Ticagrelor 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
Ticagrelor
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.
You're taking two medicines that can work against each other a bit. Ticagrelor (Brilinta) is a blood thinner that helps keep your platelets from forming dangerous clots after a heart problem. Codeine is an opioid pain reliever, and opioids slow down how fast your stomach empties.
Because of that slowdown, your body may absorb less ticagrelor and absorb it more slowly. That means the clot protection could be weaker or delayed, which matters most right after a heart attack or a stent procedure. The good news: your care team knows about this and can manage it, sometimes by using an IV antiplatelet medicine in the hospital. Please don't change anything on your own, just talk with your doctor or pharmacist.
Effect: Opioid agonists (including codeine) delay gastric emptying, reducing and delaying oral ticagrelor absorption and lowering exposure to ticagrelor and its active metabolite.
- Direction: Reduced ticagrelor exposure/effect (attenuated platelet inhibition).
- Magnitude (opioid data): IV morphine + 180 mg ticagrelor lowered mean exposure ~25% (healthy) to ~36% (ACS/PCI); Tmax delayed 1-2 h; active metabolite reduced similarly. IV fentanyl showed comparable effects.
- Onset: Unspecified (acute, absorption phase).
- Evidence: Probable.
Management: Clinically important in the acute loading setting. In ACS patients requiring concomitant opioids, consider a parenteral antiplatelet agent. Individualize therapy and monitor for adequate platelet inhibition.
What happens
Reduced absorption of ticagrelor
Interaction Deep Dive
When ticagrelor is given together with opioid agonists, the absorption of clopidogrel is both slowed and diminished, likely as a result of delayed gastric emptying, which lowers exposure to clopidogrel metabolites. A clinical study showed that giving 5 mg of intravenous morphine alongside a 180 mg loading dose of ticagrelor lowered the observed mean ticagrelor exposure by as much as 25% in healthy adults and by as much as 36% in ACS patients undergoing PCI, with Tmax pushed back by 1 to 2 hours. Exposure to the active metabolite fell by a comparable degree. Comparable outcomes regarding ticagrelor exposure and platelet inhibition were seen when intravenous fentaNYL was administered together with a 180 mg loading dose of ticagrelor in ACS patients undergoing PCI. In acute coronary syndrome patients who need concurrent morphine or other opioid agonists, a parenteral antiplatelet agent should be considered1.
Why it happens (mechanism)
Slowed gastric emptying
How to manage this interaction
Keep taking both medicines exactly as prescribed unless your care team tells you otherwise. This interaction matters most in the acute setting (right after a heart attack or a stent), where fast, reliable platelet blocking is critical.
- Your care team may choose an injectable (IV) antiplatelet medicine in the hospital when a strong opioid is also needed.
- They may monitor you more closely to confirm the ticagrelor is working as intended.
- Tell your pharmacist or doctor that you take both, especially before any heart procedure or if your pain medicine changes.
Your team can manage this by tailoring and monitoring your treatment.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) In a clinical trial, giving 5 mg of intravenous morphine together with a 180 mg loading dose of ticagrelor reduced the observed mean ticagrelor exposure by as much as 25% in healthy adults and as much as 36% in ACS patients undergoing PCI. Tmax was pushed back by 1 to 2 hours. Exposure to the active metabolite fell by a comparable amount 1.
b) In a clinical trial, administering intravenous fentaNYL together with a 180 mg loading dose of ticagrelor in ACS patients undergoing PCI led to a reduction in observed mean ticagrelor exposure, and Tmax was delayed 1.
Common questions
Can I take Ticagrelor and Acetaminophen And Codeine together?
Codeine can slow your stomach and reduce how much ticagrelor you absorb, which can weaken clot protection when it matters most. Don't change either medicine on your own; let your care team know so they can adjust or monitor, especially around heart procedures. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ticagrelor 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 Ticagrelor and Acetaminophen And Codeine interaction managed?
Keep taking both medicines exactly as prescribed unless your care team tells you otherwise. This interaction matters most in the acute setting (right after a heart attack or a stent), where fast, reliable platelet blocking is critical. Your care team may choose an injectable (IV) antiplatelet medicine in the hospital when a strong opioid is also needed. They may monitor you more closely to confirm… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Ticagrelor 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 (1)
- Product Information: BRILINTA(R) oral tablets, ticagrelor oral tablets. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2024. DailyMed
Keep reading about Acetaminophen And Codeine
Keep reading about Ticagrelor
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