Rhodiola may improve physical and mental performance by reducing fatigue caused by stress, but it may also interact with some prescription medications.
Rhodiola is used in traditional medicine in Eastern Europe and Asia as a stimulant, to improve performance, and to reduce fatigue and depression. Some pilot studies in humans do support these claims, but more studies are needed. Although drug interactions are not well documented, rhodiola may interact through some pathways the body uses to metabolize prescription medications. Therefore, patients should ask their doctor before taking rhodiola supplements.
Human studies showed that rhodiola may improve anxiety or mild to moderate depression. Further research is needed.
Several studies found that rhodiola can reduce fatigue under stressful conditions.
Rhodiola improved exercise capacity and mental performance in human studies.
Do Not Take If
You are taking drugs that are substrates of Cytochrome P450 3A4: Lab studies suggest rhodiola may increase the risk of side effects of these drugs.
You are taking drugs that are substrates of Cytochrome P450 2C9: Rhodiola may increase the risk of side effects of these drugs including phenytoin and warfarin.
You are taking drugs that are substrates of P-glycoprotein: Lab studies suggest rhodiola may increase the risk of side effects of these drugs.
You are taking antidepressants: Rhodiola may increase the risk of side effects of these drugs.
You are taking drugsfor high blood pressure: Rhodiola may increase the risk of side effects of these drugs.
You are taking drugs that stimulate the central nervous system: Rhodiola may increase the risk of side effects of these drugs.
A case of fast and irregular heart beat has been reported with simultaneous use of rhodiola and an antidepressant.
Rhodiola is a plant used in traditional medicine in Eastern Europe and Asia to enhance physical and mental performance, stimulate the nervous system, and fight depression. Rhodiola rosea extract and its key constituent salidroside have been researched, although studies in humans are limited.
In vitro studies indicate that salidroside from rhodiola may have neuroprotective (8)(9) and anticancer effects (10). Animal studies suggest benefits with rhodiola on cognitive function, but most were determined to have a high risk of bias (24).
In humans, rhodiola supplementation improved physical endurance (1) and mental performance (2)(3), reduced stress-induced fatigue (4)(5), and improved stress symptoms (19)(20). Preliminary data suggest it may improve symptoms of generalized anxiety disorder (GAD) (6) and mild to moderate depression (7). It was also better tolerated and had fewer side effects than sertraline, although it was also less effective (22).
A small study showed that salidroside may have cardioprotective effects in patients with breast cancer receiving epirubicin (11), but more data are needed to confirm this effect.
Enhanced mental and physical performance
Mechanism of Action
In animal models, rhodiola exhibits dose- and time-dependent Th1 and Th2 cytokine modulation effects (16). Salidroside in rhodiola confers neuroprotective effects via nitric oxide (NO) pathway inhibition in vitro (9) and induction of antioxidant enzymes thioredoxin, heme oxygenase-1, and peroxiredoxin-I; downregulation of proapoptotic Bax protein; and upregulation of antiapoptotic Bcl-XL proteins (8). Rhodiola constituents may have synergistic antioxidant activity (17). In vitro, rhodiola inhibits monoamine oxidases (MAOs) A and B, suggesting that it has antidepressant effects (13).
In human breast cancer cells, salidroside induces cell-cycle arrest and apoptosis via mechanisms as yet unidentified, but independent of the estrogen receptor (10).
Patients taking prescription antidepressant medications should use rhodiola with caution as concurrent use was reported to cause tachyarrhythmia (18).
A 26-year-old Chinese female presented to the emergency department with significant tachyarrhythmia following ingestion of rhodiola along with her antidepressant for 3 days (18).
Cytochrome P450 3A4 substrates: In preclinical studies, rhodiola inhibits CYP3A4 and can affect the intracellular concentration of drugs metabolized by this enzyme (12)(21). Clinical relevance is yet to be determined.
Cytochrome P450 2C9 substrates: Rhodiola modestly inhibits CYP2C9, and may affect drugs metabolized by this enzyme, particularly those with a narrow therapeutic index such as phenytoin and warfarin (23).
P-glycoprotein substrates: In preclinical studies, rhodiola was shown to inhibit P-gp activity and can interfere with the metabolism of certain drugs (12)(21). Clinical relevance is yet to be determined.
Antidepressants: Rhodiola has MAO inhibition activity and may increase the serotonergic side effects (13).
Antihypertensives: Rhodiola has MAO inhibition activity and may increase the hypotensive side effects (13).
CNS Stimulants: Rhodiola has MAO inhibition activity and may enhance the hypertensive effect (13).