Medication Guide App

Codeine Side Effects

Not all side effects for codeine may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to codeine: oral solution, oral syrup, oral tablet, oral tablet extended release

In addition to its needed effects, some unwanted effects may be caused by codeine. In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking codeine:

Incidence not known
  • Bloating
  • blurred vision
  • chills
  • cold, clammy skin
  • confusion
  • constipation
  • darkened urine
  • difficult or troubled breathing
  • dizziness
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • fainting
  • fast, irregular, pounding, or racing heartbeat or pulse
  • fast, weak pulse
  • feeling of warmth
  • fever
  • indigestion
  • irregular, fast or slow, or shallow breathing
  • lightheadedness
  • loss of appetite
  • nausea
  • no blood pressure or pulse
  • no breathing
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • pale or blue lips, fingernails, or skin
  • redness of the face, neck, arms, and occasionally, upper chest
  • shortness of breath
  • stopping of the heart
  • sweating
  • unconsciousness
  • unusual tiredness or weakness
  • vomiting
  • wheezing
  • yellow eyes or skin

If any of the following symptoms of overdose occur while taking codeine, get emergency help immediately:

Symptoms of overdose
  • Bluish lips or skin
  • change in consciousness
  • chest pain or discomfort
  • constricted, pinpoint, or small pupils (black part of the eye)
  • decreased awareness or responsiveness
  • extreme sleepiness or unusual drowsiness
  • loss of consciousness
  • no blood pressure or pulse
  • severe sleepiness
  • slow or irregular heartbeat

Some of the side effects that can occur with codeine may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Drowsiness
  • relaxed and calm
Incidence not known
  • Abdominal or stomach pain or cramps
  • blurred or loss of vision
  • diarrhea
  • disturbed color perception
  • double vision
  • dry mouth
  • false or unusual sense of well-being
  • fear or nervousness
  • feeling of constant movement of self or surroundings
  • halos around lights
  • headache
  • hives or welts
  • itching skin
  • night blindness
  • overbright appearance of lights
  • redness of the skin
  • sensation of spinning
  • shakiness
  • skin rash
  • sleeplessness
  • trouble sleeping
  • tunnel vision
  • unable to sleep
  • weight loss

For Healthcare Professionals

Applies to codeine: compounding powder, injectable solution, oral solution, oral tablet

General

The side effects have been more likely and more severe in patients with liver and/or renal disease.[Ref]

Nervous system

Nervous system side effects have included mental and respiratory depression, stupor, delirium, somnolence, and dysphoria. An increased risk of falls and hip fractures has also been associated with codeine therapy, particularly in the elderly. A case of seizures has been reported with the use of intravenous codeine phosphate.[Ref]

Opioids may result in psychotic symptoms in some patients.

One retrospective study of elderly patients who sustained a hip fracture suggested that the relative risk of hip fracture was 1.6 in patients using codeine compared to age matched nonusers.[Ref]

Other

Other side effects including withdrawal symptoms after either abrupt cessation or fast tapering of narcotic analgesics have been reported. These withdrawal symptoms have included agitation, restlessness, anxiety, insomnia, tremor, abdominal cramps, blurred vision, vomiting, and sweating.[Ref]

Cardiovascular

Hypotension is rare and has been reported most frequently with high doses.[Ref]

Cardiovascular side effects have included hypotension and dizziness.[Ref]

Gastrointestinal

Gastrointestinal side effects including nausea, vomiting, and constipation have been reported frequently. Severe constipation and ileus resulting in colonic perforation have also been reported. Four cases of acute pancreatitis have been reported.[Ref]

Genitourinary

Genitourinary side effects including urinary retention have been reported.[Ref]

Dermatologic

Dermatologic side effects including rashes, severe scarlatiniform eruptions, and generalized dermatitis have been reported rarely.[Ref]

Codeine induced rashes may be related to direct stimulation of histamine release.[Ref]

Renal

Renal side effects including acute renal failure (which may respond to naloxone therapy) have been reported in association with codeine therapy.[Ref]

Immunologic

Immunologic side effects have included one study of a patient with exercise induced anaphylaxis and three control subjects which found a correlation between codeine wheal size and recent exercise.[Ref]

Hypersensitivity

Hypersensitivity side effects including a case of codeine phosphate induced hypersensitivity syndrome have been reported.[Ref]

Ocular

Ocular side effects including a temporary 26% decrease in pupil diameter following the administration of intravenous codeine have been reported.[Ref]

Respiratory

Respiratory side effects have included respiratory depression.

References

1. "Multum Information Services, Inc. Expert Review Panel"

2. Bradley CM, Nicholson AN "Effects of a mu-opoiod receptor agonist (codeine phosphate) on visuo-motor coordination and dynamic visual acuity in man." Br J Clin Pharmacol 22 (1986): 507-12

3. Cox RG "Hypoxaemia and hypotension after intravenous codeine phosphate." Can J Anaesth 41 (1994): 1211-3

4. Stambaugh JE Jr, McAdams J "Comparison of the analgesic efficacy and safety of oral ciramadol, codeine, and placebo in patients with chronic cancer pain." J Clin Pharmacol 27 (1987): 162-6

5. Redpath JB, Pleuvry BJ "Double-blind comparison of the respiratory and sedative effects of codeine phosphate and (+/-)-glaucine phosphate in human volunteers." Br J Clin Pharmacol 14 (1982): 555-8

6. Max MB, Schafer SC, Culnane M, et al "Association of pain relief with drug side effects in postherpeticneuralgia: a single-dose study of clonidine, codeine, ibuprofen, and placebo." Clin Pharmacol Ther 43 (1988): 363-71

7. Shorr RI, Griffin MR, Daugherty JR, Ray WA "Opioid analgesics and the risk of hip fracture in the elderly: codeine and propoxyphene." J Gerontol 47 (1992): m111-5

8. Zolezzi M, Al Mohaimeed SA "Seizures with intravenous codeine phosphate." Ann Pharmacother 35 (2001): 1211-3

9. Malek-Ahmadi P, Ramsey ML "Acute psychosis associated with codeine and acetaminophen: a case report." Neurobehav Toxicol Teratol 7 (1985): 193-4

10. de Groot AC, Conemans J "Allergic urticarial rash from oral codeine." Contact Dermatitis 14 (1986): 209-14

11. "Product Information. Calcidrine (codeine)." Abbott Pharmaceutical, Abbott Park, IL.

12. Parke TJ, Nandi PR, Bird KJ, Jewkes DA "Profound hypotension following intravenous codeine phosphate: three case reports and some recommendations." Anaesthesia 47 (1992): 852-4

13. Matske GR, Chan GL, Abraham PA "Codeine dosage in renal failure." Clin Pharm 5 (1986): 15-6

14. Hastier P, Buckley MJM, Peten EP, Demuth N, Dumas R, Demarquay JF, CaroliBosc FX, Delmont JP "A new source of drug-induced acute pancreatitis: Codeine." Am J Gastroenterol 95 (2000): 3295-8

15. Stringer MD, Greenfield S, McIrvine AJ "Stercoral perforation of the colon following postoperative analgesia." J R Soc Med 80 (1987): 115-6

16. Hunskaar S, Dragsund S "Scarlatiniform rash and urticaria due to codeine." Ann Allergy 54 (1985): 240-1

17. Rodriguez F, Fernandez L, Garciaabujeta JL, Maquiera E, Llaca HF, Jerez J "Generalized dermatitis due to codeine." Contact Dermatitis 32 (1995): 120

18. Gonzalogarijo MA, Revengaarranz F "Fixed drug eruption due to codeine." Br J Dermatol 135 (1996): 498-9

19. Park GR, Shelly MP, Quinn K, Roberts P "Dihydrocodeine: a reversible cause of renal failure?" Eur J Anaesthesiol 6 (1989): 303-14

20. Barnes JN, Williams AJ, Tomson MJ, et al "Dihydrocodeine in renal failure: further evidence for an important role of the kidney in the handling of opioid drugs." Br Med J (Clin Res Ed) 290 (1985): 740-2

21. Hill SA, Quinn K, Shelly MP, Park GR "Reversible renal failure following opioid administration." Anaesthesia 46 (1991): 938-9

22. Lin RY, Barnard M "Skin testing with food, codeine, and histamine in exercise-induced anaphylaxis." Ann Allergy 70 (1993): 475-8

23. Enomoto M, Ochi M, Teramae K, Kamo R, Taguchi S, Yamane T "Codeine phosphate-induced hypersensitivity syndrome." Ann Pharmacother 38 (2004): 799-802

24. Knaggs RD, Crighton IM, Cobby TF, Fletcher AJ, Hobbs GJ "The pupillary effects of intravenous morphine, codeine, and tramadol in volunteers." Anesth Analg 99 (2004): 108-12

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.

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