Bromazepam 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
Bromazepam
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, an opioid, and you're also taking bromazepam, a benzodiazepine used for anxiety. Both of these calm down the brain and slow the body. When you take them together, those calming effects can add up.
The main worry is too much sedation and slowed breathing. In serious cases this can cause very low blood pressure, deep sleep you can't wake from, or worse. This is a real concern, but it's very manageable. Your care team can use the lowest doses needed and watch you closely. Please don't stop either medicine on your own, just talk with your doctor or pharmacist about the safest plan for you.
Mechanism: Additive CNS and respiratory depression from combining an opioid (codeine) with a benzodiazepine (bromazepam). This is a pharmacodynamic interaction, not a metabolic one; neither drug's clearance drives the effect.
Direction/effect: Increased risk of hypotension, respiratory depression, profound sedation, coma, and death.
- Onset: unspecified; evidence is theoretical but mechanistically sound and carries a major severity rating.
- Management: Reserve concurrent use for patients lacking adequate alternatives. Limit dose and duration to the minimum required. Monitor closely for sedation and respiratory depression. Consider co-prescribing naloxone.
What happens
An increased risk of hypotension, respiratory depression, profound sedation, coma, and death
Interaction Deep Dive
Concomitant use of codeine with benzodiazepines can increase the risk of hypotension, respiratory depression, profound sedation, coma and death. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients closely for signs of respiratory depression and sedation. If concomitant use is warranted, consider prescribing naloxone for the emergency treatment of opioid overdose134.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
If your prescriber has you on both, they've weighed the benefits and risks. Here's how a care team typically keeps this safe:
- Using the lowest effective doses for the shortest time needed.
- Monitoring you more closely for excess drowsiness, confusion, or slowed breathing.
- Sometimes prescribing naloxone as a rescue medicine, just in case.
What you can do: Keep taking both as prescribed, avoid alcohol, and tell someone at home about warning signs. Call your pharmacist or doctor right away if you feel very sleepy, foggy, or short of breath.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) One study found that emergency department visits related to nonmedical use that occurred between 2004 and 2011 and involved both opioid analgesics and benzodiazepines rose significantly from 11 to 34.2 per 100,000. Deaths from drug overdose attributable to prescribed and above-prescribed doses of both drug classes likewise rose significantly from 0.6 to 1.7 per 100,000, and overdose deaths involving benzodiazepines rose significantly from 18% to 31% 2.
b) In a prospective cohort study, the rate of overdose deaths associated with the dispensing of both opioid analgesics and benzodiazepines was 10 times greater than with the 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 taking opioid analgesics who had a history of a benzodiazepine prescription and rose by 3.86 fold in 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 together with benzodiazepines raises the risk of drug-related death compared with using opioid analgesics on their own. Given their comparable pharmacological characteristics, it is reasonable to anticipate a similar risk when other CNS depressant drugs are used together with opioid analgesics 34.
Common questions
Can I take Bromazepam and Acetaminophen And Codeine together?
Codeine and bromazepam both depress the brain and breathing, so together they raise the risk of dangerous sedation. Use only if needed, at the lowest doses, with close monitoring, and never combine with alcohol. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Bromazepam 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 Bromazepam and Acetaminophen And Codeine interaction managed?
If your prescriber has you on both, they've weighed the benefits and risks. Here's how a care team typically keeps this safe: Using the lowest effective doses for the shortest time needed. Monitoring you more closely for excess drowsiness, confusion, or slowed breathing. Sometimes prescribing naloxone as a rescue medicine, just in case. What you can do: Keep taking both as prescribed, avoid alcoho… 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 Bromazepam 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 (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
Keep reading about Acetaminophen And Codeine
Keep reading about Bromazepam
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