Black Cohosh + Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine
Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine brand name: Vicks NyQuil.
Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine falls into 3 drug categories that Black Cohosh can interact with; the most serious is rated moderate. Some research suggests that black cohosh might inhibit CYP2D6, but there is conflicting evidence.
Read the full interaction reportBlack Cohosh and Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine
These two interact in 3 distinct ways. Each one is explained separately below.
Why Are There 3 Interactions?
Black Cohosh interacts with whole categories of medication. Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine falls into 3 of those categories, so it can interact with Black Cohosh in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES
1 of 3Why this applies to Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine
Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES — the group Black Cohosh interacts with.
Some clinical research suggests that black cohosh might modestly inhibit CYP2D6 and increase levels of drugs metabolized by this enzyme. However, contradictory clinical research shows a specific black cohosh product (Remifemin, Enzymatic Therapy) 40 mg twice daily does not significantly inhibit metabolism of a CYP2D6 substrate in healthy study volunteers. Until more is known, use black cohosh cautiously in patients taking drugs metabolized by CYP2D6.
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.
In this NyQuil combo, the ingredient that matters here is dextromethorphan (the cough suppressant). Your body relies on a liver enzyme called CYP2D6 to clear it. Black cohosh might slow that enzyme down a little, which could let dextromethorphan build up more than usual. If that happens, you may feel extra drowsy, dizzy, or lightheaded, and at higher levels some people notice mild confusion or restlessness.
That said, the evidence is genuinely mixed. Some studies show a modest effect, while others show no meaningful change at all, so this is a possible interaction, not a sure thing. NyQuil already makes most folks sleepy, so go easy and avoid driving. If you take black cohosh regularly, just run it by your pharmacist or doctor first.
- Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes. Clin Pharmacol Ther 2005;77:415-26. PubMed
- Gurley BJ, Swain A, Hubbard MA, et al. Clinical assessement of CYP2D6-mediated herb-drug interactions in humans: Effects of milk-thistle, black cohosh, goldenseal, kava kava, St. John's wort, and Echinacea. Mol Nutr Food Res 2008;52:755-63.
HEPATOTOXIC DRUGS
2 of 3Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine also falls under HEPATOTOXIC DRUGS.
There is concern that black cohosh might be linked to cases of liver failure and autoimmune hepatitis.
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.
The piece of NyQuil that matters here is the acetaminophen (the same active ingredient as Tylenol). Acetaminophen is processed by your liver, and in higher or frequent doses it can stress that organ. Black cohosh has its own rare reports of liver trouble, including liver inflammation and, very uncommonly, liver failure. The worry is that combining the two could add up and put a little extra strain on your liver.
I want to be honest: this concern is theoretical and based on scattered case reports, not strong studies. Occasional, as-directed NyQuil use is unlikely to be a problem for most people. Still, if you take black cohosh regularly, have any liver condition, or drink alcohol often, check with your pharmacist or doctor first and watch for yellowing skin, dark urine, or belly pain.
- Whiting PW, Clouston A, Kerlin P. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2002;177:440-3. PubMed
- Lontos S, Jones RM, Angus PW, Gow PJ. Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust 2003;179:390-1.. DOI
- Cohen SM, O'Connor AM, Hart J, et al. Autoimmune hepatitis associated with the use of black cohosh: a case study. Menopause 2004;11:575-7. PubMed
- Vitetta L, Thomsen M, Sali A. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2003;178:411-2.. PubMed
- Cohen B, Schardt D. Center for Science in the Public Interest. Letter to Food and Drug Administration. Commissioner Mark McClellan, MD, PhD. March 4, 2004.
- Levitsky J, Alli TA, Wisecarver J, Sorrell MF. Fulminant liver failure associated with the use of black cohosh. Dig Dis Sci 2005;50:538-9. PubMed
- MHRA. Black cohosh (Cimicifuga racemosa) - risk of liver problems. Herbal Safety News July 2006. Available at: http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary= true&ssDocName=CON2024131&ssTargetNodeId=663.
- Lynch CR, Folkers ME, Hutson WR. Fulminant hepatic failure associated with the use of black cohosh: a case report. Liver Transpl 2006;12:989-92. PubMed
- Brar HS, Marathi R. Case of cholestatic drug-induced liver injury (DILI) associated with black cohosh. BMJ Case Rep 2021;14(5):e240408. PubMed
SEROTONERGIC DRUGS
3 of 3Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine also falls under SEROTONERGIC DRUGS.
Black cohosh might increase the risk of serotonin syndrome when combined with other serotonergic drugs. Black cohosh acts as an agonist at several serotonin receptor subtypes and might interact with other serotonergic medications. In one case, a 55-year-old female who had been on stable treatment with sertraline 50 mg and duloxetine 60 mg daily developed serotonin syndrome after taking black cohosh extract 40 mg daily for 3 days.
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.
The piece of NyQuil that matters here is the dextromethorphan (the cough suppressant). It nudges serotonin activity in the brain, and black cohosh appears to do something similar at certain serotonin receptors. Stack the two and you could, in theory, push serotonin a little too high. That can show up as agitation, shivering, a racing heart, sweating, muscle twitching, or feeling flushed and restless.
I want to be honest about the strength of this, though. The concern comes mainly from lab work and a single case report, so it is more of a caution than a sure thing. The acetaminophen, doxylamine, and pseudoephedrine parts are not the issue. Still, if you take an antidepressant or use NyQuil often, check with your pharmacist before adding black cohosh.
- Dernbach MR, Carpenter JE, Shah N, Carter GB. Black Cohosh Interactions with Prescription Medications Associated with Serotonin Toxicity and Rhabdomyolysis: A Case Report. J Emerg Med 2024;66(5):e592-e596. PubMed
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.
Black Cohosh Also Interacts With Other Medications
Black Cohosh has 635 moderate, 16 minor known drug interactions in our database — the Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Black Cohosh
We haven’t checked that one against Black Cohosh yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Black Cohosh. Pick one to open its full report.
See Every Supplement That Interacts With Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine
This page covers Black Cohosh only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine page lists 286 supplements it has a documented interaction with, worst first, each one explained.
The most serious there right now: Activated Charcoal (major), Asarabacca (major), Beer (major), Ephedra (major) and Grapefruit (major).
By severity: 14 major · 227 moderate · 45 minor.
Open the Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine interaction page
Taking Black Cohosh as Part of a Dietary Supplement Product? Check It for Interactions
We hold 1,472 real supplement products containing Black Cohosh, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Black Cohosh. Your product may carry other ingredients that interact with Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine too, on top of Black Cohosh — and those would not show on this page. Find your product and we’ll check every ingredient on its label:
Where Black Cohosh and Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine 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.
#154 of 1,452 supplements looked up here in the last 7 days
#789 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 Black Cohosh
What is Black Cohosh?
- Hot flashes and night sweats
- Other menopause symptoms
- Mood changes during menopause
- Premenstrual syndrome (PMS)
- Menstrual cramps
Black cohosh is a North American plant most often used to ease menopause symptoms like hot flashes, but the research is mixed and far from settled. It is generally well tolerated for short-term use, though rare reports of liver problems mean you should talk with your pharmacist or doctor before trying it, especially if you have liver disease.
Other Drugs & Black Cohosh
Browse every other medication we’ve checked against Black Cohosh — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
635 interactions
- Diclofenac Sodium ›
- Nifedipine ›
- Methylphenidate ›
- Doxycycline ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Tetracycline ›
- Lidocaine ›
- Amoxicillin ›
- Testosterone ›
- Verapamil ›
- Fenofibrate ›
- Levonorgestrel ›
- Quinidine ›
- Cyclosporine ›
- Glyburide ›
- Methyltestosterone ›
- Ciprofloxacin ›
- Fentanyl ›
- Oxycodone ›
- Phenytoin ›
- Allopurinol ›
- Carbamazepine ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Formoterol ›
- Morphine Sulfate ›
- Phenylephrine ›
- Trimipramine ›
- Acetaminophen ›
- Amphetamine ›
- Buprenorphine ›
- Conjugated Estrogens ›
- Lofepramine ›
- Methotrexate ›
- Nitrofurantoin ›
- Nortriptyline ›
- Ofloxacin ›
- Propoxyphene ›
- Rifampin ›
- Selegiline ›
- Sumatriptan Succinate ›
- Testosterone Undecanoate ›
- Acarbose ›
- Aripiprazole ›
- Cyclobenzaprine ›
- Dapsone ›
- Desipramine ›
- Doxepin ›
- Doxycycline Hyclate ›
- Duloxetine ›
- Eltrombopag ›
- Fluphenazine ›
- Interferon Alfa-2b ›
- Interferon Beta-1b ›
- Isoniazid ›
- Itraconazole ›
- Levofloxacin ›
- Metoclopramide ›
Showing 60 of 635 moderate interactions — see all 635 on the Black Cohosh page.
16 interactions
No interaction 2,178 drugs checked — show the list
We also checked Black Cohosh against these medications and found no known interaction in our sources. Open any page to confirm.
- Apixaban ›
- Levothyroxine ›
- Amlodipine ›
- Warfarin ›
- Losartan Potassium ›
- Aspirin ›
- Ivermectin ›
- Rivaroxaban ›
- Tadalafil ›
- Clopidogrel ›
- Valacyclovir ›
- Docusate ›
- Hydroxyurea ›
- Abemaciclib ›
- Ibuprofen ›
- Semaglutide ›
- Tirzepatide ›
- Warfarin Sodium ›
- Prednisone ›
- Acyclovir ›
- Bupropion ›
- Metformin ›
- Lisinopril ›
- Bendamustine ›
- Lamotrigine ›
- Gabapentin ›
- Pregabalin ›
- Isotretinoin ›
- Azithromycin ›
- Clonazepam ›
- Omeprazole ›
- Amlodipine Besylate ›
- Letrozole ›
- Naproxen ›
- Levothyroxine, Liothyronine ›
- Diazepam ›
- Cyclopentolate ›
- Candesartan Cilexetil ›
- Mannitol ›
- Cephalexin ›
- Roxithromycin ›
- Pegunigalsidase Alfa-iwxj ›
- Acetaminophen, Dextromethorphan, Doxylamine ›
- Daptomycin ›
- Finasteride ›
- Hexobarbitone ›
- Valsartan ›
- Levothyroxine Sodium ›
- Levetiracetam ›
- Alprazolam ›
- Amlodipine Besylate, Benazepril ›
- Bromocriptine ›
- Dutasteride ›
- Mitomycin ›
- Minoxidil ›
- Cefaclor ›
- Factor 7a ›
- Carbidopa, Levodopa ›
- Thyroid Hormone ›
- Ezetimibe ›
Showing the 60 most looked-up of 2,178 medications checked with no known interaction — see the full Black Cohosh 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
Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine Is Linked to Lower Levels of One Nutrient
Natural Medicines records Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine as a medicine that can lower these. This is not an interaction with Black Cohosh — it is a separate effect of the medicine, and it is a reason some people are advised to supplement rather than to avoid one:
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 Black Cohosh and Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine Together: Common Questions
Can you take Black Cohosh with Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine?
Why are there 3 interactions listed for Black Cohosh and Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine?
How serious is the Black Cohosh and Acetaminophen, Dextromethorphan, Doxylamine, Pseudoephedrine interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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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.