Codeine

Brand names

• Codeine is available in generic form only.

Usage

To treat mild to moderate pain or to control a severe cough.

How it works

Narcotics such as codeine relieve pain by acting on specific areas of the spinal cord and brain that process pain signals from nerves throughout the body. Codeine dulls the cough reflex, which is why it may be used to treat certain coughs.

Side effects

Serious

Serious side effects of codeine are indistinguishable from those of overdose: confusion; hallucinations; sleepiness; slurred speech; unconsciousness; small, pinpoint pupils; cold, clammy skin; slow breathing; seizures; severe drowsiness, weakness, or dizziness; difficulty urinating.

Common

Mild dizziness or lightheadedness, nausea or vomiting, constipation, drowsiness, itching, dry mouth.

Less common

Headache, sweating, false sense of well-being (euphoria).

Possible interactions

Other medicaments:

Codeine may increase the effects of:

• atropinelike medicaments and increase the risk of constipation and urinary retention.
• monoamine oxidase (MAO) inhibitors and also increase central nervous system symptoms and depression.
• other medicaments with sedative effects.
• tramadol (Ultram).

Codeine taken concurrently with:



• quinidine may decrease codeine pain control.
• rifabutin (Mycobutin) may decrease codeine effectiveness.
• ritonavir (Norvir) may blunt codeine benefits.

Herbal medicines or minerals:

Valerian and kava kava may interact additively (drowsiness). Avoid these combinations. St. John's wort can change (inducing or increasing) P450 3A4 enzymes, blunting the effects of this medicine. Talk to your doctor before you combine any herbals with codeine.

Alcohol:

Codeine intensifies alcohol, and alcohol intensifies codeine depressant effects on brain function, breathing and circulation.

Tobacco smoking:

Tobacco smoking may cause decreased pain tolerance and require an increased or more frequent dose of codeine.

Marijuana smoking:

Increases drowsiness and pain relief. Mental and physical performance will be impaired.

Discontinuation:

Best to limit use to short-term. If extended use occurs, gradual decreases in dose are prudent to minimize possible withdrawal (usually mild with codeine).