Codeine

Doctors prescribe codeine to relieve mild to moderately severe pain

Uses

Codeine is sometimes combined with decongestants and antihistamines to ease symptoms associated with the common cold, allergies and hay fever because of the way codeine reduces a dry cough. Codeine is available only with a prescription.
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Administration/Dosage

Codeine sulfate is available in tablet or liquid form and can be administered orally, intravenously, intramuscularly or subcutaneously. Each tablet contains 15 mg, 30 mg or 60 mg of codeine sulfate.
The typical codeine prescription to ease an adult's cough calls for an initial dose of 15 mg by mouth every six hours as necessary; the physician may later slowly increase the dose to 20 mg by mouth every four hours as needed to control symptoms. Never take more than 120 mg of codeine by mouth in a 24-hour period.

Physicians will normally direct nurses to administer an initial dose 30 mg of codeine by mouth, through a vein, into a muscle or just under the skin every six hours as necessary to control pain. After the patient becomes tolerant to codeine, the doctor may slowly increase dosage up to 60 mg orally, intravenously, intramuscularly or subcutaneously every four hours as needed for pain.

Older patients may be more sensitive to the effects of codeine. Physicians should be alert for signs of respiratory depression and other side effects associated with codeine when prescribing this drug to senior citizens. The initial dose to treat a geriatric patient's cough is 10 mg every six hours, titrated cautiously up to 20 mg every four hours if necessary. Likewise, the initial dose to treat pain in the older patient should be lowered to 15 mg every six hours and increased slowly to 60 mg every four hours if needed.

Pediatricians may prescribe 2.5 mg to 5 mg every four to six hours to relieve the cough of a child aged 2 to 6 years. A child of this age should not exceed 30 mg of codeine in a 24 hour period. Children from 6 to 12 years old may use 5 mg to 10 mg of codeine every four to six hours to treat a cough, with a maximum of 60 mg per day. The typical pediatric codeine dose to relieve pain in children over the age of one year is 0.5 mg per kilogram of body weight every four to six hours as necessary.

Take codeine with a full glass of water. If codeine upsets your stomach, take this medication with a snack, milk or a meal.

Doctors typically prescribe codeine to be taken only as you need it to control your symptoms, rather than on a strict schedule. This means you do not normally have to worry about missed doses – simply take a dose when you need it provided enough time has passed since your last dose. If your physician has requested you adhere to a schedule and you miss a dose, take the missed dose as soon as you remember. If it is nearly time to take another dose and you can tolerate the symptoms, skip the missed dose and resume your normal schedule.

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Action

When injured by illness or trauma, the cells of your body release chemicals that bind to pain receptors in your nerve endings. These chemicals send pain signals to your brain. Codeine works by binding with pain receptors, replacing messages of pain with signals of pleasure and euphoria. Codeine changes the way your brain perceives pain.
Codeine also works on the part of your brain responsible for the cough reflex. When a foreign object or mucus irritates your throat or lungs, your respiratory tract sends a signal to your medulla, located in your brain stem. Your medulla responds by issuing an order to cough. Codeine works directly on your medulla to suppress your cough; codeine makes your brain unaware of the need to cough.
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Precautions

Tell your doctor if you are allergic to this drug or to any other medication. Allergic reaction is a serious condition that can rapidly deteriorate into a medical emergency without warning.

Allergic drug reactions can cause:

• Skin Rash or Hives
• Itchy Skin
• Wheezing or Other Breathing Problems
• Swelling of Body Parts
• Anaphylaxis: A Life-Threatening Allergic Reaction

You may not be able to take this medication if you have a history of certain medical conditions. This drug may worsen your condition, or your medical condition may interfere with the way this medication works. Your doctor may have to prescribe a different drug or change your dosage. Tell your physician about any significant illnesses or conditions, including:

• Asthma, COPD, Sleep Apnea or Other Breathing Disorders.
• Liver or Kidney Disease.
• Underactive Thyroid.
• Curvature of the Spine.
• History of Head Injury or Brain Tumor.
• Epilepsy or Other Seizure Disorder.
• Low Blood Pressure.
• Gallbladder Disease.
• Pancreas Disorder.
• An Intestinal Disorder.
• Addison's Disease or Other Adrenal Gland Disorders.
• Enlarged Prostate.
• Urination Problems.
• Mental Illness.
• History of Drug or Alcohol Addiction.

Codeine may make you drowsy or dizzy, or it may interfere with your ability to make quick decisions. Do not operate heavy machinery, drive a car or engage in potentially risky behavior until you know how this preparation affects you.

Do not consume alcohol while taking codeine. Drinking alcohol may worsen side effects associated with this medication.

This drug can be habit-forming, especially if you take it for long periods of time or rely on high doses to reduce your symptoms. If your current prescription stops working, you may be developing tolerance to codeine. Contact your physician to discuss alternative pain management options. Do not take higher doses than prescribed in an effort to relieve your pain or cough.

Drink six to eight full glasses of water daily. Codeine and other opioids cause constipation. Water softens your stool which helps regulate your digestive tract.

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Warnings

Scientists have not yet established whether codeine can harm your unborn child but it is well-known that codeine passes into breast milk. If you take codeine shortly before delivery, your baby may experience neonatal withdrawal symptoms such as abnormal sleep patterns, diarrhea, a high-pitched cry and irritability. Your baby may also exhibit shakiness or tremor, vomiting, weight loss or failure to gain weight. Do not take codeine while breastfeeding your baby.

Stopping codeine use suddenly may cause unpleasant withdrawal symptoms. Whenever possible, wean yourself from codeine by taking smaller doses further apart. If you cannot comfortably stop using codeine, consult with your doctor or qualified in-patient or out-patient rehabilitation center.
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Drug Interactions

Taking codeine with other drugs may have unfavorable or unsafe effects. Give your doctor and pharmacist a complete list of your prescriptions, over-the-counter medications and herbal remedies. Never start or stop taking another drug without telling your doctor.

Do not take codeine with other narcotic pain medication, cold remedies, sleep aides, sedatives, tranquilizers or sleeping pills. Do not take muscle relaxers or other medications that make you sleepy or drowsy while taking codeine. Doing so may result in breathing problems and other serious side effects.

You should not take some prescription drugs while taking codeine products. Tell your doctor if you are taking pentazocine or nalbuphine, which go by the brand names Talwin and Nubain. Notify your physician and pharmacist if you are already on butorphanol, known as Stadol, or the buprenorphine preparations, Buprenex or Subutex. Your doctor may adjust the dosage of your codeine, recommend special tests while taking codeine, or switch you to another pain or cough medication.

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Side effects

You may experience side effects while taking this drug. Speak with your physician if these common side effects become intolerable or if they do not go away on their own. Common side effects include:

• Feeling Dizzy or Drowsy.
• Nausea, Vomiting, Stomach Pain.
• Constipation.
• Sweating.
• Mild Itching or Rash.

Some side effects can be serious. Seek medical help if you experience any of these serious side effects:

• Shallow Breathing, Slow Heartbeat.
• Feeling Light-Headed or Fainting.
• Confusion, Agitation, Hallucinations, Unusual Thoughts or Behavior.
• Seizure.
• Problems with Urination.

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Overdose

An overdose is a serious situation that can deteriorate into a medical emergency, or even death, quickly and without warning. If you suspect you or someone you know has taken an overdose of codeine, seek emergency assistance immediately. Contact your local poison control center at 1-800-222-1222 or go to the emergency room. While at the hospital, you can expect doctors and nurses to perform emergency, life-saving treatments including using activated charcoal, artificial respiration, fluids, laxatives, medicine to lower codeine levels in the blood, medicine to reverse the effect of the codeine or a tube through inserted the mouth into the stomach to pump out the contents of your stomach.
Overdose symptoms include:

• Extreme Drowsiness.
• Pinpoint Pupils.
• Confusion.
• Cold and Clammy Skin.
• Weak Pulse.
• Shallow Breathing.
• Fainting.
• Breathing that Stops.

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Abuse

Codeine is frequently used for recreational purposes because of the euphoric feeling associated with consumption of this opioid. Abusers use codeine to get high. While many abusers buy codeine on the street, others get this narcotic by presenting fake prescriptions to pharmacies, getting prescriptions from multiple doctors or by stealing from friends, family members or even pharmacies and hospitals.
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Withdrawal

You may experience unpleasant withdrawal symptoms when you stop taking codeine, especially if you have been using high doses or taking the opioid for a long time. Symptoms may be slightly different from person to person, and the intensity of withdrawal varies as well. One person may be able to stop taking opioids on her own while another may need the assistance of rehabilitation professionals to overcome withdrawal symptoms. Withdrawal is a normal, predictable, physical sign of dependency, not necessarily a sign of willful or criminal abuse. Confide in your doctor or seek out the help of a qualified rehabilitation center if withdrawal symptoms prevent you from stopping codeine on your own.
Withdrawal symptoms include:

• Abdominal or Stomach Cramps.
• Anxiety.
• Fever.
• Nausea.
• Runny Nose.
• Sweating.
• Tremors.
• Trouble With Sleeping.

Detox

Dependence and addiction to codeine is often difficult to overcome on your own, especially if you have been taking large doses or using this opioid for a long time. The first step in rehabilitation is always detoxification, or clearing codeine from your body. You will feel the strong, unpleasant symptoms of withdrawal as codeine leaves your body. Your withdrawal symptoms may be so strong that they prevent you from quitting codeine without the help of trained rehabilitation professionals.
Rapid detox humanely frees you from physical dependence on codeine. During rapid detox, you are sedated and anesthetized during the detoxification process. While you are asleep, physicians administer chemicals that speed the cleansing of your system. When you awaken, your body is free from codeine and you have no recollection of the unpleasant withdrawal process. After rapid detox, increase your chances for a full recovery by participating in follow-up programs, such as counseling.
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Storage

Keep this drug and all medicines out of the reach of children, pets and adults who might consume this product accidentally or on purpose. Store this drug at room temperature, between and degrees Fahrenheit. Keep this medicine away from excessive heat, humidity and light; do not store in your bathroom or car. Track your medicine and account for all doses.

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Miscellaneous information

The United States Drug Enforcement Administration calls codeine "the most widely used, naturally occurring narcotic in medical treatment in the world." Most codeine used in the United States is made from morphine, although opium contains substantial amounts of codeine. Pharmacologists make two other narcotic pain relieving drugs from codeine, dihydrocodeine and hydrocodone.
Miscellaneous Information About Codeine