Codeine has a primary dependence potential. Prolonged and high-dose use may produce tolerance as well as physical and mental dependence. Habituation to codeine may result in an habituation to other opioids and vice versa in case of a pre-existing opioid dependence severe recurrences have to be taken into account.
If cough persists for more than 2-3 weeks, further diagnostical advice has to be obtained.
Effects on ability to drive and use machines: Even when used according to instructions, this drug may change the reactivity to such an extent as to impair the ability to actively take part in road traffic or operate machinery. Therefore, driving motor vehicles or operating machinery or other dangerous activities should be avoided entirely or at least during the initial days of therapy. The treating physician decides in each individual case taking into consideration the individual reactivity and dosage. The combination of the active ingredients with alcohol or with central-active drugs (e.g. sleeping medicine, psychopharmacologic agents, some analgesics) results in a massive impairment of the psychomotor capacity (e.g. the capacity to concentrate, the perception of dangerous situations). Therefore, driving motor vehicles or operating machinery as well as other dangerous activities are excluded while on such combinations.
Use in pregnancy and lactation: Codeine should only be administered during pregnancy on the explicit instruction of the physician, since a slight teratogenic potential cannot be excluded. Codeine is contraindicated if delivery is approaching or if early delivery is imminent since it passes the placental barrier and may produce respiratory disorders in neonates Codeine appears in breast milk and may produce undesired effects for the child. The mother should interrupt nursing in case a therapy at high doses is necessary during lactation.
Use in children: Since the use of codeine is contraindicated in patients with acute asthmatic attacks it should be especially borne in mind that chronic cough in particular in children is frequently an early sign of bronchial asthma. Codeine is not indicated for the sedation of these coughing conditions.
Use in elderly: Elderly patients should be under medical supervision since they are more sensitive to the side effects.