Does Codeine Interact With Ketoconazole?

ketoconazole), protease inhibitors (e.g., ritonavir) CYP3A4 Inducers Clinical Impact: The concomitant use of Codeine Sulfate Tablets and CYP3A4 inducers can result in lower codeine levels, greater norcodeine levels, and less metabolism via 2D6 with resultant lower morphine levels [see Clinical Pharmacology ( 12.3 )] , resulting in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence [see Warnings and Precautions ( 5.7 )] .

Severity: Moderate

Severity basis: drug interactions section (keywords: caution). Combining Codeine (Opioid analgesic) and Ketoconazole (Azole antifungal (strong CYP3A4 inhibitor)) is classified as a moderate interaction.

What to Do

Use this combination with caution. Your prescriber may monitor you more closely or adjust doses.

From the FDA Label

ketoconazole), protease inhibitors (e.g., ritonavir) CYP3A4 Inducers Clinical Impact: The concomitant use of Codeine Sulfate Tablets and CYP3A4 inducers can result in lower codeine levels, greater norcodeine levels, and less metabolism via 2D6 with resultant lower morphine levels [see Clinical Pharmacology ( 12.3 )] , resulting in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence [see Warnings and Precautions ( 5.7 )] .

Source: FDA structured product labeling (set_id 010905f9-3bcb-4b50-9fe8-a3ad0010f14c).

Codeine

Opioid analgesic

Brands: Tylenol with Codeine

View Codeine safety profile

Ketoconazole

Azole antifungal (strong CYP3A4 inhibitor)

Brands: Nizoral

View Ketoconazole safety profile

Check these against your full medication list in our free Interaction Checker

This information is educational — not medical advice.

This page is provided for general educational purposes and summarizes publicly available data from sources such as the U.S. Food & Drug Administration. It is not a substitute for the judgment of a licensed clinician and should not be used to start, stop, or change any medication. It may be incomplete or out of date, and individual circumstances vary. Always talk with your prescriber or pharmacist about your specific medications and health conditions. If you think you may have a medical emergency, call 911.

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