Drug & supplement interaction

Chanca Piedra + Aspirin, Caffeine, Dihydrocodeine Bitartrate

Aspirin, Caffeine, Dihydrocodeine Bitartrate brand name: Synalgos DC.

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

Aspirin, Caffeine, Dihydrocodeine Bitartrate falls into 3 drug categories that Chanca Piedra can interact with; the most serious is rated moderate. Theoretically, chanca piedra might increase the risk of bleeding when used concomitantly with anticoagulant/antiplatelet drugs.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions3
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Chanca Piedra and Aspirin, Caffeine, Dihydrocodeine Bitartrate

These two interact in 3 distinct ways. Each one is explained separately below.

Why Are There 3 Interactions?

Chanca Piedra interacts with whole categories of medication. Aspirin, Caffeine, Dihydrocodeine Bitartrate falls into 3 of those categories, so it can interact with Chanca Piedra in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

1 of 3

Why this applies to Aspirin, Caffeine, Dihydrocodeine Bitartrate

Aspirin, Caffeine, Dihydrocodeine Bitartrate falls under ANTICOAGULANT/ANTIPLATELET DRUGS — the group Chanca Piedra interacts with.

Theoretically, chanca piedra might increase the risk of bleeding when used concomitantly with anticoagulant/antiplatelet drugs.
In vitro research suggests that methyl brevifolincarboxylate, a constituent isolated from chanca piedra, can inhibit platelet aggregation. This effect has not been reported in humans.
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 piece that matters with Synalgos DC: it contains aspirin, which already thins the blood a little by blocking platelets from clumping together. The concern with chanca piedra is that one of its plant compounds has slowed platelet activity in lab dishes. In theory, stacking that on top of aspirin could nudge your bleeding risk up a bit, meaning easier bruising, nosebleeds, or stomach upset and bleeding.

I want to be honest about how soft this evidence is. This effect has only shown up in test tube studies, never in actual people, so it's a theoretical caution rather than a proven problem. The caffeine and dihydrocodeine parts aren't really involved here. Still, before adding chanca piedra, run it by your pharmacist or doctor, especially if you bleed or bruise easily.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Iizuka, T., Nagai, M., Taniguchi, A., Moriyama, H., and Hoshi, K. Inhibitory effects of methyl brevifolincarboxylate isolated from Phyllanthus niruri L. on platelet aggregation. Biol.Pharm.Bull. 2007;30(2):382-384. PubMed
Moderate

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES

2 of 3

Aspirin, Caffeine, Dihydrocodeine Bitartrate also falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES.

Theoretically, chanca piedra might reduce the levels and clinical effects of CYP1A2 substrates.
In vitro research shows that chanca piedra extract increases CYP1A2 activity. Theoretically, chanca piedra might increase metabolism of CYP1A2 substrates and lower serum concentrations. This interaction has not been reported in humans.
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 piece of this combo that actually connects to chanca piedra: the caffeine in Synalgos DC is handled by a liver enzyme called CYP1A2. In lab (test tube) studies, chanca piedra seems to speed that enzyme up. In theory, that could clear caffeine a little faster, so you might get less of its usual lift, like feeling a bit more tired or noticing the medicine takes the edge off your headache pain a touch less. Honestly, this has never been reported in real people, so I wouldn't lose sleep over it.

The aspirin and dihydrocodeine parts aren't really driven by this enzyme, so I wouldn't expect chanca piedra to change their pain relief or side effects. Still, before adding this herb, run it by your pharmacist or doctor, especially since aspirin and an opioid are already in the mix.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Husain I, Abdulrahman B, Dale OR, et al. Interaction of Phyllanthus amarus extract and its lignans with human xenobiotic receptors, drug metabolizing enzymes and drug transporters. J Ethnopharmacol 2025;339:119142. PubMed
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

3 of 3

Aspirin, Caffeine, Dihydrocodeine Bitartrate also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.

Theoretically, use of chanca piedra might increase the levels and clinical effects of CYP3A4 substrates.
In vitro research shows that chanca piedra extract inhibits CYP3A4. Theoretically, chanca piedra might increase the levels of CYP3A4 substrates. This interaction has not been reported in humans.
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 situation with Synalgos DC and chanca piedra. The dihydrocodeine in this combo is partly handled by a liver enzyme called CYP3A4. Lab studies (in test tubes, not in real people) suggest chanca piedra can slow that enzyme down. In theory, that could let dihydrocodeine build up a bit, which might mean stronger opioid effects like extra drowsiness, dizziness, constipation, nausea, or slowed breathing in higher amounts.

The honest truth is this interaction has never actually been reported in humans, so it's more of a 'on paper' concern than something proven. The aspirin and caffeine pieces aren't really the issue here. Still, since this product contains an opioid, it's worth a quick chat with your pharmacist or doctor before pairing them, especially if you notice feeling unusually sleepy or out of it.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Husain I, Abdulrahman B, Dale OR, et al. Interaction of Phyllanthus amarus extract and its lignans with human xenobiotic receptors, drug metabolizing enzymes and drug transporters. J Ethnopharmacol 2025;339:119142. 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

Chanca Piedra Also Interacts With Other Medications

Chanca Piedra has 872 moderate, 149 minor known drug interactions in our database — the Aspirin, Caffeine, Dihydrocodeine Bitartrate one above is among them. If you take anything else, check it against the full list below.

Moderate 872 Minor 149 No known interaction 1,809 (incl. Aspirin, Caffeine, Dihydrocodeine Bitartrate)
Taking anything else?

Check Another of Your Medications Against Chanca Piedra

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

Everything else you take

See Every Supplement That Interacts With Aspirin, Caffeine, Dihydrocodeine Bitartrate

This page covers Chanca Piedra only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Aspirin, Caffeine, Dihydrocodeine Bitartrate 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.

Open the Aspirin, Caffeine, Dihydrocodeine Bitartrate interaction page

One more smart check

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

We hold 355 real supplement products containing Chanca Piedra, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Chanca Piedra. Your product may carry other ingredients that interact with Aspirin, Caffeine, Dihydrocodeine Bitartrate too, on top of Chanca Piedra — 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 Chanca Piedra and Aspirin, Caffeine, Dihydrocodeine Bitartrate 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 Chanca Piedra
Top 25%

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

29 days ago today
Medication Aspirin, Caffeine, Dihydrocodeine Bitartrate
Top half

#1,098 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 Chanca Piedra

What is Chanca Piedra?

Chanca Piedra
  • Kidney stones
  • Gallstones
  • Liver support
  • Urinary tract health
  • Digestive complaints

Chanca piedra is a tropical herb traditionally used as a 'stone breaker' for kidney and gallstones, and for liver and urinary health. Human evidence for these uses is limited and mostly small or preliminary, so it should not replace proven treatments. Talk with your pharmacist or doctor before using it, especially if you have a medical condition or take medications.

Read the full Chanca Piedra monograph & all interactions
Keep checking

Other Drugs & Chanca Piedra

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

0Major
872Moderate
149Minor
1,808No known interaction
872 Moderate 149 Minor 1,808 No interaction
Moderate

872 interactions

Showing 60 of 872 moderate interactions — see all 872 on the Chanca Piedra page.

Minor

149 interactions

Showing 60 of 149 minor interactions — see all 149 on the Chanca Piedra page.

No interaction 1,808 drugs checked — show the list

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

Showing the 60 most looked-up of 1,808 medications checked with no known interaction — see the full Chanca Piedra list.

See the full Chanca Piedra interactions page
See every supplement checked against Aspirin, Caffeine, Dihydrocodeine Bitartrate, 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
Chanca Piedra monograph › Uses, safety, and every drug interaction in one place Aspirin, Caffeine, Dihydrocodeine Bitartrate supplement interactions › Every supplement checked against Aspirin, Caffeine, Dihydrocodeine Bitartrate, 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 Chanca Piedra and Aspirin, Caffeine, Dihydrocodeine Bitartrate Together: Common Questions

Can you take Chanca Piedra with Aspirin, Caffeine, Dihydrocodeine Bitartrate?
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 3 interactions listed for Chanca Piedra and Aspirin, Caffeine, Dihydrocodeine Bitartrate?
Aspirin, Caffeine, Dihydrocodeine Bitartrate belongs to more than one drug category, and Chanca Piedra 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 Chanca Piedra and Aspirin, Caffeine, Dihydrocodeine Bitartrate 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.