Duvelisib 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
Duvelisib
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, which your body turns into morphine to relieve pain. Duvelisib can slow down the liver enzyme (called CYP3A4) that helps clear codeine and morphine from your body. Taking them together may let more of these opioids build up.
That could make side effects like heavy drowsiness, confusion, or slow, shallow breathing stronger or last longer. This concern is based mostly on theory rather than confirmed cases, but breathing problems can be serious. The good news: your care team can manage this by watching you more closely and tailoring your codeine dose. Keep taking both as prescribed and let them know about any unusual sleepiness or slowed breathing.
Effect: Duvelisib (CYP3A4 inhibitor) may reduce codeine/morphine clearance, increasing opioid exposure. Codeine is a prodrug, but its clearance and the parent/morphine pool are influenced by CYP3A4; inhibition raises circulating codeine and morphine concentrations.
- Direction: increased opioid exposure and effect
- Risk: enhanced/prolonged sedation and potentially fatal respiratory depression, especially when inhibitor added to a stable codeine dose
- Onset: unspecified; Evidence: theoretical
- Management: monitor for sedation and respiratory depression; consider codeine dose reduction until stable effects observed. On duvelisib discontinuation, watch 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
You can usually take both when your care team is aware and watching for it. Here is what typically happens:
- Your team may monitor you more closely for excess sleepiness, confusion, or slow, shallow breathing.
- Your codeine dose may be adjusted and individualized until they see how you respond.
- If duvelisib is later stopped, they may watch for opioid withdrawal and adjust the codeine dose again.
What you should do: keep taking both exactly as prescribed, do not change doses on your own, and contact your pharmacist or doctor promptly if you feel unusually drowsy or notice slowed breathing.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Duvelisib and Acetaminophen And Codeine together?
Duvelisib can slow the breakdown of codeine and morphine, raising the risk of heavy sedation and dangerously slow breathing, so your care team will monitor you closely and may adjust your codeine dose. Keep taking both as prescribed and report any unusual drowsiness or slowed breathing. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Duvelisib 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 Duvelisib and Acetaminophen And Codeine interaction managed?
You can usually take both when your care team is aware and watching for it. Here is what typically happens: Your team may monitor you more closely for excess sleepiness, confusion, or slow, shallow breathing. Your codeine dose may be adjusted and individualized until they see how you respond. If duvelisib is later stopped, they may watch for opioid withdrawal and adjust the codeine dose again. Wha… 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 Duvelisib 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 Duvelisib
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