Dibenzepin 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
Dibenzepin
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.
You've been prescribed two medicines that can both raise serotonin, a natural chemical in your body. The codeine (in your acetaminophen and codeine pills) and dibenzepin (an antidepressant) can add together. In rare cases, too much serotonin causes a reaction called serotonin syndrome.
Watch for things like feeling agitated or confused, a racing heart, shivering, sweating, twitching muscles, or shaking. This is uncommon, and the concern here is mostly based on theory, not lots of real cases. The good news is your care team can manage this by keeping a close eye on you, especially when you first start or change a dose. If any of those symptoms show up, call your doctor or pharmacist right away.
Effect: Additive serotonergic activity from codeine (an opioid with mild serotonergic properties) plus dibenzepin (a tricyclic antidepressant) may increase the risk of serotonin syndrome.
- Direction/mechanism: Pharmacodynamic (additive), not a metabolic prodrug interaction. Both agents contribute serotonergic tone.
- Evidence: Theoretical; based on class effect reports with opioids and serotonergic drugs.
- Onset: Unspecified; highest vigilance at initiation and dose changes.
- Management: If co-use is needed, monitor for autonomic instability, neuromuscular signs (clonus, tremor, rigidity), and mental status changes. Discontinue codeine if serotonin syndrome is suspected.
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
Keep taking both medicines as prescribed unless your prescriber tells you otherwise. This combination can usually be used safely with attention.
- Your care team may watch you more closely, especially when you first start either drug or change a dose.
- Learn the warning signs: agitation, confusion, fast heartbeat, sweating, shivering, muscle twitching or stiffness, and tremor.
- If those symptoms appear, contact your doctor or pharmacist promptly; codeine may be stopped if serotonin syndrome is suspected.
- Ask your pharmacist before adding other serotonergic medicines or supplements.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
Common questions
Can I take Dibenzepin and Acetaminophen And Codeine together?
Taking codeine with dibenzepin can add up to raise serotonin and, rarely, trigger serotonin syndrome. Keep taking both as prescribed, know the warning signs (agitation, fast heartbeat, sweating, muscle twitching), and call your care team if they appear. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Dibenzepin 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 Dibenzepin and Acetaminophen And Codeine interaction managed?
Keep taking both medicines as prescribed unless your prescriber tells you otherwise. This combination can usually be used safely with attention. Your care team may watch you more closely, especially when you first start either drug or change a dose. Learn the warning signs: agitation, confusion, fast heartbeat, sweating, shivering, muscle twitching or stiffness, and tremor. If those symptoms appea… 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 Dibenzepin 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
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