Garlic + Acetaminophen, Butalbital, Caffeine
Acetaminophen, Butalbital, Caffeine brand names: Tecnal, Esgic Plus, Fiogesic, Triad, Repan, and others.
Acetaminophen, Butalbital, Caffeine falls into 2 drug categories that Garlic can interact with; the most serious is rated moderate. Theoretically, garlic products containing allicin might induce intestinal CYP3A4 and inhibit hepatic CYP3A4.
Read the full interaction reportGarlic and Acetaminophen, Butalbital, Caffeine
These two interact in 2 distinct ways. Each one is explained separately below.
Why Are There 2 Interactions?
Garlic interacts with whole categories of medication. Acetaminophen, Butalbital, Caffeine falls into 2 of those categories, so it can interact with Garlic in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
1 of 2Why this applies to Acetaminophen, Butalbital, Caffeine
Acetaminophen, Butalbital, Caffeine falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group Garlic interacts with.
Some human research suggests that garlic may induce INTESTINAL CYP3A4, reducing levels of drugs metabolized by this enzyme. This is primarily based on a study showing that taking a specific allicin-containing garlic product (GarliPure Maximum Allicin Formula, Natrol Inc.) twice daily for 3 days reduces saquinavir levels by approximately 50%. It is speculated that the allicin constituent induced CYP3A4 in the gut mucosa. Another study shows that giving docetaxel intravenously, bypassing the CYP3A4 enzymes in the gut mucosa, along with the same specific garlic product for 12 consecutive days, does not affect docetaxel levels. Conversely, there is concern that garlic may inhibit HEPATIC CYP3A4. In a single case report, increased tacrolimus levels and liver injury occurred in a liver transplant patient after taking a specific garlic supplement (Garlicin Cardio, Nature's Way) at up to three times the manufacturer recommended dose for 7 days. Several other studies have evaluated the impact of other garlic formulations on CYP3A4 substrates and have found no effect. Most of the products in these studies provided little or no allicin.
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.
If you take this headache combo (acetaminophen, butalbital, and caffeine) and you're curious about garlic, here's the honest picture. Concentrated garlic supplements (the kind with active allicin) may slightly tweak a liver and gut enzyme called CYP3A4, which helps process part of this medication. The tricky part is the effect can go either way, and it's mostly theoretical, based on a few small studies and case reports rather than solid trials.
In practice, any real-world change here is likely to be small and hard to predict. I wouldn't lose sleep over garlic in your food, that amount won't matter. With daily high-dose garlic capsules, just keep an eye out for feeling extra drowsy or foggy from the butalbital. If anything feels off, check with your pharmacist or doctor before changing anything.
- Piscitelli SC, Burstein AH, Welden N, et al. The effect of garlic supplements on the pharmacokinetics of saquinavir. Clin Infect Dis 2002;34:234-8. PubMed
- Markowitz JS, Devane CL, Chavin KD, et al. Effects of garlic (Allium sativum L.) supplementation on cytochrome P450 2D6 and 3A4 activity in healthy volunteers. Clin Pharmacol Ther 2003;74:170-7.. PubMed
- Gurley BJ, Gardner SF, Hubbard MA, et al. Cytochrome P450 phenotypic ratios for predicting herb-drug interactions in humans. Clin Pharmacol Ther 2002;72:276-87.. PubMed
- Dhamija P, Malhotra S, Pandhi P. Effect of oral administration of crude aqueous extract of garlic on pharmacokinetic parameters of isoniazid and rifampicin in rabbits. Pharmacology 2006;77:100-4. PubMed
- Cox MC, Low J, Lee J, et al. Influence of garlic (Allium sativum) on the pharmacokinetics of docetaxel. Clin Cancer Res 2006;12:4636-40.
- Jalloh MA, Gregory PJ, Hein D, et al. Dietary supplement interactions with antiretrovirals: a systematic review. Int J STD AIDS. 2017 Jan;28(1):4-15. PubMed
- Gallicano K, Foster B, Choudhri S. Effect of short-term administration of garlic supplements on single-dose ritonavir pharmacokinetics in healthy volunteers. Br J Clin Pharmacol. 2003;55(2):199-202. PubMed
- Shaikh SA, Tischer S, Choi EK, Fontana RJ. Good for the lung but bad for the liver? Garlic-induced hepatotoxicity following liver transplantation. J Clin Pharm Ther. 2017;42(5):646-648. PubMed
CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES
2 of 2Acetaminophen, Butalbital, Caffeine also falls under CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES.
Clinical research suggests garlic oil can inhibit the activity of CYP2E1 by 39%. Use garlic oil cautiously in patients taking drugs metabolized by these enzymes.
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..
Here's the interesting twist with this combo pill. The acetaminophen part is normally broken down partly by a liver enzyme called CYP2E1, and one of the products it makes is a toxic byproduct that can stress the liver, especially at high doses. Garlic oil supplements may slow that enzyme down by about a third in some studies. In theory, that could mean less of that harmful byproduct, so this isn't a case where garlic makes the medicine dangerous.
The evidence here is modest and mostly about concentrated garlic oil, not the garlic in your food. The butalbital and caffeine parts aren't really affected by this. Bottom line: this is a low-concern interaction, but if you take garlic supplements regularly and use this headache medicine often, just mention it to your pharmacist or doctor.
- Gurley BJ, Gardner SF, Hubbard MA, et al. Cytochrome P450 phenotypic ratios for predicting herb-drug interactions in humans. Clin Pharmacol Ther 2002;72:276-87.. 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.
Garlic Also Interacts With Other Medications
Garlic has 988 moderate known drug interactions in our database — the Acetaminophen, Butalbital, Caffeine one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Garlic
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Covers the 2,830 medications we’ve checked against Garlic. Pick one to open its full report.
Questions About Garlic or Acetaminophen, Butalbital, Caffeine
These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Garlic or Acetaminophen, Butalbital, Caffeine, 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:
- Can You Take Berberine, Garlic, and NAC With Eliquis? ›
- Is Olanzapine Safe to Take With Garlic? ›
- Questions About Taking Garlic, Cumin And Chili With Eliquis ›
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 Acetaminophen, Butalbital, Caffeine
This page covers Garlic only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Butalbital, Caffeine page lists 252 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: 11 major · 197 moderate · 44 minor.
From our pharmacist’s overview on the Acetaminophen, Butalbital, Caffeine page
“Alcohol is the interaction I would flag first for anyone taking acetaminophen, butalbital, and caffeine (Esgic, Fiogesic, and others). Drinking raises the risk of liver injury from the acetaminophen component, and 38 of the 252 supplement ingredients on file carry that same liver concern.”
Reviewed by 2 · Jul 18, 2026
Open the Acetaminophen, Butalbital, Caffeine interaction page
Taking Garlic as Part of a Dietary Supplement Product? Check It for Interactions
We hold 4,118 real supplement products containing Garlic, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Garlic. Your product may carry other ingredients that interact with Acetaminophen, Butalbital, Caffeine too, on top of Garlic — and those would not show on this page. Find your product and we’ll check every ingredient on its label:
Where Garlic and Acetaminophen, Butalbital, Caffeine 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.
#59 of 1,452 supplements looked up here in the last 7 days
#1,161 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 Garlic
What is Garlic?
- High blood pressure
- High cholesterol
- Heart health
- Immune support and common cold
- Antimicrobial uses
Garlic is a common food and supplement that may modestly help with blood pressure and cholesterol, though the evidence is mixed and effects are usually small. It is generally safe in food amounts, but concentrated supplements can cause stomach upset, breath and body odor, and a higher risk of bleeding. Talk with your pharmacist or doctor before taking garlic supplements, especially if you take other medicines.
About Acetaminophen, Butalbital, and Caffeine
What Is Acetaminophen, Butalbital, and Caffeine Used For?
Brand names: Tecnal, Esgic Plus, Fiogesic, Triad, Repan, Esgic, Fioricet
This three-ingredient combination — butalbital, acetaminophen, and caffeine — is used to relieve the symptoms of tension headache (also called muscle contraction headache). All supported products, including tablets, capsules, and oral solution, share this same approved use.
It is worth knowing that evidence for using this combination to treat repeated, frequent tension headaches over time is limited. Because butalbital can be habit-forming, extended or repeated use is not recommended.
Other Drugs & Garlic
Browse every other medication we’ve checked against Garlic — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
988 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Nifedipine ›
- Ibuprofen ›
- Aspirin ›
- Hydrocortisone ›
- Insulin (rdna) ›
- Naproxen ›
- Pancrelipase (prescription Drug) ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Lidocaine ›
- Hydrochlorothiazide ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Glyburide ›
- Insulin (pork) ›
- Triazolam ›
- Zopiclone ›
- Colchicine ›
- Fentanyl ›
- Oxybutynin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Dipyridamole ›
- Doxorubicin ›
- Fluticasone ›
- Hydralazine ›
- Insulin (human) ›
- Miconazole ›
- Acetaminophen ›
- Buprenorphine ›
- Conjugated Estrogens ›
- Diazepam ›
- Everolimus ›
- Ivabradine ›
- Ketoprofen ›
- Medroxyprogesterone ›
- Medroxyprogesterone Acetate ›
- Rifampin ›
- Testosterone Undecanoate ›
- Trichlormethiazide ›
- Acarbose ›
- Aripiprazole ›
- Bendroflumethiazide ›
- Bivalirudin ›
Showing 60 of 988 moderate interactions — see all 988 on the Garlic page.
No interaction 1,841 drugs checked — show the list
We also checked Garlic against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Methylphenidate ›
- Ivermectin ›
- Rosuvastatin ›
- Escitalopram ›
- Valacyclovir ›
- Docusate ›
- Hydroxyurea ›
- Methamphetamine ›
- Sumatriptan ›
- Lisdexamfetamine ›
- Acyclovir ›
- Bupropion ›
- Amoxicillin ›
- Bendamustine ›
- Doxycycline ›
- Lamotrigine ›
- Fluoxetine ›
- Methotrexate ›
- Gabapentin ›
- Amphetamine ›
- Pregabalin ›
- Isotretinoin ›
- Dextroamphetamine ›
- Azithromycin ›
- Methylene Blue ›
- Duloxetine ›
- Ciprofloxacin ›
- Levothyroxine, Liothyronine ›
- Cyclopentolate ›
- Cephalexin ›
- Roxithromycin ›
- Pegunigalsidase Alfa-iwxj ›
- Acetaminophen, Dextromethorphan, Doxylamine ›
- Daptomycin ›
- Hexobarbitone ›
- Dexmethylphenidate ›
- Levothyroxine Sodium ›
- Levetiracetam ›
- Mitomycin ›
- Cefaclor ›
- Factor 7a ›
- Carbidopa, Levodopa ›
- Thyroid Hormone ›
- Ezetimibe ›
- Levodopa ›
- Vancomycin ›
- Phenylephrine ›
- Venlafaxine ›
- Dirithromycin ›
- Procainamide ›
- Lenvatinib ›
- Hethylphenidate Hcl ›
- Phentermine, Topiramate ›
- Azelaic Acid ›
- Bentoquatam ›
- Nortriptyline ›
- Digoxin ›
- Hydroxychloroquine ›
- Amoxicillin, Clavulanate Potassium ›
Showing the 60 most looked-up of 1,841 medications checked with no known interaction — see the full Garlic 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, Butalbital, Caffeine Is Linked to Lower Levels of 2 Nutrients
Natural Medicines records Acetaminophen, Butalbital, Caffeine as a medicine that can lower these. This is not an interaction with Garlic — 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 Acetaminophen, Butalbital, Caffeine 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 Garlic and Acetaminophen, Butalbital, Caffeine Together: Common Questions
Can you take Garlic with Acetaminophen, Butalbital, Caffeine?
Why are there 2 interactions listed for Garlic and Acetaminophen, Butalbital, Caffeine?
How serious is the Garlic and Acetaminophen, Butalbital, Caffeine interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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