Terminalia + Aspirin, Caffeine, Dihydrocodeine Bitartrate
Aspirin, Caffeine, Dihydrocodeine Bitartrate brand name: Synalgos DC.
Aspirin, Caffeine, Dihydrocodeine Bitartrate falls into 3 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 reportTerminalia and Aspirin, Caffeine, Dihydrocodeine Bitartrate
These two interact in 3 distinct ways. Each one is explained separately below.
Why Are There 3 Interactions?
Terminalia interacts with whole categories of medication. Aspirin, Caffeine, Dihydrocodeine Bitartrate falls into 3 of those categories, so it can interact with Terminalia 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 Aspirin, Caffeine, Dihydrocodeine Bitartrate
Aspirin, Caffeine, Dihydrocodeine Bitartrate falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES — the group Terminalia interacts with.
In vitro research shows that Terminalia arjuna extract inhibits CYP2D6 enzymes and reduces CYP2D6 substrate metabolism.
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 Synalgos DC: the painkiller part, dihydrocodeine, is a prodrug. Your body uses an enzyme called CYP2D6 to turn it into the active form that actually relieves pain. Lab studies hint that Terminalia arjuna may slow down that same enzyme. If it does, less of your dihydrocodeine gets switched on, so you could feel less pain relief than expected, not more.
I want to be honest about the evidence here. This is based only on test-tube research, not real people, so we don't truly know if it matters in everyday life. The aspirin and caffeine pieces aren't really affected. If you're considering Terminalia, just run it by your pharmacist or doctor first so they can keep an eye on how well your pain is controlled.
- 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
CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES
2 of 3Aspirin, Caffeine, Dihydrocodeine Bitartrate also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.
In vitro research shows that Terminalia arjuna extract inhibits CYP3A4 enzymes and reduces CYP3A4 substrate metabolism.
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 gist with Synalgos DC, which combines aspirin, caffeine, and dihydrocodeine. Lab studies (not human studies) hint that Terminalia arjuna may slow down a liver enzyme called CYP3A4. Some of these ingredients are partly handled by that enzyme, so in theory their levels could creep up a bit. With the dihydrocodeine piece, that could mean more drowsiness, dizziness, constipation, or slowed breathing, and the caffeine could leave you feeling extra jittery or restless.
That said, this is only test-tube evidence, so it's far from certain it matters in real life. Still, since this product contains an opioid, I'd play it safe. Chat with your pharmacist or doctor before combining them, especially if you have a heart condition.
- 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
ANTICOAGULANT/ANTIPLATELET DRUGS
3 of 3Aspirin, Caffeine, Dihydrocodeine Bitartrate also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.
In vitro, Terminalia arjuna bark extract inhibits platelet aggregation, decreases platelet activation, and shows antithrombotic properties.
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 watch with Synalgos DC: the aspirin part of this combo already thins your blood a bit by keeping platelets from sticking together. Terminalia (arjuna) appears to do something similar in lab studies, so stacking the two could, in theory, nudge your bleeding risk up a little higher.
What might that look like in real life? Easier bruising, nosebleeds, bleeding gums, or a cut that's slow to stop. I want to be honest though: this concern comes only from test-tube research, not from people, so it's more of a caution than a proven problem. Smaller dietary amounts are unlikely to matter much, but concentrated supplement doses are worth a conversation. Check with your pharmacist or doctor before combining them.
- Malik N, Dhawan V, Bahl A, Kaul D. Inihbitory effects of Terminalia arjuna on platelet activation in vitro in healthy subjects and patients with coronary artery disease. Platelets. 2009;20(3):183-1190.
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.
Terminalia Also Interacts With Other Medications
Terminalia has 932 moderate known drug interactions in our database — the Aspirin, Caffeine, Dihydrocodeine Bitartrate one above is among them. If you take anything else, check it against the full list below.
Check Another of Your Medications Against Terminalia
We haven’t checked that one against Terminalia yet — ask our pharmacists directly.
Covers the 2,830 medications we’ve checked against Terminalia. Pick one to open its full report.
See Every Supplement That Interacts With Aspirin, Caffeine, Dihydrocodeine Bitartrate
This page covers Terminalia only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Aspirin, Caffeine, Dihydrocodeine Bitartrate page lists 398 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 Danshen (major).
By severity: 17 major · 334 moderate · 47 minor.
Open the Aspirin, Caffeine, Dihydrocodeine Bitartrate interaction page
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 Aspirin, Caffeine, Dihydrocodeine Bitartrate 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:
Where Terminalia and Aspirin, Caffeine, Dihydrocodeine Bitartrate 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.
#324 of 1,452 supplements looked up here in the last 7 days
#1,532 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 Terminalia
What is 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.
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.
No drugs match “”.
932 interactions
- Diclofenac Sodium ›
- Diltiazem ›
- Nifedipine ›
- Ibuprofen ›
- Aspirin ›
- Hydrocortisone ›
- Insulin (rdna) ›
- Naproxen ›
- Erythromycin ›
- Estradiol ›
- Minocycline ›
- Propranolol ›
- Lidocaine ›
- Norethindrone ›
- Testosterone ›
- Verapamil ›
- Levonorgestrel ›
- Prednisone ›
- Quinidine ›
- Cyclosporine ›
- Dexamethasone ›
- Glyburide ›
- Insulin (pork) ›
- Triazolam ›
- Zopiclone ›
- Colchicine ›
- Fentanyl ›
- Flurbiprofen ›
- Oxybutynin ›
- Oxycodone ›
- Phenytoin ›
- Prednisolone ›
- Tacrolimus ›
- Temazepam ›
- Budesonide ›
- Carbamazepine ›
- Clindamycin ›
- Dextromethorphan ›
- Diclofenac Potassium ›
- Dipyridamole ›
- Doxorubicin ›
- Fluticasone ›
- Formoterol ›
- Indomethacin ›
- Insulin (human) ›
- Miconazole ›
- Morphine Sulfate ›
- Trimipramine ›
- Amphetamine ›
- Buprenorphine ›
- Conjugated Estrogens ›
- Diazepam ›
- Everolimus ›
- Ivabradine ›
- Ketoprofen ›
- Lofepramine ›
- Medroxyprogesterone ›
- Medroxyprogesterone Acetate ›
- Meloxicam ›
- Nortriptyline ›
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.
- Levothyroxine ›
- Methylphenidate ›
- Ivermectin ›
- Rosuvastatin ›
- Escitalopram ›
- Acetaminophen ›
- Docusate ›
- Valacyclovir ›
- Hydroxyurea ›
- Sumatriptan ›
- Bupropion ›
- Amoxicillin ›
- Acyclovir ›
- Lisinopril ›
- Bendamustine ›
- Doxycycline ›
- Methotrexate ›
- Lamotrigine ›
- Gabapentin ›
- Pregabalin ›
- Azithromycin ›
- Isotretinoin ›
- Methylene Blue ›
- Ciprofloxacin ›
- Levothyroxine, Liothyronine ›
- Cyclopentolate ›
- Candesartan Cilexetil ›
- Cephalexin ›
- Mannitol ›
- Roxithromycin ›
- Acetaminophen, Dextromethorphan, Doxylamine ›
- Pegunigalsidase Alfa-iwxj ›
- Daptomycin ›
- Hexobarbitone ›
- Levothyroxine Sodium ›
- Dexmethylphenidate ›
- Levetiracetam ›
- Spironolactone ›
- Factor 7a ›
- Thyroid Hormone ›
- Carbidopa, Levodopa ›
- Mitomycin ›
- Minoxidil ›
- Levodopa ›
- Ezetimibe ›
- Cefaclor ›
- Lenvatinib ›
- Phenylephrine ›
- Vancomycin ›
- Hethylphenidate Hcl ›
- Phentermine, Topiramate ›
- Dirithromycin ›
- Bentoquatam ›
- Procainamide ›
- Amoxicillin, Clavulanate Potassium ›
- Hydroxychloroquine ›
- Digoxin ›
- Azelaic Acid ›
- Dextrothyroxine ›
- Triptorelin ›
Showing the 60 most looked-up of 1,897 medications checked with no known interaction — see the full Terminalia 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
Aspirin, Caffeine, Dihydrocodeine Bitartrate Is Linked to Lower Levels of 4 Nutrients
Natural Medicines records Aspirin, Caffeine, Dihydrocodeine Bitartrate as a medicine that can lower these. This is not an interaction with Terminalia — 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 Aspirin, Caffeine, Dihydrocodeine Bitartrate 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 Terminalia and Aspirin, Caffeine, Dihydrocodeine Bitartrate Together: Common Questions
Can you take Terminalia with Aspirin, Caffeine, Dihydrocodeine Bitartrate?
Why are there 3 interactions listed for Terminalia and Aspirin, Caffeine, Dihydrocodeine Bitartrate?
How serious is the Terminalia and Aspirin, Caffeine, Dihydrocodeine Bitartrate 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.