Codeine - Oral

Codeine helps relieve mild to moderate pain which can't be relieved by other pain medications such as paracetamol and ibuprofen.

This medicine may also be used to treat diarrhoea and dry or painful cough.

Take Codeine exactly as directed by your doctor or according to the instructions on the label. Do not take more or less than instructed by your doctor.

This medicine is available as a tablet and oral solution.

If you are given the tablet, swallow it whole. Do not divide, chew or crush the tablet.

If you are given the oral solution, use the calibrated syringe or measuring cup provided to measure your dose.

Alert your doctor if Codeine does not seem to help control your pain. Do not stop taking it suddenly as this may worsen your condition.

The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on the severity of your condition and your response to the medication.

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule.

DO NOT double a dose under any circumstances.

Alert your doctor if you have the following conditions:

• lung disease e.g. respiratory depression (slow or ineffective breathing), acute or severe asthma
• moderate to severe breathing problems during sleep
• head injuries
• rise in pressure around your brain
• impaired consciousness
• known or suspected paralytic ileus (bowel obstruction caused by slow movement or paralysis of the intestines)
• antibiotic-associated colitis (inflammation of the lining of the colon [large intestine])
• severe liver disease

as Codeine may not be suitable for you.

Do not breastfeed while you are being treated with Codeine.

Generally, do not give this medicine to children below 12 years old. Additionally, do not give this medicine to children below 18 years who have undergone surgery or removal of tonsils and/or adenoid glands (glands that help protect the body from bacteria and viruses), unless instructed to do so by the doctor.

Some genetic traits can affect this medicine's level in the blood. Individuals who are ultrarapid metabolisers of CYP2D6 may experience enhanced effects of this medicine which also increases the risk of causing serious side effects. On the other hand, individuals who are poor metabolisers of CYP2D6 may respond poorer to this medicine. Though not routinely done, your doctor may advise you to undergo genetic testing to check if this medicine is best suited for you. If you know you have either of these gene types, alert your doctor.

Do not take Codeine if you are currently taking or have taken a medicine that is used to treat depression known as a monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine and tranylcypromine in the last 14 days.

Inform your doctor if you have the following conditions:

• allergy to other similar painkillers e.g. hydrocodone, oxycodone
• lung disease e.g. difficulty breathing
• biliary tract (group of organs that manage or process bile in the body) disorder including inflammation of the pancreas
• bowel obstruction
• Addison's disease (a rare disorder where the adrenal glands produce insufficient amounts of certain hormones)
• thyroid problem e.g. hypothyroidism (underactive thyroid gland)
• hypovolaemia (low volume of circulating fluids in the body)
• low blood pressure
• heart disease e.g. recent heart attack, unstable angina (chest pain that occurs randomly or unexpectedly)
• prostate enlargement
• delirium tremens or alcohol withdrawal delirium (severe tremors, hallucination, and disorientation caused by withdrawal from alcohol)
• mental health conditions e.g. anxiety disorders
• sleep apnoea (sleep disorder that causes interrupted breathing during sleep)
• myasthenia gravis (muscle weakness disorder)
• history of drug abuse or alcoholism
• kidney disease
• mild to moderate liver disease

Be sure to check with your doctor or pharmacist before giving Codeine to a child, the elderly, obese, or debilitated individual (a person who is physically or mentally weak usually due to illness or old age). Children, elderly people, obese, or debilitated individuals may be more sensitive to the side effects.

Individuals who are intermediate metabolisers of CYP2D6 may respond poorer to this medicine. Although not routinely done, your doctor may advise you to undergo genetic testing to check if this medicine is best suited for you. If you know you have this gene type, inform your doctor.

Avoid long-term use of any painkillers.

If you are going to have certain laboratory tests (e.g. hepatobiliary imaging), inform your doctor that you are taking Codeine.

Why is it important to keep my appointments with the doctor?

Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly.

• Routine tests (e.g. lung or bowel function) may be done while you are being treated with this medicine. Your doctor will advise you about how often you need to have these tests.
• Your blood pressure may fall to unsafe levels without you noticing it. Monitor your blood pressure regularly during treatment.
• Regular monitoring of heart rate, pain relief, mental status, and signs and symptoms of substance abuse, misuse, or addiction may also be needed.

Codeine may cause drowsiness or changes in your vision (e.g. blurred or double vision). If affected, do not drive or take part in any activity in which you need to be alert or need to see clearly.

This medicine may cause your blood pressure to fall suddenly when you get up from a sitting or lying down position and you may feel giddy. To minimise this problem, stand up slowly.

Other side effects include any of the following: headache, abdominal cramps, abdominal pain, dry mouth, confusion, mood changes, tiredness, rashes, and itching.

Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following:

• slow, shallow, or trouble breathing
• fits or seizures (particularly in children)
• severe constipation
• severe dizziness or passing out
• new or worsening pain
• excessive sweating, difficulty sleeping, anxiety, restlessness, tremors, nausea, vomiting, palpitations

Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects.

Do not take Codeine if you are currently taking or have taken a medicine to treat depression known as monoamine oxidase inhibitor (MAOI) such as isocarboxazid, phenelzine, and tranylcypromine in the last 14 days.

Inform your doctor and pharmacist if you are taking any of these medicines:

• cimetidine (medicine that reduces stomach acid production)
• cisapride (medicine for heartburn [burning pain in your chest caused by food or acid from your stomach that backs up into your mouth])
• rifampicin (medicine to treat TB, an infection known as tuberculosis)
• ritonavir (medicine for HIV infection)
• sodium oxybate (medicine to treat narcolepsy [excessive daytime sleepiness])
• certain antibiotics e.g. erythromycin
• ketoconazole (medicine used to treat fungal infection)
• medicines for nausea or vomiting e.g. metoclopramide, domperidone
• medicines for epilepsy (fits or seizures) e.g. carbamazepine, phenytoin
• medicines for cold and allergy e.g. diphenhydramine, hydroxyzine
• medicines for abnormal heart rhythm e.g. amiodarone, mexiletine, quinidine

This list does not include all medicines that may interact with Codeine.

Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements, and medicines that you buy without a prescription.

Avoid alcohol. Alcohol intake may worsen the dizziness and drowsiness caused by Codeine.

Store in a cool, dry place away from the reach of children.

Protect from light and moisture.

Medicines must not be used past the expiry date.