Astragalus and medications.
Astragalus is not in the Distil recommendation database. We surface it here deliberately, because why a compound is left out is as useful as what we recommend.
Astragalus has the same core issue as echinacea: it is an immune-active herb that the Distil pipeline cannot safely carry across an immunosuppressed or autoimmune profile. Used in traditional practice as a general tonic and immune support, it is characterised primarily as an immune stimulant, which makes it inappropriate for anyone on an immunosuppressant, living with HIV, or with an autoimmune condition, all of which the pipeline screens for.
Outside that group, the human evidence for its headline claims is thin. Between the safety screen and the weak evidence, it stays out of the database. For resilience and stress the adaptogens below have better human data, and for immune support the basics do more.
What to consider instead. Every option below is in the Distil database, so you can check each against your own medications:
- Ashwagandha: better-studied adaptogen for stress; note its own thyroid caveat
- Rhodiola Rosea: for fatigue and stress; check against serotonergic medicines
- Vitamin D3: the higher-yield move for immune support in most people
We still hold the documented interactions for Astragalus, which is why it stays in the interactions checker even though we do not recommend it. Below are the 4 documented pairs we have explicitly assessed: 4 caution. Every call is cited to a clinical reference (PMID) or the British National Formulary.
Documented interactions
Last reviewed 14 September 2026. Each interaction below lists the evidence its assessment drew on: some rest on studies of the exact pair, others on mechanism evidence, where a citation may support one part of the reasoning rather than the exact combination. The evidence line on each entry says which.
Immunosuppression caution
Caution Does Astragalus interact with Ciclosporin?
Ciclosporin works by calming the immune system down, which is what stops your body rejecting a transplant or quietens a condition such as psoriasis or arthritis, and astragalus is taken to support the immune system, so it may work against ciclosporin. In one reported case with tacrolimus, a drug the body clears the same way, the tacrolimus level fell by almost half after a herbal mixture containing astragalus was added. That case involved several herbs and a different drug, so it proves little, and astragalus has not been studied with ciclosporin. Do not start it without talking to your transplant or specialist team.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Caution Does Astragalus interact with Everolimus?
Everolimus works by calming the immune system down to stop your body rejecting a transplant, or, at a different dose, as part of cancer treatment, and astragalus is taken to support the immune system, so it may work against everolimus. In one reported case with tacrolimus, a drug the body clears the same way, the tacrolimus level fell by almost half after a herbal mixture containing astragalus was added. That case involved several herbs and a different drug, so it proves little, and astragalus has not been studied with everolimus. Do not start it without talking to your specialist who manages your everolimus.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Caution Does Astragalus interact with Sirolimus?
Sirolimus works by calming the immune system down so your body does not reject a transplant, and astragalus is taken to support the immune system, so it may work against sirolimus. In one reported case with tacrolimus, a drug the body clears the same way, the tacrolimus level fell by almost half after a herbal mixture containing astragalus was added. That case involved several herbs and a different drug, so it proves little, and astragalus has not been studied with sirolimus. Do not start it without talking to your transplant team.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Caution Does Astragalus interact with Tacrolimus?
Astragalus is taken to support the immune system, which is the opposite of what tacrolimus is prescribed to do, and in one reported case the tacrolimus level fell by almost half after a herbal mixture containing astragalus was added. That case involved several herbs, so it proves little on its own, but tacrolimus has a narrow safe range. Astragalus has not been studied with tacrolimus, so do not start it without talking to your transplant or specialist team, and ask whether an extra level check makes sense.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
What this page does not say. Leaving a compound out of our recommendations is not a verdict that it is useless for everyone. It is a statement about safety, evidence, or interaction load in the context Distil screens for. Discuss any supplement decision with whoever manages your prescriptions.
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How the checker decides
Every result has a source
Each pair we have assessed is cited to a published study (PMID) or the British National Formulary, so you can read the source yourself.
Four kinds of answer
Severe, caution, no known interaction, and not yet assessed. A pair we have not assessed is never shown as clear.
- Severe
- Caution
- No known interaction
- Not yet assessed
Nothing in our data is not a clearance
When nothing in our data records a problem with a pair, the result says no known interaction at typical doses, which is not a clearance: your pharmacist or GP can check the pair against your full medical history.
A full supplement review, built around you, not a generic stack.
The free checker answers one interaction question at a time. A Distil report reviews the bigger picture: your goals, diet, medications, current supplements and any blood results you provide, then shows what appears worth keeping, changing, adding or leaving out.
- what your diet already covers, so you are not adding a capsule for something food is already handling
- which evidence-graded compounds are worth considering for your goals, and which were considered but left out
- what to keep, change or stop from what you already take, plus the order to introduce anything new
- how your medications and complete supplement stack fit together, with daily timing and a clear point for reassessment
The interaction check is one section of the full report. You also get the reasoning behind each recommendation and the evidence references used.
£49 until 30 June 2027 · £79 from 1 July 2027.
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