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Medically Reviewed by Dr. Mohammed Saeed, MD.

Codeine, a commonly prescribed opioid pain medication, has been a vital part of pain management for many years. However, along with its pain-relieving properties, codeine carries a potential risk of respiratory depression. This adverse effect can be life-threatening and requires a comprehensive understanding of the drug and its implications. In this blog, we’ll explore codeine’s mechanism of action, the risk of respiratory depression, and the precautions that can be taken to ensure safe usage.

What is Codeine?

Codeine is a medication used for pain relief and as a mild cough suppressant. It belongs to the opioid family of drugs derived from the opium poppy plant. Even though doctors mostly prescribe codeine to treat mild to moderate pain, physicians also prescribe it to relieve coughing.

Codeine binds to opioid receptors in the brain and spinal cord, reducing pain signal transmission and producing analgesic effects. It also interacts with the brain’s cough center, reducing the urge to cough.

Codeine may be prescribed as a tablet, capsule, or liquid preparation. Although effective, codeine has a high potential for abuse and addiction. As a result, individuals taking the medicine should follow their doctor’s instructions carefully and avoid combining codeine with alcohol or other substances that can depress the central nervous system.

What Is Respiratory Depression?

Respiratory depression is a potentially serious side effect associated with codeine use. Respiratory depression happens when opioids, like codeine, depress the central nervous system. When codeine binds to specific brain and spinal cord receptors, it can slow the respiratory drive, leading to shallow or infrequent breathing. In other words, respiratory depression is when breathing slows down, becomes shallow, or may even stop altogether.

Normally, the body regulates breathing to maintain oxygen levels and remove carbon dioxide, a waste product of cellular metabolism. Respiratory depression disrupts this natural process, potentially leading to dangerously low oxygen levels in the blood (hypoxemia) and increased carbon dioxide levels (hypercapnia). If not promptly treated, severe respiratory depression can lead to respiratory arrest and even death.

How Can Codeine Use Lead To Respiratory Depression?

Codeine use can lead to respiratory depression because of its effects on the central nervous system (CNS). The receptors codeine interacts with also influence various physiological functions, including regulating breathing. Codeine can specifically cause respiratory depression by:

  • Suppressing the Respiratory Center. Codeine acts on the brain stem, specifically on the respiratory center, which controls the rate and depth of breathing. When codeine binds to opioid receptors in this area, it dampens the activity of the respiratory center, leading to a decrease in the drive to breathe. As a result of the dampened activity of the respiratory center, breathing becomes slow and shallow, reducing the amount of oxygen intake and increasing the concentration of carbon dioxide in the bloodstream. This chain of events can lead to respiratory depression, a potentially life-threatening condition if not promptly addressed.
  • Reducing Sensitivity to Carbon Dioxide. Increased carbon dioxide (CO2) levels in the blood normally trigger a reflex that stimulates breathing to remove excess CO2. Opioids, including codeine, can decrease the sensitivity of the respiratory center to elevated CO2 levels, blunting the usual respiratory response. Due to decreased sensitivity to elevated CO2 levels, the body’s natural response to increase breathing rate to eliminate excess carbon dioxide is blunted. This further exacerbates respiratory depression, causing breathing to become even shallower and potentially leading to dangerously low oxygen levels in the blood.
  • Causing Chest Wall Rigidity. Sometimes, opioids like codeine can cause a condition known as chest wall rigidity, where the muscles involved in breathing become stiff and rigid. This rigidity further impairs the ability to take deep breaths and can exacerbate respiratory depression. Because of this chest wall rigidity, affected individuals experience severe difficulty in taking deep breaths, leading to an even more compromised respiratory function. The combination of respiratory depression and chest wall rigidity creates a dangerous situation where oxygen levels continue to drop, putting the person at a heightened risk of respiratory failure and life-threatening complications. Immediate medical attention is crucial to provide appropriate interventions and support for breathing.

How Can Individuals Taking Codeine Mitigate the Risk Of Respiratory Depression?

While codeine can be effective in managing pain when used appropriately, it is crucial to follow these guidelines to minimize the risk of respiratory depression:

  1. Always take codeine under the guidance and supervision of a qualified healthcare professional who can assess your medical history and determine the appropriate dosage.
  2. Do not mix codeine with alcohol, benzodiazepines, or other central nervous system depressants to prevent dangerous interactions.
  3. Pay close attention to breathing patterns. If breathing becomes unusually slow or shallow, seek immediate medical attention.
  4. Do not self-prescribe or share codeine with others, as each individual’s response to opioids may vary.

Expertise & Treatment You Can Trust

Into Action aims to empower individuals battling addiction to discover a path toward health and peace. We understand the seriousness of respiratory depression and the risks associated with opioid use, such as codeine. Through comprehensive and compassionate care, we provide our clients with the support and resources they need to overcome substance use challenges.

Our team of dedicated professionals is committed to guiding each person on their journey to recovery, ensuring their safety and success along the way. By fostering open communication, understanding, and personalized treatment plans, we strive to create a nurturing environment where individuals can heal and regain control of their lives. Together, we can overcome addiction’s obstacles and achieve lasting health and serenity. Contact us today to learn more.


Dr. Mohammed Saeed, MD.

Dr. Saeed is a psychiatry specialist with over 40 years of experience in the medical field. He received training in General Psychiatry at the University of Texas Medical Branch, where he was selected as the Medical Director of the Division of Child and Adolescent Psychiatry. He currently serves as the medical director at Into Action Recovery Centers. Full Bio

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