Drug interactions
Codeine + Oxycodone
Severity: Major
Codeine and Oxycodone: 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
Two opioids together give additive analgesia and also additive sedation, respiratory depression, constipation and nausea. Duplicate opioid therapy increases the risk of overdose, especially if total opioid exposure is not calculated.
What this interaction means in plain words
Codeine and Oxycodone 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; Oxycodone belongs to Musculoskeletal.
Why it happens
Additive mu-opioid receptor agonism.
What to do
Avoid routine concurrent use of two opioids; if unavoidable, calculate total morphine-equivalent dose, use the lowest effective doses, and monitor for respiratory depression and sedation.
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 Codeine
- Alvimopan + Codeine Contraindicated
- Codeine + Isocarboxazid Contraindicated
- Codeine + Olanzapine / samidorphan Contraindicated
- Codeine + Phenelzine Contraindicated
- Codeine + Tranylcypromine Contraindicated
- Alfentanil + Codeine Major
Other interactions of Oxycodone
- Alvimopan + Oxycodone Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Oxycodone Contraindicated
- Isocarboxazid + Oxycodone Contraindicated
- Olanzapine / samidorphan + Oxycodone Contraindicated
- Oxycodone + Phenelzine Contraindicated
- Oxycodone + Sodium oxybate Contraindicated
Frequently asked questions
Can I take Codeine with Oxycodone?
MediHelp rates the interaction as major. Codeine and Oxycodone 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. Two opioids together give additive analgesia and also additive sedation, respiratory depression, constipation and nausea. Duplicate opioid therapy increases the risk of overdose, especially if total opioid exposure is not calculated.
How serious is the interaction between Codeine and Oxycodone?
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 concurrent use of two opioids; if unavoidable, calculate total morphine-equivalent dose, use the lowest effective doses, and monitor for respiratory depression 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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