Telithromycin 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
Telithromycin
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 pill contains codeine, and telithromycin is an antibiotic that can slow down one of the liver enzymes (called CYP3A4) that helps your body process codeine. When that enzyme is blocked, more codeine and its active form (morphine) can build up in your body.
That can make the opioid effects stronger, meaning more drowsiness, more sedation, and in serious cases dangerously slow or shallow breathing. The good news is that your care team can manage this by watching you closely and adjusting your codeine dose if needed. Don't stop either medicine on your own, but please let your pharmacist or doctor know you take both.
Effect: Telithromycin, a potent CYP3A4 inhibitor, may reduce codeine metabolism and increase codeine and morphine exposure, raising the risk of sedation and potentially fatal respiratory depression.
- Direction: Increased opioid effect (elevated codeine/morphine concentrations).
- Mechanism: Inhibition of CYP3A4-mediated codeine metabolism.
- Evidence: Theoretical; onset unspecified. Severity rated major.
- Management: Monitor for respiratory depression and sedation. Consider codeine dose reduction until stable effects are observed. On discontinuing telithromycin, monitor for opioid withdrawal and consider increasing the codeine dose.
What happens
Increased codeine and morphine exposure
Interaction Deep Dive
Taking codeine together with CYP3A4 inhibitors has led to elevated levels of both codeine and morphine, potentially intensifying or extending adverse reactions and raising the risk of respiratory depression that could be fatal, especially in cases where an inhibitor is introduced once a patient has already reached a stable codeine dose. Should combined therapy be necessary, monitor patients carefully for sedation and respiratory depression, and weigh reducing the codeine dose until steady drug effects are confirmed. When a CYP3A4 inhibitor is being stopped, watch for indications of opioid withdrawal and consider raising the codeine dose until stable drug effects have been seen12.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated codeine metabolism
How to manage this interaction
If you need both medicines, your care team can keep this safe by tailoring your treatment.
- Keep taking both exactly as prescribed unless your prescriber tells you otherwise.
- Your team may watch you more closely for excess drowsiness or slow, shallow breathing, especially when the antibiotic is first added.
- Your codeine dose may need to be adjusted and individualized until your response is stable.
- When the antibiotic is stopped, they may watch for withdrawal signs and adjust codeine again.
Tell your pharmacist or doctor right away about unusual sleepiness, confusion, or breathing changes.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Telithromycin and Acetaminophen And Codeine together?
Telithromycin can raise codeine/morphine levels and increase the risk of oversedation or slowed breathing, so keep taking both as prescribed but have your care team monitor you and adjust the codeine dose as needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Telithromycin 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 Telithromycin and Acetaminophen And Codeine interaction managed?
If you need both medicines, your care team can keep this safe by tailoring your treatment. Keep taking both exactly as prescribed unless your prescriber tells you otherwise. Your team may watch you more closely for excess drowsiness or slow, shallow breathing, especially when the antibiotic is first added. Your codeine dose may need to be adjusted and individualized until your response is stable.… 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 Telithromycin 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 Telithromycin
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