What the FDA labels say about taking them together
Acetaminophen, butalbital, caffeine and codeine and hydromorphone
Acetaminophen, butalbital, caffeine and codeine's FDA label of January 9, 2026 names hydromorphone in its drug interactions section; hydromorphone's label does not name acetaminophen, butalbital, caffeine and codeine itself but warns about its class (Barbiturates, Stimulants, Opioids (opioid agonists)). The acetaminophen, butalbital, caffeine and codeine label: “MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity.”
Check it at the source: the acetaminophen, butalbital, caffeine and codeine FDA label on DailyMed (effective January 9, 2026, Actavis Pharma, Inc.); the hydromorphone FDA label on DailyMed (effective May 14, 2026, Rhodes Pharmaceuticals LLC).
What does the acetaminophen, butalbital, caffeine and codeine label say about hydromorphone?
Acetaminophen, butalbital, caffeine and codeine label, drug interactionsMonoamine Oxidase Inhibitors (MAOIs) Clinical Impact: MAOI interactions with opioids may manifest as serotonin syndrome or opioid toxicity (…). … doses and frequent titration of small doses of other opioids (such as oxycodone, hydrocodone, oxymorphone, hydromorphone, or buprenorphine) to treat pain while closely monitoring blood pressure and signs and symptoms of CNS and respiratory depression. Examples: phenelzine, tranylcypromine, linezolid
Source: FDA drug label (Butalbital, Acetaminophen, Caffeine, and Codeine Phosphate), Actavis Pharma, Inc., effective January 9, 2026 (SPL set a58819b8-a52c-44a7-9ab0-c74480d98506), via openFDA; the full label on DailyMed
What does the hydromorphone label say about acetaminophen, butalbital, caffeine and codeine?
Hydromorphone's label does not name acetaminophen, butalbital, caffeine and codeine itself; it warns about its class (Barbiturates, Stimulants, Opioids (opioid agonists)):
Hydromorphone label, boxed warningTo reduce the risk of respiratory depression, proper dosing and titration of hydromorphone hydrochloride oral solution or hydromorphone hydrochloride tablets are essential. ( 5.3 ) Accidental ingestion of hydromorphone hydrochloride oral solution or hydromorphone hydrochloride tablets, especially by children, can result in a fatal overdose of hydromorphone. …
Hydromorphone label, warnings and precautionsLife-Threatening Respiratory Depression Serious, life-threatening, or fatal respiratory depression has been reported with the use of opioids, even when used as recommended.
Source: FDA drug label (Hydromorphone Hydrochloride), Rhodes Pharmaceuticals LLC, effective May 14, 2026 (SPL set 37565441-0d95-4743-a695-d7b3326f58a1), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Acetaminophen, butalbital, caffeine and codeine | Hydromorphone | |
|---|---|---|
| Labeled for | Pain | Pain |
| Boxed warning | Yes | Yes |
| Pharmacy cost (NADAC) | $0.798 per capsule 50-325-40-30 mg capsule | $0.219 per tablet 4 mg tablet |
| Shortage now | No current entry | In shortage |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
What next?
- Check more medicines together
- up to five at once