Drug & supplement interaction

Rooibos + Tramadol, Acetaminophen

Tramadol, Acetaminophen brand name: Tramacet.

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

Tramadol, Acetaminophen falls into 3 drug categories that Rooibos can interact with; the most serious is rated moderate. Theoretically, taking rooibos with CYP1A2 substrates may increase the effects of CYP1A2 substrates.

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

Rooibos and Tramadol, Acetaminophen

These two interact in 3 distinct ways. Each one is explained separately below.

Why Are There 3 Interactions?

Rooibos interacts with whole categories of medication. Tramadol, Acetaminophen falls into 3 of those categories, so it can interact with Rooibos 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 1A2 (CYP1A2) SUBSTRATES

1 of 3

Why this applies to Tramadol, Acetaminophen

Tramadol, Acetaminophen falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES — the group Rooibos interacts with.

Theoretically, taking rooibos with CYP1A2 substrates may increase the effects of CYP1A2 substrates.
In vitro research shows that the methanol extract of rooibos leaves and stems inhibits CYP1A2 enzyme activity.
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 honest picture with Tramacet (the tramadol plus acetaminophen combo) and rooibos tea. The concern on file is that compounds in rooibos might slow down a liver enzyme called CYP1A2. In theory, blocking an enzyme that helps clear a drug could let it build up a bit, nudging up effects and side effects. For tramadol that could mean more drowsiness, dizziness, nausea, or constipation.

But I want to keep this in perspective. This signal comes only from lab dish studies using concentrated extracts, not from people drinking tea, and tramadol relies more on a different enzyme (CYP2D6) anyway. A normal cup or two of rooibos is very unlikely to cause trouble. If you use concentrated rooibos extracts, mention it to your pharmacist.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Fantoukh OI, Dale OR, Parveen A, et al. Safety Assessment of Phytochemicals Derived from the Globalized South African Rooibos Tea (Aspalathus linearis) through Interaction with CYP, PXR, and P-gp. J Agric Food Chem. 2019;67(17):4967-4975.
Moderate

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES

2 of 3

Tramadol, Acetaminophen also falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES.

Theoretically, taking rooibos with CYP2D6 substrates may increase the effects of CYP2D6 substrates.
In vitro research shows that the methanol extract of rooibos leaves and stems inhibits CYP2D6 enzyme activity.
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 wrinkle with this combo: tramadol is partly a prodrug. Your liver uses an enzyme called CYP2D6 to convert tramadol into its stronger, more active pain-relieving form. Lab studies suggest rooibos may gently block that same enzyme. In theory, that could mean a little less of the active painkiller forms, so you might notice tramadol working slightly less well. The acetaminophen half isn't really affected here.

I want to be honest about how thin this evidence is. It comes only from test-tube research, not from people, and a normal cup or two of rooibos tea is very unlikely to cause any real problem. Concentrated rooibos extracts are the bigger unknown. If you're relying on Tramacet for pain, just mention your rooibos habit to your pharmacist or doctor.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Fantoukh OI, Dale OR, Parveen A, et al. Safety Assessment of Phytochemicals Derived from the Globalized South African Rooibos Tea (Aspalathus linearis) through Interaction with CYP, PXR, and P-gp. J Agric Food Chem. 2019;67(17):4967-4975.
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

3 of 3

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

Theoretically, taking rooibos with CYP3A4 substrates may increase the effects of CYP3A4 substrates.
In vitro research shows that the methanol extract of rooibos leaves and stems strongly inhibits CYP3A4 enzyme activity.
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 Tramacet (tramadol plus acetaminophen) and rooibos. Lab tests in a dish suggest a concentrated rooibos extract can slow down the CYP3A4 enzyme. Tramadol is partly handled by that pathway, so in theory blocking it could let tramadol linger a bit longer in your system. That might mean more of the usual effects, like drowsiness, dizziness, nausea, constipation, or feeling foggy.

That said, this is only test-tube evidence, not something proven in people, and a normal cup or two of rooibos tea is very unlikely to cause a problem. Concentrated extract capsules are the bigger question mark. If you use those regularly, just give your pharmacist or doctor a quick heads-up before mixing them.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Fantoukh OI, Dale OR, Parveen A, et al. Safety Assessment of Phytochemicals Derived from the Globalized South African Rooibos Tea (Aspalathus linearis) through Interaction with CYP, PXR, and P-gp. J Agric Food Chem. 2019;67(17):4967-4975.

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

Rooibos Also Interacts With Other Medications

Rooibos has 878 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 878 No known interaction 1,952 (incl. Tramadol, Acetaminophen)
Taking anything else?

Check Another of Your Medications Against Rooibos

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

Everything else you take

See Every Supplement That Interacts With Tramadol, Acetaminophen

This page covers Rooibos 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

One more smart check

Taking Rooibos as Part of a Dietary Supplement Product? Check It for Interactions

We hold 142 real supplement products containing Rooibos, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Rooibos. Your product may carry other ingredients that interact with Tramadol, Acetaminophen too, on top of Rooibos — 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 Rooibos 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 Rooibos
Top half

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

29 days ago today
Medication Tramadol, Acetaminophen
Top 25%

#441 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 Rooibos

What is Rooibos?

Rooibos
  • Caffeine-free beverage
  • Antioxidant support
  • Heart health
  • Blood sugar support
  • Digestive upset
  • General wellness

Rooibos is a caffeine-free herbal tea from South Africa that is rich in antioxidants and generally considered safe as a beverage. While lab and early studies suggest possible benefits for heart health, blood sugar, and inflammation, strong human evidence is lacking for most medical uses. Enjoy it as a tea, but talk to your pharmacist or doctor before using concentrated extracts for health reasons.

Read the full Rooibos monograph & all interactions
Keep checking

Other Drugs & Rooibos

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

0Major
878Moderate
0Minor
1,951No known interaction
878 Moderate 1,951 No interaction
Moderate

878 interactions

Showing 60 of 878 moderate interactions — see all 878 on the Rooibos page.

No interaction 1,951 drugs checked — show the list

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

Showing the 60 most looked-up of 1,951 medications checked with no known interaction — see the full Rooibos list.

See the full Rooibos 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
Rooibos 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 Rooibos and Tramadol, Acetaminophen Together: Common Questions

Can you take Rooibos 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 3 interactions listed for Rooibos and Tramadol, Acetaminophen?
Tramadol, Acetaminophen belongs to more than one drug category, and Rooibos 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 Rooibos 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.