Acetaminophen And Codeine and Glycopyrronium Tosylate: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jun 30, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Acetaminophen And Codeine
Glycopyrronium Tosylate
No brand names on record
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.
Your pain medicine contains codeine, an opioid, and acetaminophen (Tylenol). Codeine can slow down your gut and make you constipated. Glycopyrronium tosylate is an anticholinergic medicine, and it can also slow the gut and make it harder to empty your bladder.
When you take both, these effects can add up. In rare cases, the gut can slow down so much that it nearly stops moving, which doctors call paralytic ileus. This concern is mostly theoretical, so please do not panic. Keep taking both as prescribed, and let your care team know if you notice severe constipation, belly pain and bloating, or trouble urinating. They can easily manage this.
Effect: Additive reduction in GI motility (and possible urinary retention) with combined opioid (codeine) and anticholinergic (glycopyrronium) use, theoretically increasing risk of severe constipation and paralytic ileus.
Mechanism: Codeine reduces peristalsis via mu-opioid receptor agonism; glycopyrronium reduces smooth muscle tone via muscarinic antagonism. Effects are additive, pharmacodynamic (not PK-mediated).
- Direction: Additive GI/GU slowing.
- Severity/evidence: Major but theoretical; onset unspecified.
- Management: Monitor for reduced bowel motility, abdominal distension, and urinary retention. Consider prophylactic bowel regimen; dose may be individualized by the care team.
What happens
An increased risk of paralytic ileus
Interaction Deep Dive
Concomitant use of codeine with anticholinergic drugs may increase the risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Monitor patients for signs of urinary retention or reduced gastric motility when codeine is used concomitantly with anticholinergic drugs1.
Why it happens (mechanism)
Additive effects on gastric motility
How to manage this interaction
Keep taking both medicines as prescribed unless your prescriber tells you otherwise. This is a manageable situation your care team can handle.
- Watch for severe constipation, belly bloating or pain, no bowel movement, or trouble urinating, and report these promptly.
- Your team may monitor you more closely for these signs while you use both drugs.
- Ask your pharmacist whether a stool softener or extra fluids and fiber would help prevent constipation.
- Dosing may be adjusted and individualized by your care team if needed.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Acetaminophen And Codeine and Glycopyrronium Tosylate together?
Codeine and glycopyrronium can both slow your gut, so together they may raise the risk of severe constipation or, rarely, a stalled bowel; keep taking both as prescribed and tell your care team about severe constipation, belly pain, or trouble urinating. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acetaminophen And Codeine and Glycopyrronium Tosylate 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 Glycopyrronium Tosylate interaction managed?
Keep taking both medicines as prescribed unless your prescriber tells you otherwise. This is a manageable situation your care team can handle. Watch for severe constipation, belly bloating or pain, no bowel movement, or trouble urinating, and report these promptly. Your team may monitor you more closely for these signs while you use both drugs. Ask your pharmacist whether a stool softener or extra… 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 Glycopyrronium Tosylate 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 (1)
- Product Information: CARISOPRODOL, ASPIRIN, CODEINE PHOSPHATE oral tablets, carisoprodol, aspirin, codeine phosphate oral tablets. Ingenus Pharmaceuticals LLC (per DailyMed), Orlando, FL, 2021. DailyMed
Keep reading about Acetaminophen And Codeine
Keep reading about Glycopyrronium Tosylate
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist