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Neem (Azadirachta indica) is a tree that grows in tropical regions such as India. The leaf extract is used to reduce tooth plaque and to treat lice.

Neem contains chemicals that might help reduce blood sugar levels, heal ulcers in the digestive tract, prevent pregnancy, kill bacteria, and prevent plaque from forming in the mouth.

People use neem for lice, tooth plaque, gingivitis, psoriasis, to repel insects, and for many other purposes, but there is no good scientific evidence to support most of these uses. Neem seed oil is used as a pesticide.

Natural Medicines rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.
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  • Dental plaque.  Topical neem mouth rinses and gel extracts may reduce dental plaque. It is unclear if neem is as effective as chlorhexidine for this purpose.
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  • Gingivitis.  Topical neem mouth rinses and gel extracts may reduce gingivitis, but neem may not be effective in patients with chronic gingivitis. It is unclear if neem is as effective as chlorhexidine for this purpose.
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  • Lice.  Topical neem extract shampoo may treat lice in children.
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When taken by mouth: Neem bark extract is possibly safe for most adults when used short-term. Doses of up to 60 mg daily for up to 10 weeks have been used safely. Neem is possibly unsafe when taken by mouth in large doses or for long periods of time. It might harm the kidneys and liver.

When applied to the skin: Neem oil or cream is possibly safe when applied to the skin for up to 2 weeks.

When applied inside the mouth: Neem leaf extract gel is possibly safe when applied inside the mouth for up to 6 weeks.

Special Precautions & Warnings:

Pregnancy: Neem oil and neem bark are likely unsafe when taken by mouth during pregnancy. They can cause a miscarriage.

Breast-feeding: There isn't enough reliable information to know if neem is safe to use when breast-feeding. Stay on the safe side and avoid use.

Children: Neem extract shampoo is possibly safe in children when applied once or twice to the head for 10 minutes, then rinsed with warm water. Taking neem seeds and seed oil by mouth is likely unsafe in children. Serious side effects in infants and small children can happen within hours after taking neem oil. These serious side effects include vomiting, diarrhea, drowsiness, seizures, loss of consciousness, coma, and death.

"Auto-immune diseases" such as multiple sclerosis (MS), lupus (systemic lupus erythematosus, SLE), rheumatoid arthritis (RA), or other conditions: Neem might cause the immune system to become more active. This could increase the symptoms of auto-immune diseases. If you have one of these conditions, it's best to avoid using neem.

Reduced ability to have children (infertility): There is some evidence that neem can harm sperm. It might also reduce fertility in other ways. If you are trying to have children, avoid using neem.

Organ transplant: There is a concern that neem might decrease the effect of medications that are used to prevent organ rejection. Do not use neem if you have had an organ transplant.

Surgery: Neem might lower blood sugar levels. There is a concern that it might interfere with blood sugar control during and after surgery. Stop using neem at least 2 weeks before a scheduled surgery.

Lithium

Interaction Rating=Moderate Be cautious with this combination.

Neem might have an effect like a water pill or "diuretic." Taking neem might decrease how well the body gets rid of lithium. This could increase how much lithium is in the body and result in serious side effects. Talk with your healthcare provider before using this product if you are taking lithium. Your lithium dose might need to be changed.

Medications for diabetes (Antidiabetes drugs)

Interaction Rating=Moderate Be cautious with this combination.

Neem might decrease blood sugar. Diabetes medications are also used to lower blood sugar. Taking neem along with diabetes medications might cause your blood sugar to go too low. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.

Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.

Medications that decrease the immune system (Immunosuppressants)

Interaction Rating=Moderate Be cautious with this combination.

Neem might increase the immune system. By increasing the immune system, neem might decrease the effectiveness of medications that decrease the immune system.

Some medications that decrease the immune system include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), corticosteroids (glucocorticoids), and others.

Herbs and supplements that might lower blood sugar: Neem might lower blood sugar. Taking it with other supplements with similar effects might lower blood sugar too much. Examples of supplements with this effect include aloe, bitter melon, cassia cinnamon, chromium, and prickly pear cactus.

There are no known interactions with foods.

Neem leaf, bark, and twig have been taken by mouth in adults. Neem creams, gels, and shampoos have also been used. Speak with a healthcare provider to find out what type of product and dose might be best for a specific condition.

Antelaea azadirachta, Arishta, Arishtha, Azadirachta indica, Bead Tree, Holy Tree, Huile de Neem, Indian Lilac, Indian Neem, Lilas des Indes, Lilas de Perse, Margosa, Margosa Tree, Margousier, Margousier à Feuilles de Frêne, Margousier d'Inde, Melia azadirachta, Neem Oil, Neem Tree, Melia azadirachta, Nim, Nimb, Nimba, Persian Lilac, Pride of China.

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