The short answer
A specific interaction between Rhodiola rosea and asenapine is not established. Review a mood or energy supplement with your prescriber, particularly if sleep or behavior is changing.
What this answer covers
Oral Rhodiola rosea; extract-specific probe trial and excessive-use case are different exposures.
- Supplement or preparation
- Rhodiola rosea
- Medication ingredient
- asenapine
The case concerns the supplement, not this combination
A patient taking excessive rhodiola and other supplements developed severe agitation and mania-like symptoms. The requested medicine was not part of the preceding regimen.
Human metabolism results limit laboratory extrapolation
A small trial of one commercial rhodiola product found a modest CYP2C9 effect but no significant CYP1A2, CYP2C19, CYP2D6 or CYP3A4 effect. It did not test asenapine.
Neither result defines your product’s effect
The case cannot establish a risk at all doses, and the small probe study cannot prove every extract is safe. Bring the actual product and amount for review.
Respond to changes in sleep and behavior
Contact the treating clinician promptly if a new supplement is followed by markedly reduced sleep, unusual energy, severe agitation or confusion. Do not change asenapine on your own.
Evidence and practical considerations
Side effects & toxicity
Exact-pair side-effect claim remains insufficient; standalone psychiatric signal warrants individualized review.
- Exact scope
- Oral Rhodiola rosea; extract-specific probe trial and excessive-use case are different exposures. with Exact asenapine maleate sublingual tablets or asenapine transdermal system, distinguished by route. Exact RxNorm IN784649; SAPHRIS maleate sublingual tablet and SECUADO asenapine transdermal system distinguished. Do not assign swallowed-tablet or sublingual food/drink instructions to the patch.
- Medication form and route
- sublingual; transdermal
- Timing or duration
- Source-specific single-dose, repeated-dose and observational exposures distinguished.
What remains uncertain
- No exact combination study. A mania case and enzyme-probe findings cannot establish this medicine’s concentrations or event rate.
Factors that may matter: preparation and plant part; clinical indication; dose; other medicines; baseline alertness.
Read the supporting source summaries
Source 1: current product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People prescribed asenapine.
Somnolence, orthostatic and QT precautions. UGT1A4 and CYP1A2 major metabolism; no dose adjustment advised with CYP3A4 inducers based on PK studies. Do not eat or drink for ten minutes after a sublingual dose.
How this applies: Exact asenapine maleate sublingual route; patch instructions require the separate SECUADO label.
No supplement-specific event rate, universal timing rule or untested route/preparation equivalence.
Source 2: original human case report
psychiatrist.com · Source check Sep 10, 2026
Population: One adult without past psychiatric treatment.
Mania-like presentation with severe agitation, rhabdomyolysis and dehydration; symptoms remitted after acute supportive care.
How this applies: Supplement-only psychiatric signal, no exact-pair event or serotonin-syndrome diagnosis.
No cariprazine, iloperidone, ziprasidone, aripiprazole lauroxil or asenapine coexposure. Acute haloperidol was rescue treatment, not a pre-existing interaction.
Source 3: original human study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Thirteen healthy volunteers in randomized crossover study.
CYP2C9 metabolic ratio declined modestly; CYP1A2, CYP2C19, CYP2D6 and CYP3A4 measures did not change significantly.
How this applies: Only the named drug, preparation, route and measured endpoints apply.
Surrogate enzyme measures, one preparation and no requested antipsychotic co-use.
Source 4: official product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Adults with schizophrenia prescribed asenapine patches.
Somnolence, cognitive/motor, orthostatic and QT precautions; clinical interaction data include studies of sublingual asenapine.
How this applies: Exact ingredient in a distinct transdermal formulation; route bridge kept explicit.
No exact supplement interaction study; sublingual food/drink interval cannot be assigned to the patch.
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 | |
| Current exact available claims adjudicated using original captures and explicit identity and comparator limits. |
Article revision: e8d680d67245f06f
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.