How does this medication work? What will it do for me?

Codeine belongs to the class of medications called narcotic analgesics ("analgesic" means "pain reliever"). It is used to relieve mild-to-moderate pain. It works by blocking pain signals that are sent out by the brain to various areas of the body.

Codeine is also used to control coughing that is not controlled by non-narcotic cough suppressants. It works by acting on the brain to dull the cough reflex.

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

This medication is available as 30 mg/mL and 60 mg/mL injectables.

How should I use this medication?

Pain relief: The recommended adult dose of codeine for pain relief is 15 mg to 60 mg every 4 to 6 hours as required, not to exceed 360 mg in one day.

For children over one year of age, the recommended dose for pain relief is based on body weight. The recommended dose is 0.5 mg to 1 mg per kg of body weight per dose, given every 4 to 6 hours as needed.

Cough: The recommended adult dose of codeine as a cough suppressant is 10 mg to 20 mg every 4 to 6 hours as needed.

The dose for children is based on body weight. The recommended dose is 1 mg to 1.5 mg per kg of body weight per day, divided into doses given every 4 to 6 hours as needed. Codeine as a cough suppressant is not recommended for children less than 2 years of age.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

This medication may be habit-forming if taken for long periods of time. Do not stop taking this medication without talking with your doctor. If this medication is stopped suddenly, you may experience withdrawal symptoms such as anxiety, sweating, trouble sleeping, shakiness, nausea, tremors, diarrhea, or hallucinations. If you plan on stopping the medication, your doctor may want you to reduce the dose gradually to reduce the severity of withdrawal effects.

It is important to take this medication exactly as prescribed by your doctor. your doctor has told you to take this medication on a regular basis and you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use this medication if you:

  • are allergic to codeine or to any of the ingredients of the medication
  • are allergic to any morphine-type medications
  • are 12 years of age or younger
  • have diarrhea caused by poisoning, until the toxic substance is cleared from the gastrointestinal tract
  • have difficulty breathing or has lung disease

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • constipation
  • dizziness
  • drowsiness
  • dry mouth
  • headache
  • light-headedness
  • loss of appetite
  • nausea
  • vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • blurred or double vision, or other changes in vision
  • confusion
  • depression or other mood or mental changes
  • fast, slow, or pounding heartbeat
  • feeling faint
  • feelings of unreality
  • hallucinations (seeing, hearing, or feeling things that are not there)
  • hives, itching, or skin rash
  • signs of breathing problems (e.g., shortness of breath, wheezing, irregular or troubled breathing)
  • trembling or uncontrolled muscle movements
  • unusual excitement or restlessness (especially in children)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • seizures
  • severe weakness
  • signs of a serious allergic reaction (i.e., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
  • signs of too much codeine (overdose )
    • cold, clammy skin
    • low blood pressure
    • pinpoint pupils of eyes
    • severe drowsiness
    • severe nervousness or restlessness
    • slow heartbeat
    • weakness
  • slow or troubled breathing

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

HEALTH CANADA ADVISORY

July 28, 2016

Health Canada has issued new information concerning the use of prescription codeine. To read the full report, visit Health Canada's website at www.hc-sc.gc.ca.

A previous advisory on codeine was issued on June 6, 2013. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.

Abdominal conditions: Codeine may make the diagnosis of abdominal conditions more difficult or it may worsen these conditions. If you have an abdominal condition such as inflammatory or obstructive bowel disease, acute cholecystitis, or pancreatitis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Breathing: Codeine can suppress breathing. If you are at risk for breathing difficulties, such as asthma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Constipation: Codeine can be very constipating. Eating a high-fibre diet and following good bowel habits will help to minimize this effect. If you develop constipation easily, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dependence and withdrawal: This medication contains codeine. Physical dependence, psychological dependence, and abuse have occurred with the use of codeine. People with a history of past or current substance use problems may be at greater risk of developing abuse or addiction while taking this medication. Abuse is not a problem with people who require this medication for pain relief.

If you suddenly stop taking this medication, you may experience withdrawal symptoms such as anxiety, sweating, trouble sleeping, shaking, pain, nausea, tremors, diarrhea, and hallucinations. If you have been taking this medication for a while, it should be stopped gradually as directed by your doctor.

Dizziness: Codeine can cause severe dizziness, especially when rising from a sitting or lying position. This is more likely to occur when other medications with similar side effects are being taken. People taking medications that can cause dizziness should rise slowly from sitting or lying down to reduce the possibility of severe dizziness or fainting.

Drowsiness/reduced alertness: Codeine may cause drowsiness. Avoid activities requiring alertness such as driving, operating machinery or performing dangerous tasks until you have determined how you are affected by codeine.

Head injury: If you have a head injury or increased pressure in the head, you may have a higher risk of experiencing side effects (breathing problems) or worsening of their condition while taking this medication. Discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Inflammatory bowel disease: If you have a condition affecting the digestive system, such as inflammatory bowel disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney disease: If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Codeine should not be used by people with severely reduced kidney function.

Liver disease: If you have liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Other medical conditions: If you are about to undergo surgery of the biliary tract, approach taking codeine with caution, as it may worsen your condition. Codeine will worsen the effects of acute alcohol intoxication and delirium tremens.

As well, if you have low thyroid (hypothyroidism), Addison's disease, benign prostatic hypertrophy (enlarged prostate), gallbladder disease, urethral stricture, decreased function of the adrenal glands, or porphyria, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Seizure disorders: If you have a seizure disorder or a history of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication may pass into breast milk. Some of the codeine dose is converted into morphine by the body, once it has been taken. For some people, this change happens much faster than for others. If this happens to a nursing mother, the baby is a risk of receiving a morphine overdose through the breast milk.

If you are a breast-feeding mother and are taking codeine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Seniors: Seniors are likely to experience side effects with codeine when taken at adult doses. You may need to use a lower dose to avoid side effects of this medication.

What other drugs could interact with this medication?

There may be an interaction between codeine and any of the following:

  • alcohol
  • ammonium chloride
  • amphetamines (e.g., dextroamphetamine)
  • anesthetics
  • anticholinergic medications (e.g., atropine, scopolamine)
  • antifungal medications (e.g., fluconazole, itraconazole, ketoconazole)
  • antihistamines that cause drowsiness (e.g., chlorpheniramine, diphenhydramine)
  • baclofen
  • barbiturates (e.g., phenobarbital, butalbital)
  • benzodiazepines (e.g., diazepam, lorazepam, oxazepam)
  • beta-blockers (e.g., atenolol, propranolol)
  • bupropion
  • butorphanol
  • carbamazepine
  • chloral hydrate
  • cocaine
  • delaviridine
  • isoniazid
  • methocarbamol
  • monoamine oxidase inhibitors (MAOIs; e.g., phenelzine, tranylcypromine)
  • nalbuphine
  • naltrexone
  • other narcotic pain relievers (e.g., fentanyl, hydrocodone, morphine)
  • pentazocine
  • phenothiazines (e.g., chlorpromazine, prochlorperazine)
  • phenytoin
  • protease inhibitors (e.g., lopinavir, ritonavir)
  • quinidine
  • rifampin
  • selegiline
  • SSRIs (e.g., fluvoxamine, paroxetine, sertraline)
  • terbinafine
  • thiopental
  • tramadol
  • tricyclic antidepressants (e.g., amitriptyline, desipramine, nortriptyline)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.