Drug & supplement interaction

Grape + Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr

Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr brand name: Vicks Formula 44M Cough, Cold & Flu Relief.

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

Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr falls into 4 drug categories that Grape can interact with; the most serious is rated moderate. Theoretically, grape juice might reduce the levels of CYP1A2 substrates.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions4
EvidenceB
What do Severity, Likelihood & Evidence mean?
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Interaction report

Grape and Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr

These two interact in 4 distinct ways. Each one is explained separately below.

Why Are There 4 Interactions?

Grape interacts with whole categories of medication. Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr falls into 4 of those categories, so it can interact with Grape in 4 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES

1 of 4

Why this applies to Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr

Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES — the group Grape interacts with.

Theoretically, grape juice might reduce the levels of CYP1A2 substrates.
A small pharmacokinetic study in healthy adults shows that ingestion of 200 mL of grape juice decreases phenacetin plasma levels. This is thought to be due to induction of CYP1A2.
Severity Moderate Likelihood Possible Evidence B

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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist with this cough-and-cold combo (Vicks Formula 44M). Some of these ingredients are partly handled by a liver enzyme called CYP1A2. There's early, lower-quality research suggesting grape juice may slightly speed up that enzyme, which could nudge drug levels a touch lower. In plain terms, that would mean a little less effect, not a buildup of side effects.

Honestly, this is mostly theoretical and based on a small study. For a few days of cold relief, I wouldn't expect grape juice or a grape supplement to meaningfully change how well your medicine works. If you take grape supplements regularly or notice your cough or congestion isn't easing as expected, just check in with your pharmacist or doctor.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Xiao Dong S, Zhi Ping Z, Zhong Xiao W, et al. Possible enhancement of the first-pass metabolism of phenacetin by ingestion of grape juice in Chinese subjects. Br J Clin Pharmacol 1999;48:638-40. PubMed
Moderate

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES

2 of 4

Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr also falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES.

Theoretically, grape seed extract may increase the levels of CYP2D6 substrates.
In vitro evidence suggests that grape seed extract might inhibit CYP2D6 enzymes. However, this interaction has not been reported in humans.
Severity Moderate Likelihood Possible Evidence D

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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

This combo cold medicine has three pieces, and the one that matters here is dextromethorphan, the cough suppressant. Your body partly clears it using an enzyme called CYP2D6. Lab studies hint that concentrated grape seed extract might slow that enzyme down. If it did, dextromethorphan could build up a bit, which might mean more drowsiness, dizziness, or feeling foggy. The chlorpheniramine (an antihistamine) can already make you sleepy, so the main thing to watch is just feeling more tired than usual.

The good news: this is only a theoretical concern from test-tube work, not something seen in real people. Eating grapes won't do this. If you're using a grape seed supplement, just mention it to your pharmacist to be safe.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Nishikawa, M., Ariyoshi, N., Kotani, A., Ishii, I., Nakamura, H., Nakasa, H., Ida, M., Nakamura, H., Kimura, N., Kimura, M., Hasegawa, A., Kusu, F., Ohmori, S., Nakazawa, K., and Kitada, M. Effects of continuous ingestion of green tea or grape seed extra
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

3 of 4

Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.

It is unclear if grape seed extract inhibits or induces CYP3A4; research is conflicting.
In vitro evidence suggests that grape seed extract might inhibit CYP3A4 enzymes. However, evidence from animal research shows that grape seed extract may induce CYP3A4 in the liver. So far, these interactions have not been reported in humans.
Severity Moderate Likelihood Possible Evidence D

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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the honest picture: this combo cold medicine (acetaminophen for fever and aches, chlorpheniramine for runny nose, and dextromethorphan for cough) is partly handled by a liver enzyme called CYP3A4. Grape seed extract might bump that enzyme up or down, but the science is genuinely mixed. Some lab studies suggest it slows the enzyme, while animal studies suggest it speeds it up.

The key thing to know is that this has only been seen in test tubes and animals, never reported in real people. If the enzyme were slowed, you could in theory feel more drowsiness or grogginess from the dextromethorphan and chlorpheniramine. Eating grapes won't matter. If you're using a concentrated grape seed supplement regularly, just mention it to your pharmacist so they can keep an eye on things.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Nishikawa, M., Ariyoshi, N., Kotani, A., Ishii, I., Nakamura, H., Nakasa, H., Ida, M., Nakamura, H., Kimura, N., Kimura, M., Hasegawa, A., Kusu, F., Ohmori, S., Nakazawa, K., and Kitada, M. Effects of continuous ingestion of green tea or grape seed extra
  2. Etheridge, A. S., Black, S. R., Patel, P. R., So, J., and Mathews, J. M. An in vitro evaluation of cytochrome P450 inhibition and P-glycoprotein interaction with goldenseal, Ginkgo biloba, grape seed, milk thistle, and ginseng extracts and their constitu
Moderate

CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES

4 of 4

Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr also falls under CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES.

Theoretically, grape seed extract might increase the levels of CYP2E1 substrates.
In vitro and animal research suggests that grape seed proanthocyanidin extract inhibits CYP2E1 enzymes. However, this interaction has not been reported in humans.
Severity Moderate Likelihood Possible Evidence D

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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist for this multi-symptom cold and flu product. One of its enzymes, called CYP2E1, helps your liver process the acetaminophen (the Tylenol part). Lab and animal studies hint that concentrated grape seed extract might slow that enzyme down a bit. In theory, that could let acetaminophen linger a little longer, which is mostly a concern for how the liver handles it.

That said, this has never actually been reported in people, so I wouldn't lose sleep over it. Eating grapes or drinking grape juice is no issue at all. The bigger acetaminophen rule still matters most: watch your total daily dose and skip the alcohol. If you take a daily grape seed supplement, just mention it to your pharmacist so they can keep an eye on things.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Ray, S. D., Parikh, H., Hickey, E., Bagchi, M., and Bagchi, D. Differential effects of IH636 grape seed proanthocyanidin extract and a DNA repair modulator 4-aminobenzamide on liver microsomal cytochrome 4502E1-dependent aniline hydroxylation. Mol Cell B 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

Grape Also Interacts With Other Medications

Grape has 867 moderate, 42 minor known drug interactions in our database — the Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr one above is among them. If you take anything else, check it against the full list below.

Moderate 867 Minor 42 No known interaction 1,921 (incl. Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr)
Taking anything else?

Check Another of Your Medications Against Grape

Covers the 2,830 medications we’ve checked against Grape. Pick one to open its full report.

From our Q&A

Questions About Grape or Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Grape or Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr, 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:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr

This page covers Grape only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr page lists 275 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), Grapefruit (major) and Henbane (major).

By severity: 10 major · 220 moderate · 45 minor.

From our pharmacist’s overview on the Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr page

“A three-drug cold formula like Vicks Formula 44M (acetaminophen, chlorpheniramine, and dextromethorphan) gives supplements three separate targets, so its interaction list warrants real vigilance, starting with the ten major-rated entries. The dominant patterns track each ingredient.”

Reviewed by 2 · Jul 18, 2026

Open the Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr interaction page

One more smart check

Taking Grape as Part of a Dietary Supplement Product? Check It for Interactions

We hold 8,053 real supplement products containing Grape, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Grape. Your product may carry other ingredients that interact with Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr too, on top of Grape — 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 Grape and Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr 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 Grape
Top 5%

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

29 days ago today
Medication Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr
Top 5%

#120 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 Grape

What is Grape?

Grape
  • Antioxidant support
  • Heart and circulation health
  • Vein problems (such as varicose veins)
  • Eye health
  • General anti-inflammatory support

Grapes and grape products like grape seed extract contain antioxidant compounds such as resveratrol and proanthocyanidins that may support heart and blood vessel health. While the food is healthy and generally safe, the supplement evidence for treating specific conditions is mostly limited or preliminary. Talk with your pharmacist or doctor before starting a grape supplement.

Read the full Grape monograph & all interactions
Keep checking

Other Drugs & Grape

Browse every other medication we’ve checked against Grape — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
867Moderate
42Minor
1,920No known interaction
867 Moderate 42 Minor 1,920 No interaction
Moderate

867 interactions

Showing 60 of 867 moderate interactions — see all 867 on the Grape page.

Minor

42 interactions

No interaction 1,920 drugs checked — show the list

We also checked Grape against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 1,920 medications checked with no known interaction — see the full Grape list.

See the full Grape interactions page
See every supplement checked against Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr, 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
Grape monograph › Uses, safety, and every drug interaction in one place Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr supplement interactions › Every supplement checked against Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr, 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 Grape and Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr Together: Common Questions

Can you take Grape with Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr?
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 4 interactions listed for Grape and Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr?
Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr belongs to more than one drug category, and Grape 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 Grape and Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr 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 Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HBr and Grape?

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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.