Meta Information
ID:chamomile-extract
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/class/anticoagulants-antiplatelets
Target name:
Anticoagulants and Antiplatelets
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Chamomile contains coumarin compounds that may have mild blood-thinning effects, potentially increasing the risk of bleeding when combined with anticoagulant or antiplatelet medications like warfarin, clopidogrel, or aspirin.
Actionable advice:
It is important to talk to a doctor before use while taking any blood-thinning medication, including daily aspirin.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
CYP2C9, a polymorphic enzyme, is likely to be the principal form of human liver CYP450 that modulates the in vivo anticoagulant activity of warfarin.
Label source:
Action type:
informational_none
Target id:
/class/immunosuppressants
Target name:
Calcineurin Inhibitors
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Chamomile can inhibit the CYP3A4 enzyme, which is crucial for metabolizing drugs like cyclosporine and tacrolimus, leading to dangerously elevated drug levels and increased risk of toxicity.
Actionable advice:
Chamomile should not be taken alongside calcineurin inhibitors like cyclosporine or tacrolimus.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
chamomile preparations contain constituents inhibiting the activities of major human drug metabolizing enzymes; interactions with drugs whose route of elimination is mainly via cytochromes (especially CYP1A2) are therefore possible
Label source:
Ganzera et al. 2006, PMID 16137701. Confirms chamomile inhibits CYP enzymes including CYP3A4 (strongest on CYP1A2); the cyclosporine/tacrolimus specific is a class-level extension.
Action type:
avoid
Target id:
/procedure/surgery
Target name:
Scheduled Surgery
Severity:
major
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
336
Hours after target:
0
Description:
Due to its potential effects on blood clotting and its sedative properties, chamomile may increase bleeding risk and interfere with anesthesia during and after surgery.
Actionable advice:
Use should be discontinued at least 2 weeks prior to any scheduled surgery.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
In patients on anticoagulants, ginkgo biloba, chondroitin-glucosamine, melatonin, turmeric, bilberry, chamomile, fenugreek, milk thistle, and peppermint are associated with bleeding risk.
Label source:
PubMed: Proceedings (Baylor University. Medical Center) (2022)
Source url:
Exact phrase from label:
The results of repeated measures Analysis of Variance (ANOVA) showed that both of the intervention groups experienced a decrease in pain and anxiety over time compared to the control group (P <
.001).
Label source:
PubMed: Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses (2024)
Action type:
avoid
Target id:
/condition/asteraceae-allergy
Target name:
Allergy to Asteraceae/Compositae Plants
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Individuals with allergies to plants in the Asteraceae family, such as ragweed, chrysanthemums, marigolds, and daisies, may experience a cross-reactive allergic reaction to chamomile.
Actionable advice:
Chamomile should be avoided completely with an allergy to ragweed, marigolds, daisies, or related plants.
Validation status:
unvalidatable
Evidence tier:
tier_e
Evidence basis:
unvalidatable
Evidence anchors:
Source url:
Scientific literature support not found
Exact phrase from label:
Label source:
Action type:
avoid
Target id:
/class/cns-depressants
Target name:
Other Sedating Herbs & Supplements
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Combining chamomile with other sedative herbs such as valerian root, kava, or passionflower can result in excessive drowsiness and central nervous system depression.
Actionable advice:
This is best not taken with other sleep-promoting herbs like valerian root or kava, to prevent over-sedation.
Validation status:
validated_via_class_inference
Evidence tier:
tier_c
Evidence basis:
class_inference_summary
Evidence anchors:
Source url:
Established mechanism / class pharmacology (no single primary source quoted)
Exact phrase from label:
Pharmacodynamic inference: chamomile has mild sedative/anxiolytic (apigenin-GABAergic) activity that can be additive with other sedative herbs (valerian, kava, passionflower) and CNS depressants. Plausible additive sedation, not a studied combination.
Label source:
Class inference
Action type:
avoid
Target id:
/dietary/alcohol-acute
Target name:
Alcohol (Acute Consumption)
Severity:
moderate
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
2
Hours after target:
2
Description:
Combining chamomile with alcohol can significantly increase drowsiness, dizziness, and impairment of motor skills due to additive CNS depressant effects.
Actionable advice:
Alcohol is best avoided within a few hours of taking chamomile extract.
Validation status:
unvalidatable
Evidence tier:
tier_e
Evidence basis:
unvalidatable
Evidence anchors:
Source url:
Scientific literature support not found
Exact phrase from label:
Label source:
Action type:
avoid
Target id:
/class/cyp3a4-substrates
Target name:
CYP3A4 Substrates
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Chamomile can inhibit the CYP3A4 enzyme, slowing the breakdown of many common medications (e.g., some statins, calcium channel blockers) and potentially increasing their concentration and risk of side effects.
Actionable advice:
It is important to talk to a pharmacist or doctor to check for interactions while taking any prescription medications.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
However, strong inhibitors of CYP3A4 (e.g., ketoconazole, itraconazole, ritonavir)
may increase the plasma concentrations of amlodipine to a greater extent.
Label source:
Action type:
informational_none
Target id:
/class/cyp2c9-substrates
Target name:
Drugs Metabolized by CYP2C9
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Chamomile may inhibit the CYP2C9 enzyme, which can increase blood levels of drugs like warfarin and some NSAIDs, elevating the risk of their associated side effects, such as bleeding.
Actionable advice:
Use is best avoided with drugs like warfarin, as it can dangerously increase their effects and bleeding risk.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
CYP2C9, a polymorphic enzyme, is likely to be the principal form of human liver CYP450 that modulates the in vivo anticoagulant activity of warfarin.
Label source:
Action type:
avoid
Target id:
/class/antidiabetic-medications
Target name:
Diabetes Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Chamomile may have a mild glucose-lowering effect. When taken with antidiabetic drugs, this can lead to an additive effect and increase the risk of hypoglycemia (low blood sugar).
Actionable advice:
Blood sugar levels should be monitored closely if combining chamomile with diabetes medications.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
When such drugs are withdrawn from a patient receiving metformin hydrochloride, observe the patient closely for hypoglycemia.
Label source:
Action type:
monitor
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Chamomile has been traditionally considered an emmenagogue and may have uterine-stimulating properties, posing a theoretical risk to pregnancy, especially in high doses.
Actionable advice:
Use is best avoided during pregnancy due to a theoretical risk of uterine stimulation.
Validation status:
unvalidatable
Evidence tier:
tier_e
Evidence basis:
unvalidatable
Evidence anchors:
Source url:
Scientific literature support not found
Exact phrase from label:
Label source:
NatMed Pro Monograph: German Chamomile
Action type:
avoid
Target id:
/class/herbal-anticoagulants
Target name:
Herbal Anticoagulants/Antiplatelets
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The mild anticoagulant properties of chamomile can be additive with other herbs that thin the blood (e.g., ginkgo, garlic, ginger), increasing the overall risk of bleeding or bruising.
Actionable advice:
This is best not combined with other blood-thinning supplements like ginkgo, garlic, or high-dose fish oil.
Validation status:
validated_via_class_inference
Evidence tier:
tier_c
Evidence basis:
class_inference_summary
Evidence anchors:
Source url:
Established mechanism / class pharmacology (no single primary source quoted)
Exact phrase from label:
Mechanistic inference: chamomile contains coumarin constituents and there are case reports of chamomile-warfarin interaction, so additive bleeding risk with other blood-thinning herbs is plausible. Weak/case-level evidence (the cited Semantic Scholar link is not a primary source).
Label source:
Class inference
Action type:
avoid
Target id:
/class/herbal-sedatives
Target name:
Other Sedating Herbs & Supplements (Herbal Additive)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Combining chamomile with other sedative herbs such as valerian root, kava, or passionflower can result in excessive drowsiness and central nervous system depression.
Actionable advice:
This is best not taken with other sleep-promoting herbs like valerian root or kava, to prevent over-sedation.
Validation status:
unvalidatable
Evidence tier:
tier_e
Evidence basis:
unvalidatable
Evidence anchors:
Source url:
Scientific literature support not found
Exact phrase from label:
Label source:
Action type:
avoid
Target id:
/circadian/sleep
Target name:
Going to Sleep
Severity:
moderate
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
1
Hours after target:
0.5
Description:
Chamomile's primary active compound, apigenin, binds to benzodiazepine receptors in the brain, which promotes relaxation and helps initiate sleep.
Actionable advice:
It is best taken 30 to 60 minutes before the intended bedtime to promote relaxation and sleep.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Apigenin competitively inhibited the binding of flunitrazepam with a Ki of 4 microM and had no effect on muscarinic receptors, alpha 1-adrenoceptors, and on the binding of muscimol to GABAA receptors.
Label source:
PubMed: Planta medica (1995)
Source url:
Exact phrase from label:
The results reported in this paper demonstrate that apigenin is a ligand for the central benzodiazepine receptors exerting anxiolytic and slight sedative effects but not being anticonvulsant or myorelaxant.
Label source:
PubMed: Planta medica (1995)
Source url:
Exact phrase from label:
The effects of apigenin extend beyond CD38 inhibition, encompassing agonistic and antagonistic modulation of various targets, including GABA and inflammatory pathways.
Label source:
PubMed: Frontiers in nutrition (2024)
Action type:
separate
Target id:
/class/cyp1a2-substrates
Target name:
CYP1A2 Substrates
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Chamomile may mildly inhibit the CYP1A2 enzyme, which could slow the metabolism of substrates like caffeine or theophylline, potentially increasing their effects or side effects.
Actionable advice:
The effects of substances like caffeine may be prolonged or intensified.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Crude essential oil demonstrated inhibition of each of the enzymes, with CYP1A2 being more sensitive than the other isoforms.
Label source:
PubMed: Life sciences (2006)
Source url:
Exact phrase from label:
Activity of CYP1A2 in the liver microsomes of rats receiving dandelion, peppermint or chamomile tea was significantly decreased (P < 0.05) to 15%, 24% and 39% of the control value, respectively.
Label source:
PubMed: The Journal of pharmacy and pharmacology (2001)
Source url:
Exact phrase from label:
As indicated by these in vitro data, chamomile preparations contain constituents inhibiting the activities of major human drug metabolizing enzymes; interactions with drugs whose route of elimination is mainly via cytochromes (especially CYP1A2) are therefore possible.
Label source:
PubMed: Life sciences (2006)
Action type:
informational_none
Target id:
/class/estrogens
Target name:
Estrogens and Progestins (Hormonal Therapy & Contraceptives)
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Chamomile contains compounds like apigenin that may exert weak estrogenic or anti-estrogenic effects, theoretically interfering with hormone therapies or hormone-sensitive conditions.
Actionable advice:
This is best used with caution for those on estrogen therapy or with a history of hormone-sensitive conditions.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
It contains two female hormones, an estrogen called ethinyl estradiol, and a progestin called norelgestromin.
Label source:
Action type:
informational_none
Target id:
/class/serms
Target name:
Selective Estrogen Receptor Modulators (SERMs)
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Due to its potential effects on estrogen receptors, chamomile could theoretically interfere with the action of SERMs like tamoxifen or raloxifene.
Actionable advice:
This is best used with caution when taking SERMs like tamoxifen, as chamomile may interfere with their action.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The underlying mechanism is unknown, but may be related to the estrogen-like effect of tamoxifen.
Label source:
Action type:
informational_none
Target id:
/class/glucose-lowering-supplements
Target name:
Glucose-Lowering Supplements
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Chamomile's potential to lower blood sugar can be additive with other supplements that have similar effects, such as berberine or cinnamon, slightly increasing the risk of hypoglycemia.
Actionable advice:
This is best used with caution, and it is worth monitoring for signs of low blood sugar when taken with supplements like berberine.
Validation status:
unvalidatable
Evidence tier:
tier_e
Evidence basis:
unvalidatable
Evidence anchors:
Source url:
Scientific literature support not found
Exact phrase from label:
Label source:
Action type:
monitor