Berberine + Aspirin, Butalbital, Caffeine, Codeine Phosphate
Aspirin, Butalbital, Caffeine, Codeine Phosphate brand name: Fiorinal w/ Codeine.
Aspirin, Butalbital, Caffeine, Codeine Phosphate falls into 4 drug categories that Berberine can interact with; the most serious is rated moderate. Theoretically, berberine might increase the sedative effects of CNS depressants.
Read the full interaction reportBerberine and Aspirin, Butalbital, Caffeine, Codeine Phosphate
These two interact in 4 distinct ways. Each one is explained separately below.
Why Are There 4 Interactions?
Berberine interacts with whole categories of medication. Aspirin, Butalbital, Caffeine, Codeine Phosphate falls into 4 of those categories, so it can interact with Berberine in 4 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
CNS DEPRESSANTS
1 of 4Why this applies to Aspirin, Butalbital, Caffeine, Codeine Phosphate
Aspirin, Butalbital, Caffeine, Codeine Phosphate falls under CNS DEPRESSANTS — the group Berberine interacts with.
Animal research suggests that berberine may have sedative effects. Theoretically, use of berberine along with CNS depressants might produce additive therapeutic and adverse effects.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Fiorinal with Codeine already has two ingredients that can make you drowsy: butalbital (a barbiturate) and codeine (an opioid). The concern here is simple addition. In animal studies, berberine showed some calming, sedative-like effects of its own. So in theory, pairing it with this medicine might pile on top of the sleepiness you may already feel, leaving you more groggy, lightheaded, or slow to react than usual.
I want to be honest about the strength here: this is based on lab and animal work, not solid human studies, so it is more of a theoretical caution than a proven problem. Still, since this combination affects driving and alertness, it is worth a quick chat with your pharmacist or doctor before adding berberine, especially if you already feel drowsy on it.
- Janbaz KH, Gilani AH. Studies on preventive and curative effects of berberine on chemical-induced hepatotoxicity in rodents. Fitoterapia 2000;71:25-33.. PubMed
- Shanbhag, S. M., Kulkarni, H. J., and Gaitonde, B. B. Pharmacological actions of berberine on the central nervous system. Jpn.J Pharmacol 1970;20(4):482-487. PubMed
- Peng, W. H., Hsieh, M. T., and Wu, C. R. Effect of long-term administration of berberine on scopolamine-induced amnesia in rats. Jpn J Pharmacol 1997;74(3):261-266. DOI
- Sabir M and Bhide NK. Study of some pharmacological actions of berberine. Ind J Physiol & Pharmac 1971;15(3):111-132.
CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES
2 of 4Aspirin, Butalbital, Caffeine, Codeine Phosphate also falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES.
In vitro research and preliminary clinical evidence show that berberine can inhibit CYP2D6. Theoretically, use of berberine with drugs metabolized by CYP2D6 might increase drug levels and increase the risk of adverse effects.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Here's the wrinkle with Fiorinal with Codeine: the codeine part is a prodrug. Your body has to convert codeine into morphine using a liver enzyme called CYP2D6 before you feel real pain relief. Berberine appears to block that same enzyme, at least in lab studies and some early human research. So in theory, less codeine gets turned into morphine, which could mean weaker pain relief rather than more side effects.
The evidence here is fairly soft and somewhat theoretical, so I wouldn't panic. But if you've started berberine and notice your headache medicine just isn't working like it used to, that's worth mentioning. Please loop in your pharmacist or doctor before changing anything on your own.
- Chatterjee P, Franklin MR. Human cytochrome p450 inhibition and metabolic-intermediate complex formation by goldenseal extract and its methylenedioxyphenyl components. Drug Metab Dispos 2003;31:1391-7. PubMed
- Guo, Y., Chen, Y., Tan, Z. R., Klaassen, C. D., and Zhou, H. H. Repeated administration of berberine inhibits cytochromes P450 in humans. Eur J Clin Pharmacol 2012;68(2):213-217. PubMed
- Hermann, R. and von, Richter O. Clinical evidence of herbal drugs as perpetrators of pharmacokinetic drug interactions. Planta Med 2012;78(13):1458-1477. PubMed
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
3 of 4Aspirin, Butalbital, Caffeine, Codeine Phosphate also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
In vitro research and preliminary clinical research show that berberine moderately inhibits CYP3A4. Theoretically, use of berberine with drugs metabolized by CYP3A4 might increase drug levels and increase the risk of adverse effects.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Here's the wrinkle with Fiorinal with Codeine: this combo pill has a few moving parts. Berberine can mildly slow down a liver enzyme called CYP3A4, which helps clear butalbital (the barbiturate) and caffeine. If those build up a little, you might feel extra drowsy, foggy, or lightheaded from the butalbital. The codeine piece is different, since codeine is a prodrug that needs a separate enzyme (CYP2D6) to turn into its active painkilling form, so berberine isn't the main player there.
This is mostly theoretical, based on lab and early human data, so I wouldn't panic. Still, before pairing berberine with this medication, please check in with your pharmacist or doctor, especially since drowsiness can add up.
- Wu X, Li Q, Xin H, Yu A, Zhong M. Effects of berberine on the blood concentration of cyclosporin A in renal transplanted recipients: clinical and pharmacokinetic study. Eur J Clin Pharmacol 2005;61:567-72. PubMed
- Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:273-82. PubMed
- Guo, Y., Chen, Y., Tan, Z. R., Klaassen, C. D., and Zhou, H. H. Repeated administration of berberine inhibits cytochromes P450 in humans. Eur J Clin Pharmacol 2012;68(2):213-217. PubMed
- Hermann, R. and von, Richter O. Clinical evidence of herbal drugs as perpetrators of pharmacokinetic drug interactions. Planta Med 2012;78(13):1458-1477. PubMed
ANTICOAGULANT/ANTIPLATELET DRUGS
4 of 4Aspirin, Butalbital, Caffeine, Codeine Phosphate also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.
In vitro and in vivo research suggest that berberine can inhibit platelet aggregation. Theoretically, berberine might have additive effects when used with anticoagulant and antiplatelet drugs and increase the risk of bleeding.
Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
Here's the piece to pay attention to with Fiorinal with Codeine: it contains aspirin, which already thins the blood a bit by making platelets less sticky. Berberine appears to do something similar, slowing platelet clumping. So far that overlap is only seen in lab and animal studies, not solid human trials, so think of it as a theoretical caution rather than a proven problem.
Still, two things nudging platelets in the same direction could add up and raise your chance of bleeding or bruising. Watch for easy bruising, nosebleeds, bleeding gums, or stomach upset (aspirin can already irritate the stomach). Before you add berberine, check with your pharmacist or doctor, especially if you also take other blood thinners or have any bleeding history. Please don't change either one on your own.
- Wu, J. F. and Liu, T. P. [Effects of berberine on platelet aggregation and plasma levels of TXB2 and 6-keto-PGF1 alpha in rats with reversible middle cerebral artery occlusion]. Yao Xue.Xue.Bao. 1995;30(2):98-102.
- Tripathi YB and Shukla SD. Berberis artistata inhibits PAF induced aggregation of rabbit platelets. Phytotherapy Research 1996;10:628-630.
What These Ratings Mean
Every interaction above is graded three ways — here’s the key to each label.
Clinically significant. Avoid the combination, or use only under close professional supervision.
Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.
Generally not serious. Be aware of it and mention it to your pharmacist.
- LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
- ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
- PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
- UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
- AHigh-quality meta-analysis (quantitative systematic review).
- BCase-control study.
- CConsensus.
- DAnecdotal evidence.
These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.
Berberine Also Interacts With Other Medications
Berberine has 1 major, 1,158 moderate known drug interactions in our database — the Aspirin, Butalbital, Caffeine, Codeine Phosphate one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Berberine
We haven’t checked that one against Berberine yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Berberine. Pick one to open its full report.
Questions About Berberine or Aspirin, Butalbital, Caffeine, Codeine Phosphate
These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Berberine or Aspirin, Butalbital, Caffeine, Codeine Phosphate, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:
- Can You Replace an Evening Apixaban Dose With Berberine? ›
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- Can You Take Phentermine With Berberine? ›
- Can You Take Berberine With Methotrexate? ›
Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.
See Every Supplement That Interacts With Aspirin, Butalbital, Caffeine, Codeine Phosphate
This page covers Berberine only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Aspirin, Butalbital, Caffeine, Codeine Phosphate page lists 398 supplements it has a documented interaction with, worst first, each one explained.
The most serious there right now: 1,4-butanediol (major), Activated Charcoal (major), Asarabacca (major), Beer (major) and Danshen (major).
By severity: 17 major · 334 moderate · 47 minor.
From our pharmacist’s overview on the Aspirin, Butalbital, Caffeine, Codeine Phosphate page
“Fiorinal with Codeine packs four active drugs into one capsule, and I would treat its supplement list with genuine wariness rather than a quick skim. The aspirin component is why roughly half of the 398 ingredients on file raise bleeding risk, while the codeine and butalbital explain a second large cluster that deepens sedation, someti…”
Reviewed by 2 · Jul 18, 2026
Open the Aspirin, Butalbital, Caffeine, Codeine Phosphate interaction page
Taking Berberine as Part of a Dietary Supplement Product? Check It for Interactions
We hold 908 real supplement products containing Berberine, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Berberine. Your product may carry other ingredients that interact with Aspirin, Butalbital, Caffeine, Codeine Phosphate too, on top of Berberine — and those would not show on this page. Find your product and we’ll check every ingredient on its label:
Where Berberine and Aspirin, Butalbital, Caffeine, Codeine Phosphate Sit Against Everything Else
Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.
#113 of 1,452 supplements looked up here in the last 7 days
#1,795 of 2,830 medications looked up here in the last 7 days
Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.
About Berberine
What is Berberine?
- Blood sugar control
- High cholesterol
- Heart and metabolic health
- Digestive upset
- Antimicrobial support
- Weight management
Berberine is a yellow plant compound that has shown promise for lowering blood sugar and cholesterol in some studies, but the quality of research varies and it is not a replacement for prescribed medicine. It can cause stomach upset and should be avoided during pregnancy and breastfeeding. Always check with your pharmacist or doctor before starting it, especially if you take other medications.
Other Drugs & Berberine
Browse every other medication we’ve checked against Berberine — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
1 interaction
1,158 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Nifedipine ›
- Ibuprofen ›
- Diphenhydramine ›
- Aspirin ›
- Hydrocortisone ›
- Insulin (rdna) ›
- Naproxen ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Lidocaine ›
- Guaifenesin ›
- Hydrochlorothiazide ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Dexamethasone ›
- Flurazepam ›
- Glyburide ›
- Insulin (pork) ›
- Triazolam ›
- Zopiclone ›
- Colchicine ›
- Fentanyl ›
- Flurbiprofen ›
- Oxybutynin ›
- Oxycodone ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Dipyridamole ›
- Doxorubicin ›
- Fluticasone ›
- Formoterol ›
- Hydralazine ›
- Indomethacin ›
- Insulin (human) ›
- Miconazole ›
- Morphine Sulfate ›
- Nitrazepam ›
- Trimipramine ›
- Amphetamine ›
- Buprenorphine ›
- Conjugated Estrogens ›
- Diazepam ›
- Everolimus ›
- Ivabradine ›
- Ketoprofen ›
Showing 60 of 1,158 moderate interactions — see all 1,158 on the Berberine page.
No interaction 1,670 drugs checked — show the list
We also checked Berberine against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Methylphenidate ›
- Ivermectin ›
- Rosuvastatin ›
- Acetaminophen ›
- Escitalopram ›
- Docusate ›
- Valacyclovir ›
- Hydroxyurea ›
- Sumatriptan ›
- Amoxicillin ›
- Bupropion ›
- Bendamustine ›
- Acyclovir ›
- Methotrexate ›
- Doxycycline ›
- Azithromycin ›
- Isotretinoin ›
- Methylene Blue ›
- Ciprofloxacin ›
- Levothyroxine, Liothyronine ›
- Cephalexin ›
- Cyclopentolate ›
- Roxithromycin ›
- Pegunigalsidase Alfa-iwxj ›
- Ezetimibe ›
- Daptomycin ›
- Levothyroxine Sodium ›
- Dexmethylphenidate ›
- Amoxicillin, Clavulanate Potassium ›
- Hexobarbitone ›
- Thyroid Hormone ›
- Carbidopa, Levodopa ›
- Factor 7a ›
- Levodopa ›
- Hethylphenidate Hcl ›
- Mitomycin ›
- Lenvatinib ›
- Cefaclor ›
- Azelaic Acid ›
- Phenylephrine ›
- Hydroxychloroquine ›
- Dirithromycin ›
- Vancomycin ›
- Pizotifen ›
- Triptorelin ›
- Bentoquatam ›
- Digoxin ›
- Ribavirin Aerosol ›
- Dextrothyroxine ›
- Procainamide ›
- Ropinirole ›
- Tocainide ›
- Rocuronium ›
- Mitomycin C ›
- Paracetamol ›
- Lomustine ›
- Digitoxin ›
- Chenodiol ›
- Salbutamol Sulfate ›
Showing the 60 most looked-up of 1,670 medications checked with no known interaction — see the full Berberine list.
Sources & How We Checked
Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for vitamins, herbs and supplements — the basis for our interaction data.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for the medication overviews.
- NIH Dietary Supplement Label Database (DSLD) — Official supplement product labels.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.
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
Aspirin, Butalbital, Caffeine, Codeine Phosphate Is Linked to Lower Levels of 4 Nutrients
Natural Medicines records Aspirin, Butalbital, Caffeine, Codeine Phosphate as a medicine that can lower these. This is not an interaction with Berberine — it is a separate effect of the medicine, and it is a reason some people are advised to supplement rather than to avoid one:
Read the full Aspirin, Butalbital, Caffeine, Codeine Phosphate nutrient depletion report ›
Depletion records come from the licensed Natural Medicines database. Do not start a supplement on the strength of this page — ask your pharmacist or doctor whether it applies to you.
Taking Berberine and Aspirin, Butalbital, Caffeine, Codeine Phosphate Together: Common Questions
Can you take Berberine with Aspirin, Butalbital, Caffeine, Codeine Phosphate?
Why are there 4 interactions listed for Berberine and Aspirin, Butalbital, Caffeine, Codeine Phosphate?
How serious is the Berberine and Aspirin, Butalbital, Caffeine, Codeine Phosphate interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
Still Have a Question About Aspirin, Butalbital, Caffeine, Codeine Phosphate and Berberine?
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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.