Select a medication above to begin.
Fioricet with Codeine
butalbital/ acetaminophen/ caffeine/ codeine
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate assoc. risks; reserve opioid analgesics for patients w/ inadequate tx alternatives; proper dosing and titration essential to decr. resp. depression risk
Addiction, Abuse, and Misuse
Schedule III controlled substance combination containing an opioid agonist w/ risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all patients for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even w/ recommended use, esp. during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Accidental Ingestion
accidental ingestion of even one dose, esp. by children, can result in fatal codeine overdose
Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for patients w/ inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
advise pregnant patients w/ extended opioid use of risk of potentially life-threatening neonatal opioid withdrawal syndrome; ensure tx by neonatology experts avail. at delivery
Opioid Analgesic REMS
providers are strongly encouraged to complete risk evaluation and mitigation strategy (REMS)-compliant education program, counsel patients and/or caregivers w/ each Rx on serious risks, safe use, and importance of reading medication guide
Ultra-Rapid Metabolism of Codeine and Other Respiratory Depression Risk in Children
resp. depression and death have occurred in children; most cases occurred in patients post-tonsillectomy and/or adenoidectomy and who were CYP2D6 ultra-rapid metabolizers; contraindicated in patients <12 yo and in patients <18 yo post-tonsillectomy and/or adenoidectomy; avoid use in patients 12-18 yo w/ risk factors that incr. sensitivity to resp. depressant effects of codeine
CYP450 Interactions
concomitant use or D/C of concomitant CYP450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors are complex requiring careful consideration of the effects on codeine and its active metabolite, morphine
Hepatotoxicity
acetaminophen assoc. w/ acute liver failure incl. cases of liver transplant and death; most liver injury assoc. w/ acetaminophen doses >4000 mg per day and >1 acetaminophen-containing product
Adult Dosing .
Dosage forms: CAP: 50 mg/300 mg/40 mg/30 mg
Special Note
- [prescribing info]
- Info: consider prescribing opioid overdose reversal agent (e.g., naloxone, nalmefene), especially if risk of opioid overdose or accidental ingestion
tension-type headache, refractory
- [1-2 caps PO q4h prn]
- Max: 6 caps/day; 4 g/day acetaminophen from all sources; Info: use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in patients 65 yo and older; taper total daily dose by no more than 10-25% q2-4wk to D/C if long-term use
renal dosing
- [see below]
- renal impairment: decr. usual start dose or frequency, amount not defined, titrate slowly; CrCl <10: avoid use
- HD/PD: avoid use
hepatic dosing
- [see below]
- hepatic impairment: decr. usual start dose or frequency, amount not defined; Info: titrate slowly
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
-
com.epocrates.rxweb.beans.StringCollection@71e778c
- hypersensitivity to drug or ingredient
- hypersensitivity to morphine
- MAO inhibitor use w/in 14 days
- breastfeeding
- CYP2D6 ultra-rapid metabolizers
- patients <12 yo
- respiratory depression risk (patients 12-18 yo)
- post-tonsillectomy use (patients <18 yo)
- post-adenoidectomy use (patients <18 yo)
- CrCl <10
- respiratory depression, severe
- asthma, acute
- asthma, severe
- GI obstruction, known or suspected
- paralytic ileus
- coma
- consciousness, impaired
- circulatory shock
- porphyria
- abrupt withdrawal (long-term use)
- caution: hypersensitivity to opioids
- caution: hypersensitivity to tartrazine (generic form)
- caution: elderly patients
- caution: debilitated patients
- caution: renal impairment
- caution: hepatic impairment
- caution: pulmonary impairment
- caution: sleep apnea (long-term use)
- caution: CNS depression
- caution: CNS depressant use, concurrent
- caution: alcohol use, concurrent
- caution: alcohol abuse history
- caution: drug abuse history
- caution: mental illness history
- caution: head injury
- caution: ICP incr.
- caution: seizure disorder
- caution: hypovolemia
- caution: GI motility disorder
- caution: pancreatitis, acute
- caution: biliary dz, acute
- caution: GU obstruction
Drug Interactions .
Overview
acetaminophen
centrally-acting analgesic/antipyretic
- CYP2E1 substrate
- UGT1A1 substrate
- UGT2B15 substrate
- affected by altered gastrointestinal motility
- methemoglobinemia
butalbital
barbiturate
- CYP1A2 inducer, weak
- CYP2B6 inducer, weak
- CYP2C8 inducer, weak
- CYP2C9 inducer, weak
- CYP2C19 inducer, weak
- CYP3A4 inducer, strong
- UGT1A1 inducer
- UGT1A9 inducer
- UGT2B4 inducer
- UGT2B15 inducer
- CNS depression
- hypotensive effects
caffeine
xanthine
- CYP1A2 substrate
- CYP1A2 inhibitor, moderate
- hypertensive effects
- tachycardia
codeine
opioid
- CYP2D6 substrate
- CYP3A4 substrate
- antidiuretic hormone effects
- CNS depression
- decreases gastrointestinal motility
- hyponatremia
- hypotensive effects
- lowers seizure threshold
- opioid agonist
- potentiates neuromuscular blockade
- serotonergic effects
- urinary retention
- consider prescribing an opioid overdose reversal agent, especially w/ concomitant CNS depressant use
- add MAO inhibitor to Interaction Check if recent (14 days) use
Contraindicated
- artemether/lumefantrine
- atazanavir
- cobicistat
- darunavir
- doravirine
- elbasvir
- fezolinetant
- fostemsavir
- grazoprevir
- isavuconazonium
- isocarboxazid
- isoniazid
- lenacapavir
- lidocaine topical
- linezolid
- lonafarnib
- lorlatinib
- lurasidone
- mavacamten
- methylene blue injection
- methylene blue oral
- naltrexone
- nirmatrelvir
- pacritinib
- potassium citrate
- safinamide
Contraindicated
butalbital + artemether/ lumefantrine
contraindicated: combo may decr. artemether/lumefantrine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + artemether/ lumefantrine
use alternative or monitor resp. rate, withdrawal sx: combo may incr. or decr. codeine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy; may decr. active metabolite morphine levels, efficacy (hepatic metab. altered, decr. conversion to morphine)
Contraindicated
butalbital + atazanavir
contraindicated: combo may decr. atazanavir levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + atazanavir
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Monitor/Modify Tx
acetaminophen + atazanavir
consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)
Contraindicated
butalbital + cobicistat
contraindicated: combo may decr. cobicistat levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + cobicistat
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine, alter metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine)
Contraindicated
butalbital + darunavir
contraindicated if darunavir boosted w/ cobicistat; otherwise, caution advised: combo may decr. darunavir levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + darunavir
use alternative or monitor resp. rate, withdrawal sx; consider codeine dose adjustment: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, conversion to morphine altered)
Contraindicated
butalbital + doravirine
contraindicated; D/C butalbital at least 4wk before starting doravirine: combo may decr. doravirine levels, efficacy (hepatic metab. induced)
Contraindicated
butalbital + elbasvir
contraindicated: combo may decr. elbasvir levels, efficacy (hepatic metab. induced)
Contraindicated
caffeine + fezolinetant
contraindicated: combo may incr. fezolinetant levels, risk of adverse effects (hepatic metab. inhibited)
Contraindicated
butalbital + fostemsavir
contraindicated: combo may decr. temsavir levels, efficacy (hepatic metab. induced)
Contraindicated
butalbital + grazoprevir
contraindicated: combo may decr. grazoprevir levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + grazoprevir
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Contraindicated
butalbital + isavuconazonium
contraindicated: combo may decr. isavuconazole levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + isavuconazonium
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Contraindicated
codeine + isocarboxazid
contraindicated w/in 14 days of isocarboxazid use; if urgent use, consider alternative, incl. buprenorphine or oxymorphone: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + isocarboxazid
use alternative during and x10 days after isocarboxazid use: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
Monitor/Modify Tx
caffeine + isocarboxazid
monitor BP; contraindicated w/ excessive caffeine intake: combo may incr. risk of HTN, incl. hypertensive crisis (additive effects)
Contraindicated
codeine + isoniazid
contraindicated w/in 14 days of isoniazid use; if urgent use, consider alternative, incl. buprenorphine or oxymorphone: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, serotonin syndrome, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine; additive effects, isoniazid inhibits monoamine oxidase)
Caution Advised
acetaminophen + isoniazid
caution advised: combo may incr. acetaminophen reactive intermediate metabolite levels, risk of hepatotoxicity, other adverse effects (hepatic metab. possibly induced, increased toxic metabolite formation)
Contraindicated
butalbital + lenacapavir
HIV INFECTION: contraindicated; HIV PRE-EXPOSURE PROPHYLAXIS: start butalbital at least 2 days after lenacapavir initiation; on day butalbital is initiated, give supplemental lenacapavir 927 mg SC x1 and 600 mg PO x1, then give 600 mg PO x1 the day after butalbital initiation; if butalbital use >6mo, continue supplemental SC and PO doses every 6mo from butalbital initiation; consider alternative if already receiving butalbital, dosing regimen not established: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, UGT induced)
Avoid/Use Alternative
codeine + lenacapavir
use alternative or monitor resp. rate, consider decr. codeine dose during and x9mo after lenacapavir tx: combo may incr. codeine and active metabolite morphine levels, incr. risk of, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Contraindicated
acetaminophen + lidocaine topical
contraindicated if <1 yo; otherwise, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of methemoglobinemia (additive effects)
Contraindicated
codeine + linezolid
contraindicated w/in 14 days of linezolid use; if urgent use, consider alternative, incl. buprenorphine or oxymorphone: combo may incr. risk of resp. depression, serotonin syndrome (additive effects, linezolid reversibly inhibits monoamine oxidase)
Caution Advised
butalbital + linezolid
caution advised: combo may decr. linezolid levels, efficacy (mechanism unknown, hepatic metab. possibly induced)
Contraindicated
butalbital + lonafarnib
contraindicated: combo may decr. lonafarnib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + lonafarnib
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Contraindicated
butalbital + lorlatinib
contraindicated; D/C butalbital x3 half-lives before starting lorlatinib: combo may decr. lorlatinib levels, efficacy; may incr. risk of hepatotoxicity (hepatic metab. induced; pregnane X receptor possibly activated)
Avoid/Use Alternative
codeine + lorlatinib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Monitor/Modify Tx
caffeine + lorlatinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Contraindicated
butalbital + lurasidone
contraindicated: combo may decr. lurasidone levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
Avoid/Use Alternative
codeine + lurasidone
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine and active metabolite morphine levels, risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine; additive effects)
Contraindicated
butalbital + mavacamten
contraindicated: combo may decr. mavacamten levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + mavacamten
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Contraindicated
codeine + methylene blue injection
contraindicated w/in 14 days of methylene blue use; hold codeine if emergency use; monitor resp. rate, BP, serotonin syndrome sx up to 4h after last methylene blue dose; may resume codeine 72h after last methylene blue dose: combo may incr. risk of resp. depression, psychomotor impairment, serotonin syndrome, severe hypotension, incl. orthostasis, syncope (additive effects, methylene blue reversibly inhibits monoamine oxidase)
Contraindicated
codeine + methylene blue oral
contraindicated w/in 14 days of methylene blue use; if urgent use, consider alternative, incl. buprenorphine or oxymorphone: combo may incr. risk of resp. depression, serotonin syndrome (additive effects, methylene blue reversibly inhibits monoamine oxidase)
Contraindicated
codeine + naltrexone
contraindicated; D/C codeine at least 7-10 days before naltrexone start: combo may decr. codeine efficacy, precipitate withdrawal in opioid dependent patients (antagonistic effects)
Avoid/Use Alternative
butalbital + naltrexone
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
Contraindicated
butalbital + nirmatrelvir
contraindicated: combo may decr. nirmatrelvir levels, efficacy (hepatic metab. induced)
Contraindicated
butalbital + pacritinib
contraindicated: combo may decr. pacritinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + pacritinib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Contraindicated
codeine + potassium citrate
contraindicated w/ solid potassium formulations; consider alternative, incl. liquid potassium formulations: combo may incr. risk of GI ulcerative, stenotic lesions (GI transit delayed, increased local exposure to high potassium concentration)
Caution Advised
butalbital + potassium citrate
caution advised: combo may decr. barbiturate efficacy (renal excretion enhanced in alkaline urine)
Contraindicated
codeine + safinamide
contraindicated w/in 14 days of safinamide use; if urgent use, consider alternative, incl. buprenorphine or oxymorphone: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + safinamide
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
- adagrasib
- aldesleukin
- alfentanil
- allopurinol
- almotriptan
- alosetron
- alpelisib
- alprazolam
- amantadine
- amifampridine
- amiodarone
- amitriptyline
- amlodipine
- amoxapine
- amphetamine
- apalutamide
- apixaban
- apomorphine
- apraclonidine ophthalmic
- apremilast
- aprepitant
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- armodafinil
- asciminib
- asenapine
- atogepant
- atorvastatin
- atrasentan
- avacopan
- avanafil
- avapritinib
- axitinib
- baclofen
- baclofen intrathecal
- bedaquiline
- belumosudil
- belzutifan
- bendamustine
- berberine
- berotralstat
- bexarotene
- bicalutamide
- bictegravir
- black cohosh
- bortezomib
- bosentan
- bosutinib
- brexpiprazole
- brigatinib
- brimonidine ophthalmic
- brimonidine topical
- brivaracetam
- bromocriptine
- brompheniramine
- buprenorphine
- bupropion
- buspirone
- butalbital
- butorphanol
- cabotegravir
- cabozantinib
- caffeine
- caffeine citrate
- cannabidiol
- cannabis
- capivasertib
- capmatinib
- carbamazepine
- carbinoxamine
- cariprazine
- carisoprodol
- celecoxib
- cenobamate
- ceritinib
- cetirizine
- chamomile, German
- chlophedianol
- chloramphenicol
- chlordiazepoxide
- chlorpheniramine
- chlorpromazine
- chlorzoxazone
- cilostazol
- cimetidine
- cinacalcet
- ciprofloxacin
- citalopram
- clarithromycin
- clemastine
- clobazam
- clofazimine
- clomipramine
- clonazepam
- clonidine
- clopidogrel
- clorazepate
- clotrimazole oropharyngeal
- clozapine
- cobimetinib
- cocaine
- codeine
- conivaptan
- copanlisib
- cranberry
- crizotinib
- cyclobenzaprine
- cyclosporine
- cyproheptadine
- dabrafenib
- dacomitinib
- danazol
- danshen
- dantrolene
- daridorexant
- darifenacin
- darolutamide
- dasatinib
- defactinib
- deferasirox
- deflazacort
- desflurane
- desipramine
- desogestrel (contraceptive)
- desvenlafaxine
- deuruxolitinib
- deutetrabenazine
- dexamethasone
- dexbrompheniramine
- dexchlorpheniramine
- dexmedetomidine
- dexmedetomidine injection
- dexmethylphenidate
- dextroamphetamine
- dextromethorphan
- diazepam
- diazoxide
- dichlorphenamide
- diclofenac
- dicloxacillin
- dienogest (contraceptive)
- difelikefalin
- difenoxin
- dihydrocodeine
- dihydroergotamine
- diltiazem
- dimenhydrinate
- diosmin
- diphenhydramine
- diphenoxylate
- dolutegravir
- domperidone
- dordaviprone
- doxepin
- doxepin topical
- doxorubicin
- doxylamine
- dronabinol
- dronedarone
- droperidol
- drospirenone (contraceptive)
- duloxetine
- duvelisib
- echinacea
- efavirenz
- elacestrant
- elafibranor
- elagolix
- eletriptan
- elexacaftor/tezacaftor/ivacaftor
- eliglustat
- eluxadoline
- elvitegravir
- enasidenib
- encorafenib
- ensartinib
- entacapone
- entrectinib
- enzalutamide
- ephedra
- ephedrine oral
- epinephrine inhaled
- erdafitinib
- ergotamine
- erlotinib
- erythromycin
- escitalopram
- esketamine
- eslicarbazepine acetate
- estazolam
- estradiol (contraceptive)
- eszopiclone
- ethanol
- ethanol (in some formulations)
- ethinyl estradiol (contraceptive)
- ethosuximide
- ethynodiol (contraceptive)
- etomidate
- etonogestrel (contraceptive)
- etravirine
- everolimus
- fedratinib
- felbamate
- felodipine
- fenfluramine
- fentanyl
- fesoterodine
- fexinidazole
- finerenone
- flibanserin
- fluconazole
- fluoxetine
- fluphenazine
- flurazepam
- fluvoxamine
- fosamprenavir
- fosaprepitant
- foslevodopa
- fosphenytoin
- fostamatinib
- frovatriptan
- fruquintinib
- furosemide
- futibatinib
- gabapentin
- gabapentin enacarbil
- ganaxolone
- garlic
- gefitinib
- gepirone
- gepotidacin
- gilteritinib
- ginkgo
- ginseng, Asian
- givinostat
- givosiran
- glasdegib
- glecaprevir
- glofitamab
- glycerol phenylbutyrate
- glycopyrrolate
- goldenseal
- granisetron
- grapefruit
- griseofulvin
- guanfacine
- haloperidol
- hydralazine
- hydrocodone
- hydromorphone
- hydroxychloroquine
- hydroxyzine
- hyoscyamine
- ibrexafungerp
- ibrutinib
- idelalisib
- ifosfamide
- iloperidone
- imatinib
- imipramine
- iohexol
- irinotecan
- isoflurane
- isradipine
- istradefylline
- itraconazole
- ivabradine
- ivacaftor
- ivosidenib
- ixabepilone
- ixazomib
- kava
- ketamine
- ketoconazole
- kratom
- labetalol
- lacosamide
- lamotrigine
- lapatinib
- larotrectinib
- lasmiditan
- lazertinib
- lefamulin
- lemborexant
- leniolisib
- letermovir
- levetiracetam
- levocetirizine
- levodopa
- levoketoconazole
- levomilnacipran
- levonorgestrel (contraceptive)
- levonorgestrel (post-coital contraceptive)
- levorphanol
- linagliptin
- linvoseltamab
- lisdexamfetamine
- lithium
- lofexidine
- lomitapide
- lopinavir/ritonavir
- lorazepam
- lovastatin
- loxapine
- lumacaftor/ivacaftor
- lumateperone
- lurbinectedin
- macitentan
- maraviroc
- maribavir
- mavorixafor
- meclizine
- medroxyprogesterone (contraceptive)
- melatonin
- meperidine
- meprobamate
- meropenem
- metaxalone
- methadone
- methamphetamine
- methocarbamol
- methohexital
- methotrexate
- methsuximide
- methyldopa
- methylergonovine
- methylphenidate
- metoclopramide
- metyrapone
- metyrosine
- midazolam
- midodrine
- midostaurin
- mifepristone
- migalastat
- milnacipran
- mirabegron
- mirtazapine
- mitapivat
- mitotane
- mobocertinib
- modafinil
- molindone
- morphine
- mosunetuzumab
- mycophenolate mofetil
- nafcillin
- nalbuphine
- naldemedine
- naloxegol
- naratriptan
- nefazodone
- nelarabine
- nelfinavir
- neratinib
- netupitant
- nevirapine
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- nintedanib
- nirogacestat
- nisoldipine
- norelgestromin (contraceptive)
- norethindrone (contraceptive)
- norgestimate (contraceptive)
- norgestrel (contraceptive)
- nortriptyline
- odevixibat
- olanzapine
- olaparib
- oliceridine
- olutasidenib
- omaveloxolone
- ondansetron
- opicapone
- opium
- orphenadrine
- osilodrostat
- osimertinib
- oxazepam
- oxcarbazepine
- oxybate
- oxybutynin
- oxycodone
- oxymorphone
- palbociclib
- paliperidone
- palonosetron
- palovarotene
- panobinostat
- paroxetine
- passion flower
- pazopanib
- pemigatinib
- pentazocine
- pentobarbital
- peppermint
- perampanel
- perphenazine
- pexidartinib
- phenazopyridine
- pheniramine
- phenobarbital
- phenytoin
- pibrentasvir
- pimavanserin
- pimozide
- pioglitazone
- pirfenidone
- pirtobrutinib
- ponatinib
- posaconazole
- pralsetinib
- pramipexole
- pramlintide
- prasugrel
- prednisone
- pregabalin
- pretomanid
- primidone
- prochlorperazine
- promethazine
- propafenone
- propofol
- propranolol
- protriptyline
- pyrilamine
- quazepam
- quercetin
- quetiapine
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quinine
- quizartinib
- ramelteon
- regorafenib
- relugolix
- remdesivir
- remifentanil
- remimazolam
- repotrectinib
- resveratrol
- revefenacin inhaled
- revumenib
- ribociclib
- rifabutin
- rifampin
- rifapentine
- rilpivirine
- rimegepant
- ripretinib
- risperidone
- ritlecitinib
- ritonavir
- rivaroxaban
- rizatriptan
- roflumilast
- rolapitant
- romidepsin
- ropeginterferon alfa-2b
- ropinirole
- rotigotine transdermal
- rucaparib
- rufinamide
- sacituzumab govitecan
- SAMe
- sarilumab
- scopolamine
- sebetralstat
- segesterone (contraceptive)
- selinexor
- selpercatinib
- selumetinib
- sertraline
- sevoflurane
- simvastatin
- siponimod
- sirolimus
- sirolimus albumin-bound
- solifenacin
- sonidegib
- sorafenib
- sotorasib
- sparsentan
- spironolactone
- St. John's wort
- stiripentol
- sufentanil
- sumatriptan
- sunitinib
- sunvozertinib
- suvorexant
- suzetrigine
- tadalafil
- tamoxifen
- tapentadol
- tasimelteon
- tazemetostat
- tecovirimat
- telotristat ethyl
- temazepam
- temsirolimus
- terbinafine
- tetrabenazine
- tezacaftor/ivacaftor
- thalidomide
- thioridazine
- thiotepa
- thiothixene
- tiagabine
- ticagrelor
- tivozanib
- tizanidine
- tocilizumab
- tofacitinib
- tolcapone
- tolterodine
- tolvaptan
- topiramate
- toremifene
- tovorafenib
- trabectedin
- tramadol
- trazodone
- treosulfan
- tretinoin
- triazolam
- trifluoperazine
- trihexyphenidyl
- trimethobenzamide
- trimipramine
- triprolidine
- trofinetide
- trospium
- tucatinib
- ubrogepant
- ulipristal (post-coital contraceptive)
- upadacitinib
- vaborbactam
- valbenazine
- valerian
- valproic acid
- vamorolone
- vandetanib
- vanzacaftor/tezacaftor/deutivacaftor
- velpatasvir
- vemurafenib
- venetoclax
- venlafaxine
- verapamil
- vigabatrin
- vilazodone
- viloxazine
- vinblastine
- vincristine
- vinorelbine
- voclosporin
- vonoprazan
- vorapaxar
- vorasidenib
- vortioxetine
- voxelotor
- voxilaprevir
- xanomeline
- zaleplon
- zanubrutinib
- ziconotide
- zileuton
- ziprasidone
- zolmitriptan
- zolpidem
- zongertinib
- zonisamide
- zuranolone
Avoid/Use Alternative
butalbital + adagrasib
avoid combo: combo may decr. adagrasib levels, efficacy (hepatic metab. induced)
codeine + adagrasib
consider alternative: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine)
Avoid/Use Alternative
butalbital + aldesleukin
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + aldesleukin
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe or life-threatening hypotension (incl. orthostasis, syncope), seizures (additive effects)
Avoid/Use Alternative
butalbital + alfentanil
use alternative or monitor BP, resp. rate; consider decr. dose of one or both drugs: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, hypotension, delayed recovery from anesthesia; may decr. alfentanil levels, efficacy (additive effects; hepatic metab. induced)
codeine + alfentanil
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus (additive effects)
Avoid/Use Alternative
butalbital + allopurinol
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + allopurinol
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + almotriptan
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + almotriptan
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of serotonin syndrome, profound CNS and resp. depression, psychomotor impairment (additive effects)
Monitor/Modify Tx
caffeine + almotriptan
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
caffeine + alosetron
use alternative: combo may incr. alosetron levels, risk of adverse effects (hepatic metab. inhibited)
Caution Advised
codeine + alosetron
caution advised: combo may incr. risk of severe constipation, paralytic ileus (additive effects)
Avoid/Use Alternative
butalbital + alpelisib
avoid combo: combo may decr. alpelisib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + alprazolam
avoid combo: combo may decr. alprazolam levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + alprazolam
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine and active metabolite morphine levels, risk of profound CNS and resp. depression, psychomotor impairment, vasodilation, severe hypotension (incl. orthostasis, syncope), other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
butalbital + amantadine
avoid combo: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)
codeine + amantadine
avoid combo if antitussive use; otherwise, monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
codeine + amifampridine
consider alternative: combo may incr. risk of seizures (additive effects)
Avoid/Use Alternative
codeine + amiodarone
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine)
Caution Advised
butalbital + amiodarone
caution advised: combo may decr. amiodarone levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + amitriptyline
avoid combo: combo may decr. amitriptyline and active metabolite nortriptyline levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + amitriptyline
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Monitor/Modify Tx
caffeine + amitriptyline
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Avoid/Use Alternative
codeine + amlodipine
use alternative or monitor resp. rate, BP; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine; additive effects)
Monitor/Modify Tx
butalbital + amlodipine
monitor BP: combo may decr. (lev)amlodipine levels, efficacy (hepatic metab. induced)
caffeine + amlodipine
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
Avoid/Use Alternative
butalbital + amoxapine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + amoxapine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Monitor/Modify Tx
caffeine + amoxapine
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Avoid/Use Alternative
codeine + amphetamine
use alternative or decr. amphetamine start dose; monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + amphetamine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Avoid/Use Alternative
codeine + apalutamide
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Caution Advised
butalbital + apalutamide
caution advised: combo may decr. apalutamide levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + apixaban
avoid combo if also combined w/ P-gp inducer; otherwise, caution advised: combo may decr. apixaban levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + apomorphine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + apomorphine
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
codeine + apraclonidine ophthalmic
avoid combo if antitussive use; otherwise, monitor resp. rate, BP, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx if apraclonidine IOP adjunct use; postop use OK: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
butalbital + apraclonidine ophthalmic
monitor resp. rate if apraclonidine IOP adjunct use; postop use OK: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + apremilast
avoid combo: combo may decr. apremilast levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + aprepitant
avoid combo: combo may decr. aprepitant levels, efficacy (hepatic metab. induced)
codeine + aprepitant
if aprepitant 3-day regimen, use alternative or monitor resp. rate; consider decr. codeine dose; aprepitant single dose-regimen OK: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + aripiprazole bimonthly injection
avoid combo: combo may decr. aripiprazole levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + aripiprazole bimonthly injection
avoid combo if antitussive use; otherwise monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + aripiprazole lauroxil
avoid combo: combo may decr. aripiprazole levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + aripiprazole lauroxil
avoid combo if antitussive use; otherwise, monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + aripiprazole monthly injection
avoid combo: combo may decr. aripiprazole levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + aripiprazole monthly injection
avoid combo if antitussive use; otherwise, monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + aripiprazole oral
avoid combo: combo may decr. aripiprazole levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + aripiprazole oral
avoid combo if antitussive use; otherwise, monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
codeine + armodafinil
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Monitor/Modify Tx
caffeine + armodafinil
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Caution Advised
butalbital + armodafinil
caution advised: combo may decr. armodafinil levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + asciminib
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Monitor/Modify Tx
caffeine + asciminib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + asenapine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + asenapine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Avoid/Use Alternative
butalbital + atogepant
CHRONIC MIGRAINE: avoid combo; EPISODIC MIGRAINE: incr. atogepant dose to 30 or 60 mg/day: combo may decr. atogepant levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + atogepant
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
codeine + atorvastatin
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Caution Advised
butalbital + atorvastatin
caution advised: combo may decr. atorvastatin levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + atrasentan
avoid combo: combo may decr. atrasentan levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + avacopan
avoid combo: combo may decr. avacopan levels, efficacy (hepatic metab. induced)
codeine + avacopan
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + avanafil
avoid combo: combo may decr. avanafil levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
codeine + avanafil
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + avapritinib
avoid combo: combo may decr. avapritinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + axitinib
avoid combo: combo may decr. axitinib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + axitinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + baclofen
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + baclofen
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + baclofen intrathecal
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + baclofen intrathecal
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + bedaquiline
avoid combo: combo may decr. bedaquiline levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + belumosudil
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Monitor/Modify Tx
acetaminophen + belumosudil
consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)
butalbital + belumosudil
incr. belumosudil dose to 200 mg bid: combo may decr. belumosudil levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + belzutifan
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
caffeine + bendamustine
consider alternatives: combo may incr. bendamustine levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
codeine + berberine
use alternative or monitor resp. rate, BP, withdrawal sx; consider decr. codeine dose: combo may incr. codeine, alter metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine; additive effects)
Avoid/Use Alternative
codeine + berotralstat
use alternative or monitor resp. rate, withdrawal sx; consider codeine dose adjustment: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. inhibited, conversion to morphine altered)
Avoid/Use Alternative
codeine + bexarotene
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
codeine + bicalutamide
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + bictegravir
use alternative: combo may decr. bictegravir levels, efficacy (hepatic metab. induced, UGT induced)
Avoid/Use Alternative
codeine + black cohosh
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Avoid/Use Alternative
butalbital + bortezomib
avoid combo: combo may decr. bortezomib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
codeine + bortezomib
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
codeine + bosentan
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Caution Advised
butalbital + bosentan
caution advised: combo may decr. bosentan levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + bosutinib
avoid combo: combo may decr. bosutinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + brexpiprazole
avoid combo: combo may decr. brexpiprazole levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + brexpiprazole
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + brigatinib
avoid combo: combo may decr. brigatinib levels, efficacy (hepatic metab. induced)
codeine + brigatinib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Monitor/Modify Tx
caffeine + brigatinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + brimonidine ophthalmic
avoid combo if elevated IOP use; OTC ocular redness use OK: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + brimonidine ophthalmic
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx if elevated IOP use; OTC ocular redness use OK: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + brimonidine topical
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + brimonidine topical
avoid combo if antitussive use; otherwise monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + brivaracetam
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + brivaracetam
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + bromocriptine
avoid combo: combo may decr. bromocriptine levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + bromocriptine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + brompheniramine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + brompheniramine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + buprenorphine
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may decr. buprenorphine levels, efficacy (additive effects; hepatic metab. induced)
codeine + buprenorphine
avoid combo if antitussive use; otherwise, use alternative or monitor withdrawal sx, resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine efficacy, precipitate withdrawal in opioid dependent patients; may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation, paralytic ileus (antagonistic effects; additive effects)
Avoid/Use Alternative
codeine + bupropion
use alternative or monitor resp. rate, withdrawal sx; consider lower bupropion doses: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, seizures, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Monitor/Modify Tx
caffeine + bupropion
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Caution Advised
butalbital + bupropion
caution advised: combo may decr. bupropion and metabolite levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + buspirone
avoid combo: combo may decr. buspirone levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + buspirone
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)
Avoid/Use Alternative
codeine + butalbital
avoid combo: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
butalbital + butorphanol
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may decr. butorphanol levels, efficacy (additive effects; hepatic metab. induced)
codeine + butorphanol
avoid combo if antitussive use; otherwise use alternative or monitor for withdrawal sx, resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine efficacy, precipitate withdrawal in opioid dependent patients; may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (antagonistic effects; additive effects)
Avoid/Use Alternative
butalbital + cabotegravir
consider alternative: combo may decr. cabotegravir levels, efficacy (UGT induced)
Avoid/Use Alternative
butalbital + cabozantinib
use alternative or incr. cabozantinib daily dose by 40 mg if medullary thyroid CA use; incr. cabozantinib dose by 20 mg if renal cell CA, hepatocellular CA, differentiated thyroid CA, or NET use: combo may decr. cabozantinib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + cabozantinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
caffeine + caffeine
avoid excessive caffeine intake from all sources: combo may incr. caffeine levels, risk of HTN, tachycardia, other adverse effects (additive effects, duplicate tx)
Avoid/Use Alternative
caffeine + caffeine citrate
avoid excessive caffeine intake from all sources: combo may incr. caffeine levels, risk of HTN, tachycardia, other adverse effects (additive effects, duplicate tx)
Monitor/Modify Tx
butalbital + caffeine citrate
monitor caffeine levels: combo may decr. caffeine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + cannabidiol
avoid combo: combo may decr. cannabidiol levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + cannabidiol
avoid combo if antitussive use; otherwise, monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + cannabis
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment; may decr. cannabis levels, efficacy (additive effects; hepatic metab. induced)
codeine + cannabis
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + cannabis
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Avoid/Use Alternative
butalbital + capivasertib
avoid combo: combo may decr. capivasertib levels, efficacy (hepatic metab. induced)
codeine + capivasertib
use alternative or monitor resp. rate, withdrawal sx; consider decr. codeine dose: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may incr. or decr. active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. inhibited, may incr. or decr. production of active metabolite morphine)
Monitor/Modify Tx
acetaminophen + capivasertib
consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)
Avoid/Use Alternative
butalbital + capmatinib
avoid combo: combo may decr. capmatinib levels, efficacy (hepatic metab. induced)
Caution Advised
caffeine + capmatinib
caution advised: combo may incr. caffeine levels, risk of adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + carbamazepine
avoid combo: combo may decr. carbamazepine levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment, hypotension, incl. syncope (hepatic metab. induced; additive effects)
codeine + carbamazepine
avoid combo if antitussive use; otherwise, use alternative or monitor BP, resp. rate, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment, hypotension (incl. syncope), serotonin syndrome; may alter seizure control (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Monitor/Modify Tx
acetaminophen + carbamazepine
consider monitoring LFTs w/ acetaminophen use greater than standard max acetaminophen doses; otherwise, caution advised: combo may incr. acetaminophen reactive intermediate metabolite levels, risk of hepatotoxicity, other adverse effects (hepatic metab. induced, increased toxic metabolite formation)
caffeine + carbamazepine
monitor carbamazepine levels: combo may incr. carbamazepine levels, risk of adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + carbinoxamine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + carbinoxamine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + cariprazine
avoid combo: combo may decr. cariprazine and active metabolite levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + cariprazine
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + carisoprodol
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment; may decr. carisoprodol levels, incr. active metabolite meprobamate levels, alter risk of adverse effects and efficacy (additive effects; hepatic metab. possibly induced, incr. conversion to active metabolite)
codeine + carisoprodol
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
codeine + celecoxib
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine)
Monitor/Modify Tx
caffeine + celecoxib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + cenobamate
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + cenobamate
avoid combo if antitussive use, otherwise use alternative or monitor withdrawal sx, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + ceritinib
avoid combo: combo may decr. ceritinib levels, efficacy (hepatic metab. induced)
codeine + ceritinib
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + cetirizine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + cetirizine
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + chamomile, German
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + chamomile, German
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + chlophedianol
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + chlophedianol
avoid combo if antitussive use; otherwise, monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
codeine + chloramphenicol
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + chlordiazepoxide
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + chlordiazepoxide
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + chlorpheniramine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + chlorpheniramine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + chlorpromazine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + chlorpromazine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation/paralytic ileus, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. codeine conversion to morphine; additive effects)
Avoid/Use Alternative
butalbital + chlorzoxazone
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + chlorzoxazone
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine and active metabolite morphine levels, risk of profound CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
codeine + cilostazol
use alternative or monitor resp. rate, BP; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
codeine + cimetidine
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine)
Avoid/Use Alternative
codeine + cinacalcet
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine)
Avoid/Use Alternative
codeine + ciprofloxacin
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Caution Advised
caffeine + ciprofloxacin
caution advised: combo may incr. caffeine levels, risk of adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + citalopram
avoid combo: combo may decr. citalopram levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + citalopram
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Avoid/Use Alternative
butalbital + clarithromycin
use alternative: combo may decr. clarithromycin levels, efficacy (hepatic metab. induced)
codeine + clarithromycin
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + clemastine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + clemastine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + clobazam
avoid combo: combo may incr. clobazam active metabolite levels, risk of profound CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. induced, incr. active metabolite formation, additive effects)
codeine + clobazam
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, withdrawal sx, BP; consider decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may alter codeine or decr. active metabolite morphine levels, incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects or decr. efficacy; may alter seizure control (hepatic metab. altered, may decr. production of active metabolite morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
codeine + clofazimine
use alternative or monitor resp. rate, withdrawal sx; consider decr. codeine dose: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine)
Avoid/Use Alternative
codeine + clomipramine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Monitor/Modify Tx
butalbital + clomipramine
monitor resp. rate: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
caffeine + clomipramine
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Avoid/Use Alternative
butalbital + clonazepam
avoid combo: combo may decr. clonazepam levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + clonazepam
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + clonidine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + clonidine
avoid combo if ADHD or antitussive use; otherwise, monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + clonidine
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
Avoid/Use Alternative
codeine + clopidogrel
consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. clopidogrel and active metabolite levels, efficacy (absorption of clopidogrel possibly affected by delayed gastric emptying)
Avoid/Use Alternative
butalbital + clorazepate
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + clorazepate
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
codeine + clotrimazole oropharyngeal
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + clozapine
avoid combo: combo may decr. clozapine levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + clozapine
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, BP, HR, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, severe constipation, paralytic ileus (incl. life-threatening), other anticholinergic adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. possibly inhibited, decr. conversion to morphine, additive effects)
Monitor/Modify Tx
caffeine + clozapine
monitor ECG, BP, HR; consider decr. clozapine dose: combo may incr. clozapine levels, risk of QT prolongation, cardiac arrhythmias, hypotension, bradycardia, other adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + cobimetinib
avoid combo: combo may decr. cobimetinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + cocaine
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + cocaine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia, seizures (additive effects)
Avoid/Use Alternative
butalbital + codeine
avoid combo: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects)
codeine + codeine
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation, paralytic ileus, other adverse effects (additive effects, duplicate tx)
Avoid/Use Alternative
codeine + conivaptan
use alternative or monitor resp. rate; consider decr. codeine dose during and x7 days after conivaptan tx: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + copanlisib
avoid combo: combo may decr. copanlisib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + copanlisib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects, copanlisib may cause infusion-related HTN)
Avoid/Use Alternative
codeine + cranberry
use alternative or monitor resp. rate, consider decr. codeine dose, especially w/ large amounts of cranberry: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (GI metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + crizotinib
avoid combo: combo may decr. crizotinib levels, efficacy (hepatic metab. induced)
codeine + crizotinib
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + cyclobenzaprine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + cyclobenzaprine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe constipation/paralytic ileus, other adverse effects (additive effects)
Avoid/Use Alternative
codeine + cyclosporine
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Monitor/Modify Tx
butalbital + cyclosporine
monitor cyclosporine levels: combo may decr. cyclosporine levels, efficacy (hepatic metab. induced)
caffeine + cyclosporine
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + cyproheptadine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + cyproheptadine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
codeine + dabrafenib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Caution Advised
butalbital + dabrafenib
caution advised: combo may decr. dabrafenib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + dacomitinib
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine)
Avoid/Use Alternative
codeine + danazol
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Monitor/Modify Tx
caffeine + danazol
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
codeine + danshen
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + dantrolene
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + dantrolene
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + daridorexant
avoid combo: combo may decr. daridorexant levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + daridorexant
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine and active metabolite morphine levels, risk of profound CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
butalbital + darifenacin
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + darifenacin
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, withdrawal sx; use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Avoid/Use Alternative
butalbital + darolutamide
avoid combo if also combined w/ P-gp inducer; otherwise, caution advised: combo may decr. darolutamide levels, efficacy (hepatic metab. induced)
codeine + darolutamide
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + dasatinib
use alternative or consider incr. dasatinib dose: combo may decr. dasatinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + defactinib
avoid combo: combo may decr. defactinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + deferasirox
use alternative or consider incr. initial deferasirox dose by 50%; monitor serum ferritin levels: combo may decr. deferasirox levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + deflazacort
avoid combo: combo may decr. deflazacort active metabolite levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + deflazacort
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + desflurane
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + desflurane
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + desipramine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + desipramine
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation, paralytic ileus, urinary retention (additive effects)
Monitor/Modify Tx
caffeine + desipramine
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Caution Advised
acetaminophen + desipramine
caution advised w/ oral acetaminophen: combo may decr. peak acetaminophen levels, delay analgesic onset, efficacy (absorption delayed, possibly decreased)
Avoid/Use Alternative
butalbital + desogestrel (contraceptive)
use additional non-hormonal or alternative contraception during and x28 days after butalbital tx: combo may decr. desogestrel levels, contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + desvenlafaxine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)
Monitor/Modify Tx
butalbital + desvenlafaxine
monitor resp. rate: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
caffeine + desvenlafaxine
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + deuruxolitinib
avoid combo: combo may decr. deuruxolitinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + deutetrabenazine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + deutetrabenazine
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + dexamethasone
if multiple myeloma use, consider alternative; otherwise, consider incr. dexamethasone dose: combo may decr. dexamethasone levels, efficacy (hepatic metab. induced)
codeine + dexamethasone
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Monitor/Modify Tx
caffeine + dexamethasone
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + dexbrompheniramine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + dexbrompheniramine
avoid combo if antitussive use; otherwise, monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
butalbital + dexchlorpheniramine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + dexchlorpheniramine
avoid combo if antitussive use; otherwise, monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
butalbital + dexmedetomidine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + dexmedetomidine
avoid combo if antitussive use; otherwise monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + dexmedetomidine injection
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + dexmedetomidine injection
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe or life-threatening hypotension (incl. orthostasis, syncope), bradycardia, AV block (additive effects)
Avoid/Use Alternative
codeine + dexmethylphenidate
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + dexmethylphenidate
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Avoid/Use Alternative
codeine + dextroamphetamine
use alternative or decr. dextroamphetamine start dose; monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + dextroamphetamine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Avoid/Use Alternative
codeine + dextromethorphan
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Avoid/Use Alternative
butalbital + diazepam
avoid combo: combo may decr. diazepam levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + diazepam
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + diazoxide
avoid combo if also combined w/ moderate or strong CYP1A2 inducer; otherwise, caution advised: combo may decr. diazoxide levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + dichlorphenamide
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + dichlorphenamide
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
acetaminophen + diclofenac
use alternative or monitor LFTs; use lowest effective doses, shortest effective tx duration: combo may incr. risk of hepatotoxicity (possible additive effects)
Monitor/Modify Tx
caffeine + diclofenac
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
codeine + dicloxacillin
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + dienogest (contraceptive)
use additional non-hormonal or alternative contraception during and x28 days after butalbital tx: combo may decr. dienogest levels, contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + difelikefalin
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + difelikefalin
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + difenoxin
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + difenoxin
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus (additive effects)
Avoid/Use Alternative
butalbital + dihydrocodeine
use alternative or monitor resp. rate, withdrawal sx; consider decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. dihydrocodeine and active metabolite dihydromorphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced, may decr. production of active metabolite dihydromorphine; additive effects)
codeine + dihydrocodeine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation, paralytic ileus (additive effects)
Avoid/Use Alternative
codeine + dihydroergotamine
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + dihydroergotamine
monitor BP; avoid excessive caffeine intake: combo may incr. risk of severe HTN, vasospasm, ischemia (additive effects)
Avoid/Use Alternative
butalbital + diltiazem
use alternative: combo may decr. diltiazem levels, efficacy (hepatic metab. induced)
codeine + diltiazem
use alternative or monitor resp. rate, BP, withdrawal sx: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine; additive effects)
Monitor/Modify Tx
caffeine + diltiazem
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
Avoid/Use Alternative
butalbital + dimenhydrinate
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + dimenhydrinate
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
codeine + diosmin
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
codeine + diphenhydramine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. codeine conversion to morphine; additive effects)
Monitor/Modify Tx
butalbital + diphenhydramine
monitor resp. rate: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + diphenoxylate
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + diphenoxylate
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + dolutegravir
avoid combo: combo may decr. dolutegravir levels, efficacy (hepatic metab. induced, UGT induced)
Avoid/Use Alternative
butalbital + domperidone
avoid combo: combo may decr. domperidone levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + domperidone
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may decr. domperidone efficacy (additive effects; antagonistic effects)
Avoid/Use Alternative
butalbital + dordaviprone
avoid combo: combo may decr. dordaviprone levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + doxepin
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + doxepin
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Monitor/Modify Tx
caffeine + doxepin
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Avoid/Use Alternative
butalbital + doxepin topical
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + doxepin topical
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
butalbital + doxorubicin
avoid combo: combo may decr. doxorubicin levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + doxylamine
avoid combo if doxylamine use for pregnancy-related nausea/vomiting, otherwise monitor resp. rate: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + doxylamine
avoid combo if antitussive use or doxylamine use for pregnancy-related nausea/vomiting; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + dronabinol
avoid combo: combo may decr. dronabinol levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + dronabinol
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + dronabinol
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Avoid/Use Alternative
butalbital + dronedarone
avoid combo: combo may decr. dronedarone levels, efficacy (hepatic metab. induced)
codeine + dronedarone
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine, alter metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine)
Avoid/Use Alternative
butalbital + droperidol
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + droperidol
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + drospirenone (contraceptive)
use additional non-hormonal or alternative contraception during and x28 days after butalbital tx: combo may decr. drospirenone levels, contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + duloxetine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + duloxetine
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Caution Advised
caffeine + duloxetine
caution advised: combo may incr. duloxetine levels, risk of adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + duvelisib
avoid combo: combo may decr. duvelisib levels, efficacy (hepatic metab. induced)
codeine + duvelisib
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, incr. risk of, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
codeine + echinacea
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + efavirenz
avoid combo: combo may decr. efavirenz levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + efavirenz
avoid combo if antitussive use; otherwise monitor resp. rate, withdrawal sx; use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
butalbital + elacestrant
avoid combo: combo may decr. elacestrant levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + elafibranor
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
codeine + elagolix
use alternative or monitor withdrawal sx: combo may decr. codeine levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + elagolix
caution advised: combo may decr. elagolix levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + eletriptan
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)
Monitor/Modify Tx
butalbital + eletriptan
monitor resp. rate: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
caffeine + eletriptan
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + elexacaftor/ tezacaftor/ ivacaftor
avoid combo: combo may decr. elexacaftor/tezacaftor/ivacaftor levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + eliglustat
avoid combo: combo may decr. eliglustat levels, efficacy (hepatic metab. induced)
codeine + eliglustat
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine)
Avoid/Use Alternative
codeine + eluxadoline
avoid combo: combo may incr. risk of severe constipation, paralytic ileus (additive effects)
Avoid/Use Alternative
butalbital + elvitegravir
avoid combo: combo may decr. elvitegravir levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + enasidenib
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. altered, decr. conversion to morphine)
Monitor/Modify Tx
caffeine + enasidenib
consider decr. caffeine intake from all sources: combo may incr. caffeine levels, risk of adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + encorafenib
avoid combo: combo may decr. encorafenib levels, efficacy (hepatic metab. induced)
codeine + encorafenib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + ensartinib
avoid combo: combo may decr. ensartinib levels, efficacy (hepatic metab. possibly induced)
Avoid/Use Alternative
codeine + entacapone
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Caution Advised
butalbital + entacapone
caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + entrectinib
avoid combo: combo may decr. entrectinib levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + entrectinib
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine and active metabolite morphine levels, risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
butalbital + enzalutamide
use alternative or incr. enzalutamide dose to 240 mg/day: combo may decr. enzalutamide levels, efficacy (hepatic metab. induced)
codeine + enzalutamide
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Monitor/Modify Tx
caffeine + enzalutamide
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
caffeine + ephedra
avoid combo: combo may incr. risk of excessive CNS, cardiovascular stimulatory effects incl. HTN, tachycardia, MI, stroke, seizures (additive effects)
Avoid/Use Alternative
caffeine + ephedrine oral
avoid combo: combo may incr. risk of HTN, tachycardia (additive effects)
Avoid/Use Alternative
caffeine + epinephrine inhaled
avoid combo: combo may incr. risk of tachycardia, HTN, incl. hypertensive crisis (additive effects)
Avoid/Use Alternative
butalbital + erdafitinib
avoid combo: combo may decr. erdafitinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + ergotamine
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + ergotamine
monitor BP; avoid excessive caffeine intake: combo may incr. risk of severe HTN, vasospasm, ischemia (additive effects)
Avoid/Use Alternative
butalbital + erlotinib
use alternative or incr. erlotinib dose by 50 mg/day q2wk up to 450 mg/day: combo may decr. erlotinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + erythromycin
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. erythromycin efficacy when used for GI promotility (hepatic metab. inhibited, may incr. production of active metabolite morphine; antagonistic effects)
Caution Advised
butalbital + erythromycin
caution advised: combo may decr. erythromycin levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + escitalopram
avoid combo: combo may decr. escitalopram levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + escitalopram
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Avoid/Use Alternative
butalbital + esketamine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + esketamine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Monitor/Modify Tx
caffeine + esketamine
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + eslicarbazepine acetate
avoid combo: combo may decr. eslicarbazepine levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + eslicarbazepine acetate
avoid combo if antitussive use; otherwise, use alternative or monitor withdrawal sx, resp. rate; use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + estazolam
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + estazolam
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + estradiol (contraceptive)
use additional non-hormonal or alternative contraception during and x28 days after butalbital tx: combo may decr. estradiol levels, contraceptive efficacy (hepatic metab. induced, UGT induced)
Monitor/Modify Tx
caffeine + estradiol (contraceptive)
monitor BP; avoid excessive caffeine intake: combo may incr. caffeine levels, risk of HTN, other adverse effects (hepatic metab. inhibited, additive effects)
Avoid/Use Alternative
butalbital + eszopiclone
avoid combo: combo may decr. eszopiclone levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + eszopiclone
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + ethanol
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + ethanol
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
acetaminophen + ethanol
consider monitoring LFTs w/ acetaminophen use greater than standard max acetaminophen doses; otherwise, caution advised: combo may incr. acetaminophen reactive intermediate metabolite levels, risk of hepatotoxicity, other adverse effects (hepatic metab. induced, increased toxic metabolite formation)
Avoid/Use Alternative
butalbital + ethanol (in some formulations)
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + ethanol (in some formulations)
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + ethinyl estradiol (contraceptive)
use additional non-hormonal or alternative contraception during and x28 days after butalbital tx: combo may decr. ethinyl estradiol levels, contraceptive efficacy (hepatic metab. induced, UGT induced)
codeine + ethinyl estradiol (contraceptive)
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine)
Monitor/Modify Tx
acetaminophen + ethinyl estradiol (contraceptive)
monitor thrombosis s/sx: combo may incr. ethinyl estradiol levels, risk of thromboembolism, other adverse effects (mechanism unknown)
caffeine + ethinyl estradiol (contraceptive)
monitor BP; avoid excessive caffeine intake: combo may incr. caffeine levels, risk of HTN, other adverse effects (hepatic metab. inhibited, additive effects)
Avoid/Use Alternative
butalbital + ethosuximide
avoid combo: combo may decr. ethosuximide levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + ethosuximide
avoid combo if antitussive use; otherwise, monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + ethynodiol (contraceptive)
use additional non-hormonal or alternative contraception during and x28 days after butalbital tx: combo may decr. ethynodiol and active metabolite levels, contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + etomidate
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + etomidate
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, hypotension (additive effects)
Avoid/Use Alternative
butalbital + etonogestrel (contraceptive)
use additional non-hormonal or alternative contraception during and x28 days after butalbital tx: combo may decr. etonogestrel levels, contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + etravirine
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Caution Advised
butalbital + etravirine
caution advised: combo may decr. etravirine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + everolimus
BREAST CA, PNET, RENAL CELL CA, RENAL ANGIOMYOLIPOMA W/ TSC: if also combined w/ P-gp inducer, use alternative or double everolimus dose using increments of 5 mg or less; otherwise, caution advised; TSC-ASSOC. SEGA or TSC-ASSOC. PARTIAL-ONSET SEIZURES: if also combined w/ P-gp inducer, double everolimus dose using increments of 5 mg or less and monitor everolimus levels; otherwise, monitor everolimus levels; TRANSPLANT: use alternative or monitor everolimus levels: combo may decr. everolimus levels, efficacy (hepatic metab. induced)
codeine + everolimus
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + fedratinib
avoid combo: combo may decr. fedratinib levels, efficacy (hepatic metab. induced)
codeine + fedratinib
use alternative or monitor resp. rate, withdrawal sx; consider codeine dose adjustment: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, conversion to morphine altered)
Avoid/Use Alternative
butalbital + felbamate
avoid combo: combo may decr. felbamate levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + felbamate
avoid combo if antitussive use; otherwise, use alternative or monitor withdrawal sx, resp. rate; use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced, may decr. production of morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + felodipine
use alternative: combo may decr. felodipine levels, efficacy (hepatic metab. induced)
codeine + felodipine
use alternative or monitor resp. rate, BP, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Monitor/Modify Tx
caffeine + felodipine
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
Avoid/Use Alternative
butalbital + fenfluramine
avoid combo: combo may decr. fenfluramine levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + fenfluramine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Monitor/Modify Tx
caffeine + fenfluramine
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN, incl. hypertensive crisis (additive effects)
Avoid/Use Alternative
butalbital + fentanyl
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may decr. fentanyl levels, efficacy (additive effects; hepatic metab. induced)
codeine + fentanyl
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe hypotension (incl. orthostasis, syncope), severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + fesoterodine
avoid combo: combo may decr. fesoterodine active metabolite levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + fesoterodine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
butalbital + fexinidazole
avoid combo: combo may incr. fexinidazole active metabolite levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced, incr. conversion to active metabolites)
codeine + fexinidazole
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Caution Advised
caffeine + fexinidazole
caution advised: combo may incr. caffeine levels, risk of adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + finerenone
avoid combo: combo may decr. finerenone levels, efficacy (hepatic metab. induced)
codeine + finerenone
use alternative or monitor resp. rate if on finerenone 40 mg/day; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + flibanserin
avoid combo: combo may decr. flibanserin levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + flibanserin
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine and active metabolite morphine levels, risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
codeine + fluconazole
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Caution Advised
butalbital + fluconazole
caution advised: combo may decr. fluconazole levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + fluoxetine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + fluoxetine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Avoid/Use Alternative
butalbital + fluphenazine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + fluphenazine
avoid combo if antitussive use; otherwise, monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
butalbital + flurazepam
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + flurazepam
avoid combo if antitussive use; otherwise, use alternative or monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + fluvoxamine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + fluvoxamine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine; additive effects)
Caution Advised
caffeine + fluvoxamine
caution advised: combo may incr. caffeine levels, risk of adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + fosamprenavir
avoid combo: combo may decr. amprenavir levels, efficacy (hepatic metab. induced)
codeine + fosamprenavir
use alternative or monitor resp. rate, withdrawal sx: combo may alter codeine and active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. altered, may alter production of active metabolite morphine)
Avoid/Use Alternative
butalbital + fosaprepitant
avoid combo: combo may decr. aprepitant levels, efficacy (hepatic metab. induced)
codeine + fosaprepitant
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may alter production of active metabolite morphine)
Avoid/Use Alternative
butalbital + foslevodopa
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + foslevodopa
avoid combo if antitussive use; otherwise, monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + fosphenytoin
avoid combo: combo may decr. fosphenytoin levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + fosphenytoin
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, withdrawal sx; use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Caution Advised
caffeine + fosphenytoin
caution advised: combo may decr. caffeine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + fostamatinib
use alternative: combo may decr. fostamatinib active metabolite levels, efficacy (hepatic metab. induced)
codeine + fostamatinib
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Monitor/Modify Tx
caffeine + fostamatinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
codeine + frovatriptan
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)
Monitor/Modify Tx
butalbital + frovatriptan
monitor resp. rate: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
caffeine + frovatriptan
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + fruquintinib
avoid combo: combo may decr. fruquintinib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + fruquintinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN, incl. hypertensive crisis (additive effects)
Avoid/Use Alternative
caffeine + furosemide
use alternative or monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
Monitor/Modify Tx
butalbital + furosemide
monitor BP: combo may incr. risk of hypotension, incl. orthostasis (additive effects)
codeine + furosemide
monitor BP: combo may decr. furosemide efficacy; may incr. risk of severe hypotension, incl. orthostasis, syncope (antagonistic effects, opioids may induce antidiuretic hormone release; additive effects)
Avoid/Use Alternative
butalbital + futibatinib
avoid combo if also combined w/ P-gp inducer; otherwise, caution advised: combo may decr. futibatinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + gabapentin
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + gabapentin
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + gabapentin enacarbil
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + gabapentin enacarbil
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + ganaxolone
avoid combo: combo may decr. ganaxolone levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + ganaxolone
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
codeine + garlic
use alternative or monitor withdrawal sx, BP w/ supplemental garlic; dietary intake OK: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of severe hypotension, incl. orthostasis, syncope (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
codeine + gefitinib
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine)
Monitor/Modify Tx
butalbital + gefitinib
incr. gefitinib dose to 500 mg during and x7 days after butalbital D/C: combo may decr. gefitinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + gepirone
avoid combo: combo may decr. gepirone levels, efficacy (hepatic metab. induced)
codeine + gepirone
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Avoid/Use Alternative
butalbital + gepotidacin
avoid combo: combo may decr. gepotidacin levels, efficacy (hepatic metab. induced)
codeine + gepotidacin
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + gilteritinib
avoid combo if also combined w/ P-gp inducer; otherwise, consider alternative: combo may decr. gilteritinib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
codeine + gilteritinib
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
codeine + ginkgo
avoid combo: combo may alter codeine and active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. altered, may alter production of active metabolite morphine)
Avoid/Use Alternative
codeine + ginseng, Asian
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Avoid/Use Alternative
codeine + givinostat
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (GI metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
codeine + givosiran
use alternative or monitor resp. rate, withdrawal sx, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, may incr. or decr. conversion to active metabolite morphine; givosiran effects on hepatic heme biosynthesis may reduce CYP450 enzyme activity)
Caution Advised
caffeine + givosiran
caution advised: combo may incr. caffeine levels, risk of adverse effects (hepatic metab. inhibited; givosiran effects on hepatic heme biosynthesis may reduce CYP450 enzyme activity)
Avoid/Use Alternative
butalbital + glasdegib
avoid combo: combo may decr. glasdegib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + glecaprevir
avoid combo: combo may decr. glecaprevir levels, efficacy (hepatic metab. induced)
codeine + glecaprevir
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + glofitamab
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + glofitamab
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
codeine + glycerol phenylbutyrate
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + glycopyrrolate
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + glycopyrrolate
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)
Monitor/Modify Tx
caffeine + glycopyrrolate
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Avoid/Use Alternative
codeine + goldenseal
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
codeine + granisetron
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Caution Advised
acetaminophen + granisetron
caution advised: combo may decr. acetaminophen analgesic efficacy (mechanism unknown, possible 5-HT3 antagonism)
Avoid/Use Alternative
codeine + grapefruit
avoid grapefruit juice: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (GI metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + griseofulvin
use alternative: combo may decr. griseofulvin efficacy (hepatic metab. induced)
codeine + griseofulvin
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + guanfacine
avoid combo: combo may decr. guanfacine levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + guanfacine
avoid combo if antitussive use; otherwise, monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + guanfacine
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
Avoid/Use Alternative
butalbital + haloperidol
avoid combo: combo may decr. haloperidol levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + haloperidol
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
codeine + hydralazine
use alternative or monitor resp. rate, BP, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Monitor/Modify Tx
caffeine + hydralazine
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
Avoid/Use Alternative
butalbital + hydrocodone
avoid combo: combo may decr. hydrocodone levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + hydrocodone
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + hydromorphone
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + hydromorphone
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus (additive effects)
Avoid/Use Alternative
codeine + hydroxychloroquine
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy; may incr. risk of seizures (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Avoid/Use Alternative
butalbital + hydroxyzine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + hydroxyzine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + hyoscyamine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + hyoscyamine
avoid combo if antitussive use; otherwise, monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)
Monitor/Modify Tx
caffeine + hyoscyamine
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Caution Advised
acetaminophen + hyoscyamine
caution advised w/ oral acetaminophen: combo may decr. peak acetaminophen levels, delay analgesic onset, efficacy (absorption delayed, possibly decreased)
Avoid/Use Alternative
butalbital + ibrexafungerp
avoid combo: combo may decr. ibrexafungerp levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + ibrutinib
avoid combo: combo may decr. ibrutinib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + ibrutinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + idelalisib
avoid combo: combo may decr. idelalisib levels, efficacy (hepatic metab. induced)
codeine + idelalisib
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + ifosfamide
avoid combo: combo may incr. ifosfamide active and toxic metabolite levels, risk of CNS and resp. depression, psychomotor impairment, myelosuppression, serious infection, encephalopathy, nephrotoxicity, cardiotoxicity, other adverse effects (hepatic metab. induced, incr. metabolite formation, additive effects)
codeine + ifosfamide
avoid combo if antitussive use; otherwise, monitor resp. rate; decr. codeine dose, use lowest effective doses and shortest duration of concomitant tx; D/C one or both drugs if encephalopathy occurs: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + iloperidone
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + iloperidone
avoid combo if antitussive use; otherwise, monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + imatinib
use alternative or incr. imatinib dose at least 50%: combo may decr. imatinib levels, efficacy (hepatic metab. induced)
codeine + imatinib
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine)
Avoid/Use Alternative
butalbital + imipramine
avoid combo: combo may decr. imipramine levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + imipramine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Monitor/Modify Tx
caffeine + imipramine
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Avoid/Use Alternative
codeine + iohexol
avoid combo if intrathecal iohexol use: combo may incr. risk of seizures (additive effects)
Avoid/Use Alternative
butalbital + irinotecan
use alternative or D/C butalbital at least 2wk prior to irinotecan start: combo may decr. irinotecan and active metabolite levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + isoflurane
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + isoflurane
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + isradipine
consider alternative: combo may decr. isradipine levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + isradipine
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + isradipine
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + istradefylline
avoid combo: combo may decr. istradefylline levels, efficacy (hepatic metab. induced)
codeine + istradefylline
use alternative or monitor resp. rate, consider decr. codeine dose, especially w/ istradefylline 40 mg dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + itraconazole
avoid combo 2wk before and during itraconazole tx: combo may decr. itraconazole levels, efficacy (hepatic metab. induced)
codeine + itraconazole
use alternative or monitor resp. rate; consider decr. codeine dose during and x2wk after itraconazole tx: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + ivabradine
avoid combo: combo may decr. ivabradine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + ivacaftor
avoid combo: combo may decr. ivacaftor levels, efficacy (hepatic metab. induced)
codeine + ivacaftor
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + ivosidenib
avoid combo: combo may decr. ivosidenib levels, efficacy (hepatic metab. induced)
codeine + ivosidenib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + ixabepilone
use alternative or consider gradually incr. ixabepilone dose to 60 mg/m^2: combo may decr. ixabepilone levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + ixazomib
avoid combo: combo may decr. ixazomib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + kava
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + kava
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + ketamine
avoid combo: combo may incr. risk of profound CNS and resp. depression (incl. life-threatening), psychomotor impairment (additive effects)
codeine + ketamine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate; decr. dose of one or both drugs; use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression (incl. life-threatening), psychomotor impairment, delayed recovery from anesthesia (additive effects)
Monitor/Modify Tx
caffeine + ketamine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Avoid/Use Alternative
butalbital + ketoconazole
avoid combo 2wk before and during ketoconazole tx if possible; monitor for breakthrough fungal infection; consider incr. ketoconazole dose: combo may decr. ketoconazole levels, efficacy (hepatic metab. induced)
codeine + ketoconazole
use alternative or monitor resp. rate; consider decr. codeine dose during and up to 1wk after ketoconazole tx: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Monitor/Modify Tx
acetaminophen + ketoconazole
consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)
Avoid/Use Alternative
butalbital + kratom
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + kratom
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine and active metabolite morphine levels, risk of profound CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine, additive effects)
Avoid/Use Alternative
codeine + labetalol
use alternative or monitor resp. rate, withdrawal sx, BP: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Monitor/Modify Tx
caffeine + labetalol
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
Avoid/Use Alternative
butalbital + lacosamide
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + lacosamide
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + lamotrigine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment; may decr. lamotrigine levels, efficacy (additive effects; hepatic metab. induced)
codeine + lamotrigine
avoid combo if antitussive use; otherwise, monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + lapatinib
use alternative or consider gradually incr. lapatinib dose from 1250 mg up to 4500 mg/day in HER2-positive breast CA, from 1500 mg up to 5500 mg/day in hormone receptor-positive HER2-positive breast CA pts: combo may decr. lapatinib levels, efficacy (hepatic metab. induced)
codeine + lapatinib
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + larotrectinib
use alternative or double larotrectinib dose: combo may decr. larotrectinib levels, efficacy (hepatic metab. induced)
codeine + larotrectinib
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + lasmiditan
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + lasmiditan
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)
Avoid/Use Alternative
butalbital + lazertinib
avoid combo: combo may decr. lazertinib levels, efficacy (hepatic metab. induced)
codeine + lazertinib
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + lefamulin
use alternative, especially w/ oral lefamulin: combo may decr. lefamulin levels, efficacy (hepatic metab. induced)
codeine + lefamulin
ORAL LEFAMULIN: use alternative or monitor resp. rate, consider decr. codeine dose; IV lefamulin use OK: combo may incr. codeine and active metabolite morphine levels, incr. risk of, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + lemborexant
avoid combo: combo may decr. lemborexant levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + lemborexant
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + leniolisib
avoid combo: combo may decr. leniolisib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + letermovir
avoid combo: combo may decr. letermovir levels, efficacy (hepatic metab. induced, UGT induced)
codeine + letermovir
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + levetiracetam
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + levetiracetam
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + levocetirizine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + levocetirizine
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + levodopa
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + levodopa
avoid combo if antitussive use; otherwise, monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + levoketoconazole
avoid combo x2wk before and during levoketoconazole tx: combo may decr. levoketoconazole levels, efficacy (hepatic metab. induced)
codeine + levoketoconazole
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + levomilnacipran
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + levomilnacipran
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + levomilnacipran
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Avoid/Use Alternative
butalbital + levonorgestrel (contraceptive)
use additional non-hormonal or alternative contraception during and x28 days after butalbital tx: combo may decr. levonorgestrel levels, contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + levonorgestrel (post-coital contraceptive)
consider alternative: combo may decr. levonorgestrel levels, post-coital contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + levorphanol
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + levorphanol
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. levorphanol start dose by at least 50%, consider decr. codeine dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation, paralytic ileus (additive effects)
Avoid/Use Alternative
butalbital + linagliptin
use alternative or monitor glucose: combo may decr. linagliptin levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + linvoseltamab
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + linvoseltamab
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
codeine + lisdexamfetamine
use alternative or decr. lisdexamfetamine start dose; monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + lisdexamfetamine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Avoid/Use Alternative
codeine + lithium
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + lithium
monitor lithium levels if caffeine consumption changes: combo may decr. lithium levels, efficacy (renal excretion enhanced)
Avoid/Use Alternative
butalbital + lofexidine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + lofexidine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
codeine + lomitapide
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Monitor/Modify Tx
acetaminophen + lomitapide
consider monitoring LFTs w/ acetaminophen use greater than standard max acetaminophen doses for greater than 3 days per week: combo may incr. risk of hepatotoxicity (mechanism unknown)
Avoid/Use Alternative
butalbital + lopinavir/ ritonavir
avoid combo: combo may decr. lopinavir/ritonavir levels, efficacy (hepatic metab. induced)
codeine + lopinavir/ ritonavir
use alternative or monitor resp. rate, withdrawal sx: combo may alter codeine and active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. altered, may alter production of active metabolite morphine)
Monitor/Modify Tx
acetaminophen + lopinavir/ ritonavir
consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)
Avoid/Use Alternative
butalbital + lorazepam
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + lorazepam
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
codeine + lovastatin
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Caution Advised
butalbital + lovastatin
caution advised: combo may decr. lovastatin levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + loxapine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + loxapine
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + lumacaftor/ ivacaftor
avoid combo: combo may decr. ivacaftor levels, efficacy (hepatic metab. induced)
codeine + lumacaftor/ ivacaftor
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Monitor/Modify Tx
caffeine + lumacaftor/ ivacaftor
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + lumateperone
avoid combo: combo may decr. lumateperone levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + lumateperone
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + lurbinectedin
avoid combo: combo may decr. lurbinectedin levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + macitentan
avoid combo: combo may decr. macitentan levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + maraviroc
ADULTS: adjust maraviroc dose to 600 mg bid; if also combined w/ strong CYP3A4 inhibitor, adjust maraviroc dose to 150 mg bid; PEDS: avoid combo: combo may decr. maraviroc levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
codeine + maraviroc
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + maribavir
avoid combo: combo may decr. maribavir levels, efficacy (hepatic metab. induced)
codeine + maribavir
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + mavorixafor
avoid combo: combo may decr. mavorixafor levels, efficacy (hepatic metab. induced)
codeine + mavorixafor
use alternative or monitor resp. rate, withdrawal sx; consider decr. codeine dose: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine)
Avoid/Use Alternative
butalbital + meclizine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + meclizine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + medroxyprogesterone (contraceptive)
use additional non-hormonal or alternative contraception: combo may decr. medroxyprogesterone levels, contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + melatonin
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + melatonin
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Caution Advised
caffeine + melatonin
caution advised: combo may incr. melatonin levels, risk of adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + meperidine
avoid combo: combo may decr. meperidine levels, efficacy; may incr. normeperidine levels, risk of neurotoxicity; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced, incr. toxic metabolite formation; additive effects)
codeine + meperidine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. meperidine dose 25-50%, consider decr. codeine dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + meprobamate
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + meprobamate
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
codeine + meropenem
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. possibly induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + metaxalone
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + metaxalone
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)
Avoid/Use Alternative
butalbital + methadone
avoid combo: combo may decr. methadone levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + methadone
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; consider decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Avoid/Use Alternative
codeine + methamphetamine
use alternative or decr. methamphetamine start dose; monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + methamphetamine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Avoid/Use Alternative
butalbital + methocarbamol
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + methocarbamol
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + methohexital
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + methohexital
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
caffeine + methotrexate
if rheumatoid arthritis use, consider avoiding caffeine: combo may decr. methotrexate efficacy (methotrexate anti-inflammatory effect mediated by adenosine, caffeine antagonize adenosine receptors)
Avoid/Use Alternative
butalbital + methsuximide
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + methsuximide
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + methyldopa
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + methyldopa
avoid combo if antitussive use; otherwise, monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + methyldopa
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
Avoid/Use Alternative
codeine + methylergonovine
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + methylergonovine
monitor BP; avoid excessive caffeine intake: combo may incr. risk of severe HTN, vasospasm, ischemia (additive effects)
Caution Advised
butalbital + methylergonovine
caution advised: combo may decr. methylergonovine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + methylphenidate
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + methylphenidate
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Avoid/Use Alternative
butalbital + metoclopramide
use alternative or monitor resp. rate: combo may incr. risk of CNS and resp. depression, psychomotor impairment; may decr. metoclopramide levels, efficacy (additive effects; hepatic metab. induced)
codeine + metoclopramide
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx; monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome; may decr. metoclopramide efficacy (additive effects; antagonistic effects; absorption of oral metoclopramide affected by delayed gastric emptying)
Monitor/Modify Tx
caffeine + metoclopramide
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
acetaminophen + metyrapone
avoid combo: combo may incr. acetaminophen reactive intermediate metabolite levels, risk of hepatotoxicity, other adverse effects (UGT possibly inhibited, increased toxic metabolite formation)
butalbital + metyrapone
avoid combo: combo may decr. metyrapone levels, efficacy; test results may be inaccurate; may incr. risk of CNS and resp. depression, psychomotor impairment (UGT possibly induced; additive effects)
codeine + metyrapone
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + metyrosine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + metyrosine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + midazolam
use alternative or monitor resp. rate; use lowest effective doses and shortest duration of concomitant tx: combo may decr. oral midazolam levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + midazolam
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
caffeine + midodrine
use alternative or monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + midostaurin
avoid combo: combo may decr. midostaurin levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + mifepristone
avoid combo if daily mifepristone use; caution advised if pregnancy termination use: combo may decr. mifepristone levels, efficacy (hepatic metab. induced)
codeine + mifepristone
use alternative or monitor resp. rate; consider decr. codeine dose during and x14 days after daily mifepristone use; caution advised if pregnancy termination use: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
caffeine + migalastat
avoid caffeine consumption at least 2h before and 2h after migalastat: combo may decr. migalastat levels, efficacy (mechanism unknown)
Avoid/Use Alternative
butalbital + milnacipran
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + milnacipran
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + milnacipran
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Avoid/Use Alternative
codeine + mirabegron
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine)
Monitor/Modify Tx
caffeine + mirabegron
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + mirtazapine
avoid combo: combo may decr. mirtazapine levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + mirtazapine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + mitapivat
avoid combo: combo may decr. mitapivat levels, efficacy (hepatic metab. induced)
codeine + mitapivat
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + mitotane
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + mitotane
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, withdrawal sx; use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
butalbital + mobocertinib
avoid combo: combo may decr. mobocertinib levels, efficacy (hepatic metab. induced)
codeine + mobocertinib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
codeine + modafinil
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Monitor/Modify Tx
caffeine + modafinil
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Caution Advised
butalbital + modafinil
caution advised: combo may decr. modafinil levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + molindone
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + molindone
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
butalbital + morphine
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + morphine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe hypotension (incl. orthostasis, syncope), severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Caution Advised
acetaminophen + morphine
caution advised w/ oral acetaminophen: combo may decr. peak acetaminophen levels, delay analgesic onset, efficacy (absorption delayed, possibly decreased)
Avoid/Use Alternative
butalbital + mosunetuzumab
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + mosunetuzumab
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + mycophenolate mofetil
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + mycophenolate mofetil
avoid combo if antitussive use; otherwise monitor resp. rate, decr. codeine dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
codeine + nafcillin
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + nalbuphine
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + nalbuphine
avoid combo if antitussive use; otherwise use alternative or monitor for withdrawal sx, resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine efficacy, precipitate withdrawal in opioid dependent patients; may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (antagonistic effects; additive effects)
Avoid/Use Alternative
butalbital + naldemedine
use alternative: combo may decr. naldemedine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + naloxegol
avoid combo: combo may decr. naloxegol levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + naratriptan
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)
Monitor/Modify Tx
butalbital + naratriptan
monitor resp. rate: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
caffeine + naratriptan
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + nefazodone
avoid combo: combo may decr. nefazodone levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + nefazodone
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine and active metabolite morphine levels, risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
butalbital + nelarabine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + nelarabine
avoid combo if antitussive use; otherwise monitor resp. rate, decr. codeine dose, use lowest effective doses and shortest duration of concomitant tx; withhold nelarabine if Grade 2 or greater somnolence occurs: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + nelfinavir
avoid combo: combo may decr. nelfinavir levels, efficacy (hepatic metab. induced)
codeine + nelfinavir
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + neratinib
avoid combo: combo may decr. neratinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + netupitant
avoid combo: combo may decr. netupitant levels, efficacy (hepatic metab. induced)
codeine + netupitant
use alternative or monitor resp. rate, consider decr. codeine dose during and x1wk after (fos)netupitant tx: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + nevirapine
avoid combo: combo may decr. nevirapine levels, efficacy (hepatic metab. induced)
codeine + nevirapine
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + nicardipine
use alternative or monitor BP: combo may decr. nicardipine levels, efficacy (hepatic metab. induced)
codeine + nicardipine
use alternative or monitor resp. rate, BP; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine; additive effects)
Monitor/Modify Tx
caffeine + nicardipine
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
Avoid/Use Alternative
butalbital + nifedipine
use alternative: combo may decr. nifedipine levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + nifedipine
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + nifedipine
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + nilotinib
avoid combo: combo may decr. nilotinib levels, efficacy (hepatic metab. induced)
codeine + nilotinib
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + nimodipine
use alternative or monitor BP: combo may decr. nimodipine levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + nimodipine
monitor BP; avoid excessive caffeine intake: combo may decr. nimodipine efficacy (antagonistic effects)
codeine + nimodipine
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + nintedanib
avoid combo: combo may decr. nintedanib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + nirogacestat
avoid combo: combo may decr. nirogacestat levels, efficacy (hepatic metab. induced)
codeine + nirogacestat
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, incr. risk of, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + nisoldipine
use alternative or monitor BP: combo may decr. nisoldipine levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + nisoldipine
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + nisoldipine
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + norelgestromin (contraceptive)
use additional non-hormonal or alternative contraception during and x28 days after butalbital tx: combo may decr. norelgestromin levels, contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + norethindrone (contraceptive)
use additional non-hormonal or alternative contraception during and x28 days after butalbital tx: combo may decr. norethindrone levels, contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + norgestimate (contraceptive)
use additional non-hormonal or alternative contraception during and x28 days after butalbital tx: combo may decr. norgestimate and active metabolites levels, contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + norgestrel (contraceptive)
use additional non-hormonal or alternative contraception during and x28 days after butalbital tx: combo may decr. norgestrel levels, contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + nortriptyline
avoid combo: combo may decr. nortriptyline levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + nortriptyline
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Monitor/Modify Tx
caffeine + nortriptyline
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Avoid/Use Alternative
codeine + odevixibat
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
codeine + olanzapine
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus (incl. life-threatening), other anticholinergic adverse effects (additive effects)
Monitor/Modify Tx
butalbital + olanzapine
monitor BP, resp. rate: combo may decr. olanzapine levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment, hypotension, incl. orthostasis (hepatic metab. induced; additive effects)
Avoid/Use Alternative
butalbital + olaparib
avoid combo: combo may decr. olaparib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + oliceridine
use alternative or monitor withdrawal sx, BP, resp. rate; consider oliceridine dose adjustment, decr. dose of butalbital, use lowest effective doses and shortest duration of concomitant tx: combo may decr. oliceridine levels, efficacy; combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, hypotension (hepatic metab. induced; additive effects)
codeine + oliceridine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + olutasidenib
avoid combo: combo may decr. olutasidenib levels, efficacy (hepatic metab. induced)
codeine + olutasidenib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. possibly induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + omaveloxolone
avoid combo: combo may decr. omaveloxolone levels, efficacy (hepatic metab. induced)
codeine + omaveloxolone
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
codeine + ondansetron
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Caution Advised
butalbital + ondansetron
caution advised: combo may decr. ondansetron levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + opicapone
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
butalbital + opicapone
consider decr. dose of one or both drugs: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + opium
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + opium
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome (additive effects)
Avoid/Use Alternative
butalbital + orphenadrine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + orphenadrine
avoid combo if antitussive use; otherwise, monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)
Monitor/Modify Tx
caffeine + orphenadrine
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Avoid/Use Alternative
codeine + osilodrostat
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine)
Monitor/Modify Tx
butalbital + osilodrostat
monitor cortisol levels: combo may decr. osilodrostat levels, efficacy (hepatic metab. induced)
caffeine + osilodrostat
monitor BP; avoid excessive caffeine intake: combo may incr. caffeine levels, risk of HTN, other adverse effects (hepatic metab. inhibited, additive effects)
Avoid/Use Alternative
butalbital + osimertinib
use alternative or incr. osimertinib dose to 160 mg qd, then resume usual dose 3wk after butalbital D/C: combo may decr. osimertinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + oxazepam
avoid combo: combo may decr. oxazepam levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (UGT induced; additive effects)
codeine + oxazepam
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
codeine + oxcarbazepine
avoid combo if antitussive use; otherwise, use alternative or monitor withdrawal sx, resp. rate; use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced, may decr. production of morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Monitor/Modify Tx
butalbital + oxcarbazepine
monitor resp. rate; consider monitoring 10-hydroxyoxcarbazepine levels: combo may decr. oxcarbazepine active metabolite levels, efficacy; may incr. risk of CNS and respiratory depression, psychomotor impairment (hepatic metab. induced; additive effects)
Avoid/Use Alternative
butalbital + oxybate
use alternative or monitor resp. rate; decr. dose of one or both drugs: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, hypotension, syncope (additive effects)
codeine + oxybate
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate; consider holding oxybate, especially if peri- or post-operative opioid analgesia required: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, hypotension, syncope (additive effects)
Avoid/Use Alternative
butalbital + oxybutynin
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + oxybutynin
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs or consider oxybutynin transdermal patch, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other anticholinergic adverse effects; somnolence less likely w/ oxybutynin transdermal patch (additive effects)
Avoid/Use Alternative
butalbital + oxycodone
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may decr. oxycodone levels, efficacy (additive effects; hepatic metab. induced)
codeine + oxycodone
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. oxycodone start dose by at least 50%, consider decr. codeine dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + oxymorphone
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + oxymorphone
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. oxymorphone start dose by at least 50%, consider decr. codeine dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation, paralytic ileus (additive effects)
Avoid/Use Alternative
butalbital + palbociclib
avoid combo: combo may decr. palbociclib levels, efficacy (hepatic metab. induced)
codeine + palbociclib
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + paliperidone
IM PALIPERIDONE: use alternative or monitor resp. rate; ORAL PALIPERIDONE: monitor resp. rate, consider paliperidone dose adjustment: combo may decr. paliperidone levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + paliperidone
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
codeine + palonosetron
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Avoid/Use Alternative
butalbital + palovarotene
avoid combo: combo may decr. palovarotene levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + panobinostat
avoid combo: combo may decr. panobinostat levels, efficacy (hepatic metab. induced)
codeine + panobinostat
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine)
Avoid/Use Alternative
butalbital + paroxetine
avoid combo: combo may decr. paroxetine levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + paroxetine
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Avoid/Use Alternative
butalbital + passion flower
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + passion flower
avoid combo if antitussive use; otherwise, monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + pazopanib
avoid combo: combo may decr. pazopanib levels, efficacy (hepatic metab. induced)
codeine + pazopanib
use alternative or monitor resp. rate, withdrawal sx; consider decr. codeine dose: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine)
Monitor/Modify Tx
caffeine + pazopanib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + pemigatinib
avoid combo: combo may decr. pemigatinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + pentazocine
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + pentazocine
avoid combo if antitussive use; otherwise use alternative or monitor for withdrawal sx, resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine efficacy, precipitate withdrawal in opioid dependent patients; may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (antagonistic effects; additive effects)
Avoid/Use Alternative
butalbital + pentobarbital
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + pentobarbital
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, withdrawal sx, BP; use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
codeine + peppermint
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + perampanel
avoid combo: combo may decr. perampanel levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + perampanel
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, withdrawal sx; consider decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy if on perampanel 12 mg/day; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + perphenazine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + perphenazine
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + pexidartinib
avoid combo: combo may decr. pexidartinib levels, efficacy (hepatic metab. induced)
codeine + pexidartinib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Monitor/Modify Tx
acetaminophen + pexidartinib
consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT possibly inhibited)
caffeine + pexidartinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
acetaminophen + phenazopyridine
avoid combo: combo may incr. acetaminophen levels, risk of adverse effects (additive effects, duplicate tx, phenazopyridine active metabolite is acetaminophen)
Avoid/Use Alternative
butalbital + pheniramine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + pheniramine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + phenobarbital
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects (additive effects, duplicate tx)
codeine + phenobarbital
avoid combo if antitussive use; otherwise, use alternative or monitor BP, resp. rate, withdrawal sx; use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope; may alter seizure control (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + phenytoin
avoid combo: combo may decr. phenytoin levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + phenytoin
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, withdrawal sx; use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Caution Advised
caffeine + phenytoin
caution advised: combo may decr. caffeine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + pibrentasvir
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + pimavanserin
avoid combo: combo may decr. pimavanserin levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + pimozide
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + pimozide
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
codeine + pioglitazone
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
caffeine + pirfenidone
avoid combo if also combined w/ mod-strong CYP2C9, CYP2C19, CYP2D6, or CYP2E1 inhibitor; otherwise, consider alternative or decr. pirfenidone dose to 534 mg tid: combo may incr. pirfenidone levels, risk of adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + pirtobrutinib
avoid combo: combo may decr. pirtobrutinib levels, efficacy (hepatic metab. induced)
codeine + pirtobrutinib
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + ponatinib
use alternative: combo may decr. ponatinib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + ponatinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
codeine + posaconazole
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + pralsetinib
if adding pralsetinib to ongoing butalbital tx or 7 days after adding butalbital to ongoing pralsetinib tx, use alternative or double current pralsetinib dose: combo may decr. pralsetinib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + pralsetinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + pramipexole
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + pramipexole
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
codeine + pramlintide
consider alternative: combo may incr. risk of severe constipation, paralytic ileus (additive effects)
Monitor/Modify Tx
acetaminophen + pramlintide
give oral acetaminophen at least 1h before or 2h after pramlintide: combo may decr. peak acetaminophen levels, delay analgesic onset, efficacy (absorption delayed, possibly decreased)
Avoid/Use Alternative
codeine + prasugrel
consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. prasugrel active metabolite levels, efficacy (absorption of prasugrel possibly affected by delayed gastric emptying)
Avoid/Use Alternative
codeine + prednisone
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Monitor/Modify Tx
butalbital + prednisone
consider prednisone dose adjustment: combo may decr. prednisone levels, efficacy (hepatic metab. induced)
caffeine + prednisone
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + pregabalin
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + pregabalin
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + pretomanid
avoid combo: combo may decr. pretomanid levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + primidone
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + primidone
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, withdrawal sx; use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + prochlorperazine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + prochlorperazine
avoid combo if antitussive use; otherwise consider alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + promethazine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + promethazine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP; decr. codeine dose by at least 25-50%, consider decr. promethazine dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, seizures, severe hypotension (incl. orthostasis, syncope), severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
codeine + propafenone
use alternative or monitor resp. rate, withdrawal sx, BP: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine, additive effects)
Caution Advised
butalbital + propafenone
caution advised: combo may decr. propafenone levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + propofol
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + propofol
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
codeine + propranolol
use alternative or monitor resp. rate, withdrawal sx, BP: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Monitor/Modify Tx
caffeine + propranolol
monitor BP, HR; avoid excessive caffeine intake: combo may incr. propranolol levels, risk of hypotension, bradycardia, AV block, other adverse effects; may decr. antihypertensive agent efficacy (hepatic metab. inhibited; antagonistic effects)
Avoid/Use Alternative
butalbital + protriptyline
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + protriptyline
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Monitor/Modify Tx
caffeine + protriptyline
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Avoid/Use Alternative
butalbital + pyrilamine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + pyrilamine
avoid combo if antitussive use; otherwise, monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
butalbital + quazepam
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + quazepam
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
codeine + quercetin
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + quetiapine
avoid combo: combo may decr. quetiapine levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + quetiapine
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Monitor/Modify Tx
caffeine + quetiapine
monitor BP, especially in pts <18 yo; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
codeine + quinidine (antiarrhythmic)
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine)
Monitor/Modify Tx
butalbital + quinidine (antiarrhythmic)
monitor quinidine levels: combo may decr. quinidine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + quinidine (CYP2D6 inhibitor)
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine)
Caution Advised
butalbital + quinidine (CYP2D6 inhibitor)
caution advised: combo may decr. quinidine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + quinine
avoid combo: combo may decr. quinine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + quizartinib
avoid combo: combo may decr. quizartinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + ramelteon
avoid combo: combo may decr. ramelteon levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + ramelteon
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Caution Advised
caffeine + ramelteon
caution advised: combo may incr. ramelteon levels, risk of adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + regorafenib
avoid combo: combo may decr. regorafenib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
acetaminophen + regorafenib
consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)
caffeine + regorafenib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + relugolix
FIBROID-ASSOC. BLEEDING: if also combined w/ P-gp inducer, avoid combo; otherwise, caution advised; PROSTATE CANCER: if also combined w/ P-gp inducer, use alternative or incr. relugolix maint. dose to 240 mg/day; otherwise, caution advised: combo may decr. relugolix levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + remdesivir
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + remifentanil
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + remifentanil
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
codeine + remimazolam
avoid combo if antitussive use; otherwise use alternative or monitor BP, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of severe hypotension (incl. orthostasis, syncope), profound CNS and resp. depression, psychomotor impairment (additive effects)
Monitor/Modify Tx
butalbital + remimazolam
monitor resp. rate; use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + repotrectinib
avoid combo: combo may decr. repotrectinib levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + repotrectinib
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
codeine + resveratrol
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
codeine + revefenacin inhaled
consider alternative: combo may incr. risk of severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + revumenib
avoid combo: combo may decr. revumenib levels, efficacy; may incr. revumenib active metabolite levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced; incr. active metabolite formation)
Avoid/Use Alternative
butalbital + ribociclib
use alternative: combo may decr. ribociclib levels, efficacy (hepatic metab. induced)
codeine + ribociclib
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
codeine + rifabutin
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Monitor/Modify Tx
acetaminophen + rifabutin
consider monitoring LFTs w/ acetaminophen use greater than standard max acetaminophen doses; otherwise, caution advised: combo may incr. acetaminophen reactive intermediate metabolite levels, risk of hepatotoxicity, other adverse effects (hepatic metab. possibly induced, increased toxic metabolite formation)
Caution Advised
butalbital + rifabutin
caution advised: combo may decr. rifabutin levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + rifampin
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Monitor/Modify Tx
acetaminophen + rifampin
consider monitoring LFTs w/ acetaminophen use greater than standard max acetaminophen doses; otherwise, caution advised: combo may incr. acetaminophen reactive intermediate metabolite levels, risk of hepatotoxicity, other adverse effects (hepatic metab. possibly induced, increased toxic metabolite formation)
Caution Advised
caffeine + rifampin
caution advised: combo may decr. caffeine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + rifapentine
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Monitor/Modify Tx
acetaminophen + rifapentine
consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)
Avoid/Use Alternative
butalbital + rilpivirine
avoid combo: combo may decr. rilpivirine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + rimegepant
avoid combo: combo may decr. rimegepant levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + rimegepant
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + ripretinib
avoid combo: combo may decr. ripretinib and active metabolite levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + ripretinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + risperidone
avoid combo: combo may decr. risperidone levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + risperidone
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + ritlecitinib
avoid combo: combo may decr. ritlecitinib levels, efficacy (hepatic metab. induced)
codeine + ritlecitinib
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + ritonavir
use alternative: combo may decr. ritonavir levels, efficacy (hepatic metab. induced)
codeine + ritonavir
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine)
Caution Advised
caffeine + ritonavir
caution advised: combo may decr. caffeine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + rivaroxaban
avoid combo if also combined w/ P-gp inducer; otherwise, caution advised: combo may decr. rivaroxaban levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + rizatriptan
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)
Monitor/Modify Tx
butalbital + rizatriptan
monitor resp. rate: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
caffeine + rizatriptan
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + roflumilast
avoid combo: combo may decr. roflumilast levels, efficacy (hepatic metab. induced)
Caution Advised
caffeine + roflumilast
if also combined w/ CYP3A4 inhibitor, caution advised: combo may incr. roflumilast levels, risk of adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + rolapitant
avoid combo: combo may decr. rolapitant levels, efficacy (hepatic metab. induced)
codeine + rolapitant
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine)
Avoid/Use Alternative
butalbital + romidepsin
use alternative: combo may incr. or decr. romidepsin levels, incr. risk of adverse effects or efficacy (mechanism unknown)
Avoid/Use Alternative
butalbital + ropeginterferon alfa-2b
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + ropeginterferon alfa-2b
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + ropinirole
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + ropinirole
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + ropinirole
monitor BP, consider decr. ropinirole dose; avoid excessive caffeine intake: combo may incr. ropinirole levels, risk of HTN, other adverse effects (hepatic metab. inhibited, additive effects)
Avoid/Use Alternative
butalbital + rotigotine transdermal
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + rotigotine transdermal
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + rotigotine transdermal
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Avoid/Use Alternative
codeine + rucaparib
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Caution Advised
caffeine + rucaparib
caution advised: combo may incr. caffeine levels, risk of adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + rufinamide
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + rufinamide
avoid combo if antitussive use; otherwise, use alternative or monitor withdrawal sx, resp. rate; use lowest effective doses and shortest duration of concomitant tx: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + sacituzumab govitecan
avoid combo: combo may decr. SN-38 levels, efficacy (UGT metab. induced, SN-38 active small molecule moiety of sacituzumab govitecan)
Avoid/Use Alternative
codeine + SAMe
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Avoid/Use Alternative
codeine + sarilumab
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. altered; sarilumab may reverse inflammatory cytokine-induced downregulation of CYP450 enzymes resulting in relative induction of enzymes upon tx start and downregulation upon D/C)
Avoid/Use Alternative
butalbital + scopolamine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + scopolamine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
butalbital + sebetralstat
avoid combo: combo may decr. sebetralstat levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + segesterone (contraceptive)
use additional non-hormonal or alternative contraception during and x28 days after butalbital tx: combo may decr. segesterone levels, contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + selinexor
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + selinexor
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + selpercatinib
avoid combo: combo may decr. selpercatinib levels, efficacy (hepatic metab. induced)
codeine + selpercatinib
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Monitor/Modify Tx
caffeine + selpercatinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + selumetinib
avoid combo: combo may decr. selumetinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + sertraline
avoid combo: combo may decr. sertraline levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + sertraline
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Avoid/Use Alternative
butalbital + sevoflurane
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + sevoflurane
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + simvastatin
consider alternative: combo may decr. simvastatin levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + siponimod
if CYP2C9 *1/*3 or *2/*3 genotype or if also combined w/ moderate or strong CYP2C9 inducer, avoid combo; otherwise, caution advised: combo may decr. siponimod levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + siponimod
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + sirolimus
use alternative or monitor sirolimus levels: combo may decr. sirolimus levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + sirolimus albumin-bound
avoid combo: combo may decr. sirolimus albumin-bound levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + solifenacin
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + solifenacin
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of severe constipation, paralytic ileus, urinary retention, profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + sonidegib
avoid combo: combo may decr. sonidegib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + sorafenib
avoid combo: combo may decr. sorafenib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
acetaminophen + sorafenib
consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)
caffeine + sorafenib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + sotorasib
avoid combo: combo may decr. sotorasib levels, efficacy (hepatic metab. induced)
codeine + sotorasib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + sparsentan
avoid combo: combo may decr. sparsentan levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
codeine + sparsentan
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
codeine + spironolactone
use alternative or monitor resp. rate, BP; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects; may decr. spironolactone efficacy (hepatic metab. possibly inhibited, may incr. production of active metabolite morphine; additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)
Monitor/Modify Tx
butalbital + spironolactone
monitor BP: combo may incr. risk of hypotension, incl. orthostasis (additive effects)
caffeine + spironolactone
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
Avoid/Use Alternative
codeine + St. John's wort
use alternative or monitor withdrawal sx, serotonin syndrome sx, especially during initiation/titration: combo may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of serotonin syndrome (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects)
Caution Advised
caffeine + St. John's wort
caution advised: combo may decr. caffeine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + stiripentol
avoid combo: combo may decr. stiripentol levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. possibly induced; additive effects)
codeine + stiripentol
avoid combo if antitussive use; otherwise, use alternative or monitor withdrawal sx, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. or decr. codeine and active metabolite morphine levels, risk of profound CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy; may alter seizure control (hepatic metab. possibly altered, may incr. or decr. production of morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Caution Advised
caffeine + stiripentol
caution advised: combo may incr. or decr. caffeine levels, incr. risk of adverse effects or decr. efficacy (hepatic metab. possibly altered)
Avoid/Use Alternative
butalbital + sufentanil
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may decr. sufentanil levels, efficacy (additive effects; hepatic metab. induced)
codeine + sufentanil
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. sufentanil start dose, consider decr. codeine dose, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + sumatriptan
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + sumatriptan
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)
Monitor/Modify Tx
caffeine + sumatriptan
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + sunitinib
use alternative or consider adjusting sunitinib max dose as follows: GIST or RCC: 87.5 mg/day, 4wk on, 2wk off; PNET: 62.5 mg/day: combo may decr. sunitinib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + sunitinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + sunvozertinib
use alternative or incr. sunvozertinib dose to 400 mg once daily: combo may decr. sunvozertinib levels, efficacy (hepatic metab. induced)
codeine + sunvozertinib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + suvorexant
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment; may decr. suvorexant levels, efficacy (additive effects; hepatic metab. induced)
codeine + suvorexant
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + suzetrigine
avoid combo: combo may decr. suzetrigine and active metabolite levels, efficacy (hepatic metab. induced)
codeine + suzetrigine
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + tadalafil
PULMONARY HTN: avoid combo; ERECTILE DYSFUNCTION and BENIGN PROSTATIC HYPERPLASIA: consider alternative: combo may decr. tadalafil levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
codeine + tadalafil
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + tamoxifen
avoid combo: combo may decr. tamoxifen and active metabolite levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + tapentadol
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + tapentadol
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + tasimelteon
avoid combo: combo may decr. tasimelteon levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + tasimelteon
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + tazemetostat
avoid combo: combo may decr. tazemetostat levels, efficacy (hepatic metab. induced)
codeine + tazemetostat
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
codeine + tecovirimat
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
codeine + telotristat ethyl
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + temazepam
avoid combo: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
codeine + temazepam
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + temsirolimus
use alternative or consider incr. temsirolimus dose to 50 mg/wk: combo may decr. temsirolimus and active metabolite sirolimus levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + terbinafine
use alternative or monitor resp. rate, withdrawal sx: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine)
Caution Advised
butalbital + terbinafine
caution advised: combo may decr. terbinafine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + tetrabenazine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + tetrabenazine
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + tezacaftor/ ivacaftor
avoid combo: combo may decr. tezacaftor/ivacaftor levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + thalidomide
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + thalidomide
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + thioridazine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + thioridazine
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, BP, withdrawal sx; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Avoid/Use Alternative
butalbital + thiotepa
avoid combo: combo may decr. thiotepa levels, efficacy; may incr. thiotepa active metabolite levels, risk of serious infection, myelosuppression, other adverse effects; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced, incr. metabolite formation; additive effects)
codeine + thiotepa
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + thiothixene
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment; may decr. thiothixene levels, efficacy (additive effects; hepatic metab. possibly induced)
codeine + thiothixene
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
butalbital + tiagabine
avoid combo: combo may decr. tiagabine levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; further induction possible if on concurrent enzyme-inducing AEDs; additive effects)
codeine + tiagabine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + ticagrelor
avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metab. induced)
codeine + ticagrelor
use alternative or monitor resp. rate, consider decr. codeine dose; consider alternative parenteral antiplatelet agent for acute tx of ACS: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. ticagrelor and active metabolite levels, efficacy (hepatic metab. inhibited, may incr. production of active metabolite morphine; absorption of ticagrelor possibly affected by delayed gastric emptying)
Avoid/Use Alternative
butalbital + tivozanib
avoid combo: combo may decr. tivozanib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + tivozanib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN, incl. hypertensive crisis (additive effects)
Avoid/Use Alternative
butalbital + tizanidine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
caffeine + tizanidine
use alternative or monitor BP, HR: combo may incr. tizanidine levels, risk of hypotension (incl. orthostasis, syncope), bradycardia, CNS depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)
codeine + tizanidine
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Caution Advised
acetaminophen + tizanidine
caution advised w/ oral acetaminophen: combo may decr. peak acetaminophen levels, delay analgesic onset, efficacy (mechanism unknown)
Avoid/Use Alternative
codeine + tocilizumab
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. altered; tocilizumab may reverse inflammatory cytokine-induced downregulation of CYP450 enzymes resulting in relative induction of enzymes)
Avoid/Use Alternative
butalbital + tofacitinib
avoid combo: combo may decr. tofacitinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + tolcapone
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + tolcapone
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + tolterodine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + tolterodine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
butalbital + tolvaptan
avoid combo: combo may decr. tolvaptan levels, efficacy (hepatic metab. induced)
codeine + tolvaptan
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + topiramate
avoid combo: combo may decr. topiramate levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + topiramate
avoid combo if antitussive use; otherwise, use alternative or monitor withdrawal sx, resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo w/ topiramate doses >200 mg/day may decr. codeine and active metabolite morphine levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (hepatic metab. induced, may decr. production of active metabolite morphine; additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + toremifene
avoid combo: combo may decr. toremifene levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + tovorafenib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + trabectedin
avoid combo: combo may decr. trabectedin levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + tramadol
avoid combo: combo may decr. tramadol levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + tramadol
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), seizures, serotonin syndrome, severe constipation, paralytic ileus (additive effects)
Avoid/Use Alternative
butalbital + trazodone
avoid combo: combo may decr. trazodone levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + trazodone
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome (additive effects)
Avoid/Use Alternative
codeine + treosulfan
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, seizures, other adverse effects (hepatic metab. possibly inhibited, may incr. production of active metabolite morphine; additive effects)
Avoid/Use Alternative
butalbital + tretinoin
use alternative: combo may decr. tretinoin levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + triazolam
avoid combo: combo may decr. triazolam levels, efficacy; may incr. risk of profound CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + triazolam
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension, incl. orthostasis, syncope (additive effects)
Avoid/Use Alternative
butalbital + trifluoperazine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + trifluoperazine
avoid combo if antitussive use; otherwise monitor resp. rate, BP; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
butalbital + trihexyphenidyl
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + trihexyphenidyl
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)
Avoid/Use Alternative
butalbital + trimethobenzamide
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + trimethobenzamide
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + trimipramine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + trimipramine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), serotonin syndrome, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Monitor/Modify Tx
caffeine + trimipramine
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Avoid/Use Alternative
butalbital + triprolidine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + triprolidine
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
codeine + trofinetide
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + trospium
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + trospium
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, severe constipation, paralytic ileus, urinary retention (additive effects)
Monitor/Modify Tx
caffeine + trospium
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Avoid/Use Alternative
butalbital + tucatinib
avoid combo: combo may decr. tucatinib levels, efficacy (hepatic metab. induced)
codeine + tucatinib
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + ubrogepant
avoid combo: combo may decr. ubrogepant levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + ubrogepant
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + ulipristal (post-coital contraceptive)
avoid combo: combo may decr. ulipristal levels, post-coital contraceptive efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + upadacitinib
avoid combo: combo may decr. upadacitinib levels, efficacy (hepatic metab. induced)
codeine + upadacitinib
use alternative or monitor resp. rate, withdrawal sx if taking upadacitinib dose 45 mg qd: combo may incr. codeine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine)
Avoid/Use Alternative
codeine + vaborbactam
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. possibly induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + valbenazine
avoid combo: combo may decr. valbenazine levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + valbenazine
avoid combo if antitussive use; otherwise monitor resp. rate, decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + valerian
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + valerian
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + valproic acid
avoid combo: combo may decr. valproic acid levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (UGT induced; additive effects)
codeine + valproic acid
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Monitor/Modify Tx
acetaminophen + valproic acid
consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)
Avoid/Use Alternative
codeine + vamorolone
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. possibly induced, may decr. production of morphine)
Monitor/Modify Tx
caffeine + vamorolone
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + vandetanib
avoid combo: combo may decr. vandetanib levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + vandetanib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + vanzacaftor/ tezacaftor/ deutivacaftor
avoid combo: combo may decr. vanzacaftor/tezacaftor/deutivacaftor levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + velpatasvir
avoid combo: combo may decr. velpatasvir levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + vemurafenib
use alternative or incr. vemurafenib dose by 240 mg as tolerated during and x2wk after butalbital tx: combo may decr. vemurafenib levels, efficacy (hepatic metab. induced)
codeine + vemurafenib
use alternative or monitor resp. rate, withdrawal sx: combo may alter codeine and decr. active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, other adverse effects or decr. efficacy (hepatic metab. altered, may decr. production of active metabolite morphine)
Caution Advised
caffeine + vemurafenib
caution advised: combo may incr. caffeine levels, risk of adverse effects (hepatic metab. inhibited)
Avoid/Use Alternative
butalbital + venetoclax
avoid combo: combo may decr. venetoclax levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + venlafaxine
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + venlafaxine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, withdrawal sx, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. codeine levels, risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, decr. conversion to morphine; additive effects)
Monitor/Modify Tx
caffeine + venlafaxine
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + verapamil
use alternative: combo may decr. verapamil levels, efficacy (hepatic metab. induced)
codeine + verapamil
use alternative or monitor resp. rate, BP, withdrawal sx: combo may incr. codeine, alter active metabolite morphine levels, incr. risk of CNS and resp. depression, psychomotor impairment, severe hypotension (incl. orthostasis, syncope), other adverse effects or decr. efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine; additive effects)
Monitor/Modify Tx
caffeine + verapamil
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
Avoid/Use Alternative
butalbital + vigabatrin
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + vigabatrin
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + vilazodone
avoid combo: combo may decr. vilazodone levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + vilazodone
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)
Avoid/Use Alternative
codeine + viloxazine
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, withdrawal sx; consider codeine dose adjustment: combo may incr. codeine and active metabolite morphine levels, risk of profound CNS and resp. depression, psychomotor impairment, other adverse effects; may decr. active metabolite morphine levels, efficacy (hepatic metab. inhibited, may alter production of active metabolite morphine; additive effects)
Monitor/Modify Tx
butalbital + viloxazine
monitor resp. rate: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
caffeine + viloxazine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. caffeine levels, risk of HTN, tachycardia, other adverse effects (hepatic metab. inhibited, additive effects)
Avoid/Use Alternative
butalbital + vinblastine
avoid combo: combo may decr. vinblastine levels, efficacy (hepatic metab. induced)
codeine + vinblastine
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + vincristine
avoid combo: combo may decr. vincristine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + vinorelbine
avoid combo: combo may decr. vinorelbine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + voclosporin
avoid combo: combo may decr. voclosporin levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + voclosporin
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Avoid/Use Alternative
butalbital + vonoprazan
avoid combo: combo may decr. vonoprazan levels, efficacy (hepatic metab. induced)
codeine + vonoprazan
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + vorapaxar
avoid combo: combo may decr. vorapaxar levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
caffeine + vorasidenib
use alternative: combo may incr. vorasidenib levels, risk of adverse effects (hepatic metab. inhibited)
codeine + vorasidenib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. possibly induced, may decr. production of morphine)
Caution Advised
butalbital + vorasidenib
caution advised: combo may decr. vorasidenib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + vortioxetine
use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome (additive effects)
Monitor/Modify Tx
butalbital + vortioxetine
consider incr. vortioxetine dose up to 3x maintenance dose if butalbital coadmin. for >14 days: combo may decr. vortioxetine levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + voxelotor
ADULTS or >12 YO: use alternative or incr. voxelotor dose to 2500 mg qd; PEDS: use alternative or incr. voxelotor dose as follows: if wt >40 kg, incr. voxelotor dose to 2400-2500 mg qd; if wt 20-39 kg, incr. voxelotor dose to 1500 mg qd; if wt 10-19 kg, incr. voxelotor dose to 900 mg qd: combo may decr. voxelotor levels, efficacy (hepatic metab. induced)
codeine + voxelotor
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + voxilaprevir
avoid combo: combo may decr. voxilaprevir levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
codeine + xanomeline
use alternative or monitor resp. rate, consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (GI metab. possibly inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + zaleplon
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment; may decr. zaleplon levels, efficacy (additive effects; hepatic metab. induced)
codeine + zaleplon
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + zanubrutinib
avoid combo: combo may decr. zanubrutinib levels, efficacy (hepatic metab. induced)
codeine + zanubrutinib
use alternative or monitor withdrawal sx: combo may decr. codeine and active metabolite morphine levels, efficacy (hepatic metab. induced, may decr. production of morphine)
Avoid/Use Alternative
butalbital + ziconotide
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + ziconotide
avoid combo if antitussive use; otherwise, monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
codeine + zileuton
use alternative or monitor resp. rate; consider decr. codeine dose: combo may incr. codeine and active metabolite morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)
Avoid/Use Alternative
butalbital + ziprasidone
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
codeine + ziprasidone
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate, BP, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome, severe hypotension (incl. orthostasis, syncope), severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Avoid/Use Alternative
codeine + zolmitriptan
avoid combo if antitussive use; otherwise use alternative or monitor resp. rate, serotonin syndrome sx, especially during initiation/titration; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment, serotonin syndrome (additive effects)
Monitor/Modify Tx
butalbital + zolmitriptan
monitor resp. rate: combo may incr. risk of CNS and resp. depression, psychomotor impairment (additive effects)
caffeine + zolmitriptan
monitor BP; avoid excessive caffeine intake: combo may incr. zolmitriptan levels, risk of HTN, other adverse effects (hepatic metab. inhibited, additive effects)
Caution Advised
acetaminophen + zolmitriptan
caution advised w/ oral acetaminophen: combo may decr. peak acetaminophen levels, delay analgesic onset, efficacy (mechanism unknown)
Avoid/Use Alternative
butalbital + zolpidem
avoid combo: combo may incr. risk of CNS and resp. depression, psychomotor impairment; may decr. zolpidem levels, efficacy (additive effects; hepatic metab. induced)
codeine + zolpidem
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Avoid/Use Alternative
butalbital + zongertinib
use alternative or incr. zongertinib dose based on body weight as follows: LESS THAN 90 KG: incr. zongertinib dose from 120 mg to 240 mg; 90 KG OR GREATER: incr. zongertinib dose from 180 mg to 360 mg: combo may decr. zongertinib levels, efficacy (hepatic metab. induced)
Avoid/Use Alternative
butalbital + zonisamide
avoid combo: combo may decr. zonisamide levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + zonisamide
avoid combo if antitussive use; otherwise monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, codeine may decr. seizure threshold)
Avoid/Use Alternative
butalbital + zuranolone
avoid combo: combo may decr. zuranolone levels, efficacy; may incr. risk of CNS and resp. depression, psychomotor impairment (hepatic metab. induced; additive effects)
codeine + zuranolone
avoid combo if antitussive use; otherwise, use alternative or monitor resp. rate; decr. dose of one or both drugs, use lowest effective doses and shortest duration of concomitant tx: combo may incr. risk of profound CNS and resp. depression, psychomotor impairment (additive effects)
Monitor/Modify Tx
- acebutolol
- adenosine
- albuterol
- albuterol inhaled
- alfuzosin
- aliskiren
- amifostine
- amiloride
- aminophylline
- angiotensin II
- aprocitentan
- arformoterol inhaled
- articaine
- atenolol
- atomoxetine
- atracurium
- atropine
- atropine ophthalmic
- avatrombopag
- azilsartan medoxomil
- benazepril
- benzphetamine
- benztropine
- betamethasone
- betaxolol
- betaxolol ophthalmic
- bethanechol
- bevacizumab
- bexagliflozin
- bismuth subsalicylate
- bisoprolol
- budesonide
- bumetanide
- bupivacaine
- bupivacaine liposomal
- cabergoline
- calcitriol
- canagliflozin
- candesartan cilexetil
- captopril
- carfilzomib
- carteolol ophthalmic
- carvedilol
- caspofungin
- chloroprocaine
- chlorothiazide
- chlorthalidone
- cholecalciferol (vitamin D3)
- cisatracurium
- clevidipine
- clofarabine
- coenzyme Q-10
- cortisone
- crinecerfont
- cyclophosphamide
- dapagliflozin
- darbepoetin alfa
- denileukin diftitox
- desmopressin
- diclofenac topical
- dicyclomine
- diethylpropion
- diflunisal
- dinutuximab
- dipyridamole
- disopyramide
- dobutamine
- doxazosin
- doxercalciferol
- empagliflozin
- enalapril
- enalaprilat
- ephedrine injection
- epinephrine
- eplerenone
- epoetin alfa
- epoprostenol
- eptinezumab
- eravacycline
- erenumab
- ertugliflozin
- esmolol
- estetrol (contraceptive)
- ethacrynic acid
- ethinyl estradiol (hormone replacement)
- etodolac
- etrasimod
- exemestane
- exenatide
- fenoldopam
- fenoprofen
- fingolimod
- flaxseed
- fludrocortisone
- flurbiprofen
- formoterol inhaled
- fosinopril
- fremanezumab
- galcanezumab
- gemfibrozil
- hoodia
- hydrochlorothiazide
- hydrocortisone
- hydroxocobalamin IV
- iloprost
- iloprost inhaled
- indapamide
- indomethacin
- irbesartan
- iron sucrose
- isoproterenol
- isosorbide mononitrate
- ketoprofen
- landiolol
- leflunomide
- lenvatinib
- levalbuterol inhaled
- levothyroxine
- licorice
- lidocaine
- liothyronine
- liraglutide
- lisinopril
- losartan
- luspatercept
- macimorelin
- magnesium salicylate
- magnesium sulfate
- mannitol
- meclofenamate
- meloxicam
- methoxy polyethylene glycol-epoetin beta
- methscopolamine
- methylprednisolone
- methyltestosterone
- metolazone
- milrinone
- minoxidil
- moexipril
- nabumetone
- nadolol
- naproxen
- nattokinase
- naxitamab
- nebivolol
- niacin (vitamin B3)
- niraparib
- nitisinone
- nitrite
- nitroglycerin
- norepinephrine
- olodaterol inhaled
- oxymetazoline nasal
- ozanimod
- palopegteriparatide
- pamabrom
- phendimetrazine
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine ophthalmic
- phenylephrine rectal
- piroxicam
- pitolisant
- ponesimod
- prazosin
- probenecid
- pseudoephedrine
- quinapril
- ramipril
- regadenoson
- repaglinide
- riociguat
- rocuronium
- ropivacaine
- sacubitril
- salsalate
- sildenafil
- sodium ferric gluconate complex
- solriamfetol
- succinylcholine
- tacrolimus
- tagraxofusp
- tamsulosin
- telmisartan
- terazosin
- terbutaline
- teriflunomide
- theophylline
- thyroid
- tolmetin
- trametinib
- trandolapril
- treprostinil
- triamcinolone
- triamterene
- triclabendazole
- vadadustat
- valsartan
- vardenafil
- vasopressin
- vecuronium
- vilanterol inhaled
- vosoritide
- warfarin
- zavegepant
- ziv-aflibercept
Monitor/Modify Tx
caffeine + acebutolol
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + acebutolol
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + adenosine
hold caffeine 24h prior to cardiac stress test; consider incr. adenosine dose in pts w/ significant caffeine blood level: combo may decr. adenosine efficacy; intrinsic cellular adenosine antagonized by caffeine but exogenous adenosine may not be affected (possible antagonistic effects)
Monitor/Modify Tx
caffeine + albuterol
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + albuterol inhaled
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
codeine + alfuzosin
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + aliskiren
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + aliskiren
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Caution Advised
butalbital + aliskiren
caution advised: combo may decr. aliskiren levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
codeine + amifostine
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + amiloride
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + amiloride
monitor BP: combo may decr. amiloride efficacy; may incr. risk of severe hypotension, incl. orthostasis, syncope (antagonistic effects, opioids may induce antidiuretic hormone release; additive effects)
Monitor/Modify Tx
butalbital + aminophylline
monitor theophylline levels: combo may decr. theophylline levels, efficacy (hepatic metab. induced, aminophylline converted to theophylline)
caffeine + aminophylline
monitor theophylline levels: combo may incr. theophylline levels, risk of cardiac arrhythmias, seizures, other toxicities (hepatic metab. inhibited; aminophylline converted to theophylline)
Monitor/Modify Tx
caffeine + angiotensin II
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
butalbital + aprocitentan
monitor BP: combo may incr. risk of hypotension, incl. orthostasis (additive effects)
caffeine + aprocitentan
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + aprocitentan
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + arformoterol inhaled
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
codeine + articaine
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Caution Advised
acetaminophen + articaine
caution advised: combo may incr. risk of methemoglobinemia (additive effects)
Monitor/Modify Tx
caffeine + atenolol
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + atenolol
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + atomoxetine
monitor BP, HR: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
codeine + atracurium
monitor resp. rate; consider decr. dose of one or both drugs: combo may incr. risk of resp. depression, potentiate, prolong neuromuscular blockade (additive effects)
Monitor/Modify Tx
caffeine + atropine
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Caution Advised
codeine + atropine
caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)
Monitor/Modify Tx
caffeine + atropine ophthalmic
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
butalbital + avatrombopag
CHRONIC IMMUNE THROMBOCYTOPENIA: monitor platelets; if avatrombopag tablet also combined w/ moderate or strong CYP2C9 inducer, incr. start dose to 40 mg qd; if avatrombopag sprinkle also combined w/ moderate or strong CYP2C9 inducer, incr. start dose to 20 mg qd; CHRONIC LIVER DZ: monitor platelets: combo may decr. avatrombopag levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + azilsartan medoxomil
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + azilsartan medoxomil
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
butalbital + benazepril
monitor BP: combo may incr. risk of hypotension, incl. orthostasis (additive effects)
caffeine + benazepril
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + benazepril
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + benzphetamine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + benztropine
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Caution Advised
codeine + benztropine
caution advised: combo may incr. risk of severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Monitor/Modify Tx
butalbital + betamethasone
consider betamethasone dose adjustment: combo may decr. betamethasone levels, efficacy (hepatic metab. induced)
caffeine + betamethasone
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + betaxolol
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + betaxolol
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + betaxolol ophthalmic
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + bethanechol
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + bevacizumab
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
codeine + bexagliflozin
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + bismuth subsalicylate
monitor BP w/ high-dose bismuth subsalicylate; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + bisoprolol
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + bisoprolol
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + budesonide
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Caution Advised
butalbital + budesonide
caution advised: combo may decr. budesonide levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + bumetanide
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + bumetanide
monitor BP: combo may decr. bumetanide efficacy; may incr. risk of severe hypotension, incl. orthostasis, syncope (antagonistic effects, opioids may induce antidiuretic hormone release; additive effects)
Monitor/Modify Tx
codeine + bupivacaine
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Caution Advised
acetaminophen + bupivacaine
caution advised: combo may incr. risk of methemoglobinemia (additive effects)
Monitor/Modify Tx
codeine + bupivacaine liposomal
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Caution Advised
acetaminophen + bupivacaine liposomal
caution advised: combo may incr. risk of methemoglobinemia (additive effects)
Monitor/Modify Tx
codeine + cabergoline
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
butalbital + calcitriol
monitor vitamin D levels: combo may decr. vitamin D levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
butalbital + canagliflozin
monitor glucose and adjust dose as follows: if eGFR >60 and usual dose 100 mg, incr. canagliflozin dose to 200 mg/day; if eGFR >60 and usual dose 200 mg, incr. canagliflozin dose to 300 mg/day; if eGFR <60 and usual dose 100 mg, incr. canagliflozin dose to 200 mg/day and consider additional antihyperglycemic agent: combo may decr. canagliflozin levels, efficacy (UGT induced)
codeine + canagliflozin
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + candesartan cilexetil
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + candesartan cilexetil
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + captopril
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + captopril
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + carfilzomib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
codeine + carteolol ophthalmic
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + carvedilol
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + carvedilol
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
butalbital + caspofungin
consider incr. caspofungin dose to 70 mg/day in adults, 70 mg/m^2 in peds: combo may decr. caspofungin levels, efficacy (mechanism unknown, hepatic metab. possibly induced)
Monitor/Modify Tx
codeine + chloroprocaine
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Caution Advised
acetaminophen + chloroprocaine
caution advised: combo may incr. risk of methemoglobinemia (additive effects)
Monitor/Modify Tx
butalbital + chlorothiazide
monitor BP: combo may incr. risk of hypotension, incl. orthostasis (additive effects)
caffeine + chlorothiazide
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + chlorothiazide
monitor BP: combo may decr. chlorothiazide efficacy; may incr. risk of severe hypotension, incl. orthostasis, syncope (antagonistic effects, opioids may induce antidiuretic hormone release; additive effects)
Monitor/Modify Tx
butalbital + chlorthalidone
monitor BP: combo may incr. risk of hypotension, incl. orthostasis (additive effects)
caffeine + chlorthalidone
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + chlorthalidone
monitor BP: combo may decr. chlorthalidone efficacy; may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects; antagonistic effects, opioids may induce antidiuretic hormone release)
Monitor/Modify Tx
butalbital + cholecalciferol (vitamin D3)
monitor vitamin D levels: combo may decr. vitamin D levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
codeine + cisatracurium
monitor resp. rate; consider decr. dose of one or both drugs: combo may incr. risk of resp. depression, potentiate, prolong neuromuscular blockade (additive effects)
Monitor/Modify Tx
caffeine + clevidipine
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + clevidipine
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + clofarabine
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + coenzyme Q-10
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
butalbital + cortisone
consider cortisone dose adjustment: combo may decr. cortisone levels, efficacy (hepatic metab. induced)
caffeine + cortisone
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
butalbital + crinecerfont
ADULTS: incr. crinecerfont dose to 200 mg bid; PEDS 4 YO AND OLDER: incr. crinecerfont dose based on weight as follows: if 10-19 kg, incr. crinecerfont dose to 50 mg bid; if 20-54 kg, incr. crinecerfont dose to 100 mg bid; if 55 kg or greater, incr. crinecerfont dose to 200 mg bid: combo may decr. crinecerfont levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
butalbital + cyclophosphamide
monitor CBC, renal, cardiac fxn: combo may incr. cyclophosphamide active metabolite levels, risk of serious infection, myelosuppression, nephrotoxicity, cardiotoxicity, other adverse effects (hepatic metab. possibly induced, incr. active metabolite formation)
Monitor/Modify Tx
codeine + dapagliflozin
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + darbepoetin alfa
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
codeine + denileukin diftitox
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + desmopressin
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
codeine + desmopressin
monitor sodium: combo may incr. risk of hyponatremia, incl. life-threatening (additive effects)
Monitor/Modify Tx
caffeine + diclofenac topical
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + dicyclomine
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Caution Advised
codeine + dicyclomine
caution advised: combo may incr. risk of severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Monitor/Modify Tx
caffeine + diethylpropion
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + diflunisal
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Caution Advised
acetaminophen + diflunisal
caution advised: combo may incr. acetaminophen levels, risk of hepatotoxicity, other adverse effects (mechanism unknown)
Monitor/Modify Tx
codeine + dinutuximab
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + dipyridamole
hold caffeine 24h prior to cardiac stress test: combo w/ caffeine may decr. dipyridamole-induced vasodilation; effect may not be clinically significant in stress-testing if HR incr. >5% (antagonistic effects)
codeine + dipyridamole
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
butalbital + disopyramide
monitor disopyramide levels: combo may decr. disopyramide levels, efficacy (hepatic metab. induced)
Caution Advised
codeine + disopyramide
caution advised: combo may incr. risk of severe constipation/paralytic ileus, other adverse effects (additive effects)
Monitor/Modify Tx
caffeine + dobutamine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + doxazosin
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + doxazosin
monitor BP, especially during doxazosin initiation/titration: combo may incr. doxazosin levels, risk of severe hypotension (incl. orthostasis, syncope), other adverse effects (additive effects)
Monitor/Modify Tx
butalbital + doxercalciferol
monitor calcium, iPTH: combo may alter doxercalciferol and active metabolite levels, efficacy (hepatic metab. induced, net effect on vitamin D activation/inactivation unknown)
Monitor/Modify Tx
codeine + empagliflozin
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + enalapril
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + enalapril
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + enalaprilat
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + enalaprilat
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + ephedrine injection
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + epinephrine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + eplerenone
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + eplerenone
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + epoetin alfa
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
codeine + epoprostenol
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + eptinezumab
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
butalbital + eravacycline
incr. eravacycline dose to 1.5 mg/kg IV q12h: combo may decr. eravacycline levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + erenumab
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Caution Advised
codeine + erenumab
caution advised: combo may incr. risk of severe constipation, paralytic ileus (additive effects)
Monitor/Modify Tx
codeine + ertugliflozin
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + esmolol
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + esmolol
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + estetrol (contraceptive)
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + ethacrynic acid
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + ethacrynic acid
monitor BP: combo may decr. ethacrynic acid efficacy; may incr. risk of severe hypotension, incl. orthostasis, syncope (antagonistic effects, opioids may induce antidiuretic hormone release; additive effects)
Monitor/Modify Tx
acetaminophen + ethinyl estradiol (hormone replacement)
monitor thrombosis s/sx: combo may incr. ethinyl estradiol levels, risk of thromboembolism, other adverse effects (mechanism unknown)
Caution Advised
butalbital + ethinyl estradiol (hormone replacement)
caution advised: combo may decr. ethinyl estradiol levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + etodolac
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + etrasimod
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Caution Advised
butalbital + etrasimod
caution advised: combo may decr. etrasimod levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
butalbital + exemestane
incr. exemestane dose to 50 mg qd: combo may decr. exemestane levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
acetaminophen + exenatide
give oral acetaminophen at least 1h before twice daily exenatide; caution w/ weekly exenatide: combo may decr. peak acetaminophen levels, delay analgesic onset, efficacy (absorption delayed, possibly decreased)
Monitor/Modify Tx
caffeine + fenoldopam
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + fenoldopam
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + fenoprofen
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + fingolimod
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Caution Advised
butalbital + fingolimod
caution advised: combo may decr. fingolimod levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
codeine + flaxseed
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
butalbital + fludrocortisone
consider fludrocortisone dose adjustment: combo may decr. fludrocortisone levels, efficacy (hepatic metab. induced)
caffeine + fludrocortisone
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + flurbiprofen
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + formoterol inhaled
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + fosinopril
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + fosinopril
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + fremanezumab
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + galcanezumab
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
acetaminophen + gemfibrozil
consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)
Monitor/Modify Tx
caffeine + hoodia
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
butalbital + hydrochlorothiazide
monitor BP: combo may incr. risk of hypotension, incl. orthostasis (additive effects)
caffeine + hydrochlorothiazide
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + hydrochlorothiazide
monitor BP: combo may decr. hydrochlorothiazide efficacy; may incr. risk of severe hypotension, incl. orthostasis, syncope (antagonistic effects, opioids may induce antidiuretic hormone release; additive effects)
Monitor/Modify Tx
butalbital + hydrocortisone
consider hydrocortisone dose adjustment: combo may decr. hydrocortisone levels, efficacy (hepatic metab. induced)
caffeine + hydrocortisone
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + hydroxocobalamin IV
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
codeine + iloprost
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + iloprost inhaled
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
butalbital + indapamide
monitor BP: combo may incr. risk of hypotension, incl. orthostasis (additive effects)
caffeine + indapamide
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + indapamide
monitor BP: combo may decr. indapamide efficacy; may incr. risk of severe hypotension, incl. orthostasis, syncope (antagonistic effects, opioids may induce antidiuretic hormone release; additive effects)
Monitor/Modify Tx
caffeine + indomethacin
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + irbesartan
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + irbesartan
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + iron sucrose
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + isoproterenol
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Monitor/Modify Tx
codeine + isosorbide mononitrate
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + ketoprofen
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
codeine + landiolol
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + leflunomide
monitor BP; avoid excessive caffeine intake: combo may decr. caffeine levels, efficacy; may incr. risk of HTN (hepatic metab. induced; additive effects)
Monitor/Modify Tx
acetaminophen + lenvatinib
consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT possibly inhibited)
caffeine + lenvatinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + levalbuterol inhaled
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
butalbital + levothyroxine
monitor thyroid fxn: combo may decr. thyroid hormone levels, efficacy (UGT induced)
Monitor/Modify Tx
caffeine + licorice
monitor BP w/ large amounts of licorice; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + lidocaine
monitor lidocaine levels if lidocaine antiarrhythmic use; otherwise, monitor BP, HR: combo may incr. lidocaine levels, risk of hypotension, bradycardia, other adverse effects; risk may be higher w/ continuous infusion or higher doses for local anesthesia (hepatic metab. inhibited)
codeine + lidocaine
monitor BP, HR: combo may incr. risk of bradycardia, severe hypotension, incl. orthostasis, syncope (additive effects)
Caution Advised
acetaminophen + lidocaine
caution advised: combo may incr. risk of methemoglobinemia (additive effects)
Monitor/Modify Tx
butalbital + liothyronine
monitor thyroid fxn: combo may decr. thyroid hormone levels, efficacy (UGT induced)
Monitor/Modify Tx
caffeine + liraglutide
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Caution Advised
acetaminophen + liraglutide
caution advised w/ oral acetaminophen: combo may decr. peak acetaminophen levels, delay analgesic onset, efficacy (absorption delayed, possibly decreased)
Monitor/Modify Tx
caffeine + lisinopril
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + lisinopril
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + losartan
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + losartan
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + luspatercept
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
butalbital + macimorelin
D/C butalbital, allowing sufficient washout time before diagnostic test: combo may decr. macimorelin levels, result in false positive test (hepatic metab. induced)
Monitor/Modify Tx
caffeine + magnesium salicylate
monitor BP w/ high-dose magnesium salicylate; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
codeine + magnesium sulfate
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + mannitol
monitor BP, consider incr. mannitol dose: combo may decr. mannitol efficacy (antagonistic effects, opioids may induce antidiuretic hormone release)
Monitor/Modify Tx
caffeine + meclofenamate
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + meloxicam
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + methoxy polyethylene glycol-epoetin beta
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + methscopolamine
monitor HR; avoid excessive caffeine intake: combo may incr. risk of tachycardia (additive effects)
Caution Advised
codeine + methscopolamine
caution advised: combo may incr. risk of severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Monitor/Modify Tx
butalbital + methylprednisolone
consider methylprednisolone dose adjustment: combo may decr. methylprednisolone levels, efficacy (hepatic metab. induced)
caffeine + methylprednisolone
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + methyltestosterone
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + metolazone
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + metolazone
monitor BP: combo may decr. metolazone efficacy; may incr. risk of severe hypotension, incl. orthostasis, syncope (antagonistic effects, opioids may induce antidiuretic hormone release; additive effects)
Monitor/Modify Tx
codeine + milrinone
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + minoxidil
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + minoxidil
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + moexipril
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + moexipril
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + nabumetone
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + nadolol
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + nadolol
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + naproxen
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
codeine + nattokinase
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + naxitamab
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
codeine + naxitamab
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + nebivolol
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + nebivolol
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + niacin (vitamin B3)
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + niraparib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
acetaminophen + nitisinone
consider monitoring LFTs w/ acetaminophen use greater than standard max acetaminophen doses; otherwise, caution advised: combo may incr. acetaminophen reactive intermediate metabolite levels, risk of hepatotoxicity, other adverse effects (hepatic metab. induced, increased toxic metabolite formation)
Monitor/Modify Tx
codeine + nitrite
monitor BP: combo may incr. risk of severe or life-threatening hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + nitroglycerin
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + norepinephrine
monitor BP; avoid excessive caffeine intake: combo may incr. risk of severe HTN (additive effects)
Monitor/Modify Tx
caffeine + olodaterol inhaled
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + oxymetazoline nasal
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + ozanimod
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN, incl. hypertensive crisis (additive effects)
Monitor/Modify Tx
codeine + palopegteriparatide
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + pamabrom
monitor BP, consider incr. pamabrom dose: combo may decr. pamabrom efficacy (antagonistic effects, opioids may induce antidiuretic hormone release)
Monitor/Modify Tx
caffeine + phendimetrazine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + phenoxybenzamine
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + phenoxybenzamine
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + phentermine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + phentolamine
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + phentolamine
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + phenylephrine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + phenylephrine injection
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + phenylephrine ophthalmic
monitor BP, HR; avoid excessive caffeine intake; risk may be lower w/ phenylephrine ophthalmic 2.5%: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + phenylephrine rectal
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + piroxicam
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
butalbital + pitolisant
if usual pitolisant dose 8.9 mg qd, double to 17.8 mg qd over 7 days; if usual pitolisant dose 17.8 mg qd, double to 35.6 mg qd over 7 days: combo may decr. pitolisant levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
caffeine + ponesimod
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + prazosin
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + prazosin
monitor BP, especially during prazosin initiation/titration: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
acetaminophen + probenecid
consider acetaminophen dose adjustment: combo may incr. acetaminophen levels, risk of adverse effects (UGT inhibited)
Monitor/Modify Tx
caffeine + pseudoephedrine
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + quinapril
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + quinapril
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + ramipril
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + ramipril
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + regadenoson
avoid caffeine >12h prior to regadenoson use; caffeine may be used to treat severe and/or persistent adverse rxns: combo may decr. regadenoson vasodilatory effects (antagonistic effects)
Monitor/Modify Tx
butalbital + repaglinide
monitor glucose: combo may decr. repaglinide levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
codeine + riociguat
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Caution Advised
butalbital + riociguat
caution advised: combo may decr. riociguat levels, efficacy (hepatic metab. induced)
Monitor/Modify Tx
codeine + rocuronium
monitor resp. rate; consider decr. dose of one or both drugs: combo may incr. risk of resp. depression, potentiate, prolong neuromuscular blockade (additive effects)
Monitor/Modify Tx
codeine + ropivacaine
monitor BP, HR: combo may incr. risk of severe hypotension (incl. orthostasis, syncope), bradycardia (additive effects)
Caution Advised
acetaminophen + ropivacaine
caution advised: combo may incr. risk of methemoglobinemia (additive effects)
Monitor/Modify Tx
codeine + sacubitril
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + salsalate
monitor BP w/ high-dose salsalate; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
butalbital + sildenafil
PULMONARY HTN: consider sildenafil dose adjustment; ED: caution advised: combo may decr. sildenafil levels, efficacy (hepatic metab. induced)
codeine + sildenafil
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + sodium ferric gluconate complex
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + solriamfetol
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
codeine + succinylcholine
monitor resp. rate; consider decr. dose of one or both drugs: combo may incr. risk of resp. depression, potentiate, prolong neuromuscular blockade (additive effects)
Monitor/Modify Tx
butalbital + tacrolimus
monitor tacrolimus levels: combo may decr. tacrolimus levels, efficacy (hepatic metab. induced)
caffeine + tacrolimus
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + tagraxofusp
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
codeine + tagraxofusp
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + tamsulosin
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + telmisartan
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + telmisartan
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + terazosin
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + terazosin
monitor BP, especially during terazosin initiation/titration: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + terbutaline
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
caffeine + teriflunomide
monitor BP; avoid excessive caffeine intake: combo may decr. caffeine levels, efficacy; may incr. risk of HTN (hepatic metab. induced; additive effects)
Monitor/Modify Tx
butalbital + theophylline
monitor theophylline levels: combo may decr. theophylline levels, efficacy (hepatic metab. induced)
caffeine + theophylline
monitor theophylline levels: combo may incr. theophylline levels, risk of cardiac arrhythmias, seizures, other toxicities (hepatic metab. inhibited)
Monitor/Modify Tx
butalbital + thyroid
monitor thyroid fxn: combo may decr. thyroid hormone levels, efficacy (UGT induced)
Monitor/Modify Tx
caffeine + tolmetin
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + trametinib
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + trandolapril
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + trandolapril
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + treprostinil
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
butalbital + triamcinolone
consider triamcinolone dose adjustment: combo may decr. triamcinolone levels, efficacy (hepatic metab. induced)
caffeine + triamcinolone
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + triamterene
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + triamterene
monitor BP: combo may decr. triamterene efficacy; may incr. risk of severe hypotension, incl. orthostasis, syncope (antagonistic effects, opioids may induce antidiuretic hormone release; additive effects)
Monitor/Modify Tx
caffeine + triclabendazole
monitor ECG: combo may incr. triclabendazole levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)
Monitor/Modify Tx
caffeine + vadadustat
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN, incl. hypertensive crisis (additive effects)
Monitor/Modify Tx
caffeine + valsartan
monitor BP; avoid excessive caffeine intake: combo may decr. antihypertensive agent efficacy (antagonistic effects)
codeine + valsartan
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
codeine + vardenafil
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
caffeine + vasopressin
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
codeine + vasopressin
monitor sodium: combo may incr. risk of hyponatremia (additive effects)
Monitor/Modify Tx
codeine + vecuronium
monitor resp. rate; consider decr. dose of one or both drugs: combo may incr. risk of resp. depression, potentiate, prolong neuromuscular blockade (additive effects)
Monitor/Modify Tx
caffeine + vilanterol inhaled
monitor BP, HR; avoid excessive caffeine intake: combo may incr. risk of HTN, tachycardia (additive effects)
Monitor/Modify Tx
codeine + vosoritide
monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)
Monitor/Modify Tx
acetaminophen + warfarin
monitor INR, bleeding s/sx, especially w/ chronic acetaminophen use greater than standard max acetaminophen doses: combo may incr. risk of bleeding, incl. life-threatening (mechanism unknown)
butalbital + warfarin
monitor INR: combo may decr. warfarin levels, efficacy (hepatic metab. induced)
caffeine + warfarin
monitor INR, bleeding s/sx, especially during initiation/titration: combo may incr. warfarin levels, risk of bleeding (incl. life-threatening), other adverse effects (hepatic metab. inhibited)
Monitor/Modify Tx
caffeine + zavegepant
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Monitor/Modify Tx
caffeine + ziv-aflibercept
monitor BP; avoid excessive caffeine intake: combo may incr. risk of HTN (additive effects)
Caution Advised
- acetazolamide
- aclidinium inhaled
- albendazole
- aluminum hydroxide
- barium
- bazedoxifene
- belladonna alkaloids
- benzocaine topical
- botulinum toxin
- brentuximab vedotin
- busulfan
- butamben
- chlorambucil
- cisapride
- clidinium
- clindamycin
- colchicine
- creatine
- dapsone
- dapsone topical
- donepezil
- doxycycline
- drospirenone (hormone replacement)
- dulaglutide
- enfortumab vedotin
- esomeprazole
- estradiol (hormone replacement)
- estrogens, conjugated (hormone replacement)
- estrogens, esterified (hormone replacement)
- etoposide
- finasteride
- flavoxate
- glutathione
- glyburide
- glycopyrrolate inhaled
- glycopyrronium topical
- homatropine
- ipratropium inhaled
- isotretinoin
- levonorgestrel (hormone replacement)
- levonorgestrel intrauterine device (contraceptive)
- loperamide
- magnesium carbonate
- magnesium citrate
- magnesium hydroxide
- medroxyprogesterone (hormone replacement)
- mefloquine
- methazolamide
- methoxsalen
- metronidazole
- mexiletine
- montelukast
- moxifloxacin
- nafarelin
- norethindrone (hormone replacement)
- omeprazole
- ospemifene
- paclitaxel
- polatuzumab vedotin
- polyethylene glycol
- polyethylene glycol/electrolytes
- potassium acid phosphate
- potassium gluconate
- potassium phosphate
- procaine
- progesterone (hormone replacement)
- progesterone vaginal (hormone replacement)
- pyridostigmine
- raltegravir
- red yeast rice
- riluzole
- roflumilast topical
- ruxolitinib
- sodium picosulfate
- sofpironium topical
- sulfate bowel prep
- tetracaine
- tinidazole
- tiotropium inhaled
- tirzepatide
- tisotumab vedotin
Caution Advised
codeine + acetazolamide
caution advised if seizure disorder use: combo may alter seizure control (antagonistic effects, codeine may decr. seizure threshold)
Caution Advised
codeine + aclidinium inhaled
caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)
Caution Advised
butalbital + albendazole
caution advised: combo may decr. albendazole levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + aluminum hydroxide
caution advised w/ frequent or high-dose antacid use: combo may decr. barbiturate efficacy (renal excretion enhanced in alkaline urine)
Caution Advised
codeine + barium
caution advised: combo may incr. risk of intestinal obstruction (additive effects)
Caution Advised
butalbital + bazedoxifene
caution advised: combo may decr. bazedoxifene levels, efficacy (UGT induced)
Caution Advised
codeine + belladonna alkaloids
caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)
Caution Advised
acetaminophen + benzocaine topical
caution advised: combo may incr. risk of methemoglobinemia (additive effects)
Caution Advised
codeine + botulinum toxin
caution advised: combo may incr. risk of urinary retention (additive effects)
Caution Advised
butalbital + brentuximab vedotin
caution advised: combo may decr. brentuximab vedotin levels, efficacy (hepatic metab. induced)
Caution Advised
acetaminophen + busulfan
caution advised w/ acetaminophen use w/in 72h of busulfan admin.: combo may incr. busulfan levels, risk of serious infection, myelosuppression, other adverse effects (clearance decreased, glutathione depleted by acetaminophen)
codeine + busulfan
caution advised: combo may incr. risk of seizures (additive effects)
Caution Advised
acetaminophen + butamben
caution advised: combo may incr. risk of methemoglobinemia (additive effects)
Caution Advised
codeine + chlorambucil
caution advised: combo may incr. risk of seizures (additive effects)
Caution Advised
codeine + cisapride
caution advised: combo may decr. cisapride efficacy (antagonistic effects)
Caution Advised
codeine + clidinium
caution advised: combo may incr. risk of severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Caution Advised
butalbital + clindamycin
caution advised: combo may decr. clindamycin levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + colchicine
caution advised: combo may decr. colchicine levels, efficacy (hepatic metab. induced)
Caution Advised
caffeine + creatine
caution advised: combo may decr. creatine efficacy (phosphocreatine resynthesis possibly inhibited by caffeine)
Caution Advised
butalbital + dapsone
caution advised: combo may decr. dapsone levels, incr. toxic metabolite levels, risk of hematologic adverse effects or decr. efficacy (hepatic metab. induced, incr. toxic metabolite formation)
Caution Advised
acetaminophen + dapsone topical
caution advised: combo may incr. risk of methemoglobinemia (additive effects)
Caution Advised
butalbital + donepezil
caution advised: combo may decr. donepezil levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + doxycycline
caution advised: combo may decr. doxycycline levels, efficacy (mechanism unknown)
Caution Advised
butalbital + drospirenone (hormone replacement)
caution advised: combo may decr. drospirenone levels, efficacy (hepatic metab. induced)
Caution Advised
acetaminophen + dulaglutide
caution advised w/ oral acetaminophen: combo may decr. peak acetaminophen levels, delay analgesic onset, efficacy (absorption delayed, possibly decreased)
Caution Advised
butalbital + enfortumab vedotin
caution advised: combo may decr. enfortumab vedotin levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + esomeprazole
caution advised: combo may decr. esomeprazole levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + estradiol (hormone replacement)
caution advised: combo may decr. estradiol levels, efficacy (hepatic metab. induced)
caffeine + estradiol (hormone replacement)
caution advised: combo may incr. caffeine levels, risk of adverse effects (hepatic metab. inhibited)
Caution Advised
butalbital + estrogens, conjugated (hormone replacement)
caution advised: combo may decr. estrogen levels, efficacy (hepatic metab. induced)
caffeine + estrogens, conjugated (hormone replacement)
caution advised: combo may incr. caffeine levels, risk of adverse effects (hepatic metab. inhibited)
Caution Advised
butalbital + estrogens, esterified (hormone replacement)
caution advised: combo may decr. estrogen levels, efficacy (hepatic metab. induced)
caffeine + estrogens, esterified (hormone replacement)
caution advised: combo may incr. caffeine levels, risk of adverse effects (hepatic metab. inhibited)
Caution Advised
butalbital + etoposide
caution advised: combo may decr. etoposide levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + finasteride
caution advised: combo may decr. finasteride levels, efficacy (hepatic metab. induced)
Caution Advised
codeine + flavoxate
caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)
Caution Advised
acetaminophen + glutathione
caution advised: combo may decr. glutathione efficacy (glutathione depleted by acetaminophen)
Caution Advised
butalbital + glyburide
caution advised: combo may decr. glyburide levels, efficacy (hepatic metab. induced)
Caution Advised
codeine + glycopyrrolate inhaled
caution advised: combo may incr. risk of severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Caution Advised
codeine + glycopyrronium topical
caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)
Caution Advised
codeine + homatropine
caution advised: combo may incr. risk of severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Caution Advised
codeine + ipratropium inhaled
caution advised: combo may incr. risk of severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Caution Advised
butalbital + isotretinoin
caution advised: combo may decr. isotretinoin levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + levonorgestrel (hormone replacement)
caution advised: combo may decr. levonorgestrel levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + levonorgestrel intrauterine device (contraceptive)
caution advised: combo may decr. levonorgestrel levels, contraceptive efficacy (hepatic metab. possibly induced)
Caution Advised
codeine + loperamide
caution advised: combo may incr. risk of severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Caution Advised
butalbital + magnesium carbonate
caution advised w/ frequent or high-dose antacid use: combo may decr. barbiturate efficacy (renal excretion enhanced in alkaline urine)
Caution Advised
codeine + magnesium citrate
caution advised, especially if magnesium citrate bowel prep use: combo may incr. risk of seizures (additive effects)
Caution Advised
butalbital + magnesium hydroxide
caution advised w/ frequent or high-dose antacid use: combo may decr. barbiturate efficacy (renal excretion enhanced in alkaline urine)
Caution Advised
butalbital + medroxyprogesterone (hormone replacement)
caution advised: combo may decr. medroxyprogesterone levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + mefloquine
caution advised: combo may decr. mefloquine levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + methazolamide
caution advised: combo may decr. barbiturate levels, efficacy (barbiturate and calcium renal excretion increased in alkaline urine)
Caution Advised
caffeine + methoxsalen
caution advised: combo may incr. caffeine levels, risk of adverse effects (hepatic metab. inhibited)
Caution Advised
butalbital + metronidazole
caution advised: combo may decr. metronidazole levels, efficacy (hepatic metab. possibly induced)
Caution Advised
caffeine + mexiletine
caution advised: combo may incr. caffeine levels, risk of adverse effects (hepatic metab. inhibited)
codeine + mexiletine
caution advised: combo may decr. peak mexiletine levels, delay antiarrhythmic onset (absorption delayed)
Caution Advised
butalbital + montelukast
caution advised: combo may decr. montelukast levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + moxifloxacin
caution advised: combo may decr. moxifloxacin levels, efficacy (UGT induced)
Caution Advised
butalbital + nafarelin
caution advised: combo may incr. risk of bone loss (additive effects)
Caution Advised
butalbital + norethindrone (hormone replacement)
caution advised: combo may decr. norethindrone levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + omeprazole
caution advised: combo may decr. omeprazole levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + ospemifene
caution advised: combo may decr. ospemifene levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + paclitaxel
caution advised: combo may decr. paclitaxel levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + polatuzumab vedotin
caution advised: combo may decr. polatuzumab vedotin levels, efficacy (hepatic metab. induced)
Caution Advised
codeine + polyethylene glycol
caution advised, especially if polyethylene glycol bowel prep use: combo may incr. risk of seizures (additive effects)
Caution Advised
codeine + polyethylene glycol/ electrolytes
caution advised: combo may incr. risk of seizures (additive effects)
Caution Advised
codeine + potassium acid phosphate
caution advised w/ solid potassium formulations; liquid potassium formulations OK: combo may incr. risk of GI ulcerative, stenotic lesions (GI transit delayed, increased local exposure to high potassium concentration)
Caution Advised
codeine + potassium gluconate
caution advised w/ solid potassium formulations; liquid potassium formulations OK: combo may incr. risk of GI ulcerative, stenotic lesions (GI transit delayed, increased local exposure to high potassium concentration)
Caution Advised
codeine + potassium phosphate
caution advised w/ solid potassium formulations; liquid potassium formulations OK: combo may incr. risk of GI ulcerative, stenotic lesions (GI transit delayed, increased local exposure to high potassium concentration)
Caution Advised
acetaminophen + procaine
caution advised: combo may incr. risk of methemoglobinemia (additive effects)
Caution Advised
butalbital + progesterone (hormone replacement)
caution advised: combo may decr. progesterone levels, efficacy (hepatic metab. induced)
Caution Advised
butalbital + progesterone vaginal (hormone replacement)
caution advised: combo may decr. progesterone levels, efficacy (hepatic metab. induced)
Caution Advised
codeine + pyridostigmine
caution advised: combo may incr. risk of bradycardia, hypotension (additive effects)
Caution Advised
butalbital + raltegravir
caution advised: combo may decr. raltegravir levels, efficacy (UGT induced)
Caution Advised
butalbital + red yeast rice
caution advised: combo may decr. lovastatin levels, efficacy (hepatic metab. induced, red yeast rice contains varying amounts of lovastatin)
Caution Advised
caffeine + riluzole
caution advised: combo may incr. riluzole levels, risk of adverse effects (hepatic metab. inhibited)
Caution Advised
caffeine + roflumilast topical
if also combined w/ CYP3A4 inhibitor, caution advised: combo may incr. roflumilast levels, risk of adverse effects (hepatic metab. inhibited)
Caution Advised
butalbital + ruxolitinib
caution advised: combo may decr. ruxolitinib levels, efficacy; may incr. active metabolite levels, risk of adverse effects (hepatic metab. induced)
Caution Advised
codeine + sodium picosulfate
caution advised: combo may incr. risk of seizures (additive effects)
Caution Advised
codeine + sofpironium topical
caution advised: combo may incr. risk of severe constipation, paralytic ileus, urinary retention (additive effects)
Caution Advised
codeine + sulfate bowel prep
caution advised: combo may incr. risk of seizures (additive effects)
Caution Advised
acetaminophen + tetracaine
caution advised: combo may incr. risk of methemoglobinemia (additive effects)
Caution Advised
butalbital + tinidazole
caution advised: combo may decr. tinidazole levels, efficacy (hepatic metab. induced)
Caution Advised
codeine + tiotropium inhaled
caution advised: combo may incr. risk of severe constipation/paralytic ileus, other anticholinergic adverse effects (additive effects)
Caution Advised
acetaminophen + tirzepatide
caution advised w/ oral acetaminophen: combo may decr. peak acetaminophen levels, delay analgesic onset, efficacy (absorption delayed, possibly decreased)
Caution Advised
butalbital + tisotumab vedotin
caution advised: combo may decr. tisotumab vedotin levels, efficacy (hepatic metab. induced)
Adverse Reactions .
Serious Reactions
-
com.epocrates.rxweb.beans.StringCollection@62d19454
- respiratory depression
- central sleep apnea
- CNS depression
- hypotension, severe
- ICP incr.
- seizures
- bradycardia
- biliary spasm
- opioid-induced esophageal dysfunction
- hepatotoxicity
- hypersensitivity rxn
- anaphylaxis
- skin rxn, severe
- agranulocytosis
- thrombocytopenia
- adrenal insufficiency
- opioid-induced androgen deficiency (long-term use)
- nephropathy, analgesic-assoc. (chronic use)
- dependency (prolonged high-dose use)
- abuse
- withdrawal sx if abrupt D/C (long-term use)
- opioid-induced hyperalgesia
- allodynia
- medication overuse headache (use >10 days/mo)
Common Reactions
-
com.epocrates.rxweb.beans.StringCollection@78398ad
- drowsiness
- lightheadedness
- dizziness
- sedation
- dyspnea
- nausea
- vomiting
- abdominal pain
- intoxicated feeling
- constipation
Safety/Monitoring .
Monitoring Parameters
Cr at baseline, then if renal dz cont. periodically; s/sx resp. depression; LFTs if severe hepatic dz; s/sx hypotension incl. BP after tx start if hypotension risk, then after dose incr.
Pregnancy/Lactation .
Pregnancy
Clinical Summary
butalbital: weigh risk/benefit during pregnancy, esp. in 3rd trimester; no known risk of teratogenicity, though possible risk of neonatal withdrawal sx based on limited human data
acetaminophen: may use during pregnancy; drug of choice for analgesic and antipyretic use during pregnancy; no known risk of fetal harm w/ short-term use based on human data w/ PO form; possible risk of cryptorchidism and adverse neurodevelopmental outcomes w/ long-term use based on limited human data w/ PO form
caffeine: weigh risk/benefit if dose >200 mg/day, otherwise may use during pregnancy; no known risk of teratogenicity based on human data; possible risk of miscarriage, stillbirth, and low birth wt based on conflicting human data at doses >200 mg/day
codeine: weigh risk/benefit during pregnancy, esp. if prolonged use, or immed. before and during labor; risk of teratogenicity low, though risk of neonatal complications, incl. resp. depression and neonatal opioid withdrawal syndrome, based on human data and drug's mechanism of action
Lactation
Clinical Summary
butalbital: weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
acetaminophen: may use while breastfeeding; drug of choice for analgesic and antipyretic use while breastfeeding; no known risk of infant harm based on human data; no human data available to assess effects on milk production
caffeine: may use while breastfeeding; monitor infants closely if high-risk or chronic high-dose use; risk of irritability and insomnia w/ high-dose use based on limited human data; inadequate human data available to assess risk of infant harm, though possible risk of decr. iron levels in milk; no human data available to assess effects on milk production
codeine: avoid use while breastfeeding; risk of infant CNS and resp. depression, esp. if breastfeeding patient is CYP2D6 ultra-rapid metabolizer, based on limited human data; no human data available to assess effects on milk production
Pharmacology .
com.epocrates.rxweb.beans.DrugOtherInfoBean@5b659815Metabolism: for butalbital: liver; CYP450: unknown; for acetaminophen: liver; CYP450: 1A2, 2E1 (primary), 3A4 substrate; Info: toxic metabolites; for caffeine: liver; CYP450: 1A2 substrate; Info: active metabolites; for codeine: liver primarily; CYP450: 2D6 substrate; Info: active metabolite (morphine)
Excretion: for butalbital: urine 59-88% (3.6% unchanged); Half-life: 35h; for acetaminophen: urine (<5% unchanged); Half-life: 2-3h; for caffeine: urine (3% unchanged); Half-life: 3h; for codeine: urine 90% (5% unchanged), feces 10%; Half-life: 2.9h
Subclass: Headache/Migraine ; Opioid Combos
Mechanism of Action
butalbital produces sedation; acetaminophen's analgesic mechanism of action unknown; produces analgesia and anti-pyretic effects; caffeine's exact mechanism of action unknown; antagonizes adenosine A1 and A2 receptors (methylxanthine); codeine binds to various opioid receptors, producing analgesia and sedation
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Teva Pharmaceuticals USA, Inc.
com.epocrates.rxweb.beans.DrugOtherInfoBean@73d85e2cDEA/FDA: Schedule III
Retail Price
Estimated prices only. For current pricing, visit GoodRx.
oral capsule:
- 50 mg/300 mg/40 mg/30 mg (30 ea): $391.00
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