BMA Concise Guide to Medicine & Drugs

Codeine

Used in the following combined preparations Co-codamol, Codafen Continus, Codis, Cuprofen Plus, Feminax, Migraleve, Nurofen Plus, Panadol Ultra, Paracodol, Pulmo Bailly, Solpadeine, Solpadol, Syndol, Tylex, Veganin, and others

QUICK REFERENCE

Drug group Opioid analgesic, antidiarrhoeal drug, and cough suppressant

Overdose danger rating High

Dependence rating Medium

Prescription needed Yes (some preparations)

Available as generic Yes

GENERAL INFORMATION

Codeine is a mild opioid analgesic that is similar to, but weaker than, morphine. It has been in common medical use since the beginning of the last century, although raw opium, of which codeine is a constituent, has been used for much longer.

Codeine is prescribed primarily to relieve mild to moderate pain, and is often combined with a non-opioid analgesic such as paracetamol. It is also an effective cough suppressant and, for this reason, is included as an ingredient in many non-prescription cough syrups and cold relief preparations.

Like the other opioid drugs, codeine is constipating, a characteristic that sometimes makes it useful in the short-term control of diarrhoea.

Although codeine is habit-forming, addiction seldom occurs if the drug is used for a limited period of time and the recommended dosage is followed.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, liquid, injection.

Frequency and timing of doses 4–6 x daily (pain); 3–4 x daily when necessary (cough); every 6–8 hours when necessary (diarrhoea).

Adult dosage range 120–240mg daily (pain); 45–120mg daily (cough); 30–120mg daily (diarrhoea).

Onset of effect 30–60 minutes.

Duration of action 4–6 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Take as soon as you remember if needed for relief of symptoms. If not needed, do not take the missed dose, and return to your normal dose schedule when necessary.

Stopping the drug Can be safely stopped as soon as you no longer need it.

OVERDOSE ACTION

Seek immediate medical advice in all cases. Take emergency action if there are symptoms such as slow or irregular breathing, severe drowsiness, or loss of consciousness.

POSSIBLE ADVERSE EFFECTS

Serious adverse effects are rare with codeine. Constipation is common, especially with prolonged use, but most other side effects (such as nausea, vomiting, drowsiness, and dizziness) are not usually troublesome at the recommended dose and usually disappear if the dose is reduced. However, if you experience restlessness or agitation, stop taking the drug and discuss with your doctor. If you develop a rash, hives, wheezing, or breathlessness, stop taking the drug and seek urgent medical advice.

INTERACTIONS

Sedatives All drugs, including alcohol, that have a sedative effect on the central nervous system are likely to increase sedation with codeine. Such drugs include sleeping drugs, antidepressant drugs, antihistamines, and antipsychotics.

SPECIAL PRECAUTIONS

Be sure to consult your doctor or pharmacist before taking this drug if:

· You have long-term liver or kidney problems.

· You have a lung disorder such as asthma or bronchitis.

· You are taking other medicines.

Pregnancy No evidence of risk, but may adversely affect the baby’s breathing if taken during labour.

Breast-feeding Should not be used by women who are breast-feeding as the drug passes into the breast milk and may harm the baby.

Infants and children Not for use in children under 12 years, nor for children under 18 years having tonsillectomy or adenoidectomy for obstructive sleep apnoea. Not recommended for children of any age with respiratory problems.

Over 60 Reduced dose may be necessary.

Driving and hazardous work Avoid such activities until you have learned how codeine affects you because the drug may cause dizziness and drowsiness.

Alcohol Avoid. Alcohol may increase the sedative effects of this drug.

PROLONGED USE

Codeine is normally used only for short-term relief of symptoms. It can be habit-forming if taken for extended periods, especially if higher-than-average doses are taken.