Phellodendron + Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine
Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine brand names: Robitussin Cold, Suphedrine Cold/Cough, Severe Cold.
Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine falls into 3 drug categories that Phellodendron can interact with; the most serious is rated moderate. Theoretically, phellodendron might increase serum levels of drugs metabolized by CYP2D6.
Read the full interaction reportPhellodendron and Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine
These two interact in 3 distinct ways. Each one is explained separately below.
Why Are There 3 Interactions?
Phellodendron interacts with whole categories of medication. Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine falls into 3 of those categories, so it can interact with Phellodendron in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES
1 of 3Why this applies to Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine
Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES — the group Phellodendron interacts with.
Phellodendron contains berberine. In vitro research and preliminary clinical evidence show that berberine can inhibit CYP2D6. Theoretically, phellodendron might also inhibit CYP2D6.
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.
In this combo cold product, the piece that matters here is the dextromethorphan (the cough suppressant). Your body relies on a liver enzyme called CYP2D6 to break it down. The berberine in phellodendron may slow that enzyme, so dextromethorphan could clear more slowly and build up a bit. If that happens, you might feel more of its usual effects, like drowsiness, dizziness, or feeling foggy. The acetaminophen, guaifenesin, and pseudoephedrine aren't really affected by this particular pathway.
I want to be honest: this is a theoretical concern based mostly on lab work, not strong human data, so for most people it's unlikely to cause trouble. Still, if you use phellodendron regularly, run it by your pharmacist or doctor first.
- 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
- Guo, Y., Chen, Y., Tan, Z. R., Klaassen, C. D., and Zhou, H. H. Repeated administration of berberine inhibits cytochromes P450 in humans. Eur J Clin Pharmacol 2012;68(2):213-217. PubMed
- Hermann, R. and von, Richter O. Clinical evidence of herbal drugs as perpetrators of pharmacokinetic drug interactions. Planta Med 2012;78(13):1458-1477. PubMed
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
2 of 3Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
Phellodendron contains berberine. In vitro research and preliminary clinical research show that berberine moderately inhibits CYP3A4. Theoretically, phellodendron might also inhibit CYP3A4.
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 short version: this combo cold product has several ingredients, and the one that matters most here is dextromethorphan (the cough suppressant). Phellodendron contains berberine, which lab and early human studies suggest can mildly slow down CYP3A4, an enzyme that helps clear dextromethorphan. If that enzyme is partly blocked, dextromethorphan could build up a bit, leading to more drowsiness, dizziness, or feeling foggy. The acetaminophen, guaifenesin, and pseudoephedrine aren't really driven by this pathway.
I want to be honest that this concern is theoretical, based on how things work in the lab, not strong real-world reports. For most people taking a short-term cold remedy, it's unlikely to cause trouble, but it's worth a quick word with your pharmacist before pairing them.
- Wu X, Li Q, Xin H, Yu A, Zhong M. Effects of berberine on the blood concentration of cyclosporin A in renal transplanted recipients: clinical and pharmacokinetic study. Eur J Clin Pharmacol 2005;61:567-72. PubMed
- 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
- Guo, Y., Chen, Y., Tan, Z. R., Klaassen, C. D., and Zhou, H. H. Repeated administration of berberine inhibits cytochromes P450 in humans. Eur J Clin Pharmacol 2012;68(2):213-217. PubMed
- Hermann, R. and von, Richter O. Clinical evidence of herbal drugs as perpetrators of pharmacokinetic drug interactions. Planta Med 2012;78(13):1458-1477. PubMed
DEXTROMETHORPHAN (Robitussin DM, others)
3 of 3Phellodendron contains berberine. Preliminary clinical research shows that berberine can inhibit cytochrome P450 2D6 (CYP2D6) activity and reduce the metabolism of dextromethorphan. Theoretically, phellodendron may also inhibit the metabolism of dextromethorphan.
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 cold product contains dextromethorphan, the cough suppressant, and that is the piece phellodendron may affect. Phellodendron supplies berberine, which can slow down a liver enzyme called CYP2D6, the same enzyme your body uses to clear dextromethorphan. If that pathway is partly blocked, more dextromethorphan can hang around in your system.
In plain terms, you might feel more of its usual effects, things like drowsiness, dizziness, a foggy or floaty feeling, or nausea. Keep in mind this is a theoretical concern based on how these compounds behave, not a proven problem, so it is not something to panic over. Still, before pairing them, it is worth a quick chat with your pharmacist or doctor, especially if you already feel groggy on cough medicine.
- Guo, Y., Chen, Y., Tan, Z. R., Klaassen, C. D., and Zhou, H. H. Repeated administration of berberine inhibits cytochromes P450 in humans. Eur J Clin Pharmacol 2012;68(2):213-217. PubMed
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.
Phellodendron Also Interacts With Other Medications
Phellodendron has 1,159 moderate known drug interactions in our database — the Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Phellodendron
We haven’t checked that one against Phellodendron yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Phellodendron. Pick one to open its full report.
See Every Supplement That Interacts With Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine
This page covers Phellodendron only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine page lists 262 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), Ephedra (major) and Grapefruit (major).
By severity: 12 major · 207 moderate · 43 minor.
Open the Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine interaction page
Taking Phellodendron as Part of a Dietary Supplement Product? Check It for Interactions
We hold 393 real supplement products containing Phellodendron, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Phellodendron. Your product may carry other ingredients that interact with Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine too, on top of Phellodendron — and those would not show on this page. Find your product and we’ll check every ingredient on its label:
Where Phellodendron and Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine 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.
#313 of 1,452 supplements looked up here in the last 7 days
#1,420 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 Phellodendron
What is Phellodendron?
- Digestive complaints and diarrhea
- Inflammation and joint discomfort
- Stress and weight management (in combination products)
- Skin conditions (topical, traditional)
- Antimicrobial support
Phellodendron is a traditional Chinese medicine bark (Huang Bai) that contains berberine and other plant compounds with antimicrobial and anti-inflammatory activity in lab studies. Human evidence for most uses is limited, and it is often sold in combination with other herbs, making its individual effects hard to judge. Talk with your pharmacist or doctor before using it, and avoid it during pregnancy and breastfeeding.
Other Drugs & Phellodendron
Browse every other medication we’ve checked against Phellodendron — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
1,159 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Nifedipine ›
- Ibuprofen ›
- Diphenhydramine ›
- Aspirin ›
- Hydrocortisone ›
- Insulin (rdna) ›
- Naproxen ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Lidocaine ›
- 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 ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Dipyridamole ›
- Doxorubicin ›
- Fluticasone ›
- Formoterol ›
- Hydralazine ›
- Indomethacin ›
- Insulin (human) ›
- Miconazole ›
- Morphine Sulfate ›
- Nitrazepam ›
- Trimipramine ›
- Amphetamine ›
- Buprenorphine ›
- Conjugated Estrogens ›
- Diazepam ›
- Everolimus ›
- Ivabradine ›
Showing 60 of 1,159 moderate interactions — see all 1,159 on the Phellodendron page.
No interaction 1,670 drugs checked — show the list
We also checked Phellodendron against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Methylphenidate ›
- Ivermectin ›
- Rosuvastatin ›
- Escitalopram ›
- Acetaminophen ›
- Docusate ›
- Valacyclovir ›
- Hydroxyurea ›
- Sumatriptan ›
- Bupropion ›
- Amoxicillin ›
- Acyclovir ›
- Bendamustine ›
- Doxycycline ›
- Methotrexate ›
- Azithromycin ›
- Isotretinoin ›
- Methylene Blue ›
- Ciprofloxacin ›
- Levothyroxine, Liothyronine ›
- Cyclopentolate ›
- Cephalexin ›
- Roxithromycin ›
- Pegunigalsidase Alfa-iwxj ›
- Daptomycin ›
- Hexobarbitone ›
- Levothyroxine Sodium ›
- Dexmethylphenidate ›
- Factor 7a ›
- Thyroid Hormone ›
- Carbidopa, Levodopa ›
- Mitomycin ›
- Levodopa ›
- Ezetimibe ›
- Cefaclor ›
- Lenvatinib ›
- Phenylephrine ›
- Vancomycin ›
- Hethylphenidate Hcl ›
- Dirithromycin ›
- Bentoquatam ›
- Procainamide ›
- Amoxicillin, Clavulanate Potassium ›
- Hydroxychloroquine ›
- Digoxin ›
- Azelaic Acid ›
- Triptorelin ›
- Dextrothyroxine ›
- Lomustine ›
- Pizotifen ›
- Tocainide ›
- Rocuronium ›
- Succimer ›
- Mitomycin C ›
- Paracetamol ›
- Halothane ›
- Gestodene ›
- Chenodiol ›
- Desflurane ›
Showing the 60 most looked-up of 1,670 medications checked with no known interaction — see the full Phellodendron 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
Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine Is Linked to Lower Levels of One Nutrient
Natural Medicines records Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine as a medicine that can lower these. This is not an interaction with Phellodendron — it is a separate effect of the medicine, and it is a reason some people are advised to supplement rather than to avoid one:
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 Phellodendron and Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine Together: Common Questions
Can you take Phellodendron with Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine?
Why are there 3 interactions listed for Phellodendron and Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine?
How serious is the Phellodendron and Acetaminophen, Dextromethorphan, Guaifenesin, Pseudoephedrine interaction?
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.