Ozanimod 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
Ozanimod
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.
These two medicines are not meant to be taken together. One product contains codeine, a pain medicine that can raise brain chemicals like serotonin. Ozanimod, used for conditions like multiple sclerosis or ulcerative colitis, has a breakdown product that acts a little like an older type of drug called an MAO inhibitor. Combining them could push serotonin too high or make the opioid effects too strong.
This could lead to a dangerous reaction called serotonin syndrome (things like agitation, fast heartbeat, sweating, or shaking) or heavy sedation and slowed breathing. Please don't start or stop anything on your own. Talk with your pharmacist or doctor so they can pick a safer plan for you.
Contraindicated combination. An active metabolite of ozanimod inhibits MAO-B in vitro. Codeine is a serotonergic/norepinephrine-active opioid (and a prodrug activated via CYP2D6 to morphine). Combined use risks additive serotonergic effects, potential serotonin syndrome, and opioid-related toxicity.
- Mechanism: MAO-B inhibition plus additive serotonergic/noradrenergic activity.
- Evidence: Theoretical; extrapolated from opioid/MAOI class data, which includes serious and fatal reactions.
- Management: Avoid coadministration. Separate MAOI (ozanimod) and codeine by 14 days. If urgent opioid needed, use an alternative (oxycodone, hydrocodone, oxymorphone, buprenorphine) with IR test doses, cautious titration, and monitoring of BP, CNS, and respiratory status.
What happens
Increased risk of serious adverse reactions and an increased risk of serotonin syndrome or opioid-related toxicity
Interaction Deep Dive
Because of the risk of serotonin syndrome, giving codeine together with an MAOI is contraindicated. An MAOI should be stopped 14 days prior to beginning codeine. When an opioid is required urgently, select a different agent (eg, oxyCODONE, HYDROcodone, oxyMORphone, buprenorphine), begin with test doses of an immediate-release formulation, and titrate the dose cautiously while watching blood pressure along with signs and symptoms of CNS and respiratory depression12. In vitro, an active metabolite of ozanimod inhibits MAO-B, so coadministering ozanimod with agents capable of raising norepinephrine or serotonin (eg, opioid drugs) carries the potential for serious adverse reactions. Concurrent use of opioids with MAOIs, including selective MAO-B inhibitors, has triggered serious and sometimes fatal adverse reactions 4.
Why it happens (mechanism)
MAO-B inhibition; additive serotonergic effects
How to manage this interaction
These drugs should generally not be used together. Your care team manages this by avoiding the combination and building in a safe gap.
- Keep taking exactly what is prescribed, and do not add the other drug on your own.
- Because ozanimod acts like an MAO inhibitor, a gap of about 14 days is typically needed between it and codeine.
- If you truly need pain relief, your team may choose a different opioid and start low, watching your blood pressure, alertness, and breathing.
- Tell your prescriber or pharmacist about all your medicines, and report agitation, confusion, fever, sweating, shaking, fast heartbeat, or unusual drowsiness right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Ozanimod and Acetaminophen And Codeine together?
Codeine and ozanimod should not be combined because of the risk of serotonin syndrome and opioid toxicity; a roughly 14-day separation is needed, and your care team can choose a safer pain option if needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ozanimod and Acetaminophen And Codeine interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Ozanimod and Acetaminophen And Codeine interaction managed?
These drugs should generally not be used together. Your care team manages this by avoiding the combination and building in a safe gap. Keep taking exactly what is prescribed, and do not add the other drug on your own. Because ozanimod acts like an MAO inhibitor, a gap of about 14 days is typically needed between it and codeine. If you truly need pain relief, your team may choose a different opioid… 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 Ozanimod 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: Codeine sulfate oral tablets, codeine sulfate oral tablets. West-Ward Pharmaceuticals Corp (per DailyMed), Eatontown, NJ, 2016. DailyMed
- Product Information: CARISOPRODOL, ASPIRIN, CODEINE PHOSPHATE oral tablets, carisoprodol, aspirin, codeine phosphate oral tablets. Ingenus Pharmaceuticals LLC (per DailyMed), Orlando, FL, 2021. DailyMed
- Product Information: ZEPOSIA(R) oral capsules, ozanimod oral capsules. Celgene Corporation (per FDA), Summit, NJ, 2020. DailyMed
- Product Information: ZEPOSIA(R) oral capsules, ozanimod oral capsules. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2024. DailyMed
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