Acetaminophen And Codeine and Troleandomycin: 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
Troleandomycin
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.
One of your medicines contains codeine, and the other, troleandomycin, is an antibiotic that can slow down one of the liver pathways that clears codeine from your body. When codeine hangs around longer, more of it can build up (along with the morphine your body makes from it), which can lead to stronger effects like heavy drowsiness or slowed, shallow breathing.
This is based on theory more than confirmed cases, so please don't be alarmed. Just keep taking both exactly as prescribed and let your pharmacist or doctor know you're on them. They can watch you a little more closely and adjust your codeine dose if needed to keep you safe.
Effect: Increased codeine and morphine exposure via troleandomycin inhibition of CYP3A4, one of codeine's metabolic pathways. Reduced 3A4 clearance shifts more codeine toward CYP2D6-mediated conversion to morphine, raising the risk of sedation and respiratory depression.
- Direction: Increased opioid effect (accumulation).
- Severity/Evidence: Major but theoretical; onset unspecified.
- Management: If used together, monitor for respiratory depression and sedation; consider codeine dose reduction until stable effects seen. If troleandomycin is discontinued, watch for opioid withdrawal and consider increasing codeine.
What happens
Increased codeine and morphine exposure
Interaction Deep Dive
Taking codeine together with CYP3A4 inhibitors has led to elevated levels of codeine and morphine, which may intensify or extend adverse reactions and can produce respiratory depression that is potentially fatal, especially when the inhibitor is introduced once a patient has reached a stable codeine dose. When such combined use is necessary, watch patients carefully for sedation and respiratory depression, and think about lowering the codeine dose until steady drug effects are seen. Conversely, when a CYP3A4 inhibitor is being stopped, observe patients for indications of opioid withdrawal and consider raising the codeine dose until stable drug effects have been observed12.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated codeine metabolism
How to manage this interaction
Your care team can manage this safely. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- Your team may monitor you more closely for excessive drowsiness or slowed, shallow breathing, especially right after the antibiotic is added.
- Your codeine dose may be adjusted and individualized until your response is stable.
- If the antibiotic is later stopped, your team may watch for withdrawal signs and adjust codeine again.
Call your pharmacist or prescriber right away if you notice unusual sleepiness, confusion, or trouble breathing.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Acetaminophen And Codeine and Troleandomycin together?
Troleandomycin can raise codeine and morphine levels by slowing codeine's breakdown, increasing the risk of oversedation and slowed breathing. Keep taking both as prescribed and let your care team monitor you and adjust the codeine dose as needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acetaminophen And Codeine and Troleandomycin 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 Troleandomycin interaction managed?
Your care team can manage this safely. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. Your team may monitor you more closely for excessive drowsiness or slowed, shallow breathing, especially right after the antibiotic is added. Your codeine dose may be adjusted and individualized until your response is stable. If the antibiotic is later stopped, your t… 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 Troleandomycin 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 (2)
- 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
Keep reading about Acetaminophen And Codeine
Keep reading about Troleandomycin
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