Butalbital, aspirin, caffeine, and codeine and Duloxetine interaction
Butalbital, aspirin, caffeine, and codeine and Duloxetine: both prescribing labels flag this combination with the strongest language, such as a contraindication, a boxed warning, or an instruction to avoid it.
Do not combine without a prescriber's guidance. The label language below is the strongest FDA uses.
What the FDA labels say
From the Butalbital, aspirin, caffeine, and codeine (BUTALBITAL, ASPIRIN, CAFFEINE and CODEINE PHOSPHATE) label · effective 2026-01-15
The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with codeine are complex.
Use of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with BUTALBITAL, ASPIRIN, CAFFEINE and CODEINE PHOSPHATE requires careful consideration of the effects on codeine, and the active metabolite, morphine.
Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with codeine are complex.
Intervention: Avoid concomitant use Serotonergic Drugs : Concomitant use may result in serotonin syndrome.
Risks of Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with codeine are complex.
From the Duloxetine label · effective 2026-03-02
Inform patients about the increased risk of bleeding associated with the concomitant use of Duloxetine Delayed-Release Capsules and NSAIDs, aspirin, or other drugs that affect coagulation [see Drug Interactions ( 7.1 )] .
Concomitant use of antiplatelet drugs and anticoagulants may increase this risk.
The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, and St.
Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, and other anti-coagulants may add to this risk.
Drugs that Interfere with Hemostasis Prevention or Management Closely monitor for bleeding for patients receiving an antiplatelet or anticoagulant drug when Duloxetine Delayed-Release Capsules are initiated or discontinued [Warnings and Precaution ( 5.5 )] .
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Open in the checkerNot medical advice. Interaction Checker quotes FDA label text and NIH fact sheets. Whether an interaction matters for you depends on doses, timing, kidney and liver function, and other conditions. Confirm with a pharmacist or prescriber.