The short answer
Not known in people. We found no study of neem taken with any blood pressure medicine. In rats with high blood pressure, a polyphenol-rich fraction of neem extract lowered blood pressure. In lab tests, a neem extract blocked CYP3A4, a liver enzyme that helps clear amlodipine.
Memorial Sloan Kettering's herb database says the clinical importance of that lab finding is not known. The amlodipine label says to watch for low blood pressure and swelling when it is taken with anything that blocks CYP3A. If you take a blood pressure medicine and use neem capsules, extract or juice, tell your prescribing doctor and ask whether your blood pressure should be checked.
Common blood pressure medicines in India include Telma (telmisartan), Amlong (amlodipine) and Cardace (ramipril).
At a glance
| What was seen | How it may work | Direction | Evidence |
|---|---|---|---|
| Neem fraction lowered blood pressure in hypertensive rats[1] | Not established; less oxidative stress was also seen | Could add to blood pressure medicines | Animal |
| Neem extract blocked CYP3A4/5, CYP2C8 and CYP2C9 in lab tests[2][3] | Enzyme inhibition | Possibly more amlodipine in the blood; low blood pressure, swelling | In vitro |
No listing is not a clearance. A missing interaction here never means a combination is safe.
The evidence, study by study
Rat study, 2019 Animal
Fifty rats made hypertensive with a chemical (L-NAME) were split into five groups and given a polyphenol-rich fraction of neem extract, captopril (an ACE inhibitor) or no treatment for 21 days. The neem fraction lowered blood pressure and improved markers of oxidative stress. Captopril was given to a separate group, not combined with neem, and a correction to the paper has since been published.[1]
Laboratory finding, reported by Memorial Sloan Kettering In vitro
A neem extract blocked the liver enzymes CYP3A4/5, CYP2C8 and CYP2C9 in the lab. Memorial Sloan Kettering notes that the clinical relevance is not known. Lab findings like this show a possible route for an interaction. They do not show that one happens in people.[2]
What your doctor may watch for
- Blood pressure, dizziness and swelling of the ankles or feet (oedema), which the amlodipine label asks doctors to watch when it is combined with CYP3A blockers.[3]
What to tell your prescribing doctor
You can read this out, or show them this page:
“I am taking, or planning to take, neem (leaf powder, capsules, extract or juice, and how much) along with my blood pressure medicine. Neem lowered blood pressure in rats and blocked an enzyme that clears amlodipine in lab tests. Should my blood pressure be checked more often?”
Withheld until review
Questions people ask
Is neem juice or neem oil the same as a neem extract?
No. Leaves, twigs, bark, extracts and oil are different products, and results for one do not carry over to another. Tell your doctor exactly which form you use.[2]
Related
Neem and diabetes medicines (metformin, insulin)
In a 12-week trial, a neem leaf and twig extract lowered blood sugar further in people already on metformin. Insulin was not studied.
InteractionGokshura (gokhru) and blood pressure medicines
Gokshura lowered blood pressure on its own in one trial, so it could add to BP medicines. We found no study of the two taken together.
InteractionNeem and transplant medicines (immunosuppressants)
In lab tests, neem blocked the liver enzymes that clear tacrolimus, which could raise its levels. We found no study of neem with transplant medicines.
InteractionArjuna and blood pressure medicines
Arjuna capsules lowered blood pressure further in people taking telmisartan, in one small 28-day trial. Other BP drugs are untested.
Sources
- Omobowale TO, Oyagbemi AA, Ogunpolu BS, Ola-Davies OE, Olukunle JO, Asenuga ER, Ajibade TO, Adejumobi OA, Afolabi JM, Falayi OO, Ashafa A, Adedapo AA, Yakubu MA. Antihypertensive effect of polyphenol-rich fraction of Azadirachta indica on N(omega)-nitro-L-arginine methyl ester-induced hypertension and cardiorenal dysfunction. Drug Res (Stuttg). 2019;69:12-22. PMID 29920624.
- Memorial Sloan Kettering Cancer Center. About Herbs: Neem. Herb-drug interactions and warnings.
- Amlodipine besylate tablets, US prescribing information (DailyMed).
Awaiting review by The Good Vaidya Medical Board. Prepared from the sources below and checked against each one.
Published 4 November 2026 · Last updated 4 November 2026
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