The short answer
Borage products need their plant part and pyrrolizidine-alkaloid content checked during nevirapine treatment. A direct increase in nevirapine-related liver injury has not been established, and leaf material should not be treated as equivalent to verified PA-free seed oil.
What this answer covers
Borago officinalis leaves/herb/tea versus seed oil; pyrrolizidine-alkaloid content and quality control require verification.
- Supplement or preparation
- Borago officinalis
- Medication ingredient
- nevirapine
Nevirapine has an independent liver warning
Nevirapine can cause severe or life-threatening hepatic reactions and requires its prescribed monitoring. This established risk does not prove that a particular borage product increases it.
The original borage study was analytical
Investigators identified pyrrolizidine alkaloids and their N-oxides in borage leaves. The study raises a product-composition concern but did not measure human liver injury or a nevirapine interaction.
Leaves and seed oil are different materials
The leaf findings cannot establish the content of a verified PA-free seed oil. Conversely, an oil or safety claim on a package should not substitute for actual identification and quality information.
Bring the exact product to the clinician
Have the HIV team review the plant part, extraction and quality documentation before use. Report liver symptoms or rash promptly according to the nevirapine plan. No safe combined dose or protective spacing interval was established.
Evidence and practical considerations
Side effects & toxicity
No exact borage-nevirapine liver-injury evidence. Analytical PA findings in leaves cannot establish additive clinical harm or PA content of seed oil; nevirapine intrinsic hepatotoxicity is not proof of interaction.
- Exact scope
- Borago officinalis leaves/herb/tea versus seed oil; pyrrolizidine-alkaloid content and quality control require verification. with Nevirapine immediate-release oral tablets; extended-release formulation considered separately.
- Medication form and route
- oral medication; oral supplement
What remains uncertain
- No unmeasured pair incidence, blanket class transfer or arbitrary spacing interval.
Factors that may matter: Preparation; Dose; Other medicines; Organ function.
Read the supporting source summaries
Source 1: current product label
dailymed.nlm.nih.gov · Source check Sep 11, 2026
Population: People prescribed nevirapine
Serious hepatic and skin reactions; metabolism through CYP3A and CYP2B6 with autoinduction. St John’s wort co-use not recommended because of reduced exposure/virologic risk.
How this applies: Exact nevirapine RxCUI 53654 IN, with stated salt/formulation/route bridge.
Exact route and formulation apply. Label precautions do not quantify untested botanical pairs or support arbitrary supplement doses.
Source 2: current product label
dailymed.nlm.nih.gov · Source check Sep 11, 2026
Population: People prescribed nevirapine
Shares CYP3A/CYP2B6 metabolism, autoinduction and serious liver/skin precautions. Different release/dosing formulation.
How this applies: Exact nevirapine RxCUI 53654 IN, with stated salt/formulation/route bridge.
Immediate-release and extended-release schedules are not interchangeable without the prescribed transition plan.
Source 3: Original analytical botanical study
pubmed.ncbi.nlm.nih.gov · Source check Sep 11, 2026
Population: Borage leaf samples.
Detected multiple PA/PANO constituents, including quantitatively relevant acetylated forms.
How this applies: Analytical leaf study, not human hepatotoxicity, nevirapine co-use or certified PA-free seed oil.
Analytical leaf study, not human hepatotoxicity, nevirapine co-use or certified PA-free seed oil.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Research summary published | |
| Article prepared | |
| Prepared exact nevirapine article with formulation-specific evidence and uncertainty. |
Article revision: 6fe9cbc6f7264189
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.