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Longevity Compounds and Medication Interactions

What regulators, NCCIH and published reviews say about interactions between common longevity compounds and medicines, substance by substance, and how strong each piece of evidence is.

Content last updated . This page has not been medically reviewed.

What this page is

Many people who read about longevity also take prescription medicines. This page lists what the sources say about interactions with some compounds often discussed in aging research. It is information only. It does not tell anyone to start, stop, combine or change anything. Ask the prescriber or pharmacist who knows your full medicine list.

How strong is the evidence?

Not all interaction warnings are equal. NCCIH says that most herb-drug interactions identified in current sources are hypothetical, inferred from animal studies, cell assays or other indirect means, and that attention is needed for drugs with a narrow therapeutic index, such as cancer chemotherapy, warfarin and digoxin. [1][2] This page uses three plain labels:
  • Label or clinical documentation: stated in an FDA label or seen in people.
  • Laboratory or reasoning only: shown in cells or enzymes, or predicted, but not confirmed in people.
  • Proper evidence not found: we looked and found nothing usable.

Substance by substance

SubstanceWhat the sources sayEvidence
Sirolimus (rapamycin), a prescription medicineThe FDA label advises avoiding strong CYP3A4 and P-gp inducers and inhibitors, and says grapefruit juice must not be taken with it. [3][4] The boxed warning concerns increased risk of infection and of lymphoma and other cancers. [5]Label or clinical documentation (approved for kidney transplant use)
Metformin, a prescription medicineAn FDA label for a metformin extended-release product says alcohol can potentiate metformin's effect on lactate metabolism, and metformin may lower vitamin B12 levels. [6][7]Label or clinical documentation
Coenzyme Q10NCCIH: may interact with warfarin and insulin. [8] MedlinePlus also lists it among products that may interact with warfarin. [9]Label or clinical documentation (cautions)
Green tea extractNCCIH: it can reduce blood levels of atorvastatin, and liver injury has been reported with extract tablets and capsules. [10][11]Label or clinical documentation (NCCIH summary)
BerberineA 2026 narrative review says interactions are documented in humans for a few pairs and mechanistic for most; one anchor is higher cyclosporine exposure in kidney-transplant recipients. [12][13]Mixed
Goldenseal (not a longevity compound; an NCCIH example involving metformin)NCCIH reports metformin levels fell about 25 percent in healthy adults given goldenseal extract plus metformin. [14]Label or clinical documentation (one study)
QuercetinA 2026 systematic review found clinically significant interactions for only a limited number of substrates, and many predicted interactions have not translated into meaningful effects in humans. [15]Mixed
ResveratrolIn human liver microsomes (a laboratory model), it inhibited CYP2C9, CYP3A and UGT1A1 enzymes. [16]Laboratory or reasoning only
NMNA 2026 meta-analysis of short trials found no clear increase in adverse events, and its abstract does not address drug interactions; larger, longer trials are still needed. [17][18] We searched for reviews of NMN or nicotinamide riboside drug interactions and found none.Proper evidence not found for interactions
St. John's wort (not a longevity compound, but a well-known example)NCCIH: overall high risk of drug interaction. [19]Label or clinical documentation

NMN means nicotinamide mononucleotide. For the NAD+ family see NAD+, NMN and nicotinamide riboside. Omega-3 fatty acids, vitamin D, hormones and GLP-1 medicines are covered on their own pages and not in this table; see for example omega-3 safety and interactions.

Reading the table carefully

  • Dose and product matter. NCCIH notes that store-bought supplements may differ in important ways from products tested in studies. [20] A laboratory finding at one concentration may not match a capsule.
  • An absent warning is not a safety guarantee. For several compounds the interaction data are limited. NCCIH says well-designed clinical studies of herbal supplement and drug interactions are limited and sometimes inconclusive. [1]
  • Prescription medicines used in aging research are still prescription medicines. Their labels describe approved uses, such as kidney transplant rejection prevention for sirolimus [21] and type 2 diabetes for metformin. [22] The word aging does not appear among the uses in the label text we read. See metformin and aging research and rapamycin and mTOR inhibitors for trial evidence.

Who needs extra care

Supplements may interact with medicines or pose risks with some medical conditions or before surgery. [23] Older adults often take several medicines, so see older adults, polypharmacy and supplements. For general safety groups, see longevity experiments and safety.

Related guides in Natural Remedy Safety

How interactions work, interactions by drug class, grapefruit and medication interactions and St. John's wort interactions.

Frequently asked questions

Can I take longevity supplements with my prescriptions?

This page cannot say. Interactions depend on the exact medicine, product and your health. Ask your prescriber or pharmacist and bring the list of everything you take. [24][25]

Does grapefruit matter for rapamycin?

For the prescription medicine sirolimus, the FDA label says grapefruit juice inhibits the CYP3A4 enzyme that breaks it down and must not be taken with it. [4] This describes the approved medicine, not a use for aging.

Which medicines are most at risk from supplement interactions?

Those with a narrow therapeutic index, such as warfarin, digoxin and cancer chemotherapy, according to NCCIH. [2]

Are resveratrol interactions proven in people?

The study we read tested human liver microsomes in the laboratory, so it does not show effects in people. [16]

Is "natural" lower risk for interactions?

No. The National Institute on Aging says a natural product might make a prescribed medicine weaker or stronger. [26]

References
  1. NCCIH Clinical Digest, Herb-Drug Interactions. Read 2026-10-22.
  2. NCCIH Clinical Digest, Herb-Drug Interactions (narrow therapeutic index). Read 2026-10-22.
  3. U.S. FDA, Rapamune prescribing information (strong inhibitors). Read 2026-10-22.
  4. U.S. FDA, Rapamune prescribing information (interactions). Read 2026-10-22.
  5. U.S. FDA, Rapamune prescribing information (boxed warning). Read 2026-10-22.
  6. U.S. FDA, Fortamet prescribing information (alcohol). Read 2026-10-22.
  7. U.S. FDA, Fortamet prescribing information (vitamin B12). Read 2026-10-22.
  8. NCCIH, Coenzyme Q10. Read 2026-10-22.
  9. MedlinePlus, Warfarin. Read 2026-10-22.
  10. NCCIH, Green Tea. Read 2026-10-22.
  11. NCCIH, Green Tea (liver). Read 2026-10-22.
  12. Berberine-Drug Interactions: Mechanisms, Clinical Relevance and Risk Stratification, a narrative review. Pharmaceuticals 2026 (PubMed 42653808). Read 2026-10-22.
  13. Berberine-Drug Interactions narrative review (cyclosporine). Read 2026-10-22.
  14. NCCIH Clinical Digest, Herb-Drug Interactions (goldenseal and metformin). Read 2026-10-22.
  15. Quercetin as a modulator of xenobiotic metabolism (systematic review). Eur J Clin Pharmacol 2026 (PubMed 42827146). Read 2026-10-22.
  16. Stereoselective inhibition of cytochrome P450 and UGT enzymes by resveratrol in human liver microsomes. PMC8470274. Read 2026-10-22.
  17. Safety and Metabolism-Related Outcomes of Oral Nicotinamide Mononucleotide Supplementation in Adults: systematic review and meta-analysis. Nutrients 2026 (PubMed 42514320). Read 2026-10-22.
  18. NMN systematic review (limits). Read 2026-10-22.
  19. NCCIH Clinical Digest, Herb-Drug Interactions (St. John's wort). Read 2026-10-22.
  20. NCCIH, Using Dietary Supplements Wisely (products versus studies). Read 2026-10-22.
  21. U.S. FDA, Rapamune (sirolimus) prescribing information (label revised 2018, FDA-hosted PDF). Read 2026-10-22.
  22. U.S. FDA, Fortamet (metformin extended-release) prescribing information (FDA-hosted PDF, boxed warning revised 8/2026). Read 2026-10-22.
  23. NCCIH, Using Dietary Supplements Wisely (interactions, surgery). Read 2026-10-22.
  24. American Geriatrics Society, 2023 Beers Criteria summary (what to do). Read 2026-10-22.
  25. American Geriatrics Society, 2023 Beers Criteria summary (bring list). Read 2026-10-22.
  26. National Institute on Aging, Dietary Supplements for Older Adults (effect on medicines). Read 2026-10-22.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.