Drug interactions
Codeine + Imipramine
Severity: Moderate
Codeine and Imipramine: moderate interaction.
Last updated
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
Imipramine adds to the sedative and respiratory depressant effects of codeine. Imipramine is also a substrate of CYP2D6 and can compete with codeine for this enzyme, which may reduce conversion of codeine to morphine and weaken analgesia. Tricyclic antidepressants may also add to serotonergic and anticholinergic burden.
What this interaction means in plain words
Codeine and Imipramine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Codeine belongs to Musculoskeletal; Imipramine belongs to Central Nervous System.
Why it happens
Additive CNS depression, plus competitive CYP2D6 inhibition that may reduce formation of morphine from codeine.
What to do
Monitor for excess sedation and respiratory depression and for inadequate analgesia. Use the lowest effective doses, or consider a non-CYP2D6-dependent opioid if pain control is poor.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Codeine
- Alvimopan + Codeine Contraindicated
- Codeine + Isocarboxazid Contraindicated
- Codeine + Olanzapine / samidorphan Contraindicated
- Codeine + Phenelzine Contraindicated
- Codeine + Tranylcypromine Contraindicated
- Alfentanil + Codeine Major
Other interactions of Imipramine
- Dronedarone + Imipramine Contraindicated
- Imipramine + Isocarboxazid Contraindicated
- Imipramine + Phenelzine Contraindicated
- Imipramine + Pimozide Contraindicated
- Imipramine + Rasagiline Contraindicated
- Imipramine + Safinamide Contraindicated
Frequently asked questions
Can I take Codeine with Imipramine?
MediHelp rates the interaction as moderate. Codeine and Imipramine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Imipramine adds to the sedative and respiratory depressant effects of codeine. Imipramine is also a substrate of CYP2D6 and can compete with codeine for this enzyme, which may reduce conversion of codeine to morphine and weaken analgesia. Tricyclic antidepressants may also add to serotonergic and anticholinergic burden.
How serious is the interaction between Codeine and Imipramine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for excess sedation and respiratory depression and for inadequate analgesia. Use the lowest effective doses, or consider a non-CYP2D6-dependent opioid if pain control is poor.
What other medicines interact with Codeine?
MediHelp also lists interactions of Codeine with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Codeine page.
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