Codeine

Brand names of codeine

  • Codeine is available in generic form only.

Codeine is somewhat like morphine and hydrocodone and because of its narcotic like quality it is used as a pain reliever. Small amounts of codeine in the body get converted to morphine. It is used for suppressing coughs also.

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What action codeine follows to suppress pain is not exactly known but comparisons to morphine indicate that codeine binds to opioid receptors in the brain. These receptors transfer pain to the body and brain. In this way discomfort is decreased and tolerance to pain increased even though the patient will still sense some pain. Codeine might be helpful in pain reduction but it can cause drowsiness or sedation and also depress breathing. When combined with acetaminophen (Tylenol) or with aspirin it becomes more effective as a pain killer.

Things you need to tell your physician before taking codeine

Before you begin with codeine make sure your doctor knows all the medical allergies you might suffer from including codeine or any ingredients in codeine products. A pharmacist will have a list of ingredients if you wish to consult him.

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The doctor also needs to be informed about any other prescribed or non-prescribed medicaments you might be taking which includes vitamins, nutritional supplements or any herbal remedies you might be taking presently or plan to take. The doctor might alter medications and also he might have to monitor you for side effects so he needs to know, before he prescribes codeine, if you take antidepressants, any cough and cold medicine, or medicines for allergies, mental illness, anxiety, nausea or for seizures. Mention to the doctor if you take monoamine oxidase (MAO) inhibitors, sedatives, tranquilizers or sleeping pills.

The following is a comprehensive list of medical conditions that need to be communicated to your doctor before he begins treatment with codeine and so do let him know if you have had any abdominal surgery, head injury, brain tumour or any condition that puts pressure on the brain, any seizures, mental illness or lung diseases like asthma, chronic obstructive pulmonary disease known as COPD which is a collective name for diseases that cause gradual lung failure or any breathing problems you might suffer from, prostatic hypertrophy (which is an enlargement of the male reproductive gland), urinary problems, low blood pressure, allergies, thyroid problems, pancreatic, intestinal, liver, gallbladder or kidney disease you might suffer from or if you have Addison's disease which is when the body does not make enough of natural substances required by the body.

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The doctor needs to know also if you are pregnant or thinking of pregnancy. In case you become pregnant while on codeine the doctor needs to know immediately.

If you are breast feeding your baby while on codeine then it is possible that codeine could be transferred to the baby through the milk and it can cause serious or fatal side-effects in the breast fed baby. Immediately call the doctor if you are unable to care for the baby or become too sleepy. You need to call your baby's doctor or emergency as well if you find your baby is sleeping more than usual, cannot breast feed properly, and is breathing with difficulty or if the baby becomes limp.

Your surgeon and dentist both need to know you are on codeine if they have planned a surgical proceeding for you including dental surgery.

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Codeine can make you drowsy and so driving a car or operating machinery can be dangerous so till you know how codeine affects you avoid these activities. Children on codeine also need to take precautions, like not riding a bike and other activities that might be considered dangerous.

If you are addicted to alcohol and are likely to drink large amounts, it is best to let your doctor know so he can guide you about the safe use of alcohol as alcohol can cause the side-effects of codeine to worsen.

When you first begin with codeine you might have side-effects like dizziness, light-headedness, or fainting fits especially when you get up too quickly from a prone position. Before you stand, when getting out of bed, rest your feet on the ground for a while.

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Constipation can also trouble anyone on codeine and if that happens consult your doctor so he can advice you on diet change or he might prescribe other medication to prevent constipation.

Usage

Codeine is used to treat severe coughs but mostly it is used to treat mild to moderate pain.

How to use codeine

Codeine must be taken exactly as prescribed; so read the directions on the prescription label carefully. Besides you cannot take codeine in larger amounts than prescribed by the doctor. If the medication becomes ineffective in controlling pain then consult your doctor again.

The medication is to be taken with a full glass of water. In addition to prevent constipation at least six to eight glasses of water must be drunk throughout the day. Laxatives to soften stool must not be used without consulting a doctor. Have codeine with food or milk if it upsets your stomach.

Do not stop codeine suddenly as you might suffer withdrawal symptoms. Ask your doctor how best to deal with unpleasant withdrawal symptoms if he advises you to stop using codeine. Codeine is sometimes abused and used as a drug, without prescription and so you must keep a track of usage in each new bottle you open. No one else should take your prescribed medicine for improper use.

If you miss a dose when you are taking codeine regularly then take the missed dose as soon as you remember. However if the scheduled time is too close to when you are thinking of taking codeine then miss it and take the scheduled dose instead. Extra medicine should never be taken to make up for a missed dose.

Codeine tablets are to be taken orally according to the doctor's directions. The medicine must not be chewed or crushed. Except for the 50 mg tablet all other codeine tablets of all strengths can be split in exact halves. Medication can be taken with or without food but taking it with food could reduce the effectiveness.

In case codeine makes you nauseous, then consult with the doctor or pharmacist who could prescribe antihistamines for decreasing nausea. Lying down with minimal head movement also helps to decrease nausea.

The dosage is based on the medical condition of the patient and therapeutic response. Pain medicines work more effectively if they are taken when the pain is less severe. In severe cases of pain it may not be effective in relieving pain. Never increase your dosage and do not take it more frequently or for longer periods than prescribed as it could lead to drug abuse.

How codeine works

Codeine works like a narcotic to dull nerve signals on those particular areas of the spinal cord and brain that are responsible for the pain process and so there is relief from pain. Codeine acts similarly to dull the cough reflex and so it helps to treat some coughs.

Side effects

Serious
Serious side effects of codeine are indistinguishable from those of overdose:
  • confusion
  • sleepiness
  • unconsciousness
  • cold, clammy skin
  • seizures
  • hallucinations
  • slurred speech
  • small, pinpoint pupils
  • slow breathing
  • severe drowsiness, weakness, or dizziness; difficulty urinating
Common
  • nausea or vomiting
  • drowsiness
  • dry mouth
  • mild dizziness or light-headedness
  • constipation
  • itching
Less common

Possible interactions

Some herbal medicines like valerian and kava kava may cause further addictive reactions including drowsiness and so are best avoided with codeine. St John's wort can blunt the effects of codeine as it can increase or induce change to the P450 3A4 enzymes. It is always best to get the doctor's opinion before combining any herbal remedies with codeine.

Alcohol could be dangerous as it can intensify the depressant effects of codeine on brain functions, on respiratory and circulatory functions. On the other hand smoking tobacco decreases pain tolerance and so more codeine, or more frequent doses will have to be administered to relieve the same intensity of pain. Marijuana, another addictive, increases pain relief and  drowsiness so mental and physical impairment is likely to result from marijuana use with codeine.

Discontinuation

It is a good idea to limit codeine use to the minimum and for as short a term as possible. If codeine is required for longer periods it is best to decrease the dose gradually to ensure minimal withdrawal symptoms, if any. You need to still talk to your doctor before you stop codeine as the dosage will be gradually changed as any sudden stop could cause complicated withdrawal symptoms.

Storage instructions

Codeine must be stored at room temperature and out of reach of children and pets. Do not store the medication in the bathroom as heat and moisture can cause codeine to deteriorate.

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