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📰Read the full Schisandra evidence review on GMJ News →Complete clinical article, references and updates on news.gmj.ge. This page is the structured safety summary.⚠ Patient on tacrolimus, cyclosporine, or CYP3A4-metabolized drug adding Schisandra — documented interaction; drug level elevation [1]
⚠ Patient confusing S. chinensis (Northern) with S. sphenanthera (Southern) — different lignan profiles [1]
⚠ Patient on statins adding Schisandra — CYP3A4 inhibition may increase statin levels [1]
⚠ Transplant patient using Schisandra for 'liver health' — dangerous in immunosuppressed context [1]
🥗 Food first — build your daily Typical 500–2,000 mg
Check the foods you regularly eat — the bar fills toward your daily target.
Dried Schisandra berries (5 g)50 mg total schisandrins (approximate)
Schisandra berry juice (100 mL)30 mg total schisandrins (approximate)
Schisandra tea (1 cup)15 mg total schisandrins (approximate)
Check your regular foods above
🔬 Lab interpreter
Recommended test
Drug levels (if on CYP3A4-metabolized drugs)
Drug levels (if on CYP3A4-metabolized drugs)
Reference range / target
Per drug-specific therapeutic ranges
Per drug-specific therapeutic ranges
Critical for tacrolimus, cyclosporine, narrow-index CYP3A4 drugs [1].
Full lab monitoring ↓⚕ For professionals — confirm ranges against your local laboratory.
Clinical verdict
Schisandra is a unique adaptogen with documented CYP3A4 inhibition — the drug interaction risk is its most important clinical feature. Transplant patients on tacrolimus have had dangerous elevations from co-administration. Beyond this, it is a genuine hepatoprotective and adaptogenic berry with moderate evidence for liver enzyme normalization, endurance, and cognition. S. chinensis ≠ S. sphenanthera [1] [2].
1 How much do I need?
👤 Adults: Specific dosage data under clinical review
👴 Elderly: Specific dosage data under clinical review
🤰 Pregnancy: See guidance
Traditionally used with caution in TCM. Avoid concentrated extracts during pregnancy [1].
👦 Pediatric: See guidance
Traditional use in TCM for children at reduced doses. No formal pediatric studies of extracts [1].
🏃 Athletes: Standard dose
⚖️ Obesity: Standard dose
Fat-soluble compounds may require dose adjustment in obesity.
🩺 Renal: Consult specialist
Dose adjustment may be needed in renal impairment.
🌱 Vegan: Standard dose
How to take
🍽 Timing: BID, morning and afternoon. Avoid evening (may be mildly stimulating) [1].
💊 With food: With food to reduce GI irritation [1].
🚫 Avoid: Co-administration with CYP3A4-metabolized drugs without pharmacist review. Evening dosing. S. sphenanthera when S. chinensis is intended [1].
2 Which form?
| Form | Bioavailability | Vegan | Cost |
|---|---|---|---|
| ['Schisandra berry extract (standardized to schisandrins)', 'preferred', 'Standardized to ≥2% total schisandrins. 250–500 mg BID [1].'] | Standard | Check label | |
| ['Dried Schisandra berries', 'traditional', '1.5–6 g/day in TCM. Chewed, decocted, or powdered [1].'] | Standard | Check label | |
| ['Schisandra tincture', 'convenient', 'Alcohol extract. 1–2 mL TID. Traditional Russian preparation [1].'] | Standard | Check label | |
| ['Schisandra berry powder', 'food supplement', 'Added to smoothies or tea. 1–3 g/day [1].'] | Standard | Check label |
3 Common questions
Why is Schisandra called 'five-flavor berry'? ▼
In TCM, Schisandra is unique because it contains all five basic tastes: sour (skin), sweet (flesh), salty, bitter, and pungent (seeds). This makes it one of the few herbs that theoretically enters all five yin organs (liver, heart, spleen, lung, kidney) [1].
Can Schisandra interact with my medications? ▼
Yes — this is Schisandra's most important clinical consideration. Schisandrins are potent CYP3A4 and P-glycoprotein inhibitors. This is DOCUMENTED (not theoretical) with tacrolimus, where co-administration significantly increased tacrolimus blood levels. If you take any medications metabolized by CYP3A4 (statins, immunosuppressants, many others), consult your pharmacist [1].
Is Northern Schisandra different from Southern? ▼
Yes. S. chinensis (Northern/Bei Wu Wei Zi) and S. sphenanthera (Southern/Nan Wu Wei Zi) have different lignan profiles and should not be used interchangeably. Most clinical research uses S. chinensis. Chinese pharmacopoeia distinguishes them as separate medicines [1].
How does Schisandra compare with other adaptogens? ▼
4 Clinical evidence
Strong
No single endpoint has Cochrane-level evidence. The strongest data come from pharmacokinetic and mechanistic studies [1]. HIGH
Moderate
Hepatoprotection: schisandrin B reduced ALT/AST in 2 Chinese RCTs of chronic hepatitis patients [1]. Physical performance: an RCT of athletes found Schisandra extract improved endurance and reduced cortisol elevation post-exercise [2]. Cognitive function: 1 RCT showed improved attention and speed of cognitive processing with Schisandra-containing adaptogen formula (ADAPT-232) [2]. Liver enzyme modulation: pharmacokinetic studies confirm schisandrins modulate CYP3A4 and other phase I enzymes [1]. MODERATE
Insufficient
Anti-aging: preclinical telomere/sirtuin data; no human trials [1]. Respiratory function: traditional TCM use for asthma/cough; insufficient modern evidence [1]. Cancer adjunct: preclinical data on schisandrin B sensitizing cancer cells; no clinical trials [1]. Anxiety/insomnia: TCM indication; no RCTs of Schisandra alone (only in combinations) [1]. LOW
5 Safety, toxicity & adverse events
Absolute contraindications
✕ Pregnancy — may stimulate the uterus
Relative
⚠ May induce CYP3A4/CYP2C9 — can alter levels of many drugs (e.g., tacrolimus, warfarin)
⚠ Epilepsy, peptic ulcer or high intracranial pressure — traditional cautions
⚠ Discontinue before surgery
🚩 Red flags
● Transplant patient on tacrolimus/cyclosporine using Schisandra — documented CYP3A4 interaction [1]
● Patient on multiple medications adding Schisandra without drug interaction review [1]
● Patient using S. sphenanthera from Southern China assuming equivalence with S. chinensis [1]
6 Interactions
Drug interactions
Tacrolimus / Cyclosporine Major
Mechanism: Schisandrins potently inhibit CYP3A4 and P-glycoprotein [1].
Effect: Significantly increased tacrolimus blood levels — documented in case series [1].
Action: AVOID combination. If unavoidable, frequent drug level monitoring [1].
Statins (atorvastatin, simvastatin) Moderate
Mechanism: CYP3A4 inhibition increases statin exposure [1].
Effect: Increased risk of myopathy/rhabdomyolysis [1].
Action: Monitor for muscle symptoms. Consider statin not metabolized by CYP3A4 (pravastatin, rosuvastatin) [1].
Supplement synergies
Rhodiola Rosea · 250 mg each, standardized
Classic adaptogen combination (ADAPT-232 formula). Complementary mechanisms: Schisandra (hepatoprotective/cognitive) + Rhodiola (anti-fatigue/mood) [2].
Classic adaptogen combination (ADAPT-232 formula). Complementary mechanisms: Schisandra (hepatoprotective/cognitive) + Rhodiola (anti-fatigue/mood) [2].
Milk Thistle (Silymarin) · 250 mg Schisandra + 140 mg silymarin
Dual hepatoprotective approach: Schisandra (CYP modulation) + silymarin (antioxidant/membrane stabilization) [1].
Dual hepatoprotective approach: Schisandra (CYP modulation) + silymarin (antioxidant/membrane stabilization) [1].
7 Regulatory
China (Chinese Pharmacopoeia): Official TCM medicine. S. chinensis and S. sphenanthera listed as separate entries [1].
Russia: Listed in the Russian Pharmacopoeia as an adaptogen. Extensive Soviet-era research [1].
European Union (EMA): Traditional herbal medicinal product for mental and physical fatigue [1].
United States (FDA): Available as dietary supplement. No FDA-approved health claims [1].
8 US supplement products
197
on-market products containing Schisandra (NIH DSLD)
Brands carrying Schisandra (98)
Click a brand to see its Schisandra products.
9 Frequently paired with
10 Cite this page
Vancouver: Pkhakadze G. Schisandra — safety profile [Internet]. Tbilisi: PHIG; 2026 [cited 2026 Aug 15]. Available from: https://supplement.ge/ingredients/schisandra/
APA 7th: Pkhakadze, G. (2026). Schisandra — Safety profile. Public Health Institute of Georgia. https://supplement.ge/ingredients/schisandra/
📋 Editorial information
Author: Prof. G. Pkhakadze, MD, MPH, PhD
Institution: Public Health Institute of Georgia (PHIG)
Affiliation: David Tvildiani Medical University (DTMU)
First published: January 2026
Last reviewed: 2026-05-29
Next review: February 2027
References: 4 cited sources
COI: SupplementIndex receives no funding from supplement manufacturers. All content independently authored by PHIG.
Process: Systematic literature review
📄 License & reuse
Published under Creative Commons Attribution 4.0 International (CC BY 4.0). You may share and adapt for any purpose with attribution.
Pkhakadze G. "Schisandra — Safety Profile." SupplementIndex, PHIG, 2026. https://supplement.ge/ingredients/schisandra/ CC BY 4.0.
GP
Prof. G. Pkhakadze, MD, MPH, PhD
Professor of Public Health · Head of Department, DTMU
Editor-in-Chief, Georgian Medical Journal (ISSN 3088-4322)
Chair, Public Health Institute of Georgia · UEMS Public Health Section
Educational and public health purposes. CC BY 4.0. Consult your healthcare provider before starting any supplement. Corrections: info@accreditation.ge. Publisher: PHIG