Nilotinib 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
Nilotinib
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.
Here's what's going on. Your pain medicine contains codeine, and codeine is a "prodrug", your body has to convert it into morphine to relieve pain. Nilotinib can slow down one of the liver enzymes (CYP3A4) that helps clear codeine and morphine from your body.
That means both can build up a bit more than usual. The main worry is too much sedation or slowed, shallow breathing, especially if the nilotinib is started after you're already on a steady codeine dose. This concern is mostly theoretical, but breathing problems are serious. The good news is your care team can manage this by adjusting your dose and keeping a closer eye on you. Please don't change anything on your own.
Mechanism: Nilotinib is a CYP3A4 inhibitor. Codeine undergoes CYP3A4-mediated metabolism (to norcodeine) and CYP2D6-mediated activation to morphine. Inhibiting CYP3A4 shunts more codeine toward morphine and reduces clearance, increasing codeine and active morphine exposure.
Effect: Increased opioid exposure with risk of enhanced/prolonged adverse effects, including potentially fatal respiratory depression, particularly when nilotinib is added to a stable codeine regimen.
- Evidence: theoretical; Severity: major; Onset: unspecified.
- Monitor: sedation, respiratory rate/depression.
- Manage: consider codeine dose reduction until stable effects seen; on nilotinib discontinuation, watch for withdrawal and consider dose increase.
What happens
Increased codeine and morphine exposure
Interaction Deep Dive
When codeine is taken together with CYP3A4 inhibitors, elevated levels of both codeine and morphine have been observed. This elevation may intensify or extend adverse effects and carries the risk of respiratory depression that can be fatal, an outcome that is especially likely when an inhibitor is introduced after the patient has already reached a stable codeine dose. Should combined therapy be required, monitor patients carefully for sedation and respiratory depression, and consider lowering the codeine dose until steady drug effects are seen. In cases where a CYP3A4 inhibitor is being withdrawn, watch for indications of opioid withdrawal and consider raising the codeine dose until stable drug effects are established12.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated codeine metabolism
How to manage this interaction
Keep taking both as prescribed unless your care team tells you otherwise. This combination can be used safely with the right precautions.
- Your team may lower the codeine dose and adjust it, individualized for you, until your response is steady.
- They may monitor you more closely for heavy drowsiness or slow, shallow breathing, especially right after nilotinib is started.
- If nilotinib is later stopped, watch for signs your pain medicine feels weaker or for withdrawal, and let your team know.
Get urgent help for very slow breathing, extreme sleepiness, or trouble waking. Raise any questions with your pharmacist or prescriber.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Nilotinib and Acetaminophen And Codeine together?
Nilotinib can raise codeine and morphine levels and increase the risk of oversedation and slowed breathing, so keep taking both as prescribed but let your care team lower the codeine dose and watch you closely, especially when nilotinib is started or stopped. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Nilotinib 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 Nilotinib and Acetaminophen And Codeine interaction managed?
Keep taking both as prescribed unless your care team tells you otherwise. This combination can be used safely with the right precautions. Your team may lower the codeine dose and adjust it, individualized for you, until your response is steady. They may monitor you more closely for heavy drowsiness or slow, shallow breathing, especially right after nilotinib is started. If nilotinib is later stopp… 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 Nilotinib 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 Nilotinib
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