Use with caution in patients with respiratory depression or respiratory disease. If used concomitantly, monitor for changes in methotrexate concentration and adjust dose. Codeine combined with an MAOI may result in a severe hypertensive reaction. To be safe, ensure a 2-week washout period before using the opioid. If this is not possible, use with caution.
Naloxone reverses the effects of codeine.
Anticoagulant activity may be enhanced, increasing the risk of bleeding. Monitor anticoagulant function and counsel patient on signs and symptoms of bleeding. Avoid use in patients with severe liver failure. Patient should consider taking with food or full glass of water to minimize gastrointestinal upset. Avoid abrupt discontinuation following prolonged use, as physiologic dependence on codeine may have developed.