Codeine Withdrawal: What It Is and How to Cope

Medically reviewed by Zara Risoldi Cochrane, PharmD, MS, FASCP on December 8, 2016Written by Christine Case-Lo

Introduction

Codeine is a prescription drug used to treat mild to moderately severe pain. It comes in a tablet. It’s also sometimes used in some cough syrups to treat cough. Like other opiates, codeine is a strong and highly addictive drug.

You can become addicted to codeine even if you’re taking a combination product such as Tylenol with Codeine. Kicking the habit can put your body through withdrawal. Getting through it can be tough, but it’s worth the effort. Read on to learn about symptoms of codeine withdrawal and how to cope.

Causes of withdrawal

Tolerance

Over time, you may develop tolerance to the effects of codeine. This means your body needs more and more of the drug to feel the same pain relief or other desired effects. In other words, tolerance makes the drug seem less effective to your body.

How quickly you develop codeine tolerance depends on factors such as:

  • your genetics
  • how long you’ve been taking the drug
  • how much of the drug you’ve been taking
  • your behavior and perceived need for the drug

Dependence

As your body becomes more tolerant of codeine, your cells begin needing the drug to function properly. This is dependence. It’s what leads to intense withdrawal side effects if codeine use is stopped suddenly. One sign of dependence is feeling that you must take codeine to prevent withdrawal symptoms.

Dependence can occur if you take codeine for more than a few weeks or if you take more than the prescribed dosage. Unfortunately, it’s also possible to develop codeine dependence even if you take the drug exactly as your doctor prescribes.

Dependence vs. addiction

Dependence and addiction both cause withdrawal when the drug is stopped, but they are not the same thing. Physical dependence on a prescribed opiate is a normal response to treatment and can be managed with help from your doctor. Addiction, on the other hand, may follow dependence and involves drug craving and loss of control over your usage. It often requires more support to get through.

Symptoms of withdrawal

Withdrawal symptoms may come in two phases. The early phase occurs within a few hours of your last dose. Other symptoms may occur later as your body readjusts to working without codeine.

Early symptoms of withdrawal may include:

  • feeling irritable or anxious
  • trouble sleeping
  • teary eyes
  • runny nose
  • sweating
  • yawning
  • muscle aches
  • faster heartbeat

Later symptoms may include:

  • loss of appetite
  • nausea and vomiting
  • stomach cramps
  • diarrhea
  • enlarged pupils
  • chills or goosebumps

Many withdrawal symptoms are a reversal of codeine side effects. For instance, codeine use can cause constipation. But if you’re going through withdrawal, you may develop diarrhea. Likewise, codeine often causes sleepiness, and withdrawal may lead to trouble sleeping.

How long withdrawal lasts

Symptoms may last for a week, or they may persist for months after stopping codeine use. Physical withdrawal symptoms are strongest in the first few days after you stop taking codeine. Most symptoms are gone within two weeks. However, behavioral symptoms and cravings for the drug can last months. In rare cases, they can even last years. Everyone’s experience with codeine withdrawal is different.

Treating withdrawal

With a doctor’s guidance, you can typically avoid severe withdrawal side effects. Your doctor will likely advise you to taper off your codeine use slowly rather than suddenly stopping the drug. Gradually reducing your use allows your body to adjust to less and less codeine until your body no longer needs it to function normally. Your doctor can help you through this process or refer you to a treatment center. They may also suggest behavioral therapy and counseling to help you avoid relapse.

Your doctor may also suggest certain medications depending on whether you have mild, moderate, or advanced withdrawal symptoms.

For mild pain and other symptoms

Your doctor may suggest non-narcotic medications to ease more mild withdrawal symptoms. These medications may include:

  • pain medications such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) to help reduce mild pain
  • loperamide (Imodium) to help stop diarrhea
  • hydroxyzine (Vistaril, Atarax) to help ease nausea and mild anxiety

For moderate withdrawal symptoms

Your doctor may prescribe stronger medications. Clonidine (Catapres, Kapvay) is often used to reduce anxiety. It can also help ease:

  • muscle aches
  • sweating
  • runny nose
  • cramps
  • agitation

Your doctor may also prescribe a long-acting benzodiazepine such as diazepam (Valium). This drug can help treat muscle cramps and help you sleep.

For advanced withdrawal symptoms

If you have severe withdrawal, your doctor may try different options. For instance, they may switch you from codeine to a different medication, such as a different opiate. Or they may prescribe one of three medications that are commonly used to treat opiate addiction and severe withdrawal symptoms:

  • Naltrexone blocks opioids from acting on the brain. This action takes away the pleasurable effects of the drug, which helps prevent relapse of misuse. However, naltrexone may not stop drug cravings due to addiction.
  • Methadone helps prevent withdrawal symptoms and cravings. It allows your body function to return to normal and makes withdrawal easier.
  • Buprenorphine produces weak opiate-like effects, such as euphoria (a feeling of intense happiness). Over time, this drug can reduce your risk of misuse, dependence, and side effects from codeine.

Talk with your doctor

Codeine is milder than other opiates (such as heroin or morphine), but it can still cause dependence and addiction. Your doctor can support you through withdrawal and recovery. If you’re concerned about codeine withdrawal, talk to your doctor and ask for help. Here are a few questions you might ask:

  • How can I avoid addiction to codeine?
  • Are there better alternatives to codeine use for me?
  • How should I stop taking codeine?
  • What signs of codeine tolerance and dependence should I watch for?
  • Will I go through withdrawal if I quit using codeine? What symptoms should I expect?
  • How long will my withdrawal and recovery take?

Q&A

Q:

Where can I find help to get through codeine withdrawal?

A:

The Substance Abuse and Mental Health Services Administration (SAMHSA) national helpline provides round-the-clock free and confidential treatment referrals. You can also find information about mental health or substance use disorders, prevention, and recovery on their website. The site also has a directory of opioid treatment programs across the country. Narcotics Anonymous is another good resource for people who are addicted to an opioid. When you’re looking for a treatment program, choose carefully. Consider asking these questions suggested by the National Institute on Drug Abuse:


1. Does the program use treatments backed by scientific evidence?
2. Does the program tailor treatment to the needs of each patient?
3. Does the program adapt treatment as the patient's needs change?
4. Is the duration of treatment sufficient?
5. How do 12-step or similar recovery programs fit into drug addiction treatment?

Healthline Medical TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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