Supplements and Pain Medicines: NSAIDs, Acetaminophen and Opioids
What official sources document about supplements and herbs taken with ibuprofen-type pain relievers, acetaminophen and opioids, including bleeding, liver and sedation concerns.
Content last updated . This page has not been medically reviewed.
Urgent first
If you think someone has taken too much acetaminophen, FDA says to get medical help or contact Poison Help at 1-800-222-1222 (US) right away. [1] Call 911 for collapse, a seizure, trouble breathing or someone who cannot be woken. Call or text 988 (US) in a mental health crisis. Do not make anyone vomit.The short answer
The concerns in the sources we read fall into three groups: bleeding (ibuprofen-type medicines with blood-thinning products), the liver (acetaminophen, alcohol and some herbs) and sedation or serotonin effects (opioids with sedating or serotonin-active products). No source we read says a particular herb is "safe with" a pain medicine. Ask a pharmacist, and never change a prescribed medicine on your own; that is for the prescriber.Labels used here
Documented: an official source states it. Reported: case reports. Preliminary: lab or small studies. Theoretical: reasoned, not shown. See how interactions work.NSAIDs (ibuprofen, naproxen, aspirin) and bleeding
| Combination | What the source says | Label |
|---|---|---|
| Ginkgo (Ginkgo biloba, leaf extract) with warfarin, aspirin or vitamin E | FDA says warfarin, ginkgo, aspirin and vitamin E can each thin the blood, and taking them together may raise the chance of internal bleeding or stroke. [2] NCCIH says ginkgo may raise bleeding risk with anticoagulants such as warfarin. [3] | Documented caution |
| Ginkgo with ibuprofen | A 2003 letter in a medical journal reported fatal brain bleeding associated with ginkgo and ibuprofen. [4] It is one case report and cannot show cause. | Reported |
| Aspirin or NSAIDs with warfarin | MedlinePlus lists aspirin and NSAIDs such as ibuprofen or naproxen among products that may interact with warfarin. [5] | Documented |
| Glucosamine with warfarin | NCCIH says glucosamine may increase the effects of anticoagulants such as warfarin, raising the risk of serious bruising and bleeding. [6] | Documented caution |
| Two NSAIDs together | The NHS says not to take ibuprofen with other NSAIDs such as naproxen or aspirin because of a higher risk of serious effects such as stomach ulcers. [7] | Documented |
The NHS also says ibuprofen may not suit people with problems with blood clotting, or a heart, liver or kidney condition. [7] Ask before adding any supplement if that applies. See supplements and blood thinners.
Alcohol with NSAIDs and acetaminophen
NIAAA lists stomach upset, bleeding and ulcers for alcohol with ibuprofen-type medicines, and liver damage for acetaminophen. [8] MedlinePlus says the risk of ibuprofen-related stomach problems may be higher in people who drink large amounts of alcohol. [9] For acetaminophen, FDA says severe liver damage may occur with three or more alcoholic drinks per day. [1] The NHS paracetamol page, by contrast, says you can drink normally (including alcohol) while taking it, and also lists alcohol dependence and binge drinking among reasons it may not suit someone. [10] The wording differs by agency and country; ask a pharmacist about your own situation.Acetaminophen and supplements
FDA says to use only one acetaminophen-containing product at a time, because it is in many products, and that too much can cause liver failure and death. [1] Proper evidence not found in the NCCIH, FDA, MedlinePlus, NHS and NIAAA pages we read for a documented interaction between a named herb and acetaminophen. That is not proof of safety. Some herbs carry their own liver warnings, for example kava. [11] If you use both, see liver safety.Opioids and tramadol
| Combination | What the source says | Label |
|---|---|---|
| St. John's wort with tramadol | MedlinePlus lists St. John's wort and tryptophan as products that may interact with tramadol. [12] NCCIH says St. John's wort with drugs that affect serotonin may increase serotonin-related side effects, which can be serious. [13] | Documented caution |
| Alcohol or other sedating products with tramadol | MedlinePlus says alcohol and certain medications with tramadol may raise the risk of breathing problems, sedation and coma. [12] | Documented |
| Herbs and supplements with tramadol in general | The NHS says there is very little information about herbal remedies and supplements with tramadol. [14] | Information gap |
| Opioid painkillers with sleep medicines | The NHS lists opioid painkillers among medicines that may not mix well with zopiclone, and strong painkillers such as codeine, morphine, oxycodone and tramadol among those to ask about before zolpidem. [15] [16] | Documented caution |
| Kratom (Mitragyna speciosa) with medicines | NCCIH says kratom acts on opioid receptors and combining it with other drugs has been linked to deaths. [17] A pharmacology review says kratom may interact with drugs as both a substrate and an inhibitor of liver enzymes. [18] FDA warns consumers not to use kratom. [19] | Reported and preliminary |
See kratom and the sedatives page.
Who should ask first
Older adults face a higher risk from alcohol-medicine interactions. [8] People with liver or kidney conditions should ask before any pain reliever. [10] Before surgery or dental work, tell the team about every supplement and pain medicine. [20] Products also vary in what they contain; see quality testing and certifications.Frequently asked questions
Can I take ginkgo with ibuprofen?
No source we read says that is safe. FDA and NCCIH document bleeding concerns with ginkgo and blood-thinning products. [2] [3] Ask a pharmacist.
Does a "natural" pain supplement avoid these risks?
Not by being natural. FDA says natural does not always mean safe. [2]
Is acetaminophen safe with alcohol?
Agencies word this differently. FDA warns about three or more drinks daily. [1] The NHS says normal drinking is fine for most but lists some groups it may not suit. [10]
Why is St. John's wort a problem with tramadol?
MedlinePlus lists it as a product that may interact, and NCCIH notes added serotonin-related side effects can be serious. [12] [13]
Where do I report a bad reaction?
References
- FDA, Acetaminophen (FDA, content current 14 August 2025). Read 2026-10-22.
- FDA, Mixing Medications and Dietary Supplements Can Endanger Your Health (FDA Consumer Update, content current 2 June 2022). Read 2026-10-22.
- NCCIH, Ginkgo: Usefulness and Safety (NCCIH, updated February 2025). Read 2026-10-22.
- PubMed, Meisel C, Johne A, Roots I. Fatal intracerebral mass bleeding associated with Ginkgo biloba and ibuprofen (letter and case report, Atherosclerosis, 2003). Read 2026-10-22.
- MedlinePlus, Warfarin: MedlinePlus Drug Information (last revised 15 March 2026). Read 2026-10-22.
- NCCIH, Know the Science: How Medications and Supplements Can Interact, Some Supplements May Increase the Effects (NCCIH). Read 2026-10-22.
- NHS, Ibuprofen for adults (NHS, page last reviewed 27 August 2025). Read 2026-10-22.
- NIAAA, Harmful Interactions: Mixing Alcohol With Medicines (NIAAA, published 2003, revised 2014). Read 2026-10-22.
- MedlinePlus, Ibuprofen: MedlinePlus Drug Information (last revised 15 September 2023). Read 2026-10-22.
- NHS, Paracetamol for adults (NHS, page last reviewed 24 March 2026). Read 2026-10-22.
- NCCIH, Kava: Usefulness and Safety (NCCIH, updated April 2025). Read 2026-10-22.
- MedlinePlus, Tramadol: MedlinePlus Drug Information. Read 2026-10-22.
- NCCIH, St. John’s Wort: Usefulness and Safety (NCCIH, updated May 2025). Read 2026-10-22.
- NHS, Taking tramadol with other medicines and herbal supplements (NHS, page last reviewed 4 February 2026). Read 2026-10-22.
- NHS, Zopiclone (NHS, page last reviewed 22 June 2026). Read 2026-10-22.
- NHS, Taking zolpidem with other medicines and herbal supplements (NHS, page last reviewed 10 January 2023). Read 2026-10-22.
- NCCIH, Kratom (NCCIH, updated April 2022). Read 2026-10-22.
- PubMed, Pharmacologic and clinical assessment of kratom: An update (American Journal of Health-System Pharmacy, 2020). Read 2026-10-22.
- FDA, FDA and Kratom (FDA, content current 2 December 2025). Read 2026-10-22.
- NCCIH, Using Dietary Supplements Wisely (NCCIH, updated January 2019). Read 2026-10-22.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.