The effects in overdosage will be potentiated by simultaneous ingestion of alcohol and psychotropic drugs.
Symptoms
Central nervous system depression, including respiratory depression, may develop but is unlikely to be severe unless other sedative agents have been co-ingested, including alcohol, or the overdose is very large. The pupils may be pin-point in size; nausea and vomiting are common. Hypotension and tachycardia are possible but unlikely.
Management
This should include general symptomatic and supportive measures including a clear airway and monitoring of vital signs until stable. Consider activated charcoal if an adult presents within one hour of ingestion of more than 350 mg or if more than 2.5 mg/kg (adults and children) has been ingested.
Give naloxone if coma or respiratory depression is present. Naloxone is a competitive antagonist and has a short half-life so large and repeated doses may be required in a seriously poisoned patient. Observe for at least four hours after ingestion, or eight hours if a sustained release preparation has been taken.
None stated.
The following undesirable effects have been reported following use of codeine phosphate or opioid analgesics and may arise following use of this medicine. The frequency of adverse effects cannot be estimated from available data.
Psychiatric disorders: hallucinations, dysphoria, euphoria, mood changes, restlessness, confusion.
Nervous system disorders: dizziness, drowsiness, seizures, addiction, tolerance, dependence, headache, vertigo, malaise, sleep disturbances.
Eye disorders: miosis, visual disturbances.
Cardiac disorders: palpitations, bradychardia, tachycardia.
Vascular disorders: postural hypotension, hypothermia, facial flushing, oedema.
Respiratory, thoracic and mediastinal disorders: respiratory depression.
Gastrointestinal disorders: nausea, vomiting, constipation, abdominal pain, anorexia, pancreatitis, dry mouth.
Hepatobiliary disorders: biliary spasm.
Skin and subcutaneous tissue disorders: rashes, urticaria, pruritis, sweating.
Musculoskeletal and connective tissue disorders: muscle fasciculation or rigidity.
Renal and urinary disorders: difficulty with micturition, ureteric spasm or retention.
Reproductive system and breast disorders: decreased libido or potency.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
None stated
RO5D A04 - Cough suppressants, excl. combinations with expectorants - opium alkaloids and derivatives
Codeine contains codeine phosphate which is an opiate with analgesic, anti-diarrhoeal and cough suppressant activities.
Codeine is a centrally acting weak analgesic. Codeine exerts its effect through µ opioid receptors, although codeine has low affinity for these receptors, and its analgesic effect is due to its conversion to morphine. Codeine, particularly in combination with other analgesics such as paracetamol, has been shown to be effective in acute nociceptive pain.
None stated.
Using the dose recommended, this medicine is not considered to be a hazard. Nevertheless, use of codeine at higher doses or in more sensitive individuals may cause sedation, dizziness and nausea.Patients should be advised not to drive or operate machinery if affected by dizziness or sedation.
This medicine can impair cognitive function and can affect a patient's ability to drive safely. This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988. When prescribing this medicine, patients should be told:
- The medicine is likely to affect your ability to drive
- Do not drive until you know how the medicine affects you
- It is an offence to drive while under the influence of this medicine
- However, you would not be committing an offence (called “statutory defenceâ€) if:
o The medicine has been prescribed to treat a medical or dental problem and
o You have taken it according to the instructions given by the prescriber and in the information provided with the medicine and
o It was not affecting your ability to drive safely
None stated.
