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The codeine consumer.
January 28, 2010 5:32 AM   Subscribe

What are the risks of regularly using codeine to relieve the pain of chronic migraines?

I recently purchased a package of Oxa Forte, a medicine primarily available in Latin American countries. The ingredients: 50 mg of diclonefac, a NSAID used to treat migraines, and 50 mg of codeine.

Though no silver bullet, this med is proving more effective for me than Fioricet, my preferred go-to med for migraines. (Note: I've tried all the other mainstream meds, so I'm not looking for answers along the lines of "You should try med XXX--it cured my migraines for good!"). What's more, it's not producing the rebound migraines that often accompany Fioricet, and I seem to be free of the constipation and other issues associated with opiates.

The codeine in each pill is still an opiate, though. Acknowledging that you're not my doctor, what risks should I be concerned about? If I were to take, say, one 50 milligram pill for three days, during an extended migraine, would I run a risk of addiction?

How does codeine compare with other opiates like Vicodin or Percocet in terms of addictiveness? Is the 50 milligram-per-pill quantity considered light or heavy, in general terms? In addition to dependence, what other side effects should I be concerned about?
posted by anonymous to Health & Fitness (15 answers total) 4 users marked this as a favorite
 
Well one risk is that you're using a controlled substance without a prescription. That's risky enough as it is, but the fact that this particular substance happens to be a narcotic suggests that you might want to get this AskMe anomyized sooner rather than later. Codeine combined with an NSAID is a Schedule III controlled substance, which is the same level as anabolic steroids, secobarbital, and smaller amounts of opium and morphine.

Seriously. Advertising that you're importing narcotics across national borders without permission isn't the sort of thing you want to do.
posted by valkyryn at 5:51 AM on January 28, 2010


I'm not a doctor, but don't be scared by the opiate demon. You're not going to get addicted on that dosage schedule. I'd say you should be more worried about the diclofenac - long-term use of NSAIDs predisposes for peptic ulcers. Make sure you take it on a full stomach and perhaps see how effective just taking codeine is.
posted by turkeyphant at 5:52 AM on January 28, 2010


They give codeine to little kids for coughs and Diclofenac is one of the drugs of choice for treating inflammatory arthritis. Millions of people take both every year on a continuous basis to manage different kinds of chronic pain, and neither one is simply dangerous to take on a regular basis. The mainstream US attitude towards anybody actually wanting to manage their pain is really screwed up. There is absolutely no reason not to go to your doctor and say, "I tried this drug from Latin America. It's codeine plus diclofenac. It really helps my migraines. Can you prescribe this for me and talk to me about any risks while taking it?"

Finally, the word you want is dependence, not addiction.
posted by hydropsyche at 6:03 AM on January 28, 2010 [2 favorites]


Codeine is quite widely abused, and yes, it's pretty much as addictive as the other opiates. One pill a day for three days every couple of weeks probably won't result in addiction, but you really should only be taking that kind of dose (especially with the diclonefac) under proper medical supervision.

The danger of addiction comes from liking the feeling you get from codeine and finding yourself taking it when you don't really need it.

When I had gallstones this time last year I was taking 60mg of codeine pretty much every day, sometimes twice a day. I noticed that I was starting to really enjoy the wooly, drowsy feeling I got from the drug. I had to be quite firm with myself about when I actually needed it (as opposed to just wanting the relaxed feeling). Fortunately, a week after surgery my supply ran out and I was no longer getting a prescription for it. So although I didn't actually abuse the drug, I can understand to some degree the temptation to slip from use to abuse.

If you're not going to do the sensible thing and consult a doctor, at least try to keep an eye on your use of the codeine; if you find yourself wanting to take it when you don't need it, or using it more frequently or in larger doses, go to your GP right away. It's a lot easier to stave off addiction early on.
posted by le morte de bea arthur at 6:09 AM on January 28, 2010


And yes, I was being a bit vague in my use of the term 'addiction' there. hydropsyche's link says addiction to opioid drugs is very rare. I have a friend who uses codeine in large doses on a daily basis and definitely shows the symptoms of classic addiction. And, as I said, I felt I could quite easily misuse the drug myself. That's one one-and-a-bit data points though, so by all means take it with a pinch of salt.
posted by le morte de bea arthur at 6:15 AM on January 28, 2010


The thing about addiction is, it sneaks up on you. So keep track of your usage - as long as you are only using it for actual migraines, for real serious pain, and as long as that isn't most days, you are probably okay.

That said - this is what medical supervision is for. It's possible that a good shot of diclofenac alone could kill the migraine... and the side-effects of long term NSAID use are more worrisome than the codeine.

The difference between 50mg of Codeine and the other pills you mention is the others use stronger opiates.
posted by TravellingDen at 6:27 AM on January 28, 2010


I suffer from Retinal migraine with aura and in the UK we can get an over the counter medication called Solphedine which is a mixture of Ibuprofen and Codeine and it is the only thing I have found that can control my migraines.

Although on the packaging it does say that it should not be used for more than three consecutive days - I usually find that after a day of taking this my migraine has cleared sufficiently for me to reduce down to only Ibuprofen.

I don't know if you can get this over the counter in the US but you may be able to get a prescription for it - being mixed with Ibuprofen it reduces the feeling that Codeine usually gives you.

I hope this helps.
posted by Edame at 6:29 AM on January 28, 2010


When I was prescribed Tylenol with Codeine I was up for 4 days straight (unlilke the typical sleepiness one would expect) and after a week, I couldn't urinate. Not joking. I had to pee, drank tons of fluids, but literally couldn't pee. It was as if my brain said "pee? How do I do that? Naaa."

The doc said while unusual, it's a nasty side effect. Thus I choose not to do codeine. Peeing is a good thing.
posted by stormpooper at 6:33 AM on January 28, 2010


Constipation is a fairly common side-effect of regular codeine use.
posted by Thorzdad at 6:48 AM on January 28, 2010


Constipation is a fairly common side-effect of regular codeine use.

Also crazy itching.
posted by le morte de bea arthur at 7:02 AM on January 28, 2010


Just as a data point, my mother became quite addicted to codeine she took for migraines. It took her years to kick it. In her case, though, it didn't help that my physician father would write her any script she wanted.
posted by gabrielsamoza at 7:22 AM on January 28, 2010


From a bit of googling and looking in my medicine stash, OTC codeine-containing products in the UK seem to have 8-12.8 mg codeine per tablet, and you usually take two of them at once. 50mg seems like a lot in comparison.
posted by peanut butter milkshake at 8:26 AM on January 28, 2010


In my experience, codeine is much more effective on an empty stomach. Unfortunately, the side effects are also more pronounced (in my case, nausea and itching).
posted by K.P. at 8:49 AM on January 28, 2010


Well, "addiction" is actually a blanket term used to describe a variety of behaviors. What you should be concerned with is building up a resistance. Basically, if you start increasing the dosage or taking it more frequently, then yeah, you're going to need more in order for it to work.

I would say that if you take it at all, you should take it irregularly, and only when it's really bad. But then again, I don't suffer from migraines, so perhaps "it's easy for me to say that."

Another thing to keep in mind -- what is your typical reaction to opiate meds? Most people get prescribed them at some point in their lives for some sort of pain or another, and don't have any problem with them -- they'll take them as directed until their prescription runs out, and then they'll stop. But a small percentage of people like it *so much* that it turns into a habit.

So, uh, make sure that you aren't one of those people. You probably aren't, but nobody ever thinks, "it can happen to me."
posted by Afroblanco at 8:56 AM on January 28, 2010


The findings of this systematic review suggest that proper management of a type of strong painkiller (opioids) in well-selected patients with no history of substance addiction or abuse can lead to long-term pain relief for some patients with a very small (though not zero) risk of developing addiction, abuse, or other serious side effects

And this study was of people who used opioids more or less continuously for chronic pain, while anonymous plans to use a lower end opioid occasionally for migraines.
posted by hydropsyche at 3:47 AM on January 29, 2010


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