Danshen (Salvia miltiorrhiza)
Also called dan shen, Salvia miltiorrhiza, red sage root, Chinese sage root, Salviae miltiorrhizae radix, tanshinones.
Best grade C across 6 graded outcomes Botanical Last checked
The short answer
From 16 sourcesDanshen is a Chinese red sage root. Most positive evidence comes from Chinese trials of multi-herb pills or hospital injections. In a Dutch placebo-controlled trial, an oral water extract did not lower blood pressure and slightly raised LDL. Two Korean trials with industry ties report better urinary symptoms in men. Danshen has caused serious bleeding when combined with warfarin.
Every graded outcome on this page
6 rows · line = participants- CGrade CAngina symptoms and ECG response when added to standard careAnginan 10,208
- CGrade CHeart function in heart failure when added to standard careHeart failuren 855
- CGrade C24-hour blood pressure in primary hypertensionBlood pressuren 320
- CGrade CLower urinary tract symptoms (IPSS) in menProstaten 136
- CGrade CLDL cholesterol, blood pressure and other cardiovascular risk markersCholesterol and BPn 20
- DGrade DUrinary symptoms vs saw palmettoProstaten 30
- 3 more graded outcomes, in the evidence chapter
Key facts
- Warfarin
- Published cases describe gross over-anticoagulation and bleeding when danshen was added to warfarin, and a review advises people on warfarin to avoid it; one manufacturer-run study of a danshen-sanqi pill found no INR change786
- Clopidogrel
- 7 days of Danshen capsules cut clopidogrel exposure by about half (AUC down 49.3%) and weakened its antiplatelet effect in 20 healthy men13
- Oral extract alone
- 4 weeks of danshen water extract did not lower blood pressure and raised LDL to 3.82 vs 3.52 mmol/l on placebo in 20 adults2
- Angina pills
- 93 Chinese-led RCTs (10,208 people) of compound danshen dripping pills added to standard care; certainty moderate to very low1
- Urinary symptoms
- 400-800 mg/day of a root extract (SAGX) improved prostate symptom scores vs placebo in 136 men over 12 weeks; the trial had industry-employed authors4
- Multi-herb products
- The dripping pill T89 combines danshen with sanqi (notoginseng), so its results cannot be credited to danshen alone6
What it is
Danshen is the root of Salvia miltiorrhiza (red sage), a Chinese medicine herb used for heart conditions and sold as extracts.
How it works
ProposedReviews describe danshen affecting blood clotting in several ways: blocking platelet aggregation, interfering with the extrinsic coagulation pathway, antithrombin III-like activity and promoting fibrinolysis. Its tanshinones inhibit and induce several liver CYP450 enzymes. These actions, mostly shown in lab and animal work, underpin both its traditional cardiovascular use and its warfarin interaction.712
Forms, side by side
3 forms named in our sources. The rest show what our data holds, and say plainly where it holds nothing yet.
Danshen (Salvia miltiorrhiza) forms compared
3 forms| 3 forms | Oral root extract (e.g., SAGX, water extracts) | Compound danshen dripping pill (danshen plus sanqi) | Intravenous danshen injection |
|---|---|---|---|
| Absorption in people | Not measured in the cited abstracts.42 | Not reported in the meta-analysis abstract.16 | Given directly into a vein in hospital.3 |
| GI tolerance | No serious adverse events led to discontinuation in the 12-week SAGX trial.42 | Adverse events not increased vs conventional therapy.16 | Mild gastrointestinal discomfort and dizziness.3 |
| Studied for | Urinary symptoms, cardiovascular risk markers | Stable angina (with standard care) | Hypertension (hospital use) |
- Oral root extract (e.g., SAGX, water extracts)
- Studied for
- Urinary symptoms, cardiovascular risk markers
- Compound danshen dripping pill (danshen plus sanqi)
- Studied for
- Stable angina (with standard care)
- Intravenous danshen injection
What the human research says
Human trials only, one row per outcome. The form line shows what each trial actually tested. Grades follow our evidence-grading policy.
Trial map
6 graded outcomes, largest study first6 graded outcomes: 5 improved, 1 worsened. The largest, a 2026 meta-analysis of 10,208 people on angina symptoms and ECG response when added to standard care, found an improvement. One outcome found a worsening: LDL cholesterol, blood pressure and other cardiovascular risk markers (20 people).
1Angina symptoms and ECG response when added to standard care
Improved · Grade C · Meta-analysis, 10,208 people, 2026
People with stable angina in 93 RCTs (mostly Chinese databases)
Dose, result and source| Outcome | Found | People | Study | Who was studied |
|---|---|---|---|---|
| Angina symptoms and ECG response when added to standard care | Improved | 10,208 | Grade C · Meta-analysis, 2026 | People with stable angina in 93 RCTs (mostly Chinese databases) |
| Heart function in heart failure when added to standard care | Improved | 855 | Grade C · Meta-analysis, 2023 | People with heart failure in 9 RCTs |
| 24-hour blood pressure in primary hypertension | Improved | 320 | Grade C · RCT, 2025 | Adults aged 30-75 with primary hypertension (China) |
| Lower urinary tract symptoms (IPSS) in men | Improved | 136 | Grade C · RCT, 2024 | Men with lower urinary tract symptoms (Korea, multicentre) |
| Urinary symptoms vs saw palmetto | Improved | 30 | Grade D · Pilot RCT, 2026 | Men with lower urinary tract symptoms (Korea) |
| LDL cholesterol, blood pressure and other cardiovascular risk markers | Worsened | 20 | Grade C · Crossover RCT, 2015 | Adults aged 40-70 with high cholesterol and high blood pressure (Netherlands) |
Every graded row
6 rowsShowing 6 of 6 outcomes. Human trials only.
CGrade CAngina symptoms and ECG response when added to standard careAnginaRR 1.26 angina responseMeta-analysis · 93 studies
n 10,208 · 2026
Improved Angina efficacy RR 1.26 (95% CI 1.19-1.33) and ECG efficacy RR 1.34 vs conventional therapy alone; angina frequency and duration fell and LVEF rose. Adverse events were not increased. Certainty ranged from moderate to very low.
- Design
- Meta-analysis, 93 studies, n = 10,208, 2026
- Population
- People with stable angina in 93 RCTs (mostly Chinese databases)
- Form
- Compound danshen dripping pills (multi-herb) plus conventional therapy vs conventional therapy alone or with nitrates
- Dose
- As used in each trial
- Duration
- Varied
- Source
- Reference 1 · PubMed 42851529 (opens PubMed)
CGrade CHeart function in heart failure when added to standard careHeart failureLVEF +5.5 pointsMeta-analysis · 9 studies
n 855 · 2023
Improved Left ventricular ejection fraction rose by a mean 5.46 percentage points (95% CI 5.32-5.60), BNP fell by 88.61 pg/mL and hs-CRP by 2.73 mg/L vs conventional treatment alone, and heart chamber diameters shrank. GRADE certainty was moderate to low; no trial reported adverse events.
- Design
- Meta-analysis, 9 studies, n = 855, 2023
- Population
- People with heart failure in 9 RCTs
- Form
- Danshen decoction plus conventional heart-failure treatment vs conventional treatment alone
- Dose
- As used in each trial
- Duration
- Varied
- Source
- Reference 16 · PubMed 37146072 (opens PubMed)
CGrade C24-hour blood pressure in primary hypertensionBlood pressureLower BP (IV only)RCT
n 320 · 2025
Improved Systolic and diastolic pressure fell from week 4 to 136.78 and 85.36 mmHg by week 12, both lower than control (p < 0.01). Adverse events were mild gastrointestinal discomfort and dizziness.
- Design
- RCT, n = 320, 2025
- Population
- Adults aged 30-75 with primary hypertension (China)
- Form
- Intravenous Salvia miltiorrhiza injection vs matching placebo infusion
- Dose
- 20 ml in 200 ml 5% glucose daily
- Duration
- 12 weeks
- Source
- Reference 3 · PubMed 40658027 (opens PubMed)
CGrade CLower urinary tract symptoms (IPSS) in menProstateBetter IPSSRCT
n 136 · 2024
Improved Both doses improved total IPSS and several secondary outcomes vs placebo; erectile function (IIEF) improved, especially at 400 mg. PSA and testosterone did not change; no serious adverse events led to discontinuation.
- Design
- RCT, n = 136, 2024
- Population
- Men with lower urinary tract symptoms (Korea, multicentre)
- Form
- Salvia miltiorrhiza root extract (SAGX) vs placebo
- Dose
- 400 or 800 mg/day
- Duration
- 12 weeks
- Source
- Reference 4 · PubMed 39796461 (opens PubMed)
CGrade CLDL cholesterol, blood pressure and other cardiovascular risk markersCholesterol and BPLDL slightly higher, BP unchangedCrossover RCT
n 20 · 2015
Worsened LDL was 3.82 mmol/l after danshen vs 3.52 after placebo (p < 0.05). 24-hour blood pressure did not change (138/84 vs 136/87), nor did endothelial function, inflammation, glucose or clotting markers.
- Design
- Crossover RCT, n = 20, 2015
- Population
- Adults aged 40-70 with high cholesterol and high blood pressure (Netherlands)
- Form
- Danshen water extract of Salvia miltiorrhiza root vs placebo
- Dose
- Not stated in the abstract
- Duration
- 4 weeks per arm (4-week washout)
- Source
- Reference 2 · PubMed 26192328 (opens PubMed)
DGrade DUrinary symptoms vs saw palmettoProstateBeat saw palmetto (pilot)Pilot RCT
n 30 · 2026
Improved Total IPSS fell more with SAGX than saw palmetto (p = 0.031), with better storage symptoms (p = 0.003), quality of life (p = 0.035) and erectile function (p = 0.005).
- Design
- Pilot RCT, n = 30, 2026
- Population
- Men with lower urinary tract symptoms (Korea)
- Form
- SAGX 400 mg vs saw palmetto extract 320 mg
- Dose
- 400 mg/day
- Duration
- 12 weeks
- Source
- Reference 5 · PubMed 42280395 (opens PubMed)
What the numbers add up to
Each point is worked out from the data and the sources numbered on this page, with the arithmetic shown under it. It adds no new data and is not medical advice.
The best-controlled oral trial was negative
Interaction risk is clearer than benefit
Studied doses
Doses used in research, shown against the official limits. They describe the studies, not a recommendation for you.
Studied doses in research, not advice. These are amounts used in research, not personal advice. Your clinician or pharmacist can say what fits you.
Doses studied in human trials
Interactions and safety
Published interactions only: each row cites a source. No row means none was found in our sources, not that a combination is safe.
What Danshen meets
5 cited rowsMedicines 5
Supplements and foods 0
No supplement rows in our sources.
- Measured in a human study
- Reference summary
- Case reports
Choose a medicine or supplement above to read its cited rows here.
Also cited:
Aspirin and other antiplatelet drugs
PK studyMeasured in a human study
Aspirin and other antiplatelet drugs, for example aspirin: In 14 healthy adults, a danshen-gegen product moderately raised aspirin exposure (AUC) and altered warfarin metabolism; danshen also inhibits platelet aggregation, so bleeding risk may add up.
Source 11, J Ethnopharmacol (2020); Source 7, Ann Pharmacother (2001)
Clopidogrel
PK studyMeasured in a human study
Clopidogrel, for example clopidogrel (Plavix): In 20 healthy men, 7 days of Danshen capsules lowered exposure (AUC0-∞) to clopidogrel by 49.3% and to its metabolite by 41.5%, and weakened clopidogrel's antiplatelet effect. The authors attribute this to CYP enzyme induction and advise caution with drugs metabolized by CYP3A4.
Source 13, Food Chem Toxicol (2018)
Rosuvastatin
PK studyMeasured in a human study
Rosuvastatin, for example rosuvastatin (Crestor): In a 6-person crossover study, a tanjin (danshen)-containing product lowered rosuvastatin peak level by 26.85% and exposure (AUC0-12) by 19.43%, apparently by reducing its absorption.
Source 14, Yonago Acta Med (2019)
Drugs cleared by CYP450 enzymes
ReviewReference summary
Drugs cleared by CYP450 enzymes, for example many prescription drugs (inferred): Tanshinones inhibit and induce several CYP450 isozymes; a review advises caution with tanshinone-rich danshen products.
Source 12, Drug Metabol Drug Interact (2012)
Warfarin
Case reportCase reports
Warfarin, for example warfarin (Coumadin): Case reports describe gross over-anticoagulation and bleeding after danshen was added to stable warfarin therapy, and a review concluded people on warfarin should avoid danshen. A 1-week study of the danshen-sanqi pill T89, run by its manufacturer Tasly, found no change in INR or warfarin levels in 23 healthy volunteers. In heart patients taking compound danshen dripping pills with warfarin, the warfarin dose did not change and no bleeding occurred, although S-warfarin peak levels changed in patients with one CYP4F2 genotype. A 2023 study in healthy volunteers with the EPHX1 A/A genotype found the dripping pill only slightly changed warfarin's levels and effect. These results cover specific multi-herb products and do not show that other danshen products are safe with warfarin.
Source 7, Ann Pharmacother (2001); Source 8, J Intern Med (1997); Source 9, Arch Intern Med (2005); Source 6, J Clin Pharmacol (2014); Source 10, Clin Ther (2019); Source 15, Front Pharmacol (2023)
Interactions
5 agents| Agent | What the source says | Evidence |
|---|---|---|
| Medicines5 | ||
| Warfarine.g. warfarin (Coumadin) | Case reports describe gross over-anticoagulation and bleeding after danshen was added to stable warfarin therapy, and a review concluded people on warfarin should avoid danshen. A 1-week study of the danshen-sanqi pill T89, run by its manufacturer Tasly, found no change in INR or warfarin levels in 23 healthy volunteers. In heart patients taking compound danshen dripping pills with warfarin, the warfarin dose did not change and no bleeding occurred, although S-warfarin peak levels changed in patients with one CYP4F2 genotype. A 2023 study in healthy volunteers with the EPHX1 A/A genotype found the dripping pill only slightly changed warfarin's levels and effect. These results cover specific multi-herb products and do not show that other danshen products are safe with warfarin.78961015 | Case report |
| Clopidogrele.g. clopidogrel (Plavix) | In 20 healthy men, 7 days of Danshen capsules lowered exposure (AUC0-∞) to clopidogrel by 49.3% and to its metabolite by 41.5%, and weakened clopidogrel's antiplatelet effect. The authors attribute this to CYP enzyme induction and advise caution with drugs metabolized by CYP3A4.13 | PK study |
| Aspirin and other antiplatelet drugse.g. aspirin | In 14 healthy adults, a danshen-gegen product moderately raised aspirin exposure (AUC) and altered warfarin metabolism; danshen also inhibits platelet aggregation, so bleeding risk may add up.117 | PK study |
| Rosuvastatine.g. rosuvastatin (Crestor) | In a 6-person crossover study, a tanjin (danshen)-containing product lowered rosuvastatin peak level by 26.85% and exposure (AUC0-12) by 19.43%, apparently by reducing its absorption.14 | PK study |
| Drugs cleared by CYP450 enzymese.g. many prescription drugs (inferred) | Tanshinones inhibit and induce several CYP450 isozymes; a review advises caution with tanshinone-rich danshen products.12 | Review |
Check with what you take
Kept on this device onlyAdd what you take. We list every interaction our evidence profiles cite between Danshen and your picks, and between your picks.
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Add a supplement or medicine you take to check it against Danshen.
Starting from one medicine? The interaction checker rates how serious each pair is, on a curated list of 19 entries for 11 medicines. This cabinet has no severity rating: it lists every interaction row our supplement pages cite.
Who should be careful
5 groups- People taking warfarin
- Serious over-anticoagulation and bleeding have been reported when danshen was added to warfarin; a review says to avoid the combination.78
- People taking clopidogrel or statins
- In healthy-volunteer studies, danshen products lowered blood levels of clopidogrel (with a weaker antiplatelet effect) and of rosuvastatin.1314
- Bleeding disorders and surgery
- Danshen affects platelets, clotting and fibrinolysis, which could add to bleeding risk; this has not been studied around surgery.7
How to read the label
What to check on the Supplement Facts panel.
How to read the label
2 checksSingle herb or formula
Extract type matters
Danshen products may be water extracts, ethanol extracts or both, with differing levels of phenolic acids and tanshinones; a review advises particular caution with tanshinone-rich products because of CYP450 effects.12
Frequently asked questions
Short answers to common questions; the numbers link to the sources below.
Common questions
7 answersDoes danshen lower blood pressure?
Does danshen help angina?
Is danshen good for prostate symptoms?
What are the side effects of danshen?
Trials report few: no serious adverse events led to stopping in the 12-week SAGX trial, and the angina meta-analysis found no increase in adverse events. Hospital injections caused mild stomach discomfort and dizziness. The main documented harm is bleeding when danshen is combined with warfarin.41378
Can I use danshen with warfarin?
Does danshen interact with clopidogrel or statins?
Is danshen the same as garden sage?
No. Danshen is the root of Salvia miltiorrhiza; culinary sage is Salvia officinalis, a different species.
Sources
16 sources: trial abstracts, NIH fact sheets and reference databases. Numbers in the text link here.
Sources cited on this page
16 sources- 1Efficacy and safety of Compound Danshen Dripping Pills as an adjunct to conventional therapy for stable angina pectoris: an updated systematic review and meta-analysis of randomized controlled trials.Meta-analysis Front Pharmacol, 2026 · PMID 42851529
- 2Salvia Miltiorrhiza Root Water-Extract (Danshen) Has No Beneficial Effect on Cardiovascular Risk Factors. A Randomized Double-Blind Cross-Over Trial.Crossover RCT PLoS One, 2015 · PMID 26192328
- 3Effects of Dan Shen (Salvia miltiorrhiza) on blood pressure management in hypertensive patients: a randomized controlled trial.RCT Blood Press, 2025 · PMID 40658027
- 4Salvia miltiorrhiza Root Extract for Men with Lower Urinary Tract Symptoms: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial.RCT Nutrients, 2024 · PMID 39796461
- 5Efficacy and Safety of Salvia miltiorrhiza Extract (SAGX) Compared with Saw Palmetto in Men with Lower Urinary Tract Symptoms: A 12-Week, Randomized, Double-Blind, Parallel-Group Pilot Study.Pilot RCT Nutrients, 2026 · PMID 42280395
- 6Absence of an effect of T89 on the steady-state pharmacokinetics and pharmacodynamics of warfarin in healthy volunteers.PK study J Clin Pharmacol, 2014 · PMID 24142885
- 7Interaction between warfarin and danshen (Salvia miltiorrhiza).Review Ann Pharmacother, 2001 · PMID 11302416
- 8Chinese herbs and warfarin potentiation by 'danshen'.Observational J Intern Med, 1997 · PMID 9159606
- 9Systematic overview of warfarin and its drug and food interactions.Systematic review Arch Intern Med, 2005 · PMID 15911722
- 10The Effect of Compound Danshen Dripping Pills on the Dose and Concentration of Warfarin in Patients with Various Genetic Polymorphisms.Observational Clin Ther, 2019 · PMID 31053296
- 11Is it safe to take Radix Salvia Miltiorrhiza - Radix Pueraria Lobate product with warfarin and aspirin? A pilot study in healthy human subjects.PK study J Ethnopharmacol, 2020 · PMID 32736050
- 12Herb-drug interactions with Danshen (Salvia miltiorrhiza): a review on the role of cytochrome P450 enzymes.Review Drug Metabol Drug Interact, 2012 · PMID 22718621
- 13Effects of Danshen capsules on the pharmacokinetics and pharmacodynamics of clopidogrel in healthy volunteers.PK study Food Chem Toxicol, 2018 · PMID 29496531
- 14Pharmacokinetic Drug Interaction Between Rosuvastatin and Tanjin in Healthy Volunteers and Rats.PK study Yonago Acta Med, 2019 · PMID 30962748
- 15Evaluation and clinical implications of interactions between compound Danshen dropping pill and warfarin associated with the epoxide hydrolase gene.PK study Front Pharmacol, 2023 · PMID 37214448
- 16Clinical effect of Danshen decoction in patients with heart failure: A systematic review and meta-analysis of randomized controlled trials.Meta-analysis PLoS One, 2023 · PMID 37146072
What changed
Every dated change to this page: what changed, who made it and why.
Change log
3 entries| Date | Change | Who and why |
|---|---|---|
| evidence; interactions; key facts; who should avoid; FAQ; questions; related | Added a 2023 meta-analysis of danshen decoction in heart failure (9 RCTs, 855 people; PMID 37146072). Added two human interaction studies: Danshen capsules roughly halved clopidogrel exposure in 20 healthy men (PMID 29496531) and a danshen product lowered rosuvastatin levels in 6 volunteers (PMID 30962748), plus a 2023 warfarin study of the dripping pill in EPHX1 A/A volunteers (PMID 37214448). Pregnancy and breastfeeding note rewritten: LactMed, LiverTox and NCCIH have no danshen entry (offline NCBI archive and NCCIH site searched). Added FAQ on clopidogrel/statins and side effects, questions this page answers and a heart goal-hub link. Injection-only meta-analyses (lipids, stroke) were left out as hospital products. | Writer: Kymata Health EditorialTrigger: A–Z audit against docs/supplements/AUDIT-STANDARD.md |
| all | Initial editorial evidence review (first draft). Every PMID checked against NCBI E-utilities esummary (titles and years taken from the record, none retracted) and the abstract read for each cited row. Studied doses are reported as research doses, not dosing advice. | Writer: Kymata Health EditorialTrigger: new page |
| all | Adversarial review: disclosed that the T89 warfarin study (PMID 24142885) was run by the manufacturer Tasly, added the CYP4F2-genotype change in S-warfarin peaks from the CDDP patient study (PMID 31053296), and balanced the warfarin key fact with that product-specific null result. | Writer: Kymata Health EditorialTrigger: adversarial review |
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