Peony + Aspirin, Butalbital, Caffeine
Aspirin, Butalbital, Caffeine brand name: Fiorinal.
Aspirin, Butalbital, Caffeine falls into 3 drug categories that Peony can interact with; the most serious is rated moderate. Theoretically, use of peony may increase the levels and clinical effects of drugs metabolized by CYP1A2.
Read the full interaction reportPeony and Aspirin, Butalbital, Caffeine
These two interact in 3 distinct ways. Each one is explained separately below.
Why Are There 3 Interactions?
Peony interacts with whole categories of medication. Aspirin, Butalbital, Caffeine falls into 3 of those categories, so it can interact with Peony in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES
1 of 3Why this applies to Aspirin, Butalbital, Caffeine
Aspirin, Butalbital, Caffeine falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES — the group Peony interacts with.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. 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.
Here's the piece that matters with Fiorinal (aspirin, butalbital, and caffeine): the caffeine in it is handled by a liver enzyme called CYP1A2. Lab and animal studies suggest peony may gently slow that enzyme down. If that happened in a person, the caffeine could hang around a bit longer than usual, so you might feel more of the jittery, wired side: a racing or pounding heart, trouble sleeping, restlessness, or an upset stomach.
I want to be honest about the evidence here. This is theoretical, based only on test-tube and animal work, and it has not been shown in real people. For most folks it's unlikely to be a big deal, but if you take peony regularly and notice extra jitteriness, check in with your pharmacist or doctor before changing anything.
- Wang W, Tian DD, Zheng B, et al. Peony-glycyrrhiza decoction, an herbal preparation, inhibits clozapine metabolism via cytochrome P450s, but not flavin-containing monooxygenase in in vitro models. Drug Metab Dispos 2015;43(7):1147-53. PubMed
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
2 of 3Aspirin, Butalbital, Caffeine also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
In vitro research shows that peony suppresses the metabolism of clozapine via weak-to-moderate inhibitory effects on CYP1A2 and CYP3A4. 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.
Here's the practical picture with Fiorinal (aspirin, butalbital, and caffeine) and peony root. Peony has shown a mild ability, in test-tube studies only, to slow down a liver enzyme called CYP3A4. The butalbital piece of this combo is partly cleared by that pathway. So in theory, if peony blocks that enzyme, butalbital could hang around a bit longer than usual.
What that might look like in real life is more drowsiness, grogginess, or feeling foggy and unsteady. I want to be honest though: this is based on lab work, not on actual people, and the effect was described as weak. Culinary or small herbal amounts are unlikely to matter much. Since butalbital is sedating and habit-forming, just run the peony past your pharmacist or doctor before combining them.
- Wang W, Tian DD, Zheng B, et al. Peony-glycyrrhiza decoction, an herbal preparation, inhibits clozapine metabolism via cytochrome P450s, but not flavin-containing monooxygenase in in vitro models. Drug Metab Dispos 2015;43(7):1147-53. PubMed
ANTICOAGULANT/ANTIPLATELET DRUGS
3 of 3Aspirin, Butalbital, Caffeine also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.
In vitro research suggests that peony might have antiplatelet, anticoagulant, and antithrombotic effects.
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.
Here's the thing to keep in mind with Fiorinal: the aspirin part already thins your blood a bit by making your platelets less sticky. Peony, in early lab and animal studies, seems to do something similar. So when you stack the two together, you could nudge your bleeding risk a little higher. In real life that might look like easier bruising, nosebleeds, bleeding gums, or a cut that takes longer to stop.
I want to be honest about the evidence, though. This concern comes only from test-tube and animal research, not from people, so it's more theoretical than proven. Still, if you take Fiorinal regularly or you're already prone to bleeding, it's worth a quick chat with your pharmacist or doctor before adding peony.
- Koo YK, Kim JM, Koo JY, et al. Platelet anti-aggregatory and blood anti-coagulant effects of compounds isolated from Paeonia lactiflora and Paeonia suffruticosa. Pharmazie 2010;65(8):624-8.
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.
Peony Also Interacts With Other Medications
Peony has 812 moderate known drug interactions in our database — the Aspirin, Butalbital, Caffeine one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Peony
We haven’t checked that one against Peony yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Peony. Pick one to open its full report.
See Every Supplement That Interacts With Aspirin, Butalbital, Caffeine
This page covers Peony only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Aspirin, Butalbital, Caffeine page lists 347 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), Danshen (major) and Ephedra (major).
By severity: 13 major · 285 moderate · 49 minor.
From our pharmacist’s overview on the Aspirin, Butalbital, Caffeine page
“The aspirin inside Fiorinal (aspirin, butalbital, caffeine) is the reason this list deserves careful reading rather than a quick skim. More than 200 of the supplements and herbs on file can thin the blood further and raise bleeding risk on top of aspirin's own antiplatelet effect, and even ordinary alcohol, beer and wine included, carr…”
Reviewed by 2 · Jul 18, 2026
Taking Peony as Part of a Dietary Supplement Product? Check It for Interactions
We hold 71 real supplement products containing Peony, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Peony. Your product may carry other ingredients that interact with Aspirin, Butalbital, Caffeine too, on top of Peony — and those would not show on this page. Find your product and we’ll check every ingredient on its label:
Where Peony and Aspirin, Butalbital, Caffeine 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.
#200 of 1,452 supplements looked up here in the last 7 days
#87 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 Peony
What is Peony?
- Menstrual cramps and irregular periods
- Muscle cramps and spasms
- Anxiety and stress
- Inflammation and pain
- Polycystic ovary syndrome (PCOS)
Peony root is a traditional Chinese medicine herb often used for menstrual problems, cramps, and inflammation, frequently as part of combination formulas. Human evidence for most uses is limited or preliminary, so it should not replace proven treatments. Talk to your pharmacist or doctor before using it, especially if you are pregnant, breastfeeding, or taking other medicines.
About Aspirin, Butalbital, and Caffeine
What Is Aspirin, Butalbital, and Caffeine Used For?
Brand name: Fiorinal
This combination is used to relieve the symptoms of tension (or muscle contraction) headache. The supported product is the oral capsule.
There is no evidence that it works or is safe for multiple recurrent headaches. Caution is needed because butalbital is habit-forming and can be abused.
Other Drugs & Peony
Browse every other medication we’ve checked against Peony — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
812 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Theophylline ›
- Nifedipine ›
- Ibuprofen ›
- Aspirin ›
- Hydrocortisone ›
- Naproxen ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Lidocaine ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Triazolam ›
- Zopiclone ›
- Colchicine ›
- Fentanyl ›
- Oxybutynin ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Dipyridamole ›
- Doxorubicin ›
- Fluticasone ›
- Miconazole ›
- Acetaminophen ›
- Buprenorphine ›
- Conjugated Estrogens ›
- Diazepam ›
- Everolimus ›
- Ivabradine ›
- Ketoprofen ›
- Lofepramine ›
- Medroxyprogesterone ›
- Medroxyprogesterone Acetate ›
- Nortriptyline ›
- Rifampin ›
- Testosterone Undecanoate ›
- Aripiprazole ›
- Bendamustine ›
- Bivalirudin ›
- Caffeine (otc Drug) ›
- Ciclesonide ›
- Clonazepam ›
- Cyclobenzaprine ›
- Dapsone ›
Showing 60 of 812 moderate interactions — see all 812 on the Peony page.
No interaction 2,017 drugs checked — show the list
We also checked Peony against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Methylphenidate ›
- Ivermectin ›
- Rosuvastatin ›
- Metoprolol ›
- Isotretinoin ›
- Tirzepatide ›
- Levothyroxine, Liothyronine ›
- Docusate ›
- Metformin ›
- Methamphetamine ›
- Lisdexamfetamine ›
- Semaglutide ›
- Amphetamine ›
- Hydroxyurea ›
- Valacyclovir ›
- Sumatriptan ›
- Lisinopril ›
- Amoxicillin ›
- Methotrexate ›
- Bupropion ›
- Azithromycin ›
- Fluoxetine ›
- Doxycycline ›
- Pregabalin ›
- Gabapentin ›
- Dextroamphetamine ›
- Lamotrigine ›
- Acyclovir ›
- Duloxetine ›
- Methylene Blue ›
- Ciprofloxacin ›
- Candesartan Cilexetil ›
- Amoxicillin, Clavulanate Potassium ›
- Insulin Degludec, Liraglutide ›
- Bisoprolol ›
- Calcium Oxybate, Magnesium Oxybate, Potassium Oxybate, Sodium Oxybate ›
- Aminophylline, Amobarbital, Ephedrine ›
- Atenolol, Chlorthalidone ›
- Amphetamine Aspartate, Amphetamine Sulfate, Dextroamphetamine Saccharate, Dextroamphetamine Sulfate ›
- Enalapril Maleate ›
- Bendroflumethiazide, Rauwolfia Serpentina ›
- Ephedrine, Phenobarbital, Theophylline ›
- Bismuth Subcarbonate, Calcium Carbonate, Opium ›
- Ezetimibe ›
- Sulfamethoxazole, Trimethoprim ›
- Rosiglitazone Maleate ›
- Cephalexin ›
- Sacubitril, Valsartan ›
- Nebivolol Hydrochloride, Valsartan ›
- Cyclopentolate ›
- Levetiracetam ›
- Levodopa ›
- Insulin Aspart, Insulin Degludec ›
- Canagliflozin, Metformin ›
- Isoniazid, Pyrazinamide, Rifampin ›
- Candesartan Cilexetil, Hydrochlorothiazide ›
- Daunorubicin, Cytarabine ›
- Hydrocortisone, Clioquinol, Pramoxine ›
- Saxagliptin, Metformin Xr ›
Showing the 60 most looked-up of 2,017 medications checked with no known interaction — see the full Peony 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, Butalbital, Caffeine Is Linked to Lower Levels of 4 Nutrients
Natural Medicines records Aspirin, Butalbital, Caffeine as a medicine that can lower these. This is not an interaction with Peony — 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, Butalbital, Caffeine 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 Peony and Aspirin, Butalbital, Caffeine Together: Common Questions
Can you take Peony with Aspirin, Butalbital, Caffeine?
Why are there 3 interactions listed for Peony and Aspirin, Butalbital, Caffeine?
How serious is the Peony and Aspirin, Butalbital, Caffeine interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
Still Have a Question About Aspirin, Butalbital, Caffeine and Peony?
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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.