The depressant effect of codeine may be enhanced by the concurrent administration of sedatives and tranquilizers. The potential for habituation may occur. Severe cases may show fever, hemorrhage, bloody urine, excitement, confusion, hallucinations, severe nervousness, convulsions or coma, and respiratory failure. Codeine and related narcotic analgesics depress respiration by an action on the brain stem respiratory centres. Other symptoms of overdose may include euphoria, dysphoria, and visual disturbances.
Treatment is essentially symptomatic and supportive.
Administer water, activated charcoal and ipecac syrup unless the patient is comatose and remove by gastric lavage or emesis. Patients with mild intoxication should be encouraged to drink plenty of fluids. In patients with more severe intoxication forced alkaline diuresis may be required. Plasma electrolytes, especially potassium, and the acid-base balance should be monitored regularly. In the presence of cardiac or renal impairment or in very severe intoxication, hemodialysis or hemoperfusion may need to be considered.