Codeine : Uses, Side Effects, Interactions & More
Codeine can be habit-forming. Take codeine exactly as directed. Do not take more, take it more often, or take it in a way other than that directed by your doctor. While taking codeine, talk with your healthcare provider about your pain management goals, the length of treatment, and other ways to manage your pain. Tell your doctor if you or anyone in your family drinks or has ever had large amounts of alcohol, uses or has ever used illegal drugs, or has overused prescription drugs, or if you have or have ever had depression or other Mental illness. There is an increased risk that you will abuse codeine if you have or have ever had any of these conditions. Talk to your healthcare provider right away for guidance if you think you have an opioid addiction or call the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP.
Codeine can cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and each time your dose is increased. Your doctor will monitor you carefully during your treatment. Tell your doctor if you have or have ever had slow breathing or asthma. Your doctor will probably tell you not to take codeine. Also tell your doctor if you have or have ever had a lung disease such as chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways), a head injury, or any condition that increases the amount of pressure on the brain. Your risk of developing breathing problems may be higher if you are an older adult or are weak or malnourished due to illness. If you experience any of the following symptoms, call your doctor immediately or seek emergency medical treatment: slow breathing, long pauses between breaths, or difficulty breathing.
When codeine was used in children, serious and life-threatening respiratory problems, such as slow breathing or difficulty breathing, and deaths were reported. Codeine should never be used to treat pain or cough in children under 18 years of age. If your child is currently prescribed a cough and cold medicine that contains codeine, talk with your child’s doctor about other treatments.
Taking certain medications during your codeine treatment may increase the risk that you will experience breathing problems or other serious and life-threatening breathing problems, sedation, or coma. Tell your doctor if you are taking or plan to take any of the following medications: certain antibiotics such as erythromycin (Erytab, Erythrocin); certain antifungal medications, including ketoconazole; benzodiazepines such as alprazolam (Xanax), diazepam (Diastat, Valium), estazolam, flurazepam, lorazepam (Ativan), and triazolam (Halcion); carbamazepine (Carbatrol, Epitol, Equetro, Tegretol, Teril); certain medications for the human immunodeficiency virus (HIV), including indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir, in Kaletra); medications for mental illness or nausea; other pain medications; muscle relaxants; phenytoin (Dilantin, Phenytek); rifampicin (Rifadin, Rimactane, in Rifamate); sedative sleeping pills; or tranquilizers. Your doctor may need to change the doses of your medications and will monitor you carefully. If you take codeine with any of these medications and experience any of the following symptoms, call your doctor immediately or seek emergency medical attention: unusual dizziness, lightheadedness, extreme drowsiness, slow or difficult breathing, or lack of response. Make sure your doctor or family members know what symptoms can be serious so they can call a doctor or emergency medical attention if you are unable to seek treatment on your own.
Drinking alcohol or using illegal drugs during your codeine treatment also increases the risk that you will experience these serious and life-threatening side effects. Do not drink alcohol, take prescription or over-the-counter medications that contain alcohol, or use illegal drugs during your treatment.
Tell your doctor if you are pregnant or plan to become pregnant. If you take codeine regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth. Tell your baby’s doctor right away if your baby experiences any of the following symptoms: irritability, hyperactivity, abnormal sleep, high-pitched crying, uncontrollable shaking of a part of the body, vomiting, diarrhea, or lack of weight gain.
Do not let anyone else take your medicine. Codeine can harm or kill others who take your medicine, especially children.
Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you start your codeine treatment and each time you get a refill. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer’s website to obtain the Medication Guide.
Why is this medication prescribed?
Codeine is used to relieve mild to moderate pain. It is also used, usually in combination with other medications, to reduce coughs. Codeine will help relieve symptoms, but it will not treat the cause of symptoms or speed recovery. Codeine is in a class of medications called opioid (narcotic) pain relievers and in a class of medications called antitussives. When codeine is used to treat pain, it works by changing the way the brain and nervous system respond to pain. When codeine is used to reduce coughing, it works by decreasing activity in the part of the brain that causes the cough.
Codeine is also available in combination with acetaminophen (Capital and codeine, Tylenol with codeine), aspirin, carisoprodol, and promethazine and as an ingredient in many cough and cold medications. This monograph only includes information on the use of codeine. If you are taking a codeine combination product, be sure to read the information on all the ingredients in the product you are taking and ask your doctor or pharmacist for more information.
How should this medicine be used?
Codeine (alone or in combination with other medications) comes as tablets, capsules, and a solution (liquid) to take by mouth. It is usually taken every 4 to 6 hours as needed. Follow the directions on your prescription label carefully and ask your doctor or pharmacist to explain any parts you do not understand. Take codeine exactly as directed.
If you have taken codeine for several weeks or more, do not stop taking the medicine without talking to your doctor. Your doctor may reduce your dose gradually. If you suddenly stop taking codeine, you may experience withdrawal symptoms such as restlessness, dilated pupils (black circles in the center of the eyes), watery eyes, irritability, anxiety, runny nose, difficulty falling or staying asleep, yawning, sweating. , fast breathing, fast heartbeat, chills, hair on your arms standing on end, nausea, loss of appetite, vomiting, diarrhea, stomach cramps, muscle aches, or back pain.
Shake the solution well before each use to mix the medicine evenly. Do not use a homemade spoon to measure your dose. Use the measuring cup or spoon that came with the medicine, or use a spoon made especially for measuring medicine.
Other uses for this medicine
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
What special precautions should I follow?
Before taking codeine,
- Tell your doctor and pharmacist if you are allergic to codeine, any other medications, or any of the ingredients in the codeine product you plan to take. Ask your doctor or pharmacist for a list of the ingredients.
- Tell your doctor or pharmacist if you are taking or receiving the following monoamine oxidase (MAO) inhibitors or if you have stopped taking them in the past 2 weeks: isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil) , selegiline (Eldepryl, Emsam, Zelapar) or tranylcypromine (Parnate). Your doctor will probably tell you not to take codeine if you are taking one or more of these medications or have taken them in the past 2 weeks.
- Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: bupropion (Aplenzin, Wellbutrin, Zyban); cyclobenzaprine (Amrix); diuretics (‘water pills’); lithium (Lithobid); cough, cold, or allergy medicine; medications for anxiety or seizures; medications for migraines, such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, in Treximet), and zolmitriptan (Zomig); mirtazapine (Remeron); 5HT3 serotonin blockers such as alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi); selective serotonin reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as duloxetine (Cymbalta), desvenlafaxine (Khedezla, Pristiq), milnacipran (Savella), and venlafaxine (Effexor); tramadol (Conzip); trazodone (Oleptro); and tricyclic antidepressants (‘mood elevators’) such as amitriptyline, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine. Many other medications can also interact with codeine, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you closely for side effects.
- Tell your doctor what herbal products you are taking, especially St. John’s wort and tryptophan.
- Tell your doctor if you have any of the conditions mentioned in the IMPORTANT WARNING section, a blockage or narrowing of your stomach or intestines, or paralytic ileus (a condition in which digested food does not move through the intestines). Your doctor may tell you not to take codeine.
- Tell your doctor if you drink or have recently had abdominal or urinary tract surgery. Also tell your doctor if you have or have ever had seizures; Mental illness; prostatic hypertrophy (enlargement of a male reproductive gland); urinary problems; low blood pressure; Addison’s disease (condition in which the body does not produce enough natural substances); or thyroid, pancreas, intestinal, gallbladder, liver, or kidney disease.
- You should know that this medicine can decrease fertility in men and women. Talk to your doctor about the risks of taking codeine.
- Tell your doctor if you are breastfeeding. You should not breastfeed while taking codeine. Codeine can cause shallow breathing, difficulty or noisy breathing, confusion, more sleepiness than usual, difficulty breastfeeding, or sagging in breastfed babies.
- If you are having surgery, including dental surgery, tell the doctor or dentist that you are taking codeine.
- You should know that this medicine may make you drowsy. Do not drive a car or operate machinery until you know how this medicine affects you.
- You should know that codeine can cause dizziness, lightheadedness, and fainting when you get up too quickly from lying down. This is more common when you start taking codeine. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
- You should know that codeine can cause constipation. Talk to your doctor about changing your diet and using other medications to treat or prevent constipation.
What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.
What should I do if I forget a dose?
Codeine is usually taken as needed. If your doctor has told you to take codeine regularly, take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for the one you forgot.
What side effects can this medication cause?
Codeine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- stomach pain
- difficulty urinating
Some side effects can be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNINGS section, stop taking codeine and call your doctor immediately or get emergency medical attention:
- agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea
- nausea, vomiting, loss of appetite, weakness, or dizziness
- inability to get or keep an erection
- irregular menstruation
- decreased sexual desire
- noisy or shallow breathing
- difficulty breathing or swallowing
- changes in heartbeat
- changes in vision
Codeine can cause other side effects. Call your doctor if you have any unusual problems while taking this medicine.
If you experience a serious side effect, you or your doctor can submit a report online to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
What should I know about storage and disposal of this medication?
Keep this medicine in the container it came in, tightly closed, and out of the reach of children. Store at room temperature and away from excess heat and moisture (not in the bathroom).
It is important to keep all medicines out of the sight and reach of children, as many containers (such as those containing weekly pills and those for eye drops, creams, patches and inhalers) are not child-resistant and small children can easily open them. To protect young children from poisoning, always close the safety caps and immediately place the medicine in a safe place, one that is upright and out of their sight and reach. http://www.upandaway.org
Unnecessary medications must be disposed of in special ways to ensure they cannot be consumed by pets, children, and others. However, you should not flush this medicine down the toilet. Instead, the best way to dispose of your medications is through a drug take-back program. Talk to your pharmacist or contact your local garbage / recycling department to learn about take-back programs in your community. Check out the FDA drug safe disposal website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
In case of emergency/overdose
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim collapsed, had a seizure, is having trouble breathing, or is unable to wake up, immediately call 911 for emergency services.
While you are taking codeine, you may be told to always have a rescue medicine called naloxone available (for example, at home, in the office). Naloxone is used to reverse the life-threatening effects of an overdose. It works by blocking the effects of opioids to relieve dangerous symptoms caused by high levels of opioids in the blood. You will probably not be able to treat yourself if you experience an opioid overdose. You need to make sure that your family members, caregivers, or the people who spend time with you know how to know if you are experiencing an overdose, how to use naloxone, and what to do until emergency medical help arrives. Your doctor or pharmacist will teach you and your family members how to use the medicine. Ask your pharmacist for instructions or visit the manufacturer’s website for instructions. If someone sees that you are experiencing symptoms of an overdose, they should give you your first dose of naloxone, call 911 immediately, stay with you, and watch you closely until emergency medical help arrives. Your symptoms may return within minutes after receiving naloxone. If their symptoms return, the person should give them another dose of naloxone. Additional doses may be given every 2 to 3 minutes, if symptoms reappear before medical help arrives.
Symptoms of overdose may include the following:
- difficulty breathing
- excessive drowsiness
- loss of consciousness
- loss of muscle tone
- cold and clammy skin
- slow heartbeat
What other information should I know?
Keep all appointments with your doctor and laboratory. Your doctor will order certain lab tests to check your body’s response to codeine.
Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are taking codeine.
Selling or giving away this medicine can kill or harm others and is illegal. Your prescription may not be able to be refilled. Ask your pharmacist any questions you have about refilling your prescription.
It is important that you keep a written list of all prescription and over-the-counter (over-the-counter) medications you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should take this list with you each time you visit a doctor or if you go into hospital. It is also important information to take with you in case of emergencies.
- Tuzistra XR® (as a combination product containing Chlorpheniramine, Codeine)
Brand names of combination products
- Airacof® (containing Codeine, Diphenhydramine, Phenylephrine)
- Ala-Hist AC® (containing Codeine, Phenylephrine)
- Allfen CD® (containing Codeine, Guaifenesin)
- Ambenyl® (containing Bromodiphenhydramine, Codeine)
- Ambophen® (containing Bromodiphenhydramine, Codeine)
- Antituss AC® (containing Codeine, Guaifenesin)
- Bitex® (containing Codeine, Guaifenesin)
- Bromanyl® (containing Bromodiphenhydramine, Codeine)
- Bromotuss® with Codeine (containing Bromodiphenhydramine, Codeine)
- Brontex® (containing Codeine, Guaifenesin)
- Bron-Tuss® (containing Codeine, Guaifenesin)
- Brovex CB® (containing Brompheniramine, Codeine)
- Brovex PBC® (containing Brompheniramine, Codeine, Phenylephrine)
- Calcidrine® (containing Anhydrous Calcium Iodide, Codeine)
- Cheracol® with Codeine (containing Codeine, Guaifenesin)
- Cheratussin® (containing Codeine, Guaifenesin)
- Codafen® (containing Codeine, Guaifenesin)
- Codimal PH® (containing Codeine, Phenylephrine, Pyrilamine)
- Cotab A® (containing Chlorpheniramine, Codeine)
- Demi-Cof® (containing Chlorpheniramine, Codeine, Phenylephrine, Potassium Iodide)
- Dex-Tuss® (containing Codeine, Guaifenesin)
- Diabetic Tussin C® (containing Codeine, Guaifenesin)
- Dicomal-PH® (containing Codeine, Phenylephrine, Pyrilamine)
- Duraganidin NR® (containing Codeine, Guaifenesin)
- EndaCof AC® (containing Brompheniramine, Codeine)
- Endal CD® (containing Codeine, Diphenhydramine, Phenylephrine)
- ExeClear-C® (containing Codeine, Guaifenesin)
- Gani-Tuss NR® (containing Codeine, Guaifenesin)
- Giltuss Ped-C® (containing Codeine, Guaifenesin, Phenylephrine)
- Glydeine® (containing Codeine, Guaifenesin)
- Guaifen AC® (containing Codeine, Guaifenesin)
- Guiatuss AC® (containing Codeine, Guaifenesin)
- Guiatussin® with Codeine (containing Codeine, Guaifenesin)
- Halotussin AC® (containing Codeine, Guaifenesin)
- Iophen® (containing Codeine, Guaifenesin)
- Mar-cof CG® (containing Codeine, Guaifenesin)
- Maxiphen CD® (containing Codeine, Guaifenesin, Phenylephrine)
- M-Clear WC® (containing Codeine, Guaifenesin)
- M-End PE® (containing Brompheniramine, Codeine, Phenylephrine)
- Mytussin AC® (containing Codeine, Guaifenesin)
- Nalex® AC (containing Brompheniramine, Codeine)
- Notuss AC® (containing Chlorpheniramine, Codeine)
- Notuss PE® (containing Codeine, Phenylephrine)
- Pediacof® (containing Chlorpheniramine, Codeine, Phenylephrine, Potassium Iodide)
- Pedituss® (containing Chlorpheniramine, Codeine, Phenylephrine, Potassium Iodide)
- Pentazine VC® (containing Codeine, Phenylephrine, Promethazine)
- Pentazine® with Codeine (containing Codeine, Promethazine)
- Phenergan® VC with Codeine (containing Codeine, Phenylephrine, Promethazine)
- Phenergan® with Codeine (containing Codeine, Promethazine)
- Poly-Tussin AC® (containing Brompheniramine, Codeine, Phenylephrine)
- Prometh® with Codeine (containing Codeine, Guaifenesin, Promethazine)
- Robafen AC® (containing Codeine, Guaifenesin)
- Robichem AC® (containing Codeine, Guaifenesin)
- Robitussin® AC (containing Codeine, Guaifenesin)
- Rolatuss® (containing Ammonium Chloride, Chlorpheniramine, Codeine, Phenylephrine)
- Romilar AC® (containing Codeine, Guaifenesin)
- Tusnel C® (containing Brompheniramine, Codeine, Guaifenesin)
- Tussi Organidin® (containing Codeine, Guaifenesin)
- Tussiden C® (containing Codeine, Guaifenesin)
- Tussirex® (containing Caffeine, Codeine, Pheniramine, Phenylephrine, Salicylic Acid)
- Tusso-C® (containing Codeine, Guaifenesin)
- Vanacof® (containing Codeine, Dexchlorpheniramine, Phenylephrine)
- Z Tuss AC® (containing Chlorpheniramine, Codeine)
- Zodryl AC® (containing Chlorpheniramine, Codeine)
- Zotex C® (containing Codeine, Phenylephrine, Pyrilamine)
Disclaimer: We have made every effort to ensure that all information is factually accurate, comprehensive and up-to-date. However, this article should not be used as a licensed health care professional’s choice of knowledge and expertise. You should always consult your doctor or other health care professional before taking any medication. The information given here is subject to change and it has not been used to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions or adverse effects. The lack of warning or other information for any drug does not indicate that the combination of medicine or medication is safe, effective or appropriate for all patients or all specific uses.