Codeine

Codeine is an opioid used to treat pain, and less commonly to suppress coughing, or for diarrhea. 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:
 * 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

Codeine variants
Codeine is commonly mixed with other drugs, and sold under a different name, e.g.:
 * Co-codaprin is aspirin and codeine
 * Co-codamol is acetaminophen (paracetamol) and codeine

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.

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

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.

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.

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
 * drug dependence
 * nausea and vomiting
 * drowsiness, and confusion
 * dry mouth
 * dizziness, sweating and facial flushing
 * headaches
 * restlessness
 * changes of mood
 * respiratory depression
 * sleep problems
 * miosis
 * suppressing the libido

Less common side effects include
 * Raised intracranial pressure
 * skin irritation

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

 * Co-codaprin (aspirin and codeine) - NHS
 * Codeine - MedlinePlus
 * A Guide to Strong Opioids (leaflet) - West Hertfordshire Hospitals NHS Trust
 * Understanding the Opioid Epidemic - CDC