Drug & supplement interaction

Hound's Tongue + Cenobamate

Cenobamate brand name: Xcopri.

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

Hound's Tongue has a moderate interaction with Cenobamate. Theoretically, CYP3A4 inducers can increase the toxicity of the pyrrolizidine alkaloid (PA) constituents of hound's tongue.

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

Hound's Tongue and Cenobamate

Here is the interaction we found between these two, with the evidence behind it.

Moderate

CYTOCHROME P450 3A4 (CYP3A4) INDUCERS

Why this applies to Cenobamate

Cenobamate falls under CYTOCHROME P450 3A4 (CYP3A4) INDUCERS — the group Hound's Tongue interacts with.

Theoretically, CYP3A4 inducers can increase the toxicity of the pyrrolizidine alkaloid (PA) constituents of hound's tongue.
Hepatotoxic PAs are substrates of cytochrome P450 3A4 (CYP3A4). Drugs that induce CYP3A4 might increase the conversion of PAs to toxic metabolites.
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 situation with this pairing. Cenobamate (Xcopri) is one of those seizure medicines that can speed up a liver enzyme called CYP3A4. That same enzyme is what turns the pyrrolizidine alkaloids in Hound's Tongue into harmful, liver-damaging byproducts. So in theory, taking Cenobamate could make Hound's Tongue more toxic to your liver, not less.

Now, I want to be honest about how solid this is. The concern comes from lab and animal data, not real human studies, so it's a theoretical worry. But here's my bigger point: Hound's Tongue can hurt the liver all on its own, and I'd steer clear of swallowing it regardless. Please check with your pharmacist or doctor before using it in any form.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Chojkier M. Hepatic sinusoidal-obstruction syndrome: toxicity of pyrrolizidine alkaloids. J Hepatol 2003;39:437-46. PubMed
  2. Wang YP, Yan J, Fu PP, Chou MW. Human liver microsomal reduction of pyrrolizidine alkaloid N-oxides to form the corresponding carcinogenic parent alkaloid. Toxicol Lett 2005;155:411-20. 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

Hound's Tongue Also Interacts With Other Medications

Hound's Tongue has 86 moderate known drug interactions in our database — the Cenobamate one above is one of them. If you take anything else, check it against the full list below.

Moderate 86 No known interaction 2,744 (incl. Cenobamate)
Taking anything else?

Check Another of Your Medications Against Hound's Tongue

Covers the 2,830 medications we’ve checked against Hound's Tongue. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Cenobamate

This page covers Hound's Tongue only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Cenobamate page lists 122 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), Beer (major), Gamma-hydroxybutyrate (ghb) (major) and Kava (major).

By severity: 7 major · 99 moderate · 16 minor.

From our pharmacist’s overview on the Cenobamate page

“Anyone taking cenobamate (Xcopri) for seizures already knows the drug can cause drowsiness on its own, which is exactly why this list warrants genuine vigilance before adding a supplement. Of the 122 ingredients with an interaction on file, seven rate major, and the pattern is lopsided: 78 are sedating in their own right, from kava dow…”

Reviewed by 2 · Jul 18, 2026

Open the Cenobamate interaction page

One more smart check

Taking Hound's Tongue as Part of a Dietary Supplement Product? Check It for Interactions

We hold 1 real supplement products containing Hound's Tongue, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Hound's Tongue. Your product may carry other ingredients that interact with Cenobamate too, on top of Hound's Tongue — 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 Hound's Tongue and Cenobamate 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 Hound's Tongue
Steady interest

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

29 days ago today
Medication Cenobamate
Top half

#1,041 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 Hound's Tongue

What is Hound's Tongue?

  • Minor wounds and skin irritation
  • Coughs and sore throat
  • Hemorrhoids
  • Burns and bruises
  • Diarrhea

Hound's Tongue is a traditional folk remedy used mostly on the skin and for coughs, but there is little to no reliable human research showing it works. More importantly, it contains pyrrolizidine alkaloids that can seriously harm the liver, so internal use is generally discouraged. Talk with a pharmacist or doctor before using it in any form.

Read the full Hound's Tongue monograph & all interactions
Medication

About Cenobamate

What Is Cenobamate Used For?

Brand name: Xcopri

Xcopri (cenobamate) tablets are approved to treat partial-onset seizures — a type of epileptic seizure that starts in one area of the brain — in adult patients. It can be used alone or alongside other seizure medications.

See full Cenobamate drug information
Keep checking

Other Drugs & Hound's Tongue

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

0Major
86Moderate
0Minor
2,743No known interaction
86 Moderate 2,743 No interaction
Moderate

86 interactions

Showing 60 of 86 moderate interactions — see all 86 on the Hound's Tongue page.

No interaction 2,743 drugs checked — show the list

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

Showing the 60 most looked-up of 2,743 medications checked with no known interaction — see the full Hound's Tongue list.

See the full Hound's Tongue interactions page
See every supplement checked against Cenobamate, 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
Hound's Tongue monograph › Uses, safety, and every drug interaction in one place Cenobamate supplement interactions › Every supplement checked against Cenobamate, ranked by severity Cenobamate drug information › The full plain-English guide to this medication 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 Hound's Tongue and Cenobamate Together: Common Questions

Can you take Hound's Tongue with Cenobamate?
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.
How serious is the Hound's Tongue and Cenobamate 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 Cenobamate and Hound's Tongue?

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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.