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Therapeutic indications

1) Indicated as an analgesic for the relief of mild to moderate pain. Codeine is indicated in patients older than 12 years of age for the treatment of acute moderate pain which is not considered to be relieved by other analgesics such as paracetamol or ibuprofen (alone).
2) For the symptomatic relief of unproductive cough and diarrhoea.

What is the most important information I should know about codeine?

Codeine may be habit-forming and should be used only by the person it was prescribed for. Codeine should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Do not drink alcohol while you are taking codeine. Dangerous side effects or death can occur when alcohol is combined with a narcotic pain medicine. Check your food and medicine labels to be sure these products do not contain alcohol.

Never take more than your prescribed dose of codeine. But, tell your doctor if the medicine seems to stop working as well in relieving your pain. Codeine can cause side effects that may impair your thinking or reactions. So, be careful if you drive or do anything that requires you to be awake and alert. Also, do not stop using codeine suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication.

Special warnings and precautions for use

Codeine phosphate should be used with caution in the following conditions:

• Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
• There is a possible risk of CNS excitation or depression with concomitant use of opioids with MAOIs and use is not recommended (see section 4.5).
• Hepatic impairment – avoid if severe. Codeine may precipitate coma.
• Renal impairment.
• Hypothyroidism.
• Inflammatory bowel disease – codeine reduces peristalsis, increases tone and segmentation in the bowel and can raise colonic pressure, therefore should be used with caution in diverticulitis, acute colitis, diarrhoea associated with pseudomembranous colitis or after bowel surgery.
• Convulsions – may be induced or exacerbated.
• Drug abuse or dependence (including alcoholism).
• Gall bladder disease or gall stones – opioids may cause biliary contraction. Avoid in biliary disorders.
• Gastro-intestinal surgery – use with caution after recent GI surgery as opioids may alter GI motility.
• Urinary tract surgery – following recent surgery patients will be more prone to urinary retention caused directly by spasm of the urethral sphincter, and via constipation caused by codeine.
• Phaeochromocytoma – opioids may stimulate catecholamine release by inducing the release of endogenous histamine.
• Prostatic hypertrophy.
• Adrenocortical insufficiency, eg Addison’s Disease.
• Hypotension and shock.
• Myasthenia gravis.
• Reduced respiratory function or history of asthma.
• Pregnancy and breast feeding (see section 4.6).
• Elderly patients may metabolise and eliminate opioid analgesics more slowly than younger patients (see section 4.2).
• The risk benefit of continued use should be assessed regularly by the prescriber

Precautions Before Taking Codeine

Opioid analgesics such as codeine relieve pain by acting directly on the central nervous system. However, this can also lead to serious side effects, such as drowsiness, dizziness, sedation and physical or mental dependence. Finally, like all narcotics, they may become habit-forming if used over long periods and have the potential for abuse.