Acetaminophen And Codeine and Rasagiline: 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
Rasagiline
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 should not be used together. Rasagiline (Azilect) is a type of drug called an MAOI, often used for Parkinson's disease. Codeine, the pain reliever in your acetaminophen and codeine product, can raise serotonin levels in the body. When you combine them, there is a risk of a serious reaction called serotonin syndrome, which can cause agitation, a fast heartbeat, sweating, shaking, and confusion.
The good news is that this is very manageable with your care team's help. There are other pain options that are safer with rasagiline. Please do not start or stop anything on your own. Talk with your pharmacist or doctor so they can plan the safest choice for you.
Contraindicated combination. Rasagiline is a selective MAO-B inhibitor; codeine has weak serotonergic activity. Concurrent use carries a theoretical risk of serotonin syndrome via additive serotonergic effects.
- Direction/mechanism: additive serotonergic effect (PD interaction), not a CYP-based change.
- Evidence: theoretical; onset unspecified.
- Management: avoid the combination. Allow a 14-day washout of the MAOI before starting codeine. If urgent opioid therapy is needed, select an alternative (oxycodone, hydrocodone, oxymorphone, buprenorphine), begin with immediate-release test doses, and titrate carefully.
- Monitor: blood pressure, CNS and respiratory depression, and signs of serotonin syndrome.
What happens
Increased risk of serotonin syndrome
Interaction Deep Dive
Combining codeine with an MAOI is contraindicated because of the risk of serotonin syndrome. An MAOI should be stopped 14 days prior to starting codeine. When opioid therapy cannot be delayed, select a different opioid instead (for example, oxyCODONE, HYDROcodone, oxyMORphone, or buprenorphine), beginning with test doses of an immediate-release formulation and titrating the dose cautiously while watching blood pressure along with signs and symptoms of CNS and respiratory depression123.
Why it happens (mechanism)
Additive serotonergic effects
How to manage this interaction
This pairing is contraindicated, so the goal is to avoid using them together. Your care team can manage this by choosing a safer plan for you.
- Keep taking your medicines as prescribed until you speak with your prescriber. Do not stop anything on your own.
- A washout is typically used: the MAOI (rasagiline) is stopped about 14 days before starting codeine.
- If pain treatment is urgently needed, your team may pick an alternative opioid (such as oxycodone, hydrocodone, oxymorphone, or buprenorphine), start with a low test dose, and monitor you closely.
- Tell your pharmacist and doctor about all medicines you take, and report any agitation, rapid heartbeat, sweating, shaking, or confusion right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Acetaminophen And Codeine and Rasagiline together?
Rasagiline (an MAOI) and codeine should not be used together because of a risk of serotonin syndrome; ask your pharmacist or doctor to choose a safer pain option, and never start or stop either drug on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acetaminophen And Codeine and Rasagiline interaction?
It is rated contraindicated. These should generally not be used together.
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 Rasagiline interaction managed?
This pairing is contraindicated, so the goal is to avoid using them together. Your care team can manage this by choosing a safer plan for you. Keep taking your medicines as prescribed until you speak with your prescriber. Do not stop anything on your own. A washout is typically used: the MAOI (rasagiline) is stopped about 14 days before starting codeine. If pain treatment is urgently needed, your… 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 Rasagiline 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: CARISOPRODOL, ASPIRIN, CODEINE PHOSPHATE oral tablets, carisoprodol, aspirin, codeine phosphate oral tablets. Ingenus Pharmaceuticals LLC (per DailyMed), Orlando, FL, 2021. DailyMed
- Product Information: Codeine sulfate oral solution, codeine sulfate oral solution. Hikma Pharmaceuticals USA Inc(per FDA), Berkeley Heights, NJ, 2023. DailyMed
Keep reading about Acetaminophen And Codeine
Keep reading about Rasagiline
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major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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