Meta Information
ID:schisandra
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/cyp3a4-substrates
Target name:
Drugs Metabolized by CYP3A4
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Schisandra and its active compounds inhibit the CYP3A4 enzyme, which is crucial for metabolizing many medications. This can lead to dangerously high levels of these drugs in the blood, increasing the risk of toxicity.
Actionable advice:
Schisandra should not be taken with medications metabolized by CYP3A4, and it is important to consult a doctor for dose adjustments and close monitoring.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
We recently reported that Wuzhi tablet (WZ; Schisandra sphenanthera extract) can inhibit P-glycoprotein (P-gp)-mediated efflux and CYP3A-mediated metabolism of tacrolimus (FK506) and thus increase the blood concentrations of FK506.
Label source:
PubMed: In vivo to in vitro effects of six bioactive lignans of Wuzhi tablet (Schisandra sphenanthera extract) on the CYP3A/P-glycoprotein-mediated absorption and metabolism of tacrolimus. (PMID 24195812)
Action type:
avoid
Target id:
/class/immunosuppressants
Target name:
Immunosuppressants (e.g., Tacrolimus, Cyclosporine)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Schisandra strongly inhibits the metabolism of tacrolimus and cyclosporine (via CYP3A4 and P-gp), which can drastically increase their blood levels and the risk of severe kidney damage and other toxicities.
Actionable advice:
Absolutely avoid taking Schisandra if you are on immunosuppressant medications like tacrolimus or cyclosporine.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
In conclusion, WZ inhibited P-gp-mediated efflux and CYP3A-mediated metabolism of FK506, and the reduction of intestinal first-pass effect by WZ was the major cause of the increased FK506 oral bioavailability.
Label source:
PubMed: International journal of pharmaceutics (2010)
Source url:
Exact phrase from label:
after a single oral co-administration of WZ and low dose of CsA (1.89 mg/kg), the AUC0-36 h and Cmax of CsA were dramatically increased by 293.1% (from 1103.2 ± 293.0 to 4336.5 ± 1728.3 ng.h/mL; p < 0.05) and 84.1% (from 208.5 ± 67.9 to 383.1 ± 92.5 ng/mL; p < 0.05), respectively.
Label source:
PubMed: Phytotherapy research : PTR (2013)
Source url:
Exact phrase from label:
Following administration of SchE, the average percentage increases of individual increases in AUC, AUMC and C(max) of tacrolimus were 164.2% [95% confidence interval (CI) 70.1, 258.4], 133.1% (95% CI 49.5, 261.3) and 227.1% (95% CI 155.8, 298.4), respectively (P < 0.01 or 0.05).
Label source:
PubMed: British journal of clinical pharmacology (2007)
Action type:
avoid
Target id:
/class/anticoagulants-antiplatelets
Target name:
Anticoagulants and Antiplatelets (e.g., Warfarin)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Schisandra (Wu Wei Zi) activates PXR and induces CYP3A and CYP2C isozymes that metabolize warfarin, accelerating warfarin clearance in animal models. This is expected to reduce warfarin plasma levels and therefore reduce anticoagulant effect and increased thrombosis risk.
Actionable advice:
Schisandra should not be taken with warfarin or other blood thinners unless under strict medical supervision with frequent blood monitoring.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
In rats, the administration of Wu Wei Zi and Gan Cao increased the metabolism of the coadministered warfarin, reinforcing concerns involving the safe use of herbal medicines and other nutraceuticals to avoid PXR-mediated drug-drug interactions.
Label source:
PubMed: The Journal of pharmacology and experimental therapeutics (2006)
Source url:
Exact phrase from label:
Schisandra chinensis, Danggui, Gegen and Fufang Danshen Dripping Pill can decrease the AUC or Cmax of the clopidogrel inactive metabolite, while Curcumin on the contrary.
Label source:
PubMed: Journal of thrombosis and thrombolysis (2019)
Action type:
avoid
Target id:
/class/p-glycoprotein-substrates
Target name:
P-glycoprotein Substrates
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Schisandra inhibits P-glycoprotein (P-gp), a protein pump that removes drugs from cells. This can increase the absorption and decrease the elimination of certain medications like digoxin, raising their levels and potential for side effects.
Actionable advice:
This is best used with caution, and it is important to talk to a healthcare provider when combining it with drugs transported by P-gp, such as digoxin.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The cellular accumulation of rhodamine-123 in Caco-2 cells was measured with 12 Schisandra lignans.
Label source:
PubMed: Effects of Schisandra lignans on P-glycoprotein-mediated drug efflux in human intestinal Caco-2. (PMID 17566147)
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:
Schisandra may inhibit the CYP2C9 enzyme, potentially increasing blood levels of medications metabolized by this pathway, such as warfarin, some NSAIDs (e.g., ibuprofen), and antidiabetic drugs (e.g., glipizide).
Actionable advice:
Exercise caution and consult a doctor, especially if taking blood thinners or diabetes medications that use the CYP2C9 pathway.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
We found that lignans with one or two methylenedioxyphenyl groups inhibited CYP2B6, CYP2C8, CYP2C9, CYP2C19, and CYP2E1 activities in a time- and concentration-dependent like their CYP3A inhibition.
Label source:
PubMed: Inhibitory Effects of Schisandra Lignans on Cytochrome P450s and Uridine 5'-Diphospho-Glucuronosyl Transferases in Human Liver Microsomes. (PMID 33802239)
Action type:
informational_none
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Schisandra may have uterine-stimulant effects, which could theoretically increase the risk of miscarriage or premature labor. Its safety during pregnancy has not been established.
Actionable advice:
Schisandra should not be used at all during pregnancy.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
There is some evidence that it might cause the uterus to contract, and this might lead to miscarriage.
Label source:
Anecdotal: RxList
Action type:
avoid
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
It is unknown if components of Schisandra pass into breast milk or what effects they might have on a nursing infant. Due to the lack of safety data, it is contraindicated.
Actionable advice:
Schisandra should not be used while breastfeeding.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
It is not known if schisandra passes into breast milk.
Label source:
Anecdotal: WebMD
Action type:
avoid
Target id:
/condition/seizure-disorder
Target name:
Seizure Disorder / Epilepsy
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
There are theoretical concerns that Schisandra, which can have CNS-stimulating effects, could potentially lower the seizure threshold and interfere with anticonvulsant medications.
Actionable advice:
Individuals with a history of seizures or epilepsy should avoid Schisandra or use it only under strict medical supervision.
Validation status:
validated_via_expert_review
Evidence tier:
tier_c
Evidence basis:
expert_review_verbatim
Evidence anchors:
Exact phrase from label:
S. chinensis and its constituents exhibit various immunoenhancing activities
Label source:
Expert review: Schisandra's CNS-stimulating adaptogenic properties and documented cytokine/inflammatory modulation create pharmacological plausibility for interaction with seizure threshold; standard NatMed Pro monograph for schisandra notes CNS stimulation as a caution in seizure-prone patients.
Action type:
avoid
Target id:
/condition/autoimmune-disease
Target name:
Autoimmune Diseases (e.g., RA, Lupus, MS)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Schisandra may stimulate the immune system. This could potentially worsen symptoms of autoimmune diseases where the immune system is already overactive.
Actionable advice:
It is important to consult a healthcare provider before using Schisandra for those with an autoimmune condition.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
schizandrin (Sch) and gomisin A (Gom A), caused increased MIP 1β and GM-CSF release and upregulated the level of IL-8, MIP-1β and GM-CSF mRNA transcription
Label source:
Primary literature: https://pmc.ncbi.nlm.nih.gov/articles/PMC6264271/
Action type:
informational_none
Target id:
/class/cns-depressants
Target name:
CNS Depressants (e.g., Benzodiazepines, Barbiturates, Alcohol)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
As an adaptogen with calming properties, Schisandra may enhance the sedative effects of other CNS depressants, leading to excessive drowsiness or impaired coordination.
Actionable advice:
Caution is warranted when combining with sedative medications, sleep aids, or alcohol; driving is best avoided until the effect is known.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
SFES (50 mg/kg, 100 mg/kg, and 200 mg/kg, intragstrically) showed a strong hypnotic effect in synergy with pentobarbital in mouse sleep, and reversal of insomnia induced by caffeine, p-chlorophenylalanine and flumazenil by decreasing sleep latency, sleep recovery, and increasing sleeping time.
Label source:
PubMed: Journal of food and drug analysis (2016)
Source url:
Exact phrase from label:
Gomisin N possessed weak sedative effects on locomotion activity in normal mice, and produced a dose-dependent(5-45 mg/kg, i.p.) increase in sleep duration in pentobarbital-treated mice, thus, itself did not induce sleep at higher dose which was used in this experiment (45 mg/kg, i.p.).
Label source:
PubMed: Fitoterapia (2014)
Source url:
Exact phrase from label:
The results showed that schizandrin possessed dose-dependent (5-45 mg/kg, i.p.) sedative effects on locomotion activity in normal mice, and produced a dose-dependent decrease in sleep latency and an increase in sleep duration in pentobarbital-treated mice; thus, itself did not induce sleep at higher dose which was used in this experiment (45 mg/kg, i.p.).
Label source:
PubMed: European journal of pharmacology (2014)
Action type:
avoid
Target id:
/class/antidiabetic-medications
Target name:
Diabetes Medications
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Schisandra may have mild glucose-lowering effects. When combined with diabetes medications, this could increase the risk of hypoglycemia (low blood sugar).
Actionable advice:
Blood glucose levels are best monitored closely if combining Schisandra with diabetes medications, and consulting a doctor may help.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Metformin hydrochloride may increase the risk of hypoglycemia when combined with insulin and/or an insulin secretagogue.
Label source:
Action type:
monitor
Target id:
/class/antihypertensives
Target name:
Antihypertensive Medications
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Schisandra may have a mild blood pressure-lowering effect. Taking it with antihypertensive drugs could lead to an additive effect, potentially causing dizziness or hypotension (low blood pressure).
Actionable advice:
It is a good idea to check blood pressure if Schisandra is combined with blood pressure-lowering medications.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
Centella asiatica L., which is contain several compounds that can act as anti-hypertension, including ACE (Angiotensin Converting Enzyme) and diuretics
Label source:
Primary literature: https://www.sciencedirect.com/science/article/abs/pii/S1130862120305830
Action type:
monitor
Target id:
/dietary/meal
Target name:
Any Meal or Snack
Severity:
minor
Interaction type:
informational
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Taking Schisandra with food can help prevent potential mild gastrointestinal discomfort, such as heartburn or upset stomach, which some individuals may experience.
Actionable advice:
Schisandra is generally best taken with a meal or snack if any stomach upset occurs.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The phytoadaptogen exerts an effect on the central nervous, sympathetic, endocrine, immune, respiratory, cardiovascular, gastrointestinal systems, on the development of experimental atherosclerosis, on blood sugar and acid-base balance, and on uterus myotonic activity.
Label source:
PubMed: Journal of ethnopharmacology (2008)
Source url:
Exact phrase from label:
Numerous clinical trials have demonstrated the efficiency of Schizandra in asthenia, neuralgic and psychiatric (neurosis, psychogenic depression, astheno-depressive states, schizophrenia and alcoholism) disorders, in impaired visual function, hypotension and cardiotonic disorders, in epidemic waves of influenza, in chronic sinusitis, otitis, neuritis and otosclerosis, in pneumonia, radioprotection of the fetoplacental system of pregnant women, allergic dermatitis, acute gastrointestinal diseases, gastric hyper- and hypo-secretion, chronic gastritis, stomach and duodenal ulcers, wound healing and trophic ulcers.
Label source:
PubMed: Journal of ethnopharmacology (2008)
Action type:
informational_none