in the small intestine and liver and transport drugs into cells. Inhibition of OATP may reduce the bioavailability of oral drugs that are substrates of OATP.
Burdock Root Extract
Anticoagulant/Antiplatelet Drugs
Theoretically, taking burdock with anticoagulant or antiplatelet drugs might increase the risk of bleeding.
In vitro research shows that lignans from burdock reduce rabbit platelet aggregation by inhibiting platelet activating factor. This interaction has not been reported in humans.
Brand information
Manufacturer and brand details for Essiac Tonic, from the product label.
Herbs, Etc
- Name
- Herbs, Etc., Inc.
- Street Address
- 1340 Rufina Circle
- City
- Sante Fe
- State
- NM
- ZipCode
- 87507
- Web Address
- www.herbsetc.com
Essiac Tonic by Herbs, Etc: Common Questions
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Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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Label information is sourced from the NIH Dietary Supplement Label Database and reflects the product version on file; always read your actual product label. This page is for education only and is not a substitute for professional medical advice. Confirm with your pharmacist or doctor before combining supplements and medications.
The Full Monographs Behind Essiac Tonic’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Burdock
Interacts with 122 drugsBurdock is a traditional herb most often used for skin problems and as a so-called 'blood purifier,' but high-quality human studies are lacking and most claims are not well proven. It is wid...
Read the full Burdock monograph → Herb & supplement monographSorrel
Interacts with 169 drugsSorrel is a tangy, leafy herb used in cooking and traditional medicine, often for congestion, digestion, and inflammation. Solid human evidence for any health benefit is limited, and its hig...
Read the full Sorrel monograph → Herb & supplement monographSlippery Elm
Interacts with 2,022 drugsSlippery elm is a traditional herbal remedy made from the inner bark of a North American elm tree, used mainly to soothe sore throats and irritated digestive tracts. Its mucilage can coat an...
Read the full Slippery Elm monograph → Herb & supplement monographRhubarb
Interacts with 658 drugsRhubarb root has a long history of use as a laxative and in traditional Chinese medicine, and its edible stalks are a common food. Most medicinal claims are backed by limited or low-quality...
Read the full Rhubarb monograph →Sources & How We Checked
Essiac Tonic'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 42 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.
Burdock 11 references
- Iwakami S, Wu JB, Ebizuka Y, Sankawa U. Platelet activating factor (PAF) antagonists contained in medicinal plants: lignans and sesquiterpenes. Chem Pharm Bull (Tokyo) 1992;40:1196-8. PubMed
- Sasaki Y, Kimura Y, Tsunoda T, Tagami H. Anaphylaxis due to burdock. Int J Dermatol 2003;42:472-3. PubMed
- Rhoads PM, Tong TG, Banner W Jr, Anderson R. Anticholinergic poisonings associated with commercial burdock root tea. J Toxicol Clin Toxicol 1984-85;22:581-4. PubMed
- Rodriguez P, Blanco J, Juste S, et al. Allergic contact dermatitis due to burdock (Arctium lappa). Contact Dermatitis 1995;33:134-5.
- Kassler, W. J., Blanc, P., and Greenblatt, R. The use of medicinal herbs by human immunodeficiency virus-infected patients. Arch Intern Med 1991;151(11):2281-2288. DOI
- Chan, Y. S., Cheng, L. N., Wu, J. H., Chan, E., Kwan, Y. W., Lee, S. M., Leung, G. P., Yu, P. H., and Chan, S. W. A review of the pharmacological effects of Arctium lappa (burdock). Inflammopharmacology. 2011;19(5):245-254. PubMed
- Breed, F. B. and Kuwabara, T. Burdock ophthalmia. Arch Ophthalmol 1966;75(1):16-20.
- Bryson, P. D., Watanabe, A. S., Rumack, B. H., and Murphy, R. C. Burdock root tea poisoning. Case report involving a commercial preparation. JAMA 5-19-1978;239(20):2157. DOI
- <p>Fletcher GF<span>, </span>Cantwell JD. Burdock root tea poisoning. JAMA <span>1978 Oct 6;240(15):1586.</span></p> DOI
- Latif A, Fichadiya H, Abid F, Capo G. Herbal Teas and Thrombocytopenia: A Curious Case of Yellow Dock and Burdock-Induced Thrombocytopenia. Eur J Case Rep Intern Med 2022;9(3):003247. PubMed
- Niazi B, Ahmed K, Ahmed M, Ali S, Song K, Elias S. Drug-Induced Liver Injury from Herbal Liver Detoxification Tea. Case Rep Gastroenterol 2022;16(3):612-617. PubMed
Sorrel 8 references
- Neubauer N, Marz RW. Placebo-controlled, randomized, double-blind, clincal trial with Sinupret sugar coated tablets on the basis of a therapy with antibiotics and decongestant nasal drops in acute sinusitis. Phytomedicine 1994;1:177-81.
- Marz RW, Ismail C, Popp MA. Action profile and efficacy of a herbal combination preparation for the treatment of sinusitis. Wien Med Wochenschr 1999;149:202-8.
- Zick, S. M., Sen, A., Feng, Y., Green, J., Olatunde, S., and Boon, H. Trial of Essiac to ascertain its effect in women with breast cancer (TEA-BC). J Altern Complement Med 2006;12(10):971-980. PubMed
- Sanz, P. and Reig, R. Clinical and pathological findings in fatal plant oxalosis. A review. Am J Forensic Med Pathol. 1992;13(4):342-345. PubMed
- Gniazdowska, B., Doroszewska, G., and Doroszewski, W. [Hypersensitivity to weed pollen allergens in the region of Bygdoszcz]. Pneumonol.Alergol.Pol. 1993;61(7-8):367-372.
- Selçuk SN, Gülhan B, Düzova A, Teksam Ö. Acute tubulointerstitial nephritis due to large amount of sorrel (Rumex acetosa) intake. Clin Toxicol (Phila) 2015;53(5):497. PubMed
- Ahn JH, Kim J, Rehman NU, Kim HJ, Ahn MJ, Chung HJ. Effect of Rumex Acetosa Extract, a Herbal Drug, on the Absorption of Fexofenadine. Pharmaceutics. 2020;12(6):E547. PubMed
- Jeong D, Irfan M, Lee DH, Hong SB, Oh JW, Rhee MH. Rumex acetosa modulates platelet function and inhibits thrombus formation in rats. BMC Complement Med Ther. 2020;20(1):98. PubMed
Slippery Elm 3 references
- The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
- Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
- Czarnecki D, Nixon R, Bekhor P, and et al. Delayed prolonged contact urticaria from the elm tree. Contact Dermatitis 1993;28:196-197. PubMed
Rhubarb 20 references
- Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.
- McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
- Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
- Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
- Nusko G, Schneider B, Schneider I, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46:651-5. PubMed
- Kwan TH, Tong MK, Leung KT, et al. Acute renal failure associated with prolonged intake of slimming pills containing anthraquinones. Hong Kong Med J 2006;12:394-7.
- Fairbairn JW. The anthraquinone laxatives. Biological assay and its relation to chemical structure. Pharmacology 1976;14:48-61. PubMed
- Siegers, C. P., Hertzberg-Lottin, E., Otte, M., and Schneider, B. Anthranoid laxative abuse--a risk for colorectal cancer? Gut 1993;34(8):1099-1101. PubMed
- Fan, J. G. Evaluating the efficacy and safety of Danning Pian in the short-term treatment of patients with non-alcoholic fatty liver disease: a multicenter clinical trial. Hepatobiliary.Pancreat.Dis.Int 2004;3(3):375-380.
- Yan, M., Zhang, L. Y., Sun, L. X., Jiang, Z. Z., and Xiao, X. H. Nephrotoxicity study of total rhubarb anthraquinones on Sprague Dawley rats using DNA microarrays. J Ethnopharmacol. 4-15-2006; PubMed
- Zhang, J. H., Li, L. S., and Zhang, M. Clinical effects of rheum and captopril on preventing progression of chronic renal failure. Chin Med J (Engl.) 1990;103(10):788-793.
- Mitsuma, T., Yokozawa, T., Oura, H., and Terasawa, K. [Rhubarb therapy in patients with chronic renal failure (Part 2)]. Nippon Jinzo Gakkai Shi 1987;29(2):195-207.
- Wu, C. X. [A preliminary study on the effect of a single Rheum officinale in heavy doses in the treatment of acute icteric hepatitis]. Zhong.Xi.Yi.Jie.He.Za Zhi.(Chinese Journal of Modern Developments in Traditional Medicine) 1984;4(2):88-89.
- Jiao, D. H. [Clinical research on the hemostatic effect of rhubarb on peptic ulcer with acute bleeding]. Zhong.Xi.Yi.Jie.He.Za Zhi.(Chinese Journal of Modern Developments in Traditional Medicine) 1984;4(10):597-600, 579.
- Jiao, D. H., Ma, Y. H., Chen, S. J., Liu, C. T., Shu, H. N., and Chu, C. M. Resume of 400 cases of acute upper digestive tract bleeding treated by rhubarb alone. Pharmacology 1980;20 Suppl 1:128-130.
- Zhang, JH, Yao, XD, Song, Y, and et al. [Long-term treating effects of rhubarb and captopril in delaying the progression of renal failure]. Chinese Kidney Disease Journal 1993;9(4):197-201.
- Rehman H, Begum W, Anjum F, Tabasum H, Zahid S. Effect of rhubarb (Rheum emodi) in primary dysmenorrhoea: a single-blind randomized controlled trial. J Complement Integr Med. 2015 Mar;12(1):61-9.
- Yu CP, Lin HJ, Lin SP, Shia CS, Chang PH, Hou YC, Hsieh YW. Rhubarb decreased the systemic exposure of cyclosporine, a probe substrate of P-glycoprotein and CYP 3A. Xenobiotica. 2016 Aug;46(8):677-82. PubMed
- Byeon JH, Kil JH, Ahn YC, Son CG. Systematic review of published data on herb induced liver injury. J Ethnopharmacol 2019;233:190-6. PubMed
- Zhao D, Feng SX, Zhang HJ, et al. Pharmacokinetics, tissue distribution and excretion of five rhubarb anthraquinones in rats after oral administration of effective fraction of anthraquinones from rheum officinale. Xenobiotica. 2021;51(8):916-925. PubMed
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.
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