codeine/triprolidine/pseudoephedrine (Rx)

Allergic Rhinitis, Cough, Sinus Congestion

Syrup: 20 mg/4 mg/60 mg (10 mL) PO q4-6hr, up to 40 mL/24 hr

Tablet: 1 tab PO q6hr

Allergic Rhinitis, Cough, Sinus Congestion

<6 years

• Not recommended

6-12 years

• 5 mL PO q4-6hr, up to 20 mL/24 hr

>12 years

• Syrup: 10 mL PO q4-6hr, up to 40 mL/24 hr
• Tablet: 1 tab PO q6hr

Nonanticholinergic antihistamines should be considered first when treating allergic reactions (Beers Criteria)

Clearance reduced with advanced age, greater risk of confusion, dry mouth, constipation, and other anticholinergic effects and toxicity

May exacerbate existing lower urinary conditions or benign prostatic hyperplasia

Contraindicated (2)

• alvimopan

  alvimopan, codeine. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.

• dihydroergotamine

  dihydroergotamine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

Serious - Use Alternative (72)

• acrivastine

  acrivastine and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• amisulpride

  amisulpride and codeine both increase sedation. Avoid or Use Alternate Drug.

• amitriptyline

  amitriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• amoxapine

  amoxapine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• asenapine

  asenapine and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• asenapine transdermal

  asenapine transdermal and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• avapritinib

  avapritinib and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen, codeine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
  
  benzhydrocodone/acetaminophen and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• bremelanotide

  bremelanotide will decrease the level or effect of codeine by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• brimonidine

  brimonidine and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine

  buprenorphine, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• buprenorphine buccal

  buprenorphine buccal, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine transdermal

  buprenorphine transdermal and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• butorphanol

  butorphanol, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• cabergoline

  cabergoline, pseudoephedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

• calcium/magnesium/potassium/sodium oxybates

  codeine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
  
  triprolidine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• clomipramine

  clomipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• clonidine

  clonidine, codeine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.

• cocaine topical

  cocaine topical increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

• desipramine

  desipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• desvenlafaxine

  desvenlafaxine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

• doxapram

  doxapram increases effects of pseudoephedrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

• doxepin

  doxepin increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• duloxetine

  duloxetine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

• eluxadoline

  triprolidine, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions.

• dacomitinib

  dacomitinib will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• diazepam intranasal

  diazepam intranasal, codeine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• eluxadoline

  codeine, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. .

• fentanyl

  fentanyl, codeine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl intranasal

  fentanyl intranasal, codeine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transdermal

  fentanyl transdermal, codeine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transmucosal

  fentanyl transmucosal, codeine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• givosiran

  givosiran will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• hydrocodone

  hydrocodone, codeine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• imipramine

  imipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• iobenguane I 123

  pseudoephedrine decreases effects of iobenguane I 123 by receptor binding competition. Avoid or Use Alternate Drug. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results. Do not administer pseudoephedrine until at least 7 days after each iobenguane dose.

• iobenguane I 131

  pseudoephedrine decreases effects of iobenguane I 131 by receptor binding competition. Avoid or Use Alternate Drug. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results. Do not administer pseudoephedrine until at least 7 days after each iobenguane dose.

• isocarboxazid

  isocarboxazid increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• isoflurane

  isoflurane increases toxicity of pseudoephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

• levomilnacipran

  levomilnacipran increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

• linezolid

  linezolid increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• lofepramine

  lofepramine, pseudoephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• maprotiline

  maprotiline, pseudoephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• methoxyflurane

  methoxyflurane increases toxicity of pseudoephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

• methylene blue

  methylene blue and codeine both increase serotonin levels. Avoid or Use Alternate Drug. If drug combination must be administered, monitor for evidence of serotonergic or opioid-related toxicities

• metoclopramide intranasal

  codeine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
  
  triprolidine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• milnacipran

  milnacipran increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

• nalbuphine

  nalbuphine, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• nortriptyline

  nortriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• olopatadine intranasal

  triprolidine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• olopatadine intranasal

  codeine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• ozanimod

  ozanimod and codeine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
  
  ozanimod increases toxicity of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• pentazocine

  pentazocine, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• protriptyline

  protriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• phenelzine

  phenelzine increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• pitolisant

  triprolidine decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.

• prasugrel

  codeine will decrease the level or effect of prasugrel by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Co-administration of opioid agonists delay and reduce absorption of prasugrel and its active metabolite presumably by slowing gastric emptying; consider the use of a parenteral anti-platelet agent in acute coronary syndrome patients requiring co-administration of opioid agonists

• procarbazine

  procarbazine increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

• rasagiline

  rasagiline increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.

• selegiline transdermal

  selegiline transdermal increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.

• selinexor

  selinexor, codeine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• sevoflurane

  sevoflurane increases toxicity of pseudoephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

• sodium oxybate

  codeine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
  
  triprolidine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• sufentanil SL

  sufentanil SL, codeine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• ticagrelor

  codeine will decrease the level or effect of ticagrelor by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Co-administration of opioid agonists delay and reduce absorption of ticagrelor and its active metabolite presumably by slowing gastric emptying; consider the use of a parenteral anti-platelet agent in acute coronary syndrome patients requiring co-administration of opioid agonists

• tramadol

  tramadol, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

• tranylcypromine

  tranylcypromine increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• trazodone

  trazodone, pseudoephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• trimipramine

  trimipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• valerian

  valerian and codeine both increase sedation. Avoid or Use Alternate Drug.

• venlafaxine

  venlafaxine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

Monitor Closely (324)

• abiraterone

  abiraterone increases levels of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• acetazolamide

  acetazolamide will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

• acrivastine

  acrivastine and triprolidine both increase sedation. Use Caution/Monitor.

• albuterol

  codeine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  albuterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alfentanil

  triprolidine and alfentanil both increase sedation. Use Caution/Monitor.
  
  alfentanil and codeine both increase sedation. Use Caution/Monitor.

• alfuzosin

  pseudoephedrine decreases effects of alfuzosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• alprazolam

  triprolidine and alprazolam both increase sedation. Use Caution/Monitor.
  
  alprazolam and codeine both increase sedation. Use Caution/Monitor.

• aluminum hydroxide

  aluminum hydroxide will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor. Caution advised with frequent or high dose antacids

• amifampridine

  triprolidine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amiodarone

  amiodarone will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• amisulpride

  amisulpride and triprolidine both increase sedation. Use Caution/Monitor.

• amitriptyline

  triprolidine and amitriptyline both increase sedation. Use Caution/Monitor.
  
  codeine and amitriptyline both increase sedation. Use Caution/Monitor.

• ammonium chloride

  ammonium chloride decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

• amobarbital

  triprolidine and amobarbital both increase sedation. Use Caution/Monitor.
  
  amobarbital and codeine both increase sedation. Use Caution/Monitor.

• amoxapine

  triprolidine and amoxapine both increase sedation. Use Caution/Monitor.
  
  codeine and amoxapine both increase sedation. Use Caution/Monitor.

• apomorphine

  codeine and apomorphine both increase sedation. Use Caution/Monitor.

• arformoterol

  arformoterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• arformoterol

  codeine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• benzphetamine

  benzphetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• aripiprazole

  triprolidine and aripiprazole both increase sedation. Use Caution/Monitor.
  
  codeine and aripiprazole both increase sedation. Use Caution/Monitor.

• armodafinil

  codeine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• artemether/lumefantrine

  artemether/lumefantrine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• asenapine

  asenapine and triprolidine both increase sedation. Use Caution/Monitor.

• asenapine transdermal

  asenapine transdermal and triprolidine both increase sedation. Use Caution/Monitor.

• avapritinib

  avapritinib and triprolidine both increase sedation. Use Caution/Monitor.

• azelastine

  azelastine and triprolidine both increase sedation. Use Caution/Monitor.
  
  azelastine and codeine both increase sedation. Use Caution/Monitor.

• baclofen

  baclofen and codeine both increase sedation. Use Caution/Monitor.

• belladonna and opium

  triprolidine and belladonna and opium both increase sedation. Use Caution/Monitor.

• belladonna and opium

  codeine and belladonna and opium both increase sedation. Use Caution/Monitor.

• benperidol

  triprolidine and benperidol both increase sedation. Use Caution/Monitor.
  
  codeine and benperidol both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen and triprolidine both increase sedation. Use Caution/Monitor.

• benzphetamine

  codeine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• benzphetamine

  triprolidine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• brexanolone

  brexanolone, codeine. Either increases toxicity of the other by sedation. Use Caution/Monitor.
  
  brexanolone, triprolidine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brexpiprazole

  brexpiprazole and triprolidine both increase sedation. Use Caution/Monitor.
  
  brexpiprazole and codeine both increase sedation. Use Caution/Monitor.

• brimonidine

  brimonidine and triprolidine both increase sedation. Use Caution/Monitor.

• brivaracetam

  brivaracetam and codeine both increase sedation. Use Caution/Monitor.

• brivaracetam

  brivaracetam and triprolidine both increase sedation. Use Caution/Monitor.

• bromocriptine

  bromocriptine, pseudoephedrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Hypertension, V tach.

• brompheniramine

  brompheniramine and triprolidine both increase sedation. Use Caution/Monitor.
  
  brompheniramine and codeine both increase sedation. Use Caution/Monitor.

• buprenorphine

  triprolidine and buprenorphine both increase sedation. Use Caution/Monitor.
  
  buprenorphine and codeine both increase sedation. Use Caution/Monitor.

• buprenorphine buccal

  triprolidine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
  
  buprenorphine buccal and codeine both increase sedation. Use Caution/Monitor.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and triprolidine both increase sedation. Use Caution/Monitor.

• buprenorphine, long-acting injection

  codeine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

• buprenorphine transdermal

  buprenorphine transdermal and triprolidine both increase sedation. Use Caution/Monitor.

• bupropion

  bupropion will decrease the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents the conversion of codeine to its active metabolite morphine.

• butabarbital

  triprolidine and butabarbital both increase sedation. Use Caution/Monitor.
  
  butabarbital and codeine both increase sedation. Use Caution/Monitor.

• butalbital

  butalbital and codeine both increase sedation. Use Caution/Monitor.
  
  triprolidine and butalbital both increase sedation. Use Caution/Monitor.

• butorphanol

  triprolidine and butorphanol both increase sedation. Use Caution/Monitor.
  
  butorphanol and codeine both increase sedation. Use Caution/Monitor.

• caffeine

  triprolidine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carbinoxamine

  carbinoxamine and codeine both increase sedation. Use Caution/Monitor.
  
  carbinoxamine and triprolidine both increase sedation. Use Caution/Monitor.

• carisoprodol

  carisoprodol and codeine both increase sedation. Use Caution/Monitor.

• cenobamate

  cenobamate, triprolidine. Either increases effects of the other by sedation. Use Caution/Monitor.

• celecoxib

  celecoxib decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• cenobamate

  cenobamate, codeine. Either increases effects of the other by sedation. Use Caution/Monitor.

• chloral hydrate

  triprolidine and chloral hydrate both increase sedation. Use Caution/Monitor.
  
  chloral hydrate and codeine both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  chlordiazepoxide and codeine both increase sedation. Use Caution/Monitor.
  
  triprolidine and chlordiazepoxide both increase sedation. Use Caution/Monitor.

• chloroquine

  chloroquine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• chlorpheniramine

  chlorpheniramine and triprolidine both increase sedation. Use Caution/Monitor.

• chlorpheniramine

  chlorpheniramine and codeine both increase sedation. Use Caution/Monitor.

• chlorpromazine

  chlorpromazine will decrease the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine
  
  codeine and chlorpromazine both increase sedation. Use Caution/Monitor.
  
  chlorpromazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.
  
  triprolidine and chlorpromazine both increase sedation. Use Caution/Monitor.

• chlorzoxazone

  chlorzoxazone and codeine both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  dexfenfluramine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• cinnarizine

  cinnarizine and triprolidine both increase sedation. Use Caution/Monitor.

• cimetidine

  cimetidine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• cinacalcet

  cinacalcet decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• cinnarizine

  cinnarizine and codeine both increase sedation. Use Caution/Monitor.

• clemastine

  clemastine and triprolidine both increase sedation. Use Caution/Monitor.
  
  clemastine and codeine both increase sedation. Use Caution/Monitor.

• clobazam

  triprolidine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
  
  codeine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
  
  clobazam decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• clomipramine

  triprolidine and clomipramine both increase sedation. Use Caution/Monitor.
  
  codeine and clomipramine both increase sedation. Use Caution/Monitor.
  
  clomipramine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• clonazepam

  triprolidine and clonazepam both increase sedation. Use Caution/Monitor.
  
  clonazepam and codeine both increase sedation. Use Caution/Monitor.

• clorazepate

  triprolidine and clorazepate both increase sedation. Use Caution/Monitor.
  
  clorazepate and codeine both increase sedation. Use Caution/Monitor.

• clozapine

  codeine and clozapine both increase sedation. Use Caution/Monitor.
  
  triprolidine and clozapine both increase sedation. Use Caution/Monitor.
  
  clozapine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• cocaine topical

  cocaine topical decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• codeine

  triprolidine and codeine both increase sedation. Use Caution/Monitor.

• cyclizine

  cyclizine and triprolidine both increase sedation. Use Caution/Monitor.
  
  cyclizine and codeine both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  cyclobenzaprine and codeine both increase sedation. Use Caution/Monitor.

• cyproheptadine

  cyproheptadine and triprolidine both increase sedation. Use Caution/Monitor.

• cyproheptadine

  cyproheptadine and codeine both increase sedation. Use Caution/Monitor.

• dantrolene

  dantrolene and codeine both increase sedation. Use Caution/Monitor.

• daridorexant

  codeine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
  
  triprolidine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  darifenacin decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• desflurane

  desflurane and triprolidine both increase sedation. Use Caution/Monitor.

• desflurane

  desflurane and codeine both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.

• desipramine

  codeine and desipramine both increase sedation. Use Caution/Monitor.
  
  triprolidine and desipramine both increase sedation. Use Caution/Monitor.
  
  desipramine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• desvenlafaxine

  desvenlafaxine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

• dexchlorpheniramine

  dexchlorpheniramine and triprolidine both increase sedation. Use Caution/Monitor.

• deutetrabenazine

  codeine and deutetrabenazine both increase sedation. Use Caution/Monitor.

• dexchlorpheniramine

  dexchlorpheniramine and codeine both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  codeine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexmedetomidine

  triprolidine and dexmedetomidine both increase sedation. Use Caution/Monitor.
  
  dexmedetomidine and codeine both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  dexmethylphenidate and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine

  triprolidine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  dextroamphetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextromoramide

  codeine and dextromoramide both increase sedation. Use Caution/Monitor.
  
  triprolidine and dextromoramide both increase sedation. Use Caution/Monitor.

• diethylpropion

  diethylpropion and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• diamorphine

  triprolidine and diamorphine both increase sedation. Use Caution/Monitor.
  
  codeine and diamorphine both increase sedation. Use Caution/Monitor.

• diazepam

  diazepam and codeine both increase sedation. Use Caution/Monitor.

• diazepam intranasal

  diazepam intranasal, triprolidine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• diethylpropion

  codeine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• difelikefalin

  difelikefalin and codeine both increase sedation. Use Caution/Monitor.
  
  difelikefalin and triprolidine both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  triprolidine and difenoxin hcl both increase sedation. Use Caution/Monitor.
  
  codeine and difenoxin hcl both increase sedation. Use Caution/Monitor.

• dimenhydrinate

  dimenhydrinate and triprolidine both increase sedation. Use Caution/Monitor.
  
  dimenhydrinate and codeine both increase sedation. Use Caution/Monitor.

• diphenhydramine

  diphenhydramine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.
  
  diphenhydramine and codeine both increase sedation. Use Caution/Monitor.
  
  diphenhydramine and triprolidine both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  triprolidine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.
  
  codeine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

• dipipanone

  codeine and dipipanone both increase sedation. Use Caution/Monitor.
  
  triprolidine and dipipanone both increase sedation. Use Caution/Monitor.

• dobutamine

  codeine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  dobutamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• donepezil transdermal

  donepezil transdermal, triprolidine. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.

• dopamine

  dopamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• dopamine

  codeine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopamine

  triprolidine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopexamine

  dopexamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dosulepin

  codeine and dosulepin both increase sedation. Use Caution/Monitor.
  
  triprolidine and dosulepin both increase sedation. Use Caution/Monitor.

• doxazosin

  pseudoephedrine decreases effects of doxazosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• doxepin

  codeine and doxepin both increase sedation. Use Caution/Monitor.
  
  triprolidine and doxepin both increase sedation. Use Caution/Monitor.

• doxylamine

  triprolidine and doxylamine both increase sedation. Use Caution/Monitor.
  
  doxylamine and codeine both increase sedation. Use Caution/Monitor.

• dronedarone

  dronedarone decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• droperidol

  triprolidine and droperidol both increase sedation. Use Caution/Monitor.

• droperidol

  codeine and droperidol both increase sedation. Use Caution/Monitor.

• droxidopa

  pseudoephedrine and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension

• duloxetine

  duloxetine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of codeine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• ephedrine

  ephedrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  ephedrine, pseudoephedrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
  
  codeine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  triprolidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  epinephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine inhaled

  pseudoephedrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• epinephrine racemic

  codeine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine racemic

  epinephrine racemic and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• esketamine intranasal

  esketamine intranasal, pseudoephedrine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with stimulants. .
  
  esketamine intranasal, codeine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
  
  esketamine intranasal, triprolidine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• estazolam

  triprolidine and estazolam both increase sedation. Use Caution/Monitor.
  
  estazolam and codeine both increase sedation. Use Caution/Monitor.

• fenfluramine

  fenfluramine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• ethanol

  triprolidine and ethanol both increase sedation. Use Caution/Monitor.
  
  codeine and ethanol both increase sedation. Use Caution/Monitor.

• etomidate

  etomidate and codeine both increase sedation. Use Caution/Monitor.
  
  etomidate and triprolidine both increase sedation. Use Caution/Monitor.

• fedratinib

  fedratinib will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenfluramine

  triprolidine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fenfluramine

  codeine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fentanyl

  fentanyl, triprolidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.

• fentanyl intranasal

  fentanyl intranasal, triprolidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.

• fentanyl transdermal

  fentanyl transdermal, triprolidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.

• fentanyl transmucosal

  fentanyl transmucosal, triprolidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.

• flibanserin

  triprolidine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.
  
  codeine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

• fluoxetine

  fluoxetine will decrease the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine

• fluphenazine

  triprolidine and fluphenazine both increase sedation. Use Caution/Monitor.
  
  fluphenazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.

• fluphenazine

  codeine and fluphenazine both increase sedation. Use Caution/Monitor.

• formoterol

  formoterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• flurazepam

  flurazepam and codeine both increase sedation. Use Caution/Monitor.
  
  triprolidine and flurazepam both increase sedation. Use Caution/Monitor.

• formoterol

  codeine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• gabapentin

  gabapentin, triprolidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
  
  gabapentin, codeine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  gabapentin enacarbil, triprolidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
  
  gabapentin enacarbil, codeine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• ganaxolone

  triprolidine and ganaxolone both increase sedation. Use Caution/Monitor.
  
  codeine and ganaxolone both increase sedation. Use Caution/Monitor.

• glycopyrronium tosylate topical

  glycopyrronium tosylate topical, triprolidine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

• haloperidol

  haloperidol decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.
  
  codeine and haloperidol both increase sedation. Use Caution/Monitor.

• gotu kola

  gotu kola increases effects of triprolidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

• haloperidol

  triprolidine and haloperidol both increase sedation. Use Caution/Monitor.

• hawthorn

  hawthorn increases effects of triprolidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

• hops

  hops increases effects of triprolidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

• hydralazine

  hydralazine, pseudoephedrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

• hydromorphone

  triprolidine and hydromorphone both increase sedation. Use Caution/Monitor.
  
  codeine and hydromorphone both increase sedation. Use Caution/Monitor.

• hydroxyzine

  hydroxyzine and codeine both increase sedation. Use Caution/Monitor.
  
  hydroxyzine and triprolidine both increase sedation. Use Caution/Monitor.

• iloperidone

  triprolidine and iloperidone both increase sedation. Use Caution/Monitor.
  
  codeine and iloperidone both increase sedation. Use Caution/Monitor.

• imipramine

  codeine and imipramine both increase sedation. Use Caution/Monitor.
  
  triprolidine and imipramine both increase sedation. Use Caution/Monitor.
  
  imipramine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• insulin degludec

  pseudoephedrine decreases effects of insulin degludec by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

• insulin degludec/insulin aspart

  pseudoephedrine decreases effects of insulin degludec/insulin aspart by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

• insulin detemir

  pseudoephedrine decreases effects of insulin detemir by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

• insulin glargine

  pseudoephedrine decreases effects of insulin glargine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

• insulin inhaled

  pseudoephedrine decreases effects of insulin inhaled by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

• insulin regular human

  pseudoephedrine decreases effects of insulin regular human by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

• isoniazid

  isoniazid decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• isoproterenol

  isoproterenol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• isoproterenol

  codeine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levalbuterol

  levalbuterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• kava

  kava increases effects of triprolidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

• ketamine

  ketamine and codeine both increase sedation. Use Caution/Monitor.
  
  ketamine and triprolidine both increase sedation. Use Caution/Monitor.

• ketoconazole

  ketoconazole decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• ketotifen, ophthalmic

  triprolidine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• ketotifen, ophthalmic

  codeine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• lasmiditan

  lasmiditan, codeine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  
  lasmiditan, triprolidine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

• lemborexant

  lemborexant, codeine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
  
  lemborexant, triprolidine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• letermovir

  letermovir increases levels of codeine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levalbuterol

  triprolidine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levalbuterol

  codeine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levoketoconazole

  levoketoconazole decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• levorphanol

  triprolidine and levorphanol both increase sedation. Use Caution/Monitor.
  
  codeine and levorphanol both increase sedation. Use Caution/Monitor.

• lisdexamfetamine

  lisdexamfetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lofepramine

  triprolidine and lofepramine both increase sedation. Use Caution/Monitor.
  
  codeine and lofepramine both increase sedation. Use Caution/Monitor.

• metaproterenol

  metaproterenol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• lofexidine

  codeine and lofexidine both increase sedation. Use Caution/Monitor.
  
  triprolidine and lofexidine both increase sedation. Use Caution/Monitor.

• lopinavir

  lopinavir decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• loprazolam

  triprolidine and loprazolam both increase sedation. Use Caution/Monitor.

• loprazolam

  loprazolam and codeine both increase sedation. Use Caution/Monitor.

• lorazepam

  triprolidine and lorazepam both increase sedation. Use Caution/Monitor.
  
  lorazepam and codeine both increase sedation. Use Caution/Monitor.

• lorcaserin

  lorcaserin will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• lormetazepam

  triprolidine and lormetazepam both increase sedation. Use Caution/Monitor.

• lormetazepam

  lormetazepam and codeine both increase sedation. Use Caution/Monitor.

• loxapine

  codeine and loxapine both increase sedation. Use Caution/Monitor.
  
  triprolidine and loxapine both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  triprolidine and loxapine inhaled both increase sedation. Use Caution/Monitor.
  
  codeine and loxapine inhaled both increase sedation. Use Caution/Monitor.

• lumefantrine

  lumefantrine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• lurasidone

  lurasidone, triprolidine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

• lurasidone

  lurasidone, codeine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

• maprotiline

  triprolidine and maprotiline both increase sedation. Use Caution/Monitor.
  
  codeine and maprotiline both increase sedation. Use Caution/Monitor.

• marijuana

  triprolidine and marijuana both increase sedation. Use Caution/Monitor.
  
  codeine and marijuana both increase sedation. Use Caution/Monitor.

• melatonin

  triprolidine and melatonin both increase sedation. Use Caution/Monitor.
  
  codeine and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  triprolidine and meperidine both increase sedation. Use Caution/Monitor.
  
  codeine and meperidine both increase sedation. Use Caution/Monitor.

• meprobamate

  triprolidine and meprobamate both increase sedation. Use Caution/Monitor.
  
  codeine and meprobamate both increase sedation. Use Caution/Monitor.

• metaproterenol

  triprolidine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaxalone

  metaxalone and codeine both increase sedation. Use Caution/Monitor.

• methadone

  triprolidine and methadone both increase sedation. Use Caution/Monitor.

• methadone

  codeine and methadone both increase sedation. Use Caution/Monitor.

• methamphetamine

  codeine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  methamphetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methenamine

  methenamine decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

• methocarbamol

  methocarbamol and codeine both increase sedation. Use Caution/Monitor.

• methyldopa

  methyldopa increases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor.

• methylenedioxymethamphetamine

  methylenedioxymethamphetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methylenedioxymethamphetamine

  codeine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• midodrine

  midodrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• midazolam

  triprolidine and midazolam both increase sedation. Use Caution/Monitor.
  
  midazolam and codeine both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  midazolam intranasal, codeine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
  
  midazolam intranasal, triprolidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  codeine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mirabegron

  mirabegron will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  triprolidine and mirtazapine both increase sedation. Use Caution/Monitor.

• mirtazapine

  codeine and mirtazapine both increase sedation. Use Caution/Monitor.

• modafinil

  codeine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  codeine and morphine both increase sedation. Use Caution/Monitor.
  
  triprolidine and morphine both increase sedation. Use Caution/Monitor.

• motherwort

  codeine and motherwort both increase sedation. Use Caution/Monitor.
  
  triprolidine and motherwort both increase sedation. Use Caution/Monitor.

• moxonidine

  codeine and moxonidine both increase sedation. Use Caution/Monitor.
  
  triprolidine and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  codeine and nabilone both increase sedation. Use Caution/Monitor.
  
  triprolidine and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  codeine and nalbuphine both increase sedation. Use Caution/Monitor.
  
  triprolidine and nalbuphine both increase sedation. Use Caution/Monitor.

• nateglinide

  pseudoephedrine decreases effects of nateglinide by pharmacodynamic antagonism. Use Caution/Monitor. Coadministration may reduce nateglinide's hypoglycemic action.

• norepinephrine

  norepinephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nortriptyline

  triprolidine and nortriptyline both increase sedation. Use Caution/Monitor.
  
  codeine and nortriptyline both increase sedation. Use Caution/Monitor.

• olodaterol inhaled

  pseudoephedrine and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects

• olanzapine

  codeine and olanzapine both increase sedation. Use Caution/Monitor.
  
  triprolidine and olanzapine both increase sedation. Use Caution/Monitor.

• oliceridine

  oliceridine, codeine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• opium tincture

  triprolidine and opium tincture both increase sedation. Use Caution/Monitor.

• opium tincture

  codeine and opium tincture both increase sedation. Use Caution/Monitor.

• orphenadrine

  orphenadrine and codeine both increase sedation. Use Caution/Monitor.

• oxazepam

  triprolidine and oxazepam both increase sedation. Use Caution/Monitor.
  
  oxazepam and codeine both increase sedation. Use Caution/Monitor.

• oxycodone

  triprolidine and oxycodone both increase sedation. Use Caution/Monitor.
  
  codeine and oxycodone both increase sedation. Use Caution/Monitor.

• oxymorphone

  triprolidine and oxymorphone both increase sedation. Use Caution/Monitor.
  
  codeine and oxymorphone both increase sedation. Use Caution/Monitor.

• oxytocin

  oxytocin increases effects of pseudoephedrine by pharmacodynamic synergism. Use Caution/Monitor.

• paliperidone

  triprolidine and paliperidone both increase sedation. Use Caution/Monitor.
  
  codeine and paliperidone both increase sedation. Use Caution/Monitor.

• papaveretum

  triprolidine and papaveretum both increase sedation. Use Caution/Monitor.
  
  codeine and papaveretum both increase sedation. Use Caution/Monitor.

• papaverine

  triprolidine and papaverine both increase sedation. Use Caution/Monitor.
  
  codeine and papaverine both increase sedation. Use Caution/Monitor.

• paroxetine

  paroxetine will decrease the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• passion flower

  passion flower increases effects of triprolidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

• peginterferon alfa 2b

  peginterferon alfa 2b, codeine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

• pegvisomant

  codeine decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.

• pentazocine

  codeine and pentazocine both increase sedation. Use Caution/Monitor.
  
  triprolidine and pentazocine both increase sedation. Use Caution/Monitor.

• pentobarbital

  triprolidine and pentobarbital both increase sedation. Use Caution/Monitor.
  
  pentobarbital and codeine both increase sedation. Use Caution/Monitor.

• perampanel

  perampanel and codeine both increase sedation. Use Caution/Monitor.

• perphenazine

  triprolidine and perphenazine both increase sedation. Use Caution/Monitor.
  
  perphenazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.

• perphenazine

  codeine and perphenazine both increase sedation. Use Caution/Monitor.

• phendimetrazine

  phendimetrazine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• phendimetrazine

  codeine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenobarbital

  triprolidine and phenobarbital both increase sedation. Use Caution/Monitor.
  
  phenobarbital and codeine both increase sedation. Use Caution/Monitor.

• phentermine

  phentermine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine

  triprolidine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  phenylephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine PO

  codeine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
  
  triprolidine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
  
  phenylephrine PO and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• pholcodine

  triprolidine and pholcodine both increase sedation. Use Caution/Monitor.
  
  codeine and pholcodine both increase sedation. Use Caution/Monitor.

• pirbuterol

  pirbuterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• pimozide

  triprolidine and pimozide both increase sedation. Use Caution/Monitor.
  
  codeine and pimozide both increase sedation. Use Caution/Monitor.

• pirbuterol

  triprolidine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• potassium phosphate

  potassium phosphate decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

• pregabalin

  pregabalin, codeine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
  
  pregabalin, triprolidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primidone

  triprolidine and primidone both increase sedation. Use Caution/Monitor.
  
  primidone and codeine both increase sedation. Use Caution/Monitor.

• prochlorperazine

  codeine and prochlorperazine both increase sedation. Use Caution/Monitor.
  
  prochlorperazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.
  
  triprolidine and prochlorperazine both increase sedation. Use Caution/Monitor.

• promazine

  promazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

• promethazine

  promethazine and triprolidine both increase sedation. Use Caution/Monitor.
  
  promethazine and codeine both increase sedation. Use Caution/Monitor.

• promethazine

  promethazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

• propofol

  propofol and triprolidine both increase sedation. Use Caution/Monitor.
  
  propofol and codeine both increase sedation. Use Caution/Monitor.

• propylhexedrine

  triprolidine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  propylhexedrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protriptyline

  codeine and protriptyline both increase sedation. Use Caution/Monitor.
  
  triprolidine and protriptyline both increase sedation. Use Caution/Monitor.

• safinamide

  pseudoephedrine and safinamide both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Monitor patients for hypertension if safinamide is prescribed concomitantly with prescription or nonprescription sympathomimetics, including nasal, oral, or ophthalmic decongestants and cold remedies.

• quazepam

  quazepam and codeine both increase sedation. Use Caution/Monitor.
  
  triprolidine and quazepam both increase sedation. Use Caution/Monitor.

• quetiapine

  codeine and quetiapine both increase sedation. Use Caution/Monitor.
  
  triprolidine and quetiapine both increase sedation. Use Caution/Monitor.

• quinidine

  quinidine will decrease the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• ramelteon

  triprolidine and ramelteon both increase sedation. Use Caution/Monitor.

• ramelteon

  codeine and ramelteon both increase sedation. Use Caution/Monitor.

• remimazolam

  remimazolam, codeine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• ribociclib

  ribociclib will increase the level or effect of codeine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• risperidone

  codeine and risperidone both increase sedation. Use Caution/Monitor.
  
  triprolidine and risperidone both increase sedation. Use Caution/Monitor.

• ritonavir

  ritonavir will decrease the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• salmeterol

  salmeterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• rolapitant

  rolapitant will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• serdexmethylphenidate/dexmethylphenidate

  serdexmethylphenidate/dexmethylphenidate and pseudoephedrine both decrease sedation. Use Caution/Monitor.
  
  serdexmethylphenidate/dexmethylphenidate and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• salmeterol

  codeine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• scullcap

  codeine and scullcap both increase sedation. Use Caution/Monitor.
  
  triprolidine and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  triprolidine and secobarbital both increase sedation. Use Caution/Monitor.
  
  secobarbital and codeine both increase sedation. Use Caution/Monitor.

• selegiline

  selegiline increases toxicity of codeine by unknown mechanism. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.

• sevoflurane

  sevoflurane and triprolidine both increase sedation. Use Caution/Monitor.

• sertraline

  sertraline decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• sevoflurane

  sevoflurane and codeine both increase sedation. Use Caution/Monitor.

• shepherd's purse

  triprolidine and shepherd's purse both increase sedation. Use Caution/Monitor.
  
  codeine and shepherd's purse both increase sedation. Use Caution/Monitor.

• silodosin

  pseudoephedrine decreases effects of silodosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• sodium bicarbonate

  sodium bicarbonate will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor. Caution advised with frequent or high dose antacids

• sodium citrate/citric acid

  sodium citrate/citric acid will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

• sodium lactate

  sodium lactate will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

• sodium phosphates, IV

  sodium phosphates, IV decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

• solriamfetol

  pseudoephedrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• spironolactone

  spironolactone decreases effects of pseudoephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

• stiripentol

  stiripentol, codeine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
  
  stiripentol, triprolidine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• sufentanil

  codeine and sufentanil both increase sedation. Use Caution/Monitor.
  
  triprolidine and sufentanil both increase sedation. Use Caution/Monitor.

• suvorexant

  suvorexant and codeine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

• tamsulosin

  pseudoephedrine decreases effects of tamsulosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• tapentadol

  triprolidine and tapentadol both increase sedation. Use Caution/Monitor.

• tapentadol

  codeine and tapentadol both increase sedation. Use Caution/Monitor.

• temazepam

  triprolidine and temazepam both increase sedation. Use Caution/Monitor.
  
  temazepam and codeine both increase sedation. Use Caution/Monitor.

• terazosin

  pseudoephedrine decreases effects of terazosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• terbinafine

  terbinafine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  terbutaline and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• terbutaline

  codeine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• thioridazine

  thioridazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.

• thioridazine

  triprolidine and thioridazine both increase sedation. Use Caution/Monitor.
  
  thioridazine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.
  
  codeine and thioridazine both increase sedation. Use Caution/Monitor.

• thiothixene

  codeine and thiothixene both increase sedation. Use Caution/Monitor.
  
  triprolidine and thiothixene both increase sedation. Use Caution/Monitor.

• ticlopidine

  ticlopidine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• topiramate

  triprolidine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• topiramate

  codeine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  triprolidine and tramadol both increase sedation. Use Caution/Monitor.
  
  codeine and tramadol both increase sedation. Use Caution/Monitor.

• tranylcypromine

  tranylcypromine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• trazodone

  triprolidine and trazodone both increase sedation. Use Caution/Monitor.

• trazodone

  codeine and trazodone both increase sedation. Use Caution/Monitor.

• triazolam

  triprolidine and triazolam both increase sedation. Use Caution/Monitor.
  
  triazolam and codeine both increase sedation. Use Caution/Monitor.

• triclofos

  triprolidine and triclofos both increase sedation. Use Caution/Monitor.
  
  triclofos and codeine both increase sedation. Use Caution/Monitor.

• trifluoperazine

  codeine and trifluoperazine both increase sedation. Use Caution/Monitor.
  
  trifluoperazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.
  
  triprolidine and trifluoperazine both increase sedation. Use Caution/Monitor.

• trimipramine

  codeine and trimipramine both increase sedation. Use Caution/Monitor.
  
  triprolidine and trimipramine both increase sedation. Use Caution/Monitor.

• xylometazoline

  pseudoephedrine and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

Minor (5)

• asenapine

  asenapine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• ashwagandha

  ashwagandha increases effects of triprolidine by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

• brimonidine

  brimonidine increases effects of codeine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
  
  brimonidine increases effects of triprolidine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• desmopressin

  desmopressin increases effects of pseudoephedrine by pharmacodynamic synergism. Minor/Significance Unknown.

• dextroamphetamine

  dextroamphetamine increases effects of codeine by unspecified interaction mechanism. Minor/Significance Unknown.

• abiraterone

  Monitor Closely (1)abiraterone increases levels of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• acetazolamide

  Monitor Closely (1)acetazolamide will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

• acrivastine

  Monitor Closely (1)acrivastine and triprolidine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)acrivastine and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• albuterol

  Monitor Closely (3)codeine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  albuterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alfentanil

  Monitor Closely (2)triprolidine and alfentanil both increase sedation. Use Caution/Monitor.
  
  alfentanil and codeine both increase sedation. Use Caution/Monitor.

• alfuzosin

  Monitor Closely (1)pseudoephedrine decreases effects of alfuzosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• alprazolam

  Monitor Closely (2)triprolidine and alprazolam both increase sedation. Use Caution/Monitor.
  
  alprazolam and codeine both increase sedation. Use Caution/Monitor.

• aluminum hydroxide

  Monitor Closely (1)aluminum hydroxide will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor. Caution advised with frequent or high dose antacids

• alvimopan

  Contraindicated (1)alvimopan, codeine. receptor binding competition. Contraindicated. Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). Patients recently exposed to opioids are expected to be more sensitive to the effects of alvimopan and therefore may experience abdominal pain, nausea and vomiting, and diarrhea. No significant interaction is expected with concurrent use of opioid analgesics and alvimopan in patients who received opioid analgesics for 7 or fewer consecutive days prior to alvimopan.

• amifampridine

  Monitor Closely (1)triprolidine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amiodarone

  Monitor Closely (1)amiodarone will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• amisulpride

  Monitor Closely (1)amisulpride and triprolidine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amisulpride and codeine both increase sedation. Avoid or Use Alternate Drug.

• amitriptyline

  Monitor Closely (2)triprolidine and amitriptyline both increase sedation. Use Caution/Monitor.
  
  codeine and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• ammonium chloride

  Monitor Closely (1)ammonium chloride decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

• amobarbital

  Monitor Closely (2)triprolidine and amobarbital both increase sedation. Use Caution/Monitor.
  
  amobarbital and codeine both increase sedation. Use Caution/Monitor.

• amoxapine

  Monitor Closely (2)triprolidine and amoxapine both increase sedation. Use Caution/Monitor.
  
  codeine and amoxapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amoxapine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• apomorphine

  Monitor Closely (1)codeine and apomorphine both increase sedation. Use Caution/Monitor.

• arformoterol

  Monitor Closely (3)arformoterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• aripiprazole

  Monitor Closely (2)triprolidine and aripiprazole both increase sedation. Use Caution/Monitor.
  
  codeine and aripiprazole both increase sedation. Use Caution/Monitor.

• armodafinil

  Monitor Closely (2)codeine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• artemether/lumefantrine

  Monitor Closely (1)artemether/lumefantrine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• asenapine

  Monitor Closely (1)asenapine and triprolidine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)asenapine and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequateMinor (1)asenapine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• asenapine transdermal

  Monitor Closely (1)asenapine transdermal and triprolidine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)asenapine transdermal and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• ashwagandha

  Minor (1)ashwagandha increases effects of triprolidine by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

• avapritinib

  Monitor Closely (1)avapritinib and triprolidine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)avapritinib and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• azelastine

  Monitor Closely (2)azelastine and triprolidine both increase sedation. Use Caution/Monitor.
  
  azelastine and codeine both increase sedation. Use Caution/Monitor.

• baclofen

  Monitor Closely (1)baclofen and codeine both increase sedation. Use Caution/Monitor.

• belladonna and opium

  Monitor Closely (2)codeine and belladonna and opium both increase sedation. Use Caution/Monitor.
  
  triprolidine and belladonna and opium both increase sedation. Use Caution/Monitor.

• benperidol

  Monitor Closely (2)triprolidine and benperidol both increase sedation. Use Caution/Monitor.
  
  codeine and benperidol both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  Monitor Closely (1)benzhydrocodone/acetaminophen and triprolidine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)benzhydrocodone/acetaminophen and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
  
  benzhydrocodone/acetaminophen, codeine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• benzphetamine

  Monitor Closely (3)benzphetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bremelanotide

  Serious - Use Alternative (1)bremelanotide will decrease the level or effect of codeine by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

• brexanolone

  Monitor Closely (2)brexanolone, codeine. Either increases toxicity of the other by sedation. Use Caution/Monitor.
  
  brexanolone, triprolidine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brexpiprazole

  Monitor Closely (2)brexpiprazole and triprolidine both increase sedation. Use Caution/Monitor.
  
  brexpiprazole and codeine both increase sedation. Use Caution/Monitor.

• brimonidine

  Monitor Closely (1)brimonidine and triprolidine both increase sedation. Use Caution/Monitor.Minor (2)brimonidine increases effects of codeine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
  
  brimonidine increases effects of triprolidine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.Serious - Use Alternative (1)brimonidine and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• brivaracetam

  Monitor Closely (2)brivaracetam and triprolidine both increase sedation. Use Caution/Monitor.
  
  brivaracetam and codeine both increase sedation. Use Caution/Monitor.

• bromocriptine

  Monitor Closely (1)bromocriptine, pseudoephedrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Hypertension, V tach.

• brompheniramine

  Monitor Closely (2)brompheniramine and triprolidine both increase sedation. Use Caution/Monitor.
  
  brompheniramine and codeine both increase sedation. Use Caution/Monitor.

• buprenorphine

  Monitor Closely (2)triprolidine and buprenorphine both increase sedation. Use Caution/Monitor.
  
  buprenorphine and codeine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• buprenorphine buccal

  Monitor Closely (2)triprolidine and buprenorphine buccal both increase sedation. Use Caution/Monitor.
  
  buprenorphine buccal and codeine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine buccal, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• buprenorphine subdermal implant

  Monitor Closely (1)buprenorphine subdermal implant and triprolidine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine subdermal implant and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine transdermal

  Monitor Closely (1)buprenorphine transdermal and triprolidine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine transdermal and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

• buprenorphine, long-acting injection

  Monitor Closely (1)codeine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

• bupropion

  Monitor Closely (1)bupropion will decrease the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents the conversion of codeine to its active metabolite morphine.

• butabarbital

  Monitor Closely (2)triprolidine and butabarbital both increase sedation. Use Caution/Monitor.
  
  butabarbital and codeine both increase sedation. Use Caution/Monitor.

• butalbital

  Monitor Closely (2)butalbital and codeine both increase sedation. Use Caution/Monitor.
  
  triprolidine and butalbital both increase sedation. Use Caution/Monitor.

• butorphanol

  Monitor Closely (2)triprolidine and butorphanol both increase sedation. Use Caution/Monitor.
  
  butorphanol and codeine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)butorphanol, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• cabergoline

  Serious - Use Alternative (1)cabergoline, pseudoephedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

• caffeine

  Monitor Closely (2)triprolidine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• calcium/magnesium/potassium/sodium oxybates

  Serious - Use Alternative (2)codeine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
  
  triprolidine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• carbinoxamine

  Monitor Closely (2)carbinoxamine and codeine both increase sedation. Use Caution/Monitor.
  
  carbinoxamine and triprolidine both increase sedation. Use Caution/Monitor.

• carisoprodol

  Monitor Closely (1)carisoprodol and codeine both increase sedation. Use Caution/Monitor.

• celecoxib

  Monitor Closely (1)celecoxib decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• cenobamate

  Monitor Closely (2)cenobamate, triprolidine. Either increases effects of the other by sedation. Use Caution/Monitor.
  
  cenobamate, codeine. Either increases effects of the other by sedation. Use Caution/Monitor.

• chloral hydrate

  Monitor Closely (2)triprolidine and chloral hydrate both increase sedation. Use Caution/Monitor.
  
  chloral hydrate and codeine both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  Monitor Closely (2)chlordiazepoxide and codeine both increase sedation. Use Caution/Monitor.
  
  triprolidine and chlordiazepoxide both increase sedation. Use Caution/Monitor.

• chloroquine

  Monitor Closely (1)chloroquine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• chlorpheniramine

  Monitor Closely (2)chlorpheniramine and codeine both increase sedation. Use Caution/Monitor.
  
  chlorpheniramine and triprolidine both increase sedation. Use Caution/Monitor.

• chlorpromazine

  Monitor Closely (4)chlorpromazine will decrease the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine
  
  codeine and chlorpromazine both increase sedation. Use Caution/Monitor.
  
  chlorpromazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.
  
  triprolidine and chlorpromazine both increase sedation. Use Caution/Monitor.

• chlorzoxazone

  Monitor Closely (1)chlorzoxazone and codeine both increase sedation. Use Caution/Monitor.

• cimetidine

  Monitor Closely (1)cimetidine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• cinacalcet

  Monitor Closely (1)cinacalcet decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• cinnarizine

  Monitor Closely (2)cinnarizine and codeine both increase sedation. Use Caution/Monitor.
  
  cinnarizine and triprolidine both increase sedation. Use Caution/Monitor.

• clemastine

  Monitor Closely (2)clemastine and triprolidine both increase sedation. Use Caution/Monitor.
  
  clemastine and codeine both increase sedation. Use Caution/Monitor.

• clobazam

  Monitor Closely (3)triprolidine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
  
  codeine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
  
  clobazam decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• clomipramine

  Monitor Closely (3)triprolidine and clomipramine both increase sedation. Use Caution/Monitor.
  
  codeine and clomipramine both increase sedation. Use Caution/Monitor.
  
  clomipramine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.Serious - Use Alternative (1)clomipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• clonazepam

  Monitor Closely (2)triprolidine and clonazepam both increase sedation. Use Caution/Monitor.
  
  clonazepam and codeine both increase sedation. Use Caution/Monitor.

• clonidine

  Serious - Use Alternative (1)clonidine, codeine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.

• clorazepate

  Monitor Closely (2)triprolidine and clorazepate both increase sedation. Use Caution/Monitor.
  
  clorazepate and codeine both increase sedation. Use Caution/Monitor.

• clozapine

  Monitor Closely (3)codeine and clozapine both increase sedation. Use Caution/Monitor.
  
  triprolidine and clozapine both increase sedation. Use Caution/Monitor.
  
  clozapine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• cocaine topical

  Monitor Closely (1)cocaine topical decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.Serious - Use Alternative (1)cocaine topical increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

• codeine

  Monitor Closely (1)triprolidine and codeine both increase sedation. Use Caution/Monitor.

• cyclizine

  Monitor Closely (2)cyclizine and triprolidine both increase sedation. Use Caution/Monitor.
  
  cyclizine and codeine both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  Monitor Closely (1)cyclobenzaprine and codeine both increase sedation. Use Caution/Monitor.

• cyproheptadine

  Monitor Closely (2)cyproheptadine and codeine both increase sedation. Use Caution/Monitor.
  
  cyproheptadine and triprolidine both increase sedation. Use Caution/Monitor.

• dacomitinib

  Serious - Use Alternative (1)dacomitinib will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• dantrolene

  Monitor Closely (1)dantrolene and codeine both increase sedation. Use Caution/Monitor.

• daridorexant

  Monitor Closely (2)codeine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
  
  triprolidine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  Monitor Closely (1)darifenacin decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• desflurane

  Monitor Closely (2)desflurane and triprolidine both increase sedation. Use Caution/Monitor.
  
  desflurane and codeine both increase sedation. Use Caution/Monitor. Opioids may decrease MAC requirements, less inhalation anesthetic may be required.

• desipramine

  Monitor Closely (3)codeine and desipramine both increase sedation. Use Caution/Monitor.
  
  triprolidine and desipramine both increase sedation. Use Caution/Monitor.
  
  desipramine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.Serious - Use Alternative (1)desipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• desmopressin

  Minor (1)desmopressin increases effects of pseudoephedrine by pharmacodynamic synergism. Minor/Significance Unknown.

• desvenlafaxine

  Monitor Closely (1)desvenlafaxine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgSerious - Use Alternative (1)desvenlafaxine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

• deutetrabenazine

  Monitor Closely (1)codeine and deutetrabenazine both increase sedation. Use Caution/Monitor.

• dexchlorpheniramine

  Monitor Closely (2)dexchlorpheniramine and triprolidine both increase sedation. Use Caution/Monitor.
  
  dexchlorpheniramine and codeine both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (3)dexfenfluramine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexmedetomidine

  Monitor Closely (2)triprolidine and dexmedetomidine both increase sedation. Use Caution/Monitor.
  
  dexmedetomidine and codeine both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  Monitor Closely (3)dexmethylphenidate and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine

  Monitor Closely (3)triprolidine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  dextroamphetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)dextroamphetamine increases effects of codeine by unspecified interaction mechanism. Minor/Significance Unknown.

• dextromoramide

  Monitor Closely (2)codeine and dextromoramide both increase sedation. Use Caution/Monitor.
  
  triprolidine and dextromoramide both increase sedation. Use Caution/Monitor.

• diamorphine

  Monitor Closely (2)triprolidine and diamorphine both increase sedation. Use Caution/Monitor.
  
  codeine and diamorphine both increase sedation. Use Caution/Monitor.

• diazepam

  Monitor Closely (1)diazepam and codeine both increase sedation. Use Caution/Monitor.

• diazepam intranasal

  Monitor Closely (1)diazepam intranasal, triprolidine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.Serious - Use Alternative (1)diazepam intranasal, codeine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• diethylpropion

  Monitor Closely (3)codeine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  diethylpropion and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• difelikefalin

  Monitor Closely (2)difelikefalin and codeine both increase sedation. Use Caution/Monitor.
  
  difelikefalin and triprolidine both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  Monitor Closely (2)triprolidine and difenoxin hcl both increase sedation. Use Caution/Monitor.
  
  codeine and difenoxin hcl both increase sedation. Use Caution/Monitor.

• dihydroergotamine

  Contraindicated (1)dihydroergotamine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

• dihydroergotamine inhaled

  Contraindicated (1)dihydroergotamine inhaled increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

• dihydroergotamine intranasal

  Contraindicated (1)dihydroergotamine intranasal increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

• dimenhydrinate

  Monitor Closely (2)dimenhydrinate and triprolidine both increase sedation. Use Caution/Monitor.
  
  dimenhydrinate and codeine both increase sedation. Use Caution/Monitor.

• diphenhydramine

  Monitor Closely (3)diphenhydramine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.
  
  diphenhydramine and codeine both increase sedation. Use Caution/Monitor.
  
  diphenhydramine and triprolidine both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  Monitor Closely (2)triprolidine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.
  
  codeine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

• dipipanone

  Monitor Closely (2)codeine and dipipanone both increase sedation. Use Caution/Monitor.
  
  triprolidine and dipipanone both increase sedation. Use Caution/Monitor.

• dobutamine

  Monitor Closely (3)codeine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  dobutamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• donepezil transdermal

  Monitor Closely (1)donepezil transdermal, triprolidine. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.

• dopamine

  Monitor Closely (3)dopamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopexamine

  Monitor Closely (3)dopexamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dosulepin

  Monitor Closely (2)codeine and dosulepin both increase sedation. Use Caution/Monitor.
  
  triprolidine and dosulepin both increase sedation. Use Caution/Monitor.

• doxapram

  Serious - Use Alternative (1)doxapram increases effects of pseudoephedrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

• doxazosin

  Monitor Closely (1)pseudoephedrine decreases effects of doxazosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• doxepin

  Monitor Closely (2)codeine and doxepin both increase sedation. Use Caution/Monitor.
  
  triprolidine and doxepin both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)doxepin increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• doxylamine

  Monitor Closely (2)triprolidine and doxylamine both increase sedation. Use Caution/Monitor.
  
  doxylamine and codeine both increase sedation. Use Caution/Monitor.

• dronedarone

  Monitor Closely (1)dronedarone decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• droperidol

  Monitor Closely (2)codeine and droperidol both increase sedation. Use Caution/Monitor.
  
  triprolidine and droperidol both increase sedation. Use Caution/Monitor.

• droxidopa

  Monitor Closely (1)pseudoephedrine and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension

• duloxetine

  Monitor Closely (1)duloxetine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.Serious - Use Alternative (1)duloxetine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

• eluxadoline

  Serious - Use Alternative (2)codeine, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. .
  
  triprolidine, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of codeine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• ephedrine

  Monitor Closely (4)ephedrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  ephedrine, pseudoephedrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
  
  codeine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  Monitor Closely (3)triprolidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  epinephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine inhaled

  Monitor Closely (1)pseudoephedrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• epinephrine racemic

  Monitor Closely (3)codeine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  epinephrine racemic and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ergoloid mesylates

  Contraindicated (1)ergoloid mesylates increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

• ergonovine

  Contraindicated (1)ergonovine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

• ergotamine

  Contraindicated (1)ergotamine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

• esketamine intranasal

  Monitor Closely (3)esketamine intranasal, pseudoephedrine. Either increases toxicity of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Closely monitor blood pressure with concomitant use of esketamine nasal with stimulants. .
  
  esketamine intranasal, codeine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
  
  esketamine intranasal, triprolidine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• estazolam

  Monitor Closely (2)triprolidine and estazolam both increase sedation. Use Caution/Monitor.
  
  estazolam and codeine both increase sedation. Use Caution/Monitor.

• ethanol

  Monitor Closely (2)triprolidine and ethanol both increase sedation. Use Caution/Monitor.
  
  codeine and ethanol both increase sedation. Use Caution/Monitor.

• etomidate

  Monitor Closely (2)etomidate and codeine both increase sedation. Use Caution/Monitor.
  
  etomidate and triprolidine both increase sedation. Use Caution/Monitor.

• eucalyptus

  Minor (2)triprolidine and eucalyptus both increase sedation. Minor/Significance Unknown.
  
  codeine and eucalyptus both increase sedation. Minor/Significance Unknown.

• fedratinib

  Monitor Closely (1)fedratinib will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenfluramine

  Monitor Closely (3)triprolidine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  fenfluramine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fentanyl

  Monitor Closely (1)fentanyl, triprolidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.Serious - Use Alternative (1)fentanyl, codeine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl intranasal

  Monitor Closely (1)fentanyl intranasal, triprolidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.Serious - Use Alternative (1)fentanyl intranasal, codeine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transdermal

  Monitor Closely (1)fentanyl transdermal, triprolidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.Serious - Use Alternative (1)fentanyl transdermal, codeine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transmucosal

  Monitor Closely (1)fentanyl transmucosal, triprolidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of fentanyl with anticholinergics may increase risk for urinary retention and/or severe constipation, which may lead to paralytic ileus.Serious - Use Alternative (1)fentanyl transmucosal, codeine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• flibanserin

  Monitor Closely (2)triprolidine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.
  
  codeine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

• fluoxetine

  Monitor Closely (1)fluoxetine will decrease the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphineMinor (1)fluoxetine decreases effects of codeine by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of codeine to active metabolite morphine.

• fluphenazine

  Monitor Closely (3)triprolidine and fluphenazine both increase sedation. Use Caution/Monitor.
  
  fluphenazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.
  
  codeine and fluphenazine both increase sedation. Use Caution/Monitor.

• flurazepam

  Monitor Closely (2)flurazepam and codeine both increase sedation. Use Caution/Monitor.
  
  triprolidine and flurazepam both increase sedation. Use Caution/Monitor.

• formoterol

  Monitor Closely (3)formoterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• gabapentin

  Monitor Closely (2)gabapentin, triprolidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
  
  gabapentin, codeine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  Monitor Closely (2)gabapentin enacarbil, triprolidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
  
  gabapentin enacarbil, codeine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• ganaxolone

  Monitor Closely (2)triprolidine and ganaxolone both increase sedation. Use Caution/Monitor.
  
  codeine and ganaxolone both increase sedation. Use Caution/Monitor.

• givosiran

  Serious - Use Alternative (1)givosiran will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• glycopyrronium tosylate topical

  Monitor Closely (1)glycopyrronium tosylate topical, triprolidine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.

• gotu kola

  Monitor Closely (1)gotu kola increases effects of triprolidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

• haloperidol

  Monitor Closely (3)triprolidine and haloperidol both increase sedation. Use Caution/Monitor.
  
  codeine and haloperidol both increase sedation. Use Caution/Monitor.
  
  haloperidol decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• hawthorn

  Monitor Closely (1)hawthorn increases effects of triprolidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

• hops

  Monitor Closely (1)hops increases effects of triprolidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

• hydralazine

  Monitor Closely (1)hydralazine, pseudoephedrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

• hydrocodone

  Serious - Use Alternative (1)hydrocodone, codeine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• hydromorphone

  Monitor Closely (2)triprolidine and hydromorphone both increase sedation. Use Caution/Monitor.
  
  codeine and hydromorphone both increase sedation. Use Caution/Monitor.

• hydroxyzine

  Monitor Closely (2)hydroxyzine and codeine both increase sedation. Use Caution/Monitor.
  
  hydroxyzine and triprolidine both increase sedation. Use Caution/Monitor.

• iloperidone

  Monitor Closely (2)triprolidine and iloperidone both increase sedation. Use Caution/Monitor.
  
  codeine and iloperidone both increase sedation. Use Caution/Monitor.

• imatinib

  Minor (2)imatinib will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
  
  imatinib decreases effects of codeine by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of codeine to active metabolite morphine.

• imipramine

  Monitor Closely (3)codeine and imipramine both increase sedation. Use Caution/Monitor.
  
  triprolidine and imipramine both increase sedation. Use Caution/Monitor.
  
  imipramine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.Serious - Use Alternative (1)imipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• insulin degludec

  Monitor Closely (1)pseudoephedrine decreases effects of insulin degludec by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

• insulin degludec/insulin aspart

  Monitor Closely (1)pseudoephedrine decreases effects of insulin degludec/insulin aspart by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

• insulin detemir

  Monitor Closely (1)pseudoephedrine decreases effects of insulin detemir by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

• insulin glargine

  Monitor Closely (1)pseudoephedrine decreases effects of insulin glargine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

• insulin inhaled

  Monitor Closely (1)pseudoephedrine decreases effects of insulin inhaled by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

• insulin regular human

  Monitor Closely (1)pseudoephedrine decreases effects of insulin regular human by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

• iobenguane I 123

  Serious - Use Alternative (1)pseudoephedrine decreases effects of iobenguane I 123 by receptor binding competition. Avoid or Use Alternate Drug. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results. Do not administer pseudoephedrine until at least 7 days after each iobenguane dose.

• iobenguane I 131

  Serious - Use Alternative (1)pseudoephedrine decreases effects of iobenguane I 131 by receptor binding competition. Avoid or Use Alternate Drug. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results. Do not administer pseudoephedrine until at least 7 days after each iobenguane dose.

• isocarboxazid

  Contraindicated (1)isocarboxazid increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.Serious - Use Alternative (1)isocarboxazid increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• isoflurane

  Serious - Use Alternative (1)isoflurane increases toxicity of pseudoephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

• isoniazid

  Monitor Closely (1)isoniazid decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• isoproterenol

  Monitor Closely (3)codeine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  isoproterenol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• kava

  Monitor Closely (1)kava increases effects of triprolidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

• ketamine

  Monitor Closely (2)ketamine and codeine both increase sedation. Use Caution/Monitor.
  
  ketamine and triprolidine both increase sedation. Use Caution/Monitor.

• ketoconazole

  Monitor Closely (1)ketoconazole decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• ketotifen, ophthalmic

  Monitor Closely (2)codeine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
  
  triprolidine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• lasmiditan

  Monitor Closely (2)lasmiditan, codeine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  
  lasmiditan, triprolidine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

• lemborexant

  Monitor Closely (2)lemborexant, codeine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
  
  lemborexant, triprolidine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• letermovir

  Monitor Closely (1)letermovir increases levels of codeine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levalbuterol

  Monitor Closely (3)levalbuterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levoketoconazole

  Monitor Closely (1)levoketoconazole decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• levomilnacipran

  Serious - Use Alternative (1)levomilnacipran increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

• levorphanol

  Monitor Closely (2)triprolidine and levorphanol both increase sedation. Use Caution/Monitor.
  
  codeine and levorphanol both increase sedation. Use Caution/Monitor.

• lidocaine

  Minor (1)lidocaine increases toxicity of codeine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.

• linezolid

  Contraindicated (1)linezolid increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.Serious - Use Alternative (1)linezolid increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• lisdexamfetamine

  Monitor Closely (3)lisdexamfetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lofepramine

  Monitor Closely (2)triprolidine and lofepramine both increase sedation. Use Caution/Monitor.
  
  codeine and lofepramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)lofepramine, pseudoephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• lofexidine

  Monitor Closely (2)codeine and lofexidine both increase sedation. Use Caution/Monitor.
  
  triprolidine and lofexidine both increase sedation. Use Caution/Monitor.

• lopinavir

  Monitor Closely (1)lopinavir decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• loprazolam

  Monitor Closely (2)triprolidine and loprazolam both increase sedation. Use Caution/Monitor.
  
  loprazolam and codeine both increase sedation. Use Caution/Monitor.

• lorazepam

  Monitor Closely (2)triprolidine and lorazepam both increase sedation. Use Caution/Monitor.
  
  lorazepam and codeine both increase sedation. Use Caution/Monitor.

• lorcaserin

  Monitor Closely (1)lorcaserin will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• lormetazepam

  Monitor Closely (2)triprolidine and lormetazepam both increase sedation. Use Caution/Monitor.
  
  lormetazepam and codeine both increase sedation. Use Caution/Monitor.

• loxapine

  Monitor Closely (2)codeine and loxapine both increase sedation. Use Caution/Monitor.
  
  triprolidine and loxapine both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  Monitor Closely (2)triprolidine and loxapine inhaled both increase sedation. Use Caution/Monitor.
  
  codeine and loxapine inhaled both increase sedation. Use Caution/Monitor.

• lumefantrine

  Monitor Closely (1)lumefantrine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• lurasidone

  Monitor Closely (2)lurasidone, triprolidine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
  
  lurasidone, codeine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

• maprotiline

  Monitor Closely (2)triprolidine and maprotiline both increase sedation. Use Caution/Monitor.
  
  codeine and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline, pseudoephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• maraviroc

  Minor (1)maraviroc will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• marijuana

  Monitor Closely (2)triprolidine and marijuana both increase sedation. Use Caution/Monitor.
  
  codeine and marijuana both increase sedation. Use Caution/Monitor.Minor (1)marijuana will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• melatonin

  Monitor Closely (2)triprolidine and melatonin both increase sedation. Use Caution/Monitor.
  
  codeine and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  Monitor Closely (2)triprolidine and meperidine both increase sedation. Use Caution/Monitor.
  
  codeine and meperidine both increase sedation. Use Caution/Monitor.

• meprobamate

  Monitor Closely (2)triprolidine and meprobamate both increase sedation. Use Caution/Monitor.
  
  codeine and meprobamate both increase sedation. Use Caution/Monitor.

• metaproterenol

  Monitor Closely (3)metaproterenol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaxalone

  Monitor Closely (1)metaxalone and codeine both increase sedation. Use Caution/Monitor.

• methadone

  Monitor Closely (2)codeine and methadone both increase sedation. Use Caution/Monitor.
  
  triprolidine and methadone both increase sedation. Use Caution/Monitor.

• methamphetamine

  Monitor Closely (3)codeine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  methamphetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methenamine

  Monitor Closely (1)methenamine decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

• methocarbamol

  Monitor Closely (1)methocarbamol and codeine both increase sedation. Use Caution/Monitor.

• methoxyflurane

  Serious - Use Alternative (1)methoxyflurane increases toxicity of pseudoephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

• methyldopa

  Monitor Closely (1)methyldopa increases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor.

• methylene blue

  Serious - Use Alternative (1)methylene blue and codeine both increase serotonin levels. Avoid or Use Alternate Drug. If drug combination must be administered, monitor for evidence of serotonergic or opioid-related toxicities

• methylenedioxymethamphetamine

  Monitor Closely (3)codeine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  methylenedioxymethamphetamine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methylergonovine

  Contraindicated (1)methylergonovine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.

• metoclopramide intranasal

  Serious - Use Alternative (2)codeine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
  
  triprolidine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• midazolam

  Monitor Closely (2)triprolidine and midazolam both increase sedation. Use Caution/Monitor.
  
  midazolam and codeine both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  Monitor Closely (2)midazolam intranasal, codeine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
  
  midazolam intranasal, triprolidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  Monitor Closely (3)midodrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• milnacipran

  Serious - Use Alternative (1)milnacipran increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

• mirabegron

  Monitor Closely (1)mirabegron will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  Monitor Closely (2)codeine and mirtazapine both increase sedation. Use Caution/Monitor.
  
  triprolidine and mirtazapine both increase sedation. Use Caution/Monitor.

• modafinil

  Monitor Closely (2)codeine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  Monitor Closely (2)codeine and morphine both increase sedation. Use Caution/Monitor.
  
  triprolidine and morphine both increase sedation. Use Caution/Monitor.

• motherwort

  Monitor Closely (2)codeine and motherwort both increase sedation. Use Caution/Monitor.
  
  triprolidine and motherwort both increase sedation. Use Caution/Monitor.

• moxonidine

  Monitor Closely (2)codeine and moxonidine both increase sedation. Use Caution/Monitor.
  
  triprolidine and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  Monitor Closely (2)codeine and nabilone both increase sedation. Use Caution/Monitor.
  
  triprolidine and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  Monitor Closely (2)codeine and nalbuphine both increase sedation. Use Caution/Monitor.
  
  triprolidine and nalbuphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)nalbuphine, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• nateglinide

  Monitor Closely (1)pseudoephedrine decreases effects of nateglinide by pharmacodynamic antagonism. Use Caution/Monitor. Coadministration may reduce nateglinide's hypoglycemic action.

• nettle

  Minor (1)nettle increases effects of triprolidine by pharmacodynamic synergism. Minor/Significance Unknown. (High dose nettle; theoretical interaction) May enhance CNS depression.

• nilotinib

  Minor (1)nilotinib will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• norepinephrine

  Monitor Closely (3)triprolidine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  norepinephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nortriptyline

  Monitor Closely (2)triprolidine and nortriptyline both increase sedation. Use Caution/Monitor.
  
  codeine and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)nortriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• olanzapine

  Monitor Closely (2)codeine and olanzapine both increase sedation. Use Caution/Monitor.
  
  triprolidine and olanzapine both increase sedation. Use Caution/Monitor.

• oliceridine

  Monitor Closely (1)oliceridine, codeine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• olodaterol inhaled

  Monitor Closely (1)pseudoephedrine and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects

• olopatadine intranasal

  Serious - Use Alternative (2)codeine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
  
  triprolidine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• opium tincture

  Monitor Closely (2)triprolidine and opium tincture both increase sedation. Use Caution/Monitor.
  
  codeine and opium tincture both increase sedation. Use Caution/Monitor.

• orphenadrine

  Monitor Closely (1)orphenadrine and codeine both increase sedation. Use Caution/Monitor.

• oxazepam

  Monitor Closely (2)triprolidine and oxazepam both increase sedation. Use Caution/Monitor.
  
  oxazepam and codeine both increase sedation. Use Caution/Monitor.

• oxycodone

  Monitor Closely (2)triprolidine and oxycodone both increase sedation. Use Caution/Monitor.
  
  codeine and oxycodone both increase sedation. Use Caution/Monitor.

• oxymorphone

  Monitor Closely (2)triprolidine and oxymorphone both increase sedation. Use Caution/Monitor.
  
  codeine and oxymorphone both increase sedation. Use Caution/Monitor.

• oxytocin

  Monitor Closely (1)oxytocin increases effects of pseudoephedrine by pharmacodynamic synergism. Use Caution/Monitor.

• ozanimod

  Serious - Use Alternative (2)ozanimod and codeine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
  
  ozanimod increases toxicity of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• paliperidone

  Monitor Closely (2)triprolidine and paliperidone both increase sedation. Use Caution/Monitor.
  
  codeine and paliperidone both increase sedation. Use Caution/Monitor.

• papaveretum

  Monitor Closely (2)triprolidine and papaveretum both increase sedation. Use Caution/Monitor.
  
  codeine and papaveretum both increase sedation. Use Caution/Monitor.

• papaverine

  Monitor Closely (2)triprolidine and papaverine both increase sedation. Use Caution/Monitor.
  
  codeine and papaverine both increase sedation. Use Caution/Monitor.

• parecoxib

  Minor (1)parecoxib will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• paroxetine

  Monitor Closely (1)paroxetine will decrease the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• passion flower

  Monitor Closely (1)passion flower increases effects of triprolidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

• peginterferon alfa 2b

  Monitor Closely (1)peginterferon alfa 2b, codeine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

• pegvisomant

  Monitor Closely (1)codeine decreases effects of pegvisomant by unknown mechanism. Use Caution/Monitor.

• pentazocine

  Monitor Closely (2)codeine and pentazocine both increase sedation. Use Caution/Monitor.
  
  triprolidine and pentazocine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)pentazocine, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Mixed opiate agonist/antagonists usually produce additive sedation with narcotics; however, in narcotic addicted pts., the antagonist activity may provoke withdrawal Sx.

• pentobarbital

  Monitor Closely (2)triprolidine and pentobarbital both increase sedation. Use Caution/Monitor.
  
  pentobarbital and codeine both increase sedation. Use Caution/Monitor.

• perampanel

  Monitor Closely (1)perampanel and codeine both increase sedation. Use Caution/Monitor.

• perphenazine

  Monitor Closely (3)triprolidine and perphenazine both increase sedation. Use Caution/Monitor.
  
  codeine and perphenazine both increase sedation. Use Caution/Monitor.
  
  perphenazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.Minor (2)perphenazine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
  
  perphenazine decreases effects of codeine by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of codeine to active metabolite morphine.

• phendimetrazine

  Monitor Closely (3)phendimetrazine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenelzine

  Contraindicated (1)phenelzine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.Serious - Use Alternative (1)phenelzine increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• phenobarbital

  Monitor Closely (2)triprolidine and phenobarbital both increase sedation. Use Caution/Monitor.
  
  phenobarbital and codeine both increase sedation. Use Caution/Monitor.

• phentermine

  Monitor Closely (3)phentermine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine

  Monitor Closely (3)triprolidine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  phenylephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine PO

  Monitor Closely (3)codeine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
  
  triprolidine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
  
  phenylephrine PO and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• pholcodine

  Monitor Closely (2)triprolidine and pholcodine both increase sedation. Use Caution/Monitor.
  
  codeine and pholcodine both increase sedation. Use Caution/Monitor.

• pimozide

  Monitor Closely (2)triprolidine and pimozide both increase sedation. Use Caution/Monitor.
  
  codeine and pimozide both increase sedation. Use Caution/Monitor.

• pirbuterol

  Monitor Closely (3)triprolidine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  pirbuterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pitolisant

  Serious - Use Alternative (1)triprolidine decreases effects of pitolisant by Other (see comment). Avoid or Use Alternate Drug. Comment: Pitolisant increases histamine levels in the brain; therefore, H1 receptor antagonists that cross the blood-brain barrier may reduce the efficacy of pitolisant.

• potassium phosphate

  Monitor Closely (1)potassium phosphate decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

• prasugrel

  Serious - Use Alternative (1)codeine will decrease the level or effect of prasugrel by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Co-administration of opioid agonists delay and reduce absorption of prasugrel and its active metabolite presumably by slowing gastric emptying; consider the use of a parenteral anti-platelet agent in acute coronary syndrome patients requiring co-administration of opioid agonists

• pregabalin

  Monitor Closely (2)pregabalin, codeine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.
  
  pregabalin, triprolidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primidone

  Monitor Closely (2)triprolidine and primidone both increase sedation. Use Caution/Monitor.
  
  primidone and codeine both increase sedation. Use Caution/Monitor.

• procarbazine

  Contraindicated (1)procarbazine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.Serious - Use Alternative (1)procarbazine increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. MAOIs may potentiate CNS depression and hypotension. Do not use within 14 days of MAOI use. .

• prochlorperazine

  Monitor Closely (3)codeine and prochlorperazine both increase sedation. Use Caution/Monitor.
  
  prochlorperazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.
  
  triprolidine and prochlorperazine both increase sedation. Use Caution/Monitor.

• promazine

  Monitor Closely (1)promazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

• promethazine

  Monitor Closely (3)promethazine and triprolidine both increase sedation. Use Caution/Monitor.
  
  promethazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.
  
  promethazine and codeine both increase sedation. Use Caution/Monitor.

• propafenone

  Minor (2)propafenone will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
  
  propafenone decreases effects of codeine by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of codeine to active metabolite morphine.

• propofol

  Monitor Closely (2)propofol and triprolidine both increase sedation. Use Caution/Monitor.
  
  propofol and codeine both increase sedation. Use Caution/Monitor.

• propylhexedrine

  Monitor Closely (3)triprolidine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  propylhexedrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protriptyline

  Monitor Closely (2)codeine and protriptyline both increase sedation. Use Caution/Monitor.
  
  triprolidine and protriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)protriptyline increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• quazepam

  Monitor Closely (2)quazepam and codeine both increase sedation. Use Caution/Monitor.
  
  triprolidine and quazepam both increase sedation. Use Caution/Monitor.

• quetiapine

  Monitor Closely (2)codeine and quetiapine both increase sedation. Use Caution/Monitor.
  
  triprolidine and quetiapine both increase sedation. Use Caution/Monitor.

• quinacrine

  Minor (2)quinacrine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
  
  quinacrine decreases effects of codeine by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of codeine to active metabolite morphine.

• quinidine

  Monitor Closely (1)quinidine will decrease the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• ramelteon

  Monitor Closely (2)codeine and ramelteon both increase sedation. Use Caution/Monitor.
  
  triprolidine and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  Minor (1)ranolazine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• rasagiline

  Contraindicated (1)rasagiline increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.Serious - Use Alternative (1)rasagiline increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.

• remimazolam

  Monitor Closely (1)remimazolam, codeine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• ribociclib

  Monitor Closely (1)ribociclib will increase the level or effect of codeine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• risperidone

  Monitor Closely (2)codeine and risperidone both increase sedation. Use Caution/Monitor.
  
  triprolidine and risperidone both increase sedation. Use Caution/Monitor.

• ritonavir

  Monitor Closely (1)ritonavir will decrease the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• rolapitant

  Monitor Closely (1)rolapitant will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• safinamide

  Monitor Closely (1)pseudoephedrine and safinamide both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Monitor patients for hypertension if safinamide is prescribed concomitantly with prescription or nonprescription sympathomimetics, including nasal, oral, or ophthalmic decongestants and cold remedies.

• sage

  Minor (2)codeine and sage both increase sedation. Minor/Significance Unknown.
  
  triprolidine and sage both increase sedation. Minor/Significance Unknown.

• salmeterol

  Monitor Closely (3)salmeterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  codeine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• scullcap

  Monitor Closely (2)codeine and scullcap both increase sedation. Use Caution/Monitor.
  
  triprolidine and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  Monitor Closely (2)triprolidine and secobarbital both increase sedation. Use Caution/Monitor.
  
  secobarbital and codeine both increase sedation. Use Caution/Monitor.

• selegiline

  Contraindicated (1)selegiline increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.Monitor Closely (1)selegiline increases toxicity of codeine by unknown mechanism. Modify Therapy/Monitor Closely. Potential for increased CNS depression, drowsiness, dizziness or hypotension, so use with any MAOI should be cautious.

• selegiline transdermal

  Contraindicated (1)selegiline transdermal increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.Serious - Use Alternative (1)selegiline transdermal increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death.

• selinexor

  Serious - Use Alternative (1)selinexor, codeine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• serdexmethylphenidate/dexmethylphenidate

  Monitor Closely (2)serdexmethylphenidate/dexmethylphenidate and pseudoephedrine both decrease sedation. Use Caution/Monitor.
  
  serdexmethylphenidate/dexmethylphenidate and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• sertraline

  Monitor Closely (1)sertraline decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.Minor (1)sertraline decreases effects of codeine by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of codeine to active metabolite morphine.

• sevoflurane

  Monitor Closely (2)sevoflurane and triprolidine both increase sedation. Use Caution/Monitor.
  
  sevoflurane and codeine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)sevoflurane increases toxicity of pseudoephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

• shepherd's purse

  Monitor Closely (2)triprolidine and shepherd's purse both increase sedation. Use Caution/Monitor.
  
  codeine and shepherd's purse both increase sedation. Use Caution/Monitor.

• Siberian ginseng

  Minor (1)Siberian ginseng increases effects of triprolidine by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

• silodosin

  Monitor Closely (1)pseudoephedrine decreases effects of silodosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• sodium bicarbonate

  Monitor Closely (1)sodium bicarbonate will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor. Caution advised with frequent or high dose antacids

• sodium citrate/citric acid

  Monitor Closely (1)sodium citrate/citric acid will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

• sodium lactate

  Monitor Closely (1)sodium lactate will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

• sodium oxybate

  Serious - Use Alternative (2)codeine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
  
  triprolidine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• sodium phosphates, IV

  Monitor Closely (1)sodium phosphates, IV decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

• solriamfetol

  Monitor Closely (1)pseudoephedrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• spironolactone

  Monitor Closely (1)spironolactone decreases effects of pseudoephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

• stiripentol

  Monitor Closely (2)stiripentol, codeine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
  
  stiripentol, triprolidine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• sufentanil

  Monitor Closely (2)codeine and sufentanil both increase sedation. Use Caution/Monitor.
  
  triprolidine and sufentanil both increase sedation. Use Caution/Monitor.

• sufentanil SL

  Serious - Use Alternative (1)sufentanil SL, codeine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• suvorexant

  Monitor Closely (1)suvorexant and codeine both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary

• tamsulosin

  Monitor Closely (1)pseudoephedrine decreases effects of tamsulosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• tapentadol

  Monitor Closely (2)codeine and tapentadol both increase sedation. Use Caution/Monitor.
  
  triprolidine and tapentadol both increase sedation. Use Caution/Monitor.

• temazepam

  Monitor Closely (2)triprolidine and temazepam both increase sedation. Use Caution/Monitor.
  
  temazepam and codeine both increase sedation. Use Caution/Monitor.

• terazosin

  Monitor Closely (1)pseudoephedrine decreases effects of terazosin by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• terbinafine

  Monitor Closely (1)terbinafine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  Monitor Closely (3)codeine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  triprolidine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  terbutaline and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• thioridazine

  Monitor Closely (4)triprolidine and thioridazine both increase sedation. Use Caution/Monitor.
  
  thioridazine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.
  
  thioridazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.
  
  codeine and thioridazine both increase sedation. Use Caution/Monitor.Minor (1)thioridazine decreases effects of codeine by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of codeine to active metabolite morphine.

• thiothixene

  Monitor Closely (2)codeine and thiothixene both increase sedation. Use Caution/Monitor.
  
  triprolidine and thiothixene both increase sedation. Use Caution/Monitor.

• ticagrelor

  Serious - Use Alternative (1)codeine will decrease the level or effect of ticagrelor by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Co-administration of opioid agonists delay and reduce absorption of ticagrelor and its active metabolite presumably by slowing gastric emptying; consider the use of a parenteral anti-platelet agent in acute coronary syndrome patients requiring co-administration of opioid agonists

• ticlopidine

  Monitor Closely (1)ticlopidine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• tipranavir

  Minor (1)tipranavir will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• topiramate

  Monitor Closely (2)triprolidine and topiramate both increase sedation. Modify Therapy/Monitor Closely.
  
  codeine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  Monitor Closely (2)triprolidine and tramadol both increase sedation. Use Caution/Monitor.
  
  codeine and tramadol both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)tramadol, codeine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tramadol may reinitiate opiate dependence in pts. previously addicted to other opiates; it may also provoke withdrawal Sx. in pts. who are currently opiate dependent.

• tranylcypromine

  Contraindicated (1)tranylcypromine increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.Monitor Closely (1)tranylcypromine decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.Serious - Use Alternative (1)tranylcypromine increases toxicity of codeine by unknown mechanism. Avoid or Use Alternate Drug. Risk of hypotension, hyperpyrexia, somnolence, or death; separate by 14 d.

• trazodone

  Monitor Closely (2)codeine and trazodone both increase sedation. Use Caution/Monitor.
  
  triprolidine and trazodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trazodone, pseudoephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• triazolam

  Monitor Closely (2)triprolidine and triazolam both increase sedation. Use Caution/Monitor.
  
  triazolam and codeine both increase sedation. Use Caution/Monitor.

• triclofos

  Monitor Closely (2)triprolidine and triclofos both increase sedation. Use Caution/Monitor.
  
  triclofos and codeine both increase sedation. Use Caution/Monitor.

• trifluoperazine

  Monitor Closely (3)codeine and trifluoperazine both increase sedation. Use Caution/Monitor.
  
  trifluoperazine, pseudoephedrine. Mechanism: unknown. Use Caution/Monitor. Consider avoiding use of pseudoephedrine in patients receiving phenothiazines (especially thioridazine) due to the potential risk of cardiac arrhythmia or sudden death. Monitor for evidence of ventricular arrhythmias during concomitant use.
  
  triprolidine and trifluoperazine both increase sedation. Use Caution/Monitor.

• trimipramine

  Monitor Closely (2)codeine and trimipramine both increase sedation. Use Caution/Monitor.
  
  triprolidine and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

• triprolidine

  Monitor Closely (1)triprolidine and codeine both increase sedation. Use Caution/Monitor.

• valerian

  Monitor Closely (1)valerian increases effects of triprolidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.Serious - Use Alternative (1)valerian and codeine both increase sedation. Avoid or Use Alternate Drug.

• venlafaxine

  Monitor Closely (1)venlafaxine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Minor (1)venlafaxine decreases effects of codeine by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of codeine to active metabolite morphine.Serious - Use Alternative (1)venlafaxine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.

• xylometazoline

  Monitor Closely (3)codeine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  pseudoephedrine and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
  
  triprolidine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• yohimbine

  Monitor Closely (2)triprolidine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  codeine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziconotide

  Monitor Closely (2)triprolidine and ziconotide both increase sedation. Use Caution/Monitor.
  
  codeine and ziconotide both increase sedation. Use Caution/Monitor.Minor (1)ziconotide, codeine. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Additive decreased GI motility. Additive analgesia. Ziconotide does NOT potentiate opioid induced respiratory depression.

• ziprasidone

  Monitor Closely (2)codeine and ziprasidone both increase sedation. Use Caution/Monitor.
  
  triprolidine and ziprasidone both increase sedation. Use Caution/Monitor.

• zotepine

  Monitor Closely (2)codeine and zotepine both increase sedation. Use Caution/Monitor.
  
  triprolidine and zotepine both increase sedation. Use Caution/Monitor.