Codeine Tablet: Uses, Interactions and Safety Information

Codeine is a prescription opioid (narcotic) medicine used mainly to relieve mild-to-moderate pain and to suppress coughs. It is often combined with other ingredients, for example, in Tylenol with codeine (acetaminophen/codeine) for pain or in promethazine codeine cough syrup for coughs. Under medical guidance, codeine can provide effective relief of discomfort and coughing, improving quality of life when used correctly.

What is Codeine?

Codeine is an opioid analgesic (painkiller) derived from the opium poppy. Chemically, it is 3-methylmorphine, closely related to morphine. It works by binding to opioid receptors in the brain and spinal cord, which changes how the body perceives pain.

In standard doses, codeine effectively eases pain and also reduces coughing by acting on the brain's cough center. It is classified as a Schedule II/III controlled substance in many countries due to its potential for dependence.

What Are the Uses of Codeine?

Codeine's primary benefits are pain relief and cough suppression. Doctors commonly prescribe codeine to treat:

1. Pain Relief

Codeine helps control mild to moderate pain, such as:

• Post-surgical pain (e.g., dental surgery)
• Pain from injuries (e.g., sprains, fractures)
• Chronic pain conditions (when other treatments fail)

It is often combined with other pain relievers like:

• Acetaminophen (e.g., Tylenol #3)
• Ibuprofen

This combination enhances pain control and allows for lower doses of codeine.

2. Cough Suppression

Codeine is also a powerful cough suppressant (antitussive) and is used to treat:

• Severe, dry, non-productive coughing
• Nighttime coughing that disrupts sleep

It is typically found in prescription cough syrups, often combined with:

• Promethazine (an antihistamine)
• Other decongestants or expectorants

These formulations work by calming the cough reflex in the brain, offering relief from persistent coughs.

3. Other (Less Common or Off-Label) Uses

In specific medical scenarios, codeine may be prescribed off-label, such as:

• Chronic cough: Low-dose codeine may help when other antitussives fail.
• Refractory diarrhea: Occasionally used in palliative care settings when other anti-diarrheal agents are ineffective.
• Restless leg syndrome (RLS): Rarely used when conventional therapies are not suitable.

These uses are less common and require close supervision by a healthcare provider.

How Does Codeine Work?

Codeine is a pain reliever and cough suppressant that works by affecting the central nervous system (CNS). It is a prodrug, meaning it becomes active after being converted into another substance.

In the liver, codeine is changed into morphine by an enzyme called CYP2D6. The morphine then binds to opioid receptors in the brain and spinal cord, blocking pain signals and reducing how pain is felt.

For cough, codeine acts on the brainstem to suppress the cough reflex.

It also causes drowsiness and may affect mood by influencing the body's natural chemicals (endorphins). People's response to codeine can vary depending on how fast their body converts it into morphine.

Codeine Dosage

Codeine is a prescription medication used to relieve mild to moderate pain and suppress coughing. It is available in tablet and syrup forms and should always be taken exactly as directed by your doctor.

Typical Dosage Instructions (As Per Doctor's Advice)

Codeine comes in tablets and liquid syrups. The exact dose and schedule depend on the patient's condition, age, and other factors.

• For Adults (Pain Relief): 15-60 mg of codeine every 4-6 hours as needed. Do not exceed 360 mg in 24 hours.
• For Adults (Cough Syrup): Typically 5 mL every 4-6 hours, not exceeding 30 mL per day.
• For Children: Doses are significantly lower and must be determined by a doctor. Codeine is strongly discouraged for children under 12 years old due to serious safety concerns.

Typical Instructions: Take codeine exactly as prescribed by your doctor. For pain, one or two tablets (15-60 mg each) every 4-6 hours may be recommended.

For cough syrup, use the measuring device provided and follow the dosing label (usually 5 mL per dose). Do not exceed the recommended dosage.

What Should I Do If I Miss a Dose?

Since codeine is generally taken as needed:

• If you miss a dose, skip it.
• Resume your normal dosing schedule.
• Do not double the dose to catch up.

What Happens If an Overdose?

An overdose of codeine can be life-threatening and requires immediate emergency medical attention.

Symptoms of Overdose

• Extremely slow or irregular breathing
• Severe drowsiness or difficulty waking up
• Cold, clammy skin
• Pinpoint pupils
• Loss of consciousness

In case of a suspected overdose, call emergency services immediately. A medication called naloxone (Narcan) can reverse the effects of codeine. Patients on long-term codeine therapy should consult their doctor about keeping naloxone readily available.

What Are the Side Effects of Codeine?

Codeine can cause side effects, some of which are common and others that are serious but rare.

Most people using this medicine do not experience severe side effects. However, it's essential to be aware of the potential side effects and to consult a doctor if any symptoms worsen.

Common Side Effects

• Agitation
• Nausea
• Vomiting
• Rash
• Itching
• Hives
• Change in vision
• Seizures

If you experience any of these serious symptoms, contact your doctor immediately. If you have any adverse reactions to Codeine, avoid using it.

• Doctor's Advice: Your doctor has prescribed this medication after determining that the benefits outweigh the potential side effects. Most people using this medicine do not experience severe side effects.
• Medical Help: Seek immediate medical assistance if you experience any serious side effects from Codeine.

How to Take Codeine?

Codeine is available in the form of tablets, capsules and liquid. It is usually taken every 4 to 6 hours.

Instructions

• Follow the directions on the prescription label carefully.
• If you are taking Codeine for several weeks, consult your doctor before stopping the medication. The doctor may decrease the dosage gradually based on the medicine's effectiveness.
• Shake the liquid solution well before each use to mix the medication evenly.

Pain Management

• Pain relievers work best if used at the first signs of pain.
• Do not increase the dose, use the medicine more often, or use it for longer than prescribed.
• For ongoing pain (e.g., cancer pain), your doctor may prescribe long-acting opioid medications. Use Codeine only for sudden pain when needed.

Withdrawal and Addiction

• Stopping Codeine suddenly can cause withdrawal, especially if used for a long time or in high doses. To prevent withdrawal, your doctor may gradually reduce your dose.
• Report withdrawal symptoms to your doctor or pharmacist immediately, such as restlessness, mental/mood changes (including anxiety, trouble sleeping, suicidal thoughts), watery eyes, runny nose, nausea, diarrhea, sweating, or sudden muscle aches.
• Although Codeine helps many people, it can sometimes cause addiction. The risk may be higher if you have a substance use disorder (such as drug/alcohol abuse or addiction). Use Codeine exactly as prescribed to reduce the risk of addiction.

Precautions and Warnings

Before taking Codeine capsules or Codeine tablets, it's important to understand the potential risks and take necessary precautions to avoid complications. Always take Codeine under medical supervision, especially if you have existing health conditions or are on other medications.

Who Should Avoid This Medicine (e.g., Pregnant Women, Children)

• Children under 12 years: Codeine is not safe and should not be given.
• Children 12-18 with breathing problems: Avoid use due to high risk of respiratory depression.
• Breastfeeding mothers: Codeine passes into breast milk and may harm the baby (e.g., excessive sleepiness, breathing problems).
• Pregnant women: Should only use if absolutely necessary. Long-term use near delivery can cause withdrawal symptoms in newborns.
• People with severe breathing issues: Such as asthma, COPD-codeine can suppress breathing.
• Individuals with head injuries or brain disorders: Use with caution due to the risk of increased intracranial pressure and sedation.
• Allergy history: Avoid if allergic to codeine or similar opioids (morphine, oxycodone).

Conditions Where Caution Is Needed (Liver Issues, Allergies, etc. )

• Liver or kidney disease: Use lower doses and monitor closely; the drug may accumulate due to reduced clearance.
• Gastrointestinal obstruction: Avoid use if you have bowel obstruction or paralytic ileus-it can worsen symptoms.
• History of substance abuse or dependence: Increased risk of misuse and overdose.

Are There Any Age Restrictions for Using Codeine?

• Not recommended for children under 12 years.
• Children 12-18 years should avoid codeine, especially with existing respiratory conditions.
• Use in children under 18 should only occur under strict medical supervision.

Alcohol or Food Interactions

• Alcohol: Strongly discouraged. It increases drowsiness and risk of dangerous breathing problems.
• Sedative foods or drinks: Avoid combining with substances like grapefruit juice which may interfere with codeine metabolism.
• Ask your doctor about dietary restrictions while on codeine.

Possible Interactions with Other Medications (Drug Interactions)

Overview of How This Medicine May Interact with Other Drugs

• CNS depressants: Combining codeine with alcohol, benzodiazepines, sleep aids, or other opioids increases risk of extreme sedation and respiratory depression.
• MAO inhibitors (e.g., phenelzine, isocarboxazid): Never take with codeine or within 14 days after stopping-risk of serotonin syndrome or high blood pressure.
• Antidepressants and antipsychotics: Some SSRIs, SNRIs, and tricyclics can increase serotonin syndrome risk.

Possible Impact When Combined with Supplements, Herbal Products

• CYP enzyme modulators:
• Inhibitors (e.g., fluoxetine, paroxetine): Reduce codeine's conversion to morphine → less pain relief.
• Inducers (e.g., rifampin, carbamazepine): Lower codeine levels → reduced effect.
• Inhibitors (e.g., ketoconazole): May raise morphine levels → increased side effects.
• Herbal supplements:
• St. John's wort and tryptophan may interfere with codeine.
• Always consult a doctor before combining herbal products with codeine.

How Should Codeine Be Stored?

Proper storage helps preserve the effectiveness and safety of Codeine throughout its shelf life. Keep it in recommended conditions to prevent loss of potency or degradation.

Recommended Storage Temperature for Codeine

• Store at room temperature (20-25°C or 68-77°F).
• Keep in the original container with a tightly closed lid.
• Avoid refrigeration, freezing, or humid environments like bathrooms.

What Happens If Codeine Is Not Stored Properly?

• Heat, cold, or moisture can degrade the medication.
• Pills that crumble, change color, or syrups that appear cloudy should not be used.
• Improper storage increases the risk of accidental ingestion, especially by children.

Keep Away from Children, Sunlight, or Moisture

• Store in a locked cabinet or on a high shelf out of children's reach.
• Protect from sunlight and humidity to ensure safety and effectiveness.
• Dispose of expired or unused codeine properly- FDA-approved drug take-back programs are recommended. If unavailable, certain opioids may be flushed (as per FDA guidance).

Codeine vs Morphine

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