Codeine

What is Codeine?

Codeine (codeine phosphate) is a mild opioid analgesic derived from the opium poppy. It is indicated for the short-term treatment of mild to moderate pain not adequately controlled by non-opioid analgesics, for the symptomatic relief of dry or irritating coughs, and for the short-term management of acute diarrhoea. Codeine è un farmaco soggetto a prescrizione medica in tutti gli stati membri dell’UE.

How does Codeine work?

Codeine is a prodrug that is converted in the liver to morphine by the cytochrome P450 enzyme CYP2D6. The resulting morphine produces analgesic effects through the following mechanisms:

• Opioid receptor binding: Morphine (and to a lesser extent codeine itself) binds to mu-opioid receptors distributed throughout the central nervous system and peripheral tissues. This binding inhibits the transmission and perception of pain signals along ascending pain pathways.
• Antitussive action: Codeine acts on cough centres in the medulla oblongata, raising the threshold for the cough reflex and suppressing dry, nonproductive coughing.
• Antidiarrhoeal action: Opioid receptors in the gastrointestinal tract slow intestinal motility, reducing the frequency of bowel movements and increasing water absorption in the gut.
• Anxiolytic and sedative effects: Like other opioids, codeine produces mild sedation and anxiolysis, which can contribute to its perception as a pain reliever.

The degree of analgesic effect varies considerably between individuals depending on their CYP2D6 genotype. Poor metabolisers (approximately 7–10% of the European population) produce minimal morphine from codeine and experience reduced analgesia. Ultra-rapid metabolisers (approximately 1–3% of Europeans) produce excess morphine and are at risk of opioid toxicity even at standard doses.

Who is Codeine for?

Codeine is indicated for adults and adolescents aged 12 years and older (with restrictions in those under 18 who have undergone certain surgical procedures) for the following conditions:

• Mild to moderate pain: When paracetamol, ibuprofen, or other non-opioid analgesics have been insufficient. Examples include musculoskeletal pain, dental pain, headache, and post-traumatic pain.
• Dry, irritating cough: When non-opioid cough suppressants (such as dextromethorphan) have not provided adequate relief.
• Acute diarrhoea: Short-term symptomatic management of acute loose stools in adults.

Codeine is not appropriate for children under 12 years of age, patients under 18 who have undergone tonsillectomy or adenoidectomy, known ultra-rapid CYP2D6 metabolisers, breastfeeding mothers, or patients with significant respiratory depression, severe asthma, or paralytic ileus. È necessaria una valutazione medica completa prima di emettere qualsiasi prescrizione.

Posologia

Codeine phosphate is available in tablet and oral solution forms. Doses vary by indication:

Indicazione	Dose per adulti	Frequenza	Dose giornaliera massima
Pain	30–60 mg	Every 4 hours	240 mg/day
Cough	15–30 mg	Every 4–6 hours	120 mg/day
Diarrhoea	30 mg	Up to 4 times daily	120 mg/day

Codeine for pain should be used for no longer than 3 days. For cough, treatment should not typically exceed 5 days. If symptoms persist beyond these timeframes, patients should seek medical reassessment.

The lowest effective dose for the shortest duration should always be used. Patients should not adjust their dose without guidance from their prescribing doctor.

Effetti collaterali

Come tutti i farmaci, Codeine può causare effetti collaterali. The risks associated with opioid medicines require particular attention.

Effetti collaterali comuni (possono interessare fino a 1 persona su 10)

• Constipation (very common with opioid use)
• Nausea and vomiting
• Drowsiness and sedation
• Dizziness and light-headedness
• Dry mouth
• Headache

Effetti collaterali non comuni ma gravi

• Dependence and withdrawal: Even short-term use of codeine can lead to physical dependence. Prolonged use or misuse significantly increases this risk. Abrupt discontinuation may cause withdrawal symptoms including restlessness, anxiety, muscle aches, and insomnia.
• Respiratory depression: Codeine can dangerously suppress breathing, particularly in ultra-rapid metabolisers, those with respiratory conditions, or when combined with other CNS depressants. This is a medical emergency.
• Neonatal opioid toxicity: Codeine is contraindicated during breastfeeding because morphine produced from codeine passes into breast milk and can cause serious harm — including fatal respiratory depression — in neonates.
• Serotonin syndrome: Risk exists when codeine is used concurrently with serotonergic agents such as SSRIs, SNRIs, triptans, or MAO inhibitors.
• Misuse and addiction: Codeine has a recognised potential for misuse and addiction, particularly in individuals with a personal or family history of substance use disorder.

Questa non è una lista completa degli effetti collaterali. Consulti le informazioni sul prodotto approvate dall’EMA per i dettagli completi sulla prescrizione.

How to get Codeine online in Europe

Codeine phosphate è un farmaco soggetto a prescrizione medica in tutti gli stati membri dell’UE. Non può essere legalmente dispensato senza una prescrizione valida da parte di un professionista medico autorizzato.

Prescrivia opera come piattaforma intermediaria tecnologica: non prescriviamo farmaci, non impieghiamo medici né vendiamo medicinali. La nostra piattaforma mette in contatto i pazienti con medici indipendenti registrati nell’UE che possono condurre valutazioni sanitarie online riservate.

Il processo funziona come segue:

1. Completi una valutazione della salute: Risponda a un insieme strutturato di domande sulla salute covering your medical history, current medications, the nature and duration of your symptoms, and prior use of analgesics or opioid-containing medicines.
2. Revisione medica: Un medico indipendente registrato nell’UE esamina la Sua valutazione. If Codeine is clinically appropriate for your situation, they may issue a short-term prescription. If it is not appropriate, the doctor will recommend alternatives.
3. Prescrizione e dispensazione: Se viene emessa una prescrizione, viene inoltrata a una farmacia partner autorizzata dell’UE, che dispensa e spedisce il farmaco direttamente a Lei.

Importante: Prescrivia non garantisce che venga emessa una prescrizione. Tutte le decisioni prescrittive vengono prese in modo indipendente da professionisti medici qualificati in base alle Sue circostanze cliniche individuali.

Informazioni importanti sulla sicurezza

Non utilizzi Codeine se Lei:

• Are under 12 years of age
• Are under 18 and have had your tonsils or adenoids removed for sleep apnoea
• Are breastfeeding
• Are a known ultra-rapid CYP2D6 metaboliser
• Have significant respiratory depression, severe asthma, or chronic obstructive pulmonary disease
• Have paralytic ileus or acute inflammatory bowel conditions
• Are taking or have recently stopped taking MAO inhibitors (within 14 days)

Informi il Suo medico prima di starting Codeine if you have:

• A personal or family history of opioid dependence or substance misuse
• Liver or kidney disease
• Adrenal insufficiency (Addison’s disease)
• Hypothyroidism
• A history of head injury or raised intracranial pressure
• Enlarged prostate or urinary difficulties
• Gallbladder disease or biliary colic

Interazioni farmacologiche: Codeine interacts with alcohol (increased CNS and respiratory depression), sedatives, benzodiazepines, antidepressants, antipsychotics, other opioids, and CYP2D6 inhibitors (such as bupropion, fluoxetine, paroxetine, which reduce codeine’s conversion to morphine). Informi sempre il Suo medico di tutti i farmaci attualmente assunti.

Fonti

Le informazioni mediche presenti in questa pagina si basano sulle seguenti fonti:

• European Medicines Agency (EMA). Codeine-containing medicinal products — Restricted indications, new contraindications and warnings. EMA/PRAC/384580/2013.
• European Medicines Agency (EMA). Questions and answers on the use of codeine for pain relief in children. Disponibile su: ema.europa.eu
• World Health Organization (WHO). Codeine — Critical Review. Expert Committee on Drug Dependence.
• Derry S, et al. Single dose oral codeine, as a single agent, for acute postoperative pain in adults. Cochrane Database Syst Rev. 2010.

Questo contenuto viene rivisto periodicamente per riflettere le linee guida cliniche aggiornate. Viene fornito esclusivamente a scopo informativo e non costituisce consulenza medica. Consulti sempre un professionista sanitario qualificato per consigli pertinenti alle Sue circostanze di salute individuali.