Acetaminophen And Codeine and Abiraterone Acetate, Micronized: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 1, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Acetaminophen And Codeine
Abiraterone Acetate, Micronized
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Here's what's going on with these two medicines. Codeine is what we call a prodrug, meaning your body has to change it into morphine to give you pain relief. That conversion happens through a liver enzyme called CYP2D6.
Abiraterone can slow that enzyme down. So your body may make less morphine from your codeine, which can mean weaker pain relief. If you already take codeine regularly, you might even feel some withdrawal-type discomfort. The good news is this is a theoretical concern, and your care team can manage it easily by watching how well your pain is controlled and adjusting your dose if needed. Please don't change anything on your own, just talk with your pharmacist or doctor.
Mechanism: Abiraterone inhibits CYP2D6, the enzyme that O-demethylates codeine (a prodrug) to its active metabolite morphine.
Direction: Increased parent codeine exposure with reduced morphine formation, so expect diminished analgesia and possible opioid withdrawal in chronic users.
- Evidence: theoretical
- Severity on file: major
- Onset: unspecified
Management: If co-use is necessary, monitor for inadequate analgesia and withdrawal symptoms; the codeine dose may need to be increased and individualized. When abiraterone is stopped, CYP2D6 activity recovers, so consider reducing the codeine dose and monitor for sedation and respiratory depression.
What happens
Increased codeine exposure and reduced active metabolite (morphine) exposure
Interaction Deep Dive
Concomitant use of codeine and a CYP2D6 inhibitor may reduce plasma concentrations of morphine, the active metabolite of codeine, thus potentially leading to reduced efficacy and withdrawal symptoms. If concomitant use is necessary, monitor patients for withdrawal symptoms and consider increasing the codeine dose. Once the CYP2D6 inhibitor is discontinued, consider reducing the codeine dose and monitor for signs and symptoms of respiratory depression and sedation312.
Why it happens (mechanism)
Inhibition of CYP2D6-mediated codeine metabolism
How to manage this interaction
Keep taking both medicines as prescribed unless your care team tells you otherwise. Here is what they typically do with this combination:
- Watch how well your pain is being controlled, since your relief may become weaker.
- Check for any withdrawal-type symptoms if you take codeine regularly.
- Your codeine dose may need to be adjusted and individualized by your care team.
- If abiraterone is later stopped, your team may lower the codeine dose and watch for extra drowsiness or slowed breathing.
Tell your pharmacist or doctor if your pain isn't well controlled or you feel unwell, so they can fine-tune your treatment.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Acetaminophen And Codeine and Abiraterone Acetate, Micronized together?
Abiraterone can reduce the pain relief you get from codeine by blocking its conversion to morphine, so watch for weaker pain control and let your care team adjust and monitor your treatment. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acetaminophen And Codeine and Abiraterone Acetate, Micronized interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Acetaminophen And Codeine and Abiraterone Acetate, Micronized interaction managed?
Keep taking both medicines as prescribed unless your care team tells you otherwise. Here is what they typically do with this combination: Watch how well your pain is being controlled, since your relief may become weaker. Check for any withdrawal-type symptoms if you take codeine regularly. Your codeine dose may need to be adjusted and individualized by your care team. If abiraterone is later stopp… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Acetaminophen And Codeine or Abiraterone Acetate, Micronized need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: Codeine sulfate oral solution, codeine sulfate oral solution. Hikma Pharmaceuticals USA Inc(per FDA), Berkeley Heights, NJ, 2023. DailyMed
- Product Information: Codeine sulfate oral tablets, codeine sulfate oral tablets. Hikma Pharmaceuticals USA Inc. (per FDA), Berkeley Heights, NJ, 2023. DailyMed
- Product Information: codeine sulfate oral tablets, codeine sulfate oral tablets. West-Ward Pharmaceuticals Corp. (per FDA), Eatontown, NJ, 2017. DailyMed
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