Drug & supplement interaction

Phellodendron + Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide

Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide brand name: Ascriptin Codeine #2.

Moderate Interaction
The bottom line Moderate

Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide falls into 3 drug categories that Phellodendron can interact with; the most serious is rated moderate. Theoretically, phellodendron might increase the sedative effects of CNS depressants.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions3
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Phellodendron and Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide

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. Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide 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).

Moderate

CNS DEPRESSANTS

1 of 3

Why this applies to Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide

Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide falls under CNS DEPRESSANTS — the group Phellodendron interacts with.

Theoretically, phellodendron might increase the sedative effects of CNS depressants.
Phellodendron contains berberine. Animal research suggests that berberine may have sedative effects. Theoretically, phellodendron might also have CNS depressants effects.
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 combination product contains codeine, an opioid pain reliever that already makes some people feel drowsy or foggy. Phellodendron contains berberine, and in animal studies berberine showed mild sedative-like effects. The concern here is simple: stacking a calming herb on top of a medicine that can already slow you down might add up to more sleepiness, dizziness, or trouble concentrating.

I'll be honest, this is a theoretical worry based on lab and animal work, not strong human evidence, so it isn't a reason to panic. The aspirin and antacids in this product aren't part of the issue. Still, if you plan to use phellodendron, mention it to your pharmacist or doctor first, and go easy on driving until you know how the mix affects you.

References
  1. Janbaz KH, Gilani AH. Studies on preventive and curative effects of berberine on chemical-induced hepatotoxicity in rodents. Fitoterapia 2000;71:25-33.. PubMed
  2. Shanbhag, S. M., Kulkarni, H. J., and Gaitonde, B. B. Pharmacological actions of berberine on the central nervous system. Jpn.J Pharmacol 1970;20(4):482-487. PubMed
  3. Peng, W. H., Hsieh, M. T., and Wu, C. R. Effect of long-term administration of berberine on scopolamine-induced amnesia in rats. Jpn J Pharmacol 1997;74(3):261-266. DOI
  4. Sabir M and Bhide NK. Study of some pharmacological actions of berberine. Ind J Physiol & Pharmac 1971;15(3):111-132.
Moderate

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES

2 of 3

Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide also falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES.

Theoretically, phellodendron might increase serum levels of drugs metabolized by CYP2D6.
Phellodendron contains berberine. In vitro research and preliminary clinical evidence show that berberine can inhibit CYP2D6. Theoretically, phellodendron might also inhibit CYP2D6.
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 part of this combo product that matters: codeine. Codeine is what we call a prodrug, meaning it has to be switched on by a liver enzyme called CYP2D6 before your body turns it into morphine, which is what actually relieves pain. Phellodendron contains berberine, which lab and early human studies suggest can slow down CYP2D6.

So in theory, taking phellodendron alongside this product could mean less of your codeine gets activated, giving you weaker pain relief or a weaker cough effect. The aspirin and the antacid pieces (aluminum and magnesium) aren't really involved here. Keep in mind this concern is theoretical and based on pharmacology, not strong real-world proof. If you rely on this medicine for pain, check with your pharmacist or doctor before adding phellodendron.

References
  1. 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
  2. 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
  3. 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
Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

3 of 3

Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.

Theoretically, phellodendron might increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.
Phellodendron contains berberine. In vitro and in vivo research suggest that berberine can inhibit platelet aggregation. Theoretically, phellodendron might also inhibit platelet aggregation.
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 combination product (Ascriptin Codeine #2) contains aspirin, which already thins the blood a little by keeping platelets from clumping together. Phellodendron contains berberine, and in lab and animal studies berberine appears to slow platelet activity too. Stack the two and, in theory, you could lean further toward easy bruising, nosebleeds, or bleeding that takes longer to stop.

I want to be honest about the strength of this: it comes from test tube and animal data, not solid human studies, so it's more of a caution flag than a proven problem. Still, since aspirin's whole job here involves platelets, it's worth a quick chat with your pharmacist or doctor before pairing them, especially if you bruise easily or take other blood thinners.

References
  1. Wu, J. F. and Liu, T. P. [Effects of berberine on platelet aggregation and plasma levels of TXB2 and 6-keto-PGF1 alpha in rats with reversible middle cerebral artery occlusion]. Yao Xue.Xue.Bao. 1995;30(2):98-102.
  2. Tripathi YB and Shukla SD. Berberis artistata inhibits PAF induced aggregation of rabbit platelets. Phytotherapy Research 1996;10:628-630.

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

Phellodendron Also Interacts With Other Medications

Phellodendron has 1,159 moderate known drug interactions in our database — the Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide one above is among them. If you take anything else, check it against the full list below.

Taking anything else?

Check Another of Your Medications Against Phellodendron

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

Everything else you take

See Every Supplement That Interacts With Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide

This page covers Phellodendron only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide page lists 339 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 Danshen (major).

By severity: 11 major · 286 moderate · 42 minor.

From our pharmacist’s overview on the Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide page

“A person taking Ascriptin Codeine #2 for pain is getting aspirin, codeine, and two antacids in a single tablet, and the 339 supplement interactions on file deserve real attention before adding anything alongside it. Most of the list splits two ways.”

Reviewed by 2 · Jul 18, 2026

Open the Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide interaction page

One more smart check

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 Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide 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:

How much people look this up

Where Phellodendron and Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide 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 Phellodendron
Top 25%

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

29 days ago today
Medication Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide
Steady interest

#1,606 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 Phellodendron

What is Phellodendron?

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.

Read the full Phellodendron monograph & all interactions
Keep checking

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.

0Major
1,159Moderate
0Minor
1,670No known interaction
Moderate

1,159 interactions

Showing 60 of 1,159 moderate interactions — see all 1,159 on the Phellodendron page.

No interaction 1,670 drugs checked — show the list
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

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Pharmacist Counseling Corner

Taking Phellodendron and Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide Together: Common Questions

Can you take Phellodendron with Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide?
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 3 interactions listed for Phellodendron and Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide?
Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide belongs to more than one drug category, and Phellodendron 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 Phellodendron and Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide 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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