Acetaminophen And Codeine and Opipramol: 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
Opipramol
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.
You've been prescribed two medicines that can each nudge up a brain chemical called serotonin. One is your acetaminophen with codeine pain pill, and the other is opipramol. When two serotonin-raising drugs are taken together, there's a small chance the level climbs too high, which is called serotonin syndrome.
Signs to watch for include feeling agitated or restless, a fast heartbeat, sweating, shivering, shaking, muscle twitching, or fever. This concern is based on theory more than lots of real cases, so try not to worry. Your doctor and pharmacist can manage this by keeping an eye on you, especially when you first start or when a dose changes. Let them know right away if you notice those symptoms.
Effect: Additive serotonergic activity may increase the risk of serotonin syndrome when codeine (an opioid with weak serotonergic properties) is combined with opipramol.
- Mechanism: Pharmacodynamic, additive serotonergic effects (not a CYP prodrug-activation issue here).
- Direction/magnitude: Increased serotonergic tone; magnitude undefined.
- Onset: Unspecified; risk highest at initiation and dose escalation.
- Evidence: Theoretical.
- Management: If co-prescribed, monitor for agitation, autonomic instability, hyperreflexia, clonus, hyperthermia. Discontinue codeine if serotonin syndrome is suspected.
What happens
Increased risk of serotonin syndrome
Interaction Deep Dive
Taking opioids like codeine together with serotonergic agents has led to cases of serotonin syndrome. When such combined therapy is necessary, monitor the patient closely, especially when starting treatment and when doses are being changed. Should serotonin syndrome be suspected, stop codeine123.
Why it happens (mechanism)
Additive serotonergic effects
How to manage this interaction
Both of these medicines can raise serotonin, so used together they carry a small, mostly theoretical risk of serotonin syndrome. Here is how this is typically handled:
- Keep taking both as prescribed unless your care team tells you otherwise.
- Your team may watch you more closely, especially when you start either drug or change a dose.
- Seek help promptly for symptoms like agitation, confusion, fast heartbeat, sweating, shivering, muscle twitching, or fever.
Ask your pharmacist or prescriber if you have any questions or notice these symptoms. Codeine may be stopped if serotonin syndrome is suspected, but let your care team make that call.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
Common questions
Can I take Acetaminophen And Codeine and Opipramol together?
Taking acetaminophen-codeine with opipramol slightly raises the theoretical risk of serotonin syndrome; keep taking both as directed and tell your care team right away if you feel agitated, feverish, sweaty, or notice muscle twitching. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acetaminophen And Codeine and Opipramol 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 Opipramol interaction managed?
Both of these medicines can raise serotonin, so used together they carry a small, mostly theoretical risk of serotonin syndrome. Here is how this is typically handled: Keep taking both as prescribed unless your care team tells you otherwise. Your team may watch you more closely, especially when you start either drug or change a dose. Seek help promptly for symptoms like agitation, confusion, fast… 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 Opipramol 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 tablets, codeine sulfate oral tablets. West-Ward Pharmaceuticals Corp (per DailyMed), Eatontown, NJ, 2016. DailyMed
- 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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