Drug & supplement interaction

Terminalia + Aspirin, Chlorpheniramine, Phenylpropanolamine

Aspirin, Chlorpheniramine, Phenylpropanolamine brand name: Alka-Seltzer Plus Cold.

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

Aspirin, Chlorpheniramine, Phenylpropanolamine 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 CYP3A4 substrates.

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

Terminalia and Aspirin, Chlorpheniramine, Phenylpropanolamine

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. Aspirin, Chlorpheniramine, Phenylpropanolamine 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 3A4 (CYP3A4) SUBSTRATES

1 of 2

Why this applies to Aspirin, Chlorpheniramine, Phenylpropanolamine

Aspirin, Chlorpheniramine, Phenylpropanolamine falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group Terminalia interacts with.

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 cold product (aspirin, chlorpheniramine, and phenylpropanolamine). Lab and animal studies hint that Terminalia arjuna may slow down a liver enzyme called CYP3A4. If that enzyme runs slower, certain medicines it helps break down can build up a bit. The chlorpheniramine (the antihistamine here) is the piece most affected by CYP3A4, so in theory you might feel more of its usual effects, like drowsiness, dry mouth, or dizziness.

But please don't read too much into this. The evidence is only from test tube and animal work, not real people, so it's more of a maybe than a proven problem. Still, since this product already affects your heart rate and blood pressure, and Terminalia is a heart-targeted herb, it's worth a quick chat with your pharmacist before combining 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
Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

2 of 2

Aspirin, Chlorpheniramine, Phenylpropanolamine also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.

Theoretically, concomitant use of Terminalia arjuna with anticoagulant or antiplatelet drugs may increase the risk of bleeding in some patients.
In vitro, Terminalia arjuna bark extract inhibits platelet aggregation, decreases platelet activation, and shows antithrombotic properties.
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 cold product (Alka-Seltzer Plus Cold) contains aspirin, which thins your blood by keeping platelets from clumping together. Terminalia arjuna seems to do something similar in lab studies, slowing platelet activity. So when you stack the two, the worry is a little extra bleeding risk. In real life that might look like easier bruising, nosebleeds, bleeding gums, or a cut that takes longer to stop.

I want to be honest about the strength of this concern: it comes only from test-tube and animal research, not from people, so it's theoretical. It's worth a heads-up, not a panic. If you take aspirin regularly or have any bleeding issues, just check with your pharmacist or doctor before adding Terminalia.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. 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.

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 934 moderate known drug interactions in our database — the Aspirin, Chlorpheniramine, Phenylpropanolamine one above is among them. If you take anything else, check it against the full list below.

Moderate 934 No known interaction 1,896 (incl. Aspirin, Chlorpheniramine, Phenylpropanolamine)
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 Aspirin, Chlorpheniramine, Phenylpropanolamine

This page covers Terminalia only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Aspirin, Chlorpheniramine, Phenylpropanolamine page lists 372 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), Danshen (major) and Ephedra (major).

By severity: 16 major · 308 moderate · 48 minor.

Open the Aspirin, Chlorpheniramine, Phenylpropanolamine 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 Aspirin, Chlorpheniramine, Phenylpropanolamine 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 Aspirin, Chlorpheniramine, 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.

Supplement Terminalia
Top 25%

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

29 days ago today
Medication Aspirin, Chlorpheniramine, Phenylpropanolamine
Top 5%

#104 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
934Moderate
0Minor
1,895No known interaction
934 Moderate 1,895 No interaction
Moderate

934 interactions

Showing 60 of 934 moderate interactions — see all 934 on the Terminalia page.

No interaction 1,895 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 1,895 medications checked with no known interaction — see the full Terminalia list.

See the full Terminalia interactions page
See every supplement checked against Aspirin, Chlorpheniramine, Phenylpropanolamine, 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 Aspirin, Chlorpheniramine, Phenylpropanolamine supplement interactions › Every supplement checked against Aspirin, Chlorpheniramine, Phenylpropanolamine, 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 Aspirin, Chlorpheniramine, Phenylpropanolamine Together: Common Questions

Can you take Terminalia with Aspirin, Chlorpheniramine, Phenylpropanolamine?
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 Aspirin, Chlorpheniramine, Phenylpropanolamine?
Aspirin, Chlorpheniramine, Phenylpropanolamine 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 Aspirin, Chlorpheniramine, Phenylpropanolamine 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 Aspirin, Chlorpheniramine, Phenylpropanolamine 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.