Codeine Withdrawal Symptoms & Treatment

October 10, 2022

Table of Contents

As an opioid drug, codeine withdrawal includes physical symptoms similar to other opioid withdrawal symptoms. Codeine is often mixed with tylenol in a combination with the brand name Tylenol #3. It is usually prescribed as a pain killer or sometimes as a cough suppressant in severe cases. 

Taking codeine, even for a short period of time, can cause dependence just like other opioids. Once dependence has formed, discontinuing Codeine abruptly can lead to withdrawal symptoms. 

 Codeine withdrawal can vary in severity based on the following:

  • Amount of time used, average dosage, and frequency of use
  • Method of use, such as swallowed, snorted, smoked, or injected
  • Biological factors, such as metabolism, or underlying medical or mental health conditions
  • Whether or not it is taken with other drugs or alcohol

Opioid withdrawal is never a dangerous or life-threatening condition, but can be extremely unpleasant and  may require pharmacological (medication) treatment to manage symptoms. [1] 

Timeline of Codeine Withdrawal

The timeline of opioid withdrawal depends on how long it takes the drug to process out of the body. Codeine is considered a short-acting opioid, so it takes about 12-16 hours to fully process out of the body. Withdrawal can start within 4 hours up to a few days of the last dose of codeine. Depending on how significant the dependence on the drug is (based on how much and how long the drug has been taken), withdrawal can last for a few days to weeks. 

The basic codeine withdrawal timeline can look like this:[2]

Early Withdrawal 

This begins about 4 hours to 24 hours after the last codeine dose. Symptoms include the following: 

  • Anxiety
  • Insomnia
  • Muscle aches
  • Teary eyes
  • Runny nose
  • Sweating
  • Agitation
  • Yawning

Acute Withdrawal

This can begin one to seven days after the last dose. The following symptoms may occur:  

  • Nausea
  • Abdominal cramping
  • Diarrhea
  • Vomiting 
  • Goosebumps
  • General malaise
  • Dilated pupils
  • Drug cravings
  • Depression
  • Irritability
  • Difficulty focusing and thinking clearly

Long-Term Withdrawal

This can last from a week up to a few months after the last dose. Symptoms include the following:

  • Sleep issues
  • Depression
  • Anxiety
  • Fatigue and low energy
  • Difficulty feeling pleasure
  • Cravings for codeine and other opioids

Treatment for Codeine Opioid Withdrawal

Codeine withdrawal, like withdrawal for other opioids, can be managed with Medications for Addiction Treatment (MAT), such as methadone or buprenorphine, as well as other “adjunctive” medications for specific symptoms, such as those to regulate moods and help with gastrointestinal issues. 

Methadone and buprenorphine are opioid medications that can alleviate drug cravings and minimize withdrawal symptoms during acute detox from Codeine. Methadone is a long-acting opioid medication that is dispensed only at specialized methadone clinics. 

Buprenorphine (Suboxone), in contrast, is a partial opioid agonist that can be prescribed by any outpatient doctor with the proper license.

To find an opioid treatment program near you, use the Substance Abuse and Mental Health Services Administration’s directory.[3] You’ll find a drop-down menu where you can select your state to view local providers. Some treatment providers also offer telehealth services, so you can receive MAT in virtually any location.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Opioid Withdrawal. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK526012/. May 2022. Accessed August 2022.
  2. Opiate and Opioid Withdrawal. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/000949.htm. May 2020. Accessed August 2022.
  3. Opioid Treatment Program Directory. Substance Abuse and Mental Health Services Administration. https://dpt2.samhsa.gov/treatment/. Accessed August 2022.

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