Boceprevir and Acetaminophen And Codeine: 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
Boceprevir
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 medicine Empracet (acetaminophen with codeine) contains codeine, which your body changes into morphine to relieve pain. Boceprevir can slow down one of the liver enzymes that handles codeine. That means more codeine and morphine can build up in your body than usual.
When opioid levels rise, you may feel very drowsy or your breathing can slow down, which can be dangerous. This concern is based mostly on how the drugs work rather than lots of real-world reports, but it's worth taking seriously. The good news: your care team can manage this safely by watching you closely and adjusting your codeine dose if needed. Please don't stop either medicine on your own, just talk with your pharmacist or doctor.
Effect: Boceprevir, a CYP3A4 inhibitor, may reduce CYP3A4-mediated metabolism of codeine, increasing codeine and its active metabolite morphine (raised exposure). Codeine is a prodrug, but the primary concern here is accumulation of parent drug and reduced clearance leading to higher opioid effect.
- Direction: Increased opioid exposure and effect.
- Risk: Sedation, respiratory depression (potentially fatal), especially when inhibitor added to a stable codeine dose.
- Onset: Unspecified. Evidence: Theoretical.
- Management: Monitor for respiratory depression and sedation; consider codeine dose reduction. On boceprevir discontinuation, monitor for withdrawal and consider dose increase.
What happens
Increased codeine and morphine exposure
Interaction Deep Dive
Concomitant use of codeine with CYP3A4 inhibitors has resulted in increased codeine and morphine concentrations, which could increase or prolong adverse reactions and may cause potentially fatal respiratory depression, particularly when an inhibitor is added after a stable dose of codeine is achieved. If concomitant use is needed, closely monitor patients for respiratory depression and sedation, and consider dose reduction of codeine until stable drug effects have been observed. If a CYP3A4 inhibitor is being discontinued, monitor patients for signs of opioid withdrawal, and consider increasing dose of codeine until stable drug effects have been observed12.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated codeine metabolism
How to manage this interaction
Keep taking both medicines as prescribed unless your care team tells you otherwise. Here is how this is typically handled:
- Your team may monitor you more closely for excess drowsiness and slowed or shallow breathing, especially soon after boceprevir is started.
- Your codeine dose may be adjusted and individualized until steady, reliable effects are seen.
- If boceprevir is later stopped, your team may watch for withdrawal signs and adjust codeine again.
Call your pharmacist or prescriber right away if you feel unusually sleepy, confused, or notice slow or difficult breathing.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Boceprevir and Acetaminophen And Codeine together?
Boceprevir can raise codeine and morphine levels, increasing the risk of heavy sedation and slowed breathing, so watch for these signs and let your care team monitor you and adjust your codeine dose. Take both as prescribed and don't change anything on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Boceprevir 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 Boceprevir and Acetaminophen And Codeine interaction managed?
Keep taking both medicines as prescribed unless your care team tells you otherwise. Here is how this is typically handled: Your team may monitor you more closely for excess drowsiness and slowed or shallow breathing, especially soon after boceprevir is started. Your codeine dose may be adjusted and individualized until steady, reliable effects are seen. If boceprevir is later stopped, your team ma… 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 Boceprevir 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 (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 Boceprevir
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