Goldenseal + Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine
Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine brand name: Multi Symptom Cold Relief.
Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine falls into 4 drug categories that Goldenseal can interact with; the most serious is rated moderate. Goldenseal might increase serum levels of drugs metabolized by CYP2D6.
Read the full interaction reportGoldenseal and Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine
These two interact in 4 distinct ways. Each one is explained separately below.
Why Are There 4 Interactions?
Goldenseal interacts with whole categories of medication. Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine falls into 4 of those categories, so it can interact with Goldenseal in 4 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES
1 of 4Why this applies to Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine
Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES — the group Goldenseal interacts with.
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..
This combo cold product has a few ingredients, but the one to watch with goldenseal is the dextromethorphan (the cough suppressant). Your body relies on a liver enzyme called CYP2D6 to break it down. Goldenseal can slow that enzyme, and research suggests this is a likely, real-world effect. With dextromethorphan clearing more slowly, levels can climb and you may feel more drowsy, dizzy, or, less often, restless or confused.
The chlorpheniramine (an antihistamine) also leans on CYP2D6 a bit, so sleepiness could stack up too. The acetaminophen and decongestant part aren't really affected here. Nothing dangerous in most healthy people, but I'd run it by your pharmacist before pairing them, especially if you already feel groggy on this product.
- 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 3A4 (CYP3A4) SUBSTRATES
2 of 4Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
Most clinical and in vitro research shows that goldenseal inhibits CYP3A4 enzyme activity and increases serum levels of CYP3A4 substrates, such as midazolam. However, in one small clinical study, goldenseal did not affect the levels of indinavir, a CYP3A4 substrate, in healthy volunteers. This is likely due to the fact that indinavir has a high oral bioavailability, making it an inadequate probe for CYP3A4 interactions and/or that it is primarily metabolized by hepatic CYP3A, while goldenseal has more potential to inhibit intestinal CYP3A enzyme activity. Both goldenseal extract and its isolated constituents berberine and hydrastine inhibit CYP3A, with hydrastine possibly having more inhibitory potential than berberine.
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 cold and cough combo has a few active pieces, and the one most likely to feel a goldenseal effect is the dextromethorphan. Goldenseal can slow down certain liver enzymes (including CYP3A4), and dextromethorphan is partly cleared that way. If it builds up, you might feel more drowsy, dizzy, or, rarely, jittery or confused. The acetaminophen, chlorpheniramine, and phenylpropanolamine pieces aren't strongly tied to this same pathway, so they're less of a concern here.
The evidence for this is moderate and not certain for every product, so I wouldn't panic. Still, since this medicine already causes drowsiness on its own, it's worth a quick chat with your pharmacist before pairing it with goldenseal, especially if you take goldenseal in concentrated supplement doses.
- Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:273-82. PubMed
- Sandhu RS, Prescilla RP, Simonelli TM, Edwards DJ. Influence of goldenseal root on the pharmacokinetics of indinavir. J Clin Pharmacol 2003;43:1283-8.. PubMed
- 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
- Chatterjee P, Franklin MR. Human cytochrome p450 inhibition and metabolic-intermediate complex formation by goldenseal extract and its methylenedioxyphenyl components. Drug Metab Dispos 2003;31:1391-7. PubMed
- Gurley BJ, et al. Supplementation with goldenseal (Hydrastis canadensis), but not kava kava (Piper methysticum), inhibits human CYP3A activitiy In Vivo. Clin Pharmacol Ther. 2008;83(1):61-69.
- 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
- Nguyen JT, Tian DD, Tanna RS, et al. An Integrative Approach to Elucidate Mechanisms Underlying the Pharmacokinetic Goldenseal-Midazolam Interaction: Application of In Vitro Assays and Physiologically Based Pharmacokinetic Models to Understand Clinical Ob
CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES
3 of 4Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine 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.
In this combination cold product, the piece that connects to goldenseal is the acetaminophen (the fever and pain reliever). A small amount of acetaminophen is handled by a liver enzyme called CYP2E1. In lab dish studies, goldenseal seemed to slow that enzyme down a bit. In theory, slowing it could shift how acetaminophen is processed in the liver.
Here is the honest part: this has only been seen in a test tube, never confirmed in real people, so I would not lose sleep over it. The bigger everyday rule with any acetaminophen product still applies, watch your total daily dose and go easy on alcohol to protect your liver. Before pairing goldenseal with this cold medicine, just run it by your pharmacist or doctor.
- 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
DEXTROMETHORPHAN (Robitussin DM, others)
4 of 4Goldenseal contains berberine. A small clinical study shows that berberine can inhibit cytochrome P450 2D6 (CYP2D6) activity and reduce the metabolism of dextromethorphan.
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.
Your cold relief combo includes dextromethorphan, the cough suppressant in it. Your body clears dextromethorphan using a liver enzyme called CYP2D6. Goldenseal contains berberine, which can gently slow that enzyme down. The concern here is that dextromethorphan could build up a bit higher than usual, leading to stronger effects like drowsiness, dizziness, or feeling foggy. The antihistamine in this product (chlorpheniramine) can already make you sleepy, so the two together might add to that tired feeling.
Keep in mind this is a theoretical interaction based mostly on how these compounds behave in the lab, not strong real-world reports. It is usually mild, but if you take goldenseal as a supplement, just mention it to your pharmacist or doctor first.
- Guo, Y., Chen, Y., Tan, Z. R., Klaassen, C. D., and Zhou, H. H. Repeated administration of berberine inhibits cytochromes P450 in humans. Eur J Clin Pharmacol 2012;68(2):213-217. 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, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine 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, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine
This page covers Goldenseal only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine page lists 300 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: 14 major · 241 moderate · 45 minor.
Open the Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine 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, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine 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, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine 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.
#115 of 1,452 supplements looked up here in the last 7 days
#32 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 ›
- Isotretinoin ›
- Docusate ›
- Sumatriptan ›
- Valacyclovir ›
- Hydroxyurea ›
- Amoxicillin ›
- Levothyroxine, Liothyronine ›
- Methotrexate ›
- Bupropion ›
- Bendamustine ›
- Azithromycin ›
- Acyclovir ›
- Methylene Blue ›
- Ciprofloxacin ›
- Amoxicillin, Clavulanate Potassium ›
- Calcium Oxybate, Magnesium Oxybate, Potassium Oxybate, Sodium Oxybate ›
- Ezetimibe ›
- Cyclopentolate ›
- Cephalexin ›
- Isoniazid, Pyrazinamide, Rifampin ›
- Thyroid Hormone ›
- Carbidopa, Levodopa ›
- Levodopa ›
- Roxithromycin ›
- Magnesium Hydroxide (otc Drug) ›
- Alginic Acid, Aluminum Hydroxide ›
- Mitomycin ›
- Flutemetamol F-18 ›
- Ceftolozane Sulfate, Tazobactam Sodium ›
- Levothyroxine Sodium ›
- Charcoal (otc Drug) ›
- Hydrocortisone, Clioquinol, Pramoxine ›
- Articaine, Epinephrine ›
- Dexmethylphenidate ›
- Peginterferon Alfa-2a, Ribavirin ›
- Atropine Methyl Nitrate, Digestive Enzymes ›
- Efgartigimod Alfa-fcab ›
- Daunorubicin, Cytarabine ›
- Alpha-1 Proteinase Inhibitor ›
- Aminolevulinic Acid Hydrochloride ›
- Cefaclor ›
- Daptomycin ›
- Cytomegalovirus Immune Globulin ›
- Sodium Bicarbonate (otc Drug) ›
- Colistin, Neomycin, Hydrocortisone ›
- Tubocurarine ›
- Imipenem, Cilastatin, Relebactam ›
- Hydroxychloroquine ›
- Alendronate Sodium, Cholecalciferol ›
- Rosuvastatin Calcium, Ezetimibe ›
- Carbinoxamine Maleate ›
- Ephedrine, Hydroxyzine, Theophylline ›
- Dihydroxyaluminum Sodium Carbonate ›
- Pyrilamine Maleate ›
- Bismuth Subcarbonate, Calcium Carbonate, Opium ›
- Factor 7a ›
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, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine Is Linked to Lower Levels of One Nutrient
Natural Medicines records Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine 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:
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, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine Together: Common Questions
Can you take Goldenseal with Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine?
Why are there 4 interactions listed for Goldenseal and Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine?
How serious is the Goldenseal and Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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