Acetaminophen And Codeine and Tipranavir: 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
Tipranavir
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, which is a bit unusual. Codeine itself does not do much for pain until your body turns it into morphine using a liver enzyme called CYP2D6. In other words, codeine is a prodrug. Tipranavir (Aptivus) can slow down that enzyme, so your body may make less morphine. That can mean your pain is not controlled as well as expected.
The good news is this is manageable. If you take both, your care team may watch how well your pain is controlled and adjust your dose to fit you. Please don't change anything on your own. Just let your pharmacist or doctor know you take both.
Effect: Codeine is a prodrug bioactivated to morphine via CYP2D6. Tipranavir may inhibit CYP2D6, increasing parent codeine exposure while reducing morphine (active metabolite) exposure, potentially causing reduced analgesia and, in opioid-dependent patients, withdrawal.
- Direction: reduced active-drug (morphine) effect
- Onset: unspecified
- Evidence: theoretical
- Severity: major
Management: If co-administered, monitor for inadequate analgesia and withdrawal; the codeine dose may need to be increased and individualized. On discontinuation of tipranavir, morphine formation may rebound; consider reducing the codeine dose and monitor for sedation and respiratory depression.
What happens
Increased codeine exposure and reduced active metabolite (morphine) exposure
Interaction Deep Dive
Taking codeine together with a CYP2D6 inhibitor can lower plasma levels of morphine, which is codeine's active metabolite, and this may result in diminished effectiveness along with withdrawal symptoms. When these agents must be given together, watch patients for withdrawal symptoms and think about raising the codeine dose. After the CYP2D6 inhibitor has been stopped, consider lowering the codeine dose while monitoring for signs and symptoms of sedation and respiratory depression312.
Why it happens (mechanism)
Inhibition of CYP2D6-mediated codeine metabolism
How to manage this interaction
Keep taking both medicines exactly as prescribed unless your care team tells you otherwise. This interaction is manageable.
- Your team may monitor how well your pain is controlled and watch for withdrawal-type symptoms.
- Your codeine dose may need to be adjusted and individualized by your prescriber to keep your pain controlled.
- If tipranavir is ever stopped, tell your team, since your codeine dose may need to come back down. They will watch for excess drowsiness or slowed breathing.
Raise with your pharmacist or prescriber: that you take both, plus any poorly controlled pain or new symptoms.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Acetaminophen And Codeine and Tipranavir together?
Tipranavir may block the enzyme that turns codeine into morphine, so your pain relief could be weaker; your care team can manage this by adjusting your codeine dose and monitoring you. Do not change either medicine on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acetaminophen And Codeine and Tipranavir 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 Tipranavir interaction managed?
Keep taking both medicines exactly as prescribed unless your care team tells you otherwise. This interaction is manageable. Your team may monitor how well your pain is controlled and watch for withdrawal-type symptoms. Your codeine dose may need to be adjusted and individualized by your prescriber to keep your pain controlled. If tipranavir is ever stopped, tell your team, since your codeine dose… 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 Tipranavir 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 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
- Product Information: codeine sulfate oral tablets, codeine sulfate oral tablets. West-Ward Pharmaceuticals Corp. (per FDA), Eatontown, NJ, 2017. DailyMed
Keep reading about Acetaminophen And Codeine
Keep reading about Tipranavir
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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