Goldenseal + Acetaminophen, Butalbital, Codeine
Acetaminophen, Butalbital, Codeine brand name: Bancap w/ Codeine.
Acetaminophen, Butalbital, Codeine falls into 3 drug categories that Goldenseal can interact with; the most serious is rated moderate. Theoretically, goldenseal might increase the sedative effects of CNS depressants.
Read the full interaction reportGoldenseal and Acetaminophen, Butalbital, Codeine
These two interact in 3 distinct ways. Each one is explained separately below.
Why Are There 3 Interactions?
Goldenseal interacts with whole categories of medication. Acetaminophen, Butalbital, Codeine falls into 3 of those categories, so it can interact with Goldenseal 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 Acetaminophen, Butalbital, Codeine
Acetaminophen, Butalbital, Codeine falls under CNS DEPRESSANTS — the group Goldenseal interacts with.
Goldenseal contains berberine. Animal research shows that berberine can have sedative effects. However, this effect has not been reported in humans.
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.
This combination pill already does a lot to calm the nervous system. The butalbital is a barbiturate, the codeine is an opioid, and both can leave you feeling drowsy, foggy, or slow to react. The concern here is simple: goldenseal contains berberine, and in animal studies berberine showed some sedative activity. If that carries over to people, stacking it on top of this medicine could, in theory, add to the sleepiness, dizziness, or low energy you might already feel.
I want to be honest that this is theoretical only. We have not actually seen it reported in humans, so I would not lose sleep over it. Still, if you notice extra grogginess, it is worth a quick chat with your pharmacist or doctor before mixing the two.
- Janbaz KH, Gilani AH. Studies on preventive and curative effects of berberine on chemical-induced hepatotoxicity in rodents. Fitoterapia 2000;71:25-33.. PubMed
- Shanbhag, S. M., Kulkarni, H. J., and Gaitonde, B. B. Pharmacological actions of berberine on the central nervous system. Jpn.J Pharmacol 1970;20(4):482-487. PubMed
- Peng, W. H., Hsieh, M. T., and Wu, C. R. Effect of long-term administration of berberine on scopolamine-induced amnesia in rats. Jpn J Pharmacol 1997;74(3):261-266. DOI
- Sabir M and Bhide NK. Study of some pharmacological actions of berberine. Ind J Physiol & Pharmac 1971;15(3):111-132.
CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES
2 of 3Acetaminophen, Butalbital, Codeine also falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES.
Clinical and in vitro research shows that goldenseal can significantly inhibit CYP2D6 enzymes, potentially increasing levels of drugs metabolized by CYP2D6.
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 wrinkle with this combination pill: the codeine part is a prodrug. Your body uses an enzyme called CYP2D6 to convert codeine into morphine, which is what actually relieves pain. Goldenseal can block that very enzyme, so less of your codeine gets turned into the active painkiller. In plain terms, you may notice weaker pain relief than you'd expect.
The acetaminophen and butalbital portions aren't really affected by this. The main takeaway is that goldenseal could blunt the codeine's benefit, not make it stronger. The evidence here is moderate, not rock solid. Before pairing goldenseal with this medication, please check in with your pharmacist or doctor so you don't end up with poorly controlled pain.
- Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes. Clin Pharmacol Ther 2005;77:415-26. PubMed
- Gurley BJ, Swain A, Hubbard MA, et al. Clinical assessement of CYP2D6-mediated herb-drug interactions in humans: Effects of milk-thistle, black cohosh, goldenseal, kava kava, St. John's wort, and Echinacea. Mol Nutr Food Res 2008;52:755-63.
- Sevior, D. K., Hokkanen, J., Tolonen, A., Abass, K., Tursas, L., Pelkonen, O., and Ahokas, J. T. Rapid screening of commercially available herbal products for the inhibition of major human hepatic cytochrome P450 enzymes using the N-in-one cocktail. Xeno PubMed
CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES
3 of 3Acetaminophen, Butalbital, Codeine also falls under CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES.
In vitro research shows that goldenseal root extract can inhibit the activity of CYP2E1. However, this effect has not been reported in humans.
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.
Here's the situation with this combo pill, which mixes acetaminophen (Tylenol), butalbital, and codeine. Lab dish studies suggest goldenseal may slow down an enzyme called CYP2E1, which is one of the pathways your liver uses to process acetaminophen. In theory, that could let acetaminophen hang around a bit longer. The important thing: this has only been seen in test tubes, not in actual people, so the real-world effect is likely small.
If anything did build up, you might notice more drowsiness or stomach upset, though that's not well proven here. The bigger picture is just not overdoing total acetaminophen, since high amounts stress the liver. Before adding goldenseal, run it by your pharmacist or doctor so they can look at your full medication list.
- Yamaura K, Shimada M, Nakayama N, Ueno K. Protective effects of goldenseal (Hydrastis canadensis L.) on acetaminophen-induced hepatotoxicity through inhibition of CYP2E1 in rats. Pharmacognosy Res. 2011;3(4):250-5. 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.
Goldenseal Also Interacts With Other Medications
Goldenseal has 1,235 moderate, 1 minor known drug interactions in our database — the Acetaminophen, Butalbital, Codeine one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Goldenseal
We haven’t checked that one against Goldenseal yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Goldenseal. Pick one to open its full report.
See Every Supplement That Interacts With Acetaminophen, Butalbital, Codeine
This page covers Goldenseal only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Butalbital, Codeine page lists 240 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 Gamma-hydroxybutyrate (ghb) (major).
By severity: 9 major · 191 moderate · 40 minor.
Open the Acetaminophen, Butalbital, Codeine interaction page
Taking Goldenseal as Part of a Dietary Supplement Product? Check It for Interactions
We hold 1,726 real supplement products containing Goldenseal, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Goldenseal. Your product may carry other ingredients that interact with Acetaminophen, Butalbital, Codeine too, on top of Goldenseal — and those would not show on this page. Find your product and we’ll check every ingredient on its label:
Where Goldenseal and Acetaminophen, Butalbital, Codeine 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.
#116 of 1,452 supplements looked up here in the last 7 days
#201 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 Goldenseal
What is Goldenseal?
- Digestive upset and diarrhea
- Colds and respiratory infections
- Sore throat and mouth sores
- Skin and eye irritation (topical/traditional)
- Antimicrobial support
Goldenseal is a popular North American herb that contains berberine, a compound studied for antimicrobial effects. However, strong human evidence for its many traditional uses is largely lacking, and it should be avoided during pregnancy and breastfeeding. Talk to a pharmacist or doctor before using it.
Other Drugs & Goldenseal
Browse every other medication we’ve checked against Goldenseal — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
1,235 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Nifedipine ›
- Ibuprofen ›
- Diphenhydramine ›
- Aspirin ›
- Hydrocortisone ›
- Insulin (rdna) ›
- Naproxen ›
- Doxycycline ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Tetracycline ›
- Lidocaine ›
- Ranitidine ›
- Guaifenesin ›
- Hydrochlorothiazide ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Flurazepam ›
- Glyburide ›
- Insulin (pork) ›
- Triazolam ›
- Zopiclone ›
- Colchicine ›
- Fentanyl ›
- Flurbiprofen ›
- Oxybutynin ›
- Oxycodone ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Triamcinolone ›
- Apomorphine ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Dipyridamole ›
- Doxorubicin ›
- Fluticasone ›
- Formoterol ›
- Hydralazine ›
- Indomethacin ›
- Insulin (human) ›
- Miconazole ›
- Morphine Sulfate ›
- Nitrazepam ›
- Trimipramine ›
- Acetaminophen ›
Showing 60 of 1,235 moderate interactions — see all 1,235 on the Goldenseal page.
1 interaction
No interaction 1,593 drugs checked — show the list
We also checked Goldenseal against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Methylphenidate ›
- Rosuvastatin ›
- Escitalopram ›
- Docusate ›
- Sumatriptan ›
- Valacyclovir ›
- Hydroxyurea ›
- Isotretinoin ›
- Methotrexate ›
- Amoxicillin ›
- Bupropion ›
- Bendamustine ›
- Acyclovir ›
- Azithromycin ›
- Levothyroxine, Liothyronine ›
- Methylene Blue ›
- Ciprofloxacin ›
- Amoxicillin, Clavulanate Potassium ›
- Cyclopentolate ›
- Cephalexin ›
- Ezetimibe ›
- Carbidopa, Levodopa ›
- Thyroid Hormone ›
- Roxithromycin ›
- Levodopa ›
- Levothyroxine Sodium ›
- Dexmethylphenidate ›
- Mitomycin ›
- Alginic Acid, Aluminum Hydroxide ›
- Magnesium Hydroxide (otc Drug) ›
- Daptomycin ›
- Cefaclor ›
- Hydroxychloroquine ›
- Pegunigalsidase Alfa-iwxj ›
- Isoniazid, Pyrazinamide, Rifampin ›
- Factor 7a ›
- Hexobarbitone ›
- Bentoquatam ›
- Flutemetamol F-18 ›
- Pizotifen ›
- Birth Control Pills ›
- Casanthranol, Docusate ›
- Succinylcholine ›
- Triptorelin ›
- Vancomycin ›
- Famotidine ›
- Alglucosidase Alpha ›
- Azelaic Acid ›
- Articaine, Epinephrine ›
- Choline Magnesium Trisalicylate ›
- Salbutamol Sulfate ›
- Hethylphenidate Hcl ›
- Rituximab ›
- Tocainide ›
- Peginterferon Alfa-2a, Ribavirin ›
- Phenylephrine ›
- Alendronate Sodium, Cholecalciferol ›
- Metronidazole ›
- Bleomycin ›
Showing the 60 most looked-up of 1,593 medications checked with no known interaction — see the full Goldenseal 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, Codeine Is Linked to Lower Levels of One Nutrient
Natural Medicines records Acetaminophen, Butalbital, Codeine as a medicine that can lower these. This is not an interaction with Goldenseal — 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, Codeine 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 Goldenseal and Acetaminophen, Butalbital, Codeine Together: Common Questions
Can you take Goldenseal with Acetaminophen, Butalbital, Codeine?
Why are there 3 interactions listed for Goldenseal and Acetaminophen, Butalbital, Codeine?
How serious is the Goldenseal and Acetaminophen, Butalbital, Codeine interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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