Acetaminophen And Codeine and Pinazepam: 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
Pinazepam
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. Codeine is an opioid pain reliever (combined here with acetaminophen), and pinazepam is a benzodiazepine, a calming or anti-anxiety type of medicine. When taken together, their sedating effects can add up. This can make you very sleepy, lower your blood pressure, and, most importantly, slow your breathing. In serious cases this can lead to very deep sedation or even become life threatening.
The good news is your care team can manage this. Do not stop either medicine on your own. Talk with your pharmacist or doctor about whether you truly need both, and watch for unusual drowsiness or slow, shallow breathing.
Mechanism: additive CNS depression from an opioid (codeine) plus a benzodiazepine (pinazepam). Neither is a relevant prodrug concern here for direction; the effect is pharmacodynamic, not PK based.
Direction/effect: increased risk of hypotension, respiratory depression, profound sedation, coma, and death.
- Onset: unspecified; effects track with dosing.
- Evidence: theoretical, but class effect is well recognized.
- Management: reserve concomitant use for patients lacking adequate alternatives. Use the lowest effective doses for the shortest duration. Monitor closely 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. Prescribing these agents together should be limited to patients in whom other treatment approaches are insufficient. Keep both doses and treatment durations to the lowest necessary levels, and monitor patients carefully for indications of sedation and respiratory depression. When combined use is justified, consider providing naloxone to enable emergency management of opioid overdose134.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
Keep taking both medicines as prescribed unless your care team tells you otherwise, but this combination should be reviewed.
- Your team may reserve using both together only when other options are not enough.
- Doses and how long you take them may be adjusted and individualized to the lowest amount needed.
- Your team may monitor you more closely for heavy drowsiness, slow or shallow breathing, and low blood pressure.
- Your prescriber may also provide naloxone as an emergency backup.
Ask your pharmacist or doctor before adding alcohol or any other sedating medicine.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) In one study, the rate of nonmedical use-related emergency department visits between 2004 and 2011 that involved opioid analgesics and benzodiazepines rose significantly from 11 to 34.2 per 100,000. Deaths from drug overdose attributable to prescribed and greater than prescribed doses of both drug classes likewise increased significantly from 0.6 to 1.7 per 100,000, and overdose deaths attributable to benzodiazepines increased 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 with the 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 increased significantly by 2.33 fold in patients taking opioid analgesics who had a history of a benzodiazepine prescription and increased by 3.86 fold in those with a current benzodiazepine prescription, compared with those taking opioid analgesics without a history of a benzodiazepine prescription. The risk of drug overdose deaths rose as daily doses of benzodiazepines increased 2.
d) Observational studies have shown that combined use of opioid analgesics and benzodiazepines raises the risk of drug-related mortality compared with use of opioid analgesics alone. Given similar pharmacological properties, it is reasonable to anticipate comparable risk when other CNS depressant drugs are used together with opioid analgesics 34.
Common questions
Can I take Acetaminophen And Codeine and Pinazepam together?
Codeine and pinazepam together can add up to dangerous sedation, low blood pressure, and slowed breathing. Do not stop either on your own, but ask your pharmacist or doctor to review the combination and watch for excessive drowsiness or breathing changes. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acetaminophen And Codeine and Pinazepam 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 Pinazepam interaction managed?
Keep taking both medicines as prescribed unless your care team tells you otherwise, but this combination should be reviewed. Your team may reserve using both together only when other options are not enough. Doses and how long you take them may be adjusted and individualized to the lowest amount needed. Your team may monitor you more closely for heavy drowsiness, slow or shallow breathing, and low… 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 Pinazepam 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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