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.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. 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?
Ratio-Codeine is no longer being manufactured for sale in Canada. For brands that may still be available, search under codeine. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.
How should I use this medication?
In general codeine should be used at the lowest dose that provides relief for the shortest duration of time possible.
Pain relief: The recommended dose of codeine for pain relief for is 15 mg to 60 mg every 4 to 6 hours as required, not to exceed 360 mg in one day.
Cough: The recommended adult dose of codeine as a cough suppressant is 15 mg to 30 mg every 6 to 8 hours as needed, up to a maximum of 120 mg daily.
Codeine is no longer recommended for children, due to the increased risk of breathing difficulty and other complications of this medication.
Codeine may be taken with or without food. Swallow the tablets whole with a glass of water. Tablets should not be chewed, cut, broken or crushed, as this can be dangerous and lead to serious harm or death.
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. If 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 any ingredients of the medication
- are allergic to any morphine-type medications
- are experiencing acute alcoholism or delirium tremens
- are experiencing acute asthma or other obstructive airway disease
- are experiencing acute respiratory depression
- are experiencing pain that can be controlled with pain relievers that are not narcotics
- have been identified as an "ultra-rapid metabolizer" (e.g., your body breaks down codeine too fast)
- have a blockage of the gastrointestinal tract, particularly paralytic ileus
- have a head injury, a brain tumour, or increased pressure inside the head or spinal cord
- have taken an MAO inhibitor such as phenelzine or tranylcypromine in the past 14 days
- have a convulsive (seizure) disorder
- have cor pulmonale
- have suspected abdominal conditions that may require surgery
- are less than 18 years of age and have had your tonsils and adenoids removed to treat obstructive sleep apnea
- are pregnant or breast-feeding, in labour, or delivering
Do not give this medication to children less than 12 years of age.
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.
- decreased interest in sexual activity
- decreased sexual ability
- dry mouth
- loss of appetite
- trouble sleeping
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- decreased coordination
- fast, slow, or irregular heartbeat
- hives, itching, or skin rash
- signs of breathing problems (e.g., shortness of breath, wheezing, irregular or troubled breathing)
- symptoms of withdrawal (e.g., nausea, vomiting, diarrhea, anxiety, shivering, cold and clammy skin, body aches, sweating, loss of appetite)
Stop taking the medication and seek immediate medical attention if any of the following occur:
- 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 codeine overdose: cold and clammy skin, low blood pressure, pinpoint pupils of eyes, severe drowsiness, severe nervousness or restlessness, slow heartbeat, weakness
- slow or troubled breathing
- symptoms of bowel blockage (e.g., abdominal pain, severe constipation, nausea)
- symptoms of serotonin syndrome (e.g., agitation or restlessness, loss of muscle control, muscle twitching, tremor, diarrhea)
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
August 24, 2020
Health Canada has issued new restrictions concerning the use of prescription codeine. 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.
Accidental use: When codeine is used by anyone other than the person for whom it was prescribed, the effects of the medication may be fatal. Children are especially at risk. Keep this medication out of sight and reach of children.
Adrenal gland problems: Adrenal glands produce chemical messengers that are responsible for the normal function of the body's organs, including how your body responds to injury or stress. On rare occasions, particularly if it is taken for longer than a month, codeine may cause your adrenal gland to function improperly.
Alcohol and other medications that cause drowsiness: Alcohol increases the risk of severe side effects from codeine, such as decreased blood pressure, seizures, breathing problems, and severe drowsiness. Consuming alcohol while you are taking codeine is not recommended. Other medications that cause drowsiness or slow down your breathing (e.g., antidepressants, sleeping pills, anxiety medications) should be avoided if possible, as additive side effects may occur and can be dangerous and potentially fatal.
Asthma and other respiratory conditions: Codeine may cause increased breathing difficulty for anyone who is having an asthma attack or who has chronic obstructive pulmonary disease (chronic bronchitis, emphysema) or other conditions that affect breathing. If you have asthma or another breathing disorder, 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.
Heart rhythm: Codeine can cause changes to the normal rhythm of the heart. If you are at risk for heart rhythm problems (e.g., people with heart failure, angina, low potassium or magnesium levels), 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 hypothyroidism (low thyroid), 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: Codeine may increase the risk of seizures for people who have a seizure disorder. 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.
Serotonin Syndrome: Although rare, severe reactions are possible when codeine is combined with other medications that act on serotonin, such as tricyclic antidepressants and serotonin reuptake inhibitors, medications used to treat depression. These combinations should be avoided if possible. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. Coma and death are possible.
If you are taking antidepressants, 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.
Sleep Apnea: Sleep apnea is a condition where you stop breathing for short periods of time while asleep. This can be caused or made worse by medications slow breathing. If you or your partner notice episodes where you are not breathing then suddenly start to breathe again, contact your doctor as soon as possible.
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.
Infants born to mothers who have been taking codeine may experience breathing difficulties and withdrawal symptoms, which can be life-threatening.
Breast-feeding: This medication passes 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, which could be fatal. 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.
Children: The safety and effectiveness of using this medication have not been established for children under 12 years of age. It is not recommended for children and adolescents less than 18 years of age.
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:
- amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
- antihistamines (e.g., azelastine, bilastine, cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine, rupatadine)
- antipsychotics (e.g., cariprazine, chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
- "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
- barbiturates (e.g., phenobarbital, butalbital)
- benzodiazepines (e.g., diazepam, lorazepam, oxazepam)
- certain HIV protease inhibitors (e.g., darunavir, lopinavir, ritonavir, saquinavir, tipranavir)
- chloral hydrate
- diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
- general anesthetics (medications used to put people to sleep before surgery)
- grapefruit juice
- kava kava
- monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
- muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine, tizanidine)
- other narcotic pain relievers (e.g., fentanyl, hydrocodone, oxycodone, morphine, tapentadol, tramadol)
- protein kinase inhibitors (e.g., ceritinib, crizotinib, imatinib, nilotinib)
- St. John's wort
- seizure medications (e.g., carbamazepine, clobazam, ethosuximide, gabapentin, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, rufinamide, sertraline)
- serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
- somatostatin analogues (e.g., lanreotide, octreotide, pasireotide)
- 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.
All material copyright MediResource Inc. 1996 – 2023. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/ratio-Codeine