Sage + Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine
Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine brand name: Colrex.
Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine falls into 5 drug categories that Sage can interact with; the most serious is rated moderate. Theoretically, taking sage might increase the sedative and adverse effects of CNS depressants.
Read the full interaction reportSage and Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine
These two interact in 5 distinct ways. Each one is explained separately below.
Why Are There 5 Interactions?
Sage interacts with whole categories of medication. Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine falls into 5 of those categories, so it can interact with Sage in 5 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).
CNS DEPRESSANTS
1 of 5Why this applies to Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine
Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine falls under CNS DEPRESSANTS — the group Sage interacts with.
Some constituents of sage have CNS depressant activity.
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 know about Colrex: it already contains two ingredients that can make you drowsy, the codeine and the chlorpheniramine (an older antihistamine). Some compounds in sage appear to have a mild calming, sedative-type effect of their own. So the worry is that pairing them could stack that drowsiness, leaving you sleepier, foggier, or more lightheaded than you'd expect.
I want to be honest about the strength of this one. It's theoretical, based mostly on lab and animal studies, not real-world reports. A little sage in your cooking is very unlikely to cause any trouble. Concentrated sage extracts or the essential oil are where I'd be more cautious. If you take Colrex regularly, just check with your pharmacist or doctor before adding a sage supplement.
- Perry NS, Bollen C, Perry EK, Ballard C. Salvia for dementia therapy: review of pharmacological activity and pilot tolerability clinical trial. Pharmacol Biochem Behav 2003;75:651-9.. PubMed
CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES
2 of 5Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine also falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES.
In vitro evidence suggests that aqueous extracts of sage can inhibit CYP2D6. So far, this interaction 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 wrinkle with Colrex: the codeine part is a prodrug. Your body has to switch it on using an enzyme called CYP2D6 to turn codeine into morphine, which is what actually relieves cough and pain. Lab studies hint that sage might slow that same enzyme down. So in theory, sage could mean less codeine gets activated, and you might get weaker cough or pain relief rather than stronger effects.
I want to be honest, though: this is only seen in test tube studies, never in real people, so the risk looks small. The other ingredients (acetaminophen, chlorpheniramine, phenylephrine) aren't much affected here. Cooking with sage won't matter; concentrated extracts are the question mark. If you lean on sage supplements, just run it by your pharmacist or doctor.
- Foster BC, Vandenhoek S, Hana J, et al. In vitro inhibition of human cytochrome P450-mediated metabolism of marker substrates by natural products. Phytomedicine 2003;10:334-42.. PubMed
- Hellum BH, Nilsen OG. The in vitro inhibitory potential of trade herbal products on human CYP2D6-mediated metabolism and the influence of ethanol. Basic Clin Pharmacol Toxicol. 2007 Nov;101:350-8.
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
3 of 5Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
In vitro evidence suggests that aqueous extracts of sage can inhibit CYP3A4. So far, this interaction 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.
This Colrex combo has several ingredients, and the one to watch with sage is the codeine. Lab studies hint that concentrated sage extracts might slow down CYP3A4, an enzyme that helps clear codeine. If codeine hangs around a bit longer, you could feel more of its effects, like extra drowsiness, constipation, or that foggy, sleepy feeling. The chlorpheniramine in here is already sedating, so any added grogginess could stack up.
That said, this is only a theoretical concern seen in test tubes, never reported in real people, and ordinary cooking amounts of sage are very unlikely to matter. Strong sage supplements or oils are a different story. If you take those regularly, just check with your pharmacist or doctor before combining.
- Foster BC, Vandenhoek S, Hana J, et al. In vitro inhibition of human cytochrome P450-mediated metabolism of marker substrates by natural products. Phytomedicine 2003;10:334-42.. PubMed
- Hellum, B. H. and Nilsen, O. G. In vitro inhibition of CYP3A4 metabolism and P-glycoprotein-mediated transport by trade herbal products. Basic Clin Pharmacol Toxicol. 2008;102(5):466-475.
ANTICHOLINERGIC DRUGS
4 of 5Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine also falls under ANTICHOLINERGIC DRUGS.
In vitro evidence suggests that common sage (Salvia officinalis) and Spanish sage (Salvia lavandulaefolia) can inhibit acetylcholinesterase and might increase acetylcholine levels.
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.
Your Colrex combination includes chlorpheniramine, an antihistamine that works partly by blocking acetylcholine, a messenger in your body. Here's the wrinkle with sage: lab studies suggest some sage compounds raise acetylcholine levels by slowing the enzyme that breaks it down. In theory, that could nudge against chlorpheniramine and slightly soften the effects you take it for, like drying up a runny nose. The other pieces (acetaminophen, codeine, phenylephrine) aren't really involved here.
I want to be honest with you: this is only test-tube evidence, not human data, and food or tea amounts of sage almost certainly won't matter. Concentrated sage extracts are a different story. If you're using a strong supplement regularly, just mention it to your pharmacist so they can keep an eye on things.
- Orhan, I., Kartal, M., Kan, Y., and Sener, B. Activity of essential oils and individual components against acetyl- and butyrylcholinesterase. Z.Naturforsch.C. 2008;63(7-8):547-553.
- Perry, N. S., Houghton, P. J., Theobald, A., Jenner, P., and Perry, E. K. In-vitro inhibition of human erythrocyte acetylcholinesterase by salvia lavandulaefolia essential oil and constituent terpenes. J Pharm Pharmacol 2000;52(7):895-902.
- Savelev, S. U., Okello, E. J., and Perry, E. K. Butyryl- and acetyl-cholinesterase inhibitory activities in essential oils of Salvia species and their constituents. Phytother Res 2004;18(4):315-324.
- Kennedy, D. O., Pace, S., Haskell, C., Okello, E. J., Milne, A., and Scholey, A. B. Effects of cholinesterase inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery. Neuropsychopharmacology 2006;31(4):84 PubMed
CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES
5 of 5Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine also falls under CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES.
Animal research suggests that drinking common sage (Salvia officinalis) tea increases the expression of CYP2E1. So far, this interaction 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.
This combo product (Colrex) bundles together a pain/fever reliever (acetaminophen), an antihistamine, codeine for cough, and a decongestant. The piece that touches on sage is acetaminophen. A liver enzyme called CYP2E1 helps process some acetaminophen, and animal studies hint that sage tea may slightly speed up that enzyme. In theory, faster processing could nudge acetaminophen levels down a bit.
Here is the honest part: this is based on animal research only and has not been seen in people, so I would not lose sleep over it. Normal cooking amounts of sage are not a concern. Concentrated sage extracts or sage essential oil are where I would be more cautious. If you regularly drink strong sage tea, just mention it to your pharmacist.
- Lima, C. F., Fernandes-Ferreira, M., and Pereira-Wilson, C. Drinking of Salvia officinalis tea increases CCl(4)-induced hepatotoxicity in mice. Food Chem.Toxicol. 2007;45(3):456-464.
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.
Sage Also Interacts With Other Medications
Sage has 1,295 moderate known drug interactions in our database — the Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Sage
We haven’t checked that one against Sage yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Sage. Pick one to open its full report.
See Every Supplement That Interacts With Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine
This page covers Sage only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine page lists 338 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 Ephedra (major).
By severity: 18 major · 275 moderate · 45 minor.
From our pharmacist’s overview on the Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine page
“Someone taking Colrex is usually fighting a miserable cold, and cold season is also when people reach for herbal sleep aids and energy boosters, which is exactly where this list bites hardest. Colrex combines acetaminophen, chlorpheniramine, codeine, and phenylephrine, and 18 of its 338 supplement interactions rate major, enough to war…”
Reviewed by 2 · Jul 18, 2026
Open the Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine interaction page
Taking Sage as Part of a Dietary Supplement Product? Check It for Interactions
We hold 718 real supplement products containing Sage, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Sage. Your product may carry other ingredients that interact with Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine too, on top of Sage — and those would not show on this page. Find your product and we’ll check every ingredient on its label:
Where Sage and Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine 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.
#260 of 1,452 supplements looked up here in the last 7 days
#270 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 Sage
What is Sage?
- Sore throat and mouth irritation
- Digestive upset
- Excessive sweating
- Memory and thinking
- Menopause symptoms (hot flashes)
- General antioxidant support
Sage is a common kitchen herb that is generally safe in food amounts and is traditionally used for sore throats, digestion, sweating, and memory. Some early research is encouraging for sore throat and menopausal hot flashes, but most uses are not well proven. Concentrated extracts and the essential oil should be used carefully because high doses contain a compound called thujone, which can be harmful.
Other Drugs & Sage
Browse every other medication we’ve checked against Sage — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
1,295 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Nifedipine ›
- Ibuprofen ›
- Diphenhydramine ›
- Hydrocortisone ›
- Insulin (rdna) ›
- Naproxen ›
- Doxycycline ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Tetracycline ›
- Lidocaine ›
- Ranitidine ›
- Hydrochlorothiazide ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Flurazepam ›
- Glyburide ›
- Glycopyrrolate ›
- Insulin (pork) ›
- Triazolam ›
- Zopiclone ›
- Colchicine ›
- Fentanyl ›
- Flurbiprofen ›
- Oxybutynin ›
- Oxycodone ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Triamcinolone ›
- Apomorphine ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Doxorubicin ›
- Fluticasone ›
- Formoterol ›
- Hydralazine ›
- Indomethacin ›
- Insulin (human) ›
- Ipratropium ›
- Miconazole ›
- Morphine Sulfate ›
- Nitrazepam ›
- Procainamide ›
- Trimipramine ›
- Acetaminophen ›
Showing 60 of 1,295 moderate interactions — see all 1,295 on the Sage page.
No interaction 1,534 drugs checked — show the list
We also checked Sage against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Methylphenidate ›
- Aspirin ›
- Rosuvastatin ›
- Escitalopram ›
- Valacyclovir ›
- Docusate ›
- Hydroxyurea ›
- Sumatriptan ›
- Bupropion ›
- Amoxicillin ›
- Acyclovir ›
- Bendamustine ›
- Methotrexate ›
- Isotretinoin ›
- Azithromycin ›
- Methylene Blue ›
- Ciprofloxacin ›
- Levothyroxine, Liothyronine ›
- Cyclopentolate ›
- Cephalexin ›
- Roxithromycin ›
- Pegunigalsidase Alfa-iwxj ›
- Daptomycin ›
- Hexobarbitone ›
- Dexmethylphenidate ›
- Levothyroxine Sodium ›
- Mitomycin ›
- Factor 7a ›
- Cefaclor ›
- Thyroid Hormone ›
- Carbidopa, Levodopa ›
- Ezetimibe ›
- Levodopa ›
- Vancomycin ›
- Phenylephrine ›
- Dirithromycin ›
- Lenvatinib ›
- Hethylphenidate Hcl ›
- Azelaic Acid ›
- Bentoquatam ›
- Tenecteplase ›
- Amoxicillin, Clavulanate Potassium ›
- Hydroxychloroquine ›
- Triptorelin ›
- Dextrothyroxine ›
- Lomustine ›
- Acetylsalicylic Acid ›
- Succimer ›
- Tocainide ›
- Rocuronium ›
- Halothane ›
- Mitomycin C ›
- Pizotifen ›
- Gestodene ›
- Chenodiol ›
- Desflurane ›
- Niacin (prescription Drug) ›
- Famotidine ›
- Cabergoline ›
Showing the 60 most looked-up of 1,534 medications checked with no known interaction — see the full Sage 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, Chlorpheniramine, Codeine, Phenylephrine Is Linked to Lower Levels of One Nutrient
Natural Medicines records Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine as a medicine that can lower these. This is not an interaction with Sage — 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 Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine 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 Sage and Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine Together: Common Questions
Can you take Sage with Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine?
Why are there 5 interactions listed for Sage and Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine?
How serious is the Sage and Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine interaction?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
Still Have a Question About Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine and Sage?
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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.