Anyone Know About Coming Off OTC Codeine Based Painkillers?

[MarmaladeSandwich7]

I’m due to have a colonoscopy & have to stop any codeine a week before. I take Solpadeine Max (paracetamol with codeine) & some form of ibuprofen & codeine daily. Have done for many months. I read that you shouldn’t go “cold turkey” although I reckon that’s with pure codeine phosphate. Certainly don’t want to suffer any nasty withdrawal symptoms. What’s the best thing to do? My procedure is in 2 weeks.

You have one week to cut it down to zero. Work out whether you half the dose each day to get to zero on day 8, or if you will have to reduce by more or if you can do it more slowly. Have you told them how much codeine you are taking and for how long? Depending on how many mg of codeine per day, you might need longer to wean off it. A week isn't very long at all.
How many mg of codeine are you taking per day?

I came off 2 years of prescribed 30/500 mg cocodamol with no ill effects but everyone is different.

i stopped 4 years of max dose codeine phos daily overnight with no issue

Bit last-minute Op, shouldnhave been doing rhis weeks ago. What if you have issues?

You need to chat to the team doing the scope so they can weigh up the pros and cons of reducing/continuing given how close to the appointment it is. If you’re having sedation they’ll want to know too so they can plan it sensibly if your total codeine dose is high.

I didn’t know until I received my medication pack a couple of days ago.

I take approx 50mg 4 or 5 times a day

Just be honest with the anaesthetist - they are qualified clinicians, will be used to people taking OTC medications and adjust the level of anaesthetic accordingly.

Is this a combination of both paracetamol and codeine or just codeine? If this is just codeine, it’s actually more than the permitted prescribable amount of codeine (240mg in 24 hours) and equivalent to 25mg of morphine. That will take more than a week to taper off from and so the hospital will need to be made aware. If a combination, how much is the codeine proportion?

Five x daily is a little bit more than the legal maximum dose (240mg in 24 hours) for adults, a little bit less if only 4 times a day. The usual recommendation at that dose is slow withdrawal of 20% per week, but you haven't got time to do that. I would start by substituting plain paracetamol/ibuprofen for one dose today and tomorrow and ring your GP asap Monday. Can you do an online consult? Does your GP know how much you are taking? I am not a doctor, but I am a retired nurse and I really do think you need medical advice about this.

This. I assumed OP meant that this was the codeine content. OP can you check the package and confirm? Are you buying it over the counter or is it prescribed?

I have 4 tablets each time - each tablet has 12.5 mg of codeine.

It’s over the counter.

what’s the paracetamol content because it sounds like you may be overdosing on paracetamol

You need a very honest chat with your GP about your addiction to codeine to support you with a reducing plan.

Are you taking 4 tablets of paracetamol at a time? If so you will need bloods to look at liver damage, the ibruprofen without food that frequently could be causing intestinal damage. I think you rally really need urgent support with this.

just because drugs are over the counter doesn’t mean they don’t have the potential to cause significant harms.

500mg per tablet and you are taking 4 tablets 4 or 5 times a day ? thats a higher concern than the codeine

I have been taking prescription codamol 30mg per tablet. I have been taking 2 tablets at night to help sleep but only about 3 or 4 nights a week. I have been feeling sick on the days I wasn't taking them. It's only now I realise I think I was experiencing a type of withdrawal. I really didn't think I was taking enough to cause that but Google informed me that it could be.

Just sharing cos I think you are wise to reduce gradually. Interesting to see others have had no ill effects. You might be lucky

I take super strength Cocodamol 30/500 every single day long term for lupus related pain and I’ve never been told I had to stop them for colonoscopies. I would double check this.

At the level of tablets you’re taking, I really think you need to discuss with your GP. Your procedure could I guess be rescheduled whilst this is tackled, and I wouldn’t rule out that level of ibuprofen causing problems that might have prompted the colonoscopy in the first place. Please contact them first thing Monday and be completely honest with them, you need proper medical help. Best of luck

Can I ask, are you taking it because you have a diagnosed pain condition, or are you taking it because you’re abusing it?

If it’s the first, I think you need to have a conversation with the doctor who is overseeing your pain management. If it’s the second, unless it’s an urgent referral to explore possible cancer rather than a routine colonoscopy, I think you may need to seek support to deal with this first and push back the colonoscopy. That is an enormous dose of paracetamol and codeine to be taking on a daily basis.

To give you an idea though, I was previously on cocodamol and oramorph plus pregabalin for cancer pain. I came off them by tapering the pregabalin 25mg a week (was on 100mg). The cocodamol (normal 8mg/250mg one) I tapered by one dose every few days and replaced it with paracetamol. So was taking it 3x a day, so went to 2x a day plus the paracetamol. Then I switched another dose to just paracetamol. Then I eventually got rid of the afternoon paracetamol and then a few days later the morning one. I kept the oramorph to top up whenever I did feel pain but didn’t want to take a full dose. Eventually I didn’t need that either.

Personally, I think you are going to need a supported detox here, not necessarily medicated, but someone needs to be monitoring you and supporting you. I say this with no judgement - I’m a recovering alcoholic. I used to drink over 200 units a week. But quitting something your body is physiologically dependent on and staying off requires more than just safely coming off whatever you’re taking. If you don’t want to go to the GP with this (I didn’t), find a peer support group. Look on Facebook for NA or something similar (it doesn’t have to be NA and you don’t have to engage with the philosophy of any of it), but do it with support from people who’ve done it before. Probably not MN. (Sorry, MN! 😂).

With those levels I would really recommend speaking to someone professional about this. It is very telling that you haven't mentioned why you take them and implies you have a problem so you are highly unlikely to be able to manage this alone. You are not the first person to end up in this position, your GP will have seen it before and be able to help.

I had surgery two weeks ago and had been taking both codeine , prescribed and Nurofen plus (4 or 5 a day) for roughly 6 weeks before due to the pain I was in. I spoke to the anaesthetist who didn't seem too worried. But, yes, be honest and things will be adjusted if needed. I'm now back to one or two basic codeine a day and hopefully will be finished with it all soon. It is horribly addictive - and as an ex alcoholic, the temptation to continue is strong, but I can't let myself, and won't

I won’t need an anaesthetic but may have a sedative - I have to stop the codeine because it can be constipating.

The paracetamol are 500mg & the ibuprofen are 200mg

Thank you everyone. I’m a recovering alcoholic & have in effect replaced one addiction with another. The codeine was initially for pain but now I admit that I am taking it for the feeling it gives me. I have been trying to cut down lately anyway, not very successfully. I’m aware of the long term damage 😢