Experiences with
Codeine

Codeine is a painkiller that is part of a group of medicines called opiates. It's used to treat pain, for example, after an operation or an injury. It's also used for ongoing pain when painkillers such as paracetamol, ibuprofen and aspirin have not worked. Codeine is also used to treat diarrhoea.

It works in the central nervous system and the brain to block pain signals to the rest of the body. It also reduces the anxiety and stress caused by pain.

Codeine is available on prescription and comes as tablets, a liquid you swallow, a syrup (linctus) and as an injection. Codeine injections are usually only given in hospital.

You can also buy lower-strength codeine from a pharmacy. It comes mixed with paracetamol (co-codamol) or with aspirin (co-codaprin) or with ibuprofen (Nurofen Plus).

Who can take codeine

Adults and children aged 12 and older can take codeine. But only give codeine to children (aged 12 to 18 years) if everyday painkillers such as paracetamol and ibuprofen have not worked.

Who may not be able to take codeine

Codeine is not suitable for some people. To make sure it's safe for you, tell your doctor before starting the medicine if you have:

ever had an allergic reaction to codeine or any other medicine
a lung problem
a head injury
adrenal gland problems
a condition which causes seizures or fits
an addiction to alcohol
an underactive thyroid gland
kidney or liver problems
gallstones
an enlarged prostate
low blood pressure
myasthenia gravis, a rare illness that causes muscle weakness
symptoms of ulcerative colitis, a bowel condition
been trying to get pregnant, are already pregnant or breastfeeding – codeine is not generally recommended during pregnancy or breastfeeding

Do not give codeine to children who are under 18 if they have had their tonsils or adenoids removed because of a sleep problem called obstructive sleep apnoea (OSA). This is because:

OSA can cause breathing problems while sleeping
codeine can also cause breathing problems

Giving codeine to a child with this condition could be dangerous because of this.

Dosage and strength

Codeine comes as:

tablets – these contain 15mg, 30mg or 60mg of codeine
a liquid that you swallow – this contains 25mg of codeine in a 5ml spoonful
cough syrup – this contains 15mg of codeine in a 5ml spoonful
an injection (usually given in hospital)

The usual dose of codeine is 15mg to 60mg.

The usual dose for treating pain is:

adults – one or two 30mg tablets, taken every 4 hours, up to a maximum of 8 tablets (240mg) in 24 hours
children (aged 12 to 17 years) – one or two 30mg tablets (or one or two 5ml spoonfuls of liquid), taken every 6 hours
older people or people with kidney or liver problems – one 15mg tablet, taken every 4 hours

The usual dose for treating diarrhoea is:

adults – one or two 30mg tablets (or one or two 5ml spoonfuls of liquid)
children (aged 12 to 17 years) – one or two 30mg tablets (or one or two 5ml spoonfuls of liquid)
older people, or people with kidney or liver problems – one 15mg tablet

You can take this dose 3 or 4 times a day.

The usual dose for treating a cough is:

adults and children – one or two 5ml spoonfuls of cough syrup, taken 3 or 4 times a day

It's important not to take more than your prescribed dose. Do not take more than 4 doses of codeine in 24 hours if you're:

a child (aged 12 to 17 years)
taking a 60mg dose

Changes to your dose

If you get side effects from taking codeine, your doctor may lower your dose.

If your symptoms do not go away, your doctor may increase your dose or prescribe a different medicine.

Talk to your doctor if your pain or diarrhoea is not relieved by the dose of codeine prescribed for you, or if side effects bother you or do not go away.

How to take it

Swallow your codeine tablet whole with a drink of water. Take it with, or just after, a meal or snack so it's less likely to make you feel sick.

You can take codeine at any time of day but try to take it at the same times every day, and space your doses evenly.

If you're taking codeine as a liquid, it will come with a plastic spoon or syringe to help you measure the correct amount. Ask your pharmacist for one if you do not have it. Do not measure the liquid with a kitchen teaspoon because it will not give the right amount.

How long to take it for

You might only need to take codeine for a few days. Sometimes, you may need to take it for longer. But usually, a different medicine will be prescribed for long-term pain or diarrhoea, especially if you have side effects like constipation.

If you forget to take it

If you forget to take a dose, check the information on the leaflet inside the packaging, or ask your pharmacist or doctor for advice on what to do.

Never take 2 doses at the same time to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicine.

If you take too much

It's important not to take more than your prescribed dose, even if you think it's not enough to relieve your pain. Speak to your doctor first, if you think you need a different dose.

Taking too much codeine can be dangerous. It may make you feel very sleepy, sick or dizzy. You may also find it difficult to breathe. In serious cases, you can become unconscious and may need emergency treatment in hospital.

The amount of codeine that can lead to an overdose varies from person to person.

you've taken more than your recommended dose of codeine

Go to 111.nhs.uk or call 111 .

you have taken more than your recommended dose of codeine and are having problems with your breathing

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the codeine packet or leaflet inside it, any remaining medicine, and any other medicines you take.

you are losing consciousness – if you're with someone, ask them to call for you

Meds - overdose 999 only safety messaging

If you have been taking codeine for a long time and want to stop, talk to your doctor first. Your dose can be reduced gradually so you do not get withdrawal symptoms. If you stop taking it suddenly, it can cause:

agitation
anxiety
shaking
sweating

If you have been taking codeine for more than a few weeks, do not stop taking it without speaking to your doctor first.

If you've been prescribed codeine, it's particularly important to:

store it properly and safely at home
keep it out of the sight and reach of children
never share your medicine with anyone else

Return any unused codeine to your pharmacist. They will get rid of it.

Common side effects

These common side effects of codeine happen in more than 1 in 100 people. There are things you can do to help cope with them:

Try to get more fibre into your diet, such as fresh fruit, vegetables and cereals. Try to drink several glasses of water or other non-alcoholic liquid each day. If you can, it may also help to do some gentle exercise.

It's safe to use a laxative if your constipation does not go away. Usually, lactulose is best but check with a pharmacist or doctor first.

Take codeine with or just after a meal or snack to ease feelings of sickness. If you're being sick, try small frequent sips of water. This side effect should normally wear off after a few days. Talk to your doctor about taking an anti-sickness medicine if it carries on for longer.

If you take the combined contraceptive pill or progestogen-only pill and you're being sick, your contraception may not protect you from pregnancy. Check the pill packet to find out what to do.

This side effect should go away within a few days as your body gets used to codeine. Talk to your doctor if it carries on for longer. Do not drive, cycle or use tools or machinery if you're feeling sleepy.

This side effect should wear off within a few days as your body gets used to codeine. Talk to your doctor if it carries on for longer.

Do not drive, cycle or use tools or machinery. GOV.UK has more information on the law on drugs and driving.

If codeine makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you do not faint, then sit until you feel better.

Do not drive, cycle or use tools or machinery if you're feeling dizzy. GOV.UK has more information on the law on drugs and driving.

Try chewing sugar-free gum or sucking sugar-free sweets. Your doctor can also prescribe an artificial saliva substitute to keep your mouth moist. This comes as a spray, gel or lozenge.

It's safe to take an everyday painkiller such as paracetamol or ibuprofen. Talk to your doctor if the headaches get worse or last longer than a week.

If this advice does not help and any of these side effects continue to bother you, speak to your doctor or pharmacist.

Serious side effects

Serious side effects happen in less than 1 in 100 people.

Call a doctor or call 111 now if you:

have muscle stiffness
get symptoms of low blood pressure, which include feeling dizzy and tired

you have breathing difficulty or short, shallow breathing
you have a fit or seizure

Find your nearest A&E

Meds - serious side effects A&E safety messaging

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to codeine.

Meds New IA (H4) - serious allergic reaction

Some people with conditions that need long-term pain relief may need to take codeine for a long time.

If you need to take it for a long time your body can become used to it (known as tolerance). That means you need higher doses to control your pain over time.

Some people can become more sensitive to pain (hyperalgesia). If this happens, your doctor will reduce your dose gradually to help these symptoms.

It's possible to become addicted to codeine. For this reason, your dose will be reviewed to make sure you're only having the amount you need to control your pain.

Your treatment plan may include details of how and when you'll stop codeine.

If you're having treatment for cancer pain or other severe pain, your pain control will be carefully monitored. Speak to your doctor if you're worried about tolerance, hyperalgesia or becoming addicted.

Other side effects

These are not all the side effects of codeine. For a full list, see the leaflet inside your medicine packet.

Codeine and pregnancy

Codeine can be taken in pregnancy, although long-term use is not recommended.

If you take codeine at the end of pregnancy there's a risk that your baby will be used to having codeine. This means that they may have withdrawal symptoms. If this happens, your baby may need extra time in hospital after delivery for observation.

It is important to treat pain in pregnancy. For some pregnant women with severe pain, codeine might be the best option. Your doctor can help you decide what's right for you and your baby.

Codeine and breastfeeding

Do not take codeine if you're breastfeeding. Small amounts of codeine pass into breast milk and can cause breathing problems in your baby and make them feel drowsy.

Talk to your doctor or pharmacist, as they will be able to recommend a more suitable painkiller.

Codeine and fertility

If you're taking codeine for a short time and at normal doses, there's no evidence that it reduces fertility in either men or women.

However, if you've been taking it for a long time and you're concerned about your fertility, or you're trying to get pregnant, speak to a pharmacist or your doctor.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

Some medicines can affect the way codeine works, and increase the chances of you having side effects.

Tell your doctor if you're taking any medicines:

to help you sleep
for depression – some types cannot be taken with codeine
for high blood pressure
to help stop you feeling or being sick
to treat symptoms of an allergy
to reduce tension or anxiety
for mental health problems

Taking codeine with other painkillers

It's safe to take codeine with paracetamol, ibuprofen or aspirin (aspirin is suitable for most people aged 16 and over).

Some painkillers that you can buy without a prescription from pharmacies contain codeine. They include co-codamol, ibuprofen and codeine (such as Nurofen Plus) and Solpadeine.

If you are taking prescribed codeine, do not take painkillers that contain codeine that you have bought from a pharmacy at the same time. You'll be more likely to get side effects.

Mixing codeine with herbal remedies and supplements

It is not possible to say that herbal remedies and supplements are safe to take with codeine. They are not tested in the same way as pharmacy and prescription medicines, and are generally not tested for the effect they have on other medicines.

Meds New IA (H2) - Cautions with other medicines alert