Codeine + bupropion/fluoxetine/paroxetine — ↓ activation
- Codeine needs CYP2D6 → morphine
- Strong 2D6 inhibitors block activation
- morphine formation falls
- Analgesia may fail despite codeine dose
- Do not chase effect with more codeine
- Use analgesic not dependent on CYP2D6
Interaction at a glance
- Analgesia may fail despite codeine dose
- Do not chase effect with more codeine
Mechanism
- Codeine needs CYP2D6 → morphine
- Strong 2D6 inhibitors block activation
- morphine formation falls
Management
- Analgesia may fail despite codeine dose
Management / timing
- Do not chase effect with more codeine
- Use analgesic not dependent on CYP2D6
Self-check
- Key risk with Codeine + bupropion/fluoxetine/paroxetine?
Analgesia may fail despite codeine dose. - What is the main mechanism of the Codeine + bupropion/fluoxetine/paroxetine interaction?
Strong 2D6 inhibitors block activation; morphine formation falls.
Drugs in this interaction (4)
All interaction examples · Open Codeine + bupropion/fluoxetine/paroxetine — ↓ activation in the interactive console ↗