Stephania tetrandra · PhytoNexus

01 Identity and provenance

Accepted binomial: Stephania tetrandra
Common names: Han Fang Ji
Family (APG IV): Menispermaceae
Part used: Root
Verification tier: Tier 2 · Verified Clinical columns reviewed and a source is on record.
Reviewer note (2026 audit): Debelle FD et al. Kidney Int 2008;74:158-69 | Vanherweghem JL et al. (index Belgian cases) | PMC5343833 | VERIFIED 2026 (batch 2) - synthetic analogue, application, interactions, side effects and references populated from retrieved primary/regulatory sources. Interactions labelled CLINICAL vs THEORETICAL. Marketed-formulation column intentionally blank. | IDENTITY

02 Constituent chemistry

Chemical class	Marker compound	Synthetic analogue in use
Bisbenzylisoquinoline alkaloids	Tetrandrine Root	Tetrandrine is investigated as a calcium-channel blocker; no marketed synthetic equivalent.

The analogue column is what makes the interaction reasoning tractable: where a constituent has a marketed structural counterpart, the counterpart's interaction profile is the starting hypothesis for the plant.

Looking up structures and physicochemical properties from PubChem…

03 Stated application

Reported activity: Traditional use for oedema, pain and rheumatic complaint (Han Fang Ji). Tetrandrine has reported anti-inflammatory and antihypertensive activity.
Reported adverse effects: S. tetrandra ITSELF is not the nephrotoxin. The hazard is misidentification: S. tetrandra (Han Fang Ji) is routinely confused with and substituted by ARISTOLOCHIA FANGCHI (Guang Fang Ji) because both trade under the common name "fang ji". Aristolochic acid causes rapidly progressive interstitial renal fibrosis (aristolochic acid nephropathy, formerly "Chinese herb nephropathy") and upper-tract urothelial carcinoma. The Belgian slimming-regimen incident produced 128 AAN cases; batches sold as S. tetrandra contained aristolochic acids and no tetrandrine. ALWAYS require identity testing (tetrandrine present, aristolochic acid absent) before sourcing.

04 Interaction matrix

Source column, verbatim: THEORETICAL pharmacological interactions. THE CRITICAL RISK IS NOT INTERACTION BUT SUBSTITUTION - see side effects.
Normalised onto 0 canonical drug classes below.

Predicted from constituent chemistry

These edges are not clinical findings. Each one is a rule inference: a constituent class in this plant is known to act on a target that the drug class also acts on. They are shown because a blank cell reads as “safe”, and for a Tier 1 entry a blank cell only means “not yet looked at”. Treat them as a literature-search agenda, not as a warning.

Drug class	Severity	Mechanism type	Provenance	Expected effect
Immunosuppressants (ciclosporin, tacrolimus, mycophenolate) Transplant	4Contraindicated	PK-CYP3A4/P-gp + PD-antagonistic	predicted D	Acute graft rejection with inducers; nephrotoxicity, neurotoxicity and hy…	why ▾
Chemistry of this pair. Berberine inhibits CYP3A4 and P-glycoprotein, lowers glucose through AMPK activation, and displaces bilirubin from albumin. Class mechanism. These are narrow-therapeutic-index CYP3A4 and P-glycoprotein substrates. Botanical induction collapses trough levels; inhibition causes toxic accumulation. Immunostimulant botanicals separately oppose the therapeutic goal. Expected Acute graft rejection with inducers; nephrotoxicity, neurotoxicity and hypertension with inhibitors; autoimmune flare with immunostimulants. Management Treat as contraindicated in transplant recipients. Any exposure requires immediate trough level measurement and transplant team notification. Onset unspecified Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism
Narrow-therapeutic-index CYP3A4 substrates Pharmacokinetic	4Contraindicated	PK-CYP3A4	predicted D	Toxic accumulation or subtherapeutic failure of the co-prescribed drug, s…	why ▾
Chemistry of this pair. Berberine inhibits CYP3A4 and P-glycoprotein, lowers glucose through AMPK activation, and displaces bilirubin from albumin. Class mechanism. Furanocoumarins, bergamottin, piperine, glabridin and berberine inhibit CYP3A4; hyperforin, andrographolide and several diterpenes induce it through PXR. Because CYP3A4 handles roughly half of marketed drugs, the affected list is broad and the direction is product-specific. Expected Toxic accumulation or subtherapeutic failure of the co-prescribed drug, sometimes fatal for antiarrhythmics, immunosuppressants and oncology agents. Management Screen the full regimen for 3A4 substrates. Where the substrate has a narrow index, avoid rather than monitor. Onset unspecified Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism
Antidiabetic drugs (insulin, sulfonylureas, biguanides, GLP-1, SGLT2) Endocrine	3Major	PD-additive	predicted D	Symptomatic hypoglycaemia, sweating, tremor, confusion; severe events rep…	why ▾
Chemistry of this pair. Berberine inhibits CYP3A4 and P-glycoprotein, lowers glucose through AMPK activation, and displaces bilirubin from albumin. Class mechanism. Hypoglycaemic botanicals act through insulin secretagogue, insulin-sensitising, alpha-glucosidase-inhibiting or glucose-transport routes. Added to a titrated pharmacological regimen the effects summate rather than plateau. Expected Symptomatic hypoglycaemia, sweating, tremor, confusion; severe events reported with insulin and sulfonylureas. Management Increase self-monitoring frequency for 2 weeks after starting or stopping. Anticipate a downward dose adjustment of insulin or sulfonylurea. Onset rapid Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism
Antacids, PPIs and H2 blockers Gastrointestinal	2Moderate	PK-absorption	predicted D	Reduced or erratic absorption of alkaloids; heartburn and reflux from pre…	why ▾
Chemistry of this pair. Alkaloidal bases have pH-dependent absorption and commonly interact with hepatic CYP isoenzymes and efflux transporters. Class mechanism. Gastric pH elevation alters the dissolution and ionisation of alkaloidal and enteric-coated botanical products; menthol- and peppermint-oil products lose their enteric protection at high pH and can be released prematurely. Expected Reduced or erratic absorption of alkaloids; heartburn and reflux from premature release of volatile-oil preparations. Management Separate administration by 2 hours. Avoid non-enteric peppermint oil in reflux disease. Onset unspecified Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism

05 Hazard register

substitution - misidentified as/adulterated with Aristolochia fa

06 Confusable material

No same-genus or shared-common-name entry in the corpus.

07 Mechanism map

Chemistry sorts to the left, pharmacology to the right. Dashed edges are predicted. Drag nodes, scroll to zoom, export at 3× for a figure.

species

chemical class

marker compound

drug class

expected effect

hazard

08 Open literature

Abstract-scoped query built from this binomial, its common names and its marker compounds, run live against Europe PMC, PubMed and OpenAlex, then ranked locally against an evidence hierarchy.

Checking openFDA spontaneous reports…

09 Isomechanistic neighbours

Species whose interaction profile overlaps this one, ranked by shared severity weight rather than by count — a shared contraindication counts for more than a shared minor signal. Practical use: these are the plants you should not stack with this one, because the mechanisms summate.

Species	Family	Shared classes	Jaccard
Carapichea ipecacuanha Ipecac	Rubiaceae	4	0.67
Tinospora cordifolia Giloy	Menispermaceae	4	1.00
Chelidonium majus Greater Celandine	Papaveraceae	4	0.80
Berberis vulgaris Barberry	Berberidaceae	4	1.00
Coptis chinensis Chinese Goldthread	Ranunculaceae	4	1.00
Corydalis yanhusuo Yan Hu Suo	Papaveraceae	4	1.00

10 References and notes

Source column: Nortier JL et al. N Engl J Med 2000;342:1686-92

Nortier JL et al. N Engl J Med 2000

Nortier JL et al. N Engl J Med 2000 manual

342:1686-92

manual

BibTeX for all 2 records

@article{NortierJLe2000,
  title = {Nortier JL et al. N Engl J Med 2000},
  author = {Nortier JL et al.},
  journal = {N Engl J Med},
  year = {2000},
}

@article{anon,
  title = {342:1686-92},
}

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