Cannabis + Aspirin, Butalbital, Caffeine, Codeine Phosphate
Aspirin, Butalbital, Caffeine, Codeine Phosphate brand name: Fiorinal w/ Codeine.
Aspirin, Butalbital, Caffeine, Codeine Phosphate falls into 3 drug categories that Cannabis can interact with; the most serious is rated moderate. Theoretically, cannabis might have additive effects if used with other CNS depressants.
Read the full interaction reportCannabis and Aspirin, Butalbital, Caffeine, Codeine Phosphate
These two interact in 3 distinct ways. Each one is explained separately below.
Why Are There 3 Interactions?
Cannabis interacts with whole categories of medication. Aspirin, Butalbital, Caffeine, Codeine Phosphate falls into 3 of those categories, so it can interact with Cannabis in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
CNS DEPRESSANTS
1 of 3Why this applies to Aspirin, Butalbital, Caffeine, Codeine Phosphate
Aspirin, Butalbital, Caffeine, Codeine Phosphate falls under CNS DEPRESSANTS — the group Cannabis interacts with.
Cannabis can have CNS depressant effects. Combining cannabis with other CNS depressants might result in additive or synergistic effects. A small clinical trial in healthy adults shows that inhaling a high-grade cannabis (Bedrocan International B.V., Veendam, The Netherlands) 100 mg, containing delta-9-tetrahydrocannabinol 21.8% and cannabinol 0.1%, modestly increases subjective feelings of sedation when compared with cannabis alone.
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 combination here, Fiorinal with Codeine, packs two ingredients that calm the brain: butalbital (a barbiturate) and codeine (an opioid). Cannabis adds its own sedating, mind-slowing effects on top of those. So this is really about overlap, not about cannabis changing how the medicine is broken down. Putting them together can stack up the drowsiness.
What might that look like? More grogginess, dizziness, trouble concentrating, slowed reaction time, and in heavier combinations, slowed breathing. That makes driving or operating machinery risky. To be fair, this caution is theoretical, based on how these substances act rather than strong studies, and one small trial only showed a modest bump in sedation. Still, play it safe and check with your pharmacist or doctor before mixing them.
- Marinol Prescribing Information. Solvay Pharmaceuticals, Rev March 2008. Available at: http://www.solvaypharmaceuticals-us.com/static/wma/pdf/1/3/2/5/0/004InsertText500012RevMar2008.pdf (Accessed 2 July 2009).
- Hollister, L. E. Interactions of cannabis with other drugs in man. NIDA Res.Monogr 1986;68:110-116. DOI
- van Dam CJ, van der Schrier R, van Velzen M, et al. Inhaled Delta(9)-tetrahydrocannabinol does not enhance oxycodone-induced respiratory depression: randomised controlled trial in healthy volunteers. Br J Anaesth 2023;130(4):485-493.
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
2 of 3Aspirin, Butalbital, Caffeine, Codeine Phosphate also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
In vitro research shows that cannabis can inhibit the activity of CYP3A4 enzymes, which might decrease the metabolism of CYP3A4 substrates. In vitro research also shows that cannabis extracts modestly inhibit the CYP3A4 metabolism of testosterone; extracts providing the specific cannabinoids CBD and cannabigerol (CBG) had stronger inhibitory effects than extracts containing THC and CBD.
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 is a mix of four ingredients, and a couple of them lean on the liver enzyme CYP3A4 to get cleared, including butalbital (the barbiturate) and codeine. The lab-only finding here is that cannabis may slow down CYP3A4. In theory, that could let these pieces linger a bit longer, which might add to drowsiness, dizziness, foggy thinking, slowed breathing, or constipation.
One wrinkle worth knowing: codeine is a prodrug that the body must activate (mainly through a different enzyme, CYP2D6) to relieve pain, so this particular interaction is mostly about the sedating side, not pain relief. Keep in mind this is based only on test-tube research, so it is theoretical and far from certain. Still, since both cannabis and this medicine can cause sedation on their own, please run it by your pharmacist or doctor first.
- Pellinen, P., Honkakoski, P., Stenback, F., Niemitz, M., Alhava, E., Pelkonen, O., Lang, M. A., and Pasanen, M. Cocaine N-demethylation and the metabolism-related hepatotoxicity can be prevented by cytochrome P450 3A inhibitors. Eur.J Pharmacol 1-3-1994;2 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
ANTICOAGULANT/ANTIPLATELET DRUGS
3 of 3Aspirin, Butalbital, Caffeine, Codeine Phosphate also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.
In vitro research shows that the cannabis constituents delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) inhibit platelet aggregation.
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 Fiorinal with Codeine I want to focus on here is the aspirin. Aspirin already thins your blood by making your platelets (the cells that form clots) less sticky. The concern on file is that cannabis may do a little of the same thing. In lab studies, THC and CBD slowed platelets from clumping together, so stacking the two could, in theory, raise your bleeding risk a bit.
I want to be honest about how soft this evidence is. It comes from test-tube and animal research only, not from real patients, so it's more of a caution than a proven problem. Still, watch for things like easy bruising, nosebleeds, bleeding gums, or stomach upset from the aspirin. If you notice any of that, or before mixing the two regularly, check in with your pharmacist or doctor.
- Levy, R., Schurr, A., Nathan, I., Dvilanski, A., and Livne, A. Impairment of ADP-induced platelet aggregation by hashish components. Thromb.Haemost. 12-31-1976;36(3):634-640. DOI
- Formukong, E. A., Evans, A. T., and Evans, F. J. The inhibitory effects of cannabinoids, the active constituents of Cannabis sativa L. on human and rabbit platelet aggregation. J.Pharm.Pharmacol. 1989;41(10):705-709.
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.
Cannabis Also Interacts With Other Medications
Cannabis has 2 major, 1,108 moderate, 25 minor 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 Cannabis
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Covers the 2,830 medications we’ve checked against Cannabis. Pick one to open its full report.
Questions About Cannabis 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 Cannabis 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:
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 Cannabis 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 Cannabis as Part of a Dietary Supplement Product? Check It for Interactions
We hold 21 real supplement products containing Cannabis, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Cannabis. Your product may carry other ingredients that interact with Aspirin, Butalbital, Caffeine, Codeine Phosphate too, on top of Cannabis — and those would not show on this page. Find your product and we’ll check every ingredient on its label:
Where Cannabis 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.
#226 of 1,452 supplements looked up here in the last 7 days
#311 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 Cannabis
What is Cannabis?
- Chronic pain
- Nausea and vomiting from chemotherapy
- Muscle spasticity (e.g., multiple sclerosis)
- Anxiety and stress
- Sleep problems
- Appetite stimulation
Cannabis contains many active compounds, mainly THC (which causes a 'high') and CBD (which does not). Some uses, such as chemotherapy-related nausea, certain seizure disorders, and muscle spasticity, have meaningful evidence, while many other popular uses are not well proven. It can cause real side effects and impairment, so talk to your doctor or pharmacist and follow your local laws before using it.
Other Drugs & Cannabis
Browse every other medication we’ve checked against Cannabis — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
2 interactions
1,108 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Theophylline ›
- Nifedipine ›
- Ibuprofen ›
- Metronidazole ›
- Diphenhydramine ›
- Aspirin ›
- Hydrocortisone ›
- Naproxen ›
- Doxycycline ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Tetracycline ›
- Lidocaine ›
- Ranitidine ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Fenofibrate ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Flurazepam ›
- Glyburide ›
- Triazolam ›
- Zopiclone ›
- Ciprofloxacin ›
- Colchicine ›
- Fentanyl ›
- Flurbiprofen ›
- Oxybutynin ›
- Oxycodone ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Triamcinolone ›
- Apomorphine ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Dipyridamole ›
- Doxorubicin ›
- Fluticasone ›
- Formoterol ›
- Indomethacin ›
- Miconazole ›
- Morphine Sulfate ›
- Nitrazepam ›
- Trimipramine ›
- Acetaminophen ›
- Buprenorphine ›
- Conjugated Estrogens ›
Showing 60 of 1,108 moderate interactions — see all 1,108 on the Cannabis page.
25 interactions
- Fluphenazine ›
- Asenapine ›
- Clozapine ›
- Prochlorperazine ›
- Acetophenazine ›
- Butaperazine ›
- Carphenazine ›
- Chlorprothixene ›
- Isopropamide Iodide ›
- Mesoridazine Besylate ›
- Methotrimeprazine Maleate ›
- Molindone ›
- Olanzapine ›
- Paliperidone ›
- Paliperidone Palmitate ›
- Pericyazine ›
- Perphenazine ›
- Piperacetazine ›
- Promazine ›
- Sertindole ›
- Thiothixene ›
- Trifluoperazine ›
- Triflupromazine ›
- Isopropamide, Trifluoperazine ›
- Isopropamide, Prochlorperazine ›
No interaction 1,694 drugs checked — show the list
We also checked Cannabis against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Methylphenidate ›
- Metoprolol ›
- Rosuvastatin ›
- Escitalopram ›
- Docusate ›
- Tirzepatide ›
- Hydroxyurea ›
- Valacyclovir ›
- Methamphetamine ›
- Semaglutide ›
- Sumatriptan ›
- Lisdexamfetamine ›
- Metformin ›
- Amoxicillin ›
- Lisinopril ›
- Bupropion ›
- Methotrexate ›
- Bendamustine ›
- Isotretinoin ›
- Amphetamine ›
- Acyclovir ›
- Azithromycin ›
- Dextroamphetamine ›
- Methylene Blue ›
- Duloxetine ›
- Levothyroxine, Liothyronine ›
- Bisoprolol ›
- Candesartan Cilexetil ›
- Cyclopentolate ›
- Cephalexin ›
- Amoxicillin, Clavulanate Potassium ›
- Mannitol ›
- Ezetimibe ›
- Levothyroxine Sodium ›
- Dexmethylphenidate ›
- Pegunigalsidase Alfa-iwxj ›
- Spironolactone ›
- Thyroid Hormone ›
- Daptomycin ›
- Carbidopa, Levodopa ›
- Mitomycin ›
- Levodopa ›
- Venlafaxine ›
- Factor 7a ›
- Cefaclor ›
- Minoxidil ›
- Bentoquatam ›
- Hethylphenidate Hcl ›
- Azelaic Acid ›
- Nortriptyline ›
- Lenvatinib ›
- Pizotifen ›
- Phenylephrine ›
- Hydroxychloroquine ›
- Rocuronium ›
- Salbutamol Sulfate ›
- Insulin Degludec, Liraglutide ›
- Alglucosidase Alpha ›
- Flutemetamol F-18 ›
Showing the 60 most looked-up of 1,694 medications checked with no known interaction — see the full Cannabis 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 Cannabis — 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 Cannabis and Aspirin, Butalbital, Caffeine, Codeine Phosphate Together: Common Questions
Can you take Cannabis with Aspirin, Butalbital, Caffeine, Codeine Phosphate?
Why are there 3 interactions listed for Cannabis and Aspirin, Butalbital, Caffeine, Codeine Phosphate?
How serious is the Cannabis and Aspirin, Butalbital, Caffeine, Codeine Phosphate interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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