Rheum officinale
Rhubarb/Drug Interactions:
ACE inhibitorsACE inhibitors: Rhubarb root contains tannins that may possess inhibitory activity against angiotensin converting enzyme (ACE) (36). In a clinical trial, rhubarb synergistically interacted with ACE inhibitors to decrease serum creatinine levels (37). Hyperkalemia, corrected with furosemide, occurred in one case of a person taking rhubarb and captopril (25). AntacidsAntacids: If taken within one hour, antacids may decrease the effectiveness of rhubarb.Anti-arrhythmic drugsAnti-arrhythmic drugs: Overuse of rhubarb may cause potassium depletion, increasing the risk of the toxicity of other anti-arrhythmic agents, such as quinidine.Anti-psychotic drugsAnti-psychotic drugs: In a clinical trial, rhubarb and low doses of anti-psychotic drugs reduced the need for higher doses of anti-psychotic drugs in schizophrenic patients (11). CaptoprilCaptopril: In clinical trials, rhubarb has shown a synergistic effect with captopril to reduce serum creatinine levels (26; 25; 38; 39; 37). Cardiac glycosidesCardiac glycosides: Overuse of rhubarb may increase the risk of adverse effects of cardiac glycosides, e.g., digoxin (9; 10). ChlorhexidineChlorhexidine: In a clinical trial, rhubarb reduced gingivitis when used with chlorhexidine (40). CisplatinCisplatin: In mice treated with cisplatin, co-therapy with rhubarb significantly reduced the lethal toxicity and renal toxicity of this common chemotherapeutic agent; the combination did not interfere with the chemotherapeutic effect of cisplatin (41). CorticosteroidsCorticosteroids: Rhubarb may increase potassium loss, thus aggravating electrolyte imbalance (e.g., with steroids). Rhubarb along with dexamethasone reduced the lung edema in rats due to endotoxin-induced lung injury (42). DigoxinDigoxin: Overuse of rhubarb may cause potassium depletion, increasing the risk of digoxin toxicity.Hepatotoxic drugsHepatotoxic drugs: The high tannin level of rhubarb root may increase the chance of hepatic necrosis (15). LaxativesLaxatives: Concomitant use of rhubarb with other laxatives may increase electrolyte and fluid loss, potentiating their effect (43). Nephrotoxic drugsNephrotoxic drugs: In an animal study, rhubarb orally administrated anthraquinones induced nephrotoxicity in rats (35). NifedipineNifedipine: In a clinical trial, rhubarb enhanced nifedipine's anti-pre-eclampsia effects (12). Oral drugsOral drugs: Rhubarb's laxative effects with may reduce the absorption of other oral drugs, due to a reduction in gastrointestinal transit time.Potassium-depleting diureticsPotassium-depleting diuretics: Overuse of rhubarb may compound diuretic-induced potassium loss (25). Rhubarb/Herb/Supplement Interactions:
NoteNote: Rhubarb is frequently used as a small component in multi-herb traditional Chinese medicine decoctions. As the effect of rhubarb cannot be isolate in these decoctions, herbs in combinations containing more than three components have not been added to the interactions below.Alismatics orientalisAlismatics orientalis: In a clinical trial, rhubarb has shown hypolipidemic properties when used with Alismatics orientalis (44). CalciumCalcium: Rhubarb may decrease mineral absorption. Its oxalate content may bind multivalent metal ions in the gastrointestinal tract and decrease their absorption. However, in an animal study rhubarb stalk fiber did not alter the bioavailability of calcium at a dose of 5% in diet as compared to cellulose (45). Cardiac glycoside-containing herbsCardiac glycoside-containing herbs: Because of its potential to deplete potassium, concomitant use of rhubarb may increase cardiac toxicity of cardiac glycoside-containing herbs (9; 10). Cardio-active herbsCardio-active herbs: An increase in potassium depletion and severe cardiac toxicity may be caused by concomitant use of rhubarb with cardio-active herbs, such as calamus, cereus, cola, coltsfoot, devil's claw, European mistletoe, fenugreek, fumitory, ginger, Panax ginseng, hawthorn, white horehound, mate, parsley, quassia, scotch broom flower, shepherd's pure, and wild carrot.Diuretic herbsDiuretic herbs: In rabbit studies, rhubarb has shown diuretic properties (46); rhubarb may compound diuretic-induced potassium loss.Glauber's salt (mirabilite)Glauber's salt (mirabilite): In a clinical trial, rhubarb enhanced Glauber's salt's laxative effects (47).Hepatotoxic herbsHepatotoxic herbs: The high tannin level of rhubarb root may increase the chance of hepatic necrosis (15). HorsetailHorsetail: Concomitant use of rhubarb and horsetail may cause potassium depletion.IronIron: Rhubarb may decrease mineral absorption. Its oxalate content may bind multivalent metal ions in the gastrointestinal tract and decrease their absorption.JimsonweedJimsonweed: The action of jimsonweed may be increased in chronic use or abuse of rhubarb.Laxative herbsLaxative herbs: Rhubarb is proposed to cause bowel movements and may cause potassium depletion when used with other laxatives (43). LeechesLeeches: In a clinical trial, rhubarb and leeches reduced the need for anti-psychotic drugs in schizophrenic patients (11). LicoriceLicorice: Concomitant use of rhubarb and licorice may cause potassium depletion.Nephrotoxic herbsNephrotoxic herbs: In an animal study, total rhubarb anthraquinones administrated orally for 13 weeks induced nephrotoxicity in rats (35). Oral herbsOral herbs: Concomitant use of rhubarb with other oral herbs may reduce their absorption, due to reduction in gastrointestinal transit time.SageSage: In a clinical trial, rhubarb and sage cream reduced the symptoms of herpes labialis (48). Sanchi powderSanchi powder: In a clinical trial, rhubarb and sanchi powder were used together for hemorrhagic fever from nephritic syndrome (49). Steroid herbsSteroid herbs: Rhubarb may increase potassium loss when used with steroids.ZincZinc: Rhubarb may decrease mineral absorption. Its oxalate content may bind multivalent metal ions in the gastrointestinal tract and decrease their absorption.Rhubarb/Food Interactions:
Calcium, iron, and zincCalcium, iron, and zinc: Absorption of minerals from food may be decreased. Rhubarb's oxalate content may bind multivalent metal ions in the gastrointestinal tract and decrease their absorption. However, in an animal study rhubarb stalk fiber did not alter the bioavailability of calcium at a dose of 5% in diet as compared to cellulose (45). MilkMilk: The effectiveness of rhubarb may be decreased when taken concurrently with milk.Rhubarb/Lab Interactions:
Renal testsRenal tests: Rhubarb tannins have been shown to improve BUN, creatinine, glomerular filtration rate, renal plasma flow, and renal blood flow (50). Urine testUrine test: Rhubarb may discolor urine bright yellow to red and interfere with diagnostic tests.