Poisonous Ingredient

Codeine

Where Found

• Actifed with codeine
• Empirin #3
• Gelonida
• Oxa forte
• Robitussin A-C
• Tylenol #3
• Voltaren forte

Note: This list may not be all-inclusive.

Symptoms

• Bluish-colored fingernails and lips
• Breathing - shallow
• Breathing - slow and labored
• Breathing stops
• Cold, clammy skin
• Coma
• Constipation
• Dizziness
• Drowsiness
• Low blood pressure
• Muscle spasticity
• Muscle twitches
• Nausea and vomiting
• Pinpoint pupils
• Seizures
• Skin itching
• Spasms of stomach or intestines
• Weak pulse

Before Calling Emergency

Determine the following information:

• Patient's age, weight, and condition
• The name of the product (ingredients and strengths, if known)
• When it was swallowed
• The amount swallowed
• If the medication was prescribed for the patient

Poison Control

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number 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.

See: Poison control center - emergency number

What to Expect at the Emergency Room

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The patient may receive:

• Activated charcoal
• Breathing support (possibly artificial respiration)
• Fluids through a vein (by IV)
• Laxative
• Medication to reverse the effect of the painkiller (a narcotic antagonist)
• Tube through the nose into the stomach to empty the stomach (gastric lavage)

Outlook (Prognosis)

Codeine is usually found in combination with other medications such as acetaminophen. Therefore outcome also depends on how well the toxicity of these other medications is treated. Shock, brain damage, and death are possible.

Alternative Names

Methylmorphine overdose

References

Murphy NG, Benowitz NL, Goldschlager N. Cardiovascular toxicology. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 8.

Yip L, Megarbane B, Borron SW. Opioids. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 33.

Update Date: 1/18/2012

Reviewed by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.