Codeine pills come in a variety of strengths, ranging from 15 mg to 60 mg in immediate-release pills and from 50 mg to 200 mg in extended-release pills.[1]
Codeine typically comes in the form of tablets, capsules or syrup.[1] It can also be crushed into a powder if being sold illegally.
Compared to other opioids, codeine isn’t especially potent but can still be dangerous and even life-threatening. It should only be used as prescribed by a doctor. Misuse of codeine has the potential to cause an overdose or lead to an opioid use disorder (OUD). It shouldn’t be viewed as a “safe” opioid, although it does have legitimate medical uses.
Common Uses of Codeine Pills
Codeine is an opioid, a group of powerful painkillers with significant misuse potential.[1] While one of the milder opioids, codeine is still dangerous if misused. Even normal, prescribed use has the potential to lead to physical dependence on the drug.[1]
Its primary use is as a painkiller, specifically in situations where less powerful painkillers with less misuse potential won’t provide necessary relief.
Codeine should only ever be used as prescribed and only for as long as one needs a powerful painkiller to manage their pain. If you’ve been prescribed codeine or another opioid but are struggling not to misuse your medication or find you’re not in significant pain even when the effects of your medication wear off, you should talk to your doctor.
Codeine Dosage & Administration
Codeine isn’t especially potent. When comparing the strength of opioids, the baseline strength opioid is typically considered to be morphine. Depending on the source referenced, codeine is typically listed as being between one-fifth to one-tenth as potent as morphine.[1,2]
Codeine comes in a variety of forms, and immediate-release codeine pills are typically found in three different strengths: 15 mg, 30 mg and 60 mg. Broadly speaking, taking two 15 mg pills will cause a similar effect to taking one 30 mg pill.[3] In addition, the drug is available in extended-release forms, with between 50 mg and 200 mg of codeine that is slowly released over a period of many hours.[1]
A doctor, not their patient, should always be the one who decides how much of an opioid a person should be taking and at what time intervals. Doctors are trained to understand the dangers of opioids and can reduce your risk of misuse and OUD, as well as help you avoid any dangerous drug interactions. Never adjust your dosing without talking with a doctor.
With that said, most adults who are prescribed codeine will take 15 mg to 60 mg repeated up to every four hours.[3] This is done as needed, and a doctor will generally attempt to find the minimum amount of prescription painkillers a patient needs to get the necessary pain relief.
The maximum 24-hour dose of codeine is 360 mg. It is uncommon for an individual to be prescribed that much codeine.[3]
Potential Side Effects
Codeine is associated with a number of side effects, including these:[1]
- Cardiovascular system
- Faintness
- Flushing
- Hypotension
- Palpitations
- Syncope
- Digestive System
- Abdominal cramps
- Anorexia
- Diarrhea
- Dry mouth
- Gastrointestinal distress
- Pancreatitis
- Nervous system
- Anxiety
- Drowsiness
- Fatigue
- Headache
- Insomnia
- Nervousness
- Shakiness
- Somnolence
- Vertigo
- Visual disturbances
- Weakness
- Skin & Limbs
- Rash
- Sweating
- Hives
Potentially serious adverse reactions to codeine include severe allergic reaction, severe respiratory depression, circulatory depression, respiratory arrest, shock and cardiac arrest. If you experience any severe symptoms while taking codeine or are unsure if the symptoms you’re experiencing warrant concern, talk with a doctor immediately or seek emergency medical care.[3]
Precautions & Warnings
Codeine has legitimate medical uses, but it should only be used as prescribed. As an opioid painkiller, it has significant addiction potential if misused.
It is also possible to overdose on codeine, with the drug weakening a person’s ability to breathe. At prescribed doses, this isn’t generally a major concern, but it can become dangerous when the drug is overused or combined with drugs that cause a similar effect, like alcohol.
Codeine should not be used if breastfeeding, as small amounts can get into the breast milk and affect the baby, potentially causing breathing problems or making them feel drowsy.[4] It can be used while pregnant but shouldn’t be used long-term. If codeine is used near the end of a pregnancy, a baby may be born dependent on codeine, going into withdrawal once born and cut off from the codeine supply the parent’s body was providing.[4]
Risks of Counterfeit Codeine Pills
The U.S. and many other parts of the world is in the middle of an opioid misuse epidemic.[5] The rate at which people are getting addicted to opioids and/or overdosing on them is very high.[6] These drugs are dangerous when misused.
If one intends to illegally misuse opioids regardless, they should beware of the dangers of opioids acquired through the black market. This is especially true if they’re seeking a relatively mild opioid like codeine. While codeine misuse is already dangerous, criminals selling opioids can be incentivized to try to make a product cheaper or more powerful to draw customers to their products over their competitors.
This means codeine may be cut with potentially dangerous agents that the buyer isn’t made aware of, or even that other drugs are mixed with or totally replace the codeine a person was told they’re buying. Of particular concern are synthetic opioids like fentanyl.[7]
These powerful opioids are one of the major contributors to the rise in OUD and fatal overdose. They are fairly cheap to produce in a criminal lab, and they’re often used to “enhance” drugs being sold on the street.
Synthetic opioids like fentanyl are much more potent than codeine. If a person purchases drugs and thinks it’s codeine, but it has been cut with this type of opioid, they could easily overdose.[8] Consider that a person intentionally misusing codeine will likely take several pills at once. If these pills are multiple times more potent than they expect, their body is going to experience a much more intense effect than desired.
FAQs: Common User Questions About Codeine Pills
Some common user questions about codeine pills include the following:
You should not drink alcohol while taking codeine. Alcohol is a depressant, as is codeine. The effects of these drugs can dangerously stack, causing breathing to be severely weakened. In severe cases, breathing can become so weak that the body cannot draw in enough air to support the brain. This has the potential to lead to brain damage or even death.
It is best practice to wait until your next scheduled dose if you miss a dose of an opioid medication. This reduces the risk of accidental misuse and potentially causing a dangerous overlap of your doses by mistake. If you are uncertain how to proceed, consult your prescribing doctor.
It is possible to take codeine during pregnancy, but you should talk to a doctor if you’re on codeine and become pregnant. The concern is primarily with taking codeine late in the pregnancy, as a baby born while a mother is taking codeine can be born dependent on opioids, going into opioid withdrawal shortly after being born. This is generally treatable but should be avoided if possible.
You cannot be sure if codeine pills are real if you purchase them through non-legitimate sources (i.e., on the black market). Most legitimately acquired codeine is going to look like small, white tablets or transparent capsules. It may also come in the form of a red/orange syrup-like substance, although this type of syrup is becoming more tightly regulated.
If you’re not an expert with the proper equipment, you should not assume you can recognize a codeine pill by sight alone. Many criminals have the ability to press their own pills or fill capsules and then pass off those products as something they’re not. Codeine is naturally colorless or white (cough syrup is dyed). Discoloration could be a sign that drugs that were supposed to be codeine may be tainted or counterfeit.
If you suspect your codeine pills are counterfeit, do not take them. This is especially true if they were purchased on the black market, where criminals have a strong incentive to sell counterfeit medications. Pills you suspect to be counterfeit can be dropped off at a safe medication disposal site, offered at many pharmacies. They should not be thrown or flushed away, as this can potentially cause the drugs to leech into nearby water sources.
Reviewed By Peter Manza, PhD
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More
- Peechakara BV, Gupta M. Codeine. StatPearls. Published October 2, 2019. Accessed February 12, 2024. https://www.ncbi.nlm.nih.gov/books/NBK526029/
- WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents. World Health Organization. Published 2018. Accessed February 12, 2024. https://www.ncbi.nlm.nih.gov/books/NBK537482/table/appannex6.tab2/
- Highlights of prescribing information: Codeine. U.S. Food and Drug Administration. Published April 2013. Accessed February 12, 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/022402s006lbl.pdf
- Pregnancy, breastfeeding and fertility while taking codeine. UK NHS. Published January 2022. Accessed February 12, 2024. https://www.nhs.uk/medicines/codeine/pregnancy-breastfeeding-and-fertility-while-taking-codeine/
- Judd DB, King CR, Galke CL. The opioid epidemic: A review of the contributing factors, negative consequences, and best practices. Cureus. 2023;15(7). https://doi.org/10.7759/cureus.41621
- Opioid overdose crisis: time for a radical rethink. The Lancet Public Health. 2022;7(3):e195. https://doi.org/10.1016/S2468-2667(22)00043-3
- Ciccarone D. The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Current Opinion in Psychiatry. 2021;34(4):344-350. https://doi.org/10.1097/yco.0000000000000717
- Babu K. What is fentanyl and why is it behind the deadly surge in US drug overdoses? UMass Chan Medical School. Published May 10, 2022. Accessed February 14, 2024. https:// www.umassmed.edu/news/news-archives/2022/05/what-is-fentanyl-and-why-is-it-behind-the-deadly-surge-in-us-drug-overdoses/
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