Echinacea - DayQuil Severe (acetaminophen, dextromethorphan, phenylephrine, guaifenesin) Interaction
Herbal: Echinacea
Also Known As: American Cone Flower, Black Sampson, Black Susans, Comb Flower, Coneflower, Echinaceawurzel, Hedgehog, Igelkopfwurzel, Indian Head, Kansas Snakeroot
Drug: acetaminophen, dextromethorphan, phenylephrine, guaifenesin
Brand names:
DayQuil Severe
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Mar 07, 2023
Interaction Details
acetaminophen, dextromethorphan, phenylephrine, guaifenesin is classified as belonging to the following category: Dayquil Severe
Echinacea is reported to have varying effects on a number of Cytochrome P450 metabolizing enzymes in the liver, including CYP1A2 and CYP3A4, which play a role in acetaminophen and dextromethorphan metabolism (both contained in DayQuil Severe), respectively. Studies have reported both enzyme inhibition and induction, making it difficult to predict clinically significant drug interactions with reliability. Specific drug interaction studies reporting definitive results are rare, and potential drug interactions involving echinacea should likely be taken on a case-by-case basis. Based on what we know about how acetaminophen and dextromethorphan are metabolized, the risk of a clinically significant interaction between echinacea and DayQuil Severe is low.
Interaction Rating
Likelihood of Occurrence
UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Pharmacist Analysis
There are a number of different DayQuil products on the market, including DayQuil Cold & Flu, and DayQuil Cold & Flu Severe.The 'original' DayQuil Cold & Flu contains:
- Acetaminophen (pain reliever)
- Dextromethorphan (cough suppressant)
- Guaifenesin (expectorant)
The 'Severe' version adds on phenylephrine, a nasal decongestant.
In regard to interactions, echinacea has been reported to affect a number of different CYP metabolizing enzymes in the liver, including CYP1A2 and CYP3A4.
This is of interest as Tylenol (acetaminophen) is partially metabolized by CYP1A2 while dextromethorphan is partially metabolized by CYP3A4. Theoretically, echinacea, via inhibition of these liver metabolizing enzymes, could increase the concentrations of each of these drugs, increasing the risk of side effects.
Regardless, the risk of a clinically significant drug interaction here is low.
For starters, while echinacea may inhibit CYP1A2 to some degree, it has not been reported as being responsible for causing adverse effects when combined with acetaminophen when used at recommended dosages, likely due to the fact that acetaminophen has multiple metabolic pathways (e.g., glucuronidation and sulfate conjugation in addition to CYP1A2).
Additionally, dextromethorphan is primarily metabolized via CYP2D6, which echinacea isn't known to affect to any significant degree.
While you should be aware of the potential interaction here between echinacea and DayQuil, it is unlikely the combination will cause any serious adverse effects.
- Dr. Brian Staiger, PharmDEchinacea Overview
Echinacea is a type of flowering plant that belongs to the daisy family and is native to cental and eastern North America. It is known for its purple, cone-shaped flowers. In traditional medicine, echinacea has been used to treat a variety of conditions, including colds, flu, and other respiratory infections. It is believed to work by stimulating the immune system and helping the body to fight off infection. Some studies have suggested that echinacea may be effective at reducing the severity and duration of colds and other respiratory infections, but more research is needed to confirm its effectiveness.
Echinacea - More Interactions
Echinacea interacts with 768 drugs
Interaction Rating Key
These severity listings are for informational use only. Never start, stop or otherwise change your therapy before speaking with your provider.
| Major | The combined use of these agents is strongly discouraged as serious side effects or other negative outcomes could occur. |
| Moderate | Use cautiously under the care of a healthcare professional or avoid this combination. A significant interaction or negative outcome could occur. |
| Minor | Be aware that there is a chance of an interaction. Watch for warning signs of a potential interaction. |
| Unknown | No interactions have been reported or no interaction data is currently available. |
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Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
© 2021 Therapeutic Research Center, LLC
Drug descriptions are provided by MedlinePlus.
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Dr. Brian Staiger, PharmD
In addition to being a clinical pharmacist specializing in pharmacotherapy, Dr. Brian Staiger is a registered herbalist through the American Herbalist Guild. He has combined his passion for pharmacy practice with the study of medical ethnobotany to improve patient care. Feel free to reach out about any of your herbal or medication questions!
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