Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: codeine

BRAND NAMES: none

DRUG CLASS AND MECHANISM: Codeine is a weak narcotic pain-reliever and cough suppressant similar to morphine and hydrocodone. In fact, a small amount of codeine is converted to morphine in the body. The precise mechanism of action of codeine is not known; however, like morphine, codeine binds to receptors in the brain (opioid receptors) that are important for transmitting the sensation of pain throughout the body and brain. Codeine increases tolerance to pain, decreasing discomfort, but the pain still is apparent to the patient. In addition to reducing pain, codeine also causes sedation drowsiness and depresses breathing. Codeine frequently is combined with acetaminophen (Tylenol) or aspirin for more effective pain relief.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Tablets: 15, 30, 60 mg. Solution: 15 mg/5ml (teaspoon). Injection: 15 and 30 mg/ml.

STORAGE: Codeine should be stored between 15 to 30 C (59 to 86 F).

PRESCRIBED FOR: Codeine is used for the relief of mild to moderately severe pain and for suppressing cough.

DOSING: The usual adult dose of codeine is 15-60 mg every 4-6 hours.

DRUG INTERACTIONS: Codeine can impair thinking and physical abilities required for driving or operating machinery. Alcohol and other sedatives such as alprazolam (Xanax) can produce further brain impairment and even confusion when combined with codeine. Therefore, alcohol and other sedatives should be limited when taking codeine.

PREGNANCY: Safety during pregnancy has not been established. Codeine is generally avoided in pregnancy because it may cause fetal physical dependence, withdrawal and growth retardation.

NURSING MOTHERS: Small amounts of codeine are secreted in breast-milk, but the risk of adverse events in the infant is small.

SIDE EFFECTS: The most frequent side effects of codeine include lightheadedness, dizziness, nausea, vomiting, shortness of breath, and sedation. Other side effects include allergic reactions, constipation, abdominal pain, rash and itching. Codeine is habit forming. Mental and physical dependence can occur but are unlikely when used for short-term pain relief. If codeine is suddenly withdrawn after prolonged use, symptoms of withdrawal may develop. The dose of codeine should be reduced gradually in order to avoid withdrawal symptoms.

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