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Codeine overdose
     
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Codeine overdose

Methylmorphine overdose

 

Codeine is a drug in some prescription pain medicines. It is in the class of medicines known as opioids, which refers to any synthetic, semisynthetic, or natural drug that has morphine-like properties.

Codeine overdose occurs when someone takes more than the normal or recommended amount of this medicine. This can be by accident or on purpose.

This article is for information only. DO NOT use it to treat or manage an actual overdose. If you or someone you are with overdoses, call the local emergency number (such as 911), or the local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

Poisonous Ingredient

 

Codeine can be poisonous in large amounts.

 

Where Found

 

Codeine is found in these medicines:

  • Acetaminophen and codeine phosphate
  • Fioricet with codeine
  • Promethazine with codeine cough syrup
  • Robitussin A-C
  • Triacin-C

Other medicines may also contain codeine.

 

Symptoms

 

Below are symptoms of a codeine overdose in different parts of the body:

AIRWAYS AND LUNGS

  • Breathing problems, such as slow and labored breathing, shallow breathing, no breathing

BLADDER AND KIDNEYS

  • Difficult or slow urination
  • Inability to completely empty the bladder

EYES, EARS, NOSE, MOUTH, AND THROAT

  • Tiny pupils

HEART AND BLOOD

  • Low blood pressure (severe)
  • Weak pulse

MUSCLES AND JOINTS

  • Muscle spasms or twitches

NERVOUS SYSTEM

  • Confusion
  • Drowsiness, fatigue, weakness
  • Lightheadedness, dizziness
  • Loss of consciousness, coma

SKIN

  • Bluish fingernails and lips (cyanosis)
  • Cold, clammy skin
  • Flushing of the skin
  • Itching

STOMACH AND INTESTINES

  • Constipation
  • Nausea and vomiting
  • Spasms of the stomach and intestines

Some of these symptoms may occur even when a person takes the correct amount of codeine.

 

Before Calling Emergency

 

Have this information ready:

  • The person's age, weight, and condition
  • The name of the product (ingredients and strength, if known)
  • When it was swallowed
  • The amount swallowed
  • If the medicine was prescribed for the person

 

Poison Control

 

The local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

You can also get online poison help now at Poisonhelp.org. Just enter the product, poison, or medicine to get expert help.

 

What to Expect at the Emergency Room

 

Take the container with you to the hospital, if possible.

Your health care provider will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure.

Tests that may be done include:

  • Blood and urine tests
  • CT scan (advanced imaging) of the brain for neurologic symptoms
  • Chest x-ray
  • Electrocardiogram (ECG)

Treatment may include:

  • Fluids through a vein (IV)
  • Medicine (naloxone) to reverse the depressive effects of the painkiller and treat other symptoms
  • Activated charcoal (if a reversal agent is not given)
  • Laxative
  • Breathing support, including oxygen, tube through the mouth into the lungs, and breathing machine (ventilator)

 

Outlook (Prognosis)

 

Codeine is usually combined with other medicines, such as acetaminophen. Because of this, the harmful effects of these other medicines must also be treated. Shock, severe pneumonia, brain damage, and death are possible.

 

 

Open References

References

Aronson JK. Opioid receptor agonists. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:348-380.

Nelson LS, Calello DP. Acute poisoning. Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 96.

Nikolaides JK, Thompson TM. Opioids. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 151.

Theobald JL, Corcoran JN. Poisoning. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 94.

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              Review Date: 7/1/2025

              Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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