Cannabidiol (cbd) + Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine
Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine brand name: Theracaps.
Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine falls into 5 drug categories that Cannabidiol (cbd) can interact with; the most serious is rated moderate. Theoretically, cannabidiol might increase levels of drugs metabolized by CYP2D6.
Read the full interaction reportCannabidiol (cbd) and Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine
These two interact in 5 distinct ways. Each one is explained separately below.
Why Are There 5 Interactions?
Cannabidiol (cbd) interacts with whole categories of medication. Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine falls into 5 of those categories, so it can interact with Cannabidiol (cbd) in 5 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 5Why this applies to Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine
Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES — the group Cannabidiol (cbd) interacts with.
In vitro research shows that cannabidiol inhibits CYP2D6. Theoretically, concomitant use of cannabidiol with CYP2D6 substrates might increase the risk for adverse effects from these substrates. However, a clinical crossover trial in healthy adults shows that cannabidiol does not inhibit dextromethorphan, a substrate of 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.
This combo cold-and-cough product (Theracaps) includes dextromethorphan, the cough suppressant, which your body partly clears through a liver enzyme called CYP2D6. In lab dishes, CBD can slow that enzyme down. On paper, that could let dextromethorphan build up a bit and cause more of its usual effects, like drowsiness, dizziness, or a foggy feeling.
Here's the reassuring part: this is mostly a theoretical concern. In fact, a real study in healthy people found that CBD did not meaningfully affect dextromethorphan. The other ingredients (acetaminophen, phenylpropanolamine, pyrilamine) aren't a big worry here. Still, if you plan to use both regularly, it's smart to run it by your pharmacist or doctor first.
- Yamaori S, Okamoto Y, Yamamoto I, Watanabe K. Cannabidiol, a major phytocannabinoid, as a potent atypical inhibitor for CYP2D6. Drug Metab Dispos 2011;39(11):2049-56. PubMed
- Nasrin S, Watson CJW, Perez-Paramo YX, Lazarus P. Cannabinoid Metabolites as Inhibitors of Major Hepatic CYP450 Enzymes, with Implications for Cannabis-Drug Interactions. Drug Metab Dispos 2021;49(12):1070-1080. PubMed
- Bansal S, Zamarripa CA, Spindle TR, et al. Evaluation of Cytochrome P450-Mediated Cannabinoid-Drug Interactions in Healthy Adult Participants. Clin Pharmacol Ther 2023.
CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES
2 of 5Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine also falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES.
In vitro research shows that cannabidiol inhibits CYP1A2. Furthermore, clinical studies show that cannabidiol may inhibit the metabolism of caffeine, a CYP1A2 substrate. Two pharmacokinetic studies in healthy adults show that taking cannabidiol dosed 640 mg once up to 750 twice daily increases the area under the curve of caffeine. However, results are mixed over whether cannabidiol impacts peak serum levels of caffeine.
Interaction 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..
This Theracaps combo is a cold and cough product, and the piece worth talking about here is the dextromethorphan (the cough suppressant). CBD can slow down a liver enzyme called CYP1A2, which is one of the pathways that helps clear certain medicines. When that pathway runs slower, a drug can build up a bit more than usual.
In practice, that might mean stronger or longer-lasting effects from the dextromethorphan, like extra drowsiness, dizziness, or a foggy, off feeling. None of these ingredients are prodrugs that get switched on by this enzyme, so the concern is more medicine, not less. For a short-term cold remedy this usually isn't a big deal, but if you use CBD regularly, check with your pharmacist or doctor first before combining them.
- Yamaori S, Kushihara M, Yamamoto I, Watanabe K. Characterization of major phytocannabinoids, cannabidiol and cannabinol, as isoform-selective potent inhibitors of human CYP1 enzymes. Biochem Pharmacol 2010;79(11):1691-8.
- Thai C, Tayo B, Critchley D. A Phase 1 Open-Label, Fixed-Sequence Pharmacokinetic Drug Interaction Trial to Investigate the Effect of Cannabidiol on the CYP1A2 Probe Caffeine in Healthy Subjects. Clin Pharmacol Drug Dev. 2021. PubMed
- Nasrin S, Watson CJW, Perez-Paramo YX, Lazarus P. Cannabinoid Metabolites as Inhibitors of Major Hepatic CYP450 Enzymes, with Implications for Cannabis-Drug Interactions. Drug Metab Dispos 2021;49(12):1070-1080. PubMed
- Bansal S, Zamarripa CA, Spindle TR, et al. Evaluation of Cytochrome P450-Mediated Cannabinoid-Drug Interactions in Healthy Adult Participants. Clin Pharmacol Ther 2023.
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
3 of 5Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
In vitro and animal research shows that cannabidiol inhibits CYP3A4. In human studies and case reports, cannabidiol has been associated with an increase in plasma levels of the CYP3A4 substrates zonisamide, tacrolimus, everolimus, citalopram, midazolam, and methadone.
Interaction 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..
This combo product (Theracaps) is a cold and cough medicine, and one of its ingredients, dextromethorphan, leans on CYP3A4 (and CYP2D6) to be cleared from your body. CBD can slow down CYP3A4, so dextromethorphan may build up a bit higher than usual. That could mean more drowsiness, dizziness, or feeling foggy or jittery.
The acetaminophen and the antihistamine (pyrilamine) parts aren't handled the same way, so this mainly nudges the dextromethorphan piece. For most people taking a short course of a cold medicine this is a mild, manageable concern, but if you use CBD regularly or take more than the label says, it's worth a quick chat with your pharmacist before combining them.
- Yamaori S, Ebisawa J, Okushima Y, et al. Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resorcinol moiety. Life Sci 2011;88(15-16):730-6. PubMed
- Harvey DJ. Absorption, distribution, and biotransformation of the cannabinoids. Marijuana and Medicine. 1999;91-103. DOI
- Bornheim LM, Everhart ET, Li J, Correia MA. Characterization of cannabidiol-mediated cytochrome P450 inactivation. Biochem Pharmacol 1993;45(6):1323-31. PubMed
- Gaston TE, Bebin EM, Cutter GR, Liu Y, Szaflarski JP; UAB CBD Program. Interactions between cannabidiol and commonly used antiepileptic drugs. Epilepsia. 2017 Sep;58(9):1586-92. PubMed
- Leino AD, Emoto C, Fukuda T, Privitera M, Vinks AA, Alloway RR. Evidence of a clinically significant drug-drug interaction between cannabidiol and tacrolimus. Am J Transplant. 2019;19(10):2944-2948. PubMed
- Wiemer-Kruel A, Stiller B, Bast T. Cannabidiol Interacts Significantly with Everolimus-Report of a Patient with Tuberous Sclerosis Complex. Neuropediatrics. 2019. PubMed
- Madden K, Tanco K, Bruera E. Clinically Significant Drug-Drug Interaction Between Methadone and Cannabidiol. Pediatrics. 2020;e20193256. PubMed
- Anderson LL, Doohan PT, Oldfield L, et al. Citalopram and Cannabidiol: In Vitro and In Vivo Evidence of Pharmacokinetic Interactions Relevant to the Treatment of Anxiety Disorders in Young People. J Clin Psychopharmacol. 2021. PubMed
- Nasrin S, Watson CJW, Perez-Paramo YX, Lazarus P. Cannabinoid Metabolites as Inhibitors of Major Hepatic CYP450 Enzymes, with Implications for Cannabis-Drug Interactions. Drug Metab Dispos 2021;49(12):1070-1080. PubMed
- Treyer A, Reinhardt JK, Eigenmann DE, Oufir M, Hamburger M. Phytochemical comparison of medicinal cannabis extracts and study of their CYP-mediated interactions with coumarinic oral anticoagulants. Med Cannabis Cannabinoids. 2023;6(1):21-31. PubMed
- Bansal S, Zamarripa CA, Spindle TR, et al. Evaluation of Cytochrome P450-Mediated Cannabinoid-Drug Interactions in Healthy Adult Participants. Clin Pharmacol Ther 2023.
GLUCURONIDATED DRUGS
4 of 5Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine also falls under GLUCURONIDATED DRUGS.
In vitro research shows that cannabidiol inhibits uridine diphosphoglucuronosyl transferase (UGT) 1A9 and UGT2B7, enzymes responsible for glucuronidation. Theoretically, this could decrease the clearance and increase levels of glucuronidated drugs.
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.
This combo product (Theracaps) is a cold and cough medicine that contains acetaminophen (for pain and fever), dextromethorphan (a cough suppressant), phenylpropanolamine (a decongestant), and pyrilamine (an antihistamine). The piece that matters here is acetaminophen, since the body clears a good chunk of it through a process called glucuronidation. CBD has been shown in a lab setting to slow some of the enzymes (UGT1A9 and UGT2B7) that handle this step.
In theory, that could let acetaminophen build up a bit, and at high or frequent doses acetaminophen is hard on the liver. Keep in mind this is only test-tube data, not proven in people, so it's a caution rather than an alarm. The bigger everyday tip is to avoid doubling up on acetaminophen from other products. If you use CBD regularly, just check in with your pharmacist or doctor first.
- Epidiolex (cannabidiol) prescribing information. Greenwich Biosciences, Inc., Carlsbad, CA, 2019. Available at: https://www.epidiolex.com/sites/default/files/EPIDIOLEX_Full_Prescribing_Information.pdf (accessed 5/9/2019)
CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES
5 of 5Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine also falls under CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES.
In vitro research shows that cannabidiol inhibits CYP2E1. So far, this interaction has not been reported in humans.
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.
This combo product (Theracaps) blends acetaminophen for pain and fever, dextromethorphan for cough, plus a decongestant and an antihistamine. The piece that matters here is the acetaminophen. Some of it is broken down by a liver enzyme called CYP2E1, and lab studies suggest CBD may slow that enzyme down a bit. In theory, that could let a little more acetaminophen hang around.
I'll be honest with you though: this is based only on test-tube research and has never actually been reported in people, so I wouldn't lose sleep over it. The bigger, well-known rule with acetaminophen is simply not to exceed the daily dose, since too much can stress the liver. If you use CBD regularly or take this product often, just mention it to your pharmacist so we can double-check your total acetaminophen.
- Nasrin S, Watson CJW, Perez-Paramo YX, Lazarus P. Cannabinoid Metabolites as Inhibitors of Major Hepatic CYP450 Enzymes, with Implications for Cannabis-Drug Interactions. Drug Metab Dispos 2021;49(12):1070-1080. 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.
Cannabidiol (cbd) Also Interacts With Other Medications
Cannabidiol (cbd) has 1,050 moderate known drug interactions in our database — the Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Cannabidiol (cbd)
We haven’t checked that one against Cannabidiol (cbd) yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Cannabidiol (cbd). Pick one to open its full report.
See Every Supplement That Interacts With Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine
This page covers Cannabidiol (cbd) only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine page lists 282 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 · 223 moderate · 45 minor.
From our pharmacist’s overview on the Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine page
“Of everything on this page, ephedra worries me most for anyone using Theracaps (acetaminophen, dextromethorphan, phenylpropanolamine, and pyrilamine), because the decongestant in this cold formula is itself a stimulant. Adding ephedra or any of the 44 stimulant entries can push blood pressure and heart rate to unsafe levels.”
Reviewed by 2 · Jul 18, 2026
Open the Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine interaction page
Where Cannabidiol (cbd) and Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine 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.
#437 of 1,452 supplements looked up here in the last 7 days
#127 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 Cannabidiol (cbd)
What is Cannabidiol (cbd)?
- Anxiety and stress
- Sleep problems
- Chronic pain
- Certain seizure disorders
- Inflammation
CBD is a compound from the cannabis (hemp) plant that does not cause a 'high.' It has strong evidence only for certain rare seizure disorders (as a prescription drug), while most other popular uses are still backed by limited or early research. Product quality varies a lot, so talk with your pharmacist or doctor before using it, especially if you take other medicines.
Other Drugs & Cannabidiol (cbd)
Browse every other medication we’ve checked against Cannabidiol (cbd) — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
1,050 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Theophylline ›
- Nifedipine ›
- Ibuprofen ›
- Metronidazole ›
- Diphenhydramine ›
- Hydrocortisone ›
- Naproxen ›
- Erythromycin ›
- Estradiol ›
- Propranolol ›
- Lidocaine ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Flurazepam ›
- Glyburide ›
- Triazolam ›
- Zopiclone ›
- Bupropion ›
- Ciprofloxacin ›
- Colchicine ›
- Fentanyl ›
- Flurbiprofen ›
- Isotretinoin ›
- Orphenadrine ›
- Oxybutynin ›
- Oxycodone ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Apomorphine ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Doxorubicin ›
- Fluticasone ›
- Formoterol ›
- Indomethacin ›
- Miconazole ›
- Morphine Sulfate ›
- Nitrazepam ›
- Trimipramine ›
- Acetaminophen ›
- Amphetamine ›
- Buprenorphine ›
- Conjugated Estrogens ›
- Diazepam ›
- Everolimus ›
- Griseofulvin ›
- Ivabradine ›
Showing 60 of 1,050 moderate interactions — see all 1,050 on the Cannabidiol (cbd) page.
No interaction 1,779 drugs checked — show the list
We also checked Cannabidiol (cbd) against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Methylphenidate ›
- Ivermectin ›
- Rosuvastatin ›
- Aspirin ›
- Tirzepatide ›
- Levothyroxine, Liothyronine ›
- Docusate ›
- Metformin ›
- Valacyclovir ›
- Hydroxyurea ›
- Sumatriptan ›
- Semaglutide ›
- Methotrexate ›
- Amoxicillin ›
- Lisinopril ›
- Azithromycin ›
- Doxycycline ›
- Acyclovir ›
- Methylene Blue ›
- Candesartan Cilexetil ›
- Amoxicillin, Clavulanate Potassium ›
- Acetylsalicylic Acid ›
- Aluminum Hydroxide, Aspirin, Magnesium Hydroxide ›
- Insulin Degludec, Liraglutide ›
- Calcium Oxybate, Magnesium Oxybate, Potassium Oxybate, Sodium Oxybate ›
- Atenolol, Chlorthalidone ›
- Bendroflumethiazide, Rauwolfia Serpentina ›
- Ezetimibe ›
- Cephalexin ›
- Avatrombopag Maleate ›
- Canagliflozin, Metformin ›
- Aspirin, Butalbital ›
- Enalapril Maleate ›
- Cyclopentolate ›
- Levodopa ›
- Daunorubicin, Cytarabine ›
- Carbidopa, Levodopa ›
- Thyroid Hormone ›
- Bismuth Subcarbonate, Calcium Carbonate, Opium ›
- Ceftolozane Sulfate, Tazobactam Sodium ›
- Mannitol ›
- Alginic Acid, Aluminum Hydroxide ›
- Hydrocortisone, Clioquinol, Pramoxine ›
- Efgartigimod Alfa-fcab ›
- Acarbose ›
- Insulin Aspart, Insulin Degludec ›
- Spironolactone ›
- Peginterferon Alfa-2a, Ribavirin ›
- Sodium Bicarbonate (otc Drug) ›
- Measles, Mumps, Rubella Virus Live ›
- Aminolevulinic Acid Hydrochloride ›
- Atropine Methyl Nitrate, Digestive Enzymes ›
- Atenolol ›
- Saxagliptin, Metformin Xr ›
- Alpha-1 Proteinase Inhibitor ›
- Tubocurarine ›
- Cytomegalovirus Immune Globulin ›
- Articaine, Epinephrine ›
- Glycerol Phenylbutyrate ›
Showing the 60 most looked-up of 1,779 medications checked with no known interaction — see the full Cannabidiol (cbd) 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, Phenylpropanolamine, Pyrilamine Is Linked to Lower Levels of One Nutrient
Natural Medicines records Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine as a medicine that can lower these. This is not an interaction with Cannabidiol (cbd) — 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 Cannabidiol (cbd) and Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine Together: Common Questions
Can you take Cannabidiol (cbd) with Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine?
Why are there 5 interactions listed for Cannabidiol (cbd) and Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine?
How serious is the Cannabidiol (cbd) and Acetaminophen, Dextromethorphan, Phenylpropanolamine, Pyrilamine 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.