NutriStack
Fluticasone Inhaled and Schisandra, a caution.
Schisandra has human evidence of CYP3A inhibition, and fluticasone is highly dependent on CYP3A metabolism. Strong CYP3A inhibition has caused adrenal suppression and Cushing syndrome with inhaled fluticasone, so Schisandra could increase systemic steroid exposure in high-risk use.
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At a glance
- Substances
- Fluticasone 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 has human evidence of CYP3A inhibition, and fluticasone is highly dependent on CYP3A metabolism. Strong CYP3A inhibition has caused adrenal suppression and Cushing syndrome with inhaled fluticasone, so Schisandra could increase systemic steroid exposure in high-risk use.
Mechanism. Schisandra can inhibit CYP3A and increase exposure to CYP3A substrates. Fluticasone is extensively metabolized by CYP3A4, and reduced clearance can convert a locally acting inhaled steroid into clinically significant systemic glucocorticoid exposure.
Recommendation. Do not add concentrated Schisandra extract to chronic or high-dose inhaled fluticasone without clinician review. Monitor for easy bruising, facial rounding, weight gain, high glucose, or fatigue that could suggest adrenal suppression.
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
- Foisy MM, Yakiwchuk EM, Chiu I, Singh AE. Adrenal suppression and Cushing's syndrome secondary to an interaction between ritonavir and fluticasone: a review of the literature. HIV Med. 2008;9(6):389-396. PMID 18459946
Stack Score
How this pair moves the number.
Effect on the composite score
If both Fluticasone 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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