CODEINE
Drugs in Pregnancy and Lactation.
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Name: CODEINE
Class: Narcotic Agonist Analgesic/Antitussive
Risk Factor: C*
Fetal Risk Summary
The Collaborative Perinatal Project monitored 50,282 mother-child pairs, 563 of whom had 1st trimester exposure to codeine (1, pp. 287295). No evidence was found to suggest a relationship to large categories of major or minor malformations. Associations were found with six individual defects (1, pp. 287295, 471). Only the association with respiratory malformation is statistically significant. The significance of the other associations is unknown. However, independent confirmation is required for all associations found in this study.
Respiratory (8 cases)
Genitourinary (other than hypospadias) (7 cases)
Down's syndrome (1 case)
Tumors (4 cases)
Umbilical hernia (3 cases)
Inguinal hernia (12 cases)
For use anytime during pregnancy, 2,522 exposures were recorded (1, p. 434). With the same qualifications, possible associations with four individual defects were found (1, p. 484):
Hydrocephaly (7 cases)
Pyloric stenosis (8 cases)
Umbilical hernia (7 cases)
Inguinal hernia (51 cases)
In an investigation of 1,427 malformed newborns compared to 3,001 controls, 1st trimester use of narcotic analgesics (codeine most common) was associated with inguinal hernias, cardiac and circulatory system defects, cleft lip and palate, dislocated hip and other musculoskeletal defects (2). Second trimester use was associated with alimentary tract defects. In a large retrospective Finnish study, the use of opiates (mainly codeine) during the 1st trimester was associated with an increased risk of cleft lip and palate (3,4). Finally, a survey of 390 infants with congenital heart disease matched with 1,254 normal infants found a higher rate of exposure to several drugs, including codeine, in the offspring with defects (5). Although all four of these studies contain several possible biases that could have affected the results, the data serve as a possible warning that indiscriminate use of codeine may present a risk to the fetus.
In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 7,640 newborns had been exposed to codeine during the 1st trimester (F. Rosa, personal communication, FDA, 1993). A total of 375 (4.9%) major birth defects were observed (325 expected). Specific data were available for six defect categories, including (observed/expected) 74/76 cardiovascular defects, 14/13 oral clefts, 4/4 spina bifida, 25/22 polydactyly, 15/13 limb reduction defects, and 14/18 hypospadias. Only with the total number of defects is there a suggestion of an association between codeine and congenital defects, but other factors, including the mother's disease, concurrent drug use, and chance may be involved.
Use of codeine during labor produces neonatal respiratory depression to the same degree as other narcotic analgesics (6). The first known case of neonatal codeine addiction was described in 1965 (7). The mother had taken analgesic tablets containing 360480 mg of codeine/day for 8 weeks prior to delivery.
A second report described neonatal codeine withdrawal in two infants of nonaddicted mothers (8). The mother of one infant began consuming a codeine cough medication 3 weeks prior to delivery. Approximately 2 weeks before delivery, analgesic tablets with codeine were taken at a frequency of up to six tablets/day (48 mg of codeine/day). The second mother was treated with a codeine cough medication consuming 90120 mg of codeine/day for the last 10 days of pregnancy. Apgar scores of both infants were 810 at 1 and 5 minutes. Typical symptoms of narcotic withdrawal were noted in the infants shortly after birth but not in the mothers.
[* Risk Factor D if used for prolonged periods or in high doses at term.]
Breast Feeding Summary
Codeine passes into breast milk in very small amounts that are probably insignificant (9,10 and 11). The American Academy of Pediatrics considers codeine to be compatible with breast feeding (12).
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References
- Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA:Publishing Sciences Group, 1977.
- Bracken MB, Holford TR. Exposure to prescribed drugs in pregnancy and association with congenital malformations. Obstet Gynecol 1981;58:33644.
- Saxen I. Associations between oral clefts and drugs taken during pregnancy. Int J Epidemiol 1975; 4;3744.
- Saxen I. Epidemiology of cleft lip and palate: an attempt to rule out chance correlations. Br J Prev Soc Med 1975;29:10310.
- Rothman KJ, Fyler DC, Goldblatt A, Kreidberg MB. Exogenous hormones and other drug exposures of children with congenital heart disease. Am J Epidemiol 1979;109:4339.
- Bonica JJ. Principles and Practice of Obstetric Analgesia and Anesthesia. Philadelphia, PA:FA Davis, 1967:245.
- Van Leeuwen G, Guthrie R, Stange F. Narcotic withdrawal reaction in a newborn infant due to codeine. Pediatrics 1965;36;6356.
- Mangurten HH, Benawra R. Neonatal codeine withdrawal in infants of nonaddicted mothers. Pediatrics 1980;65:15960.
- Kwit NT, Hatcher RA. Excretion of drugs in milk. Am J Dis Child 1935;49:9004.
- Horning MG, Stillwell WG, Nowlin J, Lertratanangkoon K, Stillwell RN, Hill RM. Identification and quantification of drugs and drug metabolites in human breast milk using GC-MS-COM methods. Mod Probl Paediatr 1975;15:739.
- Anonymous. Drugs in breast milk. Med Lett Drugs Ther 1974;16:257.
- Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:13750.
Q&A about Codeine
does codeine get you "high" or whatever and how many should i take if so...i have 60...you want some.....ive taken 1 and smoked a fat blunt buit didnt really notice anything form the codeine, maybe i should take 2 or 3?
Also, mixing weed and medicine?? No wonder you didnt notice the codeine.
My wife had a random drug screen and it came up positive for Codeine. She takes no meds that have even a trace of codeine. What could cause that? She only took a Dramamine the day before for motion sickness. Thank you.
There is no way to detect codeine because it is converted into small amounts of morphine in the body and the same thing happens to all other opiate drugs.
She got a false positive, I would demand a retest.
And have her stay away from any foods that have poppy seeds.
Eating poppy seeds can cause a false positive.
Dramamine is a type of antihistamine and is in no way related
to the narcotic class of drugs. There is no way Dramamine could have caused her false positive.
My friend Peter is secretly abusing drugs. I discovered his addiction last Friday. I know it's wrong and I want to put a stop into it. I really want to help him get over his hobby. The only problem is, I don't know the drug that he's been taking. All I know is the symptoms he's been experiencing. I have a feeling that he's taking codeine but I'm not really sure. Can anyone tell me the symptoms of codeine addiction that I have to take note of? Thanks.
I have severe kidney infections mixed with a 4mm kidney stone. They gave me oxycodone and i just ran out. But i do have some tylenol with codeine left over from my back injury a few months ago. Now i just want to know if i take the tylenol with codeine will it pop up something different than oxycodone on a drug test? I need some help quick i am in alot of pain. So is codeine and oxycodone the same thing?
How do you counteract tylenol and codeine when it is mixed or taken with alcohol (hard liquor not beer). No one has taken any but just curious because my wife usually has a shot or two as a night cap and is currently on codeine for pain.
I was perscribed codeine a while back for something, but I saved them for when I was bored instead of for the pain. I was just curious how many pills would make me sufficiently high?
About two weeks ago, I had a thoracic-lumbar spinal fusion after suffering a burst fracture in my L3. The doctors gave me Tylenol 3 for the pain. For two days in the hospital, they gave me painkillers and narcotics for the pain, then I took an average of about six pills of Tylenol at day for four days. Eventually, I had to ease off because they were making me nauseous so I started taking only two, then one, then a half, then I stopped. Everyday since then (almost a week), I've been getting these bad headaches after I sit/stand/lie down too long and after I eat. Is this codeine withdrawal? How long does it last? Anything I can do, other than take another kind of painkiller? My doctor said that headaches sometimes occur after spinal surgery because of leaking spinal fluid, but there was no fluid around my incision. That's a lot of info, but if anyone can help, it'd be greatly appreciated. Thanks in advance!
I would advise placing an ice pack on the surgery area for fifteen minutes, several times a day. Also use an ice pack on the back of your neck for fifteen minutes, several times a day, this should cut the headache.
My boyfriend was prescribe codeine for stomach and sleeping problems. He severely reacted (hives, spots all over the skin, difficult urination, constant itching). He stopped taking it immediately (3 days ago), but the side-effects still persist. How long does it take codeine to work its way out of the body?
Can anybody show the conversion of thebaine to codeine in a mechanism? It's for an orgo exam im studying for.
