Syrian Rue + Acetaminophen, Caffeine, Dihydrocodeine
Acetaminophen, Caffeine, Dihydrocodeine brand names: Panlor DC, Panlor SS, DHC Plus.
Acetaminophen, Caffeine, Dihydrocodeine falls into 4 drug categories that Syrian Rue can interact with; the most serious is rated moderate. Theoretically, Syrian rue might increase the levels and clinical effects of drugs metabolized by CYP2D6.
Read the full interaction reportSyrian Rue and Acetaminophen, Caffeine, Dihydrocodeine
These two interact in 4 distinct ways. Each one is explained separately below.
Why Are There 4 Interactions?
Syrian Rue interacts with whole categories of medication. Acetaminophen, Caffeine, Dihydrocodeine falls into 4 of those categories, so it can interact with Syrian Rue in 4 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 4Why this applies to Acetaminophen, Caffeine, Dihydrocodeine
Acetaminophen, Caffeine, Dihydrocodeine falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES — the group Syrian Rue interacts with.
Syrian rue contains beta-carboline alkaloids, including harmine, harmaline, harmalol, harmol, and harmane. In vitro research suggests that these beta-carboline alkaloids can inhibit CYP2D6 enzymes.
Interaction 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..
Here's the wrinkle with this combo: the dihydrocodeine part of your medication is a prodrug. Your liver uses an enzyme called CYP2D6 to turn it into its stronger, more active painkilling form. Syrian Rue's harmala alkaloids appear to block that same enzyme, at least in lab studies. So instead of building up, your pain relief could actually be weakened, because less of the drug gets converted to its active form.
In plain terms, you might notice your pain isn't as well controlled. I want to be honest, though: this is a theoretical concern based on pharmacology and test-tube research, not solid human studies. On top of that, Syrian Rue carries its own real toxicity risks. Please don't start or stop anything on your own. Check with your pharmacist or doctor first.
- Zhao, T., He, Y. Q., Wang, J., Ding, K. M., Wang, C. H., and Wang, Z. T. Inhibition of human cytochrome P450 enzymes 3A4 and 2D6 by β-carboline alkaloids, harmine derivatives. Phytother Res 2011;25(11):1671-1677.
HEPATOTOXIC DRUGS
2 of 4Acetaminophen, Caffeine, Dihydrocodeine also falls under HEPATOTOXIC DRUGS.
Cases of hepatotoxicity and hepatic failure have been reported in patients who ingested a large quantity (up to 100 grams) of Syrian rue seeds.
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 pill already includes acetaminophen (Tylenol), which is the part that's hard on the liver, especially at higher doses or with regular alcohol use. The concern here is mostly about your liver, not a brain chemistry effect. Large amounts of Syrian Rue seeds (we're talking very high quantities, like dozens of grams) have been linked to liver injury and even liver failure. So stacking a known liver stressor on top of acetaminophen could, in theory, add up.
To be fair, this is a theoretical worry based on how these things work, not a proven everyday interaction. Still, since this product also carries an opioid, dihydrocodeine, please check with your pharmacist or doctor before pairing it with Syrian Rue.
- Yuruktumen, A., Karaduman, S., Bengi, F., and Fowler, J. Syrian rue tea: a recipe for disaster. Clin Toxicol (Phila) 2008;46(8):749-752. PubMed
- Berdai MA, Labib S, Harandou M. Peganum harmala L. Intoxication in a Pregnant Woman. Case Rep Emerg Med 2014;2014:783236.
- Ghizlane EA, Manal M, Ines HA, et al. Fatal poisoning of pregnant women by peganum harmala L.: a case reports. Ann Med Surg (Lond) 2021;68:102649. PubMed
- Durmaz Çelik N, Ger Akarsu F, Ozkan S, Özdemir AÖ, Aykac Ö, Memmedova F. Herbal teas can be harmful: a case of Peganum harmala induced coma in a patient with Parkinson's disease. Neurocase 2021;27(2):117-119.
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
3 of 4Acetaminophen, Caffeine, Dihydrocodeine also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
Syrian rue contains beta-carboline alkaloids, including harmine, harmol, and harmane. In vitro research suggests that these beta-carboline alkaloids competitively inhibit CYP3A4 enzymes.
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 pill pairs acetaminophen and caffeine with dihydrocodeine, an opioid for pain. Here's the wrinkle worth knowing: lab studies suggest the harmala alkaloids in Syrian Rue can slow down CYP3A4, one of the liver enzymes that helps clear dihydrocodeine and caffeine. If that enzyme is blocked, these ingredients could linger longer than usual, which theoretically nudges up opioid effects like drowsiness, dizziness, constipation, and slowed breathing, plus more caffeine jitters.
One extra caution: Syrian Rue also acts like an MAO inhibitor, and combining MAO inhibitors with opioids can be risky on its own. The evidence here is theoretical, not proven in people, but I'd be conservative. Please check with your pharmacist or doctor before pairing these.
- Zhao, T., He, Y. Q., Wang, J., Ding, K. M., Wang, C. H., and Wang, Z. T. Inhibition of human cytochrome P450 enzymes 3A4 and 2D6 by β-carboline alkaloids, harmine derivatives. Phytother Res 2011;25(11):1671-1677.
CAFFEINE
4 of 4Acetaminophen, Caffeine, Dihydrocodeine also falls under CAFFEINE.
Syrian rue contains the constituent harmaline. Animal research suggests that a combination of caffeine and harmaline increases the intensity and duration of harmaline-induced tremors.
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.
The piece of your combo pill that matters here is the caffeine. Syrian Rue contains harmaline, and in animal studies, mixing harmaline with caffeine made tremors stronger and longer-lasting. So in theory, pairing Syrian Rue with this medication could leave you feeling jittery, shaky, or wired, with a faster heartbeat or trouble sitting still.
I want to be honest with you: this is a theoretical concern based on animal data, not human studies, so I don't want to alarm you. There's a separate issue too. Syrian Rue acts like an MAO inhibitor, and dihydrocodeine is an opioid, so combining them deserves caution. Please check with your pharmacist or doctor before using Syrian Rue alongside this.
- Al-Deeb, S., Al-Moutaery, K., Arshaduddin, M., Biary, N., and Tariq, M. Effect of acute caffeine on severity of harmaline induced tremor in rats. Neurosci Lett 2002;325(3):216-218. PubMed
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.
Syrian Rue Also Interacts With Other Medications
Syrian Rue has 1,121 moderate known drug interactions in our database — the Acetaminophen, Caffeine, Dihydrocodeine one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Syrian Rue
We haven’t checked that one against Syrian Rue yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Syrian Rue. Pick one to open its full report.
See Every Supplement That Interacts With Acetaminophen, Caffeine, Dihydrocodeine
This page covers Syrian Rue only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Caffeine, Dihydrocodeine page lists 303 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: 15 major · 244 moderate · 44 minor.
From our pharmacist’s overview on the Acetaminophen, Caffeine, Dihydrocodeine page
“Anything else that sedates you is the headline risk with this combination painkiller. Panlor and DHC Plus pair acetaminophen and caffeine with the opioid dihydrocodeine, and 78 of the 303 supplements on file, kava and even beer or wine among them, can deepen the opioid's drowsiness and, at the extreme, dangerously slow breathing.”
Reviewed by 2 · Jul 18, 2026
Open the Acetaminophen, Caffeine, Dihydrocodeine interaction page
Where Syrian Rue and Acetaminophen, Caffeine, Dihydrocodeine 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.
#740 of 1,452 supplements looked up here in the last 7 days
#251 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 Syrian Rue
What is Syrian Rue?
- Traditional remedy for digestive complaints
- Used as a sedative or for mood
- Antimicrobial and antiparasitic folk use
- Used as a dye and incense
- Recreational psychoactive use
Syrian Rue (Peganum harmala) is a traditional plant whose seeds contain potent compounds called harmala alkaloids, including MAO-inhibiting harmine and harmaline. There is little reliable human evidence that it safely treats any condition, and it carries real risks of toxicity, so it is not recommended for self-treatment. Talk to a pharmacist or doctor before considering it.
Other Drugs & Syrian Rue
Browse every other medication we’ve checked against Syrian Rue — both the ones with a known interaction and the ones without. Select any drug for the full detail.
No drugs match “”.
1,121 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Nifedipine ›
- Diphenhydramine ›
- Hydrocortisone ›
- Methylphenidate ›
- Doxycycline ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Tetracycline ›
- Lidocaine ›
- Amoxicillin ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Fenofibrate ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Glyburide ›
- Glycopyrrolate ›
- Methyltestosterone ›
- Triazolam ›
- Zopiclone ›
- Ciprofloxacin ›
- Colchicine ›
- Fentanyl ›
- Oxybutynin ›
- Oxycodone ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Allopurinol ›
- Apomorphine ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Doxorubicin ›
- Fluticasone ›
- Formoterol ›
- Ipratropium ›
- Miconazole ›
- Morphine Sulfate ›
- Phenylephrine ›
- Procainamide ›
- Trimipramine ›
- Acetaminophen ›
- Amphetamine ›
- Buprenorphine ›
- Conjugated Estrogens ›
- Diazepam ›
- Dimenhydrinate ›
- Everolimus ›
Showing 60 of 1,121 moderate interactions — see all 1,121 on the Syrian Rue page.
No interaction 1,708 drugs checked — show the list
We also checked Syrian Rue against these medications and found no known interaction in our sources. Open any page to confirm.
- Levothyroxine ›
- Ivermectin ›
- Aspirin ›
- Docusate ›
- Tirzepatide ›
- Ibuprofen ›
- Valacyclovir ›
- Hydroxyurea ›
- Semaglutide ›
- Metformin ›
- Lisinopril ›
- Isotretinoin ›
- Bendamustine ›
- Bupropion ›
- Azithromycin ›
- Acyclovir ›
- Pregabalin ›
- Lamotrigine ›
- Gabapentin ›
- Levothyroxine, Liothyronine ›
- Naproxen ›
- Candesartan Cilexetil ›
- Acetaminophen, Dextromethorphan, Doxylamine ›
- Cyclopentolate ›
- Cephalexin ›
- Acetylsalicylic Acid ›
- Ezetimibe ›
- Mannitol ›
- Roxithromycin ›
- Levetiracetam ›
- Thyroid Hormone ›
- Phentermine, Topiramate ›
- Spironolactone ›
- Levothyroxine Sodium ›
- Valsartan ›
- Pizotifen ›
- Daptomycin ›
- Canagliflozin, Metformin ›
- Flutemetamol F-18 ›
- Mitomycin ›
- Cefaclor ›
- Hethylphenidate Hcl ›
- Hexobarbitone ›
- Insulin Degludec, Liraglutide ›
- Pegunigalsidase Alfa-iwxj ›
- Atenolol ›
- Magnesium Hydroxide (otc Drug) ›
- Hydroxychloroquine ›
- Minoxidil ›
- Amobarbital, Ephedrine Sulfate ›
- Casanthranol, Docusate ›
- Digoxin ›
- Acenocoumarol ›
- Telmisartan ›
- Alginic Acid, Aluminum Hydroxide ›
- Salbutamol Sulfate ›
- Hydrochlorothiazide ›
- Factor 7a ›
- Insulin Human, Sodium Chloride ›
- Sacubitril, Valsartan ›
Showing the 60 most looked-up of 1,708 medications checked with no known interaction — see the full Syrian Rue 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, Caffeine, Dihydrocodeine Is Linked to Lower Levels of 2 Nutrients
Natural Medicines records Acetaminophen, Caffeine, Dihydrocodeine as a medicine that can lower these. This is not an interaction with Syrian Rue — 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, Caffeine, Dihydrocodeine 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 Syrian Rue and Acetaminophen, Caffeine, Dihydrocodeine Together: Common Questions
Can you take Syrian Rue with Acetaminophen, Caffeine, Dihydrocodeine?
Why are there 4 interactions listed for Syrian Rue and Acetaminophen, Caffeine, Dihydrocodeine?
How serious is the Syrian Rue and Acetaminophen, Caffeine, Dihydrocodeine 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.