Interactions on record — worth a quick check against your medications. Based on 7 of 8 ingredients. Check your meds →
Dietary supplement

Flor-Essence Ingredients & Drug Interactions

by Flora

Flor-Essence label
See full label image
Liquid Category: Other Combinations
Most serious interaction: Moderate
Clinical methodology reviewed by · Updated Sep 16, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Flor-Essence 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

The interaction bottom line Most serious interaction: Moderate

Flor-Essence is a dietary supplement by Flora with 8 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, 2,182 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are certified organic Slippery Elm bark extract, certified organic Red Clover blossom extract, certified organic Rhubarb (Rheum palmatum) root extract. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

Jump to a section

Check Your Meds Against Flor-Essence by Flora

Ask about any prescription or over-the-counter medication and we check it for interactions with Flor-Essence by Flora — and tell you which ingredient is responsible.

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HelloPharmacist Scorecard of Flor-Essence by Flora

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.

From our pharmacy team — supplement deep dive

Generated from HelloPharmacist’s pharmacist-curated databases and editorial rules · Last generated Jul 30, 2026

What’s inside

Low disclosure
Ingredient Transparency · database check
Low

Most active ingredients don't disclose an individual amount — you can't tell how much of each you're getting.

Why this rating?
  • The label discloses an exact amount for 0 of its 8 active ingredients.
  • “A Proprietary Blend from Aqueous extracts of” is a proprietary blend — the label gives one combined amount (1.30 Gram(s)) without saying how much of each component you get.

Flor-Essence contains 8 active ingredients in a proprietary blend of aqueous extracts: certified organic burdock root, sheep sorrel herb, slippery elm bark, watercress herb, blessed thistle herb, red clover blossom, rhubarb root, and kelp. The product is a liquid and includes filtered water and citric acid as inactive ingredients.

These herbs have been used traditionally in herbal medicine, though the evidence for specific health benefits varies. Each ingredient brings different traditional uses — burdock as a blood purifier, sorrel as a cleansing herb, slippery elm to soothe the digestive tract, watercress as a nutritive green, blessed thistle to support digestion, red clover for general wellness, rhubarb as a laxative, and kelp as a mineral source — but research supporting these uses remains limited.

Does it work?

Couldn't assess
Evidence for Intended Use · database check
By FDA rules, dietary supplements can’t claim to treat, cure, or prevent disease — so labels speak in careful marketing language. We discern each product’s intended use from its name, label claims, and label statements, then grade the clinical evidence for that use. How these ratings are computed
Not assessable

We hold no graded evidence for this product's ingredients for its stated purpose.

Why this rating?
  • The label markets this product for: support whole body natural elimination process.
  • Our graded evidence for these ingredients doesn't cover that particular purpose.

The effectiveness of Flor-Essence and its individual ingredients is not well established in the data we hold. Burdock, sorrel, slippery elm, watercress, and blessed thistle all show insufficient reliable evidence to rate for the conditions they've been studied in, including skin health, cold symptoms, digestive issues, and others.

Red clover similarly has insufficient evidence for menopausal symptoms, bone health, and hair loss. Rhubarb shows possibly effective evidence for two uses — menopausal symptoms and pancreatitis — but insufficient evidence for its traditional role in constipation relief.

We could not check kelp's effectiveness. If you're considering this product for a specific health concern, talk with your doctor or pharmacist about what the current evidence actually supports.

The evidence, ingredient by ingredient Burdock Sorrel Slippery Elm Watercress Blessed Thistle Red Clover Rhubarb

How safe is it?

Well-documented data
Safety Information · database check
Well characterized

Adverse-effect, pregnancy, and general safety data are on file for most of these ingredients.

Why this rating?
  • We hold adverse-effect (side-effect) data for 7 of the 7 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 7 of 7.
  • General safety write-ups exist for 7 of 7.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Burdock is likely safe as a food and for short-term use in healthy adults, though serious adverse effects are rare and include allergic reactions and contact dermatitis; a single case of liver disease was reported after use of a multi-ingredient detox tea. Sorrel is generally safe in food amounts but has high oxalate content that can pose kidney concerns at larger, medicinal doses; one case of kidney inflammation was documented.

Slippery elm is well tolerated short-term but may cause contact dermatitis. Watercress is safe in food amounts and well tolerated in a clinical trial; raw wild watercress carries a risk of parasitic liver disease.

Blessed thistle is often well tolerated in small amounts but can cause nausea and vomiting at doses above 5 grams per cup of tea. Red clover is generally well tolerated and may cause muscle aches, nausea, or vaginal spotting.

Rhubarb root can cause cramping, diarrhea, and gastrointestinal discomfort, and chronic use or abuse can lead to electrolyte loss, kidney damage, and dehydration; the leaf is toxic due to oxalic acid content. We hold no safety data for kelp in this product.

Side effects, ingredient by ingredient Burdock Sorrel Slippery Elm Watercress Blessed Thistle Red Clover Rhubarb

Meds to double-check

Moderate interaction found
Known Interaction Concern · database check
Moderate identified

The most serious documented interaction for these ingredients is Moderate. Check your medications for a personalized result.

Why this rating?
  • 7 of the 7 matched ingredients can interact with medications — Blessed Thistle, Burdock, Rhubarb, Red Clover, Watercress, among others.
  • The most serious interaction on file is rated Moderate.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; immunosuppressants / transplant drugs; heart-rhythm medications; lithium.
  • For scale: 2,183 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.

Before taking Flor-Essence, check with your doctor or pharmacist if you take any blood thinners or antiplatelet drugs (warfarin, aspirin, clopidogrel), muscle relaxants (chlorzoxazone), diuretics, corticosteroids, digoxin, cyclosporine, heartburn medications (H2-blockers, antacids, PPIs), methotrexate, tamoxifen, estrogen therapy, lithium, fexofenadine, or any drugs metabolized through your liver's CYP enzymes. Altogether, these interactions span 2,183 individual medications.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFormula with limited ingredient disclosure with no assessable stated purpose. Moderate medication interactions have been identified, and safety information is well characterized.

Flor-Essence is a multi-herb liquid that has not been shown to be effective for any specific condition in the research we hold. Its ingredients interact with numerous medications — most seriously with blood thinners, some heartburn drugs, muscle relaxants, and drugs that affect potassium or kidney function — and several ingredients carry pregnancy and breastfeeding cautions.

If you take any prescription medications, use the checker below to look up your exact drugs before you start this product. Discuss it with your own doctor or pharmacist, especially if you're pregnant, nursing, or managing a chronic condition.

Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI

Assessment coverage: 7 of 8 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated May 19, 2022.

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

At a glance

General information

Key facts about Flor-Essence, straight from the product label.

Brand Flora
Barcode (UPC) 061998680704
Net contents 17 Fluid Ounce(s); 503 mL
Market status On market
Date entered into DSLD May 19, 2022
DSLD ID 265500
Product type Other Combinations
Supplement form Liquid
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Adult (18 - 50 Years), Kosher, Women (not pregnant or lactating), Organic
From the label
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 Flor-Essence by Flora, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
2 fl. Oz.
Maximum serving Sizes:
2 fl. Oz.
Servings per container
8
UPC/BARCODE
061998680704
IngredientAmount% DV
A Proprietary Blend from Aqueous extracts of1.3 Gram(s)--
certified organic Burdock root extract0 NP--
certified organic Sheep Sorrel herb extract0 NP--
certified organic Slippery Elm bark extract0 NP--
Watercress herb extract0 NP--
certified organic Blessed Thistle herb extract0 NP--
certified organic Red Clover blossom extract0 NP--
certified organic Rhubarb (Rheum palmatum) root extract0 NP--
certified organic Kelp extract0 NP--

Other ingredients: filtered Water, Citric Acid

Tap any ingredient to jump to its full detail below.

Label statements
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.
General Statements

Elaine Alexander, the late Canadian health researcher and radio producer/broadcaster, collaborated exclusively with Flora to produce Flor-Essence. This purification tea was entrusted to Elaine by Dr. Charles Brusch, M.D., personal physician to the late President John F. Kennedy. Dr. Brusch was a partner in research and co-owner with the famous Canadian nurse Rene Caisse in perfecting this formula at his Cambridge, Massachusetts clinic.

Flor-Essence is the only product on the market authorized to carry Elaine's signature on the packaging to vouch for its historical authenticity.

Premium herbal formulas

Authorized by Elaine Alexander

Formulation

Flor-Essence supports the whole body in its natural elimination process.

Gentle detox for the whole body

97% organic ingredients

Non GMO Project Verified nongmoproject.org

Certified organic by QAI

Product of Canada

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.

Formula

Made with organic burdock root, sheep sorrel, & slippery elm bark

Kosher Check

FDA Statement of Identity

Dietary Supplement

Seals/Symbols

Quality Assurance International Certified Organic Non GMO Project Verified nongmoproject.org Kosher Check

Suggested/Recommended/Usage/Directions

Suggested use for adults: Shake bottle well. Measure 2 oz. of tea and dilute with 2 oz. or more of hot water. Take on an empty stomach preferably 1/2 hour before eating in the morning and at bedtime. Sip slowly. For extra strength: take 3 times daily. Shake the Flor-Essence liquid well before use.

Storage

After opening, keep refrigerated and use within 3 weeks.

Precautions

Do not use while pregnant or nursing.

Security sealed for your protection. Do not use if seal is missing or damaged.

Not to be sold outside the USA.

Is this label outdated? Report a formula or label change and our pharmacy team will review it.

See for yourself

Flor-Essence by Flora label

The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.

Flor-Essence label

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)
What’s inside

The Ingredients in Flor-Essence by Flora

These are the 8 active ingredients this product is made of. Select any to open its full monograph.

Serving size2 fl. Oz. Dosage formLiquid Servings per container8 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.

Other (inactive) ingredients: Filtered Water, Citric Acid. These complete the product’s ingredient list but are not active constituents.

Interaction report

Flor-Essence by Flora Drug Interactions

Want to check YOUR meds against Flor-Essence?

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 checker
2,182Drugs
2,133 Moderate 49 Minor

Ingredients driving the most interactions

certified organic Slippery Elm bark extract 2,022
certified organic Red Clover blossom extract 867
certified organic Rhubarb (Rheum palmatum) root extract 658
certified organic Sheep Sorrel herb extract 169
certified organic Burdock root extract 122

Individual Drug Interactions

The ingredients in Flor-Essence interact with 2,182 drugs. Click any drug to see the details.

7 of the 8 ingredients in Flor-Essence interact with drugs. Each result below shows which ingredient is responsible. certified organic Slippery Elm bark extract certified organic Red Clover blossom extract certified organic Rhubarb (Rheum palmatum) root extract certified organic Sheep Sorrel herb extract certified organic Burdock root extract certified organic Blessed Thistle herb extract Watercress herb extract

Each ingredient & the kinds of drugs it affects

For each ingredient in Flor-Essence 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.

certified organic Slippery Elm bark extract1 drug type · 2,022 drugs

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.

Likelihood Possible Evidence D
certified organic Slippery Elm bark extract full monograph & interactions

certified organic Red Clover blossom extract9 drug types · 867 drugs

Estrogens

Theoretically, concomitant use of large amounts of red clover might interfere with estrogen therapy.
Red clover contains phytoestrogens which might have estrogenic activity in some people. Theoretically, red clover might compete for estrogen receptors and interfere with estrogen-containing drug therapy.

Likelihood Probable Evidence D
Methotrexate (Trexall, Others)

Theoretically, red clover might increase the risk of methotrexate toxicity.
In a case report, a 52-year-old female receiving weekly methotrexate injections for psoriasis developed symptoms of methotrexate toxicity, including severe vomiting and epigastric pain, after three days of taking red clover 430 mg daily. Toxicity resolved after red clover was discontinued. However, no liver function tests or methotrexate levels were reported.

Likelihood Possible Evidence D
Tamoxifen (Nolvadex)

Theoretically, the phytoestrogens in red clover might interfere with tamoxifen.
In vitro and animal research suggests that genistein, a constituent of red clover, might antagonize the antitumor effects of tamoxifen. However, there is some evidence from an animal study that red clover does not reduce the efficacy of tamoxifen. Until more is known, tell patients taking tamoxifen to avoid red clover.

Likelihood Possible Evidence D
Anticoagulant/Antiplatelet Drugs

Although some laboratory research suggests that red clover may have anticoagulant and antiplatelet activity, clinical research has not shown this effect.
In vitro research suggests that genistein in red clover has antiplatelet effects, and historically, red clover was thought to have anticoagulant effects due to its coumarin content. However, some experts state that this is unlikely as most natural coumarins have not been shown to have anticoagulant effects, and their content in red clover is low. Additionally, some clinical research in postmenopausal patients found no effect on coagulation or prothrombin time with the use of red clover flowering tops 378 mg daily for 12 months or red clover isoflavone (Rimostil) 50 mg daily for 2 years.

Likelihood Unlikely Evidence B
Caffeine

Theoretically, soy might reduce the clearance of caffeine; however, a small clinical study found no effect.
Red clover contains genistein. Taking genistein 1 gram daily for 14 days seems to inhibit caffeine clearance and metabolism in healthy females. However, this effect does not seem to occur with the lower amounts of genistein found in red clover. A clinical study in healthy postmenopausal individuals shows that taking red clover capsules standardized to contain 60 mg isoflavones twice daily for 14 days does not affect the pharmacokinetics of caffeine.

Likelihood Unlikely Evidence D
Cytochrome P450 1A2 (Cyp1A2) Substrates

Theoretically, red clover might increase levels of drugs metabolized by CYP1A2; however, a small clinical study found no effect.
In vitro evidence shows that red clover inhibits CYP1A2. However, a clinical study in healthy postmenopausal individuals shows that taking red clover capsules standardized to contain 60 mg isoflavones twice daily for 14 days does not affect the pharmacokinetics of caffeine, a CYP1A2 probe substrate.

Likelihood Unlikely Evidence D
Cytochrome P450 2C19 (Cyp2C19) Substrates

Theoretically, red clover might increase the levels and clinical effects of drugs metabolized by CYP2C19.
In vitro evidence suggests that red clover weakly inhibits CYP2C19. This interaction has not been reported in humans.

Likelihood Unlikely Evidence D
Cytochrome P450 2C9 (Cyp2C9) Substrates

Theoretically, red clover might increase levels of drugs metabolized by CYP2C9; however, a small clinical study found no effect.
In vitro evidence suggests that red clover might inhibit CYP2C9. However, a clinical study in healthy postmenopausal individuals shows that taking red clover capsules standardized to contain 60 mg isoflavones twice daily for 14 days does not affect the pharmacokinetics of tolbutamide, a CYP2C9 probe substrate.

Likelihood Unlikely Evidence D
Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, red clover might increase levels of drugs metabolized by CYP3A4; however, a small clinical study found no effect.
In vitro evidence shows that red clover might inhibit CYP3A4 isoenzymes. However, a clinical study in healthy postmenopausal individuals shows that taking red clover capsules standardized to contain 60 mg isoflavones twice daily for 14 days does not affect the pharmacokinetics of alprazolam, a CYP3A4 probe substrate.

Likelihood Unlikely Evidence B
certified organic Red Clover blossom extract full monograph & interactions

certified organic Rhubarb (Rheum palmatum) root extract8 drug types · 658 drugs

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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
certified organic Rhubarb (Rheum palmatum) root extract full monograph & interactions

certified organic Sheep Sorrel herb extract3 drug types · 169 drugs

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.

Likelihood Possible Evidence D
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).

Likelihood Likely Evidence D
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.

Likelihood Possible Evidence D
certified organic Sheep Sorrel herb extract full monograph & interactions

certified organic Burdock root extract1 drug type · 122 drugs

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.

Likelihood Possible Evidence D
certified organic Burdock root extract full monograph & interactions

certified organic Blessed Thistle herb extract3 drug types · 36 drugs

Antacids

Theoretically, blessed thistle might decrease the effectiveness of antacids.
There are reports that blessed thistle increases stomach acid.

Likelihood Possible Evidence D
H2-Blockers

Theoretically, blessed thistle might decrease the effectiveness of H2-blockers.
There are reports that blessed thistle increases stomach acid.

Likelihood Possible Evidence D
Proton Pump Inhibitors (Ppis)

Theoretically, blessed thistle might decrease the effectiveness of PPIs.
There are reports that blessed thistle increases stomach acid.

Likelihood Possible Evidence D
certified organic Blessed Thistle herb extract full monograph & interactions

Watercress herb extract3 drug types · 6 drugs

Chlorzoxazone (Parafon Forte, Paraflex)

Watercress might reduce the metabolism of chlorzoxazone and increase its effects and side effects. Clinical research in healthy volunteers shows that a single ingestion of watercress 50 grams increases the chlorzoxazone plasma concentration-time curve by about 56% and increases its half-life by about 53%.

Likelihood Probable Evidence B
Lithium

Watercress is thought to have diuretic properties. Theoretically, due to these potential diuretic effects, watercress might reduce excretion and increase levels of lithium.

Likelihood Probable Evidence D
Warfarin (Coumadin)

Watercress contains vitamin K. Consuming large amounts of watercress might antagonize the anticoagulant effects of warfarin.

Likelihood Possible Evidence B
Watercress herb extract full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Flor-Essence, from the product label.

Flora

See all Flora products
Name
FLORA INC.
Street Address
805 E. BADGER RD.
City
LYNDEN
State
WA
ZipCode
98264
Phone Number
1.800.446.2110
Web Address
www.florahealth.com
Pharmacist Counseling Corner

Flor-Essence by Flora: Common Questions

Does Flor-Essence by Flora interact with any medications?
Yes. Based on its ingredients, Flor-Essence has a known interaction with 2,182 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Flor-Essence contains 8 active ingredients, and an interaction can come from any of them. We check every ingredient, combine the results into one list per medication, and show which ingredient and mechanism is responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.
Is it safe to take Flor-Essence while pregnant or breastfeeding?
No. Several ingredients in Flor-Essence, including burdock, watercress, and blessed thistle, should be avoided during pregnancy due to lack of safety data or possible effects on the uterus. Multiple ingredients also lack sufficient safety information for breastfeeding. Talk with your doctor or pharmacist before considering this product if you are pregnant, nursing, or planning either.
What is slippery elm in this product supposed to do?
Slippery elm bark has been used traditionally to soothe the digestive tract, but we hold insufficient reliable evidence to confirm it works for constipation, diarrhea, cough, or inflammatory bowel disease. It is generally well tolerated for short-term use.
Can Flor-Essence help with menopausal symptoms or any specific health condition?
The evidence for Flor-Essence as a whole is not established in our data. Red clover, one of its ingredients, shows possibly effective evidence only for menopausal symptoms and pancreatitis, but most other ingredients show insufficient evidence for their traditional uses. Your doctor is the best person to discuss whether this product might help your specific situation.
Does Flor-Essence have any common side effects?
Most ingredients are well tolerated, but rhubarb commonly causes cramping, diarrhea, and gastrointestinal discomfort. Red clover may cause muscle aches, nausea, or vaginal spotting. Blessed thistle at higher doses can trigger nausea and vomiting. If you experience persistent side effects, stop the product and contact your doctor.
What is watercress in Flor-Essence, and is there anything I should know about it?
Watercress is a leafy herb traditionally used as a nutritive food and supplement. In food amounts it is well tolerated, but this liquid extract is concentrated. Watercress contains vitamin K, which can interfere with blood thinners like warfarin, and it may slow the metabolism of the muscle relaxant chlorzoxazone. Raw wild watercress can carry parasitic contamination, though the extract in this product is unlikely to pose that risk.
Can I take this if I'm on any blood pressure or heart medications?
That depends on your specific medications. Watercress may affect lithium levels, rhubarb may worsen potassium loss if you take diuretics, and digoxin toxicity risk may increase with rhubarb overuse. Several ingredients also interact with blood thinners. Use the medication checker below with your exact drugs, and talk with your doctor or pharmacist before starting.

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.

Flor-Essence label
Go deeper

The Full Monographs Behind Flor-Essence’s Ingredients

Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.

Herb & supplement monograph

Burdock

Interacts with 122 drugs

Burdock 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 monograph

Sorrel

Interacts with 169 drugs

Sorrel 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 monograph

Slippery Elm

Interacts with 2,022 drugs

Slippery 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 monograph

Watercress

Interacts with 6 drugs

Watercress is a nutrient-rich leafy green that provides vitamins A, C, and K plus minerals and antioxidant plant compounds. Eaten as a food it is generally safe and healthy for most people,...

Read the full Watercress monograph → Herb & supplement monograph

Blessed Thistle

Interacts with 36 drugs

Blessed thistle is a bitter herb traditionally used to stimulate appetite and ease mild digestive complaints. High-quality human studies are lacking, so its benefits are not well proven. It...

Read the full Blessed Thistle monograph → Herb & supplement monograph

Red Clover

Interacts with 867 drugs

Red clover is a plant rich in isoflavones (plant compounds with weak estrogen-like activity) that is most often used for menopause symptoms like hot flashes. The evidence is mixed and genera...

Read the full Red Clover monograph → Herb & supplement monograph

Rhubarb

Interacts with 658 drugs

Rhubarb 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...

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Sources

Sources & How We Checked

Flor-Essence'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.

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 102 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
  1. 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
  2. Sasaki Y, Kimura Y, Tsunoda T, Tagami H. Anaphylaxis due to burdock. Int J Dermatol 2003;42:472-3. PubMed
  3. 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
  4. Rodriguez P, Blanco J, Juste S, et al. Allergic contact dermatitis due to burdock (Arctium lappa). Contact Dermatitis 1995;33:134-5.
  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
  6. 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
  7. Breed, F. B. and Kuwabara, T. Burdock ophthalmia. Arch Ophthalmol 1966;75(1):16-20.
  8. 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
  9. <p>Fletcher GF<span>, </span>Cantwell JD. Burdock root tea poisoning. JAMA <span>1978 Oct 6;240(15):1586.</span></p> DOI
  10. 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
  11. 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

See these in context on the Burdock monograph →

Sorrel 8 references
  1. 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.
  2. 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.
  3. 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
  4. 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
  5. 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.
  6. 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
  7. 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
  8. 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

See these in context on the Sorrel monograph →

Slippery Elm 3 references
  1. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
  2. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  3. Czarnecki D, Nixon R, Bekhor P, and et al. Delayed prolonged contact urticaria from the elm tree. Contact Dermatitis 1993;28:196-197. PubMed

See these in context on the Slippery Elm monograph →

Watercress 34 references
  1. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  2. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  3. Leclercq I, Desager JP, Horsmans Y. Inhibition of chlorzoxazone metabolism, a clinical probe for CYP2E1, by a single ingestion of watercress. Clin Pharmacol Ther 1998;64:144-9. PubMed
  4. Bolton-Smith C, Price RJ, Fenton ST, et al. Compilation of a provisional UK database for the phylloquinone (vitamin K1) content of foods. Br J Nutr 2000;83:389-99.
  5. Rondelaud, D., Dreyfuss, G., Bouteille, B., and Darde, M. L. Changes in human fasciolosis in a temperate area: about some observations over a 28-year period in central France. Parasitol.Res 2000;86(9):753-757. PubMed
  6. Sanchez-Sosa, S., Rojas-Ortega, S., Reed-San Roman, G., and Torres-Santana, M. A. [Massive hepatobiliary fascioliasis]. Rev Gastroenterol.Mex. 2000;65(4):179-183.
  7. van Daele, P. L., Madretsma, G. S., and van Agtmael, M. A. [Stomach ache and fever after consumption of watercress in Turkey: fascioliasis]. Ned.Tijdschr.Geneeskd. 9-29-2001;145(39):1896-1899.
  8. Cosme, A., Ojeda, E., Cilla, G., Torrado, J., Alzate, L., Beristain, X., Orive, V., and Arenas, J. [Fasciola hepatica. study of a series of 37 patients]. Gastroenterol.Hepatol. 2001;24(8):375-380.
  9. Martinez-Bebert, K., Rodriguez-Baez, R., Pila-Perez, R., Pila-Pelaez, R., and Tamakloe, K. [Hepatic hematoma caused by fascioliasis]. Gac.Med Mex. 2002;138(3):271-274.
  10. Dreyfuss, G., Vignoles, P., Abrous, M., and Rondelaud, D. Unusual snail species involved in the transmission of Fasciola hepatica in watercress beds in central France. Parasite 2002;9(2):113-120.
  11. Christmann, M., Henrich, R., Mayer, G., and Ell, C. [Infection with fasciola hepatica causing elevated liver-enzyme results and eosinophilia - serologic and endoscopic diagnosis and therapy]. Z.Gastroenterol. 2002;40(9):801-806.
  12. Cosme, A., Ojeda, E., Poch, M., Bujanda, L., Castiella, A., and Fernandez, J. Sonographic findings of hepatic lesions in human fascioliasis. J Clin Ultrasound 2003;31(7):358-363. PubMed
  13. Sapunar, J., Latorre, R., Guerra, M., and Defilippi, C. [Clinical considerations on 2 cases of hepatic fascioliasis. Importance of the imaging examinations]. Bol.Chil.Parasitol. 1992;47(3-4):70-76.
  14. de Gorgolas, M., Torres, R., Verdejo, C., Garay, J., Robledo, A., Ponte, M. C., and Fernandez Guerrero, M. L. [Fasciola hepatica infestation. Biopathology and new diagnostic and therapeutic aspects]. Enferm.Infecc.Microbiol.Clin 1992;10(9):514-519.
  15. Carrada-Bravo, T. [Fascioliasis: diagnosis, epidemiology and treatment]. Rev Gastroenterol.Mex. 2003;68(2):135-142.
  16. Yilmaz, H. and Godekmerdan, A. Human fasciolosis in Van province, Turkey. Acta Trop. 2004;92(2):161-162.
  17. Dobrucali, A., Yigitbasi, R., Erzin, Y., Sunamak, O., Polat, E., and Yakar, H. Fasciola hepatica infestation as a very rare cause of extrahepatic cholestasis. World J Gastroenterol. 10-15-2004;10(20):3076-3077. PubMed
  18. Alvarez-Chacon, R., Garcia-Rosales, J. J., de la Cruz-Otero MC, Wong-Chio, M., Cabrera-Bravo, M., Gomez-Gomez, J. V., and Gamez-Aranda, V. [Fascioliasis in children. A study of 10 cases]. Bol.Med Hosp.Infant Mex. 1992;49(6):365-371.
  19. Mailles, A., Capek, I., Ajana, F., Schepens, C., Ilef, D., and Vaillant, V. Commercial watercress as an emerging source of fascioliasis in Northern France in 2002: results from an outbreak investigation. Epidemiol.Infect. 2006;134(5):942-945.
  20. Cruz, Lopez O., Adan, Pimentel A., Tamariz Cruz, O. J., Munoz, Lopez A., Cruz Lopez, M. C., Cruz Lopez, M. E., and Munoz, Lopez S. [Hepatic fasciolasis diagnosed in state phase]. Rev Gastroenterol Mex. 2006;71(1):59-62.
  21. el Shazly, A. M., Handousa, A. E., Youssef, M. E., Rizk, H., and Hamouda, M. M. Human fascioliasis: a parasitic health problem in Dakahlia Governorate, Egypt. J Egypt.Soc Parasitol. 1991;21(2):553-559.
  22. Cosme, A., Alzate, L., Orive, V., Recasens, M., Torrado, J., Ruiz, I., and Arenas, J. [Laparoscopic findings in liver fascioliasis. Study of 13 cases]. Rev Esp.Enferm.Dig. 1990;78(6):359-362.
  23. Diaz, J., Pina, B., Lastre, M., Rivera, L., and Perez, O. [Epidemic human fascioliasis. Cuba 1983. VI. Clinical study of 40 children in the Hospital Provincial of Sagua la Grande]. G.E.N. 1990;44(4):385-388.
  24. Borie, C., Corona, S., Garin, A., Olea, P., Salcedo, M., Perez, C., and Apt, W. [A family outbreak of acute hepatic fascioliasis]. Rev Med Chil. 1990;118(1):67-72.
  25. Diamond, S. P., Wiener, S. G., and Marks, J. G., Jr. Allergic contact dermatitis to nasturtium. Dermatol.Clin. 1990;8(1):77-80. DOI
  26. Delasalle, P., Beytout, J., Cambon, M., and Bommelaer, G. [Distomatosis: diagnosis and treatment]. Rev Prat. 1-21-1990;40(3):230-236.
  27. Rivera, J. V. and Bermudez, R. H. Radionuclide imaging of the liver in human fascioliasis. Clin Nucl.Med 1984;9(8):450-453. PubMed
  28. Croese, J., Chapman, G., and Gallagher, N. D. Evolution of fascioliasis after eating wild watercress. Aust.N.Z.J.Med. 1982;12(5):525-527. PubMed
  29. Bendezu, P., Frame, A., and Hillyer, G. V. Human fascioliasis in Corozal, Puerto Rico. J Parasitol. 1982;68(2):297-299. DOI
  30. Derrick, E. and Darley, C. Contact dermatitis to nasturtium. Br.J Dermatol 1997;136(2):290-291. PubMed
  31. Narain, K., Biswas, D., Rajguru, S. K., and Mahanta, J. Human distomatosis due to Fasciola hepatica infection in Assam, India. J Commun.Dis 1997;29(2):161-165.
  32. Brinker, F. Herb Contraindications and Drug Interactions. 1998;2nd edition.
  33. Gruenwald, J. PDR for Herbal Medicines. 1998;1st ed.
  34. Clemente M, Miguel MD, Felipe KB, et al. Effect of watercress extract supplementation on lipid profile and oxidative stress markers in overweight people with physical disability: A randomized, double-blind, and placebo-controlled trial. Phytother Res. 202 PubMed

See these in context on the Watercress monograph →

Blessed Thistle 2 references
  1. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  2. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.

See these in context on the Blessed Thistle monograph →

Red Clover 24 references
  1. Kurzer MS, Xu X. Dietary phytoestrogens. Annu Rev Nutr 1997;17:353-81. PubMed
  2. Electronic Code of Federal Regulations. Title 21. Part 182 -- Substances Generally Recognized As Safe. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=182
  3. Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:273-82. PubMed
  4. This P, De La Rochefordiere A, Clough K, et al. Phytoestrogens after breast cancer. Endocr Relat Cancer 2001;8:129-34. PubMed
  5. Tice J, Cummings SR, Ettinger B, et al. Few adverse effects of two red clover extracts rich in phytoestrogens: a multicenter, placebo-controlled trial. Alt Ther 2001;7:S33.
  6. Ingram DM, Hickling C, West L, et al. A double-blind randomized controlled trial of isoflavones in the treatment of cyclical mastalgia. The Breast 2002;11:170-4. PubMed
  7. Unger M, Frank A. Simultaneous determination of the inhibitory potency of herbal extracts on the activity of six major cytochrome P450 enzymes using liquid chromatography/mass spectrometry and automated online extraction. Rapid Commun Mass Spectrom 2004;1 PubMed
  8. Cheong JL, Bucknall R. Retinal vein thrombosis associated with a herbal phytoestrogen preparation in a susceptible patient. Postgrad Med J 2005;81:266-7.. PubMed
  9. Geller SE, Shulman LP, van Breemen RB, et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause 2009;16:1156-66. PubMed
  10. Hidalgo LA, Chedraui PA, Morocho N, et al. The effect of red clover isoflavones on menopausal symptoms, lipids and vaginal cytology in menopausal women: a randomized, double-blind, placebo-controlled study. Gynecol Endocrinol 2005;21(5):257-264. PubMed
  11. Campbell MJ, Woodside JV, Honour JW, et al. Effect of red clover-derived isoflavone supplementation on insulin-like growth factor, lipid and antioxidant status in healthy female volunteers: a pilot study. Eur J Clin Nutr 2004;58(1):173-179. PubMed
  12. Guerrero JA, Lozano ML, Castillo J, et al. Flavonoids inhibit platelet function through binding to the thromboxane A2 receptor. J Thromb Haemost 2005;3(2):369-376. PubMed
  13. Kondo K, Suzuki Y, Ikeda Y, Umemura K. Genistein, an isoflavone included in soy, inhibits thrombotic vessel occlusion in the mouse femoral artery and in vitro platelet aggregation. Eur J Pharmacol 2002;455(1):53-57. PubMed
  14. Polini N, Rauschemberger MB, Mendiberri J, et al. Effect of genistein and raloxifene on vascular dependent platelet aggregation. Mol Cell Endocrinol 2007;267(1-2):55-62. PubMed
  15. Wuttke W, Jarry H, Seidlova-Wuttke D. Plant-derived alternative treatments for the aging male: facts and myths. Aging Male 2010;13(2):75-81. PubMed
  16. Villaseca P. Non-estrogen conventional and phytochemical treatments for vasomotor symptoms: what needs to be known for practice. Climacteric 2012;15(2):115-124. PubMed
  17. Chen, Y., Xiao, C. Q., He, Y. J., Chen, B. L., Wang, G., Zhou, G., Zhang, W., Tan, Z. R., Cao, S., Wang, L. P., and Zhou, H. H. Genistein alters caffeine exposure in healthy female volunteers. Eur.J Clin.Pharmacol. 2011;67(4):347-353. PubMed
  18. Friedman, J. A., Taylor, S. A., McDermott, W., and Alikhani, P. Multifocal and recurrent subarachnoid hemorrhage due to an herbal supplement containing natural coumarins. Neurocrit.Care 2007;7(1):76-80. PubMed
  19. Hooper, L., Madhavan, G., Tice, J. A., Leinster, S. J., and Cassidy, A. Effects of isoflavones on breast density in pre- and post-menopausal women: a systematic review and meta-analysis of randomized controlled trials. Hum.Reprod.Update. 2010;16(6):745-7 PubMed
  20. Orr A and Parker R. Red clover causing symptoms suggestive of methotrexate toxicity in a patient on high-dose methotrexate. Menopause Int. 2013;19(3):133-134. PubMed
  21. Clifton-Bligh PB, et al. Red cover isoflavones enriched with formononetin lower serum LDL cholesterol- a randomized, double-blind, placebo-controlled trial. Eur J Clin Nutr. 2015;69(1):134-142.
  22. Risk assessment for peri- and post-menopausal women taking food supplements containing isolated isoflavones. EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS). 2015. DOI
  23. Ferraris C, Ballestra B, Listorti C, et al. Red clover and lifestyle changes to contrast menopausal symptoms in premenopausal patients with hormone-sensitive breast cancer receiving tamoxifen. Breast Cancer Res Treat 2020;180(1):157-65. doi: 10.1007/s1054 PubMed
  24. Chen L, Choi J, Leonard SW, et al. No Clinically Relevant Pharmacokinetic Interactions of a Red Clover Dietary Supplement with Cytochrome P450 Enzymes in Women. J Agric Food Chem. 2020;68(47):13929-13939. PubMed

See these in context on the Red Clover monograph →

Rhubarb 20 references
  1. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.
  2. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  3. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  4. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  5. 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
  6. 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.
  7. Fairbairn JW. The anthraquinone laxatives. Biological assay and its relation to chemical structure. Pharmacology 1976;14:48-61. PubMed
  8. 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
  9. 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.
  10. 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
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. 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
  19. 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
  20. 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

See these in context on the Rhubarb monograph →

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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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