Acetaminophen And Codeine and Nordazepam: 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
Nordazepam
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.
These two medicines both slow down your brain and body. The codeine in your pain pill is an opioid, and nordazepam is a sedative in the benzodiazepine family. Taken together, they can add up and make you very sleepy, lower your blood pressure, and slow your breathing. In serious cases this can be dangerous.
The good news is your care team can manage this. They may keep both doses as low as possible for as short a time as possible, and watch you closely. Please don't stop or change either medicine on your own. Call your doctor or pharmacist right away if you feel unusually drowsy, dizzy, confused, or short of breath.
Additive CNS and respiratory depression from combined opioid (codeine) and benzodiazepine (nordazepam) use. This is a pharmacodynamic interaction, not a metabolic one; codeine is a prodrug activated via CYP2D6 to morphine, but the concern here is additive sedation rather than any enzyme effect.
- Direction: increased risk of hypotension, profound sedation, respiratory depression, coma, death.
- Evidence: theoretical; onset unspecified.
- Management: reserve co-prescribing for when alternatives are inadequate; use lowest effective doses and shortest duration; monitor for sedation and respiratory depression; consider prescribing naloxone.
What happens
An increased risk of hypotension, respiratory depression, profound sedation, coma, and death
Interaction Deep Dive
Taking codeine together with benzodiazepines may heighten the likelihood of hypotension, respiratory depression, deep sedation, coma, and death. Combined prescribing of these agents should be limited to patients whose alternative treatment options prove insufficient. Keep doses and treatment durations to the lowest levels needed. Monitor patients carefully for indications of sedation and respiratory depression. When co-administration is justified, consider prescribing naloxone to allow emergency management of opioid overdose134.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
Keep taking both exactly as prescribed unless your care team tells you otherwise. This combination is usually reserved for when other options aren't enough.
- Your team may use the lowest doses for the shortest time needed and individualize this for you.
- They may monitor you more closely for heavy sedation or slowed breathing.
- Your prescriber may consider giving you naloxone as an emergency rescue medicine.
Ask your pharmacist or doctor before adding alcohol, sleep aids, or other sedating medicines. Seek help right away for severe drowsiness, confusion, or trouble breathing.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) One study found that emergency department visits related to nonmedical use that took place between 2004 and 2011 and involved both opioid analgesics and benzodiazepines rose significantly from 11 to 34.2 per 100,000. Deaths from drug overdose attributable to prescribed and above-prescribed doses of both drug classes likewise rose significantly from 0.6 to 1.7 per 100,000, while overdose deaths caused by benzodiazepines rose significantly from 18% to 31% 2.
b) In a prospective cohort study, the rate of overdose deaths associated with the dispensing of both opioid analgesics and benzodiazepines was 10 times greater than that seen with dispensing of opioid analgesics alone (7 versus 0.7 per 10,000 person years) 2.
c) In a cohort study using data from 2004 to 2009, the risk of fatal overdose rose significantly by 2.33 fold among patients taking opioid analgesics who had a prior benzodiazepine prescription, and rose by 3.86 fold among those with a current benzodiazepine prescription, when compared with patients taking opioid analgesics who had no history of a benzodiazepine prescription. The risk of drug overdose deaths grew as daily benzodiazepine doses increased 2.
d) Observational studies have shown that using opioid analgesics and benzodiazepines together raises the risk of drug-related mortality relative to using opioid analgesics alone. Given their comparable pharmacological properties, it is reasonable to anticipate a similar risk when other CNS depressant drugs are used concurrently with opioid analgesics 34.
Common questions
Can I take Acetaminophen And Codeine and Nordazepam together?
Combining codeine with nordazepam can add up to dangerous sedation and slowed breathing, so your care team will use the lowest doses for the shortest time and watch you closely. Keep both as prescribed and get help fast if you feel very drowsy or short of breath. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acetaminophen And Codeine and Nordazepam 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 Nordazepam interaction managed?
Keep taking both exactly as prescribed unless your care team tells you otherwise. This combination is usually reserved for when other options aren't enough. Your team may use the lowest doses for the shortest time needed and individualize this for you. They may monitor you more closely for heavy sedation or slowed breathing. Your prescriber may consider giving you naloxone as an emergency rescue m… 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 Nordazepam 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 (4)
- Product Information: CARISOPRODOL, ASPIRIN, CODEINE PHOSPHATE oral tablets, carisoprodol, aspirin, codeine phosphate oral tablets. Ingenus Pharmaceuticals LLC (per DailyMed), Orlando, FL, 2021. DailyMed
- US Food and Drug Administration (FDA): Drug Safety Communications: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. US Food and Drug Administration (FDA). Silver Spring, MD. 2016.
- 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
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