Drug & supplement interaction

Phellodendron + Dextromethorphan

Dextromethorphan brand names: Hold, Benylin Adult, Benylin Pediatric, Theraflu Thin Strips Long Acting Cough, Neo Citran Thin Strips Cough.

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

Dextromethorphan 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 report
SeverityModerate
LikelihoodPossible
Interactions3
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Phellodendron and Dextromethorphan

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. Dextromethorphan 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

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES

1 of 3

Why this applies to Dextromethorphan

Dextromethorphan falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES — the group Phellodendron interacts with.

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 gist with this pairing. Your body relies on an enzyme called CYP2D6 to break down dextromethorphan, the active cough suppressant. The berberine in phellodendron may slow that same enzyme down. If it does, dextromethorphan can stick around longer and build up, which means you could feel its effects more strongly than usual, things like drowsiness, dizziness, feeling lightheaded, or a bit foggy and unsteady.

The honest caveat: this is a theoretical concern based on lab work and early research, not strong human studies, so it may not amount to much in real life. Still, if you're taking phellodendron and reaching for a cough medicine, it's worth a quick check with your pharmacist or doctor first. Don't change anything on your own.

Contact Dr. Brian directly if you have additional questions on this interaction
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

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

2 of 3

Dextromethorphan also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.

Theoretically, phellodendron might increase serum levels of drugs metabolized by CYP3A4.
Phellodendron contains berberine. In vitro research and preliminary clinical research show that berberine moderately inhibits CYP3A4. Theoretically, phellodendron might also inhibit CYP3A4.
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 basic idea with cough syrups containing dextromethorphan. Your body uses liver enzymes to break this medicine down and clear it out. Phellodendron contains berberine, which lab and early human studies suggest can mildly slow one of those enzymes (CYP3A4). If that pathway slows, a bit more dextromethorphan could linger in your system than usual.

In plain terms, that might mean stronger side effects like drowsiness, dizziness, or feeling foggy or lightheaded. I want to be honest though: this concern is theoretical, based mostly on how things work in a test tube, not on strong real-world reports. For most folks taking a short course of cough medicine, it's likely a minor issue. Still, it's worth a quick chat with your pharmacist, especially if you take phellodendron regularly.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. 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
  2. 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
  3. 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
  4. 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

DEXTROMETHORPHAN (Robitussin DM, others)

3 of 3
Theoretically, phellodendron may increase serum levels of dextromethorphan.
Phellodendron 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.
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 this pair: your body relies on a liver enzyme called CYP2D6 to clear dextromethorphan, the cough suppressant in products like Robitussin DM and Benylin. Phellodendron contains berberine, and early research suggests berberine can slow that enzyme down. If clearance slows, more dextromethorphan can linger in your bloodstream, which may nudge up its usual effects, things like drowsiness, dizziness, or feeling lightheaded or foggy.

I want to be straight with you, though: this is a theoretical concern based on how the two work, not a string of real-world reports. For occasional cough use it's likely a small issue, but if you take phellodendron regularly or feel extra woozy, just check in with your pharmacist or doctor first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. 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.

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 1,161 moderate known drug interactions in our database — the Dextromethorphan one above is among them. If you take anything else, check it against the full list below.

Moderate 1,161 No known interaction 1,669 (incl. Dextromethorphan)
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.

From our Q&A

Questions About Phellodendron or Dextromethorphan

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Phellodendron or Dextromethorphan, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Dextromethorphan

This page covers Phellodendron only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Dextromethorphan page lists 171 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Grapefruit (major), Lithium (major), St. John's Wort (major) and 1,3-dmaa (moderate).

By severity: 4 major · 125 moderate · 42 minor.

From our pharmacist’s overview on the Dextromethorphan page

“A glass of grapefruit juice can push dextromethorphan (Benylin, Hold, and other cough medicines) to higher levels than intended, one of four major-rated entries among the 171 supplements and herbs on file, and the list as a whole warrants real care. Most interactions trace back to the liver enzymes (CYP3A4 and CYP2D6) that clear dextro…”

Reviewed by 2 · Jul 18, 2026

Open the Dextromethorphan 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 Dextromethorphan 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 Dextromethorphan 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%

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

29 days ago today
Medication Dextromethorphan
Top 25%

#340 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
Medication

About Dextromethorphan

What Is Dextromethorphan Used For?

Brand names: Hold, Benylin Adult, Benylin Pediatric, Theraflu Thin Strips Long Acting Cough, Neo Citran Thin Strips Cough

Dextromethorphan temporarily relieves cough due to minor throat and bronchial irritation. This can happen with the common cold or from inhaled irritants.

Some products are also labeled to help you get to sleep by reducing the urge to cough. Some labels also list helping reduce how intense the coughing is. Honey Works syrup, Premier Value Tussin Cough and CVS Long Acting Cough liquids are also labeled to help loosen phlegm (mucus) and thin bronchial secretions so they drain from the bronchial tubes.

See full Dextromethorphan drug information
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
1,161Moderate
0Minor
1,668No known interaction
1,161 Moderate 1,668 No interaction
Moderate

1,161 interactions

Showing 60 of 1,161 moderate interactions — see all 1,161 on the Phellodendron page.

No interaction 1,668 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.

Showing the 60 most looked-up of 1,668 medications checked with no known interaction — see the full Phellodendron list.

See the full Phellodendron interactions page
See every supplement checked against Dextromethorphan, 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
Phellodendron monograph › Uses, safety, and every drug interaction in one place Dextromethorphan supplement interactions › Every supplement checked against Dextromethorphan, ranked by severity Dextromethorphan 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 Phellodendron and Dextromethorphan Together: Common Questions

Can you take Phellodendron with Dextromethorphan?
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 Dextromethorphan?
Dextromethorphan 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 Dextromethorphan 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 Dextromethorphan and Phellodendron?

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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.