codeine

• Risk factors: Personal or family history of alcohol or substance use disorder | Personal or family history of mental health problems

Codeine is a controlled substance because it has a risk for addiction and misuse. Take the medication exactly as prescribed. Don't change the dose or how often you take it without talking to your provider first. Misusing this medication might cause it to not work as well. It can also raise the risk for serious and possibly life-threatening side effects, such as dangerously slow breathing, inability to stay awake, and opioid overdose. Your healthcare provider will prescribe the lowest amount of codeine that's necessary to manage your pain for the shortest period of time possible.

Because of the risk for misuse and dependency, codeine is only available through a Risk Evaluation and Mitigation Strategy (REMS) program called the Opioid Analgesic REMS program. The FDA-required REMS program for codeine helps make sure the medication is distributed and used in a safe manner. Your healthcare provider must register with the program and receive training on proper medication use. Under this program, they'll discuss with you about safe and responsible storage, use, and disposal of codeine.

• Risk factors: Taking medications that can cause slow breathing | Drinking alcohol | Older age | Being frail | Medical conditions that cause breathing problems (e.g., COPD, asthma, head injury) | Taking too much codeine

Codeine can cause dangerously slow breathing, which can be life-threatening. This can happen to anyone, but the risk is greatest when you first start treatment or if your provider raises the dose. Don't take codeine with alcohol or other medications that slow your body down (e.g., benzodiazepines, other opioids, muscle relaxants). Doing so puts you at higher risk of extremely slowed breathing. If you or your loved one notices that you have trouble breathing or have bluish-colored lips, fingers, or toes, call 911 to get medical help right away.

• Risk factors: History of opioid use disorder | Previous opioid overdose | Taking high doses of codeine | Taking more opioids than prescribed | Alcohol use

Take codeine exactly as prescribed. Taking too much codeine or taking it more often than prescribed can lead to an accidental overdose. Symptoms of an opioid overdose include not responding to sound or touch, extremely slowed breathing, extreme sleepiness, slow heartbeat, and cold or clammy skin. Be sure you and your loved ones know how to recognize an overdose. Your provider will recommend you to have naloxone (Narcan, Zimhi) at hand. Naloxone is a medication that can treat an opioid overdose. Make sure you carry naloxone with you at all times in case you experience an overdose. Call 911 right away if this happens. Store your medication out of reach from children, pets, or visitors to prevent accidental exposure or overdose.

• Risk factors: Taking high doses of codeine | Age 65 years or older | Younger than 18 years old | Drinking alcohol | Taking other medications that can cause sleepiness

Codeine can cause extreme sleepiness and lower your ability to think, react, and focus. Don't drink alcohol or take other medications that can cause sleepiness or "brain fog" (e.g., benzodiazepines, muscle relaxants, sleep medications) with codeine. Doing so can worsen these side effects. Make sure you know how codeine affects you before driving a car or doing activities that require your concentration. Talk to your healthcare provider right away if you feel too sleepy from taking codeine.

Codeine interacts with a lot of common medications. Some medications can raise codeine levels in your body, which can raise your risk for side effects and even potentially life-threatening slowed breathing. These medications include erythromycin, ketoconazole, and ritonavir (Norvir).

Other medications, such as rifampin (Rifadin) and carbamazepine (Tegretol), can lower the levels of codeine in your body. This can cause codeine to not work as well to manage your pain. These interactions might also cause withdrawal symptoms.

If you're already taking stable doses of codeine together with one of these other medications, don't stop taking them suddenly without first talking with your provider. Doing so can also lead to unsafe codeine levels. Let your provider or pharmacist know what other medications you're taking before starting codeine to make sure your medications are safe for you to take.

Long-term use of codeine during pregnancy can cause your unborn baby to become dependent on the medication. This is because codeine can pass through the placenta to your unborn baby. Once your baby is born, they can experience withdrawal symptoms, such as high-pitched crying, poor feeding and sucking behavior, trembling, abnormal sleep patterns, and seizures. This condition is called neonatal opioid withdrawal syndrome and can be life-threatening if not recognized and treated in time. Let your healthcare provider know if you've used codeine during pregnancy or if you notice these symptoms in your baby.

• Risk factors: Long-term use of codeine

If taken regularly for a long time, codeine can cause physical dependence. This means that your body relies on the medication to function. You might experience withdrawal if you stop taking the medication suddenly. Withdrawal symptoms include anxiety, restlessness, irritability, runny nose, yawning, sweating, and chills. Don't lower your dose or stop taking the medication suddenly without talking to your healthcare provider first. Your provider will slowly lower your dose to prevent withdrawal symptoms. If you have concerns about taking codeine because of this risk, talk to your healthcare provider about alternative pain medications.

Codeine can cause extremely low blood pressure. Your blood pressure might drop suddenly when you stand from a sitting or lying down position. This can lead to dizziness and fainting. To avoid falling, get up slowly if you've been sitting or lying down. If dizziness or lightheadedness doesn't go away, talk to your healthcare provider.

• Risk factors: Taking codeine for longer than 1 month

Some people taking opioids like codeine experienced low adrenal hormone levels. This might be more likely to happen after taking opioids for longer than 1 month. Symptoms include tiredness, dizziness, weakness, not feeling hungry, nausea, and vomiting. Let your provider know if you experience these symptoms. If your adrenal hormone levels are too low, you might need to stop codeine and be treated with corticosteroids.

• Risk factors: History of seizure conditions

If you've had a seizure in the past, opioids can raise the risk of having seizures more often. Codeine can also raise your risk of seizures in certain situations. Get medical help immediately if you have a seizure while taking codeine.