Ethopropazine 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
Ethopropazine
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, along with acetaminophen (Tylenol). Ethopropazine is used for Parkinson-like symptoms, and it can also make you feel drowsy. When you take both together, their calming effects on the brain can stack up.
This can make you very sleepy, slow your breathing, or lower your blood pressure more than either drug alone. This warning is based on how these drugs work, not on a lot of real-world reports, but because breathing problems can be serious, it is worth taking seriously. The good news: your care team can manage this safely by using the lowest doses needed and keeping a close eye on you. Please talk with your doctor or pharmacist before changing anything.
Effect: Additive CNS and respiratory depression from combining codeine (opioid, in the acetaminophen/codeine product) with ethopropazine (a phenothiazine anticholinergic with sedative properties).
- Mechanism: Pharmacodynamic, additive CNS depression. Not a metabolic/prodrug issue in direction here; risk is sedation, hypotension, respiratory depression, coma, death.
- Evidence: Theoretical; severity rated major.
- Onset: Unspecified.
- Management: Reserve concurrent use for when alternatives are inadequate. Use lowest effective dose and shortest duration. Consider lowering the dose of codeine and/or ethopropazine. Monitor closely for sedation and respiratory depression. Consider prescribing naloxone.
What happens
An increased risk of respiratory and CNS depression
Interaction Deep Dive
Avoid concomitant use of opioid cough medication formulations and CNS depressants. Concomitant use of opioid analgesics with benzodiazepines has been associated with increased rates of emergency department visits and fatal overdose2. Concomitant use of codeine with CNS depressants 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 overdose 341.
Why it happens (mechanism)
Additive CNS depression
How to manage this interaction
If both medicines are prescribed together, that can be appropriate when other options are not enough. Here is what typically happens and what you can do:
- Your care team may use the lowest dose and shortest duration of one or both drugs.
- They may monitor you more closely for heavy drowsiness, slowed breathing, or lightheadedness.
- They may consider prescribing naloxone as an emergency backup.
Keep taking both exactly as prescribed, and do not stop or change doses on your own. Tell your pharmacist or doctor right away if you notice unusual sleepiness, confusion, slow or shallow breathing, or feeling faint.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) In a study, the rate of emergency department visits related to nonmedical use taking place between 2004 and 2011 that involved opioid analgesics along with benzodiazepines rose significantly from 11 to 34.2 per 100,000. Drug overdose fatalities attributable to prescribed and above-prescribed doses of both drug classes also rose significantly from 0.6 to 1.7 per 100,000, and overdose deaths attributable to benzodiazepines rose significantly from 18% to 31% 2.
b) In a prospective cohort study, the rate of overdose deaths involving the dispensing of both opioid analgesics and benzodiazepines was 10 times greater than the dispensing of opioid analgesics on their own (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 in patients using 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 those using 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 and benzodiazepines together raises the risk of drug-related mortality compared with using opioid analgesics alone. Owing to comparable pharmacological properties, 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 Ethopropazine and Acetaminophen And Codeine together?
Taking codeine (in your acetaminophen/codeine pain pill) with ethopropazine can add up to make you overly sedated and slow your breathing, so use the lowest doses needed and watch closely for drowsiness or trouble breathing. Never start, stop, or change these medicines without talking to your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ethopropazine 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 Ethopropazine and Acetaminophen And Codeine interaction managed?
If both medicines are prescribed together, that can be appropriate when other options are not enough. Here is what typically happens and what you can do: Your care team may use the lowest dose and shortest duration of one or both drugs. They may monitor you more closely for heavy drowsiness, slowed breathing, or lightheadedness. They may consider prescribing naloxone as an emergency backup. Keep t… 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 Ethopropazine 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 Ethopropazine
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