Drug interactions
Codeine + Nalbuphine
Severity: Moderate
Codeine and Nalbuphine: 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
Nalbuphine is a mixed agonist-antagonist that can add to codeine sedation and respiratory depression. In opioid-dependent or tolerant patients its antagonist activity at the mu receptor may blunt analgesia or precipitate withdrawal.
What this interaction means in plain words
Codeine and Nalbuphine 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; Nalbuphine belongs to Musculoskeletal.
Why it happens
Nalbuphine partially antagonizes mu-opioid receptors while having additive CNS depressant effects with full agonists such as codeine.
What to do
Avoid adding nalbuphine to codeine in opioid-tolerant patients. If used together, monitor for withdrawal symptoms, loss of analgesia and sedation.
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 Nalbuphine
- Alvimopan + Nalbuphine Contraindicated
- Nalbuphine + Olanzapine / samidorphan Contraindicated
- Alprazolam + Nalbuphine Major
- Amobarbital + Nalbuphine Major
- Benzhydrocodone / acetaminophen + Nalbuphine Major
- Brexanolone + Nalbuphine Major
Frequently asked questions
Can I take Codeine with Nalbuphine?
MediHelp rates the interaction as moderate. Codeine and Nalbuphine 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. Nalbuphine is a mixed agonist-antagonist that can add to codeine sedation and respiratory depression. In opioid-dependent or tolerant patients its antagonist activity at the mu receptor may blunt analgesia or precipitate withdrawal.
How serious is the interaction between Codeine and Nalbuphine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid adding nalbuphine to codeine in opioid-tolerant patients. If used together, monitor for withdrawal symptoms, loss of analgesia and sedation.
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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