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Supplement · Grade B/C

Cordyceps and medications.

Every documented pair, every citation. Below: 6 documented pairs grouped by mechanism.

Cordyceps is in the Distil supplement database, evidence Grade B/C. The page below lists every medication we have explicitly assessed it against.

Cordyceps, best taken as the Cordyceps militaris extract, is a medicinal fungus studied for athletic performance and energy. The evidence is Grade B to C: it may support VO2max, endurance, and fatigue through effects on mitochondrial ATP production, and it acts as a mild adaptogen with emerging signals for libido and immune function. The honest limit is that results are inconsistent. One RCT found militaris improved VO2max and exercise duration over three weeks, but a well-designed trial of the sinensis form found no benefit at all, which is part of why the militaris form is preferred over sinensis, alongside supply and standardisation problems with the latter. Typical dosing is 1,000 to 3,000mg a day. On interactions, cordyceps modulates the immune system, so it should be excluded in autoimmune conditions, and it carries a potential mild effect with anticoagulants. Taken late it can disturb sleep. A reasonable trial for endurance work if you choose the militaris form and keep expectations measured.

Below are the 6 documented pairs we have explicitly assessed for Cordyceps: 6 amber. The pairs cluster around 2 mechanisms: Additive anticoagulation and Immunosuppression caution. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not listed here is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by medication, and the missing-item form at the bottom of the page routes any uncatalogued medication into our next curation pass.

Documented interactions

Additive anticoagulation

Cordyceps may add to acenocoumarol's blood-thinning effect through a mild anti-clotting action of its own. This is based on laboratory work on human platelets rather than studies in people taking acenocoumarol, so the real-world size of the effect is unknown. If you take acenocoumarol, mention cordyceps to your anticoagulation clinic and ask whether an INR check is worth doing after you start.

PMID 17229422 · PMID 25593645 · BNF: Acenocoumarol

Reviewer-flagged: awaiting clinical-reviewer sign-off.

Cordyceps may add to warfarin's blood-thinning effect through a mild antiplatelet action of its own. This is based on laboratory work on human platelets rather than studies in people taking warfarin, so the real-world size of the effect is unknown. If you take warfarin, mention cordyceps to your anticoagulation clinic and ask whether an INR check is worth doing after you start.

Reviewer-flagged: awaiting clinical-reviewer sign-off.

Immunosuppression caution

Amber Ciclosporin

Cordyceps is often taken to support the immune system, but in transplant studies it actually adds to immune suppression rather than working against it, and patients needed less ciclosporin to reach the same blood levels. Because ciclosporin has a narrow safe range, starting or stopping cordyceps on your own could shift your levels without anyone watching. Do not change your cordyceps use without your transplant team, who can adjust monitoring if needed.

PMID 19545680 · PMID 26457607 · PMID 28137532 · BNF: Ciclosporin

Reviewer-flagged: awaiting clinical-reviewer sign-off.

Amber Everolimus

Cordyceps is taken to support the immune system, but in transplant studies it adds to immune suppression rather than opposing it. Everolimus is a narrow-range transplant and cancer medicine, so taking cordyceps on your own could shift the balance without anyone watching. Do not start or stop cordyceps without the specialist who manages your everolimus.

PMID 19545680 · PMID 26457607 · PMID 28137532 · BNF: Everolimus

Reviewer-flagged: awaiting clinical-reviewer sign-off.

Amber Sirolimus

Cordyceps is taken to support the immune system, but in transplant studies it adds to immune suppression rather than opposing it. Sirolimus is a narrow-range transplant medicine, so taking cordyceps on your own could shift the balance without anyone watching. Do not start or stop cordyceps without your transplant team.

PMID 19545680 · PMID 26457607 · PMID 28137532 · BNF: Sirolimus

Reviewer-flagged: awaiting clinical-reviewer sign-off.

Amber Tacrolimus

Cordyceps is often taken to support the immune system, but the human transplant studies actually show it adds to immune suppression rather than working against it, and it can change how much calcineurin-inhibitor medicine your body needs. Because tacrolimus has a narrow safe range, taking cordyceps on your own could shift your levels without anyone watching. Do not start or stop it without your transplant team, who can adjust monitoring if needed.

PMID 19545680 · PMID 26457607 · BNF: Tacrolimus

Reviewer-flagged: awaiting clinical-reviewer sign-off.

What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope. Use the checker below to surface any medication, and submit a missing item if you take something we have not catalogued.

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For adults over 18. This tool gives evidence-graded information, not medical advice. Always discuss changes with your GP, especially if you take any medication, are pregnant, breastfeeding, or have a serious health condition.
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