Schisandra and medications.
Schisandra is classified as a targeted supplement in the Distil database, evidence Grade B/C. The page below lists every medication we have explicitly assessed it against.
Schisandra is a berry used in traditional Chinese medicine, sold as a standardised extract for a long list of uses. Distil recommends it for one: menopausal symptoms, at Grade C, where a randomised double-blind placebo-controlled trial in 36 women who completed it found a significantly lower symptom score than placebo. Many people find that sort of support modest, and it is one small trial, so treat it as emerging rather than established. We do not recommend it for stress, burnout or the liver, and it is worth saying why: the stress and burnout uses rested entirely on a review article from a manufacturer's own research arm rather than on a trial, and the nearest published liver study tested schisandra blended with sesamin, so no effect can be credited to the berry by itself. The dose runs 500 to 2,000mg a day, and morning or early afternoon timing tends to work best because schisandrin can cause restlessness or insomnia late in the day. On interactions, schisandra inhibits CYP3A4 and P-glycoprotein, which slows the clearance of those drugs and raises their blood levels, so the real risk is drug toxicity rather than loss of effect. Most of the human drug studies used a close relative, Schisandra sphenanthera; Schisandra chinensis, the species usually sold as a supplement, shares many of the same active lignans, in different proportions, so the same caution is carried across. It matters most for narrow-window medicines: tacrolimus and the other transplant immunosuppressants (ciclosporin, sirolimus, everolimus) can rise sharply, flagged as one of our highest-severity pairs, so it should be avoided outside your transplant team's oversight. It can also change the levels of some HIV antiretrovirals that go through CYP3A4, so the same caution applies with your HIV specialist. Statins, calcium channel blockers and hormonal contraceptives are affected too, so flag it for anyone on those. In rats, schisandra extract sped up the clearance of warfarin, so if you take warfarin, mention it to your GP before starting. It can also raise gastric acid, so use it cautiously with active reflux or peptic ulcer. Avoid in pregnancy given uterine-stimulating activity in animal work and thin human safety data.
Below are the 16 documented pairs we have explicitly assessed for Schisandra: 10 severe and 6 caution. The pairs cluster around 3 mechanisms: CYP-mediated metabolism, CYP3A4 inhibition, and P-glycoprotein inhibition (raises drug levels). 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
Last reviewed 29 October 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.
CYP-mediated metabolism
Severe Does Schisandra interact with Efavirenz?
Schisandra may change the amount of efavirenz in your blood, and it is not clear in which direction, because schisandra both slows and speeds up the liver enzymes that handle medicines. Either direction is a problem, since too little efavirenz can let HIV become resistant and too much can worsen the dizziness, vivid dreams and mood effects efavirenz can cause. Do not combine schisandra with efavirenz unless your HIV team has agreed it, and note this advice comes from how schisandra behaves with other medicines rather than from any study of schisandra with efavirenz, because none has been done.
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 Schisandra interact with Warfarin sodium?
Schisandra may change how quickly your body clears warfarin, which could move your INR. In a study in rats, a schisandra extract made the body clear warfarin faster, which in people would weaken warfarin's effect, but this has not been tested in people, and other studies point to schisandra slowing some drug-clearing enzymes instead. Tell whoever manages your warfarin before you start schisandra, keep to your usual INR checks, and do not change your warfarin dose yourself.
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.
CYP3A4 inhibition
Severe Does Schisandra interact with Ciclosporin?
Schisandra can slow how the body clears ciclosporin and push ciclosporin blood levels higher than intended, which risks toxicity. Do not combine the two outside direct transplant-team supervision.
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.
Severe Does Schisandra interact with Everolimus?
Schisandra can slow how the body clears everolimus and push everolimus blood levels higher than intended, which risks toxicity. Do not combine the two outside direct transplant-team supervision.
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.
Severe Does Schisandra interact with Sirolimus?
Schisandra may slow how the body clears sirolimus and push sirolimus blood levels higher than intended, which risks toxicity: a closely related schisandra species roughly doubled sirolimus levels in people. Do not combine the two outside direct transplant-team supervision.
Evidence: Limited human data, from small studies or case reports.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Severe Does Schisandra interact with Tacrolimus?
Schisandra may slow how the body clears tacrolimus and push tacrolimus blood levels far higher than intended, which risks toxicity: with a closely related schisandra species, tacrolimus levels rose several times over in people. Do not combine the two outside direct transplant-team supervision.
Evidence: Limited human data, from small studies or case reports.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Caution Does Schisandra interact with Apixaban?
Schisandra may raise the level of apixaban in your blood a little, which could add to its bleeding risk. Schisandra has been shown in people to slow a gut transporter that helps clear apixaban, and a related schisandra species slows the liver enzyme that clears it, but the two have never been tested together. Tell your prescriber or pharmacist before you start, and watch for unusual bruising, nosebleeds or black stools, because there is no routine blood test for apixaban to catch a change.
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 Schisandra interact with Quetiapine?
Schisandra may slow how your body clears quetiapine and raise its level, which could make you more drowsy or dizzy, especially when you stand up. This has not been tested with quetiapine. The reason for caution is that a related schisandra species slowed the liver enzyme that clears quetiapine in people, and quetiapine's UK prescribing information rules out taking it with medicines that strongly block that enzyme. Tell your prescriber or pharmacist before you start schisandra.
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 Schisandra interact with Rivaroxaban?
Schisandra may raise the level of rivaroxaban in your blood a little, which could add to its bleeding risk. Schisandra has been shown in people to slow a gut transporter that helps clear rivaroxaban, and a related schisandra species slows the liver enzyme that clears it, but the two have never been tested together. Tell your prescriber or pharmacist before you start, and watch for unusual bruising, nosebleeds or black stools, because there is no routine blood test for rivaroxaban to catch a change.
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.
P-glycoprotein inhibition (raises drug levels)
Caution Does Schisandra interact with Dabigatran etexilate?
Schisandra may raise the level of dabigatran in your blood, which could add to its bleeding risk. Schisandra has been shown in people to slow the gut transporter that dabigatran depends on, and dabigatran is sensitive to medicines that do this, but the two have never been tested together. Tell your prescriber or pharmacist before you start, and watch for unusual bruising, nosebleeds or black stools, because there is no routine blood test for dabigatran to catch a change.
Evidence: Limited human data, from small studies or case reports.
Caution Does Schisandra interact with Edoxaban?
Schisandra may raise the level of edoxaban in your blood, which could add to its bleeding risk. Schisandra has been shown in people to slow a gut transporter that edoxaban depends on, but the two have never been tested together. Tell your prescriber or pharmacist before you start, and watch for unusual bruising, nosebleeds or black stools, because there is no routine blood test for edoxaban to catch a change.
Evidence: Limited human data, from small studies or case reports.
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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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.
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