NutriStack
Budesonide Inhaled and Schisandra, a caution.
Schisandra extract inhibits CYP3A in human pharmacokinetic studies. Budesonide is normally cleared extensively by CYP3A, so inhibition can raise systemic steroid exposure even when budesonide is inhaled, especially at higher doses or with prolonged use.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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At a glance
- Substances
- Budesonide Inhaled and Schisandra
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. Schisandra extract inhibits CYP3A in human pharmacokinetic studies. Budesonide is normally cleared extensively by CYP3A, so inhibition can raise systemic steroid exposure even when budesonide is inhaled, especially at higher doses or with prolonged use.
Mechanism. Schisandra can inhibit CYP3A-mediated metabolism, increasing exposure to CYP3A substrates. Budesonide undergoes extensive CYP3A metabolism, and CYP3A inhibition has been shown to increase inhaled budesonide concentrations and cortisol suppression.
Recommendation. Avoid adding high-dose Schisandra to inhaled budesonide without clinician review. Monitor for unusual steroid effects such as easy bruising, facial swelling, high glucose, or symptoms of adrenal suppression, but do not stop the inhaled steroid abruptly.
Sources (2)
- Xin HW, Wu XC, Li Q, Yu AR, Xiong L. Effects of Schisandra sphenanthera extract on the pharmacokinetics of midazolam in healthy volunteers. Br J Clin Pharmacol. 2009;67(5):541-546. PMID 19552749
- Raaska K, Niemi M, Neuvonen M, Neuvonen PJ, Kivisto KT. Plasma concentrations of inhaled budesonide and its effects on plasma cortisol are increased by the cytochrome P4503A4 inhibitor itraconazole. Clin Pharmacol Ther. 2002;72(4):362-369. PMID 12386638
Stack Score
How this pair moves the number.
Effect on the composite score
If both Budesonide Inhaled and Schisandra are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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