Quercetin: A Comprehensive Reference
1. Identity, Chemistry, and Natural Sources
Chemical Identity
Quercetin is a plant flavonol from the flavonoid group of polyphenols. Its name derives from the Latin word quercetum, meaning "oak forest," and it belongs to the flavonol category. The IUPAC name is 2-(3,4-dihydroxyphenyl)-3,5,7-trihydroxychromen-4-one, and its molecular formula is C15H10O7. An alternative systematic name is 3,3′,4′,5,7-pentahydroxyflavone, which reflects the five hydroxyl substituents on the core chromenone scaffold. The name has been applied since 1857. Quercetin is a flavonoid compound widely present in plants and exhibits a variety of biological activities.
Despite having five hydroxyl groups, quercetin is lipophilic by nature, which results in limited bioavailability. Quercetin has a relatively large resonance structure in chemical terms and exhibits a yellow color-imparting ability, antioxidation activity, vitamin-P activity, and ultraviolet-absorbing activity. Quercetin is soluble in readily water-soluble organic solvents but insoluble or scarcely soluble in water, which renders handling difficult.
Glycoside Forms and Derivatives
Quercetin is the aglycone form of a number of other flavonoid glycosides, such as rutin (also known as quercetin-3-O-rutinoside) and quercitrin, found in citrus fruit, buckwheat, and onions. In 1930, rutin (quercetin-3-O-rutinoside), one of quercetin's most common forms, was isolated from oranges, and it was initially believed to be a vitamin; for a while, rutin was called vitamin P. Isoquercetin shares the same aglycone as rutin and quercitrin: quercetin. It has been shown that quercetin-containing glycosides liberate quercetin in the intestinal tract; therefore, it is justified to assume that all the pharmacological properties of quercetin are also shared by isoquercetin and rutin when administered orally.
Natural Plant Sources
Quercetin is a plant flavonol from the flavonoid group of polyphenols. It is found in many fruits, vegetables, leaves, seeds, and grains; capers, red onions, and kale are common foods containing appreciable amounts of it. A broad list of food sources includes capers, lovage, sorrel, radish leaves, carob fiber, dill, cilantro, Hungarian wax pepper, fennel leaves, red onion, radicchio, watercress, buckwheat, kale, chokeberry, cranberry, lingonberry, black plums, cowpeas, sweet potato, blueberry, sea buckthorn berry, rowanberry, crowberry, prickly pear cactus fruits, red apples, broccoli, bilberry, tomatoes, black tea, and green tea.
Quercetin is one of the most abundant dietary flavonoids, with an average daily consumption of 25–50 mg. In red onions, higher concentrations of quercetin occur in the outermost rings and in the part closest to the root, the latter being the part of the plant with the highest concentration. One study found that organically grown tomatoes had 79% more quercetin than non-organically grown fruit. Quercetin is also present in various kinds of honey from different plant sources. Flavonoids in propolis—the resinous material produced by bees—are mainly composed of flavonol aglycones such as quercetin, which are considered a major effective component of propolis.
Biosynthesis in Plants
In plants, phenylalanine is converted to 4-coumaroyl-CoA in a series of steps known as the general phenylpropanoid pathway using phenylalanine ammonia-lyase, cinnamate-4-hydroxylase, and 4-coumaroyl-CoA-ligase. One molecule of 4-coumaroyl-CoA is added to three molecules of malonyl-CoA to form tetrahydroxychalcone. Tetrahydroxychalcone is then converted into naringenin using chalcone isomerase. Naringenin is converted into eriodictyol using flavonoid 3′-hydroxylase. Eriodictyol is then converted into dihydroquercetin with flavanone 3-hydroxylase, which is then converted into quercetin using flavonol synthase.
Supplement Forms and Preparations
Quercetin has a bitter flavor and is used as an ingredient in dietary supplements, beverages, and foods. In supplemental form, it is most commonly available as the aglycone (the "free" compound without attached sugars), but multiple enhanced-bioavailability formulations have been developed for commercial use. One delivery system based on food-grade lecithin — known as Quercetin Phytosome — was developed to improve solubility. This formulation leads to a significant improvement in quercetin bioavailability when administered to human volunteers. Other approaches include quercetin-loaded nanoparticles and self-emulsifying hydrogel systems. Quercetin, a dietary flavonoid typically consumed as a glycoside in food, is available in supplements in its aglycone form. This aglycone form is the most studied in preclinical and clinical research because of its antioxidant, anti-inflammatory, and metabolic properties.
2. Traditional and Historical Use
Overview of Traditional Systems
Many medicinal herbs used in traditional medicines such as Ayurveda, Kampo, Unani, Traditional Chinese Medicine (TCM), and Native American traditions contain quercetin. In each of these systems, the compound was not isolated but consumed as part of complex plant preparations, and its effects were understood through the lens of traditional frameworks rather than biochemical analysis.
Traditional Chinese Medicine
Quercetin has a long history of use in traditional Chinese medicine, showing a capacity to induce anti-inflammatory and antioxidant effects. In TCM, quercetin is known to give Sophora japonica (槐花, Huaihua), Ginkgo biloba (银杏, Yinxing), Scutellaria baicalensis (黄芩, Huangqin), and Morus alba (桑白皮, Sangbaipi) many of their healing properties. Over the years, classical formulas such as Huangqin Tang (黄芩汤) and Yinxingye Pian (银杏叶片) have included these herbs to help with problems like inflammation, heart diseases, and mental disorders. The ability of these TCM preparations to ease symptoms is attributed to their quercetin content, which reflects the longstanding use of quercetin-rich herbs in the treatment of chronic illnesses.
The traditional uses of quercetin-rich herbs in TCM are well matched by experimental results showing that these plant extracts reduce toxicity, dampen inflammation, and support organs such as the liver and lungs. Quercetin is widely used in botanical medicine and traditional Chinese medicine due to its potent antioxidant activity.
Foods as Traditional Preparations
Quercetin is the major polyphenolic flavonoid found in food products, including berries, apples, cauliflower, tea, cabbage, nuts, and onions, that have traditionally been treated as anticancer and antiviral remedies, and used for the treatment of allergic, metabolic, and inflammatory disorders, eye and cardiovascular diseases, and arthritis. Many of these applications in folk medicine corresponded to the functional roles that quercetin is now understood to play biochemically, though the specific compound was not identified until the mid-19th century. Quercetin has been classified as a cognitive enhancer in traditional and oriental medicine.
3. Key Constituents and Active Compounds
Structural Features Underlying Bioactivity
Investigation of the chemical structure of quercetin has found that there are four hydroxyl groups on the benzo-dihydropyran ring of the polyphenol, so quercetin has a strong antioxidant capacity, can eliminate free radicals produced in the body, and can help the body maintain a stable state. The C-3 hydroxyl group on the flavonol ring is particularly significant because it permits chelation of pro-oxidant metal ions including iron and copper. Quercetin is renowned for its potent antioxidant properties. It scavenges free radicals and chelates metal ions, thus protecting cells from oxidative stress.
Primary Active Metabolites
In vivo, quercetin undergoes extensive first-pass metabolism. Because of the high presystemic biotransformation of quercetin, mainly its conjugates appear in circulation. These conjugates include quercetin-3′-sulfate, quercetin-3-glucuronide, and isorhamnetin (a methylated metabolite). Quercetin and its metabolites (quercetin-3′-sulfate, quercetin-3-glucuronide, isorhamnetin, and isorhamnetin-3-glucuronide) showed weak inhibitory effects on CYP2C19 and CYP3A4, while they did not affect CYP2D6 activity. Rutin, the O-glycoside of quercetin, further contributes by generating aglycone metabolites through gut microbiota activity, replicating quercetin's metabolic enzyme inhibition and antioxidant actions.
4. Established Mechanisms of Action
Antioxidant Mechanisms
Quercetin is a bioactive compound widely used in botanical medicine and traditional Chinese medicine due to its potent antioxidant activity. In recent years, antioxidant activities of quercetin have been studied extensively, including its effects on glutathione (GSH), enzymatic activity, signal transduction pathways, and reactive oxygen species (ROS) caused by environmental and toxicological factors.
Quercetin interacts with NADPH oxidase, which can result in changes in reactive oxygen species levels. Elevated ROS levels can activate the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway, which subsequently promotes the expression of antioxidant genes such as superoxide dismutase (SOD) and glutathione peroxidase (GPx). As a result, the antioxidant response is potentiated, reducing oxidative stress and protecting cells from damage. Quercetin has been found to be the most effective free radical scavenger in the flavonoid family.
Anti-Inflammatory Mechanisms
Quercetin has been extensively studied for its anti-inflammatory properties, where it alleviates the inflammatory response by inhibiting the NF-κB and MAPK signaling pathways. One of the important mechanisms of quercetin's action at the molecular level is the reduction in pro-inflammatory cytokine activity, such as IL-6, IL-17, TNF-α, and IL-1β, by blocking NF-κB and AMPK signaling pathways.
This flavonoid inhibits the activity of cyclooxygenase (COX-2) and lipoxygenase, which limits the synthesis of inflammatory mediators such as prostaglandins and leukotrienes. In addition, it reduces the activity of inducible nitric oxide synthase (iNOS), which leads to reduced levels of nitric oxide. Quercetin targets inflammation by modulating the expression of cytokines and pro-inflammatory molecules and by inhibiting pro-inflammatory enzymes.
Research has demonstrated that quercetin inhibits signaling pathways related to the inflammatory process, including phosphorylation of mitogen-activated protein kinases (MAPKs), inhibitor of nuclear factor κ-B kinase (IKK)α/β, c-Jun, cAMP response element-binding protein (CREB), activating transcription factor 2 (ATF2) and nuclear factor (NF)-κB p65, and blocks the translocation of NF-κB p65 into the nucleus.
Mast Cell Stabilization
Unlike pharmaceutical antihistamines, which work by blocking histamine receptors, quercetin prevents mast cells from releasing histamine in the first place. A study compared quercetin to cromolyn sodium — a pharmaceutical mast cell stabilizer — using cultured human mast cells. Quercetin inhibited histamine secretion by 82–87%, compared to 67% for cromolyn. It also showed greater suppression of IL-8 and TNF cytokine release. These results are primarily from in vitro work, and the clinical relevance in humans requires further large-scale confirmation.
Metabolic and Glucose Homeostasis Pathways
Quercetin has been reported to stimulate glucose uptake in cultured skeletal muscle through an insulin-independent mechanism involving AMPK, a key regulator of whole body-energy homeostasis. Treatment with quercetin stimulated AMPK and increased GLUT4 translocation and protein content in cultured rat skeletal muscle cells, as well as hepatic AMPK activation in hepatocytes.
Senolytic Activity
Senolytics, including the combination of dasatinib and quercetin (D+Q), selectively eliminate senescent cells by transiently disabling pro-survival networks that defend them against their own apoptotic environment. Quercetin, a dietary flavonoid, was first documented to exert senolytic activity against senescent human endothelial cells and mouse bone marrow-derived mesenchymal stem cells. One of the first senolytic drugs to be identified was quercetin, a natural flavonoid ubiquitously present in fruits, vegetables, nuts, tea, and red wine.
Macrophage Immunomodulation
Quercetin can improve the antioxidant enzyme activity of inflammatory macrophages and inhibit their ROS production and overexpression of inflammatory factors. Additionally, quercetin upregulates mitochondrial membrane potential, ATP production, and ATP synthase content when these are reduced by inflammatory stimuli, and reverses mitochondrial morphology damage to a certain extent. Quercetin was also found to significantly upregulate the protein expressions of SIRT1 and PGC-1α. Quercetin has been found to modulate inflammatory processes through a variety of signaling pathways, including the phosphatidylinositol-3-phosphate kinase (PI3K)/Akt signaling pathway.
5. Scientific Evidence by Health Area
5.1 Cardiovascular System: Blood Pressure
Evidence strength: Moderate — multiple RCTs and meta-analyses; clinically modest effect sizes.
Quercetin, the most abundant dietary flavonol, has antioxidant effects in cardiovascular disease, but the evidence regarding its effects on blood pressure (BP) has not been conclusive; its impact on BP has been assessed through a systematic review and meta-analysis of available randomized controlled trials. Overall, the impact of quercetin on BP was reported in 7 trials comprising 9 treatment arms (587 patients). The results of the meta-analysis showed significant reductions both in systolic BP (WMD: −3.04 mm Hg, 95% CI: −5.75, −0.33, P=0.028) and diastolic BP (WMD: −2.63 mm Hg).
A separate, more recent meta-analysis in Nutrition Reviews corroborated these findings. Pooled results showed that quercetin significantly lowered both systolic BP (WMD, −3.09 mmHg; 95% CI, −4.59 to −1.59; P = 0.0001) and diastolic BP (WMD, −2.86 mmHg; 95% CI, −5.09 to −0.63; P = 0.01).
A meta-analysis of 20 RCTs examining metabolic syndrome components found that altogether 20 studies with a total sample size of 1,164 subjects were included in the analysis. A pooled analysis showed that quercetin consumption led to a significant reduction in fasting blood glucose (WMD: −1.03 mg/dL; 95% CI: −1.87 to −0.19), and systolic blood pressure (WMD: −1.96 mmHg; 95% CI: −3.11 to −0.81). However, there were no significant effects on triglycerides, HDL-C, waist circumference, and diastolic blood pressure.
A specific RCT in patients with borderline hypertension found that 162 mg of quercetin daily for 6 weeks reduced 24-hour ambulatory systolic blood pressure by 3.6 mmHg compared to placebo. This study was notable for using ambulatory blood pressure monitoring — the gold standard for blood pressure assessment — rather than single office measurements.
The results indicate that quercetin supplementation notably lowers systolic blood pressure in hypertensive and normotensive individuals, but its impact on diastolic blood pressure is insignificant. These findings hint at quercetin's potential as an auxiliary treatment for systolic hypertension, with a need for more high-quality, randomized controlled trials to determine optimal dosage and duration.
5.2 Cardiovascular System: Lipids and Broader Cardiometabolic Markers
Evidence strength: Mixed and inconsistent in human trials.
Experimental studies including both in vitro methods and in vivo animal models mainly outline the following effects of quercetin: antihypertensive, hypolipidemic, hypoglycemic, anti-atherosclerotic, and cardioprotective effects. From the clinical point of view, there are human studies and meta-analyses implicating its beneficial effects on glycemic and lipid parameters. In contrast, other human studies failed to demonstrate consistent favorable effects of quercetin on other cardiometabolic risk factors such as metabolic syndrome, obesity, and hypertension.
A double-blind, randomized clinical trial was carried out for 10 weeks on 72 women who were given 500 mg of quercetin daily. Quercetin significantly decreased tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), high-density lipoprotein cholesterol (HDL-C), and systolic blood pressure (SBP), while LDL-C, total cholesterol, and triglycerides (TG) were not significantly reduced. The results showed that quercetin supplementation did not affect cardiovascular risk factors overall.
In another study, healthy candidates with 4.0–7.2 mmol/L cholesterol levels were administered 1 g quercetin daily for 28 days. There was no alteration in the cardiovascular risk factors, including HDL, LDL, and triglyceride levels.
Significant drawbacks in the clinical trials' design were identified, while the absence of pharmacokinetic/pharmacodynamic tests prior to the studies attenuated the power of clinical results. Additional well-designed preclinical and clinical studies are required to examine the therapeutic mechanisms and clinical efficacy of quercetin in cardiovascular diseases.
5.3 Allergy and Immune Modulation
Evidence strength: Preliminary in humans; well-characterized mechanism in vitro and in animal studies.
There is much evidence that quercetin exerts anti-allergic effects in both human and experimental animal models of allergic diseases. The primary mechanism, demonstrated in cell-based research, is mast cell stabilization. A small human pilot arm (10 volunteers) in one study found significant reduction in contact dermatitis. These are in vitro and small-sample results, not large clinical trials, but the mechanism is well-established.
A 2016 study in Inflammation Research found that quercetin inhibited the activation of mast cells and their release of inflammatory cytokines. A double-blind pilot study in humans with seasonal allergies demonstrated that quercetin supplementation reduced nasal and eye symptoms significantly. Large, adequately powered, placebo-controlled trials specifically in allergic rhinitis populations remain limited.
5.4 Exercise Performance and Muscle Recovery
Evidence strength: Moderate — systematic review and meta-analysis of RCTs, but studies are small and heterogeneous.
After application of inclusion and exclusion criteria, 13 studies with a total of 249 sedentary to well-trained participants were included in a systematic review and meta-analysis. For all studies there were some concerns about the risk of bias. All but one study used a supplementation dosage of 1,000 mg/day. Quercetin supplementation accelerated recovery of muscle function and significantly decreased muscle soreness 0/24 h after exercise (SMD: −1.33; p = 0.03), creatine kinase levels 24/48 h after exercise (SMD: −1.15; p = 0.02), and post-exercise oxidative stress (SMD: −0.92; p = 0.03). However, quercetin supplementation had no effect on IL-6 concentration.
5.5 Prostatitis
Evidence strength: Preliminary — one small RCT with positive results; no large trials.
In a prospective, randomized, double-blind, placebo-controlled trial of quercetin in men with chronic prostatitis, 20% of patients taking a placebo and 67% of patients taking quercetin had an improvement of symptoms of at least 25% as measured by the NIH chronic prostatitis symptom score. In an unblinded open-label follow-up study, 82% of patients who received a formulation of quercetin, bromelain, papain, and zinc had at least a 25% improvement in symptom score. The open-label extension and combination formula used in the follow-up study limit the conclusions that can be drawn about quercetin alone.
5.6 Cellular Senescence and Aging (Senolytic Activity)
Evidence strength: Early-phase clinical trials; mechanism established in preclinical work; human outcome data emerging but not yet definitive.
In the first clinical trial of senolytics, the dasatinib and quercetin combination improved physical function in patients with idiopathic pulmonary fibrosis (IPF), a fatal senescence-associated disease. The first human studies showed a reduced senescent cell burden in the adipose tissue of patients suffering from diabetic kidney disease and improved physical functions in patients with idiopathic pulmonary fibrosis.
A randomized controlled trial examined 60 healthy women past menopause who intermittently received a senolytic combination of dasatinib and quercetin. So far the only senolytic therapy demonstrated in clinical trials to clear senescent cells in humans as well as it does in mice is the dasatinib and quercetin combination. Clinical research groups presently running human studies are still in the process of figuring out dosing and optimal use cases for the various first-generation small molecule senolytics, such as dasatinib and quercetin. Initial results from a Mayo Clinic phase 2 study in older women with osteoporosis are described as quite positive, despite the failure to produce a significant difference when considering the whole treatment group.
It is important to note that in senolytic protocols, quercetin has been studied in combination with dasatinib (a prescription tyrosine kinase inhibitor), not as a stand-alone agent. Emerging research suggests that the senolytic regimen of dasatinib+quercetin reduces senescent cells, potentially mitigating age-related health and cognitive decline. Pilot studies aim to assess the feasibility and safety of D+Q in older adults with various conditions. The senolytic applications of quercetin as a standalone supplement in humans remain unproven by clinical trial standards.
5.7 Blood Glucose and Metabolic Syndrome
Evidence strength: Preliminary to moderate; meta-analytic support for fasting glucose reduction but effect sizes are small.
A systematic review and meta-analysis of RCTs evaluated the effects of quercetin on metabolic syndrome components such as waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, triglyceride, and HDL-C. A systematic literature search up to December 2023 was completed, identifying 20 studies with a total sample size of 1,164 subjects. A pooled analysis showed that quercetin consumption led to a significant reduction in fasting blood glucose (WMD: −1.03 mg/dL; 95% CI: −1.87 to −0.19), and systolic blood pressure.
5.8 Cancer (Preclinical and Early Clinical)
Evidence strength: Preclinical only for most indications; no approved clinical use.
Quercetin is one of the most important plant molecules that has shown many pharmacological activities, including anticancer, antiviral, and treating allergic, metabolic, and inflammatory disorders. It has shown a wide range of anticancer properties, and several reports indicate its efficacy as a cancer-preventing agent. The antiproliferative and antimutagenic activities in vitro have made it a candidate for clinical trials in cancer therapy. However, at the time of writing, no clinical evidence from completed phase III trials supports quercetin as an approved cancer therapy. The evidence base remains primarily in vitro and in animal models.
5.9 Neuroprotection and Cognition
Evidence strength: Predominantly preclinical; human data very limited.
Quercetin has already been shown to be able to improve learning and memory ability, and to be a potential novel therapeutic strategy against Alzheimer's disease. Using rat hippocampal cultures, researchers have been capable of delivering encapsulated quercetin, protecting neuronal cultures from oxidative stress and hypothesizing its use against Alzheimer's disease or other neurodegenerative disorders. Quercetin and other polyphenols were used in a study to protect brain mitochondria from amyloid fragment fibrillogenesis. Quercetin was able to destabilize amyloid aggregates, thereby inhibiting the fibrillation process and rescuing the mitochondrial function. These findings are from animal and cell models, and well-designed human clinical trials are needed before clinical conclusions can be drawn.
6. Pharmacokinetics and Bioavailability
Absorption and Bioavailability Challenges
Quercetin is a lipophilic compound that is absorbed by simple diffusion and involves both oral and intestinal bacteria for its enzymatic hydrolysis. Quercetin is relatively lipophilic with low solubility in water. Quercetin glucoside is more water-soluble than the aglycone, and its absorption is limited to sodium-dependent glucose transporter-1 (SGLT-1); however, glucose transporter-2 (GLUT-2)-dependent absorption is also a significant contributor.
Unformulated standard quercetin provides a Cmax of only 14 ng/mL, and no quercetin or quercetin metabolites were detected after 5 h of consumption in some pharmacokinetic studies. Various formulation strategies have been developed to overcome this limitation. A delivery system based on food-grade lecithin — Quercetin Phytosome — was developed, and its solubility was shown to be considerably higher than that of unformulated quercetin, leading to a significant improvement in quercetin bioavailability when administered to human volunteers in a clinical study.
The intake of quercetin together with a meal could improve absorption notably — as a greater surface area promotes dissolution in the intestinal lumen and thus bioavailability. Dietary fat compounds can greatly contribute to quercetin's bioavailability and may even boost the effects of carrier systems by enhancing micellization.
Metabolism and Elimination
The overall lack of in vivo toxicity of quercetin is consistent with its known metabolic fate; specifically, its extensive microbial degradation in the gastrointestinal tract of both animals and humans, followed by methylation, oxidation and conjugative metabolic processes that occur in the liver and kidneys and eventual elimination through the bile, feces, and urine. The role of intestinal microbiota in the bioavailability and physiological function of dietary polyphenols such as quercetin has been increasingly discussed.
7. Dosage Forms and Dosages Reported in Studies
The following dosages are reported as used in cited scientific studies and clinical trials; they are not prescriptive recommendations:
- A double-blind, randomized clinical trial of 10 weeks in 72 women used 500 mg quercetin daily.
- A systematic review and meta-analysis of exercise recovery included 13 studies; all but one used 1,000 mg/day.
- For prostatitis studies, a dose of 500 mg twice daily has been examined.
- In a study of cholesterol in healthy adults, 1 g (1,000 mg) quercetin daily for 28 days was administered.
- A randomized controlled trial in borderline hypertension used 162 mg of quercetin daily for 6 weeks.
- In the Mayo Clinic Phase 1 senolytic pilot study, participants received dasatinib 100 mg and quercetin 1,000 mg orally for 3 days.
- A human clinical study with levels up to 1,000 mg/day for 12 weeks showed that quercetin supplementation was safe.
- In a CYP1A2 interaction study, quercetin capsules of 500 mg once daily were given for 13 consecutive days to volunteers.
Several clinical trials have demonstrated the benefits of quercetin for enzymatic, metabolic and cardiovascular health; however, approximately 60% of these studies fail to verify the actual concentration administered, generating uncertainty about their findings. Additionally, when five commercial brands were tested, only one contained the amount labeled; three contained approximately 80%, and one contained merely 14.8% of the stated dose. This highlights a quality-control issue that affects the interpretation of real-world outcomes.
8. Safety, Adverse Effects, and Drug Interactions
General Safety Profile
Published and unpublished information supports the safety of quercetin including ADME studies; acute, subchronic, and chronic toxicity studies; carcinogenicity, genotoxicity, and reproductive/developmental toxicity studies; pharmacokinetic studies; and human clinical and epidemiological studies. From all of the available toxicology studies in multiple species, there is an apparent lack of significant adverse systemic toxicity.
A two-year toxicity and carcinogenicity study in rats by the National Toxicology Program (NTP) was pivotal in establishing safety; the no-observed adverse effect level for this study was approximately 2,200 mg/kg body weight per day (the highest dose tested). The weight-of-the-evidence from toxicological safety studies and human clinical studies corroborating epidemiological studies, together with recent human pharmacokinetic studies, demonstrates that quercetin is safe for intended use as a supplement. Based on information provided to FDA, the agency accepted the conclusion that quercetin is generally recognized as safe (GRAS) under the intended conditions of use.
No significant differences were observed between quercetin formulation treatments and control in vital signs, physical examination results, or ECG results, demonstrating the new formulation is safe and well tolerated, and is as safe as unformulated quercetin.
Reported Adverse Effects
In a clinical trial reporting adverse events out of 30 patients enrolled, adverse events in the quercetin arm included one patient who developed a headache after the first few doses (which resolved) and one patient who noted mild tingling of the extremities after each dose. Adverse effects that have been listed in monographs include emesis, dyspnea, and nephrotoxicity; however, the nephrotoxicity has not been substantiated in recent reports, and several studies involve use of quercetin for its anti-oxidative and anti-apoptotic effects in kidney disease models.
Drug Interactions
Quercetin interacts with cytochrome P450 enzymes and drug transporters at pharmacological doses, creating the potential for herb–drug interactions. In studies, the inhibitory effects of quercetin and its metabolites were tested on CYP2C19, CYP3A4, and CYP2D6 enzymes as well as on organic anion-transporting polypeptides (OATPs) and ABC transporters (BCRP and MRP2). Most of the compounds tested proved to be strong inhibitors of OATP1B1, OATP1B3, OATP2B1, and BCRP. These data demonstrate that not only quercetin but some of its conjugates can also interact with CYP enzymes and drug transporters. Therefore, high intake of quercetin may interfere with the pharmacokinetics of drugs.
- Warfarin: Limited data suggest that flavonoids may affect the metabolism of warfarin. Quercetin has been found in vitro to inhibit CYP450 2C9, the isoenzyme responsible for the metabolic clearance of the biologically more active S(−) enantiomer of warfarin.
- Cyclosporine: A small study in healthy volunteers shows that giving quercetin before cyclosporine increases blood levels of the cyclosporine and lengthens the time it remains in the body.
- Caffeine / CYP1A2 substrates: Previous studies indicated that quercetin inhibited the activity of CYP1A2, and the combination of quercetin with the substrates of CYP1A2 might produce herb–drug interactions.
- Fluoroquinolone antibiotics, digoxin: Listed drug interactions in clinical trial protocols include cyclosporine, digoxin, and fluoroquinolones.
- CYP2C8/CYP3A5/P-glycoprotein substrates: Clinical trial protocols also flag caution with medications changed by the liver (e.g., CYP2C8, CYP2C9, CYP2D6, or CYP3A5), medications moved by pumps in cells (P-glycoprotein substrates), and antihypertensive drugs.
- Iron absorption: Quercetin and other flavonoids also significantly mitigate iron absorption due to the inhibition of basolateral transport across intestinal epithelial cells.
- Calcium supplements: Calcium supplements may also interfere with quercetin absorption despite scarce evidence. The mechanism underlying its inhibitory effects is theoretical because calcium can form insoluble complexes with quercetin in the gastrointestinal tract, thus reducing its bioavailability.
Special Populations
Clinical trial protocols flag caution for pregnant and/or breastfeeding women and individuals with kidney problems. These cautions reflect the absence of controlled safety data in these populations rather than confirmed harm from human studies at standard doses.
9. Summary of Evidence Strength
- Blood pressure reduction: Moderate evidence; multiple RCTs and meta-analyses (total N >500) support small but statistically significant reductions in systolic and, to a lesser extent, diastolic BP.
- Antioxidant and anti-inflammatory biomarkers: Consistent effects on circulating inflammatory markers (TNF-α, IL-6) in RCTs, though clinical endpoint translation is unclear.
- Exercise recovery: Moderate evidence from a meta-analysis of 13 RCTs (N=249); significant effects on muscle soreness and creatine kinase, but no effect on IL-6.
- Prostatitis: Preliminary; one small RCT with positive results, no replication in large trials.
- Allergy / mast cell stabilization: Well-established in vitro mechanism; human clinical trial evidence is limited in scale.
- Senolytic / anti-aging: Early-phase human trials with quercetin + dasatinib; promising but not yet definitive; quercetin alone as a standalone senolytic has not been validated in humans.
- Cancer: Preclinical only at this time; no approved indication.
- Neurodegeneration: Primarily preclinical; human trials are in early phases.
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