Drug & supplement interaction

Terminalia + Acetaminophen, Dextromethorphan

Acetaminophen, Dextromethorphan brand name: Tylenol Cough Ex Strength.

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

Acetaminophen, Dextromethorphan falls into 2 drug categories that Terminalia can interact with; the most serious is rated moderate. Theoretically, use of Terminalia arjuna may increase the levels and clinical effects of CYP2D6 substrates.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Terminalia and Acetaminophen, Dextromethorphan

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Terminalia interacts with whole categories of medication. Acetaminophen, Dextromethorphan falls into 2 of those categories, so it can interact with Terminalia in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES

1 of 2

Why this applies to Acetaminophen, Dextromethorphan

Acetaminophen, Dextromethorphan falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES — the group Terminalia interacts with.

Theoretically, use of Terminalia arjuna may increase the levels and clinical effects of CYP2D6 substrates.
In vitro research shows that Terminalia arjuna extract inhibits CYP2D6 enzymes and reduces CYP2D6 substrate metabolism.
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 for your Tylenol Cough product. The dextromethorphan part (the cough suppressant) is cleared from your body mostly by a liver enzyme called CYP2D6. Lab studies hint that Terminalia arjuna may slow that enzyme down. If it does, dextromethorphan could build up a bit more than usual, which might mean more drowsiness, dizziness, or feeling foggy. The acetaminophen piece isn't really affected by this particular interaction.

I want to be honest about the strength here: this is only test-tube evidence, so it's theoretical and may not happen in real life. Still, if you take Terminalia regularly, it's worth a quick chat with your pharmacist or doctor before combining the two.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Varghese A, Savai J, Pandita N, Gaud RS. In vitro modulatory effects of Terminalia arjuna, arjunic acid, arjunetin, and arjungenin on CYP3A4, CYP2D6, and CYP2C9 enzyme activity in human liver microsomes. Toxicology Reports. 2015(2):806-16. PubMed
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

2 of 2

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

Theoretically, use of Terminalia arjuna may increase the levels and clinical effects of CYP3A4 substrates.
In vitro research shows that Terminalia arjuna extract inhibits CYP3A4 enzymes and reduces CYP3A4 substrate metabolism.
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 this combo. The dextromethorphan part of your Tylenol Cough product is partly cleared by a liver enzyme called CYP3A4, and lab studies suggest Terminalia arjuna may slow that enzyme down. In theory, that could let dextromethorphan build up a bit more than usual, which might mean extra drowsiness, dizziness, or feeling foggy. The acetaminophen side isn't really affected by this particular pathway.

I want to be honest about the strength of this concern: it comes only from test-tube research, not from real people, so it's more of a 'good to know' than a red flag. For most folks taking either one short term, this isn't a big worry. Still, if you use Terminalia regularly, check with your pharmacist before pairing them.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Varghese A, Savai J, Pandita N, Gaud RS. In vitro modulatory effects of Terminalia arjuna, arjunic acid, arjunetin, and arjungenin on CYP3A4, CYP2D6, and CYP2C9 enzyme activity in human liver microsomes. Toxicology Reports. 2015(2):806-16. PubMed

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 Also Interacts With Other Medications

Terminalia has 932 moderate known drug interactions in our database — the Acetaminophen, Dextromethorphan one above is among them. If you take anything else, check it against the full list below.

Moderate 932 No known interaction 1,898 (incl. Acetaminophen, Dextromethorphan)
Taking anything else?

Check Another of Your Medications Against Terminalia

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

Everything else you take

See Every Supplement That Interacts With Acetaminophen, Dextromethorphan

This page covers Terminalia only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Dextromethorphan page lists 236 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), Grapefruit (major) and Lithium (major).

By severity: 8 major · 185 moderate · 43 minor.

From our pharmacist’s overview on the Acetaminophen, Dextromethorphan page

“Alcohol tops my worry list for Acetaminophen with Dextromethorphan (Tylenol Cough Ex Strength). Beer and wine both carry major ratings, since acetaminophen already asks a lot of the liver and regular drinking compounds that strain.”

Reviewed by 2 · Jul 18, 2026

Open the Acetaminophen, Dextromethorphan interaction page

One more smart check

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

We hold 306 real supplement products containing Terminalia, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Terminalia. Your product may carry other ingredients that interact with Acetaminophen, Dextromethorphan too, on top of Terminalia — 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 Terminalia and Acetaminophen, Dextromethorphan 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
Top 25%

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

29 days ago today
Medication Acetaminophen, Dextromethorphan
Top 5%

#139 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

What is Terminalia?

Terminalia
  • Heart health and circulation
  • Digestive problems (constipation, diarrhea)
  • Cholesterol support
  • Antioxidant and anti-inflammatory support
  • Immune support

Terminalia is a group of traditional Ayurvedic tree species (most notably Terminalia arjuna) used for heart, digestive, and general wellness purposes. Some small studies suggest possible benefits for heart and cholesterol health, but the evidence is limited and not strong enough to recommend it as a treatment. Talk to your pharmacist or doctor before using it, especially if you have a heart condition.

Read the full Terminalia monograph & all interactions
Keep checking

Other Drugs & Terminalia

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

0Major
932Moderate
0Minor
1,897No known interaction
932 Moderate 1,897 No interaction
Moderate

932 interactions

Showing 60 of 932 moderate interactions — see all 932 on the Terminalia page.

No interaction 1,897 drugs checked — show the list

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

Showing the 60 most looked-up of 1,897 medications checked with no known interaction — see the full Terminalia list.

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

Can you take Terminalia with Acetaminophen, Dextromethorphan?
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 2 interactions listed for Terminalia and Acetaminophen, Dextromethorphan?
Acetaminophen, Dextromethorphan belongs to more than one drug category, and Terminalia 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 Terminalia and Acetaminophen, Dextromethorphan 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, Dextromethorphan and Terminalia?

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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.