Codeine

Codeine is a pharmaceutical belonging in the classes narcotic analgesics and antitussives. The former is a class of narcotic medications that reduce pain, which is achieved by changing the way the body senses pain. The latter is a group of medications that reduce coughing, which it does by decreasing activity in the part of the brain that causes coughing. Codeine treats symptoms, but it does not treat the cause of the symptoms or speed recovery. Codeine can be habit-forming, so patients are instructed not to take larger doses, take it more often, or take it for a longer period of time than prescribed by a doctor.

Why It's Prescribed
Codeine is used for two labeled uses (cough and pain) and one unlabeled use (diarrhea).

Form, Route, and Dosage
Codeine comes (alone or in combination with other drugs) as a tablet, a capsule, and a solution (liquid) to take orally. Adults are advised not to exceed 360mg of codeine within a 24 hour period. Children are not advised to exceed 6mg codeine per kilogram of body weight. For example a 20kg child (44 lbs) should not take more than 120mg codeine in a 24 hour period. Codeine is often prescribed with acetaminophen (Tylenol) as Acetaminophen-Codeine #2 (with 300mg acetaminophen and 15mg codeine), Acetaminophen-Codeine #3 (with 300mg acetaminophen and 30mg codeine), or Acetaminophen-Codeine #4 (with 300mg acetaminophen and 60mg codeine).

Combination Drugs
Many drugs are combinations containing codeine and one or more other drugs. Some of these combinations include:
 * Acetaminophen, Codeine
 * Ammonium Chloride, Chlorpheniramine, Codeine, Phenylephrine
 * Anhydrous Calcium Iodide, Codeine
 * Bromodiphenhydramine, Codeine
 * Brompheniramine, Codeine
 * Brompheniramine, Codeine, Guaifenesin
 * Brompheniramine, Codeine, Phenylephrine
 * Caffeine, Codeine, Pheniramine, Phenylephrine, Salicylic Acid
 * Codeine, Dexchlorpheniramine, Phenylephrine
 * Codeine, Diphenhydramine, Phenylephrine
 * Codeine, Guaifenesin
 * Codeine, Guaifenesin, Phenylephrine
 * Codeine, Guaifenesin, Promethazine
 * Codeine, Phenylephrine
 * Codeine, Phenylephrine, Promethazine
 * Codeine, Phenylephrine, Pyrilamine
 * Codeine, Promethazine
 * Chlorpheniramine, Codeine
 * Chlorpheniramine, Codeine, Phenylephrine, Potassium Iodide

Side Effects
Codeine may cause side effects. These include:
 * dizziness
 * lightheadedness
 * headache
 * drowsiness
 * mood changes
 * nausea
 * vomiting
 * constipation
 * stomach pain
 * difficulty urinating
 * difficulty breathing or swallowing
 * fast, pounding, or irregular heartbeat
 * rash
 * itching
 * hives
 * changes in vision
 * seizures

Overdoses
Taking too much codeine may result in an overdose. Symptoms of overdose include:
 * difficulty breathing
 * excessive drowsiness
 * loss of consciousness
 * loss of muscle tone
 * cold and clammy skin
 * fainting
 * dizziness
 * slow heartbeat

As a Pollutant
Because humans and animals often do not fully metabolize pharmaceuticals in their body, they can excrete drugs or their breakdown products, which may the enter the environment.

In Sewage Sludge
Codeine has been found in sewage sludge. In the Targeted National Sewage Sludge Survey, a 2009 test of 84 samples of sewage sludge from around the U.S., the EPA found codeine in 20 samples (24%) in concentrations ranging from 9.59 to 328 parts per billion. There are no federal regulations governing how much of this drug may be present in sewage sludge applied to land as fertilizer.

In Drinking Water
An Associated Press investigation found that, of 62 metropolitan areas in the U.S., only 28 tested for pharmaceuticals, and 24 found pharmaceuticals in the drinking water when they tested it. Of those tested, Northern New Jersey tested positive for codeine.

Related SourceWatch articles

 * Biosolids
 * Sewage sludge
 * Food Rights Network
 * Pharmaceuticals