Codeine can be poisonous in large amounts.

Codeine is found in these medicines:

• Acetaminophen and codeine phosphate
• Fioricet with codeine
• Promethazine with codeine cough syrup
• Robitussin A-C
• Triacin-C
• Tuzistra XR
• Tylenol with codeine #3

Other medicines may also contain codeine.

Symptoms of a codeine overdose include:

• Bluish fingernails and lips (cyanosis)
• Breathing problems, such as slow and labored breathing, shallow breathing, no breathing
• Cold, clammy skin
• Confusion
• Constipation
• Drowsiness, fatigue, weakness
• Flushing of the skin
• Itching
• Lightheadedness, dizziness
• Loss of consciousness, coma
• Low blood pressure, weak pulse
• Muscle twitches
• Nausea and vomiting
• Tiny pupils
• Spasms of the stomach and intestines

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

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

Your 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.

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 to reverse the depressive effects of the painkiller (naloxone) 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)

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.

Methylmorphine overdose

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

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.

Updated 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.