Major interaction on record — check this product against your medications before combining. Based on 12 of 18 ingredients. Check your meds →
Dietary supplement

Nervous Fatigue Ingredients & Drug Interactions

by Nature's Sunshine

Nervous Fatigue label
See full label image
Capsule 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 Nervous Fatigue 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

Nervous Fatigue is a dietary supplement by Nature's Sunshine with 18 active ingredients. Its ingredients are commonly taken for fatigue and low energy, stress and adaptogen support, liver health.Based on those ingredients, 1,531 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Asian Ginseng, Grass-Leaf Sweetflag, Lycium. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

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Check Your Meds Against Nervous Fatigue by Nature's Sunshine

Ask about any prescription or over-the-counter medication and we check it for interactions with Nervous Fatigue by Nature's Sunshine — and tell you which ingredient is responsible.

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HelloPharmacist Scorecard of Nervous Fatigue by Nature's Sunshine

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 18 active ingredients.
  • “Proprietary Blend” is a proprietary blend — the label gives one combined amount (2,080 mg) without saying how much of each component you get.

Nervous Fatigue contains 18 ingredients, 10 of which we could verify. The active botanicals include Schisandra, Astragalus, Dong Quai, Asian Ginseng, Lycium (also called Goji), Rehmannia, Grass-Leaf Sweetflag (Calamus), Jujube, Polygala, Hoelen Sclerotium (a medicinal mushroom), Ophiopogon, Chinese Yam, Sacred Lotus, Oriental Arborvitae, Broomrape, Chinese Dodder, Amber, and Polygonatum.

These are combined in a proprietary blend, meaning the exact amounts of each ingredient are not disclosed individually. The capsule itself is made from vegetable material.

Does it work?

Moderate evidence
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
Moderate

Some clinical evidence supports this product's ingredients for its stated purpose, but it isn't conclusive.

Why this rating?
  • The label markets this product for: support cardiovascular nervous and glandular energy.
  • We looked for evidence on: Anxiety, Cardiovascular disease (CVD), Chronic fatigue syndrome (CFS), Cognitive function, Depression, Erectile dysfunction (ED) — and 4 related terms.
  • The strongest evidence on file: Panax Ginseng is rated "Possibly Effective" for Cognitive function (Natural Medicines).
  • Also on file: Panax Ginseng is rated "Possibly Effective" for Erectile dysfunction (ED).
  • Also on file: Dodder is rated "Insufficient Reliable Evidence To Rate" for Depression.

The evidence for Nervous Fatigue's ingredients is sparse. We hold effectiveness ratings for Schisandra, Astragalus, Dong Quai, Lycium, Rehmannia, Grass-Leaf Sweetflag, Hoelen Sclerotium, Sacred Lotus, Oriental Arborvitae, and Chinese Dodder across various health claims—asthma, diabetes, heart disease, anemia, and others—and in each case the rating is insufficient reliable evidence to rate the effect.

Rehmannia shows possibly effective for chronic kidney disease, which is the only positive rating in the product. For the rest of the ingredients, we hold no effectiveness data.

The evidence, ingredient by ingredient Schisandra Astragalus Dong Quai Panax Ginseng Goji Rehmannia Calamus Zizyphus

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 11 of the 12 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 12 of 12.
  • General safety write-ups exist for 12 of 12.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Most of these botanicals are generally well tolerated in the short term in healthy adults, though quality human safety data are limited for many. Schisandra, Astragalus, Hoelen Sclerotium, and Chinese Dodder may cause gastrointestinal upset—heartburn, decreased appetite, stomach upset, and in Dodder's case, intestinal colic or diarrhea at high doses.

Lycium has rare reports of allergic reactions including facial swelling and anaphylaxis. Calamus is a particular concern: it contains beta-asarone, a potential carcinogen, and is likely unsafe because of cancer risk; it can also cause nausea, vomiting, intestinal paralysis, and rapid heartbeat.

Oriental Arborvitae contains thujone, which at high or long-term doses may cause dizziness, vomiting, tremors, hallucinations, and convulsions. The safety data advises against Schisandra, Astragalus, Dong Quai, Rehmannia, Calamus, Hoelen Sclerotium, and Lotus during pregnancy.

Schisandra and Dong Quai may stimulate the uterus. Calamus is listed as likely unsafe in pregnancy.

Breastfeeding is not recommended for any ingredient where we hold pregnancy/lactation data.

Side effects, ingredient by ingredient Schisandra Astragalus Dong Quai Panax Ginseng Goji Rehmannia Calamus Zizyphus

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?
  • 10 of the 12 matched ingredients can interact with medications — Zizyphus, Lotus, Poria Mushroom, Schisandra, Calamus, among others.
  • The most serious interaction on file is rated Major.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; immunosuppressants / transplant drugs; diabetes medications; heart-rhythm medications; lithium.
  • For scale: 1,532 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.

Stop and check before taking this if you use warfarin or any blood thinner—Dong Quai and Lycium both carry Major-severity interactions that can increase bleeding risk. Also double-check Moderate interactions with: immunosuppressants or cyclophosphamide (Astragalus); blood pressure or diabetes medications (Rehmannia, Calamus, Lycium); lithium (Astragalus); sedatives or CNS depressants (Calamus, Hoelen Sclerotium, Lotus); heart rhythm drugs like flecainide (Lycium); and medications metabolized by liver enzymes CYP3A4, CYP2C9, CYP2C19, or CYP2D6 (Schisandra, Lycium, Calamus).

These pathways clear many common drugs.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFormula with limited ingredient disclosure with some supporting evidence for its stated purpose. Major medication interactions have been identified, and safety information is well characterized.

If you take any prescription medications—especially blood thinners, heart drugs, diabetes medications, immunosuppressants, or sedatives—check with your pharmacist before starting this product. The herbal ingredients interact with a wide range of common drugs, and the proprietary blend means you're getting unknown doses.

Calamus in particular carries cancer risk and is best avoided. This is not a product to add on your own if you're on regular medications.

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

Assessment coverage: 12 of 18 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Nov 22, 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 Nervous Fatigue, straight from the product label.

Brand Nature's Sunshine
Barcode (UPC) 099904018846
Net contents 100 VegCap(s)
Market status On market
Date entered into DSLD Nov 22, 2022
DSLD ID 278053
Product type Botanical
Supplement form Capsule
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Adult (18 - 50 Years)
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 Nervous Fatigue by Nature's Sunshine, 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:
4 VegCap(s)
Maximum serving Sizes:
4 VegCap(s)
Servings per container
25
UPC/BARCODE
099904018846
IngredientAmount% DV
Schisandra0 NP--
Astragalus0 NP--
Proprietary Blend2080 mg--
Dong Quai0 NP--
Asian Ginseng0 NP--
Lycium0 NP--
Rehmannia0 NP--
Grass-Leaf Sweetflag0 NP--
Jujube0 NP--
Polygala0 NP--
Hoelen Sclerotium0 NP--
Ophiopogon0 NP--
Chinese Yam0 NP--
Sacred Lotus0 NP--
Oriental Arborvitae Seed Extract0 NP--
Broomrape0 NP--
Chinese Dodder0 NP--
Amber0 NP--
Polygonatum0 NP--

Other ingredients: Vegetable Capsule

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.
FDA Disclaimer Statement

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

General Statements

Bottle made from 100% post consumer recycled material. We are committed to you and our planet. Scan to learn more.

Traditional Chinese medicine

New look! Same great product

Formulation

This blend of herbs is traditionally used to nourish the physical and emotional connections between heart and mind. Nervous Fatigue supports the cardiovascular, nervous and glandular (adrenal) systems, and may assist with energy and metabolism.

Guaranteed pure

Traditional circulatory system support Yang Xin (Nourish the fire)

Precautions

Pregnant or lactating women should consult their health care provider prior to taking this supplement.

Do not use if inner seal is missing or damaged.

FDA Statement of Identity

Dietary Supplement

Suggested/Recommended/Usage/Directions

Recommended Use: Take 4 VegCaps with a meal twice daily.

Brand IP Statement(s)

Natures Sunshine Herbal experts since 1972

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

See for yourself

Nervous Fatigue by Nature's Sunshine label

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

Nervous Fatigue 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 Nervous Fatigue by Nature's Sunshine

These are the 18 active ingredients this product is made of. Select any to open its full monograph.

Serving size4 VegCap(s) Dosage formCapsule 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 Blend

2080 mg per serving

Other (inactive) ingredients: Vegetable Capsule. These complete the product’s ingredient list but are not active constituents.

Interaction report

Nervous Fatigue by Nature's Sunshine Drug Interactions

Want to check YOUR meds against Nervous Fatigue?

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
1,531Drugs
2 Major 1,517 Moderate 12 Minor

Ingredients driving the most interactions

Asian Ginseng 1,130
Grass-Leaf Sweetflag 1,117
Lycium 1,000
Schisandra 803
Jujube 469

Individual Drug Interactions

The ingredients in Nervous Fatigue interact with 1,531 drugs. Click any drug to see the details.

10 of the 18 ingredients in Nervous Fatigue interact with drugs. Each result below shows which ingredient is responsible. Asian Ginseng Grass-Leaf Sweetflag Lycium Schisandra Jujube Hoelen Sclerotium Rehmannia Sacred Lotus Astragalus Dong Quai

Each ingredient & the kinds of drugs it affects

For each ingredient in Nervous Fatigue 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.

Asian Ginseng20 drug types · 1,130 drugs

Anticoagulant/Antiplatelet Drugs

Although Panax ginseng has shown antiplatelet effects in the laboratory, it is unlikely to increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
In vitro evidence suggests that ginsenoside constituents in Panax ginseng might decrease platelet aggregation. However, research in humans suggests that ginseng does not affect platelet aggregation. Animal research indicates low oral bioavailability of Rb1 and rapid elimination of Rg1, which might explain the discrepancy between in vitro and human research. Until more is known, use with caution in patients concurrently taking anticoagulant or antiplatelet drugs.

Likelihood Unlikely Evidence B
Antidiabetes Drugs

Theoretically, taking Panax ginseng with antidiabetes drugs might increase the risk of hypoglycemia.
Clinical research suggests that Panax ginseng might decrease blood glucose levels. Monitor blood glucose levels closely.

Likelihood Probable Evidence B
Caffeine

Theoretically, taking Panax ginseng with caffeine might increase the risk of adverse stimulant effects.
Panax ginseng has been shown to have stimulant effects. Theoretically, caffeine might have an additive effect on the stimulant effects of Panax ginseng.

Likelihood Probable Evidence B
Cytochrome P450 2D6 (Cyp2D6) Substrates

Theoretically, Panax ginseng might increase levels of drugs metabolized by CYP2D6. However, research is conflicting.
There is some evidence that Panax ginseng can inhibit the CYP2D6 enzyme by approximately 6%. In addition, in animal research, Panax ginseng inhibits the metabolism of dextromethorphan, a drug metabolized by CYP2D6, by a small amount. However, contradictory research suggests Panax ginseng might not inhibit CYP2D6. Until more is known, use Panax ginseng cautiously in patients taking drugs metabolized by these enzymes.

Likelihood Possible Evidence B
Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, Panax ginseng might increase or decrease levels of drugs metabolized by CYP3A4.
Panax ginseng may affect the clearance of drugs metabolized by CYP3A4. One such drug is imatinib. Inhibition of CYP3A4 was believed to be responsible for a case of imatinib-induced hepatotoxicity. In contrast, Panax ginseng has been shown to increase the clearance of midazolam, another drug metabolized by CYP3A4. Clinical research shows that Panax ginseng can reduce midazolam area under the curve by 44%, maximum plasma concentration by 26%, and time to reach maximum plasma concentration by 29%. Midazolam metabolism was also increased in animals given Panax ginseng. Until more is known, use Panax ginseng cautiously in combination with CYP3A4 substrates.

Likelihood Possible Evidence B
Estrogens

Theoretically, concomitant use of large amounts of Panax ginseng might interfere with hormone replacement therapy.
Laboratory research and some case reports suggest that Panax ginseng can have estrogenic effects due to competition for estrogen receptors. The estrogenic activity is attributed to the ginsenoside constituents of Panax ginseng.

Likelihood Possible Evidence D
Furosemide (Lasix)

Theoretically, Panax ginseng might reduce the effects of furosemide.
There is some concern that Panax ginseng might contribute to furosemide resistance. There is one case of resistance to furosemide diuresis in a patient taking a germanium-containing ginseng product.

Likelihood Possible Evidence D
Imatinib (Gleevec)

Theoretically, Panax ginseng might increase the effects and adverse effects of imatinib.
A case of imatinib-induced hepatotoxicity has been reported for a 26-year-old male with chronic myelogenous leukemia stabilized on imatinib for 7 years. The patient took imatinib 400 mg along with a Panax ginseng-containing energy drink daily for 3 months. Since imatinib-associated hepatotoxicity typically occurs within 2 years of initiating therapy, it is believed that Panax ginseng affected imatinib toxicity though inhibition of cytochrome P450 3A4. CYP3A4 is the primary enzyme involved in imatinib metabolism.

Likelihood Possible Evidence D
Immunosuppressants

Theoretically, Panax ginseng use might interfere with immunosuppressive therapy.
Panax ginseng might have immune system stimulating properties.

Likelihood Possible Evidence B
Insulin

Theoretically, taking Panax ginseng with insulin might increase the risk of hypoglycemia.
Clinical research suggests that Panax ginseng might decrease blood glucose levels. Insulin dose adjustments might be necessary in patients taking Panax ginseng; use with caution.

Likelihood Probable Evidence B
Midazolam (Versed)

Theoretically, Panax ginseng may increase the clearance of midazolam.
Midazolam is metabolized by cytochrome P450 3A4 (CYP3A4). Clinical research suggests that Panax ginseng can reduce midazolam area under the curve by 44%, maximum plasma concentration by 26%, and time to reach maximum plasma concentration by 29%. Midazolam metabolism was also increased in animals given Panax ginseng.

Likelihood Probable Evidence B
Monoamine Oxidase Inhibitors (Maois)

Theoretically, Panax ginseng can interfere with MAOI therapy.
Concomitant use of Panax ginseng with phenelzine (Nardil) is associated with insomnia, headache, tremors, and hypomania.

Likelihood Probable Evidence D
Nifedipine (Procardia)

Theoretically, taking Panax ginseng with nifedipine might increase serum levels of nifedipine and the risk of hypotension.
Preliminary clinical research shows that concomitant use can increase serum levels of nifedipine in healthy volunteers. This might cause the blood pressure lowering effects of nifedipine to be increased when taken concomitantly with Panax ginseng.

Likelihood Possible Evidence B
Qt Interval-Prolonging Drugs

Theoretically, Panax ginseng has an additive effect with drugs that prolong the QT interval and potentially increase the risk of ventricular arrhythmias. However, research is conflicting.
Clinical research shows that short-term use of Panax ginseng can increase the QT interval. However, no changes in QT interval have been identified with prolonged use.

Likelihood Possible Evidence B
Raltegravir (Isentress)

Theoretically, taking Panax ginseng with raltegravir might increase the risk of liver toxicity.
A case report suggests that concomitant use of Panax ginseng with raltegravir can increase serum levels of raltegravir, resulting in elevated liver enzymes levels.

Likelihood Possible Evidence D
Selegiline (Eldepryl)

Theoretically, Panax ginseng might increase or decrease levels of selegiline, possibly altering the effects and side effects of selegiline.
Animal research shows that taking selegiline with a low dose of Panax ginseng extract (1 gram/kg) reduces selegiline bioavailability, while taking a high dose of Panax ginseng extract (3 grams/kg) increases selegiline bioavailability. More research is needed to confirm these effects.

Likelihood Possible Evidence D
Stimulant Drugs

Theoretically, taking Panax ginseng with stimulant drugs might increase the risk of adverse stimulant effects.
Panax ginseng has been shown to have stimulant effects.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Panax ginseng might affect the clearance of warfarin. However, this interaction appears to be unlikely.
There has been a single case report of decreased effectiveness of warfarin in a patient who also took Panax ginseng. However, it is questionable whether Panax ginseng was the cause of this decrease in warfarin effectiveness. Some research in humans and animals suggests that Panax ginseng does not affect the pharmacokinetics of warfarin. However, other research in humans suggests that Panax ginseng might modestly increase the clearance of the S-warfarin isomer. More evidence is needed to determine whether Panax ginseng causes a significant interaction with warfarin.

Likelihood Unlikely Evidence B
Fexofenadine (Allegra)

Theoretically, Panax ginseng might decrease blood levels of oral or intravenous fexofenadine.
Animal research suggests that taking Panax ginseng in combination with oral or intravenous fexofenadine may reduce the bioavailability of fexofenadine. Some scientists have attributed this effect to the ability of Panax ginseng to increase the expression of P-glycoprotein.

Likelihood Possible Evidence D
Lopinavir/Ritonavir (Kaletra)

Although Panax ginseng has demonstrated variable effects on cytochrome P450 3A4 (CYP3A4), which metabolizes lopinavir, Panax ginseng is unlikely to alter levels of lopinavir/ritonavir.
Lopinavir is metabolized by CYP3A4 and is administered with the CYP3A4 inhibitor ritonavir to increase its plasma concentrations. Panax ginseng has shown variable effects on CYP3A4 activity in humans. However, taking Panax ginseng (Vitamer Laboratories) 500 mg twice daily for 14 days did not alter the pharmacokinetics of lopinavir/ritonavir in 12 healthy volunteers.

Likelihood Unlikely Evidence B
Asian Ginseng full monograph & interactions

Grass-Leaf Sweetflag10 drug types · 1,117 drugs

Anticholinergic Drugs

Theoretically, concurrent use of anticholinergic drugs and calamus might decrease the effectiveness of the anticholinergic drug.
In vitro evidence shows that calamus can inhibit acetylcholinesterase (AChE).

Likelihood Possible Evidence D
Antihypertensive Drugs

Theoretically, taking calamus with other antihypertensive medications might increase the risk of hypotension.
Animal research shows that calamus decreases the rate and strength of the heartbeat, which might lower blood pressure. use with caution.

Likelihood Possible Evidence D
Cholinergic Drugs

Theoretically, concurrent use of cholinergic drugs and calamus might have an additive effect and increase the risk of cholinergic effects.
In vitro evidence shows that calamus can inhibit acetylcholinesterase (AChE).

Likelihood Possible Evidence D
Cns Depressants

Theoretically, concurrent use of CNS depressants and calamus might have an additive effect and increase the risk of sedative effects.
Animal research shows that calamus is a CNS depressant and increases gamma-aminobutyric acid levels.

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

Theoretically, taking calamus with drugs metabolized by CYP2D6 might increase drug levels and potentially increase the risk of adverse effects.
In vitro research shows that calamus extract inhibits CYP2D6 enzyme.

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

Theoretically, taking calamus with drugs metabolized by CYP3A4 might increase drug levels and potentially increase the risk of adverse effects.
In vitro research shows that calamus extract inhibits CYP3A4 enzyme.

Likelihood Possible Evidence D
Monoamine Oxidase Inhibitors (Maois)

Theoretically, calamus might potentiate the effects and adverse effects of MAOIs.
Some reports suggest that calamus increases the effects of MAOIs.

Likelihood Possible Evidence D
Antacids

Theoretically, taking calamus might reduce the effectiveness of antacids.
Some research suggests that calamus lowers gastric pH.

Likelihood Possible Evidence D
H2-Blockers

Theoretically, taking calamus might reduce the effectiveness of H2-blockers.
Some research suggests that calamus lowers gastric pH.

Likelihood Possible Evidence D
Proton Pump Inhibitors (Ppis)

Theoretically, taking calamus might reduce the effectiveness of PPIs.
Some research suggests that calamus lowers gastric pH.

Likelihood Possible Evidence D
Grass-Leaf Sweetflag full monograph & interactions

Lycium8 drug types · 1,000 drugs

Warfarin (Coumadin)

Goji can increase the effects of warfarin and possibly increase the risk of bleeding.
There are at least 5 case reports of increased international normalized ratio (INR) in patients stabilized on warfarin who began drinking goji juice, concentrated goji tea, or goji wine. Goji may inhibit the metabolism of warfarin by cytochrome P450 2C9 (CYP2C9).

Likelihood Probable Evidence D
Antihypertensive Drugs

Theoretically, concomitant use of goji root bark, but not goji fruit, with antihypertensive drugs might have additive effects.
Animal and in vitro research suggest that goji root bark has hypotensive effects. However, goji fruit juice does not appear to reduce systolic or diastolic blood pressure in humans.

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

Theoretically, goji berry might inhibit CYP2C19 and reduce metabolism of CYP2C19 substrates.
In vitro research shows that goji berry tincture and juice inhibit CYP2C19 enzymes. Concomitant use with goji may decrease metabolism and increase levels of CYP2C19 substrates. However, this has not been reported in humans.

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

Theoretically, goji berry might inhibit CYP2C9 and reduce metabolism of CYP2C9 substrates.
In vitro research shows that goji berry tincture and juice inhibit CYP2C9 enzymes. Additionally, multiple case reports suggest that goji berry concentrated tea and juice inhibit the metabolism of warfarin, a CYP2C9 substrate. Concomitant use with goji may decrease metabolism and increase levels of CYP2C9 substrates.

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

Theoretically, goji berry might inhibit CYP2D6 and reduce metabolism of CYP2D6 substrates.
In vitro research shows that goji berry juice inhibits CYP2D6 enzymes. Concomitant use with goji may decrease metabolism and increase levels of CYP2D6 substrates. However, this has not been reported in humans.

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

Theoretically, goji berry might inhibit CYP3A4 and reduce metabolism of CYP3A4 substrates.
In vitro research shows that goji berry juice inhibits CYP3A4 enzymes. Concomitant use with goji may decrease metabolism and increase levels of CYP3A4 substrates. However, this has not been reported in humans.

Likelihood Possible Evidence D
Flecainide (Tambocor)

Theoretically, goji berry might increase the levels and clinical effects of flecainide.
In one case report, a 75-year-old patient stable on flecainide and warfarin presented to the emergency room with fainting and pleomorphic arrhythmia caused by flecainide toxicity. Flecainide toxicity was attributed to drinking 1-2 glasses of concentrated goji tea daily for 2 weeks. Theoretically, goji may have inhibited the cytochrome P450 2D6 (CYP2D6) metabolism of flecainide.

Likelihood Possible Evidence D
Antidiabetes Drugs

Theoretically, concomitant use of goji fruit polysaccharides or goji root bark with antidiabetes drugs might have additive effects.
Animal and in vitro research show that goji root bark and fruit polysaccharides might have hypoglycemic effects. However, clinical research has only shown that taking goji fruit polysaccharides with or without antidiabetes drugs modestly reduces postprandial glucose when compared with control, with no reports of hypoglycemia.

Likelihood Possible Evidence B
Lycium full monograph & interactions

Schisandra12 drug types · 803 drugs

Cyclophosphamide

Theoretically, schisandra might increase the levels and clinical effects of cyclophosphamide.
In vitro research shows that schisandra increases the concentration of cyclophosphamide, likely through inhibition of cytochrome P450 3A4. After multiple doses of the schisandra constituents schisandrin A and schisantherin A, the maximum concentration of cyclophosphamide was increased by 7% and 75%, respectively, while the overall exposure to cyclophosphamide was increased by 29% and 301%, respectively.

Likelihood Probable Evidence D
Cyclosporine (Neoral, Sandimmune)

Schisandra can increase the levels and clinical effects of cyclosporine.
A small observational study in children with aplastic anemia found that taking schisandra with cyclosporine increased cyclosporine trough levels by 93% without increasing the risk of adverse events. However, the dose of cyclosporine was reduced in 9% of children to maintain appropriate cyclosporine blood concentrations.

Likelihood Probable Evidence B
Cytochrome P450 2C19 (Cyp2C19) Substrates

Theoretically, schisandra might increase the levels and clinical effects of CYP2C19 substrates.
In vitro research shows that schisandra inhibits CYP2C19, and animal research shows that schisandra increases the concentration of voriconazole, a CYP2C19 substrate. Theoretically, schisandra may also inhibit the metabolism of other CYP2C19 substrates. This effect has not been reported in humans.

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

Theoretically, schisandra might decrease the levels and clinical effects of CYP2C9 substrates.
In vitro and animal research suggests that schisandra induces CYP2C9 enzymes. This effect has not been reported in humans.

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

Schisandra can increase the levels and clinical effects of drugs metabolized by CYP3A4.
Most clinical and laboratory research shows that schisandra, administered either as a single dose or up to twice daily for 14 days, inhibits CYP3A4 and increases the concentration of CYP3A4 substrates such as cyclophosphamide, midazolam, tacrolimus, and talinolol. Although one in vitro and animal study shows that schisandra may induce CYP3A4 metabolism, this effect appears to be overpowered by schisandra's CYP3A4 inhibitory activity and has not been reported in humans.

Likelihood Probable Evidence D
Midazolam (Versed)

Schisandra can increase the levels and clinical effects of midazolam.
A small pharmacokinetic study in healthy adults shows that taking schisandra extract (Hezheng Pharmaceutical Co.) containing deoxyschizandrin 33.75 mg twice daily for 8 days and a single dose of midazolam 15 mg on day 8 increases the overall exposure to midazolam by about 119%, increases the peak plasma level of midazolam by 86%, and decreases midazolam clearance by about 52%. This effect has been attributed to inhibition of CYP3A4 by schisandra.

Likelihood Probable Evidence B
P-Glycoprotein Substrates

Schisandra might increase the levels and clinical effects of P-glycoprotein substrates.
In vitro research shows that schisandra extracts and constituents such as schisandrin B inhibit P-glycoprotein mediated efflux in intestinal cells and in P-glycoprotein over-expressing cell lines. Additionally, a small clinical study shows that schisandra increases the peak concentration and overall exposure to talinolol, a P-glycoprotein probe substrate. Theoretically, schisandra might inhibit the efflux of other P-glycoprotein substrates.

Likelihood Possible Evidence D
Sirolimus (Rapamune)

Schisandra can increase the levels and clinical effects of sirolimus.
A small pharmacokinetic study in healthy volunteers shows that taking 3 capsules of schisandra (Hezheng Pharmaceutical Company) containing a total of 33.75 mg deoxyschizandrin twice daily for 13 days and then taking a single dose of sirolimus 2 mg increases the overall exposure and peak level of sirolimus by two-fold. This effect is thought to be due to inhibition of cytochrome P450 3A4 by schisandra, as well as possible inhibition of the P-glycoprotein drug transporter.

Likelihood Probable Evidence B
Tacrolimus (Prograf)

Schisandra can increase the levels and clinical effects of tacrolimus.
Clinical research in healthy children and adults, transplant patients, and patients with nephrotic syndrome and various rheumatic immunologic disorders shows that taking schisandra with tacrolimus increases tacrolimus peak levels by 183% to 268%, prolongs or delays time to peak tacrolimus concentrations, increases overall exposure to tacrolimus by 126% to 343%, and decreases tacrolimus clearance by 19% to 73%. This effect is thought to be due to inhibition of P-glycoprotein drug transporter and CYP3A4 and CYP3A5 by schisandra. Some clinical and observational studies suggest that schisandra increases tacrolimus levels similarly in both expressors and non-expressors of CYP3A5, while other studies suggest it does so to a greater degree in CYP3A5 expressors than non-expressors. Animal research suggests that the greatest increase in tacrolimus levels occurs when schisandra is taken either concomitantly or up to 2 hours before tacrolimus, and clinical and observational research in humans suggests that schisandra may increase whole blood levels of tacrolimus and decrease clearance of tacrolimus in a dose-dependent manner.

Likelihood Probable Evidence B
Talinolol

Schisandra can increase the levels and clinical effects of talinolol.
A small pharmacokinetic study in healthy volunteers shows that taking schisandra extract 300 mg twice daily for 14 days with a single dose of talinolol 100 mg on day 14 increases the peak talinolol level by 51% and the overall exposure to talinolol by 47%. This effect is thought to be due to the possible inhibition of cytochrome P450 3A4 and P-glycoprotein by schisandra. tly.

Likelihood Probable Evidence B
Voriconazole (Vfend)

Theoretically, schisandra might increase the levels and clinical effects of voriconazole.
Animal research shows that oral schisandra given daily for 1 or 14 days increases levels of intravenously administered voriconazole, a cytochrome P450 (CYP) 2C19 substrate. This effect is thought to be due to inhibition of CYP2C19 by schisandra. However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, schisandra might decrease the levels and clinical effects of warfarin.
Animal research suggests that oral schisandra extract, given daily for 6 days, reduces levels of intravenously administered warfarin. This effect might be due to the induction of cytochrome P450 (CYP) 2C9 metabolism by schisandra. However, this interaction has not been reported in humans.

Likelihood Possible Evidence D
Schisandra full monograph & interactions

Jujube3 drug types · 469 drugs

Antidiabetes Drugs

Theoretically, zizyphus might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Animal research shows that zizyphus has hypoglycemic activity. However, a small clinical study shows that zizyphus fruit powder does not reduce fasting blood glucose levels in patients with type 2 diabetes.

Likelihood Possible Evidence D
Cns Depressants

Theoretically, zizyphus might cause additive sedative effects when taken with CNS depressants.
Some animal research has found that various parts of zizyphus have sedative effects. However, other animal research shows that zizyphus plant extract does not alter sleep parameters when used in combination with pentobarbital.

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

Theoretically, zizyphus might decrease the levels and clinical effects of drugs metabolized by CYP1A2.
Animal research shows that zizyphus induces CYP1A2 enzymes. However, this effect has not been reported in humans.

Likelihood Possible Evidence D
Jujube full monograph & interactions

Hoelen Sclerotium3 drug types · 417 drugs

Anticholinergic Drugs

Theoretically, poria mushroom might decrease the clinical effects of anticholinergic drugs.
In animal research, poria mushroom essential oil reduces acetylcholinesterase activity. This interaction has not been shown in humans.

Likelihood Possible Evidence D
Cholinergic Drugs

Theoretically, poria mushroom might have additive effects when used with cholinergic drugs.
In animal research, poria mushroom essential oil reduces acetylcholinesterase activity. This interaction has not been shown in humans.

Likelihood Possible Evidence D
Cns Depressants

Theoretically, taking poria mushroom extract may enhance the therapeutic and adverse effects of sedatives.
Animal research shows that poria mushroom extract has sedative properties. This interaction has not been shown in humans.

Likelihood Possible Evidence D
Hoelen Sclerotium full monograph & interactions

Rehmannia2 drug types · 258 drugs

Antidiabetes Drugs

Theoretically, rehmannia might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Animal research shows that rehmannia may have hypoglycemic effects.

Likelihood Possible Evidence D
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).

Likelihood Possible Evidence D
Rehmannia full monograph & interactions

Sacred Lotus3 drug types · 212 drugs

Anticoagulant/Antiplatelet Drugs

Theoretically, concurrent use of lotus with other antiplatelet drugs might reduce platelet aggregation and increase the risk of bleeding.
Neferine and isoliensinine, constituents of lotus, have been shown to inhibit platelet aggregation, in vitro. These constituents can inhibit the production of pro-aggregating factors like prostaglandins.

Likelihood Possible Evidence D
Antidiabetes Drugs

Theoretically, lotus might have additive effects with antidiabetes drugs and increase the risk of hypoglycemia.
Animal research shows that the ethanolic extract of lotus reduces blood glucose levels and potentiates the effects of injected insulin. Monitor blood glucose levels closely. Dose adjustments might be necessary.

Likelihood Possible Evidence D
Pentobarbital (Nembutal)

Theoretically, taking lotus concomitantly with pentobarbital might increase sedation.
Animal research shows that lotus extract increases pentobarbitone-induced sleeping time. It is not known if this occurs in humans or if this effect occurs with other barbiturates or sedatives.

Likelihood Possible Evidence D
Sacred Lotus full monograph & interactions

Astragalus4 drug types · 208 drugs

Antidiabetes Drugs

Theoretically, taking astragalus with antidiabetes drugs might increase the risk of hypoglycemia.
Clinical research in humans shows that astragalus might have hypoglycemic effects. Theoretically, taking astragalus, especially in combination with other hypoglycemic agents, might increase the risk of hypoglycemia.

Likelihood Probable Evidence A
Cyclophosphamide

Theoretically, astragalus might interfere with cyclophosphamide therapy.
Evidence regarding the effect of astragalus on immunosuppression caused by cyclophosphamide is conflicting. Some animal research suggests that astragalus reverses cyclophosphamide-induced immunosuppression. However, other animal research shows no effect.

Likelihood Possible Evidence D
Immunosuppressants

Theoretically, astragalus might interfere with immunosuppressive therapy.
Astragalus seems to stimulate immune function. Theoretically, taking astragalus might decrease the effects of immunosuppressive therapy.

Likelihood Possible Evidence D
Lithium

Theoretically, astragalus might increase levels and adverse effects of lithium.
Animal research suggests that astragalus has diuretic properties. Theoretically, due to this diuretic effect, astragalus might reduce excretion and increase levels of lithium.

Likelihood Probable Evidence D
Astragalus full monograph & interactions

Dong Quai3 drug types · 163 drugs

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.

Likelihood Probable Evidence D
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.

Likelihood Possible Evidence D
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.

Likelihood Possible Evidence D
Dong Quai full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Nervous Fatigue, from the product label.

Nature's Sunshine

See all Nature's Sunshine products
Name
Nature's Sunshine Products, Inc.
City
Spanish Fork
State
UT
ZipCode
84660
Phone Number
1-800-223-8225
Web Address
www.naturessunshine.com
Pharmacist Counseling Corner

Nervous Fatigue by Nature's Sunshine: Common Questions

Does Nervous Fatigue by Nature's Sunshine interact with any medications?
Yes. Based on its ingredients, Nervous Fatigue has a known interaction with 1,531 medications, including 2 rated major. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Nervous Fatigue contains 18 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 while pregnant or breastfeeding?
No. The data advises against it during pregnancy—several ingredients like Schisandra and Dong Quai may stimulate the uterus, and Calamus is listed as likely unsafe. There isn't enough safety information for breastfeeding either. Talk to your doctor before considering this product if you're pregnant or nursing.
What's in the proprietary blend, and why don't I know how much of each ingredient I'm getting?
The blend contains Jujube, Polygala, Ophiopogon, Chinese Yam, and others listed individually on the label. Proprietary blends let manufacturers keep their formula ratios private, so you see the ingredients but not their amounts. This makes it harder to know your exact dose of each herb.
Can this help with fatigue or nervous tension?
We don't have reliable evidence that the ingredients in this product work for fatigue or nervousness. Most of them show insufficient evidence to rate, meaning the studies aren't robust enough yet to say either way.
What are the most common side effects?
Schisandra may cause heartburn, stomach upset, decreased appetite, or hives. Lycium and Lotus have rare reports of allergic reactions. Calamus and Oriental Arborvitae are more concerning—they can cause nausea, vomiting, dizziness, and at high doses, serious effects. Dodder may cause stomach colic and diarrhea if you take a lot.
Why is Calamus in this product if it's unsafe?
Calamus (Grass-Leaf Sweetflag) is used in traditional herbal formulas, but our data flags it as likely unsafe because it contains beta-asarone, a possible carcinogen. The FDA has banned it from food. If you're concerned, ask your pharmacist whether you should avoid this product or use a different one.
Does this interact with any over-the-counter medicines I might take?
Yes, potentially. Antacids, antihistamines, pain relievers, and cold medicines all use liver enzymes that some of these herbs affect. Run your specific over-the-counter medications through the drug checker on this page to be sure.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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Nervous Fatigue label
Go deeper

The Full Monographs Behind Nervous Fatigue’s Ingredients

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

Herb & supplement monograph

Schisandra

Interacts with 803 drugs

Schisandra is a traditional Chinese medicine berry used as an adaptogen for stress, fatigue, and liver support. Human evidence is limited and most claims are not well proven, but it appears...

Read the full Schisandra monograph → Herb & supplement monograph

Astragalus

Interacts with 208 drugs

Astragalus is a root used for centuries in traditional Chinese medicine, mainly to support the immune system and help the body cope with stress. While early studies are interesting, strong h...

Read the full Astragalus monograph → Herb & supplement monograph

Dong Quai

Interacts with 163 drugs

Dong 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 monograph

Panax Ginseng

Interacts with 1,130 drugs

Panax ginseng is a popular traditional herb used to boost energy, ease stress, and support overall wellness, though scientific evidence is mixed and mostly preliminary. It is generally well...

Read the full Panax Ginseng monograph → Herb & supplement monograph

Goji

Interacts with 1,000 drugs

Goji berries are a nutritious fruit rich in antioxidants, vitamins, and plant polysaccharides, and they are safe for most people as a food. While they are popular for eye health, immune supp...

Read the full Goji monograph → Herb & supplement monograph

Rehmannia

Interacts with 258 drugs

Rehmannia 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 monograph

Calamus

Interacts with 1,117 drugs

Calamus is a swamp plant with a long history in Ayurvedic and traditional Chinese medicine, mostly for digestive and nervous-system complaints. However, it contains beta-asarone, a compound...

Read the full Calamus monograph → Herb & supplement monograph

Zizyphus

Interacts with 469 drugs

Zizyphus (jujube) is an edible fruit and traditional remedy used mainly for sleep, anxiety, and digestion. The fruit is a nutritious food, but human evidence for its medicinal benefits is li...

Read the full Zizyphus monograph → Herb & supplement monograph

Poria Mushroom

Interacts with 417 drugs

Poria mushroom (Fu Ling) is a fungus long used in Traditional Chinese Medicine, mainly as a mild diuretic and digestive and calming aid. Modern scientific evidence in humans is very limited,...

Read the full Poria Mushroom monograph → Herb & supplement monograph

Lotus

Interacts with 212 drugs

Lotus is an edible aquatic plant used in food and traditional medicine across Asia, with parts like the seeds, leaves, and flowers taken for digestion, calm, and overall wellness. Most healt...

Read the full Lotus monograph → Herb & supplement monograph

Oriental Arborvitae

Oriental Arborvitae is an evergreen conifer used in Traditional Chinese Medicine, where the seeds (Bai Zi Ren) are taken to calm the mind and ease constipation, and the leaves (Ce Bai Ye) ar...

Read the full Oriental Arborvitae monograph → Herb & supplement monograph

Dodder

Dodder (Cuscuta) is a parasitic plant whose seeds are used in traditional Chinese and Middle Eastern medicine, mainly for sexual, kidney, and energy-related complaints. Human evidence for an...

Read the full Dodder monograph →
Sources

Sources & How We Checked

Nervous Fatigue'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 182 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.

Schisandra 26 references
  1. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.
  2. Iwata H, Tezuka Y, Kadota S, et al. Identification and characterization of potent CYP3A4 inhibitors in Schisandra fruit extract. Drug Metab Dispos 2004;32:1351-8. PubMed
  3. Mu Y, Zhang J, Zhang S, et al. Traditional Chinese medicines Wu Wei Zi (Schisandra chinensis Baill) and Gan Cao (Glycyrrhiza uralensis Fisch) activate pregnane X receptor and increase warfarin clearance in rats. J Pharmacol Exp Ther 2006;316:1369-77. PubMed
  4. Xin HW, Wu XC, Li Q, et al. Effects of Schisandra sphenanthera extract on the pharmacokinetics of tacrolimus in healthy volunteers. Br J Clin Pharmacol 2007;64:469-75.
  5. Qin XL, Bi HC, Wang XD, et al. Mechanistic understanding of the different effects of Wuhzi Tablet (Schisandra sphenanthera extract) on the absorption and first-pass intestinal and hepatic metabolism of tacrolimus (FK506). Int J Pharm 2010;389:114-21.
  6. Makino, T., Mizuno, F., and Mizukami, H. Does a kampo medicine containing schisandra fruit affect pharmacokinetics of nifedipine like grapefruit juice? Biol.Pharm.Bull. 2006;29(10):2065-2069. PubMed
  7. Fan L, Mao XQ, Tao GY, Wang G, Jiang F, Chen Y, Li Q, Zhang W, Lei HP, Hu DL, Huang YF, Wang D, Zhou HH. Effect of Schisandra chinensis extract and Ginkgo biloba extract on the pharmacokinetics of talinolol in healthy volunteers. Xenobiotica. 2009 Mar;39(
  8. Jiang W, Wang X, Xu X, Kong L. Effect of Schisandra sphenanthera extract on the concentration of tacrolimus in the blood of liver transplant patients. Int J Clin Pharmacol Ther. 2010 Mar;48(3):224-9. PubMed
  9. Xin HW, Wu XC, Li Q, Yu AR, Xiong L. Effects of Schisandra sphenanthera extract on the pharmacokinetics of midazolam in healthy volunteers. Br J Clin Pharmacol. 2009 May;67(5):541-6.
  10. Li J, Chen S, Qin X, et at. Wuzhi Tablet (<i>Schisandra sphenanthera</i> Extract) is a Promising Tacrolimus-Sparing Agent for Renal Transplant Recipients Who are CYP3A5 Expressers: a Two-Phase Prospective Study. Drug Metab Dispos. 2017;45(11):1114-1119.
  11. Qin XL, Li JL, Wang SH, Chen X, Huang M, Bi HC. Co-administration of Wuzhi tablet (Schisandra sphenanthera extract) alters tacrolimus pharmacokinetics in a dose- and time-dependent manner in rats. J Ethnopharmacol. 2020;263:113233. PubMed
  12. Yuan F, Liang X, Chen X, Qin X, Tan C, Wang L. CYP2C19 is involved in the effect of Wuzhi tablet (Schisandra sphenanthera extract) and its constituents on the pharmacokinetics of intravenous voriconazole. Pharmazie. 2020;75(11):559-564. DOI
  13. Zhang Z, Lu X, Dong L, Ma J, Fan X. Clinical observation on the effect of Wuzhi soft capsule on FK506 concentration in membranous nephropathy patients. Medicine (Baltimore). 2019;98(48):e18150. PubMed
  14. Yoo HH, Lee M, Lee MW, Lim SY, Shin J, Kim DH. Effects of Schisandra lignans on P-glycoprotein-mediated drug efflux in human intestinal Caco-2. Planta Med. 2007;73(5):444-50.
  15. Qiangrong P, Wang T, Lu Q, Hu X. Schisandrin B--a novel inhibitor of P-glycoprotein. Biochem Biophys Res Commun. 2005;335(2):406-11. PubMed
  16. Chen L, Ji N, Zhang M, Chen W. The influence of Wuzhi capsule on the pharmacokinetics of cyclophosphamide. Recent Pat Anticancer Drug Discov 2021. PubMed
  17. Cheng X, Ma J, Xu X, Zhang L, Wang X, Wu R. Effect of Wuzhi capsules on cyclosporine A concentration in children with aplastic anemia immunotherapy: a single-center observational study. Expert Rev Clin Pharmacol 2022:1-5. PubMed
  18. Cheng F, Li Q, Wang J, Zeng F, Zhang Y. Effects and safety evaluation of Wuzhi capsules combined with tacrolimus for the treatment of kidney transplantation recipients. J Clin Pharm Ther 2021;46(6):1636-49. PubMed
  19. Teng F, Wang W, Zhang W, et al. Effect of hepar-protecting Wuzhi capsule on pharmacokinetics and dose-effect character of tacrolimus in healthy volunteers. Biopharm Drug Dispos 2022.
  20. Kou K, Sun X, Li M, et al. Beneficial effects of Wuzhi capsule on tacrolimus blood concentrations in liver transplant patients with different donor-recipient CYP3A5 genotypes. J Clin Pharm Ther 2022;47(2):200-10. PubMed
  21. Peng Y, Jiang F, Zhou R, et al. Clinical evaluation of the efficacy and safety of co-administration of Wuzhi capsule and tacrolimus in adult Chinese patients with myasthenia gravis. Neuropsychiatr Dis Treat 2021;17:2281-9. PubMed
  22. Chen P, Dai R, She Y, et al. Prediction of tacrolimus and Wuzhi tablet pharmacokinetic interaction magnitude in renal transplant recipients. Clin Transplant 2022;36(12):e14807. PubMed
  23. Qu J, Bian R, Liu B, et al. The pharmacokinetic study of tacrolimus and Wuzhi capsule in Chinese liver transplant patients. Front Pharmacol 2022;13:956166. PubMed
  24. Zhou Y, Huang X, Liu L, et al. Effect of Wuzhi preparations on tacrolimus in CYP3A5 expressers during the early period after transplantation: A real-life experience from heart transplant recipients. Transpl Immunol 2023;76:101748. PubMed
  25. Huang Q, Lin X, Wang Y, et al. Tacrolimus pharmacokinetics in pediatric nephrotic syndrome: A combination of population pharmacokinetic modelling and machine learning approaches to improve individual prediction. Front Pharmacol 2022;13:942129. PubMed
  26. Wang CB, Zhang YJ, Zhao MM, Zhao LM. Population pharmacokinetic analyses of tacrolimus in non-transplant patients: a systematic review. Eur J Clin Pharmacol 2023;79(7):897-913. PubMed

See these in context on the Schisandra monograph →

Astragalus 13 references
  1. Upton R, ed. Astragalus Root: Analytical, quality control, and therapeutic monograph. Santa Cruz, CA: American Herbal Pharmacopoeia. 1999:1-25.
  2. Khoo KS, Ang PT. Extract of astragalus membranaceus and ligustrum lucidum does not prevent cyclophosphamide-induced myelosuppression. Singapore Med J 1995;36:387-90.
  3. Chu DT, Wong WL, Mavligit GM. Immunotherapy with Chinese medicinal herbs. II. Reversal of cyclophosphamide-induced immune suppression by administration of fractionated Astragalus membranaceus in vivo. J Clin Lab Immunol 1988;25:125-9.
  4. Sun Y, Hersh EM, Lee SL, et al. Preliminary observations on the effects of the Chinese medicinal herbs Astragalus membranaceus and Ligustrum lucidum on lymphocyte blastogenic responses. J Biol Response Mod 1983;2:227-37..
  5. Ma J, Peng A, Lin S. Mechanisms of the therapeutic effect of astragalus membranaceus on sodium and water retention in experimental heart failure. Chin Med J (Engl) 1998;111:17-23.
  6. Matkovic Z, Zivkovic V, Korica M, et al. Efficacy and safety of Astragalus membranaceus in the treatment of patients with seasonal allergic rhinitis. Phytother Res 2010;24:175-81.
  7. Zhang, J. G., Yang, N., He, H., Wei, G. H., Gao, D. S., Wang, X. L., Wang, X. Z., and Song, G. Y. [Effect of Astragalus injection on plasma levels of apoptosis-related factors in aged patients with chronic heart failure.]. Chin J Integr.Med 2005;11(3):18 PubMed
  8. Chen, H. W., Lin, I. H., Chen, Y. J., Chang, K. H., Wu, M. H., Su, W. H., Huang, G. C., and Lai, Y. L. A novel infusible botanically-derived drug, PG2, for cancer-related fatigue: a phase II double-blind, randomized placebo-controlled study. Clin Invest PubMed
  9. Tian H, Lu J, He H, et al.The effect of Astragalus as an adjuvant treatment in type 2 diabetes mellitus: A (preliminary) meta-analysis. J Ethnopharmacol. 2016;191:206-215. doi: 10.1016/j.jep.2016.05.062. PubMed
  10. Hong KF, Liu PY, Zhang W, Gui DK, Xu YH. The Efficacy and Safety of Astragalus as an Adjuvant Treatment for Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Integr Complement Med 2023. PubMed
  11. Chan KW, Kwong ASK, Tsui PN, et al. Add-on astragalus in type 2 diabetes and chronic kidney disease: A multi-center, assessor-blind, randomized controlled trial. Phytomedicine 2024;130:155457. PubMed
  12. Han X, Yu T, Chen X, Du Z, Yu M, Xiong J. Effect of Astragalus membranaceus on left ventricular remodeling in HFrEF: a systematic review and meta-analysis. Front Pharmacol 2024;15:1345797. PubMed
  13. Jing P, Hongzheng H, Zhenqi WU, Meijuan Z, Zuojing LI, Gang C. Long-term efficacy and safety of Huangqi ()-based Traditional Chinese Medicine in diabetic peripheral neuropathy: a Meta-analysis of randomized controlled trials. J Tradit Chin Med 2024;44(2):

See these in context on the Astragalus monograph →

Dong Quai 19 references
  1. 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
  2. Page RL II, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy 1999;19:870-6. PubMed
  3. Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm 2000;57:1221-7. DOI
  4. 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.
  5. Dr. Duke's Phytochemical and Ethnobotanical Databases. Available at: http://www.ars-grin.gov/duke/.
  6. Amato P, Christophe S, Mellon PL. Estrogenic activity of herbs commonly used as remedies for menopausal symptoms. Menopause 2002;9:145-50. PubMed
  7. 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.
  8. Hoult JR, Paya M. Pharmacological and biochemical actions of simple coumarins: natural products with therapeutic potential. Gen Pharmacol 1996;27:713-22.. PubMed
  9. 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
  10. 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
  11. 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
  12. 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.
  13. Ellis GR, Stephens MR. Untitled (photograph and a brief case report). BMJ 1999;319:650.
  14. 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.
  15. 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
  16. 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.
  17. 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
  18. 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.
  19. 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

See these in context on the Dong Quai monograph →

Panax Ginseng 66 references
  1. Scaglione F, Cattaneo G, Alessandria M, Cogo R. Efficacy and safety of the standardized Ginseng extract G115 for potentiating vaccination against the influenza syndrome and protection against the common cold. Drugs Exp Clin Res 1996;22:65-72.
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Goji 14 references
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Rehmannia 3 references
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Calamus 13 references
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Zizyphus 15 references
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Poria Mushroom 3 references
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Lotus 5 references
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Oriental Arborvitae 2 references
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  2. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.

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Dodder 3 references
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  2. Mehrbani M, Choopani R, Fekri A, Mehrabani M, Mosaddegh M, Mehrabani M. The efficacy of whey associated with dodder seed extract on moderate-to-severe atopic dermatitis in adults: A randomized, double-blind, placebo-controlled clinical trial. J Ethnopharm PubMed
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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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