codeine (for Pain)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

  • Medical and Pharmacy Editor: Jerry R. Balentine, DO, FACEP
    Jerry R. Balentine, DO, FACEP

    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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What is codeine, and how does it work (mechanism of action)?

Codeine is a narcotic pain-reliever and cough suppressant similar to morphine and hydrocodone. Moreover, 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. The FDA approved codeine in 1950.

Is codeine addictive? Is it a controlled substance?

Codeine is habit forming (addictive). Mental and physical dependence can occur but are unlikely when used for short-term pain relief.  Using codeine during pregnancy can cause opioid withdrawal syndrome in the newborn, which may be life-threatening if not treated.

Yes, you need a prescription for codeine. Codeine is a schedule II controlled substance in the US.

What are the side effects of codeine?

The most frequent side effects of codeine include:

Serious side effects of codeine include:

  • Life-threatening respiratory depression
  • Severe low blood pressure
  • Adrenal insufficiency
  • Accidental ingestion of codeine can result in fatal overdose

What is the dosage?

The usual adult dose of codeine for pain is 15-60 mg every 4-6 hours as needed. The dose for cough is 10 to 20 mg every 4-6 hours as needed. The maximum dose for treating cough is 120 mg every 24 hours.

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Can I drink alcohol with codeine? What other drugs cause interactions with codeine?

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 not be used when taking codeine.

Drugs that stimulate and also block opioid receptors (for example, pentazocine) reduce the effect of codeine. Such drugs should not be combined with codeine.

Drugs that block the action of acetylcholine (anticholinergic drugs) increase the occurrence of urinary retention and constipation when combined with codeine.

Monoamine oxidase inhibitors (MAOIs) class of antidepressants (for example, isocarboxazid [Marplan], phenelzine [Nardil], tranylcypromine [Parnate], selegiline [Eldepryl], and procarbazine [Matulane]) significantly increase the action of codeine. Codeine should not be used in patients taking MAOIs or within 14 days of stopping MAOIs.

Is it safe to take codeine if I am pregnant or breastfeeding?

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

What else should I know about this drug?

What preparations of codeine are available?

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

How should I keep codeine stored?

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

Reference: FDA Prescribing Information

Summary

Codeine is a narcotic pain reliever (analgesic) used to treat mild to moderately severe pain. It is frequently combined with Tylenol or aspirin for more effective pain relief. Common side effects include:


More serious adverse effects are severe low blood pressure, adrenal insufficiency, accidental ingestion of codeine, which can result in fatal overdose. Since codeine is a narcotic it has a potential for abuse. Patients with current or previous drug addiction problems should be monitored closely for addiction. Dependence and addiction can occur with codeine, even at prescribed dosages when taken over long periods. Misuse of codeine can lead to serious cardiac events and sudden death.

It is important to be aware of drug interactions, effects on pregnancy and nursing mothers, as well as common side effects on the user.

REFERENCE: FDA Prescribing Information for codeine.

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See more info: codeine on RxList
Reviewed on 8/7/2017
References
Reference: FDA Prescribing Information

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