The opiate codeine is used in medicine to treat dry cough (irritable cough). With paracetamol or other painkillers, it is also used in combination preparations as an analgesic. Since codeine has a depressant effect on the respiratory center, respiratory depression can occur as a side effect. The active ingredient is therefore not suitable for people with respiratory insufficiency. Learn more about the effects, side effects, and dosage of codeine here.
Effect of codeine
Codeine is an opiate and belongs to the group of opioids due to its morphine-like properties. This group also includes agents such as morphine, methadone, fentanyl, oxycodone, tramadol, and tilidine. Codeine is used, on the one hand, as a cough suppressant for irritable coughs. Such an unproductive cough can occur, for example, in the context of a cold or bronchitis. In contrast to a productive cough, irritable cough does not cause mucus to be coughed up. Secondly, codeine is used together with paracetamol as an analgesic to treat moderate to severe pain. Among other things, it is used for toothache, menstrual pain or after surgical procedures. In addition to paracetamol, codeine is also combined with other analgesics such as diclofenac or acetylsalicylic acid. In the past, the active ingredient was also used as a substitute drug in heroin withdrawal.
Side effects of codeine
The most common side effects of codeine include fatigue, constipation, and headache. Nausea and vomiting may also occur at the beginning of treatment. Rare side effects include itching, dry mouth, sleep disturbances, ringing in the ears, and shortness of breath. Very rarely, treatment may result in weight gain. Other side effects may occur in patients who are particularly sensitive or when high doses are taken. These include, for example, a morbid high, a decrease in respiratory drive, and a deterioration in visual performance. If codeine is taken over a long period of time and in high doses, the active ingredient can be addictive.
Dosage of codeine
Codeine-containing medications for the treatment of cough are available in a variety of dosage forms. Drops or juice are particularly common, but codeine tablets are also available. Together with paracetamol, codeine is available in the form of capsules, tablets and suppositories, among others. The dose varies depending on whether the active ingredient is used for coughs or to treat pain. If codeine is used to treat a dry cough, a dose of 15 to 60 milligrams can be administered every six to eight hours, depending on the severity of the cough. In children, the dose should be correspondingly lower. If, on the other hand, the opiate is used to treat pain, the dosage depends, among other things, on which combination preparation is used. In general, no more than 240 milligrams of codeine should be taken per day. Please discuss exactly how high the active ingredient should be dosed with your attending physician.
Drug Interactions
Codeine should not be taken at the same time as medications that have a depressant effect on the central nervous system. Such medications include sleeping pills, sedatives, or psychotropic drugs. Otherwise, the side effects may be intensified. This can lead to increased fatigue and drowsiness as well as increased respiratory impairment. An increase in side effects is also possible if antihistamines or antihypertensive agents are taken at the same time. Respiratory impairment may also occur with concomitant use of agents from the tricyclic antidepressant group. While the effect of codeine can be enhanced by cimetidine, the active ingredient itself in turn enhances the effect of analgesics. In addition, the simultaneous administration of MAO inhibitors can lead to an intensification of the central nervous effect. It is therefore advisable to take a two-week break between treatment with MAO inhibitors and codeine. Alcohol should be avoided while taking codeine-containing medications.
Contraindications
Codeine should not be used under certain circumstances. Among others, this is the case with:
- A hypersensitivity to the active substance
- A respiratory insufficiency
- An acute asthma attack
- a deep unconsciousness
Codeine should also not be used in chronic cough, as this symptom may be a sign of bronchial asthma, especially in children. Only after a careful risk-benefit assessment by the attending physician, codeine may be used in cases of impaired consciousness, increased intracranial pressure, disorders of respiratory function or center, opioid dependence and constipation. If low blood pressure is present due to insufficient blood volume, caution is also advised.
Lactation and pregnancy
During the first three months of pregnancy, codeine should be taken only as directed by a physician, if at all. This is because the active ingredient can cause malformations in the unborn child. The opiate should also not be used shortly before birth or in the event of a threatened premature birth, otherwise breathing disorders may occur in the newborn. If codeine is taken over a long period of time during pregnancy, the unborn child may develop a dependence on the active substance. If the opiate is used more frequently in the last third of pregnancy, withdrawal symptoms may occur in the infant after birth. Medicines containing codeine should also be avoided as far as possible during breastfeeding. This is because the active ingredient can pass into breast milk and cause symptoms such as lethargy, drowsiness and poor drinking in the infant. While there is probably no danger with a single ingestion, breastfeeding should definitely be interrupted in the case of repeated ingestion.
Codeine in children
Treatment with codeine is unsuitable for children younger than two years of age because of an increased risk for respiratory depression. To avoid undesirable side effects, it is essential to follow the dosage in older children as well. As a general rule, the dose taken should always be kept as low as possible in children. If symptoms such as shortness of breath, drowsiness, or confusion occur, treatment must be stopped immediately.
