Four Substances Teapills Ingredients & Drug Interactions
by Plum Flower
What is this page for?
First and foremost: checking Four Substances Teapills 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
Four Substances Teapills is a dietary supplement by Plum Flower with 4 active ingredients. Its ingredients are commonly taken for menopause symptoms, menstrual cramps and irregular periods, premenstrual syndrome (pms).Based on those ingredients, 1,026 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Paeonia lactiflora Root Extract, Rehmannia glutinosa Root Extract, Angelica sinensis Root Extract. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.
Check Your Meds Against Four Substances Teapills by Plum Flower
Ask about any prescription or over-the-counter medication and we check it for interactions with Four Substances Teapills by Plum Flower — and tell you which ingredient is responsible.
AI summaries are generated from our interaction database for education only — always confirm with your pharmacist. How we use AI
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HelloPharmacist Scorecard of Four Substances Teapills by Plum Flower
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
Four Substances Teapills contains four active herbal extracts: Dong quai root, Rehmannia root, Ligusticum chuanxiong rhizome, and Peony root. These are prepared as a tablet or pill with inactive ingredients including maltose, magnesium silicate, activated carbon, and China wax.
Does it work?
Not established
The evidence we hold doesn't establish that this product works reliably for any condition. Rehmannia is possibly effective for chronic kidney disease, but the other ingredients and the formula as a whole lack sufficient reliable evidence in the data we have.
Dong quai, Peony, and Ligusticum chuanxiong have been studied for migraine, anemia, eczema, and other conditions, but the research isn't solid enough to confirm they help.
How safe is it?
Well-documented data
Dong quai is generally well tolerated when taken by mouth, though burping and flatulence can occur. It may increase bleeding and can make your skin more sensitive to sunlight.
Peony is also generally well tolerated in the short term, with some people reporting abdominal bloating, loss of appetite, diarrhea, nausea, or stomach discomfort — diarrhea was seen in about 5% of people taking high-dose peony glucosides. Rehmannia has limited human safety data and quality varies between products.
All three ingredients with pregnancy data advise against use during pregnancy and breastfeeding due to insufficient safety information.
Meds to double-check
Major interaction found
Check this product against blood thinners (warfarin and others), antiplatelet drugs, blood pressure medications, diabetes medications, birth control, hormone therapy, seizure medication (phenytoin), and psychiatric medications (especially clozapine) — Dong quai carries Major risk with warfarin, and Moderate risks span the other categories.
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 is built on traditional Chinese herbs with a history of use, but modern evidence of effectiveness is sparse. If you take any blood thinners, blood pressure medication, diabetes medication, birth control, seizure medication, or psychiatric drugs, you need to check this product against your medications before starting.
Talk with your pharmacist — the interaction list is long and some are serious.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 3 of 4 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Aug 22, 2025.
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 Four Substances Teapills, straight from the product label.
| Brand | Plum Flower |
|---|---|
| Barcode (UPC) | 739934833551 |
| Net contents | 200 Pill(s); 1.2 Ounce(s); 34 Gram(s) |
| Market status | On market |
| Date entered into DSLD | Aug 22, 2025 |
| DSLD ID | 336466 |
| Product type | Botanical |
| Supplement form | Tablet Or Pill |
| Dietary claims / uses | All Other |
| Intended target group(s) | Adult (18 - 50 Years) |
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 Four Substances Teapills by Plum Flower, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Angelica sinensis Root Extract | 0 NP | -- |
| Rehmannia glutinosa Root Extract | 0 NP | -- |
| Ligusticum chuanxiong Rhizome Extract | 0 NP | -- |
| Paeonia lactiflora Root Extract | 0 NP | -- |
| Proprietary Herbal Extract | 1360 mg | -- |
Other ingredients: Magnesium Silicate, Hydrated, Maltose, Carbon, Activated, China Wax
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.
Brand IP Statement(s)
Plum Flower Trusted by Practitioners & Patients since 1969
Formula
Si Wu Wan
FDA Statement of Identity
Herbal Supplement
Suggested/Recommended/Usage/Directions
Take 8 pills 3 times daily or as directed by your health
Precautions
Keep out of reach of children
Seals/Symbols
Plum Flower Guarantee FDA Registered cGMP Compliant Made at a cGMP Certified Facility Lab Tested Quality Verified Species Verified
General Statements
Foci Pharmaceutical 1929 Foci Pharmaceutical
Formulation
Sourced Sustainably US owned & operated since 1969. Made in China in partnership with the award winning Lanzhou Foci Pharmaceutical Co. Ltd.
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Four Substances Teapills by Plum Flower 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 Four Substances Teapills by Plum Flower
These are the 4 active ingredients this product is made of. Select any to open its full monograph.
Serving size8 Pill(s) Dosage formTablet Or Pill Servings per container25 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 Herbal Extract
- › Angelica sinensis Root Extract
- › Rehmannia glutinosa Root Extract
- › Ligusticum chuanxiong Rhizome Extract
- › Paeonia lactiflora Root Extract
Other (inactive) ingredients: Magnesium Silicate, Hydrated, Maltose, Carbon, Activated, China Wax. These complete the product’s ingredient list but are not active constituents.
Four Substances Teapills by Plum Flower Drug Interactions
HelloPharmacist Interaction Report
Four Substances Teapills by Plum Flower contains ingredients with documented interactions, most notably with blood thinners.
Dong quai (Angelica sinensis) carries a Major risk with warfarin — case reports show it can increase warfarin's blood-thinning effects and raise your bleeding risk, sometimes significantly. The same ingredient also has Moderate interactions with other blood thinners and antiplatelet drugs, and theoretically may reduce how well estrogen-based hormone therapy works.
Read the full breakdown — every affected drug type, severity by severity
Rehmannia may lower your blood pressure or blood sugar when combined with blood pressure or diabetes medications (both Moderate). Peony interacts with several drug types: it may increase levels of certain psychiatric and cancer drugs (CYP1A2 and CYP3A4 substrates, Moderate), theoretically interfere with birth control or hormone therapy (Moderate), raise bleeding risk with blood thinners (Moderate), and reduce phenytoin seizure medication levels (Moderate).
We could not check Ligusticum chuanxiong because interaction data for it is not on file.
Altogether, these interactions span 1,014 individual medications. Use the medication checker below to look up your exact prescriptions before starting this product.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Four Substances Teapills?
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 Four Substances Teapills interact with 1,026 drugs. Click any drug to see the details.
3 of the 4 ingredients in Four Substances Teapills interact with drugs. Each result below shows which ingredient is responsible. Paeonia lactiflora Root Extract Rehmannia glutinosa Root Extract Angelica sinensis Root Extract
WarfarinWarfarin
How Warfarin interacts with Four Substances Teapills — through 2 ingredients. Tap an ingredient for the detail:
Angelica Sinensis Root ExtractAnticoagulant/antiplatelet Drugs, Warfarin (coumadin) Major
Interaction Summary
Theoretically, dong quai may increase the risk of bleeding when used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Angelica Sinensis Root Extract + Warfarin interactionPaeonia Lactiflora Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates +1 Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Paeonia Lactiflora Root Extract + Warfarin interactionWarfarin SodiumCoumadin, Panwarfin, Sofarin
How Warfarin Sodium interacts with Four Substances Teapills — through 2 ingredients. Tap an ingredient for the detail:
Angelica Sinensis Root ExtractWarfarin (coumadin), Anticoagulant/antiplatelet Drugs Major
Interaction Summary
Dong quai may increase the risk of bleeding when used with warfarin.
Read the full Angelica Sinensis Root Extract + Warfarin Sodium interactionPaeonia Lactiflora Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates +1 Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Paeonia Lactiflora Root Extract + Warfarin Sodium interactionAdo-trastuzumab EmtansineKadcyla
How Ado-trastuzumab Emtansine interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Paeonia Lactiflora Root Extract + Ado-trastuzumab Emtansine interactionAbciximabReoPro
How Abciximab interacts with Four Substances Teapills — through 2 ingredients. Tap an ingredient for the detail:
Angelica Sinensis Root ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, dong quai may increase the risk of bleeding when used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Angelica Sinensis Root Extract + Abciximab interactionPaeonia Lactiflora Root ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, combining peony with anticoagulant or antiplatelet drugs might increase the risk of bleeding.
Read the full Paeonia Lactiflora Root Extract + Abciximab interactionAbemaciclibVerzenio
How Abemaciclib interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Paeonia Lactiflora Root Extract + Abemaciclib interactionAbiraterone
How Abiraterone interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Paeonia Lactiflora Root Extract + Abiraterone interactionAbiraterone AcetateYonsa, Zytiga
How Abiraterone Acetate interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Paeonia Lactiflora Root Extract + Abiraterone Acetate interactionAbrocitinibCibinqo
How Abrocitinib interacts with Four Substances Teapills — through 2 ingredients. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, combining peony with anticoagulant or antiplatelet drugs might increase the risk of bleeding.
Read the full Paeonia Lactiflora Root Extract + Abrocitinib interactionAngelica Sinensis Root ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, dong quai may increase the risk of bleeding when used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Angelica Sinensis Root Extract + Abrocitinib interactionAcalabrutinibCalquence
How Acalabrutinib interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Paeonia Lactiflora Root Extract + Acalabrutinib interactionAcarboseGlucobay, Prandase, Precose
How Acarbose interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Rehmannia Glutinosa Root ExtractAntidiabetes Drugs Moderate
Interaction Summary
Theoretically, rehmannia might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Read the full Rehmannia Glutinosa Root Extract + Acarbose interactionAcebutololRhotral, Sectral
How Acebutolol interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Rehmannia Glutinosa Root ExtractAntihypertensive Drugs Moderate
Interaction Summary
Theoretically, rehmannia might increase the risk of hypotension when taken with antihypertensive drugs.
Read the full Rehmannia Glutinosa Root Extract + Acebutolol interactionAcenocoumarolSintrom
How Acenocoumarol interacts with Four Substances Teapills — through 2 ingredients. Tap an ingredient for the detail:
Angelica Sinensis Root ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, dong quai may increase the risk of bleeding when used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Angelica Sinensis Root Extract + Acenocoumarol interactionPaeonia Lactiflora Root ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, combining peony with anticoagulant or antiplatelet drugs might increase the risk of bleeding.
Read the full Paeonia Lactiflora Root Extract + Acenocoumarol interactionAcetaminophenChildren's Tylenol, Children's Tylenol Meltaways, Tylenol, Tylenol Ex Strength
How Acetaminophen interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen interactionAcetaminophen, AspirinGemnisyn
How Acetaminophen, Aspirin interacts with Four Substances Teapills — through 2 ingredients. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Anticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Aspirin interactionAngelica Sinensis Root ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, dong quai may increase the risk of bleeding when used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Angelica Sinensis Root Extract + Acetaminophen, Aspirin interactionAcetaminophen, Aspirin, CaffeineExcedrin, Excedrin Extra Strength, Excedrin Migraine
How Acetaminophen, Aspirin, Caffeine interacts with Four Substances Teapills — through 2 ingredients. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractAnticoagulant/antiplatelet Drugs, Cytochrome P450 1a2 (cyp1a2) Substrates +1 Moderate
Interaction Summary
Theoretically, combining peony with anticoagulant or antiplatelet drugs might increase the risk of bleeding.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Aspirin, Caffeine interactionAngelica Sinensis Root ExtractAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Theoretically, dong quai may increase the risk of bleeding when used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Read the full Angelica Sinensis Root Extract + Acetaminophen, Aspirin, Caffeine interactionAcetaminophen, Brompheniramine, PhenylpropanolamineDimetapp Cold and Flu
How Acetaminophen, Brompheniramine, Phenylpropanolamine interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Brompheniramine, Phenylpropanolamine interactionAcetaminophen, ButalbitalAxocet, Bancap, Bucet, Butex Forte, Esgic CF, Orbivan CF +5 more
How Acetaminophen, Butalbital interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Butalbital interactionAcetaminophen, Butalbital, CaffeineEsgic, Esgic Plus, Fiogesic, Fioricet, Repan, Tecnal +1 more
How Acetaminophen, Butalbital, Caffeine interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Butalbital, Caffeine interactionAcetaminophen, Butalbital, Caffeine, CodeineEsgic with Codeine, Fioricet w/ Codeine
How Acetaminophen, Butalbital, Caffeine, Codeine interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Butalbital, Caffeine, Codeine interactionAcetaminophen, Butalbital, CodeineBancap w/ Codeine
How Acetaminophen, Butalbital, Codeine interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Butalbital, Codeine interactionAcetaminophen, Butalbital, Codeine PhosphatePhrenilin #3
How Acetaminophen, Butalbital, Codeine Phosphate interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Butalbital, Codeine Phosphate interactionAcetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, PhenylephrineHycomine Compound
How Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine interactionAcetaminophen, Caffeine, CodeineGesic C15, Gesic C30, Gesic C8, Lenoltec 1, Lenoltec 2, Lenoltec 3 +1 more
How Acetaminophen, Caffeine, Codeine interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Caffeine, Codeine interactionAcetaminophen, Caffeine, Codeine, SalicylamideCodalan No.1, Codalan No.2, Codalan No.3
How Acetaminophen, Caffeine, Codeine, Salicylamide interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Caffeine, Codeine, Salicylamide interactionAcetaminophen, Caffeine, DihydrocodeineDHC Plus, Panlor DC, Panlor SS
How Acetaminophen, Caffeine, Dihydrocodeine interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Caffeine, Dihydrocodeine interactionAcetaminophen, Caffeine, IsomethepteneMigralam
How Acetaminophen, Caffeine, Isometheptene interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Caffeine, Isometheptene interactionAcetaminophen, Caffeine, PyrilamineMidol Max Strength Menstrual
How Acetaminophen, Caffeine, Pyrilamine interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Caffeine, Pyrilamine interactionAcetaminophen, Chlorpheniramine Maleate, Dextromethorphan HbrVicks Formula 44M Cough, Cold & Flu Relief
How Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan Hbr interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan Hbr interactionAcetaminophen, Chlorpheniramine, Codeine, PhenylephrineColrex
How Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 3a4 (cyp3a4) Substrates, Cytochrome P450 1a2 (cyp1a2) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine interactionAcetaminophen, Chlorpheniramine, DextromethorphanCoricidin II Extra Strength Cold and Flu
How Acetaminophen, Chlorpheniramine, Dextromethorphan interacts with Four Substances Teapills — through 1 ingredient. Tap an ingredient for the detail:
Paeonia Lactiflora Root ExtractCytochrome P450 1a2 (cyp1a2) Substrates, Cytochrome P450 3a4 (cyp3a4) Substrates Moderate
Interaction Summary
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full Paeonia Lactiflora Root Extract + Acetaminophen, Chlorpheniramine, Dextromethorphan interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Four Substances Teapills 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.
Paeonia lactiflora Root Extract
Anticoagulant/Antiplatelet Drugs
Theoretically, combining peony with anticoagulant or antiplatelet drugs might increase the risk of bleeding.
In vitro research suggests that peony might have antiplatelet, anticoagulant, and antithrombotic effects.
Clozapine (Clozaril)
Theoretically, peony might increase the levels and clinical effects of clozapine.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on cytochromes P450 (CYP) 1A2 and CYP3A4. This effect has not been reported in humans.
Contraceptive Drugs
Theoretically, peony might interfere with contraceptive drugs due to competition for estrogen receptors.
In vitro and animal research shows that peony extract has estrogenic activity. Concomitant use might also increase the risk for estrogen-related adverse effects.
Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. This effect has not been reported in humans.
Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP3A4.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. This effect has not been reported in humans.
Estrogens
Theoretically, concomitant use of large amounts of peony might interfere with hormone replacement therapy and/or increase the risk for estrogen-related adverse effects.
In vitro and animal research shows that peony extract has estrogenic activity. Theoretically, peony might compete for estrogen receptors and/or cause additive estrogenic effects.
Phenytoin (Dilantin)
Theoretically, peony might reduce the levels and clinical effects of phenytoin.
Animal research shows that taking peony root reduces levels of phenytoin. Some researchers suggest that peony root might affect cytochrome P450 (CYP) 2C9, which metabolizes phenytoin. However, preliminary research in humans shows that peony root does not alter levels of losartan (Cozaar), which is also metabolized by CYP2C9.
Rehmannia glutinosa Root Extract
Antidiabetes Drugs
Theoretically, rehmannia might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Animal research shows that rehmannia may have hypoglycemic effects.
Antihypertensive Drugs
Theoretically, rehmannia might increase the risk of hypotension when taken with antihypertensive drugs.
Animal research shows that rehmannia may have hypotensive effects. Laboratory research shows that formulations of dried and processed rehmannia root inhibit angiotensin-converting enzyme (ACE).
Angelica sinensis Root Extract
Warfarin (Coumadin)
Dong quai may increase the risk of bleeding when used with warfarin.
Case reports suggest that concomitant use of dong quai with warfarin can increase the anticoagulant effects of warfarin and increase the risk of bleeding. In one case, after 4 weeks of taking dong quai 565 mg once or twice daily, the international normalized ratio (INR) increased to 4.9. The INR normalized 4 weeks after discontinuation of dong quai.
Anticoagulant/Antiplatelet Drugs
Theoretically, dong quai may increase the risk of bleeding when used with anticoagulant or antiplatelet drugs; however, research is conflicting.
Animal studies suggest that dong quai has antithrombin activity and inhibits platelet aggregation due to its coumarin components. Additionally, some case reports in humans suggest that dong quai can increase the anticoagulant effects of warfarin. However, clinical research in healthy adults shows that taking 1 gram of dong quai root daily for 3 weeks does not significantly inhibit platelet aggregation or cause bleeding. Until more is known, use dong quai with caution in patients taking antiplatelet/anticoagulant drugs.
Estrogens
Theoretically, dong quai may reduce the effects of estrogens.
Dong quai has estrogenic effects. Theoretically, concomitant use of large amounts of dong quai might interfere with hormone replacement therapy due to competition for estrogen receptors.
Brand information
Manufacturer and brand details for Four Substances Teapills, from the product label.
Plum Flower
- Name
- Mayway Herbs
- City
- Oakland
- State
- CA
- Web Address
- plumflowerherbs.com
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The Full Monographs Behind Four Substances Teapills’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Dong Quai
Interacts with 163 drugsDong Quai is a traditional Chinese herb often called "female ginseng" and is mostly used for menstrual and menopausal complaints. High-quality scientific evidence that it works for these use...
Read the full Dong Quai monograph → Herb & supplement monographRehmannia
Interacts with 258 drugsRehmannia is a root used for centuries in Traditional Chinese Medicine, often to 'tonify' the kidneys and support energy or blood health. Human evidence for most modern uses is limited, so i...
Read the full Rehmannia monograph → Herb & supplement monographPeony
Interacts with 811 drugsPeony root is a traditional Chinese medicine herb often used for menstrual problems, cramps, and inflammation, frequently as part of combination formulas. Human evidence for most uses is lim...
Read the full Peony monograph →Sources & How We Checked
Four Substances Teapills'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 37 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.
Dong Quai 19 references
- Hirata JD, Swiersz LM, Zell B, et al. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril 1997;68:981-6. PubMed
- Page RL II, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy 1999;19:870-6. PubMed
- Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm 2000;57:1221-7. DOI
- Eagon PK, Elm MS, Hunter DS, et al. Medicinal herbs: modulation of estrogen action. Era of Hope Mtg, Dept Defense; Breast Cancer Res Prog, Atlanta, GA 2000;Jun 8-11.
- Dr. Duke's Phytochemical and Ethnobotanical Databases. Available at: http://www.ars-grin.gov/duke/.
- Amato P, Christophe S, Mellon PL. Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause 2002;9:145-50. PubMed
- Shi M, Chang L, He G. [Stimulating action of Carthamus tinctorius L., Angelica sinensis (Oliv.) Diels and Leonurus sibiricus L. on the uterus]. Zhongguo Zhong Yao Za Zhi 1995;20:173-5, 192.
- Hoult JR, Paya M. Pharmacological and biochemical actions of simple coumarins: natural products with therapeutic potential. Gen Pharmacol 1996;27:713-22.. PubMed
- 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
- Chang CJ, Chiu JH, Tseng LM, et al. Modulation of HER2 expression by ferulic acid on human breast cancer MCF7 cells. Eur J Clin Invest 2006;36:588-96. PubMed
- Chuang CH, Doyle P, Wang JD, et al. Herbal medicines used during the first trimester and major congenital malformations: an analysis of data from a pregnancy cohort study. Drug Saf 2006;29:537-48. PubMed
- Lau CBS, Ho TCY, Chan TWL, Kim SCF. Use of dong quai (Angelica sinensis) to treat peri- and postmenopausal symptoms in women with breast cancer: is it appropriate? Menopause 2005;12:734-40.
- Ellis GR, Stephens MR. Untitled (photograph and a brief case report). BMJ 1999;319:650.
- Nambiar, S., Schwartz, R. H., and Constantino, A. Hypertension in mother and baby linked to ingestion of Chinese herbal medicine. West J Med 1999;171(3):152.
- Lee, S. K., Cho, H. K., Cho, S. H., Kim, S. S., Nahm, D. H., and Park, H. S. Occupational asthma and rhinitis caused by multiple herbal agents in a pharmacist. Ann.Allergy Asthma Immunol. 2001;86(4):469-474. PubMed
- Xu, J. and Li, G. [Observation on short-term effects of Angelica injection on chronic obstructive pulmonary disease patients with pulmonary hypertension]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2000;20(3):187-189.
- Scott, G. N. and Elmer, G. W. Update on natural product--drug interactions. Am J Health Syst.Pharm 2-15-2002;59(4):339-347. PubMed
- Circosta, C., Pasquale, R. D., Palumbo, D. R., Samperi, S., and Occhiuto, F. Estrogenic activity of standardized extract of Angelica sinensis. Phytother.Res. 2006;20(8):665-669.
- Fung FY, Wong WH, Ang SK, et al. A randomized, double-blind, placebo- controlled study on the anti-haemostatic effects of Curcuma longa, Angelica sinensis and Panax ginseng. Phytomedicine. 2017;32:88-96. PubMed
Rehmannia 3 references
- Zhang R, Zhou J, Jia Z, et al. Hypoglycemic effect of Rehmannia glutinosa oligosaccharide in hyperglycemic and alloxan-induced diabetic rats and its mechanism. J Ethnopharmacol 2004;90:39-43. PubMed
- Zhang RX, Li MX, Jia ZP. Rehmannia glutinosa: review of botany, chemistry and pharmacology. J Ethnopharmacol 2008;117(2):199-214. PubMed
- Chao CH, Hsu JL, Chen MF, et al. Anti-hypertensive effects of Radix Rehmanniae and its active ingredients. Nat Prod Res. 2020;34(11):1547-1552.
Peony 15 references
- Chen LC, Chou MH, Lin MF, Yang LL. Effects of Paeoniae Radix, a traditional Chinese medicine, on the pharmacokinetics of phenytoin. J Clin Pharm Ther 2001;26:271-8. PubMed
- Guo TL, Zhou XW. [Clinical observations on the treatment of the gestational hypertension syndrome with Angelica and Paeonia powder]. Zhong Xi Yi Jie He Za Zhi 1986;6:714-6, 707.
- Xie HJ, Yasar U, Sandberg M, Rane A. Paeoniae Radix, a traditional Chinese medicine, and CYP2C9 activity. J Clin Pharm Ther 2002;27:229-30. . PubMed
- Harada M, Suzuki M, Ozaki Y. Effect of Japanese Angelica root and peony root on uterine contraction in the rabbit in situ. J Pharmacobiodyn 1984;7:304-11. PubMed
- Anon. Monograph. Peony (Paeonia spp). Alt Med Rev 2001;6:495-9.
- Bruynzeel DP. Contact Dermatitis Due to Paeonia (Peony). Contact Dermatitis 1989; 20:152-3..
- Bian, X., Xu, Y., Zhu, L., Gao, P., Liu, X., Liu, S., Qian, M., Gai, M., Yang, J., and Wu, Y. Prevention of maternal-fetal blood group incompatibility with traditional Chinese herbal medicine. Chin Med J (Engl.) 1998;111(7):585-587.
- Wong, A. L. and Chan, T. Y. Interaction between warfarin and the herbal product quilinggao. Ann Pharmacother 2003;37(6):836-838.
- Cai Y, Yuan Q, Xu K, et al. Assessment of the therapeutic effect of total glycosides of peony for juvenile idiopathic arthritis: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2016;2016:8292486.
- Koo YK, Kim JM, Koo JY, et al. Platelet anti-aggregatory and blood anti-coagulant effects of compounds isolated from Paeonia lactiflora and Paeonia suffruticosa. Pharmazie 2010;65(8):624-8.
- Wang W, Tian DD, Zheng B, et al. Peony-glycyrrhiza decoction, an herbal preparation, inhibits clozapine metabolism via cytochrome P450s, but not flavin-containing monooxygenase in in vitro models. Drug Metab Dispos 2015;43(7):1147-53. PubMed
- Zhou Y, Jin L, Kong F, et al. Clinical and immunological consequences of total glucosides of paeony treatment in Sjögren's syndrome: A randomized controlled pilot trial. Int Immunopharmacol. 2016 Oct;39:314-319. doi: 10.1016/j.intimp.2016.08.006. PubMed
- Zhu Q, Qi X, Wu Y, Wang K. Clinical study of total glucosides of paeony for the treatment of diabetic kidney disease in patients with diabetes mellitus. Int Urol Nephrol. 2016 Nov;48(11):1873-1880. doi: 10.1007/s11255-016-1345-5. PubMed
- Xu Y, Li X, Chen T, et al. Radix Paeoniae Alba increases serum estrogen level and up-regulates estrogen receptor expression in uterus and vagina of immature/ovariectomized mice. Phytother Res. 2019;33(1):117-29. [RETRACTED].
- Liu X, Li X, Li X, et al. The efficacy and safety of total glucosides of peony in the treatment of primary Sjögren's syndrome: a multi-center, randomized, double-blinded, placebo-controlled clinical trial. Clin Rheumatol. 2019;38(3):657-64. Erratum i
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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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