Does codeine help with cough suppression?

From the Guidelines

Codeine is effective for cough suppression, particularly in patients with chronic bronchitis, as it works as an antitussive medication by directly suppressing the cough center in the brain's medulla, reducing the urge to cough. The most recent and highest quality study, 1, suggests that opioids, including codeine, are effective for cough suppression in patients with lung cancer. However, it also notes that codeine has a greater side effect profile compared to other opioids, such as pholcodine or hydrocodone.

Key Points to Consider

• The typical dose for adults is 30-60 mg every 4-6 hours as needed, not exceeding 120 mg in 24 hours, as indicated in 1.
• Codeine is most appropriate for short-term use (less than 7 days) to treat dry, nonproductive coughs that interfere with sleep or daily activities.
• Side effects may include drowsiness, constipation, nausea, and dizziness.
• Since codeine is an opioid, it carries risks of dependence and respiratory depression, especially at higher doses or when combined with other central nervous system depressants.
• Due to these risks, many healthcare providers now prefer non-opioid alternatives like dextromethorphan for cough suppression, as mentioned in 1 and 1.
• Codeine is also a controlled substance in many countries, requiring a prescription, and some regions have restricted its use for cough treatment, particularly in children.

Alternatives and Considerations

• Other opioids, such as pholcodine or hydrocodone, may be preferred due to their lower side effect profiles, as suggested in 1.
• Non-opioid alternatives, such as dextromethorphan, may be considered for cough suppression, especially in patients who are at risk of opioid dependence or respiratory depression.
• The choice of treatment should be individualized based on the patient's medical history, current medications, and specific needs, as emphasized in 1 and 1.

From the FDA Drug Label

Uses temporarily relieves cough due to minor throat and bronchial irritations as may occur with the common cold or inhaled irritants helps loosen phlegm (mucus) and thin bronchial secretions to make cough more productive Active ingredients in each 5 mL (teaspoonful)Purposes Codeine Phosphate, USP 10 mgCough Suppressant

• Codeine is used for cough suppression.
• The primary use of codeine in this context is to temporarily relieve cough due to minor throat and bronchial irritations.
• Codeine is listed as a Cough Suppressant in the drug label 2 and 2.

From the Research

Codeine and Cough Suppression

• Codeine is widely used as a cough suppressant, but its efficacy has been questioned in several studies 3, 4.
• Some studies suggest that codeine may not be effective in suppressing cough in certain situations, such as chronic obstructive pulmonary disease (COPD) 5, 4.
• A study published in 2007 found that codeine was no more effective than placebo in suppressing cough caused by upper respiratory disorders or COPD 4.
• Another study published in 2015 found that the use of over-the-counter (OTC) codeine preparations may be unwarranted due to the lack of evidence of efficacy and the risk of acute intoxication and dependence 3.

Comparison with Other Cough Suppressants

• A study published in 1983 compared the antitussive activity of dextromethorphan and codeine in patients with chronic cough, and found that dextromethorphan was more effective in reducing cough intensity and was considered the better antitussive by the majority of patients 6.
• Other studies have suggested that slow-release morphine and other centrally acting drugs may be effective in controlling chronic cough 5, 7.

Safety and Efficacy Concerns

• The use of codeine has been associated with risks such as respiratory depression, particularly in pediatric patients 3.
• Codeine dependence is a common problem among adults and has been reported locally and internationally among adolescents 3.
• The efficacy of codeine in suppressing cough may be limited to specific situations, and caution is needed to limit its use only when and as long as it is clinically necessary, particularly in children 7.