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Codeine is a prescription opioid medication used to treat mild to moderate pain and to suppress cough. It works by binding to opioid receptors in the brain and spinal cord, which reduces the perception of pain and decreases the urge to cough. Codeine is often combined with acetaminophen or aspirin in certain formulations to enhance pain relief and is classified as a Schedule II, III, or V controlled substance depending on the formulation and concentration.
Dosage of codeine varies based on the indication, formulation, age, and patient response. For pain relief in adults, immediate-release tablets typically range from 15–60 mg every 4–6 hours as needed, with a maximum daily dose of 360 mg. For cough suppression, lower doses (10–20 mg every 4–6 hours) are often prescribed. Codeine should be taken exactly as prescribed, and combination products should not exceed the maximum recommended daily acetaminophen or aspirin limits, to avoid liver or kidney damage.
There are significant warnings associated with codeine use. It can cause respiratory depression, especially in children, older adults, or those with lung disease. Codeine is metabolized into morphine in the body, and some individuals (ultra-rapid metabolizers) may convert it too quickly, increasing the risk of overdose. Long-term use can lead to tolerance, physical dependence, and addiction, and abrupt discontinuation may cause withdrawal symptoms. Codeine should not be combined with alcohol, benzodiazepines, or other CNS depressants.
Common side effects of codeine include drowsiness, constipation, nausea, vomiting, dizziness, and dry mouth. Serious side effects can include slow or difficult breathing, confusion, severe allergic reactions, or low blood pressure. Patients should avoid driving or operating heavy machinery until they understand how codeine affects them and should seek immediate medical attention if signs of overdose occur, such as extreme sleepiness, blue lips, or difficulty breathing.
