Acetaminophen And Codeine and Remoxipride: 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
Remoxipride
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 can both make you very drowsy. Your pain medicine contains codeine, an opioid, and acetaminophen (Tylenol). Remoxipride is an antipsychotic that calms the brain. When taken together, both can slow down your breathing and your alertness at the same time. That combined effect can lead to heavy sedation, very slow breathing, or in serious cases, dangerous drops in blood pressure.
The good news: your care team can manage this safely. They may use the lowest doses for the shortest time and watch you closely. Never start, stop, or change either medicine on your own. Talk with your pharmacist or doctor, and tell them right away if you feel unusually sleepy or short of breath.
Interaction: Additive CNS and respiratory depression from combining codeine (opioid) plus acetaminophen with remoxipride (a sedating antipsychotic/CNS depressant).
- Mechanism: Pharmacodynamic, additive CNS depression. Note codeine is a prodrug requiring CYP2D6 activation to morphine, but the relevant risk here is additive PD, not PK.
- Direction/effect: Increased risk of hypotension, profound sedation, respiratory depression, coma, death.
- Evidence: Theoretical; severity major; onset unspecified.
- Management: Avoid if possible; reserve for patients lacking alternatives. Use lowest effective dose and shortest duration. Monitor sedation and respiratory status. Consider naloxone co-prescription.
What happens
An increased risk of respiratory and CNS depression
Interaction Deep Dive
Do not combine opioid-containing cough preparations with agents that depress the CNS. Taking opioid analgesics together with benzodiazepines has been linked to higher rates of emergency department visits and deaths from overdose2. When codeine is used alongside CNS depressants, the likelihood of hypotension, respiratory depression, profound sedation, coma, and death rises. Prescribing these medications together should be limited to patients for whom other therapeutic options are insufficient. Keep both the doses and the treatment duration to the lowest amount necessary. Monitor patients carefully for indications of sedation and respiratory depression. Should combined use be justified, think about prescribing naloxone so that an opioid overdose can be treated as an emergency341.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
Keep taking both medicines exactly as prescribed unless your care team tells you otherwise. Because both can cause sedation and slowed breathing, your team may take steps to keep you safe.
- Your doctor may reserve this combination for when other options are not enough.
- Doses may be adjusted and individualized, often using the lowest dose and shortest duration needed.
- Your team may monitor you more closely for heavy drowsiness or slow breathing.
- They may also prescribe naloxone as an emergency rescue option.
Call your pharmacist or doctor right away if you notice unusual sleepiness, confusion, slow or shallow breathing, or dizziness.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) A study found that the rate of emergency department visits tied to nonmedical use that occurred between 2004 and 2011 and involved opioid analgesics together with benzodiazepines rose significantly from 11 to 34.2 per 100,000. Drug overdose fatalities attributed to prescribed and higher than prescribed doses of both drug classes likewise rose significantly from 0.6 to 1.7 per 100,000, and overdose deaths attributed to benzodiazepines rose significantly from 18% to 31% 2.
b) In a prospective cohort study, the rate of overdose fatalities associated with the dispensing of both opioid analgesics and benzodiazepines was 10 times greater than that with dispensing of opioid analgesics alone (7 vs 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 receiving opioid analgesics who had a history of a benzodiazepine prescription, and rose by 3.86 fold among those with a current benzodiazepine prescription, 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 increases the risk of drug-related death compared with using opioid analgesics alone. Given similar pharmacological properties, it is reasonable to anticipate a comparable risk when other CNS depressant drugs are used together with opioid analgesics 34.
Common questions
Can I take Acetaminophen And Codeine and Remoxipride together?
Combining codeine/acetaminophen with remoxipride adds up to a higher risk of dangerous sedation and slowed breathing, so use it only if your care team decides it is necessary, at the lowest dose, with close monitoring. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acetaminophen And Codeine and Remoxipride 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 Remoxipride interaction managed?
Keep taking both medicines exactly as prescribed unless your care team tells you otherwise. Because both can cause sedation and slowed breathing, your team may take steps to keep you safe. Your doctor may reserve this combination for when other options are not enough. Doses may be adjusted and individualized, often using the lowest dose and shortest duration needed. Your team may monitor you more… 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 Remoxipride 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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