Drug Profiles:
Codeine

Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. The following should be considered:

Allergies-
Tell your doctor if you have ever had any unusual or allergic reaction to medications.

Pregnancy-
Codeine may cause addiction and withdrawal symptoms as well as other harmful effects in an unborn baby. Do not take codeine without first talking to your doctor if you are pregnant.

Breast-feeding-
Codeine may also cause addiction and withdrawal symptoms in a nursing baby. Do not take codeine without first talking to your doctor if you are breast-feeding a baby.

Children and older adults-
If you are younger than 18 years of age or older than 60 years of age, you may be more likely to experience side effects from codeine therapy. Use extra caution.

Other medicines-
Always tell your doctor all medications you are taking, both prescription and over-the-counter. Although certain medicines should not be used together at all, in other cases different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. It is especially important that you observe the following and consult your doctor:

• Avoid alcohol while taking codeine. Alcohol will greatly increase the drowsiness and dizziness caused by codeine and could be dangerous.
• Do not take codeine if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days. Dangerous side effects could result.
• The most serious interactions affecting codeine are with those drugs that also cause sedation. The following drugs may lead to dangerous sedation if taken with codeine:
  • antihistamines such as brompheniramine (Dimetane, Bromfed, others), diphenhydramine (Benadryl, Nytol, Compoz, others), chlorpheniramine (Chlor-Trimeton, Teldrin, others), and others
  • tricyclic antidepressants, such as amitriptyline (Elavil) and doxepin (Sinequan), and serotonin reuptake inhibitors such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil)
  • other commonly used antidepressants, including amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), and protriptyline (Vivactil)
  • anticholinergics such as belladonna (Donnatal), clidinium (Quarzan), dicyclomine (Bentyl, Antispas), hyoscyamine (Levsin, Anaspaz), ipratropium (Atrovent), propantheline (Pro-Banthine), and scopolamine (Transderm-Scop)
  • phenothiazines such as chlorpromazine (Thorazine), fluphenazine (Prolixin), thioridazine (Mellaril), and prochlorperazine (Compazine)
  • tranquilizers and sedatives such as phenobarbital (Solfoton, Luminal), amobarbital (Amytal), secobarbital (Seconal), alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), flurazepam (Prosom), and temazepam (Restoril).
• Do not take any of the drugs listed above without the approval of your doctor.
• Drugs other than those listed here may also interact with codeine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines. .

Other medical problems-
Codeine is habit forming and should only be used under close supervision if you have an alcohol or drug addiction. Make sure you tell your doctor if you have any other medical problems, especially:

• kidney disease
• liver disease
• asthma
• urinary retention
• an enlarged prostate
• hypothyroidism
• seizures or epilepsy
• a head injury
• Addison's disease

Proper use of this medicine-

• Take codeine exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
• Never take more of this medication than is prescribed for you. Too much codeine could be very harmful.
• Take each dose with a full glass of water.
• Take codeine with food or milk if it upsets your stomach.
• Do not stop taking codeine suddenly if you have been taking it continuously for more than 5 to 7 days. Stopping suddenly could cause withdrawal symptoms and make you feel uncomfortable. Your doctor may want to gradually reduce your dose.
• Codeine will cause constipation. Increase the amount of fiber and water (six to eight full glasses a day) in your diet to prevent constipation.
• Do not share this medication with anyone else.
• If taking codeine in liquid form, shake well before measuring a dose.

Missed dose-
Take the missed dose as soon as you remember. Do not take a double dose of this medication. Take your next dose 4 to 6 hours later.

Storage-

• Keep this medication in the container it came in, tightly closed, and out of reach of children.
• Store it at room temperature and away from excess heat and moisture (not in the bathroom).
• Throw away any medication that is outdated or no longer needed.
• Talk to your pharmacist about the proper disposal of your medication.

Side Effects of This Medicine

• If you experience any of the following serious side effects, stop taking codeine and seek emergency medical attention:
  • an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives)
  • slow, weak breathing
  • seizures
  • cold, clammy skin
  • severe weakness or dizziness
  • unconsciousness
• Other, less serious side effects may be more likely to occur. Continue to take codeine and talk to your doctor if you experience
  • constipation
  • dry mouth, nausea, vomiting, or decreased appetite
  • dizziness, tiredness, or lightheadedness
  • muscle twitches
  • sweating
  • itching
  • decreased urination
  • decreased sex drive
• Codeine is habit forming. Do not stop taking it suddenly.
• Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.