Acetaminophen And Codeine and Propiverine: 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
Propiverine
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 that slows down the gut and can cause constipation. Propiverine is a bladder medicine that also relaxes muscles and slows the digestive tract, and it can make it harder to empty your bladder.
When you take both, these effects can add up. That may lead to bad constipation or trouble urinating. In rare cases, the bowel can slow so much that it nearly stops, which is called a paralytic ileus. This concern is based on how the drugs work, not on lots of real-world reports. Watch for a bloated, painful belly, no bowel movements, or trouble peeing, and call your care team if these happen. They can manage this safely.
Additive anticholinergic/opioid effect on GI and urinary motility. Codeine (mu-opioid agonist) reduces GI motility; propiverine has antimuscarinic and smooth-muscle relaxant activity. Combined, they can potentiate constipation and urinary retention, theoretically progressing to paralytic ileus.
- Direction: additive pharmacodynamic effect, not a metabolic (CYP) interaction.
- Evidence: theoretical; severity rated major.
- Onset: unspecified.
- Monitoring: assess bowel function, abdominal distension, and urinary output; ask about constipation and voiding difficulty.
- Management: consider prophylactic bowel regimen, individualize dosing, and evaluate alternatives if symptoms emerge.
What happens
An increased risk of paralytic ileus
Interaction Deep Dive
Taking codeine together with anticholinergic agents can heighten the likelihood of urinary retention and/or serious constipation, potentially progressing to paralytic ileus. When codeine and anticholinergic drugs are given at the same time, watch patients for indications of urinary retention or diminished gastric motility1.
Why it happens (mechanism)
Additive effects on gastric motility
How to manage this interaction
Keep taking both medicines as prescribed unless your care team tells you otherwise. This combination can add up to more constipation or trouble urinating, so a little planning helps.
- Watch for warning signs: a swollen or painful belly, no bowel movements, nausea/vomiting, or difficulty passing urine.
- Support your gut: ask your pharmacist whether staying hydrated, staying active, or a stool softener/laxative would be appropriate for you.
- Report early: tell your prescriber if constipation or urinary problems start.
Your care team can manage this by monitoring you and adjusting or individualizing your doses if needed.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Acetaminophen And Codeine and Propiverine together?
Taking codeine with propiverine can add up to worse constipation and urinary retention, rarely progressing to a bowel blockage. Keep taking both as prescribed, watch for a swollen painful belly or trouble urinating, and tell your care team if these occur. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acetaminophen And Codeine and Propiverine 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 Propiverine interaction managed?
Keep taking both medicines as prescribed unless your care team tells you otherwise. This combination can add up to more constipation or trouble urinating, so a little planning helps. Watch for warning signs: a swollen or painful belly, no bowel movements, nausea/vomiting, or difficulty passing urine. Support your gut: ask your pharmacist whether staying hydrated, staying active, or a stool softene… 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 Propiverine 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
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