Almotriptan and Acetaminophen And Codeine: 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
Almotriptan
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, and almotriptan is a migraine medicine. Both can gently raise a brain chemical called serotonin. When two medicines do this together, there is a small chance of something called serotonin syndrome. Signs can include feeling agitated or restless, a fast heartbeat, sweating, shivering, muscle twitching, or shakiness.
I want to be clear: this is a theoretical concern, not something that happens to most people. Your care team can manage it easily by keeping an eye on how you feel, especially when you first start or change a dose. Keep taking both as prescribed, and let your pharmacist or doctor know if you notice any of those symptoms.
Interaction: Additive serotonergic effects between codeine (an opioid with weak serotonergic activity) and almotriptan (a 5-HT1B/1D agonist), theoretically increasing risk of serotonin syndrome.
- Direction/mechanism: Pharmacodynamic (additive), not a CYP-mediated exposure change; codeine is a prodrug but that is not the relevant mechanism here.
- Severity/evidence: Major severity rating, but evidence is theoretical; onset unspecified.
- Monitoring: Watch for autonomic instability, neuromuscular hyperactivity (clonus, hyperreflexia, tremor), and altered mental status, especially at initiation or dose changes.
- Management: If serotonin syndrome is suspected, discontinue codeine and provide supportive care.
What happens
Increased risk of serotonin syndrome
Interaction Deep Dive
Concomitant use of opioids, such as codeine, with serotonergic drugs has resulted in serotonin syndrome. If concomitant use is needed, carefully observe the patient, particularly during treatment initiation and dose adjustments. Discontinue codeine if serotonin syndrome is suspected123.
Why it happens (mechanism)
Additive serotonergic effects
How to manage this interaction
Both medicines can nudge serotonin upward, so used together there is a theoretical, small risk of serotonin syndrome. Here is what typically happens and what you can do:
- Keep taking both as prescribed unless your prescriber tells you otherwise.
- Your care team may watch you more closely, especially when you start either drug or change a dose.
- Know the warning signs: agitation, confusion, fast heartbeat, heavy sweating, shivering, muscle twitching, or shakiness.
- If those symptoms appear, contact your pharmacist or doctor promptly, since codeine may be stopped if serotonin syndrome is suspected.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
Common questions
Can I take Almotriptan and Acetaminophen And Codeine together?
Taking codeine with almotriptan carries a small, mostly theoretical risk of serotonin syndrome. Keep taking both as prescribed, watch for symptoms like agitation, sweating, fast heartbeat, or muscle twitching, and tell your pharmacist or doctor if they occur. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Almotriptan and Acetaminophen And Codeine 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 Almotriptan and Acetaminophen And Codeine interaction managed?
Both medicines can nudge serotonin upward, so used together there is a theoretical, small risk of serotonin syndrome. Here is what typically happens and what you can do: Keep taking both as prescribed unless your prescriber tells you otherwise. Your care team may watch you more closely, especially when you start either drug or change a dose. Know the warning signs: agitation, confusion, fast heart… 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 Almotriptan or Acetaminophen And Codeine 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: 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 Almotriptan
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist