Sage + Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine
Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine brand name: Anatuss.
Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine falls into 3 drug categories that Sage can interact with; the most serious is rated moderate. Theoretically, sage might increase the levels and clinical effects of drugs metabolized by CYP2D6.
Read the full interaction reportSage and Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine
These two interact in 3 distinct ways. Each one is explained separately below.
Why Are There 3 Interactions?
Sage interacts with whole categories of medication. Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine falls into 3 of those categories, so it can interact with Sage 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, Phenylpropanolamine
Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES — the group Sage interacts with.
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.
This combo product (Anatuss) has four ingredients, but the one that matters here is dextromethorphan, the cough suppressant. Your body relies on an enzyme called CYP2D6 to clear it. Lab studies hint that sage may slow that enzyme down a bit, which could let dextromethorphan build up. If that happened, you might feel more dizzy, drowsy, or notice a foggy, off feeling. The acetaminophen, guaifenesin, and phenylpropanolamine aren't really affected this way.
The good news: this is only seen in test-tube studies, not in real people, so the risk is mostly theoretical. Sage as a kitchen seasoning is very unlikely to cause trouble. Concentrated sage extracts or essential oil are the bigger question mark. If you're using those, it's worth a quick chat with your pharmacist 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 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
2 of 3Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine 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 combo product (sold as Anatuss) is a mix of acetaminophen for aches and fever, dextromethorphan to quiet a cough, guaifenesin to loosen mucus, and phenylpropanolamine as a decongestant. The piece that matters here is the dextromethorphan, which your body partly clears using an enzyme called CYP3A4. In lab tests, water-based sage extracts seemed to slow that enzyme down a bit.
In theory, that could let a little more dextromethorphan build up, which might mean more drowsiness, dizziness, or feeling foggy. I want to be honest though: this has only been seen in test tubes, never in actual people, so it's a weak, possible concern. Sage sprinkled on food won't matter. If you're using concentrated sage capsules or oil, just run it by your pharmacist first.
- 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.
CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES
3 of 3Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine 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 combination cold-and-cough product (Anatuss) contains acetaminophen for pain and fever, plus a cough suppressant, an expectorant, and a decongestant. The piece that interacts here is acetaminophen, which is partly handled by a liver enzyme called CYP2E1. Animal studies suggest sage tea may rev up that enzyme. In theory, a faster CYP2E1 could push more acetaminophen down the pathway that creates a harmful liver byproduct, which is the same concern we have with alcohol and high acetaminophen doses.
Here's the honest part: this is based on lab and animal work only, and it has not been seen in people. A little sage in cooking or an occasional cup of tea is very unlikely to matter. If you regularly use concentrated sage extracts, it's worth a quick chat with your pharmacist or doctor first.
- 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, Dextromethorphan, Guaifenesin, Phenylpropanolamine 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, Dextromethorphan, Guaifenesin, Phenylpropanolamine
This page covers Sage only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine page lists 261 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 · 206 moderate · 43 minor.
From our pharmacist’s overview on the Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine page
“Anatuss combines acetaminophen, dextromethorphan, guaifenesin, and phenylpropanolamine, and its supplement list is not one to skim, since 12 of the 261 ingredients on file carry a major rating. Two hazards top the pile.”
Reviewed by 2 · Jul 18, 2026
Open the Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine 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, Dextromethorphan, Guaifenesin, Phenylpropanolamine 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, Dextromethorphan, Guaifenesin, Phenylpropanolamine 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.
#236 of 1,452 supplements looked up here in the last 7 days
#193 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 ›
- Isotretinoin ›
- Docusate ›
- Sumatriptan ›
- Valacyclovir ›
- Hydroxyurea ›
- Methotrexate ›
- Amoxicillin ›
- Levothyroxine, Liothyronine ›
- Bupropion ›
- Bendamustine ›
- Azithromycin ›
- Acyclovir ›
- Methylene Blue ›
- Ciprofloxacin ›
- Amoxicillin, Clavulanate Potassium ›
- Acetylsalicylic Acid ›
- Ezetimibe ›
- Cyclopentolate ›
- Cephalexin ›
- Thyroid Hormone ›
- Calcium Oxybate, Magnesium Oxybate, Potassium Oxybate, Sodium Oxybate ›
- Roxithromycin ›
- Carbidopa, Levodopa ›
- Levodopa ›
- Alginic Acid, Aluminum Hydroxide ›
- Isoniazid, Pyrazinamide, Rifampin ›
- Mitomycin ›
- Magnesium Hydroxide (otc Drug) ›
- Aluminum Hydroxide, Aspirin, Magnesium Hydroxide ›
- Levothyroxine Sodium ›
- Dexmethylphenidate ›
- Flutemetamol F-18 ›
- Ceftolozane Sulfate, Tazobactam Sodium ›
- Cefaclor ›
- Daptomycin ›
- Articaine, Epinephrine ›
- Aspirin, Butalbital ›
- Acenocoumarol ›
- Peginterferon Alfa-2a, Ribavirin ›
- Charcoal (otc Drug) ›
- Hydroxychloroquine ›
- Hydrocortisone, Clioquinol, Pramoxine ›
- Alpha-1 Proteinase Inhibitor ›
- Alendronate Sodium, Cholecalciferol ›
- Colistin, Neomycin, Hydrocortisone ›
- Factor 7a ›
- Aminolevulinic Acid Hydrochloride ›
- Hexobarbitone ›
- Pegunigalsidase Alfa-iwxj ›
- Efgartigimod Alfa-fcab ›
- Bentoquatam ›
- Rosuvastatin Calcium, Ezetimibe ›
- Daunorubicin, Cytarabine ›
- Birth Control Pills ›
- Droxidopa ›
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, Dextromethorphan, Guaifenesin, Phenylpropanolamine Is Linked to Lower Levels of One Nutrient
Natural Medicines records Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine 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:
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, Dextromethorphan, Guaifenesin, Phenylpropanolamine Together: Common Questions
Can you take Sage with Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine?
Why are there 3 interactions listed for Sage and Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine?
How serious is the Sage and Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine 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.