Drug & supplement interaction

Bitter Orange + Ephedrine Sulfate, Hydroxyzine, Theophylline

Ephedrine Sulfate, Hydroxyzine, Theophylline brand name: Hydroxy Compound.

Moderate Interaction
Medically reviewed by · Updated October 2026
The bottom line Moderate

Bitter Orange has a moderate interaction with Ephedrine Sulfate, Hydroxyzine, Theophylline. Theoretically, bitter orange might increase the risk of hypertension and adverse cardiovascular effects when taken with stimulant drugs.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceB
What do Severity, Likelihood & Evidence mean?
Know someone taking this? Share
Facebook Post Reddit Email
On this page
Interaction report

Bitter Orange and Ephedrine Sulfate, Hydroxyzine, Theophylline

Here is the interaction we found between these two, with the evidence behind it.

Moderate

STIMULANT DRUGS

Why this applies to Ephedrine Sulfate, Hydroxyzine, Theophylline

Ephedrine Sulfate, Hydroxyzine, Theophylline falls under STIMULANT DRUGS — the group Bitter Orange interacts with.

Theoretically, bitter orange might increase the risk of hypertension and adverse cardiovascular effects when taken with stimulant drugs.
Bitter orange appears to have stimulant effects.
Severity Moderate Likelihood Possible Evidence B

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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

This combination product already contains ephedrine and theophylline, both of which are stimulants in their own right. Bitter orange brings its own stimulant compound, synephrine, to the table. When you stack stimulants on top of each other, their effects can add up. That means a real possibility of a faster heart rate, palpitations, a rise in blood pressure, jitteriness, trouble sleeping, or anxiety. With theophylline especially, layering stimulants can nudge you toward an irregular or pounding heartbeat.

This is considered a moderate, theoretical-leaning concern, so it is not a guaranteed problem, but it is worth taking seriously, particularly if you have heart issues or high blood pressure. Please check with your pharmacist or doctor before pairing bitter orange with this medicine.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Penzak SR, Jann MW, Cold JA, et al. Seville (sour) orange juice: synephrine content and cardiovascular effects in normotensive adults. J Clin Pharmacol 2001;41:1059-63. PubMed
  2. Keogh AM, Baron DW. Sympathomimetic abuse and coronary artery spasm. Br Med J 1985;291:940.

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • 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.
Evidence the quality of the studies behind the rating (graded A–D)
  • 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.

Keep it in perspective

Bitter Orange Also Interacts With Other Medications

Bitter Orange has 10 major, 877 moderate, 71 minor known drug interactions in our database — the Ephedrine Sulfate, Hydroxyzine, Theophylline one above is one of them. If you take anything else, check it against the full list below.

Major 10 Moderate 877 Minor 71 No known interaction 1,872 (incl. Ephedrine Sulfate, Hydroxyzine, Theophylline)
Taking anything else?

Check Another of Your Medications Against Bitter Orange

Covers the 2,830 medications we’ve checked against Bitter Orange. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Ephedrine Sulfate, Hydroxyzine, Theophylline

This page covers Bitter Orange only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ephedrine Sulfate, Hydroxyzine, Theophylline page lists 199 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Ephedra (major), Henbane (major), Peyote (major) and Rauvolfia Vomitoria (major).

By severity: 7 major · 153 moderate · 39 minor.

From our pharmacist’s overview on the Ephedrine Sulfate, Hydroxyzine, Theophylline page

“Someone taking Hydroxy Compound (ephedrine sulfate, hydroxyzine, and theophylline) for breathing problems is juggling three drugs at once, and the supplement list shows it: 199 interacting ingredients, seven of them rated major, and this page deserves genuine seriousness. The sharpest risks come from stimulant botanicals, ephedra above…”

Reviewed by 2 · Jul 18, 2026

Open the Ephedrine Sulfate, Hydroxyzine, Theophylline interaction page

One more smart check

Taking Bitter Orange as Part of a Dietary Supplement Product? Check It for Interactions

We hold 1,000 real supplement products containing Bitter Orange, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Bitter Orange. Your product may carry other ingredients that interact with Ephedrine Sulfate, Hydroxyzine, Theophylline too, on top of Bitter Orange — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Bitter Orange and Ephedrine Sulfate, Hydroxyzine, Theophylline 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.

Supplement Bitter Orange
Top 25%

#169 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Ephedrine Sulfate, Hydroxyzine, Theophylline
Top 5%

#56 of 2,830 medications looked up here in the last 7 days

29 days ago today

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.

Supplement

About Bitter Orange

What is Bitter Orange?

Bitter Orange
  • Weight loss
  • Athletic performance and energy
  • Digestive upset
  • Appetite control
  • Aromatherapy for stress (neroli oil)

Bitter orange is a citrus fruit whose extracts contain synephrine, a mild stimulant often added to weight-loss and energy supplements. Evidence that it works for weight loss or performance is limited, and because it can raise heart rate and blood pressure, people with heart problems, high blood pressure, or who are pregnant should avoid it. Talk to your pharmacist or doctor before using it, especially if you take other stimulants.

Read the full Bitter Orange monograph & all interactions
Keep checking

Other Drugs & Bitter Orange

Browse every other medication we’ve checked against Bitter Orange — both the ones with a known interaction and the ones without. Select any drug for the full detail.

10Major
877Moderate
71Minor
1,871No known interaction
10 Major 877 Moderate 71 Minor 1,871 No interaction
Major

10 interactions

Moderate

877 interactions

Showing 60 of 877 moderate interactions — see all 877 on the Bitter Orange page.

Minor

71 interactions

Showing 60 of 71 minor interactions — see all 71 on the Bitter Orange page.

No interaction 1,871 drugs checked — show the list

We also checked Bitter Orange against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 1,871 medications checked with no known interaction — see the full Bitter Orange list.

See the full Bitter Orange interactions page
See every supplement checked against Ephedrine Sulfate, Hydroxyzine, Theophylline, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

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

Keep exploring
Bitter Orange monograph › Uses, safety, and every drug interaction in one place Ephedrine Sulfate, Hydroxyzine, Theophylline supplement interactions › Every supplement checked against Ephedrine Sulfate, Hydroxyzine, Theophylline, ranked by severity Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Bitter Orange and Ephedrine Sulfate, Hydroxyzine, Theophylline Together: Common Questions

Can you take Bitter Orange with Ephedrine Sulfate, Hydroxyzine, Theophylline?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Bitter Orange and Ephedrine Sulfate, Hydroxyzine, Theophylline interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Ephedrine Sulfate, Hydroxyzine, Theophylline and Bitter Orange?

Our pharmacists answer your medication & supplement questions — free.

Ask a pharmacist

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.