Drug & supplement interaction

Cocoa + Ephedrine, Phenobarbital, Theophylline

Ephedrine, Phenobarbital, Theophylline brand name: Tedral.

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

Ephedrine, Phenobarbital, Theophylline falls into 4 drug categories that Cocoa can interact with; the most serious is rated moderate. Theoretically, concomitant use might increase stimulant adverse effects.

Read the full interaction report
SeverityModerate
LikelihoodProbable
Interactions4
EvidenceC
What do Severity, Likelihood & Evidence mean?
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Interaction report

Cocoa and Ephedrine, Phenobarbital, Theophylline

These two interact in 4 distinct ways. Each one is explained separately below.

Why Are There 4 Interactions?

Cocoa interacts with whole categories of medication. Ephedrine, Phenobarbital, Theophylline falls into 4 of those categories, so it can interact with Cocoa in 4 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

STIMULANT DRUGS

1 of 4

Why this applies to Ephedrine, Phenobarbital, Theophylline

Ephedrine, Phenobarbital, Theophylline falls under STIMULANT DRUGS — the group Cocoa interacts with.

Theoretically, concomitant use might increase stimulant adverse effects.
Cocoa contains caffeine. Concomitant use might increase the risk of stimulant adverse effects.
Severity Moderate Likelihood Probable Evidence C

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..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the simple version: cocoa naturally contains a bit of caffeine, which is a mild stimulant. Your Tedral combination already has two stimulants in it, ephedrine and theophylline. Stacking the caffeine from cocoa on top can add to that stimulant effect. The phenobarbital piece is the sedative balancer in this old formula, but it doesn't cancel out the caffeine.

So if you enjoy a lot of cocoa or take concentrated cocoa supplements, you might notice more jitteriness, a racing or pounding heart, trouble sleeping, or feeling shaky or anxious. The good news is this is based on expert reasoning rather than strong studies, and a normal cup of hot cocoa or a square of chocolate is unlikely to cause trouble. Concentrated cocoa pills are the bigger concern. Check with your pharmacist or doctor before adding cocoa supplements.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Institute of Medicine. Caffeine for the Sustainment of Mental Task Performance: Formulations for Military Operations. Washington, DC: National Academy Press, 2001. Available at: http://books.nap.edu/books/0309082587/html/index.html. DOI
Moderate

THEOPHYLLINE

2 of 4

Ephedrine, Phenobarbital, Theophylline also falls under THEOPHYLLINE.

Theoretically, cocoa might increase the levels and adverse effects of theophylline.
Cocoa contains caffeine. Large amounts of caffeine might inhibit theophylline metabolism. Caffeine decreases theophylline clearance 23% to 29%.
Severity Moderate Likelihood Probable Evidence B

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..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist with Tedral, which contains theophylline. Cocoa naturally has caffeine in it, and caffeine is broken down by your body using the same pathway that clears theophylline. When that pathway gets a little crowded, theophylline can clear more slowly and build up, by roughly a quarter in some studies. Since theophylline already has a narrow safety window, even small bumps in its level can matter.

What might you notice? Things like a racing or pounding heart, jitteriness, nausea, trouble sleeping, or feeling shaky. A cup of hot cocoa now and then is unlikely to be a big deal, but concentrated cocoa or chocolate supplements are a different story. Before adding those, please check with your pharmacist or doctor.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Burnham TH, ed. Drug Facts and Comparisons, Updated Monthly. Facts and Comparisons, St. Louis, MO.
  2. Carrillo JA, Benitez J. Clinically significant pharmacokinetic interactions between dietary caffeine and medications. Clin Pharmacokinet 2000;39:127-53. PubMed
Moderate

PHENOBARBITAL (Luminal)

3 of 4
Theoretically, cocoa might reduce the effects of phenobarbital and increase the risk for convulsions.
Cocoa contains caffeine. Animal research suggests that caffeine can decrease the anticonvulsant activity of phenobarbital. The exact mechanism of this interaction is unclear.
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 gist of it. This combo pill contains phenobarbital, which is partly used to calm the brain and (in some cases) help prevent seizures. Cocoa naturally contains a bit of caffeine, and in lab and animal studies, caffeine seemed to work against phenobarbital's seizure-calming effect. The worry, in theory, is that a lot of cocoa could blunt that protection.

I want to be honest with you: this is very weak, mostly animal-based evidence, not something proven in people. A normal square of chocolate or cup of cocoa is unlikely to matter. Concentrated cocoa supplements are a different story. If you take this medication regularly, just run your cocoa or supplement habit by your pharmacist or doctor before changing anything.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Gasior, M., Borowicz, K., Buszewicz, G., Kleinrok, Z., and Czuczwar, S. J. Anticonvulsant activity of phenobarbital and valproate against maximal electroshock in mice during chronic treatment with caffeine and caffeine discontinuation. Epilepsia 1996;37(3 PubMed
  2. Jankiewicz, K., Chroscinska-Krawczyk, M., Blaszczyk, B., and Czuczwar, S. J. [Caffeine and antiepileptic drugs: experimental and clinical data]. Przegl.Lek. 2007;64(11):965-967.
  3. Chroscinska-Krawczyk, M., Jargiello-Baszak, M., Walek, M., Tylus, B., and Czuczwar, S. J. Caffeine and the anticonvulsant potency of antiepileptic drugs: experimental and clinical data. Pharmacol.Rep. 2011;63(1):12-18. PubMed
Moderate

EPHEDRINE

4 of 4
Theoretically, concomitant use might increase the risk for stimulant adverse effects.
Cocoa contains caffeine. There is evidence that using ephedrine with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction, stroke, seizures, and death.
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 keep in mind: this Tedral-type combo product contains ephedrine, a stimulant, plus theophylline, which is chemically a close cousin of caffeine. Cocoa also brings some caffeine to the party. When you stack stimulants on top of stimulants, the effects can add up. You might notice a faster or pounding heartbeat, jitteriness, trouble sleeping, restlessness, or a bump in blood pressure. In rare, more serious cases, the concern with combining ephedrine and caffeine includes very high blood pressure and irregular heart rhythms.

To be fair, this is mostly theoretical and based on anecdotal reports, and a cup of cocoa is far weaker than a concentrated cocoa supplement. Still, since theophylline already has a narrow safety window, it's worth running it by your pharmacist or doctor.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Vahedi K, Domingo V, Amarenco P, Bousser MG. Ischemic stroke in a sportsman who consumed MaHuang extract and creatine monohydrate for bodybuilding. J Neurol Neurosurg Psychiatr 2000;68:112-3.
  2. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 2000;343:1833-8. PubMed
  3. Kockler DR, McCarthy MW, Lawson CL. Seizure activity and unresponsiveness after hydroxycut ingestion. Pharmacotherapy 2001;21:647-51.. 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

Cocoa Also Interacts With Other Medications

Cocoa has 634 moderate, 26 minor known drug interactions in our database — the Ephedrine, Phenobarbital, Theophylline one above is among them. If you take anything else, check it against the full list below.

Moderate 634 Minor 26 No known interaction 2,170 (incl. Ephedrine, Phenobarbital, Theophylline)
Taking anything else?

Check Another of Your Medications Against Cocoa

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

Everything else you take

See Every Supplement That Interacts With Ephedrine, Phenobarbital, Theophylline

This page covers Cocoa only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ephedrine, Phenobarbital, Theophylline page lists 184 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), Beer (major), Black Tea (major) and Caffeine (major).

By severity: 22 major · 140 moderate · 22 minor.

Open the Ephedrine, Phenobarbital, Theophylline interaction page

One more smart check

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

We hold 844 real supplement products containing Cocoa, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Cocoa. Your product may carry other ingredients that interact with Ephedrine, Phenobarbital, Theophylline too, on top of Cocoa — 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 Cocoa and Ephedrine, Phenobarbital, Theophylline 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 Cocoa
Top 25%

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

29 days ago today
Medication Ephedrine, Phenobarbital, Theophylline
Top 25%

#623 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 Cocoa

What is Cocoa?

Cocoa
  • Heart and blood vessel health
  • High blood pressure
  • High cholesterol
  • Mental focus and mood
  • Skin moisturizing (cocoa butter)

Cocoa is rich in plant compounds called flavanols that may modestly support blood vessel function and blood pressure, but most chocolate products are high in sugar, fat, and calories, which can offset any benefit. Enjoy cocoa as part of a balanced diet, and talk to your pharmacist before using concentrated cocoa supplements, especially if you have heart or blood pressure conditions.

Read the full Cocoa monograph & all interactions
Keep checking

Other Drugs & Cocoa

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

0Major
634Moderate
26Minor
2,169No known interaction
634 Moderate 26 Minor 2,169 No interaction
Moderate

634 interactions

Showing 60 of 634 moderate interactions — see all 634 on the Cocoa page.

Minor

26 interactions

No interaction 2,169 drugs checked — show the list

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

Showing the 60 most looked-up of 2,169 medications checked with no known interaction — see the full Cocoa list.

See the full Cocoa interactions page
See every supplement checked against Ephedrine, Phenobarbital, Theophylline, 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
Cocoa monograph › Uses, safety, and every drug interaction in one place Ephedrine, Phenobarbital, Theophylline supplement interactions › Every supplement checked against Ephedrine, Phenobarbital, Theophylline, 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 Cocoa and Ephedrine, Phenobarbital, Theophylline Together: Common Questions

Can you take Cocoa with Ephedrine, Phenobarbital, Theophylline?
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 4 interactions listed for Cocoa and Ephedrine, Phenobarbital, Theophylline?
Ephedrine, Phenobarbital, Theophylline belongs to more than one drug category, and Cocoa 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 Cocoa and Ephedrine, Phenobarbital, Theophylline 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.