Drug & supplement interaction

Padang Cassia + Tramadol, Acetaminophen

Tramadol, Acetaminophen brand name: Tramacet.

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

Tramadol, Acetaminophen falls into 2 drug categories that Padang Cassia can interact with; the most serious is rated moderate. There is some concern that ingesting large amounts of Padang cassia might cause hepatotoxicity in some people.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Padang Cassia and Tramadol, Acetaminophen

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Padang Cassia interacts with whole categories of medication. Tramadol, Acetaminophen falls into 2 of those categories, so it can interact with Padang Cassia in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

HEPATOTOXIC DRUGS

1 of 2

Why this applies to Tramadol, Acetaminophen

Tramadol, Acetaminophen falls under HEPATOTOXIC DRUGS — the group Padang Cassia interacts with.

There is some concern that ingesting large amounts of Padang cassia might cause hepatotoxicity in some people. Padang cassia contains coumarin. Coumarin has caused hepatotoxicity in animal models. In otherwise healthy humans, very high doses of coumarin, from 50-7000 mg daily, can result in hepatotoxicity that resolves when coumarin use is discontinued. Lower amounts might also cause liver problems in sensitive people, such as those with liver disease or those taking potentially hepatotoxic agents.
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 thing to keep in mind with this combo: the acetaminophen half of Tramacet is one of the most common causes of liver stress when doses run high. Padang cassia is a cassia cinnamon, and it naturally carries coumarin, a compound that has been linked to liver trouble in animals and in people taking very large amounts. The worry is that stacking a liver-taxing supplement on top of an acetaminophen-containing medicine could add to that burden.

I want to be honest that this is a theoretical concern based on how these things work, not proven harm at normal use. A sprinkle of cinnamon on your oatmeal won't matter. Concentrated cinnamon capsules taken daily are the real question. If you take Tramacet regularly or have any liver issues, check with your pharmacist or doctor before adding them.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Press release. Cinnamon capsules to reduce blood sugar are medicinal products! Efficacy has not been scientifically proven - some products contain high levels of coumarin. Federal Institute of Risk Assessment (BfM), Germany, November 11, 2006. Available a
  2. Felter SP, Vassallo JD, Carlton BD, Daston GP. A safety assessment of coumarin taking into account species-specificity of toxicokinetics. Food Chem Toxicol 2006;44:462-75. PubMed
  3. Choi, J., Lee, K. T., Ka, H., Jung, W. T., Jung, H. J., and Park, H. J. Constituents of the essential oil of the Cinnamomum cassia stem bark and the biological properties. Arch Pharm Res 2001;24(5):418-423.
  4. Wang R, Wang R, Yan B. Extraction of essential oils from five cinnamon leaves and identification of their volatile compound compositions. Innovative Food Science and Emerging Technologies 2009;10:289-92. DOI
  5. Wang YH, Avula B, Nanayakkara NP, et al. Cassia cinnamon as a source of coumarin in cinnamon-flavored food and food supplements in the United States. J Agric Food Chem 2013;61(18):4470-6. PubMed
  6. Woehrlin F, Fry H, Abraham K, Preiss-Weigert A. Quantification of flavoring constituents in cinnamon: high variation of coumarin in cassia bark from the German retail market and in authentic samples from Indonesia. J Agric Food Chem 2010;58(19):10568-75. PubMed
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

2 of 2

Tramadol, Acetaminophen also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.

In vitro research shows that a methanol extract of Padang cassia inhibits cytochrome P450 3A4 (CYP3A4) activity. Theoretically, taking Padang cassia with CYP3A4 substrates might increase the effects and side effects of these substrates.
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 Tramacet, which combines tramadol with acetaminophen. The tramadol piece relies on liver enzymes, including CYP3A4, to be processed. The lab finding here suggests that a concentrated extract of Padang cassia may slow that enzyme down. If that happened in your body, tramadol could hang around longer and feel stronger, which might mean more drowsiness, dizziness, nausea, constipation, or in rare cases trouble breathing.

I want to be honest though: this is only test-tube evidence, not something proven in people, so I wouldn't lose sleep over it. Sprinkling cinnamon on your oatmeal is no concern. Concentrated cinnamon capsules are a different story, partly because cassia also contains coumarin. Before adding a cinnamon supplement, run it by your pharmacist or doctor first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Subehan S, Kadota S, Tezuka Y. In vitro mechanism-based inactivation of cytochrome P450 3A4 by a new constituent of Cinnamomum burmani. Planta Med 2008;74(12):1474-80.

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

Padang Cassia Also Interacts With Other Medications

Padang Cassia has 933 moderate known drug interactions in our database — the Tramadol, Acetaminophen one above is among them. If you take anything else, check it against the full list below.

Moderate 933 No known interaction 1,897 (incl. Tramadol, Acetaminophen)
Taking anything else?

Check Another of Your Medications Against Padang Cassia

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

Everything else you take

See Every Supplement That Interacts With Tramadol, Acetaminophen

This page covers Padang Cassia only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Tramadol, Acetaminophen page lists 280 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: 12 major · 224 moderate · 44 minor.

From our pharmacist’s overview on the Tramadol, Acetaminophen page

“The combinations I worry about most with tramadol and acetaminophen (Tramacet) involve anything that deepens drowsiness or strains the liver. Tramadol is an opioid, so sedating supplements like kava, along with alcohol in any form, can slow breathing on top of adding sleepiness, which is why this list deserves genuine care rather than…”

Reviewed by 2 · Jul 18, 2026

Open the Tramadol, Acetaminophen interaction page

How much people look this up

Where Padang Cassia and Tramadol, Acetaminophen 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 Padang Cassia
Top half

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

29 days ago today
Medication Tramadol, Acetaminophen
Top 10%

#265 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 Padang Cassia

What is Padang Cassia?

  • Adding flavor to food
  • Digestive upset
  • Blood sugar support
  • Antimicrobial purposes
  • Antioxidant support

Padang Cassia is a type of cinnamon (Indonesian or Korintje cinnamon) grown mainly in Indonesia and used widely as a kitchen spice. As a supplement, evidence for health benefits like blood sugar control is limited and mixed, and like other cassia cinnamons it naturally contains coumarin, which can be harmful to the liver in large amounts. Use food amounts freely, but talk to a pharmacist or doctor before taking concentrated cinnamon supplements.

Read the full Padang Cassia monograph & all interactions
Keep checking

Other Drugs & Padang Cassia

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

0Major
933Moderate
0Minor
1,896No known interaction
933 Moderate 1,896 No interaction
Moderate

933 interactions

Showing 60 of 933 moderate interactions — see all 933 on the Padang Cassia page.

No interaction 1,896 drugs checked — show the list

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

Showing the 60 most looked-up of 1,896 medications checked with no known interaction — see the full Padang Cassia list.

See the full Padang Cassia interactions page
See every supplement checked against Tramadol, Acetaminophen, 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
Padang Cassia monograph › Uses, safety, and every drug interaction in one place Tramadol, Acetaminophen supplement interactions › Every supplement checked against Tramadol, Acetaminophen, 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 Padang Cassia and Tramadol, Acetaminophen Together: Common Questions

Can you take Padang Cassia with Tramadol, Acetaminophen?
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 2 interactions listed for Padang Cassia and Tramadol, Acetaminophen?
Tramadol, Acetaminophen belongs to more than one drug category, and Padang Cassia 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 Padang Cassia and Tramadol, Acetaminophen 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

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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.