The short answer
Goldenseal can affect a drug-metabolizing enzyme, but increased adagrasib levels or toxicity have not been demonstrated. Ask the oncology pharmacist to review it, particularly at treatment initiation.
What this answer covers
Oral Hydrastis canadensis root products with oral adagrasib. Authenticated root extract in the clinical probe study is not equivalent to isolated berberine or every goldenseal product.
- Supplement or preparation
- Hydrastis canadensis
- Medication ingredient
- adagrasib
What was actually measured
A study in 16 healthy adults used one authenticated goldenseal root extract and found a modest increase in midazolam exposure, a marker of CYP3A inhibition. Other medicines in the study changed differently or did not change. No participant received adagrasib, so these results do not establish its drug level or toxicity with goldenseal.
The early treatment phase matters
The U.S. Krazati label advises avoiding strong CYP3A inhibitors until drug concentrations reach steady state, about eight days. Adagrasib progressively inhibits its own metabolism. Clinical studies and modeling therefore distinguish an early inhibitor interaction from the predicted smaller effect at steady state. Goldenseal was not tested in that model study.
Goldenseal is not automatically a strong inhibitor
The measured change with the tested extract does not justify assigning every goldenseal product the same effect as a strong prescription inhibitor. Nor does the eight-day label distinction guarantee that the supplement is safe later. Review the exact root extract, amount and other ingredients with the oncology pharmacist before use.
Do not make a dose or timing change yourself
There is no established goldenseal-specific adagrasib dose adjustment or hours-apart solution. Tell the care team if you already use it, especially when treatment is starting or changing. Krazati can also raise levels of other medicines, so the pharmacist needs the whole medication list rather than only these two products.
Evidence and practical considerations
Side effects & toxicity
Goldenseal has not been shown to raise adagrasib levels or toxicity in an exact co-use study.
- Exact scope
- Oral Hydrastis canadensis root products with oral adagrasib. Authenticated root extract in the clinical probe study is not equivalent to isolated berberine or every goldenseal product. with Exact adagrasib RxCUI 2625882 IN, confirmed by current RxNorm properties. Oral Krazati tablets; the August 2026 U.S. label covers single-agent treatment of specified previously treated KRAS G12C-mutated NSCLC. Older cetuximab combination cohorts and regional label instructions are not interchangeable.
- Medication form and route
- Oral
What remains uncertain
- One extract increased midazolam exposure 1.43-fold. This does not establish strong inhibition or an adagrasib effect; single-dose and steady-state liabilities differ.
Factors that may matter: Exact preparation and dose; Treatment phase and duration; Liver function; Electrolyte results and GI symptoms; Other medicines.
Read the supporting source summaries
Source 1: Current U.S. prescribing information
bms.com · Source check Sep 10, 2026
Population: Adults with specified previously treated KRAS G12C-mutated locally advanced or metastatic non-small cell lung cancer.
Warns about GI toxicity, QT prolongation and hepatotoxicity. Monitor/correct electrolytes, particularly potassium and magnesium, and monitor liver tests. Strong CYP3A inducers lower exposure. Avoid strong CYP3A inhibitors until steady state, approximately eight days. High-fat meal did not meaningfully change exposure; tablets may be taken with or without food.
How this applies: Exact current U.S. guidance; newer than the retained March 2026 DailyMed version. Exact adagrasib RxCUI 2625882 IN, confirmed by current RxNorm properties. Oral Krazati tablets; the August 2026 U.S. label covers single-agent treatment of specified previously treated KRAS G12C-mutated NSCLC. Older cetuximab combination cohorts and regional label instructions are not interchangeable.
Not direct evidence of each botanical combination. Strong-inhibitor effects after a single dose differ from steady-state model predictions. Effects of adagrasib on other CYP substrates are a separate direction. No universal supplement prescription.
Source 2: Original clinical research
pmc.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: 16 healthy adults in an open-label crossover probe-drug study.
Midazolam total exposure rose 1.43-fold. Other tested substrates behaved differently: rosuvastatin and furosemide did not change materially, and metformin exposure fell.
How this applies: Human enzyme-probe evidence, explicitly indirect for the exact cancer drug.
No adagrasib or oncology patients; short duration and one product. The observed midazolam change does not establish strong CYP3A inhibition by every goldenseal product or predict an adagrasib toxicity rate. Laboratory transporter predictions did not consistently match human results.
Source 3: Original clinical and pharmacokinetic modeling research
ebi.ac.uk · Source check Sep 10, 2026
Population: Healthy-volunteer clinical interaction studies and pharmacokinetic data from patients with KRAS G12C tumors, used to develop and verify a model.
Itraconazole increased single-dose exposure approximately fourfold; rifampin reduced it about 95%. Adagrasib inhibits its own CYP3A metabolism. At steady state, inhibitor effects were predicted to be small, whereas strong induction still reduced exposure.
How this applies: Exact medication evidence establishes time and direction boundaries for CYP3A extrapolation.
Steady-state untested scenarios are model predictions, not observed herb interactions. No goldenseal or Hypericum trial, no measured cancer outcome from those supplements. Single-dose and repeated-dose values cannot be pooled.
Source 4: Authoritative medication terminology
rxnav.nlm.nih.gov · Source check Sep 10, 2026
Population: Medication terminology.
Identifies adagrasib as IN.
How this applies: Exact identity confirmation.
Not clinical interaction evidence.
Research assessment: · Open full citations ↗
Side effects & toxicity
Human CYP3A probe findings justify reviewing goldenseal with the oncology pharmacist, particularly when starting adagrasib.
- Exact scope
- Oral Hydrastis canadensis root products with oral adagrasib. Authenticated root extract in the clinical probe study is not equivalent to isolated berberine or every goldenseal product. with Exact adagrasib RxCUI 2625882 IN, confirmed by current RxNorm properties. Oral Krazati tablets; the August 2026 U.S. label covers single-agent treatment of specified previously treated KRAS G12C-mutated NSCLC. Older cetuximab combination cohorts and regional label instructions are not interchangeable.
- Medication form and route
- Oral
What remains uncertain
- Precaution based on indirect human evidence and exact drug pharmacology. Model-predicted small inhibitor effects at steady state do not prove every herbal product safe after eight days.
Factors that may matter: Exact preparation and dose; Treatment phase and duration; Liver function; Electrolyte results and GI symptoms; Other medicines.
Read the supporting source summaries
Source 1: Current U.S. prescribing information
bms.com · Source check Sep 10, 2026
Population: Adults with specified previously treated KRAS G12C-mutated locally advanced or metastatic non-small cell lung cancer.
Warns about GI toxicity, QT prolongation and hepatotoxicity. Monitor/correct electrolytes, particularly potassium and magnesium, and monitor liver tests. Strong CYP3A inducers lower exposure. Avoid strong CYP3A inhibitors until steady state, approximately eight days. High-fat meal did not meaningfully change exposure; tablets may be taken with or without food.
How this applies: Exact current U.S. guidance; newer than the retained March 2026 DailyMed version. Exact adagrasib RxCUI 2625882 IN, confirmed by current RxNorm properties. Oral Krazati tablets; the August 2026 U.S. label covers single-agent treatment of specified previously treated KRAS G12C-mutated NSCLC. Older cetuximab combination cohorts and regional label instructions are not interchangeable.
Not direct evidence of each botanical combination. Strong-inhibitor effects after a single dose differ from steady-state model predictions. Effects of adagrasib on other CYP substrates are a separate direction. No universal supplement prescription.
Source 2: Original clinical research
pmc.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: 16 healthy adults in an open-label crossover probe-drug study.
Midazolam total exposure rose 1.43-fold. Other tested substrates behaved differently: rosuvastatin and furosemide did not change materially, and metformin exposure fell.
How this applies: Human enzyme-probe evidence, explicitly indirect for the exact cancer drug.
No adagrasib or oncology patients; short duration and one product. The observed midazolam change does not establish strong CYP3A inhibition by every goldenseal product or predict an adagrasib toxicity rate. Laboratory transporter predictions did not consistently match human results.
Source 3: Original clinical and pharmacokinetic modeling research
ebi.ac.uk · Source check Sep 10, 2026
Population: Healthy-volunteer clinical interaction studies and pharmacokinetic data from patients with KRAS G12C tumors, used to develop and verify a model.
Itraconazole increased single-dose exposure approximately fourfold; rifampin reduced it about 95%. Adagrasib inhibits its own CYP3A metabolism. At steady state, inhibitor effects were predicted to be small, whereas strong induction still reduced exposure.
How this applies: Exact medication evidence establishes time and direction boundaries for CYP3A extrapolation.
Steady-state untested scenarios are model predictions, not observed herb interactions. No goldenseal or Hypericum trial, no measured cancer outcome from those supplements. Single-dose and repeated-dose values cannot be pooled.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Sources checked and article drafted. | |
| Research summary published |
Article revision: 30e1aaa46a9b31b6
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.