Codeine: Dosage, Side Effects & Potential for Abuse

The addictive potential of codeine is taken for granted because it is less potent than other opioids. However, it can be a gateway to severe addiction.

Codeine is an FDA-approved opioid pain medication that can be used off-label for restless leg syndrome and coughing. Compared to other opioids, codeine has very low potency and is not commonly used for pain because better options are available.

In 2015, 33,000 people died from an opioid overdose, or 90 people every day. In Florida, the number of overdose deaths has been increasing since 2015, and over half of all drug overdose deaths in 2017 involved an illicit or prescription opioid.

What Is Codeine?

Codeine is a type of opioid medication that works by binding to opioid receptors on cell membranes. The body naturally uses the opioid receptor system to send chemical messages that tell your brain when you are experiencing pain and when that pain has stopped.

Codeine is mostly used for cough, which is why it is present in certain cough syrups. Codeine can also sometimes come in tablet form, but codeine tablets are not commonly prescribed.

The FDA has different classifications for codeine based on what it is formulated with, but codeine by itself is a Schedule II medication. Schedule II medications have recognized medical use but a high potential for misuse and addiction.

Safe Dosage & Administration

Codeine doses can vary widely based on opioid tolerance. Normal doses for cough can range anywhere from 10 to 120 mg of codeine, but other ingredients in the formulation usually limit the dose. Acetaminophen (Tylenol) intake should be limited to 3,000 mg per day to protect the liver from harm.

Normal codeine dosages for pain are between 30 to 60 mg. Regardless of standard codeine dosages, a person should never take more than what is prescribed by their physician.

What Does Codeine Look Like?

Each formulation looks different, and sometimes multiple companies make the same formulation. Therefore, codeine can have a wide variety of appearances, but these are the most common:

• Syrup with acetaminophen: A thick, light red or orangish liquid
• Syrup with guaifenesin: A thick liquid that can be deep red to light pink
• Syrup with promethazine: Thick liquid that can range from light or deep purple to red
• Tablet with acetaminophen (Tylenol #2, Tylenol #3, or Tylenol #4): A medium-sized white tablet with the number 2, 3 or 4 printed on one side, depending on strength
• Tablets: Small and round white tablets

See Related: Can you take Guaifenesin with alcohol

Types of Codeine

Formulating codeine with other medications allows for better treatment of certain symptoms and helps make the formulation less addictive. The following are the most common different types of codeine found in the United States:

• Syrup with acetaminophen: A syrup formulation used to treat pain and fever. Both ingredients help with pain control, and acetaminophen (Tylenol) helps to reduce fever.
• Syrup with guaifenesin: Guaifenesin is a mucolytic, meaning it breaks up mucus. This formulation is preferred for cough because codeine stops the cough reflex. This helps to reduce inflammation in the lungs and throat, and guaifenesin clears up mucus that causes coughing.
• Syrup with promethazine: Promethazine also prevents coughing, so this formulation is an antitussive. Codeine with promethazine is the formulation that pop culture songs and media usually refer to.
• Tablet with acetaminophen (Tylenol #2, Tylenol #3, or Tylenol #4): These formulations are similar to the syrup combination but in a tablet form. Codeine and acetaminophen both have pain-killing properties, and the acetaminophen can reduce fevers. Acetaminophen also helps stop drug misuse because taking too much causes an upset stomach.
• Tablets: Codeine by itself can be used for pain or cough, but this formulation is rare. Codeine tablets are a schedule II medication and have more regulation around them than other codeine products.

Codeine Brand Names

Pure codeine tablets do not have a brand name, but codeine and its formulations have hundreds of different names. Some of the more common brand names are:

• Cheratussin
• Phenergan VC
• Poly-Tussin AC
• Prometh with Codeine
• Robitussin AC
• Tylenol #2, #3, #4

Codeine Street Names

Codeine has a variety of street names, some of which include:

• Captain Cody
• Cody
• Lean
• Purple Drank
• Schoolboy
• Sizzurp
• T2, T3, T4

Is Codeine Addictive?

Codeine and other opioids have a high potential for abuse and addiction. Is Tylenol with codeine addictive? Yes, any formulation that contains codeine has the potential for addiction.

A primary reason we do not see more addiction to codeine is that much more potent opioids are available. Codeine can act as the gateway to further and stronger opioid abuse.

Codeine addiction is one of the primary effects of codeine abuse. Like other opioids, it can produce uncomfortable withdrawal symptoms and cravings to keep taking the drug to prevent these symptoms.

Other Questions About Codeine Abuse

Information about codeine abuse is surrounded by confusing formulations, brand names and street names. Here are some common questions about codeine.

Common side effects of codeine include:

• Constipation
• Drowsiness
• Headache
• Nausea and vomiting
• Stomach pain

More serious side effects of codeine products include:

• Changes in vision
• Difficulty breathing
• Seizures
• Weakness

Symptoms of codeine overdose include:

• Cold and clammy skin
• Difficulty breathing
• Dizziness
• Excessive drowsiness
• Fainting
• Loss of consciousness
• Loss of muscle tone
• Slow heartbeat

An overdose of codeine or other opioids is a medical emergency. Thousands of people die each year from an opioid overdose, so call 911 if a friend or stranger is showing symptoms of overdose.

If you or someone close to you has a codeine addiction, The Recovery Village Palm Beach at Baptist Health is here to help. Call us today to learn more about treatment options that can work well for your situation.