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'''Codeine''' is an opioid used to treat [[pain]], and less commonly to suppress coughing, or for [[diarrhea]].<ref>{{Cite book | url = https://www.ncbi.nlm.nih.gov/books/NBK526029/ | title = Codeine | last =Peechakara | first =BV | authorlink = | last2=Gupta | first2 = M | author-link2 = | date = Jun 21, 2022|publisher=StatPearls|location=Treasure Island (FL)|archive-url=|archive-date=|url-status=|access-date=}}</ref> It is typically used to treat mild to moderate degrees of pain. Greater benefit may occur codeine is combined with [[acetaminophen]] (paracetamol) or a [[nonsteroidal anti-inflammatory drug]] (NSAID) such as [[aspirin]] or [[ibuprofen]]. Codeine is sold over the counter under many different brand names, including: <div style="column-count:3"> * Aceffein * Ascodan * Algidol * Codis 500 * Copralgir 400 * Erigon szirup (cough syrup) * Feminax * Kodamid * Kodimagnyl * Maxilief * Novacetol * Natterman Melrosum * Nurofen plus * Solpadeine migraine * Panadeine (extra strength) * Paracofdal * Parcoten * Paderyl * Panadeine * Migraleve (yellow) Paracodol * Sedaspir * Syndoland * Solpadeinels (max) * Solpadeine (plus) * Veganin<ref name="Foley2016">{{Cite journal | title = The availability of over-the-counter codeine medicines across the European Union | date = 2015-11-01 | url = https://www.sciencedirect.com/science/article/pii/S0033350615002504 | journal = Public Health|volume=129 | issue = 11|pages=1465β1470 | last =Foley | first = M. | last2=Harris | first2 = R. | last3 = Rich | first3 = E. | last4 = Rapca | first4 = A. | last5 = Bergin | first5 = M. | last6 = Norman | first6 = I. | last7 = Van Hout | first7 = M. C.|language=en|doi=10.1016/j.puhe.2015.06.014|issn=0033-3506}}</ref></div> ==Codeine variants== Codeine is commonly mixed with other drugs, and sold under a different name, e.g.: * '''Co-codaprin''' is [[aspirin]] and codeine<ref name="cocdaprinNHS">{{Cite web | url = https://www.nhs.uk/medicines/co-codaprin/ | title = Co-codaprin: painkiller containing aspirin and codeine | last = | first = | authorlink = | date = 2018-08-29 | website = NHS|language=en|archive-url=|archive-date=|url-status=|access-date=2023-01-10}}</ref> * '''Co-codamol''' is acetaminophen (paracetamol) and codeine<ref name="Strongopiods">{{Cite web | url = https://www.westhertshospitals.nhs.uk/patientinformation/documents/Pharmacy/Strong%20Opioids%20Patient%20Information%20Leaflet%2044-1027-V4.pdf | last = West Hertfordshire Hospitals NHS Trust | title = A Guide to Strong Opioids | access-date = 2023-01-10 }}</ref> ==ME/CFS== The [[International Consensus Criteria]] Primer for physicians and [[Canadian Consensus Criteria]] both state that opioids like codeine should only be used for severe pain, and with a management plan in place. No particular opioids are suggested.<ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | author-link1 = Bruce Carruthers| last2 = van de Sande | first2 = MI | author-link2 = Marjorie van de Sande| last3 = De Meirleir | first3 = KL | author-link3 = Kenny de Meirleir| last4 = Klimas | first4 = NG | author-link4 = Nancy Klimas| last5 = Broderick | first5 = G | author-link5 = Gordon Broderick| last6 = Mitchell | first6 = T | author-link6 = Terry Mitchell| last7 = Staines | first7 = D | author-link8 = Donald Staines| last8 = Powles | first8 = ACP | author-link8 = A C Peter Powles | last9 = Speight | first9 = N | author-link9 = Nigel Speight | last10 = Vallings | first10= R | author-link10 = Rosamund Vallings | last11 = Bateman | first11= L | author-link11 = Lucinda Bateman | last12 = Bell | first12= DS | author-link13 = David Bell | last13 = Carlo-Stella | first13= N | author-link13 = Nicoletta Carlo-Stella | last14 = Chia | first14= J | author-link14 = John Chia | last15 = Darragh | first15= A | author-link15 = Austin Darragh | last16 = Gerken | first16= A | author-link16 = Anne Gerken | last17 = Jo | first17= D | author-link17 = Daehyun Jo | last18 = Lewis | first18= DP | author-link18 = Donald Lewis | last19 = Light | first19= AR | author-link19 = Alan Light | last20 = Light | first20= KC | author-link20 = Kathleen Light | last21 = Marshall-Gradisnik | first21= S | author-link21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22= J | author-link22 = John McLaren-Howard | last23 = Mena | first23= I | author-link23 = Ismael Mena | last24 = Miwa | first24= K | author-link24 = Kunihisa Miwa| last25 = Murovska | first25= M | author-link25= Modra Murovska| last26 = Stevens | first26= SR | author-link26 = Staci Stevens| title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf}}</ref><ref name="CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | author-link1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | author-link2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | author-link3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | author-link4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | author-link5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | author-link6 = Martin Lerner | last7 = Bested | first7 = Alison C. | author-link8 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | author-link8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | author-link9 = Pradip Joshi | last10 = Powles | first10 = A C Peter | author-link10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | author-link11 = Jeffrey Sherkey| last12 = van de Sande | first12 = Marjorie I. | author-link12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols| journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115| date = 2003 | pmid = | doi = 10.1300/J092v11n01_02| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf}}</ref> ==Opioid crisis == Codeine is one of the drugs behind the opioid crisis. Harm from opioids includes: * accidental deaths from overdose (taking too much) * physical and psychological addiction, which may be diagnosed as '''opioid use disorder''' * deaths from side effects including breathing difficulties combined with the sedative effects of codeine<ref name="Epidemic">{{Cite web | url = https://www.cdc.gov/opioids/basics/epidemic.html | title = Understanding the Opioid Overdose Epidemic {{!}} Opioids | last = | first = | authorlink = | date = 2022-10-07 | website = CDC|language=en-us|archive-url=|archive-date=|url-status=|access-date=2023-01-10}}</ref><ref name="CDC">{{Cite web | title = Codeine Information | date = 2018-12-28 | url = https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/codeine-information | last =Center for Drug Evaluation and Research |language=en| website =FDA |access-date=|quote=|via=}}</ref> Opioid drugs including codeine variants and branded products containing codeine have special warnings on the label in many countries, and availability of some products and certain strengths have been restricted, especially over-the-counter availability, for example FDA boxed warnings in the [[United States]].<ref name="CDC" /> ==Side effects== The UK's Royal College of Anaesthetists states that opioids, including codeine, rarely result in addiction when taken by people in pain, but they can become less effective over time (opioid tolerance), dependency may develop, and withdrawal effects can occur when opiods are stopped or doses are decreased.<ref name="RCOA">{{Cite web | url = https://www.rcoa.ac.uk/node/21136 | title = Taking Opioids for Pain {{!}} Information for Patients | last = | first = | date = 2016 | website = The Royal College of Anaesthetists|language=en|archive-url=|archive-date=|access-date=2018-10-03 | url-status=}}</ref> Side effects of codeine and the similar drug [[dihydrocodeine]] are similar to those of other opioid drugs. Commonly reported side effects in adults are: * [[constipation]] which can be painful * [[addiction|drug dependence]] * [[nausea]] and [[vomiting]] * [[drowsiness]], and [[confusion]] * [[dry mouth]] * [[dizziness]], [[sweating episodes|sweating]] and [[facial flushing]] * [[headache]]s * [[restlessness]] * changes of mood * [[respiratory depression]]<ref>{{Cite web | url = https://go.drugbank.com/drugs/DB00318 | title = Codeine | last = | first = | authorlink = | date = | website = DrugBank|archive-url=|archive-date=|url-status=|access-date=2023-01-10}}</ref> * [[sleep dysfunction|sleep problems]] * miosis * suppressing the libido<ref name="Strongopiods" /> Less common side effects include * Raised [[intracranial hypertension|intracranial pressure]] * skin irritation<ref name="Strongopiods" /> Commonly reported side effects in children are: * breathing difficulties are more common in children and may be fatal * codeine has been increasingly restricted in under 18s due to safety risks ==Learn more== * [https://www.nhs.uk/medicines/co-codaprin/ Co-codaprin] (aspirin and codeine) - NHS * [https://medlineplus.gov/druginfo/meds/a682065.html Codeine] - MedlinePlus * [https://www.westhertshospitals.nhs.uk/patientinformation/documents/Pharmacy/Strong%20Opioids%20Patient%20Information%20Leaflet%2044-1027-V4.pdf A Guide to Strong Opioids (leaflet)] - West Hertfordshire Hospitals NHS Trust * [https://www.cdc.gov/opioids/basics/epidemic.html Understanding the Opioid Epidemic] - CDC == See also == * [[Pain killers]] * [[Analgesics]] == References == {{Reflist}} [[Category:Potential treatments]] [[Category:Analgesics]] [[Category:Opioids]]
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