The opiate codeine is used in medicine for the treatment of dry cough (dry cough). It is also used as a painkiller in combination preparations with acetaminophen or other analgesics. Since codeine has a damping effect on the respiratory center, respiratory depression can occur as a side effect. For people with respiratory insufficiency, the drug is therefore not suitable. Learn more about the effects, side effects and dosage of codeine.
Effect of codeine
Codeine is an opiate and belongs to the group of opioids because of its morphine-like properties. The group also includes active ingredients such as morphine, methadone, fentanyl, oxycodone, tramadol and tilidine.
Codeine is used as a cough suppressant for irritating cough. Such an unproductive cough may occur, for example, in the context of a cold or bronchitis. In contrast to the productive cough, no mucus is coughed off in the case of irritating cough.
On the other hand, codeine is used together with paracetamol as a painkiller for the treatment of moderate to severe pain. Among other things, it is used for toothache, menstrual pain or after surgical procedures. In addition to acetaminophen, codeine is also combined with other painkillers such as diclofenac or acetylsalicylic acid. Previously, the drug was also used as a replacement drug in a heroin withdrawal.
Side effects of codeine
The most common side effects with 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 disorders, ear noises and shortness of breath. Very rarely can the treatment result in weight gain.
Patients who are particularly sensitive or who are taking high doses may experience other side effects. These include, for example, a morbid high mood, a decrease in the respiratory drive and a deterioration in visual performance. If codeine is taken over a long period of time and in high doses, the drug can make it dependent.
Dosage of codeine
Codeinhaltige drugs for the treatment of cough are available in various dosage forms. Especially common are drops or juice, but there are also codeine tablets. Together with paracetamol, codeine is available in the form of capsules, tablets and suppositories.
Depending on whether the drug is used for cough or for the treatment of pain, the dose varies. When codeine is used to treat dry cough, depending on the severity of the cough, a dose of 15 to 60 milligrams may be administered every six to eight hours. In children, the dose should be correspondingly lower.
On the other hand, if the opiate is used to treat pain, the dosage depends, among other things, on which combination preparation is used. Generally, no more than 240 milligrams of codeine should be taken each day. How high the active ingredient should be exactly dosed, please discuss with your doctor.
Codeine should not be taken concurrently with medications that act to attenuate the central nervous system. Such medicines are, for example, sleeping pills, sedatives or psychotropic drugs. Otherwise, the side effects can be amplified. This can lead to increased fatigue and dizziness as well as an increased impairment of the breathing.
Even with the simultaneous use of antihistamines or antihypertensive agents, an increase in side effects is possible. The respiratory impairment can also occur with simultaneous use of drugs from the group of tricyclic antidepressants.
While the effect of codeine can be enhanced by cimetidine, the active ingredient in turn enhances the effect of analgesics. In addition, the simultaneous administration of MAO inhibitors may increase the central nervous effect. Therefore, it is advisable to take a two-week break between treatment with MAO inhibitors and codeine. Alcohol should be avoided while taking codeine-containing medicines.
Under certain circumstances codeine may not be used. This is the case with:
- a hypersensitivity to the drug
- respiratory insufficiency
- an acute asthma attack
- a deep unconsciousness
Codeine should also not be used in chronic coughing as this symptom may be a sign of bronchial asthma, especially in children.
Only after careful consideration of the benefit-risk by the attending physician may codeine be used for impaired consciousness, increased intracranial pressure, respiratory or respiratory tract disorders, opioid dependence and constipation. If there is low blood pressure due to low blood volume, care should also be taken.
Breastfeeding and pregnancy
Codeine should only be taken on the advice of a doctor during the first three months of pregnancy, if at all. The active ingredient can cause malformations on the unborn child. Shortly before birth or in the case of imminent premature birth, the opiate should not be used either, otherwise respiratory disorders may occur in the newborn.
If codeine is taken for a prolonged period during pregnancy, dependence on the drug may develop in the unborn child. If the opiate is used more frequently in the last third of the pregnancy, withdrawal symptoms may occur in the baby after birth.
During breast-feeding, no codein-containing medicines should be taken as much as possible. Because the active ingredient can pass into breast milk and cause symptoms such as lethargy, drowsiness and dehydration in the baby. While there is probably no risk of a single dose, breastfeeding should be stopped in case of repeated ingestion.
Codeine in children
For children under the age of two, treatment with codeine is inappropriate as there is an increased risk of respiratory depression. In order to avoid unwanted side effects, the dosage must be observed even in older children. As a general rule, the dose in children should always be kept as low as possible. If symptoms such as shortness of breath, drowsiness or confusion occur, the treatment must be stopped immediately.