Major interaction on record — check this product against your medications before combining. Check your meds →
Dietary supplement

Formula Thirty-One Ingredients & Drug Interactions

by Pure Herbs

Formula Thirty-One label
See full label image
Liquid Category: Botanical
Most serious interaction: Major
Clinical methodology reviewed by · Updated Sep 16, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Formula Thirty-One 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: Major

Formula Thirty-One is a dietary supplement by Pure Herbs with 6 active ingredients. Its ingredients are commonly taken for heart failure symptoms, high blood pressure, chest pain (angina).Based on those ingredients, 929 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Black Cohosh Root Extract, Hawthorn (Crataegus sp.) berry, leaf & flower extract, Lily of the Valley 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 Formula Thirty-One by Pure Herbs

Ask about any prescription or over-the-counter medication and we check it for interactions with Formula Thirty-One by Pure Herbs — and tell you which ingredient is responsible.

Pharmacist-reviewed data Checks every ingredient Answer in seconds
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HelloPharmacist Scorecard of Formula Thirty-One by Pure Herbs

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 11, 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 6 active ingredients.
  • “Proprietary Blend” is a proprietary blend — the label gives one combined amount (1,951 mg) without saying how much of each component you get.

Formula Thirty-One contains 6 ingredients in a proprietary blend delivery format. The active components are hawthorn (berry, leaf, and flower extract), Irish moss extract, black cohosh root extract, bugleweed (aerial parts extract), lily-of-the-valley root extract, and black walnut hull extract.

There are no inactive other ingredients listed.

Does it work?

Not established
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 established

The graded evidence we hold for these ingredients covers different conditions than the ones this product is marketed for, so there's no established rating for its stated use.

Why this rating?
  • The label markets this product for: Helps maintain a healthy circulatory system.
  • We looked for evidence on: Angina, Arrhythmia, Atherosclerosis, Cardiovascular disease (CVD), Congestive heart failure (CHF), Coronary heart disease (CHD) — and 4 related terms.
  • The closest evidence on file: Lily-of-the-valley is rated "Insufficient Reliable Evidence To Rate" for Arrhythmia (Natural Medicines).
  • Also on file: Lily-of-the-valley is rated "Insufficient Reliable Evidence To Rate" for Heart failure.
  • Also on file: Hawthorn is rated "Insufficient Reliable Evidence To Rate" for Angina, Arrhythmia, Atherosclerosis, Cardiovascular disease (CVD), and more.

The evidence supporting these ingredients is limited. Hawthorn shows insufficient reliable evidence for angina, anxiety, arrhythmia, atherosclerosis, cardiovascular disease, and cognitive function.

Black cohosh is possibly effective for menopausal symptoms but shows insufficient evidence for acne, sexual dysfunction, anxiety, and breast cancer-related hot flashes. Bugleweed, lily-of-the-valley, and black walnut all show insufficient evidence for their listed uses — hyperthyroidism and insomnia (bugleweed), arrhythmia and heart failure (lily-of-the-valley), and coronary heart disease and wound healing (black walnut).

We hold no effectiveness data for Irish moss extract in the facts provided.

The evidence, ingredient by ingredient Hawthorn Sea Moss Black Cohosh Bugleweed Lily-of-the-valley Black Walnut

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 5 of the 6 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 6 of 6.
  • General safety write-ups exist for 6 of 6.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Hawthorn is generally well tolerated in studies, though heart conditions require medical supervision. Serious adverse effects are rare but include multiorgan hypersensitivity reactions with acute kidney failure, bronchitis, and heart palpitations or circulation problems in a small number of trial participants.

Black cohosh is generally well tolerated short-term; common side effects include breast tenderness, dizziness, upset stomach, headache, irritability, rash, and tiredness, though rare serious effects include liver damage and abnormal uterine tissue growth. Bugleweed has no reported adverse effects in the data, but it may affect thyroid function and requires medical guidance.

Lily-of-the-valley is unsafe without medical supervision — all its parts are poisonous and can cause life-threatening heart rhythm problems, headache, visual disturbances, and in one case report, severe complications including seizures and kidney failure from accidental poisoning. Black walnut hull is well tolerated orally in the short term, though the hull contains tannins that may cause upset stomach; it can trigger tree nut allergies in sensitive individuals.

Side effects, ingredient by ingredient Hawthorn Sea Moss Black Cohosh Bugleweed Lily-of-the-valley Black Walnut

Meds to double-check

Major interaction found
Known Interaction Concern · database check
Major identified

At least one ingredient has a documented Major-severity interaction. Check your medications for a personalized result.

Why this rating?
  • 5 of the 6 matched ingredients can interact with medications — Bugleweed, Lily-of-the-valley, Hawthorn, Black Cohosh, Sea Moss.
  • The most serious interaction on file is rated Major.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; heart-rhythm medications; lithium.
  • For scale: 930 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 this product, check with your pharmacist if you take digoxin or other heart glycosides, nitrates, phosphodiesterase-5 inhibitors, prolonged corticosteroids, quinine, beta-blockers, calcium channel blockers, blood thinners, diuretics, lithium, stimulant laxatives, macrolide or tetracycline antibiotics, medications metabolized by CYP2D6, hepatotoxic drugs, atorvastatin, cisplatin, estrogen therapy, serotonergic antidepressants (like duloxetine or sertraline), or OATP-dependent drugs. Altogether, these interactions span 912 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 established evidence rating for its marketed use. Major medication interactions have been identified, and safety information is well characterized.

This product carries serious medication interactions, especially if you take heart drugs, blood thinners, blood pressure medications, thyroid medication, or antidepressants. Lily-of-the-valley and hawthorn create the highest-risk profiles.

It's essential to check every medication you take against this page's interaction tool before starting. Talk with your pharmacist or doctor — don't start this on your own if you have any heart condition or take prescription drugs.

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

Assessment coverage: 6 of 6 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Jan 23, 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

At a glance

General information

Key facts about Formula Thirty-One, straight from the product label.

Brand Pure Herbs
Net contents 4 Fluid Ounce(s); 120 mL
Market status On market
Date entered into DSLD Jan 23, 2023
DSLD ID 281235
Product type Botanical
Supplement form Liquid
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Adult (18 - 50 Years), Women (not pregnant or lactating)
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 Formula Thirty-One by Pure Herbs, 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 mL
Maximum serving Sizes:
2 mL
Servings per container
60
IngredientAmount% DV
Proprietary Blend1951 mg--
Hawthorn (Crataegus sp.) berry, leaf & flower extract0 NP--
Irish Moss Extract0 NP--
Black Cohosh Root Extract0 NP--
American Bugleweed Aerial Parts Extract0 NP--
Lily of the Valley Root Extract0 NP--
Black Walnut Hull Extract0 NP--

Other ingredients: None

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.
Suggested/Recommended/Usage/Directions

Directions: For adults, mix 2 mL (abt. 1/2 tsp) of extract in 2 fl. oz (60 mL) water one time daily preferably with a meal.

Shake well before use

Formulation

Helps to maintain a healthy circulatory system.

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.

Precautions

Warning: Discontinue use and consult a healthcare practitioner if you have a liver disorder or develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice.

Not intended for use by pregnant or nursing women. If you have a medical condition or are taking medication, consult your doctor prior to use.

Keep out of reach of children

Contains: Walnuts

Brand IP Statement(s)

Pure Herbs, LTD. Natural Herbal Extracts

FDA Statement of Identity

Dietary Supplement

General Statements

"No expense has been spared to provide the finest nature has to offer."

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

See for yourself

Formula Thirty-One by Pure Herbs label

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

Formula Thirty-One 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 Formula Thirty-One by Pure Herbs

These are the 6 active ingredients this product is made of. Select any to open its full monograph.

Serving size2 mL Dosage formLiquid Servings per container60 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: None. These complete the product’s ingredient list but are not active constituents.

Interaction report

Formula Thirty-One by Pure Herbs Drug Interactions

Want to check YOUR meds against Formula Thirty-One?

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
929Drugs
40 Major 875 Moderate 14 Minor

Ingredients driving the most interactions

Black Cohosh Root Extract 652
Hawthorn (Crataegus sp.) berry, leaf & flower extract 191
Lily of the Valley Root Extract 157
Irish Moss Extract 22
American Bugleweed Aerial Parts Extract 16

Individual Drug Interactions

The ingredients in Formula Thirty-One interact with 929 drugs. Click any drug to see the details.

5 of the 6 ingredients in Formula Thirty-One interact with drugs. Each result below shows which ingredient is responsible. Black Cohosh Root Extract Hawthorn (Crataegus sp.) berry, leaf & flower extract Lily of the Valley Root Extract Irish Moss Extract American Bugleweed Aerial Parts Extract

Each ingredient & the kinds of drugs it affects

For each ingredient in Formula Thirty-One 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.

Black Cohosh Root Extract7 drug types · 652 drugs

Atorvastatin (Lipitor)

Taking black cohosh with atorvastatin might increase the risk for elevated liver function tests.
In one case report, a patient taking atorvastatin (Lipitor) developed significantly elevated liver function enzymes after starting black cohosh 100 mg four times daily. Liver enzymes returned to normal when black cohosh was discontinued. It is unclear whether the elevated liver enzymes were due to black cohosh itself or an interaction between atorvastatin and black cohosh.

Likelihood Possible Evidence D
Cisplatin (Platinol-Aq)

Theoretically, black cohosh may reduce the clinical effects of cisplatin.
Animal research suggests that black cohosh might decrease the cytotoxic effect of cisplatin on breast cancer cells.

Likelihood Possible Evidence D
Cytochrome P450 2D6 (Cyp2D6) Substrates

Some research suggests that black cohosh might inhibit CYP2D6, but there is conflicting evidence.
Some clinical research suggests that black cohosh might modestly inhibit CYP2D6 and increase levels of drugs metabolized by this enzyme. However, contradictory clinical research shows a specific black cohosh product (Remifemin, Enzymatic Therapy) 40 mg twice daily does not significantly inhibit metabolism of a CYP2D6 substrate in healthy study volunteers. Until more is known, use black cohosh cautiously in patients taking drugs metabolized by CYP2D6.

Likelihood Possible Evidence B
Estrogens

Theoretically, black cohosh may alter the effects of estrogen therapy.
Some research suggests that black cohosh has estrogenic effects. This may enhance or inhibit the effects of estrogen therapy.

Likelihood Possible Evidence D
Hepatotoxic Drugs

Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
There is concern that black cohosh might be linked to cases of liver failure and autoimmune hepatitis.

Likelihood Possible Evidence D
Serotonergic Drugs

Combining serotonergic drugs with black cohosh might cause additive serotonergic effects.
Black cohosh might increase the risk of serotonin syndrome when combined with other serotonergic drugs. Black cohosh acts as an agonist at several serotonin receptor subtypes and might interact with other serotonergic medications. In one case, a 55-year-old female who had been on stable treatment with sertraline 50 mg and duloxetine 60 mg daily developed serotonin syndrome after taking black cohosh extract 40 mg daily for 3 days.

Likelihood Possible Evidence D
Organic Anion-Transporting Polypeptide Substrates (Oatp)

Black cohosh may inhibit one form of OATP, OATP2B1, which could reduce the bioavailability and clinical effects of OATP2B1 substrates.
In vitro research shows that black cohosh modestly inhibits OATP2B1. OATPs are expressed in the small intestine and liver and are responsible for the uptake of drugs and other compounds into the body. Inhibition of OATP may reduce the bioavailability of oral drugs that are substrates of OATP.

Likelihood Possible Evidence D
Black Cohosh Root Extract full monograph & interactions

Hawthorn (Crataegus sp.) berry, leaf & flower extract6 drug types · 191 drugs

Nitrates

Theoretically, concomitant use might cause additive coronary vasodilatory effects.
Some evidence shows that hawthorn might lower blood pressure due to vasodilatory effects.

Likelihood Probable Evidence D
Phosphodiesterase-5 Inhibitors

Theoretically, concomitant use might result in additive vasodilation and hypotension.
Hawthorn might inhibit PDE-5 and cause vasodilation.

Likelihood Probable Evidence D
Anticoagulant/Antiplatelet Drugs

Theoretically, hawthorn may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
In vitro and animal research shows that hawthorn can inhibit platelet aggregation. However, its effect in humans is unclear. One observational study shows that patients taking hawthorn shortly before undergoing coronary artery bypass graft (CABG) surgery or valve replacement surgery have a 10% incidence of postoperative bleeding, compared with 1% in those who never consumed hawthorn extract. However, clinical research shows that taking a specific preparation of dried hawthorn leaves and flowers (Crataesor, Soria Natural Lab) 800 mg three times daily for 15 days does not affect platelet aggregation or levels of thromboxane B2, the metabolite of thromboxane A2, in healthy humans.

Likelihood Possible Evidence D
Beta-Blockers

Theoretically, concomitant use might cause additive effects on blood pressure and heart rate.
Some evidence shows that hawthorn might lower blood pressure and heart rate.

Likelihood Possible Evidence D
Calcium Channel Blockers

Theoretically, concomitant use might cause additive coronary vasodilation and hypotensive effects.
Some evidence shows that hawthorn might lower blood pressure due to vasodilatory effects.

Likelihood Possible Evidence D
Digoxin (Lanoxin)

Theoretically, hawthorn might potentiate the effects and adverse effects of digoxin.
Hawthorn appears to improve cardiac output; however, hawthorn does not appear to affect digoxin pharmacokinetics. Case reports suggest that at least one species of hawthorn root extract (Crataegus mexicana) may produce adverse effects similar to digoxin and can cross-react with digoxin assays, leading to falsely elevated plasma digoxin levels.

Likelihood Possible Evidence D
Hawthorn (Crataegus sp.) berry, leaf & flower extract full monograph & interactions

Lily of the Valley Root Extract8 drug types · 157 drugs

Corticosteroids

Theoretically, using lily-of-the-valley with prolonged corticosteroid therapy can cause cardiac glycoside toxicity.
Lily-of-the-valley contains cardiac glycosides. Concomitant, long-term corticosteroid use can increase the risk of cardiac glycoside toxicity due to potassium depletion and electrolyte imbalance.

Likelihood Probable Evidence D
Digoxin (Lanoxin)

Using lily-of-the-valley with digoxin can cause cardiac glycoside toxicity.
Lily-of-the-valley contains cardiac glycosides. Use of the cardiac glycoside digoxin and lily-of-the-valley concomitantly increases the risk of cardiac glycoside toxicity.

Likelihood Likely Evidence D
Quinine

Theoretically, using lily-of-the-valley with quinine can increase the risk of cardiac glycoside toxicity.
Quinine may reduce the clearance of oral digoxin. Theoretically, concomitant use of quinine with lily-of-the-valley might reduce the clearance of cardiac glycosides found in lily-of-the-valley and increase the risk of toxicity.

Likelihood Probable Evidence D
Diuretic Drugs

Theoretically, using lily-of-the-valley with diuretics can increase the risk of cardiac glycoside toxicity.
Lily-of-the-valley contains cardiac glycosides. Concomitant use of potassium depleting diuretics and lily-of-the-valley can increase the risk of cardiac glycoside toxicity due to potassium depletion and electrolyte imbalance.

Likelihood Possible Evidence D
Lithium

Theoretically, lily-of-the-valley can increase levels of lithium and increase toxicity.
Lily-of-the-valley is thought to have diuretic properties. Theoretically, due to these potential diuretic effects, lily-of-the-valley might reduce excretion and increase levels of lithium. The dose of lithium might need to be decreased.

Likelihood Probable Evidence D
Macrolide Antibiotics

Theoretically, using lily-of-the-valley with macrolide antibiotics can increase the risk of cardiac glycoside toxicity.
Macrolide antibiotics appear to increase the gastrointestinal absorption of oral digoxin. Theoretically, concomitant use of macrolide antibiotics might increase the absorption of the cardiac glycosides found in lily-of-the-valley.

Likelihood Possible Evidence D
Stimulant Laxatives

Theoretically, using lily-of-the-valley with stimulant laxatives can increase the risk of cardiac glycoside toxicity.
Lily-of-the-valley contains cardiac glycosides. The overuse of stimulant laxatives can increase the risk of cardiac glycoside toxicity with lily-of-the-valley due to potassium depletion.

Likelihood Possible Evidence D
Tetracycline Antibiotics

Theoretically, using lily-of-the-valley with tetracycline antibiotics might increase the risk of cardiac glycoside toxicity.
Tetracycline antibiotics appear to increase the gastrointestinal absorption of oral digoxin, a cardiac glycoside. Theoretically, concomitant use of tetracycline antibiotics might increase the absorption of the cardiac glycosides found in lily-of-the-valley.

Likelihood Possible Evidence D
Lily of the Valley Root Extract full monograph & interactions

Irish Moss Extract3 drug types · 22 drugs

Amiodarone (Cordarone)

Theoretically, combining sea moss with amiodarone might cause excessively high iodine levels.
Amiodarone contains 37.3% iodine and can increase iodine levels. Concomitant use with sea moss, which contains approximately 4-7 mcg of iodine per gram, might increase the risk of adverse effects from iodine, including altered thyroid function.

Likelihood Possible Evidence D
Antithyroid Drugs

Due to its iodine content, sea moss might alter the effects of antithyroid drugs.
Sea moss contains approximately 4-7 mcg of iodine per gram. Iodine in high doses has been reported to cause both hyperthyroidism and hypothyroidism, depending on the individual's past medical history. Taking sea moss could theoretically alter the effects of antithyroid drugs.

Likelihood Possible Evidence D
Thyroid Hormone

Due to its iodine content, sea moss might alter the effects of thyroid hormone.
Sea moss contains approximately 4-7 mcg of iodine per gram. Iodine in high doses has been reported to cause both hyperthyroidism and hypothyroidism, depending on the individual's past medical history. Taking sea moss could theoretically alter the effects of thyroid hormone.

Likelihood Possible Evidence D
Irish Moss Extract full monograph & interactions

American Bugleweed Aerial Parts Extract1 drug type · 16 drugs

Thyroid Hormone

Theoretically, bugleweed may alter thyroid function.
Concomitant use of bugleweed may reduce the effects of thyroid hormones by blocking peripheral conversion of thyroxine (T4) to triiodothyronine (T3).

Likelihood Probable Evidence D
American Bugleweed Aerial Parts Extract full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Formula Thirty-One, from the product label.

Pure Herbs

See all Pure Herbs products
Name
Pure Herbs, Ltd.
City
Sterling Heights
State
MI
Phone Number
(800) 860-4372
Web Address
www.pureherbs.com
Pharmacist Counseling Corner

Formula Thirty-One by Pure Herbs: Common Questions

Does Formula Thirty-One by Pure Herbs interact with any medications?
Yes. Based on its ingredients, Formula Thirty-One has a known interaction with 929 medications, including 40 rated major. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Formula Thirty-One contains 6 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 this during pregnancy?
No. Black cohosh is possibly unsafe, bugleweed is likely unsafe, lily-of-the-valley is likely unsafe, and black walnut hull is possibly unsafe during pregnancy. Hawthorn and Irish moss data aren't on file for pregnancy. Do not use this product if you're pregnant; talk to your doctor first.
Can I breastfeed while taking this?
No. Black cohosh, bugleweed, and lily-of-the-valley should all be avoided while breastfeeding because safety hasn't been established or milk production may be affected. Black walnut hull data aren't on file for breastfeeding. If you're nursing, don't use this product without talking to your pharmacist or doctor.
What is lily-of-the-valley in this formula for?
Lily-of-the-valley is traditionally used for heart and arrhythmia support, but we have insufficient evidence to show it works for these. More importantly, all parts of the plant are toxic and can cause dangerous heart problems — it should not be used without medical supervision.
Does black cohosh in this product help with hot flashes?
Black cohosh is possibly effective for menopausal symptoms like hot flashes, which is the strongest evidence claim for any ingredient in this formula. However, you should discuss use with your doctor, especially if you take other medications, because it has documented interactions with several drug types.
What does hawthorn do?
Hawthorn traditionally supports heart health, but we have insufficient reliable evidence that it actually works for angina, arrhythmia, heart disease, or the other conditions listed. It does lower blood pressure and affect heart rate, which is why it interacts with so many heart and blood pressure medications.
What are the most common side effects?
Black cohosh is most likely to cause side effects from this blend — breast tenderness, dizziness, upset stomach, headache, irritability, rash, and tiredness are the most common. Hawthorn and black walnut hull are generally well tolerated. Serious side effects are rare but possible, so report any unusual symptoms to your pharmacist or doctor.

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.

Formula Thirty-One label
Go deeper

The Full Monographs Behind Formula Thirty-One’s Ingredients

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

Herb & supplement monograph

Hawthorn

Interacts with 191 drugs

Hawthorn is a plant traditionally used for heart-related complaints, and some studies suggest it may modestly help symptoms of mild heart failure when added to standard care. However, the ev...

Read the full Hawthorn monograph → Herb & supplement monograph

Sea Moss

Interacts with 22 drugs

Sea moss is a type of red seaweed that is naturally rich in iodine and several minerals, and it is popular as a 'whole-food' supplement. Strong human evidence for most of its health claims i...

Read the full Sea Moss monograph → Herb & supplement monograph

Black Cohosh

Interacts with 652 drugs

Black cohosh is a North American plant most often used to ease menopause symptoms like hot flashes, but the research is mixed and far from settled. It is generally well tolerated for short-t...

Read the full Black Cohosh monograph → Herb & supplement monograph

Bugleweed

Interacts with 16 drugs

Bugleweed is a traditional herb most often used for mild overactive thyroid symptoms and the rapid heartbeat that can come with it, but high-quality human evidence is very limited. Because i...

Read the full Bugleweed monograph → Herb & supplement monograph

Lily-of-the-valley

Interacts with 157 drugs

Lily-of-the-valley is a poisonous plant that contains powerful heart-affecting compounds called cardiac glycosides, similar to the drug digoxin. While it was used historically for heart cond...

Read the full Lily-of-the-valley monograph → Herb & supplement monograph

Black Walnut

Black walnut is a tree whose green hulls are traditionally used as a natural antiparasitic and digestive remedy, but solid human evidence for these uses is lacking. It contains a compound ca...

Read the full Black Walnut monograph →
Sources

Sources & How We Checked

Formula Thirty-One'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 110 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.

Hawthorn 25 references
  1. Tauchert M. Efficacy and safety of crataegus extract WS 1442 in comparison with placebo in patients with chronic stable New York Heart Association class-III heart failure. Am Heart J 2002;143:910-5. PubMed
  2. Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med 2003;114:665-74.. PubMed
  3. Chang Q, Zuo Z, Harrison F, Chow MS. Hawthorn. J Clin Pharmacol 2002;42:605-12.
  4. Holubarsch CJ, Colucci WS, Meinertz T, et al. The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial. Eur J Heart Fail 2008;10:1255-63. PubMed
  5. Pittler MH, Guo R, and Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane.Database.Syst Rev 2008:CD005312. PubMed
  6. Zick SM, Vautaw BM, Gillespie B, Aaronson KD. Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial. Eur J Heart Fail. 2009;11:990-99. PubMed
  7. Werner NS, Duschek S, and Schandry R. D-camphor-crataegus berry extract combination increases blood pressure and cognitive functioning in the elderly - a randomized, placebo controlled double blind study. Phytomedicine. 2009;16:1077-82. PubMed
  8. Dalli E, Colomer E, Tormos MC, et al. Crataegus laevigata decreases neutrophil elastase and has hypolipidemic effect: a randomized, double-blind, placebo-controlled trial. Phytomedicine. 6-15-2011;18:769-75. PubMed
  9. Maek-a-nantawat W, Phonrat B, Dhitavat J, et al. Safety and efficacy of CKBM-A01, a Chinese herbal medicine, among asymptomatic HIV patients. Southeast Asian J Trop.Med Public Health 2009;40:494-501.
  10. Asher GN, Viera AJ, Weaver MA, et al. Effect of hawthorn standardized extract on flow mediated dilation in prehypertensive and mildly hypertensive adults: a randomized, controlled cross-over trial. BMC.Complement Altern.Med 2012;12:26. PubMed
  11. Walker AF, Marakis G, Simpson E, et al. Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial. Br J Gen.Pract 2006;56:437-43.
  12. Daniele C, Mazzanti G, Pittler MH, et al. Adverse-event profile of Crataegus spp.: a systematic review. Drug Saf 2006;29:523-35. PubMed
  13. Tankanow R, Tamer HR, Streetman DS, et al. Interaction study between digoxin and a preparation of hawthorn (Crataegus oxyacantha). J.Clin.Pharmacol. 2003;43:637-42. DOI
  14. Tauchert, M., Gildor, A., and Lipinski, J. [High-dose Crataegus extract WS 1442 in the treatment of NYHA stage II heart failure]. Herz 1999;24(6):465-474.
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Sea Moss 3 references
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Black Cohosh 68 references
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Bugleweed 4 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. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physician's Guide to Herbal Medicine. Terry C. Telger, transl. 3rd ed. Berlin, GER: Springer, 1998.
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  4. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.

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Lily-of-the-valley 7 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.
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Black Walnut 3 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. Food and Drug Administration. Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA); Public Law 108-282, Title II. Accessed on May 19, 2021. Available at: https://www.fda.gov/food/food-allergensgluten-free-guidance-documents-regulatory-infor

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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.

© 2021 Therapeutic Research Center, LLC

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