Drug & supplement interaction

Terminalia Chebula + Acetaminophen, Chlorzoxazone, Codeine

Acetaminophen, Chlorzoxazone, Codeine brand names: Parafon Forte C8, Acetazone Forte C8.

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

Terminalia Chebula has a moderate interaction with Acetaminophen, Chlorzoxazone, Codeine. Theoretically, use of Terminalia chebula may increase the risk of adverse effects from chlorzoxazone.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
Know someone taking this? Share
Facebook Post Reddit Email
On this page
Interaction report

Terminalia Chebula and Acetaminophen, Chlorzoxazone, Codeine

Here is the interaction we found between these two, with the evidence behind it.

Moderate

CHLORZOXAZONE (Parafon Forte, Paraflex)

Theoretically, use of Terminalia chebula may increase the risk of adverse effects from chlorzoxazone.
Animal research shows that enteral administration of Terminalia chebula for 15 days prior to administration of chlorzoxazone increases blood levels of chlorzoxazone and decreases chlorzoxazone clearance. It is speculated that Terminalia chebula reduces the metabolism of chlorzoxazone by inhibiting cytochrome P450 2E1.
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

This combination pill includes chlorzoxazone, a muscle relaxant. Your body clears chlorzoxazone using a liver enzyme called CYP2E1, and lab and animal research hints that haritaki (Terminalia chebula) may slow that enzyme down. If that happens, chlorzoxazone could build up a bit higher than usual, which might mean more drowsiness, dizziness, lightheadedness, or stomach upset than you'd normally feel.

I want to be honest about the strength of this: it's theoretical, mostly from animal studies, so we don't know how much (if at all) it matters in people. It's not a reason to panic. Still, since this product also contains codeine and acetaminophen, it's worth a quick chat with your pharmacist or doctor before adding haritaki, especially if you notice extra grogginess.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Wu G, Dong Z, Dong J, et al. Effects of mongolian medicine Terminalia chebula Retz. on 6 CYP450 enzymes in rats. Int J Clin Exp Pathol 2020;13(12):3128-3138.

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

Terminalia Chebula Also Interacts With Other Medications

Terminalia Chebula has 92 moderate known drug interactions in our database — the Acetaminophen, Chlorzoxazone, Codeine one above is one of them. If you take anything else, check it against the full list below.

Moderate 92 No known interaction 2,738 (incl. Acetaminophen, Chlorzoxazone, Codeine)
Taking anything else?

Check Another of Your Medications Against Terminalia Chebula

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

Everything else you take

See Every Supplement That Interacts With Acetaminophen, Chlorzoxazone, Codeine

This page covers Terminalia Chebula only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Chlorzoxazone, Codeine page lists 246 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: 10 major · 196 moderate · 40 minor.

From our pharmacist’s overview on the Acetaminophen, Chlorzoxazone, Codeine page

“A muscle relaxant, an opioid, and acetaminophen travel together in Parafon Forte C8 (acetaminophen, chlorzoxazone, codeine), and that combination demands genuine care before adding any supplement. Of the 246 ingredients on file, 78 pile sedation onto a formula that already contains two sedating drugs, and that group accounts for most o…”

Reviewed by 2 · Jul 18, 2026

Open the Acetaminophen, Chlorzoxazone, Codeine interaction page

How much people look this up

Where Terminalia Chebula and Acetaminophen, Chlorzoxazone, Codeine 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 Terminalia Chebula
Steady interest

#1,024 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Acetaminophen, Chlorzoxazone, Codeine
Steady interest

#1,725 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 Terminalia Chebula

What is Terminalia Chebula?

  • Digestive support and constipation
  • Antioxidant support
  • Oral and throat health
  • General immune support
  • Traditional tonic in Ayurvedic medicine

Terminalia chebula, often called haritaki, is a fruit widely used in Ayurvedic medicine, most commonly for digestion and as a key part of the Triphala blend. Early laboratory and small human studies suggest possible antioxidant and digestive effects, but high-quality evidence in people is limited. Talk with your pharmacist or doctor before using it, especially if you are pregnant, breastfeeding, or take other medicines.

Read the full Terminalia Chebula monograph & all interactions
Keep checking

Other Drugs & Terminalia Chebula

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

0Major
92Moderate
0Minor
2,737No known interaction
92 Moderate 2,737 No interaction
Moderate

92 interactions

Showing 60 of 92 moderate interactions — see all 92 on the Terminalia Chebula page.

No interaction 2,737 drugs checked — show the list

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

Showing the 60 most looked-up of 2,737 medications checked with no known interaction — see the full Terminalia Chebula list.

See the full Terminalia Chebula interactions page
See every supplement checked against Acetaminophen, Chlorzoxazone, Codeine, 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
Terminalia Chebula monograph › Uses, safety, and every drug interaction in one place Acetaminophen, Chlorzoxazone, Codeine supplement interactions › Every supplement checked against Acetaminophen, Chlorzoxazone, Codeine, 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 Terminalia Chebula and Acetaminophen, Chlorzoxazone, Codeine Together: Common Questions

Can you take Terminalia Chebula with Acetaminophen, Chlorzoxazone, Codeine?
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.
How serious is the Terminalia Chebula and Acetaminophen, Chlorzoxazone, Codeine 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 Acetaminophen, Chlorzoxazone, Codeine and Terminalia Chebula?

Our pharmacists answer your medication & supplement questions — free.

Ask a pharmacist

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.