Drug interactions
Codeine + Hydromorphone
Severity: Major
Codeine and Hydromorphone: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Combining two opioids duplicates therapy and increases the risk of sedation, respiratory depression and other opioid adverse effects. Codeine adds little extra analgesic benefit when a strong opioid like hydromorphone is already used.
What this interaction means in plain words
Codeine and Hydromorphone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Codeine belongs to Musculoskeletal; Hydromorphone belongs to Musculoskeletal.
Why it happens
Additive effects at mu-opioid receptors causing CNS and respiratory depression.
What to do
Avoid routine duplication of opioids; if used, reduce doses and monitor sedation and respiratory rate. Prefer a single opioid titrated to effect.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
Other interactions of Codeine
- Alvimopan + Codeine Contraindicated
- Codeine + Isocarboxazid Contraindicated
- Codeine + Olanzapine / samidorphan Contraindicated
- Codeine + Phenelzine Contraindicated
- Codeine + Tranylcypromine Contraindicated
- Alfentanil + Codeine Major
Frequently asked questions
Can I take Codeine with Hydromorphone?
MediHelp rates the interaction as major. Codeine and Hydromorphone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Combining two opioids duplicates therapy and increases the risk of sedation, respiratory depression and other opioid adverse effects. Codeine adds little extra analgesic benefit when a strong opioid like hydromorphone is already used.
How serious is the interaction between Codeine and Hydromorphone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid routine duplication of opioids; if used, reduce doses and monitor sedation and respiratory rate. Prefer a single opioid titrated to effect.
What other medicines interact with Hydromorphone?
MediHelp also lists interactions of Hydromorphone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydromorphone page.
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