Goldenseal + Aspirin, Caffeine, Dihydrocodeine Bitartrate
Aspirin, Caffeine, Dihydrocodeine Bitartrate brand name: Synalgos DC.
Aspirin, Caffeine, Dihydrocodeine Bitartrate falls into 4 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 Aspirin, Caffeine, Dihydrocodeine Bitartrate
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. Aspirin, Caffeine, Dihydrocodeine Bitartrate 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).
CNS DEPRESSANTS
1 of 4Why this applies to Aspirin, Caffeine, Dihydrocodeine Bitartrate
Aspirin, Caffeine, Dihydrocodeine Bitartrate 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.
Synalgos DC pairs aspirin and caffeine with dihydrocodeine, an opioid that already slows down your brain and breathing. The idea here is pretty simple: goldenseal contains berberine, and in animal studies berberine showed some sedative effects of its own. Stack that on top of an opioid and, in theory, you could feel extra drowsy, foggy, or lightheaded.
I want to be honest, though: this is a theoretical concern. That sedative effect hasn't actually shown up in people, so I wouldn't lose sleep over it. Just be aware that more grogginess, slowed breathing, or dizziness are the things to watch for. If you take goldenseal regularly while on this medicine, run it by your pharmacist or doctor first.
- 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 4Aspirin, Caffeine, Dihydrocodeine Bitartrate 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 Synalgos DC: the dihydrocodeine part is a prodrug. Your body uses an enzyme called CYP2D6 to turn it into the stronger painkiller that actually relieves your pain. Goldenseal can block that same enzyme, and there's reasonable human research showing it does this fairly reliably.
So in plain terms, goldenseal may weaken the pain relief you get from the dihydrocodeine, because less of it gets converted to its active form. The aspirin and caffeine pieces aren't really affected. You probably won't get more side effects, you might just notice the medicine doesn't work as well. Please don't change anything on your own. Have a quick chat with your pharmacist or doctor before pairing the two.
- 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
3 of 4Aspirin, Caffeine, Dihydrocodeine Bitartrate 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 combination pill (Synalgos DC) contains dihydrocodeine, an opioid painkiller, plus aspirin and caffeine. The piece to watch is the dihydrocodeine. Goldenseal can slow down a liver enzyme called CYP3A4, which is one of the routes your body uses to clear opioids. If that pathway is blocked, more of the drug may linger in your system.
In practical terms, that could mean stronger or longer-lasting opioid effects like extra drowsiness, dizziness, constipation, or slowed breathing in larger doses. The evidence here is moderate and the effect is only possible, not guaranteed. Caffeine is also partly handled by these enzymes, so you might feel more jittery too. Please check with your pharmacist or doctor before pairing them.
- 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
ANTICOAGULANT/ANTIPLATELET DRUGS
4 of 4Aspirin, Caffeine, Dihydrocodeine Bitartrate also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.
Goldenseal contains berberine. In vitro and animal research shows that berberine can inhibit platelet aggregation. 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.
The piece of Synalgos DC that matters most here is the aspirin. Aspirin already thins the blood by keeping platelets from clumping together. Goldenseal's main compound, berberine, has shown a similar platelet-slowing effect, but only in lab dishes and animal studies. It hasn't actually been seen to cause bleeding in people, so think of this as a theoretical caution rather than a proven problem.
Stacking two things that nudge platelets in the same direction could, in theory, raise your chance of easy bruising, nosebleeds, or stomach irritation. The risk is likely low, especially with food amounts, but if you take goldenseal regularly or notice unusual bruising or bleeding, check in with your pharmacist or doctor before changing anything.
- Wu, J. F. and Liu, T. P. [Effects of berberine on platelet aggregation and plasma levels of TXB2 and 6-keto-PGF1 alpha in rats with reversible middle cerebral artery occlusion]. Yao Xue.Xue.Bao. 1995;30(2):98-102.
- Tripathi YB and Shukla SD. Berberis artistata inhibits PAF induced aggregation of rabbit platelets. Phytotherapy Research 1996;10:628-630.
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 Aspirin, Caffeine, Dihydrocodeine Bitartrate 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 Aspirin, Caffeine, Dihydrocodeine Bitartrate
This page covers Goldenseal only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Aspirin, Caffeine, Dihydrocodeine Bitartrate page lists 398 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 Danshen (major).
By severity: 17 major · 334 moderate · 47 minor.
Open the Aspirin, Caffeine, Dihydrocodeine Bitartrate 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 Aspirin, Caffeine, Dihydrocodeine Bitartrate 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 Aspirin, Caffeine, Dihydrocodeine Bitartrate 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.
#157 of 1,452 supplements looked up here in the last 7 days
#1,496 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 ›
- Valacyclovir ›
- Hydroxyurea ›
- Sumatriptan ›
- Bupropion ›
- Amoxicillin ›
- Acyclovir ›
- Bendamustine ›
- Methotrexate ›
- Azithromycin ›
- Isotretinoin ›
- Methylene Blue ›
- Ciprofloxacin ›
- Levothyroxine, Liothyronine ›
- Cyclopentolate ›
- Cephalexin ›
- Roxithromycin ›
- Pegunigalsidase Alfa-iwxj ›
- Daptomycin ›
- Hexobarbitone ›
- Dexmethylphenidate ›
- Levothyroxine Sodium ›
- Factor 7a ›
- Thyroid Hormone ›
- Carbidopa, Levodopa ›
- Mitomycin ›
- Levodopa ›
- Ezetimibe ›
- Cefaclor ›
- Phenylephrine ›
- Vancomycin ›
- Lenvatinib ›
- Hethylphenidate Hcl ›
- Dirithromycin ›
- Bentoquatam ›
- Amoxicillin, Clavulanate Potassium ›
- Procainamide ›
- Hydroxychloroquine ›
- Azelaic Acid ›
- Triptorelin ›
- Dextrothyroxine ›
- Lomustine ›
- Pizotifen ›
- Tocainide ›
- Rocuronium ›
- Succimer ›
- Mitomycin C ›
- Halothane ›
- Chenodiol ›
- Desflurane ›
- Gestodene ›
- Niacin (prescription Drug) ›
- Cabergoline ›
- Digitoxin ›
- Metronidazole ›
- Famotidine ›
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
Aspirin, Caffeine, Dihydrocodeine Bitartrate Is Linked to Lower Levels of 4 Nutrients
Natural Medicines records Aspirin, Caffeine, Dihydrocodeine Bitartrate 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 Aspirin, Caffeine, Dihydrocodeine Bitartrate 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 Aspirin, Caffeine, Dihydrocodeine Bitartrate Together: Common Questions
Can you take Goldenseal with Aspirin, Caffeine, Dihydrocodeine Bitartrate?
Why are there 4 interactions listed for Goldenseal and Aspirin, Caffeine, Dihydrocodeine Bitartrate?
How serious is the Goldenseal and Aspirin, Caffeine, Dihydrocodeine Bitartrate interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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