Drug & supplement interaction

Cocoa + Ephedrine Sulfate, Hydroxyzine, Theophylline

Ephedrine Sulfate, Hydroxyzine, Theophylline brand name: Hydroxy Compound.

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

Ephedrine Sulfate, Hydroxyzine, Theophylline falls into 2 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
Interactions2
EvidenceC
What do Severity, Likelihood & Evidence mean?
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Interaction report

Cocoa and Ephedrine Sulfate, Hydroxyzine, Theophylline

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

Why Are There 2 Interactions?

Cocoa interacts with whole categories of medication. Ephedrine Sulfate, Hydroxyzine, Theophylline falls into 2 of those categories, so it can interact with Cocoa in 2 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 2

Why this applies to Ephedrine Sulfate, Hydroxyzine, Theophylline

Ephedrine Sulfate, Hydroxyzine, 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: your combination product contains both ephedrine and theophylline, which are stimulant-type medicines. Cocoa naturally contains a little caffeine plus related compounds, and caffeine is also a stimulant. Stacking stimulants together can add up, so the concern is more of that revved-up feeling, things like a faster or pounding heartbeat, jitteriness, trouble sleeping, restlessness, or a touch of nausea.

I'll be honest, this is based on expert reasoning rather than strong studies, and a normal cup of cocoa or a piece of chocolate is unlikely to cause trouble for most people. Concentrated cocoa supplements are a different story. Theophylline in particular has a narrow safety window, so if you notice your heart racing or feel uneasy, check in with your pharmacist or doctor before changing anything.

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 2

Ephedrine Sulfate, Hydroxyzine, 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

Let's focus on the theophylline part of this combination, since that's where cocoa comes in. Cocoa naturally contains some caffeine, and caffeine competes for the same liver pathway that breaks down theophylline. In studies, caffeine slowed theophylline's clearance by roughly a quarter, which means a little more drug can build up in your system over time.

Theophylline already works in a fairly narrow window, so even small increases can nudge you toward side effects like a racing or pounding heart, jitteriness, trouble sleeping, nausea, or feeling shaky. A cup of hot cocoa now and then is unlikely to cause trouble, but regular large amounts or concentrated cocoa supplements are worth a conversation. Please check with your pharmacist or doctor before changing anything.

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

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 Sulfate, Hydroxyzine, 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 Sulfate, Hydroxyzine, 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 Sulfate, Hydroxyzine, Theophylline

This page covers Cocoa only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ephedrine Sulfate, Hydroxyzine, Theophylline page lists 199 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Ephedra (major), Henbane (major), Peyote (major) and Rauvolfia Vomitoria (major).

By severity: 7 major · 153 moderate · 39 minor.

From our pharmacist’s overview on the Ephedrine Sulfate, Hydroxyzine, Theophylline page

“Someone taking Hydroxy Compound (ephedrine sulfate, hydroxyzine, and theophylline) for breathing problems is juggling three drugs at once, and the supplement list shows it: 199 interacting ingredients, seven of them rated major, and this page deserves genuine seriousness. The sharpest risks come from stimulant botanicals, ephedra above…”

Reviewed by 2 · Jul 18, 2026

Open the Ephedrine Sulfate, Hydroxyzine, 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 Sulfate, Hydroxyzine, 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 Sulfate, Hydroxyzine, 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%

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

29 days ago today
Medication Ephedrine Sulfate, Hydroxyzine, Theophylline
Top 25%

#330 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 Sulfate, Hydroxyzine, 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 Sulfate, Hydroxyzine, Theophylline supplement interactions › Every supplement checked against Ephedrine Sulfate, Hydroxyzine, 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 Sulfate, Hydroxyzine, Theophylline Together: Common Questions

Can you take Cocoa with Ephedrine Sulfate, Hydroxyzine, 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 2 interactions listed for Cocoa and Ephedrine Sulfate, Hydroxyzine, Theophylline?
Ephedrine Sulfate, Hydroxyzine, 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 Sulfate, Hydroxyzine, 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

Still Have a Question About Ephedrine Sulfate, Hydroxyzine, Theophylline and Cocoa?

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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.