What is happening. Quercetin inhibits CYP3A4 and P-glycoprotein in laboratory and some clinical studies. Because felodipine is a sensitive CYP3A4 substrate with low and variable oral bioavailability, high-dose quercetin supplements could raise felodipine concentrations and increase the risk of hypotension, flushing, headache, and peripheral edema.
Mechanism. Quercetin inhibits intestinal and hepatic CYP3A4 and P-glycoprotein, which can reduce first-pass metabolism and efflux of felodipine and increase its systemic exposure, similar in direction to the grapefruit-felodipine interaction.
Recommendation. Avoid high-dose quercetin supplements with felodipine unless cleared by the prescriber. If used, monitor for excessive blood-pressure lowering and dihydropyridine side effects, and keep the dose modest.