Drug & supplement interaction

Boldo + Acetaminophen, Ibuprofen

Acetaminophen, Ibuprofen brand name: Combogesic.

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

Acetaminophen, Ibuprofen falls into 2 drug categories that Boldo can interact with; the most serious is rated moderate. Theoretically, taking boldo with hepatotoxic drugs might increase the risk of hepatic injury and disease.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Boldo and Acetaminophen, Ibuprofen

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Boldo interacts with whole categories of medication. Acetaminophen, Ibuprofen falls into 2 of those categories, so it can interact with Boldo in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

HEPATOTOXIC DRUGS

1 of 2

Why this applies to Acetaminophen, Ibuprofen

Acetaminophen, Ibuprofen falls under HEPATOTOXIC DRUGS — the group Boldo interacts with.

Theoretically, taking boldo with hepatotoxic drugs might increase the risk of hepatic injury and disease.
Boldo leaf contains ascaridole, a known liver toxin. Many cases of hepatotoxicity, including elevated liver transaminase levels and jaundice, have been reported in patients taking boldo.
Severity Moderate Likelihood Possible Evidence D

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

Here's the simple version. Combogesic combines two pain relievers, acetaminophen and ibuprofen. Acetaminophen in particular is hard on the liver if you take too much or stack it with other liver stressors. Boldo leaf contains a compound called ascaridole that can be toxic to the liver on its own, and people have developed elevated liver enzymes and even jaundice from it. So the worry is that combining the two could add up and raise your chance of liver irritation or damage.

I'll be honest that this is mostly theoretical and based on scattered case reports, not strong studies, so it's a caution rather than a guarantee. Still, since both can stress the liver, it's worth a quick chat with your pharmacist or doctor before pairing them, especially if you drink alcohol or have any liver concerns.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Piscaglia F, Leoni S, Venturi A, et al. Caution in the use of boldo in herbal laxatives: a case of hepatotoxicity. Scand J Gastroenterol 2005;40:236-9. PubMed
  2. Ribeiro RJ, Silvestre C, Duarte C. Hidden risks of alternative medicines: a case of boldo-induced hepatotoxicity. J Diet Suppl 2017;14(2):186-90. PubMed
  3. Oliveira Sá A, Pimentel T, Oliveira N. Boldo-Induced Hepatotoxicity: A Case of Unexplained Jaundice. Eur J Case Rep Intern Med 2020;7(12):002116. PubMed
Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

2 of 2

Acetaminophen, Ibuprofen also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.

Theoretically, taking boldo with anticoagulant/antiplatelet drugs might increase the risk of bleeding.
Animal and in vitro research shows that boldine, a constituent of boldo, has antiplatelet activity. In one case report, an adult taking a combination of boldo and fenugreek with warfarin experienced an increase in international normalized ratio (INR); however, it is unclear if this effect was due to boldo, fenugreek, the combination, or another factor.
Severity Moderate Likelihood Possible Evidence D

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

Here's the thing to know about Combogesic, which pairs acetaminophen with ibuprofen. The ibuprofen half is an NSAID, and on its own it already nudges your bleeding risk up a little by making platelets stickier and slower to clot. Boldo may add to that, since lab and animal studies hint that boldine (one of its compounds) can also slow platelets. Put them together and you could in theory bruise more easily or have a harder time stopping minor bleeds.

I want to be straight with you though: this is mostly theoretical, built on weak, anecdotal evidence, not solid human trials. Occasional doses likely aren't a big deal for most folks. Still, if you take Combogesic regularly or have any bleeding concerns, run the boldo idea past your pharmacist or doctor first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Lambert J, Cormier J. Potential interaction between warfarin and boldo-fenugreek. Pharmacotherapy 2001;21:509-12. PubMed
  2. Teng, C. M., Hsueh, C. M., Chang, Y. L., Ko, F. N., Lee, S. S., and Liu, K. C. Antiplatelet effects of some aporphine and phenanthrene alkaloids in rabbits and man. J Pharm Pharmacol 1997;49(7):706-711. PubMed

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

Boldo Also Interacts With Other Medications

Boldo has 481 moderate known drug interactions in our database — the Acetaminophen, Ibuprofen one above is among them. If you take anything else, check it against the full list below.

Moderate 481 No known interaction 2,349 (incl. Acetaminophen, Ibuprofen)
Taking anything else?

Check Another of Your Medications Against Boldo

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

Everything else you take

See Every Supplement That Interacts With Acetaminophen, Ibuprofen

This page covers Boldo only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Ibuprofen page lists 342 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), Danshen (major) and Piracetam (major).

By severity: 7 major · 290 moderate · 45 minor.

From our pharmacist’s overview on the Acetaminophen, Ibuprofen page

“Combogesic pairs acetaminophen with ibuprofen, so it inherits the vulnerabilities of both drugs, and its supplement list deserves real attention before you add anything to it. Of the 342 ingredients on file, 7 carry a major rating, and those are the ones to understand first.”

Reviewed by 2 · Jul 18, 2026

Open the Acetaminophen, Ibuprofen interaction page

One more smart check

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

We hold 173 real supplement products containing Boldo, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Boldo. Your product may carry other ingredients that interact with Acetaminophen, Ibuprofen too, on top of Boldo — 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 Boldo and Acetaminophen, Ibuprofen 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 Boldo
Steady interest

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

29 days ago today
Medication Acetaminophen, Ibuprofen
Top 25%

#403 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 Boldo

What is Boldo?

Boldo
  • Indigestion and bloating
  • Mild constipation
  • Liver and gallbladder support
  • Appetite stimulation
  • Urinary complaints

Boldo is a South American shrub whose leaves are traditionally used for digestive and gallbladder complaints, but good human evidence is very limited. The leaves and oil contain ascaridole, which can be toxic to the liver, so only ascaridole-free products should be used and only for short periods. Talk to your pharmacist or doctor before trying it, and avoid it during pregnancy and breastfeeding.

Read the full Boldo monograph & all interactions
Keep checking

Other Drugs & Boldo

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

0Major
481Moderate
0Minor
2,348No known interaction
481 Moderate 2,348 No interaction
Moderate

481 interactions

Showing 60 of 481 moderate interactions — see all 481 on the Boldo page.

No interaction 2,348 drugs checked — show the list

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

Showing the 60 most looked-up of 2,348 medications checked with no known interaction — see the full Boldo list.

See the full Boldo interactions page
See every supplement checked against Acetaminophen, Ibuprofen, 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
Boldo monograph › Uses, safety, and every drug interaction in one place Acetaminophen, Ibuprofen supplement interactions › Every supplement checked against Acetaminophen, Ibuprofen, 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 Boldo and Acetaminophen, Ibuprofen Together: Common Questions

Can you take Boldo with Acetaminophen, Ibuprofen?
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.
Why are there 2 interactions listed for Boldo and Acetaminophen, Ibuprofen?
Acetaminophen, Ibuprofen belongs to more than one drug category, and Boldo interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Boldo and Acetaminophen, Ibuprofen 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

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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.