Opioid Analgesics
Codeine
Codeine is an opioid for mild to moderate pain, sold as codeine sulfate tablets (Schedule II) and as tablets with acetaminophen (Schedule III); prescription cough medicines such as promethazine with codeine (Schedule V) are labeled only for adults. The liver turns part of each dose into morphine, and codeine is never given to children under 12.
This page is general information about a medication and how cash prices for it are set. It is not medical advice and does not replace the label, your prescriber or your pharmacist. How we handle medical information
Codeine sulfate tablets and the acetaminophen and promethazine combinations are sold as generics, and the Tylenol with Codeine brand is discontinued. Each combination is a separate product, so check the pharmacy has the exact one prescribed.
About Codeine
Codeine works after the liver turns part of each dose into morphine through the enzyme CYP2D6, and how fast that happens varies from person to person. Codeine sulfate tablets and acetaminophen with codeine treat mild to moderate pain when an opioid is appropriate and other treatments are inadequate. Codeine sulfate is taken at 15 to 60 mg every 4 hours as needed; doses above 60 mg add side effects without more relief, and both labels set a limit of 360 mg of codeine in 24 hours. The acetaminophen counts toward a limit of 4,000 mg a day from all sources. Promethazine with codeine relieves cough and upper respiratory symptoms of allergy or a cold in adults 18 and older.
The boxed warnings cover addiction even at prescribed doses; slowed or stopped breathing; fatal overdose if a child swallows it; coma or death with benzodiazepines, alcohol or other sedatives; and withdrawal in newborns after long use in pregnancy. Another describes children who died after taking codeine, many of them ultra-rapid metabolizers, whose CYP2D6 genes turn codeine into morphine unusually fast, and the acetaminophen combinations add a liver warning. Codeine is contraindicated in all children under 12 and after tonsil or adenoid surgery in anyone under 18, as well as with significant breathing problems, acute or severe asthma without monitoring, a blocked bowel, or an MAO inhibitor taken within 14 days. Breastfeeding is not recommended: at least one nursing infant died from morphine passed in breast milk. Drowsiness, lightheadedness, dizziness, nausea, vomiting, sweating and shortness of breath are the most common side effects.
Codeine sulfate tablets cannot be refilled, and an unfilled electronic prescription can be transferred once. Acetaminophen with codeine tablets can carry up to five refills within six months, and promethazine with codeine the refills the prescriber authorizes; check the schedule printed on any other codeine product. The pain products fall under the Opioid Analgesic REMS, and prescribers are asked to discuss naloxone or nalmefene, which reverse an overdose; naloxone 4 mg nasal spray is sold without a prescription. Medicines that affect the liver enzymes CYP3A4 or CYP2D6 can change codeine’s effect in either direction. The codeine sulfate label was updated in December 2025 under the FDA’s 2025 opioid changes, which stress that higher doses carry more risk.
Taking Codeine
- How to take it
- Exactly as prescribed, usually only as needed for pain, and never more than 360 mg of codeine in 24 hours. Measure liquids in milliliters with an oral syringe or measuring cup, never a household spoon. Never give codeine to a child under 12, and check your other medicines for acetaminophen or another opioid.
- If you miss a dose
- It is usually taken only as needed. If you take it on a schedule and miss a dose, take the next one at your usual time; never take two doses at once.
- Storage
- In a secure place out of reach of children and others; one dose swallowed by a child can be fatal. Use a take-back program, or ask the pharmacy for a prepaid mail-back envelope for pain tablets you no longer need.
- Interactions to know about
- Benzodiazepines, sleep medicines, gabapentin, pregabalin, alcohol and other sedatives add to its effect on breathing. Starting or stopping medicines that affect CYP3A4 or CYP2D6 can make codeine stronger or weaker, so tell the pharmacist about every medicine you start or stop. MAO inhibitors are not taken within 14 days.
This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.
Why the cash price for Codeine differs from pharmacy to pharmacy
Acetaminophen with codeine tablets are generic, so quotes differ mainly by fee and markup, and a short course is priced mostly on the dispensing fee. Single-ingredient codeine sulfate tablets and the liquids are dispensed less often, so a pharmacy may need to order them.
Codeine sulfate tablets are Schedule II, ordered on a special DEA form from wholesalers that must flag unusual orders and may set their own ordering thresholds, so a pharmacy short of stock may fill only part of a prescription or turn it away. The combinations, in lower schedules, need no such form.
Upload it and licensed pharmacies reply with their own cash price. You pay the pharmacy, not us.
Ways to pay less for Codeine without insurance
- Confirm the pharmacy has the exact product and strength before the prescription is sent; an unfilled electronic Schedule II prescription can be transferred only once.
- For codeine sulfate tablets, ask for a partial fill if you may not need every tablet; where state law allows, the rest can be collected within 30 days of the date written.
- Ask the prescriber whether a non-opioid pain medicine, such as ibuprofen or naproxen, would suit you.
- Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.
How Script Unlock gets you a cash price for Codeine
Prices on this site come from pharmacies responding to a real prescription. We do not publish estimated, average or "typical" prices, because none of those would be your price.
- 1You upload your prescription
A photo of your Codeine prescription is enough. Nothing is sold on the site; you are asking pharmacies to quote.
- 2Licensed pharmacies respond
Pharmacies that Script Unlock has verified see the request and each can reply with its own cash price for your exact drug, strength and quantity.
- 3You choose and pay the pharmacy
You compare the responses, pick a pharmacy, and pay that pharmacy directly when you collect. Script Unlock never takes a patient payment and never sets the price.
Questions to ask your pharmacist about Codeine
- 1.Is this plain codeine or a combination, and what schedule is it?
- 2.Do any of my other medicines contain acetaminophen or another opioid?
- 3.Is it safe while I am breastfeeding?
- 4.Can I buy naloxone here, and how is it used?
Related medications
Sources
- FDA-approved labeling on DailyMed (codeine)
- FDA-approved labeling on DailyMed (acetaminophen and codeine)
- FDA-approved labeling on DailyMed (promethazine and codeine)
- FDA Orange Book (approved generics and therapeutic equivalence)
- FDA, approval of the December 2025 labeling update for codeine sulfate tablets
- FDA, Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS)
- FDA, REMS modification adding prepaid mail-back envelopes for opioid disposal
- FDA, required opioid labeling changes on long-term use (2025)
- FDA, approval of the first over-the-counter naloxone nasal spray
- DEA questions and answers on ordering thresholds for controlled substances
- Code of Federal Regulations, 21 CFR 1305.03 (order forms for Schedule I and II substances)
- Code of Federal Regulations, 21 CFR part 1306 (prescriptions)
Script Unlock is a marketplace that lets licensed pharmacies quote a cash price on your prescription. It does not prescribe, dispense or sell medication, does not process patient payments, and does not give medical advice. Always follow the instructions of your prescriber and pharmacist and read the medication guide supplied with your medicine.