Galcodine (Codeine linctus)

How does it work?

Galcodine linctus contains the active ingredient codeine phosphate, which is a type of medicine called an opioid. Codeine is a mild painkiller, but also suppresses the cough reflex in the central nervous system. Codeine linctus is used to suppress a dry, irritating, unproductive cough. (NB. Codeine linctus is also available without a brand name, ie as the generic medicine.)

Coughing is a reflex response to irritation of the airways. It is useful for clearing mucus, dust and other particles from the throat and lungs. It is important because it reduces the amount of mucus, dust and bacteria in the airways that would otherwise make breathing difficult. However, sometimes, coughing can become overstimulated even when there is no mucus to clear from the lungs or throat. In this situation coughing serves no purpose and can become painful and frustrating.

Codeine phosphate can be used to block the cough reflex in situations where the cough serves no purpose, ie when no plegm is being coughed up. It works by reducing the nerve signals sent from a part of the brain called the coughing centre to the muscles that produce coughing.

What is it used for?

  • Dry, irritating, unproductive or painful coughs in adults over 18 years of age.

How do I take it?

  • Adults over 18 years of age can take one 5ml spoonful up to four times a day when needed to relieve the cough. A reduced dose is recommended for elderly people. Ask your pharmacist for advice.
  • Codeine linctus can be taken either with or without food.
  • Do not exceed the recommended dose of this medicine.
  • If symptoms persist despite treatment, seek medical advice from your doctor or pharmacist.
  • Do not take this medicine regularly for a long time. Regular use of codeine can lead to addiction, which might cause you to feel restless and irritable when you stop taking the medicine.

Warning!

  • If you have any of the following symptoms you should not take this medicine and consult your doctor first so that the cough can be investigated further: coughing up phlegm that is green, rusty brown, yellow, blood-stained or foul smelling; shortness of breath, wheezing or difficulty breathing; chest pain; pain and swelling in the calf; sudden weight loss; recurrent night-time cough; or a long-term persistent cough.
  • This medicine may cause drowsiness, dizziness, confusion and blurred vision. If affected do not drive or operate machinery.
  • Do not drink alcohol while taking this medicine, as it is likely to make the above effects worse.
  • Do not exceed the recommended dose.
  • If this medicine is taken regularly for long periods of time your body may become dependent on the codeine. As a result, withdrawal symptoms such as restlessness and irritability may occur if the medicine is then stopped suddenly. If you find you need to use this medicine all the time you should consult your doctor for advice.
  • People can vary considerably in the way that their body metabolises codeine. For some people this may lead to an increased chance of getting side effects, such as reduced levels of consciousness; sleepiness; slow, shallow breathing; ‘pin-point’ pupils; lack of appetite; constipation; or nausea and vomiting. If you experience any of these you should stop using this medicine and get medical advice straight away. For other people it may mean that the codeine is less effective, so if you find this medicine doesn't relieve your symptoms well enough you should consult your doctor.

Use with caution in

  • Elderly people.
  • Decreased kidney function.
  • Decreased liver function.
  • People with reduced lung function, eg due to asthma.
  • People with a condition called bronchiectasis, in which there is persistent widening of the airways as a result of lung disease, eg infection, inflammation, tumours or cystic fibrosis.
  • People with biliary tract disorders, eg gallstones or recent surgery on the biliary tract.
  • People with acute abdominal conditions such as appendicitis.
  • People who have recently had surgery on the stomach, intestines or urinary tract.
  • People with constipation or potential for blockage in the gut.
  • People with inflammatory bowel disorders such as Crohn's disease or ulcerative colitis.
  • People who have difficulty passing urine, for example men with an enlarged prostate gland (prostatic hypertrophy).
  • People with an underactive thyroid gland (hypothyroidism).
  • People with underactive adrenal glands, eg Addison's disease.
  • People with low blood pressure (hypotension) or shock.
  • A condition involving abnormal muscle weakness called myasthenia gravis.
  • People with a history of convulsions or fits, eg epilepsy.
  • People with an irregular heartbeat (arrhythmia).
  • People with a history of drug abuse or dependence.

Not to be used in

  • Children and adolescents under 18 years of age.
  • People who are known to have a genetic variation of a liver enzyme called CYP2D6, which metabolises codeine into morphine (CYP2D6 ultra-rapid metabolisers). These people are more likely to experience side effects after taking codeine, because they convert more codeine into morphine than other people. See the warning section above.
  • People with very slow, shallow breathing (respiratory depression).
  • Chronic obstructive pulmonary disease (COPD).
  • People having an asthma attack.
  • People who are intoxicated with alcohol.
  • Liver failure.
  • People with or at risk of paralysis or inactivity in the intestines that prevents material moving through the gut (paralytic ileus).
  • Diverticular disease.
  • People with raised pressure inside the skull (intracranial pressure).
  • People with a head injury.
  • Breastfeeding.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • The safety of codeine for use during pregnancy has not been established. If codeine is used regularly in the third trimester it may cause withdrawal symptoms in the baby after birth. If used during labour it may cause breathing difficulties in the baby after birth. This medicine should be avoided during pregnancy and the late stages of labour, unless considered essential by your doctor, and then only if the expected benefit to the mother outweighs any potential risk to the baby. Seek further medical advice from your doctor.
  • Codeine passes into breast milk in amounts that are probably too small to be harmful in most people. However, because some people metabolise codeine in a slightly different way that can increase the risk of getting side effects from the medicine, it is recommended that women who are breastfeeding do not take codeine. It is impossible to predict which women and babies will metabolise codeine differently. Potential side effects in a nursing baby may include drowsiness or sedation, difficulty breastfeeding, vomiting, breathing difficulties and floppiness. You should not breastfeed while taking this medicine. If you do breastfeed, you should stop taking this medicine and consult your doctor immediately or seek emergency medical care if your baby shows any of the symptoms just mentioned.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

  • Constipation.
  • Nausea and vomiting.
  • Dizziness or spinning sensation.
  • Drowsiness.
  • Confusion.
  • Headache.
  • Itching or nettle rash.
  • Slow, shallow breathing (respiratory depression).
  • Decreased blood pressure (hypotension).
  • Difficulty passing urine (urinary retention).
  • Dry mouth.
  • Sweating.
  • Flushing.
  • Mood changes.
  • Hallucinations.
  • Pin point pupils.
  • Blurred or double vision.
  • Changes in heart rate.
  • Decreased sex drive.
  • Convulsions.
  • Abdominal pain.
  • Loss of appetite.
  • Dependence on the medicine if used long periods of time (see warning section above).

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.

This medicine should not be used by people who are currently taking a monoamine oxidase inhibitor (MAOI) or who have taken one of these medicines in the last 14 days. MAOIs include the antidepressants phenelzine, tranylcypromine, isocarboxazid and moclobemide and the anti-Parkinson's medicine selegiline.

This medicine may cause drowsiness. If this occurs, it may be made worse if the medicine is taken in combination with any of the following, which can also cause drowsiness:

  • alcohol
  • antipsychotics, eg haloperidol, chlorpromazine
  • benzodiazepines, eg temazepam, diazepam
  • sedating antihistamines, eg chlorphenamine, promethazine, triprolidine, hydroxyzine (some of these may be found in non-prescription cough and cold or hayfever remedies)
  • sleeping tablets, eg zopiclone
  • other strong opioid painkillers, eg dihydrocodeine, morphine, tramadol
  • tricyclic antidepressants, eg amitriptyline.

Codeine phosphate can reduce the muscular activity in the gut and so may oppose the effect of the following medicines on the gut:

  • domperidone
  • metoclopramide.

There may be an increased risk of side effects such as constipation, dry mouth and blurred vision if codeine is taken with antimuscarinic medicines that can cause these type of side effects, such as the following:

  • antimuscarinic medicines for Parkinson's symptoms, eg procyclidine, orphenadrine, trihexiphenidyl
  • antimuscarinic medicines for urinary incontinence, eg oxybutynin, flavoxate, tolterodine, propiverine, trospium
  • antispasmodics, eg atropine, hyoscine.

There is a risk of severe constipation if codeine is used with antimotility medicines for diarrhoea, such as loperamide.

Quinidine reduces the painkilling effect of codeine.

Rifampicin and ritonavir may also reduce the effects of codeine.

Other medicines containing the same active ingredient

  • Codeine phosphate syrup.
  • Codeine phosphate tablets.

Codeine linctus is also available without a brand name, ie as the generic medicine.