What is happening. Quercetin inhibits several CYP450 enzymes and the efflux transporter P-glycoprotein. Co-administration could alter the metabolism and plasma levels of pterostilbene, which undergoes phase II conjugation, potentially increasing its exposure.
Mechanism. Quercetin inhibits CYP3A4, sulfotransferases, UDP-glucuronosyltransferases, and P-glycoprotein, which can reduce first-pass conjugation of pterostilbene and increase its systemic exposure.
Recommendation. If taking both regularly, consider separating doses and start at modest amounts. Be aware that quercetin may raise pterostilbene levels and the levels of co-administered medications metabolized by the same enzymes.