Rhodiola

Rhodiola/Drug Interactions:

  • AcetaminophenAcetaminophen: In animal research, salidroside, an active constituent of rhodiola, was found to protect against acetaminophen-induced hepatotoxicity by preventing or alleviating intracellular glutathione (GSH) depletion and oxidation damage (3).
  • AcetazolamideAcetazolamide: In clinical research, a combination of Rhodiola rosea and acetazolamide did not have an additive effect on blood oxygen saturation in men living at high altitudes (110).
  • Alpha-glucosidase inhibitorsAlpha-glucosidase inhibitors: In animals and in vitro, rhodiola alone or in combination may have additive effects on alpha-glucosidase and alpha-amylase inhibition (30; 37).
  • Antianxiety agentsAntianxiety agents: In animal research, Rhodiola rosea extract significantly induced anxiolytic-like effects (25).
  • AntibioticsAntibiotics: In human research with a combination product, Rhodiola rosea may be an effective adjuvant to standard antibiotic therapy for the treatment of pneumonia (42; 117). Rhodiola extracts have also been shown to exert antibacterial activity in vitro (42; 117).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: In animal research, Rhodiola rosea (SHR-5 extract) did not alter the anticoagulant activity of warfarin (95). However, Rhodiola rosea extract has also been shown to inhibit cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2), and phospholipase A2 (PLA2), in rats (15).
  • Antidepressant agents, monoamine oxidase inhibitors (MAOIs)Antidepressant agents, monoamine oxidase inhibitors (MAOIs): In human research and a review, rhodiola inhibited monoamine oxidase (28; 96). Concurrent use of rhodiola with MAOIs may theoretically increase the risk of adverse effects.
  • Antidepressant agents, selective serotonin reuptake inhibitors (SSRIs)Antidepressant agents, selective serotonin reuptake inhibitors (SSRIs): In human research and a review, rhodiola increased serotonin levels by inhibiting monoamine oxidase (28; 96); it was also a potent inhibitor of CYP3A4 and p-glycoprotein (87; 88). Concurrent use of rhodiola with SSRIs may theoretically increase the risk of adverse effects including serotonin syndrome. In human case report, concurrent use of rhodiola and escitalopram caused significant tachyarrhythmia (80). Escitalopram is metabolized by CYP2C19, CYP2D6, and CYP3A4; therefore concurrent use may alter plasma concentrations and increase the risk of adverse effects (80).
  • Antidiabetic agentsAntidiabetic agents: In animals and in vitro, Rhodiola rosea may decrease blood glucose (79; 37).
  • Anti-inflammatory agentsAnti-inflammatory agents: In humans, Rhodiola rosea and anti-inflammatory agents may have additive effects (14). The Rhodiola rosea extract has also been shown to inhibit cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2), and phospholipase A2 (PLA2), in rats (15).
  • Antihypertensives, ACE inhibitorsAntihypertensives, ACE inhibitors: In animals and in vitro, rhodiola alone or in combination may have additive effects on ACE inhibition(30; 37).
  • Antilipemic agentsAntilipemic agents: In animal study, rhodionin and rhodiosin suppressed triglyceride elevations (36).
  • Antineoplastic agentsAntineoplastic agents: In mice, Rhodiola rosea has been shown to inhibit tumor growth (118; 91; 119; 120; 121), and decrease the toxicity of Adriamycin (118; 91; 119; 120; 121), sarcolysin (118; 91; 119; 120; 121), and cyclophosphamide (118; 91; 119; 120; 121). In breast cancer patients, Rhodiola algida was found to improve chemotherapy-induced oral mucositis (43).
  • Antiobesity agentsAntiobesity agents: In laboratory study, rhodiola was found to regulate adipogenesis through energy modulation and redox pathways (52). Tyrosol, a constituent of rhodiola, disrupted the proline-mediated energy generation and antioxidant enzyme response via pentose phosphate pathway, resulting in the suppression of adipogenesis and lipid accumulation (52). Based on secondary sources, rhodiola may be beneficial for weight loss by mobilizing fatty acids from adipose cells, particularly during exercise.
  • AntiviralagentsAntiviralagents: In vitro, rhodiola has demonstrated antiviral activity against various pathogens (65; 122; 40; 34).
  • Cardiovascular agentsCardiovascular agents: Rhodiola has displayed cardioprotective and antiarrhythmic effects in various studies (123; 82; 83; 84; 85; 86; 124; 81; 125; 126). In animals, injected Rhodiola rosea decreased coronary artery resistance, mean arterial pressure, total peripheral resistance, oxygen consumption index, myocardial oxygen consumption, and heart rate (81). In aortic atherosclerotic plaque of rabbits, rhodiola inhibited atherosclerotic formation and decreased vascular endothelial cell growth factor (VEGF) expression and suppressed angiogenesis in the plaque (126). In animals, salidroside decreased cardiomyocyte injury following ischemia/reperfusion (44; 127).
  • Catechol-O-methyltransferase (COMT) inhibitorsCatechol-O-methyltransferase (COMT) inhibitors: Active ingredients from Rhodiola rosea, such as rosavin and salidroside, may diminishing the action of COMT, according to unsubstantiated reports
  • Central nervous system(CNS) depressantsCentral nervous system(CNS) depressants: In animal study and a review, Rhodiola spp. may cause sedation (7; 57). Theoretically concurrent use of rhodiola and CNS depressants may increase the risk of CNS depression (57). In animal study, salidroside from Rhodiola sachalinensis had synergistic effects with pentobarbital in inducing hypnotic effects. Based on unsubstantiated reports, Rhodiola rosea extract may also potentiate the effect of pentobarbital (128).
  • CNS StimulantsCNS Stimulants: In animals study, callus tissue from Rhodiola rosea, rich in rosavins after biotransformation, inhibited locomotor activity and displayed stimulant effects (129).
  • Cytochrome P450metabolized agentsCytochrome P450metabolized agents: In laboratory study, rhodiola was found to be a potent inhibitor of CYP3A4 and P-glycoprotein (87; 88). Concurrent use of rhodiola with CYP3A4 inducers, inhibitors, and substrates may cause altered plasma concentrations and increase the risk of adverse effects (87; 88).
  • EstrogensEstrogens: Based on unsubstantiated reports, Rhodiola rosea root may interact with estrogen receptors.
  • Exercise performance enhancement agentsExercise performance enhancement agents: In an experimental trial, Rhodiola rosea is reported to have increased measured working capacity and improved self-assessed ratings of perceived exertion (130). In humans, Rhodiola rosea extract had beneficial effects on creatinine kinase following exhausting exercise (14). The authors suggested that this may be protective of muscle tissue during exercise. In animals, Rhodiola extract increased running and swimming time (131; 132).
  • Heart rate regulating agentsHeart rate regulating agents: Based on animal and in vitro study, Rhodiola rosea and cardioactive agents may have additive effects (81; 82; 83; 84; 85; 86; 133).
  • ImmunosuppressantsImmunosuppressants: In humans, animals and in vitro, rhodiola has demonstrated immunostimulatory effects (53; 91; 92; 93; 94; 74).
  • NicotineNicotine: In animal study, Rhodiola rosea reduced the withdrawal effects of nicotine during nicotine exposure and cessation (58).
  • OpiatesOpiates: In animal and in vitro study, Rhodiola rosea activated opioid receptors (82; 83; 84; 85; 86). In animal study, Rhodiola rosea dose-dependently attenuated the morphine dependence after acute and chronic administration (4).
  • P-glycoprotein regulated agentsP-glycoprotein regulated agents: In laboratory study, rhodiola was a potent inhibitor of P-glycoprotein (87; 88).
  • SedativesSedatives: In animal study and a review, Rhodiola spp. caused sedation as evidenced by prolonged sleep time produced by pentobarbital (7; 57; 128).
  • TheophyllineTheophylline: In animal study, Rhodiola rosea (SHR-5 extract) was not found to alter the pharmacokinetics of theophylline (95).
  • WarfarinWarfarin: In animal study, Rhodiola rosea (SHR-5 extract) did not alter the anticoagulant activity of warfarin (95).

    • Rhodiola/Herb/Supplement Interactions:

  • 5-Hydroxytryptophan (5-HTP)5-Hydroxytryptophan (5-HTP): Active ingredients from Rhodiola rosea, such as rosavin and salidroside, may enhance the transport of 5-hydroxytryptophan (5-HTP), according to unsubstantiated reports.
  • AdaptogensAdaptogens:In humans and animals, Rhodiola rosea may have additive effects with adaptogenic herbs and supplements (42; 53; 25).Other than Rhodiola, adaptogenic agents used traditionally include Panax ginseng, Panax quinquefolius, Eleutherococcus senticosus, Rhaponticum carthamoides (Leuzea carthamoides), schisandra, astragalus, ashwagandha (Withania somnifera), reishi mushroom, gotu kola, holy basil, dong quai (Angelica sinensis), Echinacea, and royal jelly.
  • AntibacterialsAntibacterials: In humans with a combination product, Rhodiola rosea may be an effective adjuvant to standard antibiotic therapy for the treatment of pneumonia (42; 117). Rhodiola extracts have also been shown to exert antibacterial activity in vitro (42; 117).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: In animal study, Rhodiola rosea (SHR-5 extract) did not alter the anticoagulant activity of warfarin (95). However; the Rhodiola rosea extract has also been shown to inhibit cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2), and phospholipase A2 (PLA2), in rats (15).
  • Antidepressant agents, monoamine oxidase inhibitors (MAOIs)Antidepressant agents, monoamine oxidase inhibitors (MAOIs): Based on laboratory study and clinical review, rhodiola inhibits monoamine oxidase (28; 96). Concurrent use of rhodiola with MAOIs may theoretically increase the risk of adverse effects.
  • Antidepressants, selective serotonin reuptake inhibitors (SSRIs)Antidepressants, selective serotonin reuptake inhibitors (SSRIs): Rhodiola increased serotonin levels by inhibiting monoamine oxidase (28); it was also a potent inhibitor of CYP3A4 and p-glycoprotein (87; 88). Concurrent use of rhodiola with SSRIs may theoretically increase the risk of adverse effects, including serotonin syndrome. In a human case report, concurrent use of rhodiola and escitalopram caused significant tachyarrhythmia (80). Escitalopram is metabolized by CYP2C19, CYP2D6, and CYP3A4; therefore, concurrent use may alter plasma concentrations and increase the risk of adverse effects (80). In breast cancer patients, Rhodiola algida was found to improve chemotherapy-induced oral mucositis (43).
  • Anti-inflammatory herbsAnti-inflammatory herbs: In humans, Rhodiola rosea and anti-inflammatory agents may have additive effects (14). The Rhodiola rosea extract has also been shown to inhibit cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2), and phospholipase A2 (PLA2), in rats (15).
  • AntilipemicsAntilipemics: In animal research, rhodionin and rhodiosin suppressed triglyceride elevations (36).
  • AntineoplasticsAntineoplastics: In mice, Rhodiola rosea has been shown to inhibit tumor growth (118; 91; 119; 120; 121) and decrease the toxicity of Adriamycin (118; 91; 119; 120; 121), sarcolysin (118; 91; 119; 120; 121), and cyclophosphamide (118; 91; 119; 120; 121).
  • Antiobesity herbs and supplementsAntiobesity herbs and supplements: In laboratory research, rhodiola was found to regulate adipogenesis through energy modulation and redox pathways (52). Tyrosol, a constituent of rhodiola, disrupted the proline-mediated energy generation and antioxidant enzyme response via the pentose phosphate pathway, resulting in the suppression of adipogenesis and lipid accumulation (52). Based on secondary sources, rhodiola may be beneficial for weight loss by mobilizing fatty acids from adipose cells, particularly during exercise.
  • AntioxidantsAntioxidants: In animals and in vitro, Rhodiola rosea may have additive effects with antioxidants (79; 1).
  • Antiviral agentsAntiviral agents: In vitro, rhodiola demonstrated antiviral activity against various pathogens (65; 122; 40; 34).
  • AnxiolyticsAnxiolytics: In animal research, Rhodiola rosea extract significantly induced anxiolytic-like effects (25).
  • Cardiovascular herbs and supplementsCardiovascular herbs and supplements: Rhodiola has displayed cardioprotective and antiarrhythmic effects in various studies (123; 82; 83; 84; 85; 86; 124; 81; 125; 126). In animals, injected Rhodiola rosea decreased coronary artery resistance, mean arterial pressure, total peripheral resistance, the oxygen consumption index, myocardial oxygen consumption, and heart rate (81). In aortic atherosclerotic plaque of rabbits, rhodiola inhibited atherosclerotic formation and decreased vascular endothelial cell growth factor (VEGF) expression and suppressed angiogenesis in the plaque (126). In animals, salidroside decreased cardiomyocyte injury following ischemia/reperfusion (44; 127).
  • Cranberry extractCranberry extract: In vitro, a combination of water extracts of cranberry, and Rhodiola rosea had additive effects on alpha-glucosidase, alpha-amylase, and ACE inhibition (30).
  • Cytochrome P450-metabolized herbs and supplementsCytochrome P450-metabolized herbs and supplements: In laboratory research, rhodiola was found to be a potent inhibitor of CYP3A4 and p-glycoprotein (87; 88). Concurrent use of rhodiola with CYP3A4 inducers, inhibitors, and substrates may cause altered plasma concentrations and increase the risk of adverse effects (87; 88).
  • Exercise performance enhancersExercise performance enhancers: In an experimental trial, Rhodiola rosea is reported to have increased measured working capacity and improved self-assessed ratings of perceived exertion (130). In humans, Rhodiola rosea extract had beneficial effects on creatinine kinase following exhausting exercise (14). The authors suggested that this may be protective of muscle tissue during exercise. In animals, rhodiola extract increased running and swimming time (131; 132).
  • Heart rate-regulating herbs and supplementsHeart rate-regulating herbs and supplements: In animals and in vitro, Rhodiola rosea and cardioactive agents may have additive effects (81; 82; 83; 84; 85; 86; 133).
  • HypoglycemicsHypoglycemics: In animals and in vitro, Rhodiola rosea may decrease blood glucose (79; 37).
  • HypotensivesHypotensives: In animals and in vitro, rhodiola alone or in combination may have additive effects on ACE inhibition (30; 37).
  • Immunomodulatory agentsImmunomodulatory agents: In humans, animals and in vitro, rhodiola has demonstrated immunostimulatory effects (53; 91; 92; 93; 94; 74).
  • MelatoninMelatonin: In vitro, melatonin was found to improve the survival of cryopreserved callus of Rhodiola crenulata though antioxidant and antistress mechanisms (134).
  • OpiatesOpiates: In animal and in vitro research, Rhodiola rosea activated opioid receptors (82; 83; 84; 85; 86). In animal research, Rhodiola rosea dose-dependently attenuated morphine dependence after acute and chronic administration (4).
  • P-glycoprotein modulatorsP-glycoprotein modulators: In laboratory research, rhodiola was a potent inhibitor of p-glycoprotein (87; 88).
  • PhytoestrogensPhytoestrogens: Based on unsubstantiated reports, Rhodiola rosea root may interact with estrogen receptors.
  • PiperinePiperine: In animal research, piperine (a constituent of black pepper) was found to alter the effects of rhodiola by changing the pharmacokinetic profile (89); both piperine and rhodiola have been found to be inhibitors of CYP3A4 and p-glycoprotein (90; 87).
  • SedativesSedatives: In animals and clinical review, Rhodiola spp. may cause sedation, as evidenced by prolonged sleep time produced by pentobarbital (7; 57; 128).
  • StimulantsStimulants: In animal research, callus tissue from Rhodiola rosea, rich in rosavins after biotransformation, inhibited locomotor activity and displayed stimulant effects (129).
  • TryptophanTryptophan: Active ingredients from Rhodiola rosea, such as rosavin and salidroside, may enhance the transport of tryptophan, according to unsubstantiated reports.

    • Rhodiola/Food Interactions:

  • Black pepperBlack pepper: In animal research, piperine (a constituent of black pepper) was found to alter the effects of rhodiola by changing the pharmacokinetic profile (89); both piperine and rhodiola have been found to be inhibitors of CYP3A4 and p-glycoprotein (90; 87).
  • Cranberry extractCranberry extract: In laboratory research, a combination of water extracts of cranberry and Rhodiola rosea had additive effects on alpha-glucosidase, alpha-amylase, and ACE inhibition (30).
  • Pasteurized foodsPasteurized foods: Salidroside and rosavin from Rhodiola rosea did not survive pasteurization (135).

    • Rhodiola/Lab Interactions:

  • Blood pressureBlood pressure: In animal research, injected Rhodiola rosea decreased mean arterial pressure (81).
  • Coronary artery resistanceCoronary artery resistance: In animal research, injected Rhodiola rosea decreased coronary artery resistance (81).
  • C-reactive proteinC-reactive protein: In human research, Rhodiola rosea extract reduced levels of C-reactive protein following exhausting exercise (14).
  • Creatine kinaseCreatine kinase: In human research, Rhodiola rosea extract reduced levels of creatine kinase (14).
  • CytokinesCytokines: In vitro, Rhodiola extract stimulated production of cytokines, including interleukin-2 (IL-2) in T-1 helper cells and intereukin-4 (IL-4), interlukin-6 (IL-6), and interleukin-10 (IL-10) in T-2 helper cells (93), as well as tumor necrosis factor-alpha (136).
  • EndorphinsEndorphins: In animal research, Rhodiola rosea extract injection increased serum beta-endorphin, thereby preventing its stress-induced increase (137).
  • Free fatty acidsFree fatty acids: Rhodiola rosea extract reduced levels of free fatty acids, according to secondary sources.
  • GlucoseGlucose: In animal research, Rhodiola rosea decreased blood glucose (79).
  • Glutathione (GSH)Glutathione (GSH): In animal research, rhodiola reduced GSH levels (138).
  • Heart rateHeart rate: In animal research, injected Rhodiola rosea decreased heart rate (81).
  • Immune mediatorsImmune mediators: In human research, Rhodiola rosea extract improved parameters of leukocyte integrins and T cell immunity (91).
  • LactateLactate: Rhodiola rosea extract reduced levels of blood lactate, according to secondary sources.
  • Malondialdehyde (MDA)Malondialdehyde (MDA): In animals, rhodiola increased malondialdehyde (MDA) (138).
  • Myocardial oxygen consumptionMyocardial oxygen consumption: In animal research, injected Rhodiola rosea decreased myocardial oxygen consumption (81).
  • NeurotransmittersNeurotransmitters: Based on unsubstantiated reports, Rhodiola rosea may increase brain levels of dopamine, acetylcholine, and norepinephrine (139).
  • Nitric oxideNitric oxide: Based on in vitro research, Rhodiola may increase nitric oxide levels (140; 141).
  • Platelet countsPlatelet counts: In animal research, salidroside increased platelets at low doses and elevated white blood cells and bone marrow cells at both high and low doses (13).
  • Total peripheral resistanceTotal peripheral resistance: In animal research, injected Rhodiola rosea decreased total peripheral resistance (81).
  • TriglyceridesTriglycerides: In animal research, rhodionin and rhodiosin suppressed triglyceride elevations (36).
  • White blood cellsWhite blood cells: Based on human research, Rhodiola rosea may increase CD3, CD4, CD5, and CD8 T cell counts, as well as IgG and IgM (53). In laboratory research, Rhodiola rosea did not modulate granulocytopoiesis (142) but did stimulate bone marrow erythropoiesis followed by a decrease in bone marrow erythrokaryocytes (143). In animal research, salidroside increased platelets at low doses and elevated white blood cells and bone marrow cells at both high and low doses (13).