Can I take Co-codamol and Sertraline together?

Caution is advised when taking co-codamol and sertraline together as combining them can increase the risk of serotonin syndrome.

Always speak to your doctor before combining these medicines.

How they work

Both drugs affect a chemical in the brain called serotonin; when levels get too high, it causes side effects.

Sertraline blocks a specific liver enzyme (CYP2D6) that the body needs to convert codeine into morphine. If this conversion doesn't happen, the pain-killing effect is lost.

How to take co-codamol and sertraline safely

• Speak to your doctor before taking these medicines.

• If you must take both, be alert for signs of serotonin syndrome, such as shivering, diarrhoea, fever, sweating, or muscle stiffness.

• If you find that co-codamol is not helping your pain, your doctor may suggest an alternative painkiller such as paracetamol (without codeine) or ibuprofen.

Important precautions

Depression and anxiety disorders

You may experience an increase in suicidal thoughts or the urge to self-harm when first starting sertraline or changing the dose. This is more common in young adults under 25. Contact your doctor or go to hospital immediately if you notice any changes in your mood or behaviour.

Serotonin syndrome

Taking these together increases the risk of serotonin syndrome, a potentially life-threatening condition. Seek immediate medical help if you experience agitation, hallucinations, rapid heart rate, or severe muscle twitching.

Paracetamol overdose

Co-codamol contains paracetamol. Do not take it with any other paracetamol-containing products (such as cold and flu remedies), as this can lead to fatal liver damage.

Opioid addiction and withdrawal

Co-codamol contains codeine, which can cause addiction if used for more than 3 days. Stopping suddenly after long-term use can cause withdrawal symptoms.

Breathing difficulties

Do not take co-codamol if you have severe asthma or breathing problems, as the codeine can dangerously slow your breathing.

Increased bleeding risk

Sertraline increases your risk of serious bleeding, especially in the stomach. This risk is significantly higher if you also take aspirin, ibuprofen (NSAIDs), or blood-thinning medications such as warfarin.

Low sodium levels (hyponatremia)

Sertraline can cause a serious drop in blood sodium levels, especially in older patients or those taking diuretics. Seek medical help if you experience extreme confusion, weakness, or unsteady gait.

Food and drink warnings

Alcohol

You must avoid drinking alcohol while taking co-codamol. Combining alcohol with codeine increases the risk of serious side effects, such as extreme sleepiness, breathing difficulties, and loss of consciousness. Additionally, both alcohol and paracetamol can affect the liver; combining them regularly increases the risk of liver damage.

It is best to avoid or strictly limit alcohol while taking sertraline. Combining alcohol with this medicine can increase side effects such as drowsiness, dizziness, and impaired coordination. It may also make your depression or anxiety symptoms worse.

Grapefruit juice

Grapefruit juice can interfere with how your body processes codeine, potentially making the medicine less effective or increasing the risk of side effects. It is best to avoid grapefruit juice while taking this medicine. Avoid drinking large amounts of grapefruit juice. Grapefruit can increase the levels of sertraline in your blood, which may increase the risk of side effects.

Caffeine

Some versions of co-codamol already contain caffeine. If you consume extra caffeine from coffee, tea, or energy drinks, it may make you feel shaky, anxious, or cause a racing heart.

Sertraline can sometimes cause nervousness or tremors. Consuming high amounts of caffeine may worsen these side effects or increase feelings of anxiety. It is advisable to monitor your caffeine intake.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.