Codeine

What is codeine?

Codeine is a narcotic pain reliever used to treat mild to moderate pain. It may also be used to suppress dry or nonproductive coughs.

Codeine binds to pain receptors in the body, to decrease the feeling of pain and a person's response to pain. It also affects the cough center in the brain.

Codeine comes in a tablet, long-acting tablet, liquid, and injection forms. Codeine may also be combined with other medicines in a single tablet or liquid (this includes some cough/cold preparations).

Before giving codeine to your child

Tell your doctor if your child has a severe allergy to codeine or other narcotic pain relievers (morphine, oxycodone, hydrocodone).

Talk with your doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has:

• lung or breathing problems, such as asthma
• kidney or liver disease
  
• colitis (inflammation of the bowel)
• heart disease
• underactive thyroid
• history of seizures

How should you give your child codeine?

Follow these instructions when giving your child codeine:

• Give your child codeine exactly as your doctor or pharmacist tells you.
• Do not change, increase, or decrease the dose. If you do not feel that it is working properly, talk to your doctor.
• The medicine may be given on an empty stomach or with a meal. If your child experiences an upset stomach, try to give the doses with food or milk to reduce the chance of an upset stomach.
• If your child is taking the liquid form of codeine, measure the dose with the special spoon or syringe that the pharmacist gave you.
• If your child is taking the long-acting tablet, it should be swallowed whole. Do not break, chew, or crush the tablet.
• You should also encourage your child to drink plenty of water or fluids each day, to prevent constipation from codeine.

What should you do if your child misses a dose of codeine?

• Give the missed dose as soon as you remember.
• If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
• Do not give your child two doses to make up for one missed dose.

How long does codeine take to work?

Your child may start to feel better within half an hour of starting codeine.

What are the possible side effects of codeine?

Your child may have some of these side effects while they take codeine. Check with your child's doctor if your child continues to have any of these side effects, and they do not go away, or they bother your child:

• drowsiness, feeling sleepy, tired or weak, and being unable to think clearly
• dizziness
• upset stomach, throwing up
• trouble having a bowel movement (constipation)

Call your child's doctor during office hours if your child has any of these side effects:

• itchy skin or skin rash

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to the Emergency Department if your child has any of these side effects:

• seizures
• signs of an allergic reaction, such as trouble breathing; severe skin rash; hives (raised red lumps on skin); or swelling of the face, lips, mouth, or throat
• slow or irregular heartbeat

What safety measures should you take when your child is using codeine?

Before your child has any kind of surgery, including dental surgery or emergency treatment, tell the doctor or dentist that your child is taking codeine.

Codeine may make your child constipated, especially if your child is getting codeine on a regular basis. To help prevent constipation, it is important for your child to:

• drink plenty of liquids throughout the day
• exercise regularly
• eat a well-balanced diet, which includes fruits, vegetables, and cereal

If necessary, talk to your doctor about using a stool softener or laxative to relieve the constipation.

Codeine may make your child dizzy, drowsy, and less alert than normal. Watch carefully when your child is doing something that they need to be alert for, such as climbing stairs. If these side effects happen, tell your child's teacher that your child is taking a medicine that can cause these side effects.

If your child has been taking codeine for a long time, do not stop the medicine suddenly. Your child may experience "withdrawal" effects, such as watery bowel movements (diarrhea), headache, sweating, muscle cramps, upset stomach, throwing up, trouble sleeping.

Your doctor will slowly decrease the dose to wean your child off the medicine. If your child has any withdrawal side effects, call your doctor right away. It could mean the dose was lowered too quickly.

Check with your child's doctor or pharmacist before giving your child any other medicines (prescription, non-prescription, herbal, or natural products).

Some medicines may cause drowsiness, and should not be taken with codeine. Examples include antihistamines (hay fever or allergy medicines), cold medicines, and sleeping medicine. This effect may last for a few days after your child stops taking this medicine.

Serious risks for some children

An enzyme in the liver converts codeine into morphine. Morphine is the active drug which relieves pain. However, up to 10% of children do not have this enzyme. For them codeine will have no effect on their pain.
On the other hand, up to 30% of children have too much of this enzyme. Their bodies convert codeine into excessive amounts of morphine which can cause serious side effects. If your child is given codeine, health care providers will monitor your child for serious side effects which include severe drowsiness, difficulty waking up, or slow or shallow breathing.

What other important information should you know about codeine?

• Keep a list of all medications your child is on and show the list to the doctor or pharmacist.
• Do not share your child's medicine with others and do not give anyone else's medicine to your child.
• Keep codeine at room temperature in a cool, dry place away from sunlight. Do NOT store it in the bathroom or kitchen.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
  

Keep codeine out of your child’s sight and reach and locked up in a safe place. If your child takes too much codeine, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.