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Does CBD Interact With Codeine (Codotab)?

CBD is a popular herbal supplement for managing pain, inflammation and promoting general health & wellness. Is it safe to take CBD if you’re using codeine?

Article By
Daily CBD , last updated on December 17, 2021

Codeine (Codotab) is a mild opioid analgesic used to treat mild to moderate pain. It’s also used in cough and sleep medications.

Cannabidiol, a cannabinoid produced in members of the cannabis family, may increase the chances of side effects when using codeine.

Here’s everything you need to know about this combination and which red flags to watch out for. 

Does CBD Interact With Codeine (Codotab)?

Yes. CBD may interact with Codeine (Codotab) by prolonging its effects and increasing the risk and severity of side effects.

The severity of this interaction is classified as mild when used within the recommended dosage ranges. The level of risk increases with higher doses (of either compound) and prolonged use. 

Using CBD to potentiate the effects of codeine is unsafe and could result in serious side effects or overdose. 

There are two main ways by which CBD can interact with codeine:

A) Slowed Elimination (Metabolic Inhibition)

Drug metabolism occurs in the body due to the effects of a group of enzymes from the cytochrome P450 family. Metabolic inhibition occurs when two drugs need the same enzymes to get metabolized. Hence, they end up competing against each other for the said enzymes. This action could result in slowing down the metabolism of one or both drugs. 

The drug codeine is extensively metabolized by cytochrome P2D6 or CYP2D6. CBD also gets metabolized by this same enzyme, and it’s also capable of inhibiting this enzyme. 

Because of this ability, if CBD and codeine are taken together, they end up competing with each other for the enzyme. 

The result is that the plasma levels of codeine may rise in the body and stay that way for long. There will also be a slowdown in the clearance of codeine causing it to last longer and cause more side effects. Thus, CBD can slow down the elimination of codeine from the body. 

B) Increased Effect (Agonistic Interaction)

An agonistic interaction occurs when two or more items exhibit the same effect on the body. These substances might act on the same or different receptors, but they produce certain effects in the same direction when consumed together.

Both CBD and codeine interact with the nervous system to block pain, prevent muscular spasms and suppress the central nervous system. These effects are much stronger in combination than on their own. 

Therefore, taking both substances at the same time could lead to side effects associated with excessive suppressant action on the nervous system. This may include sedation, loss of consciousness, dizziness, constipation, and inability to focus. 

Similar Medications: CBD & Opioid Painkillers

Codeine is classified as an opioid analgesic. CBD and opioid analgesics all share similar risks for interaction and side effects. It is used as an antitussive and as a mild pain reliever. 

Here’s a list of similar medications that share a similar level of risk when combined with CBD:

  • Buprenorphine (Cizdol, Brixadi)
  • Pethidine (Meperidine, Demerol)
  • Fentanyl (Abstral, Actiq)
  • Hydrocodone (Hysingla ER, Zohydro ER, Hycodan)
  • Hydromorphone (Dilaudid)
  • Methadone (Methadose, Dolophine)
  • Morphine (Kadian, Roxanol)
  • Oxycodone (Percodan, Endodan, Roxiprin, Percocet, Endocet, Roxicet, OxyContin)
  • Tramadol (Ultram, Ryzolt, ConZip)
CBD Hemp oil, Doctor holding a bottle of hemp oil, Medical marijuana products including cannabis leaf, cbd and hash oil, alternative medicine

Is It Safe to Take CBD & Codeine (Codotab) Together?

CBD and codeine are considered safe when used within the recommended dosages for both substances. Long-term use of this combination or higher doses of either CBD or codeine isn’t considered safe. 

The interaction between codeine and CBD is considered mild.  

It’s recommended to take these two medicines together only under supervision and with caution. You should always talk with your medical practitioner if you want to start using CBD while using codeine. 

To further minimize risk, take CBD and codeine at least two hours apart from each other and avoid using this combination for more than two days in a row without a break. Limit the dose of both substances when using these compounds together for the first time to see how your body responds before taking a higher dose. 

Is CBD A Viable Alternative to Codeine?

In some cases, CBD may be a viable alternative to codeine. However, codeine is a much stronger analgesic, sedative, and cough suppressant for CBD. 

One study showed that CBD hemp extract could decrease pain in patients who have chronic pain and improve their quality of life [1]. It may be used as an alternative to the possible addiction-forming pain relievers like opioid analgesics. 

CBD has anti-inflammatory and antioxidant properties [2]. So it may be possible to use it in conditions that codeine and other opioid analgesics are used in. 

However, while delta 9 tetrahydrocannabinol (THC), another cannabinoid from the cannabis plant, is shown to be effective in decreasing cough, CBD itself does not show such effects [3]. 

CBD has shown to have enough potential to become a good pain reliever and may even replace opioids like codeine for mild to moderate pain.

What is Codeine (Codotab)?

Codeine is a narcotic pain reliever and a cough suppressant. It’s a prodrug of morphine and belongs to the opioid family of drugs. It has sedative properties and can also depress respiratory function and treat diarrhea. 

It may be more effective when combined with another drug called acetaminophen. 

Codeine Specs:

Drug Name  Codeine
Trade Names Codotab, Cetcod, Code P, Codeine sulfate, Codmine, Codophos, Codotol, Nikodin, Cotabflu, Colrex, Fioricet with Codeine, Phrenilin with Caffeine and Codeine, Ascomp, Cheratussin, Cheratussin Dac, Codar Ar, Codar D, Codar Gf, Codeine Contin, Covan, Damylin With Codeine 
Classification  Opiate analgesic
CYP Metabolism  CYP2D6 enzyme
Interaction With CBD  Metabolic inhibitor, Agonistic
Risk of Interaction  Mild

What Does Codeine (Codotab) Do?

Codeine is a type of opioid. It acts on the central nervous system and has an analgesic effect. It’s metabolized in the liver to produce morphine. 

Opioids bind to specific opioid receptors in the nervous system. There are three main classes of opioid receptors called μ, κ, δ (mu, kappa, and delta). The abilities of an opioid depend on the receptor that it binds to. Each group of opioid receptors evokes a particular set of neurological responses. These receptors mediate both the psychoactive and the somatic effects of opioids. Opioid receptors are G-protein coupled receptors that positively and negatively regulate synaptic transmission through downstream signaling. 

Codeine is a selective agonist for the mu receptor, similar to another potent opioid morphine. But codeine has a much weaker affinity to this receptor than morphine. 

Codeine or morphine can bind to the mu receptor and result in the hyperpolarization of the neuron. This action leads to the inhibition of the release of nociceptive neurotransmitters, causing an analgesic effect and increased pain tolerance due to reduced neuronal excitability. 

When the opioids attach to their respective receptors, they block the pain signals sent from various parts of the body through the spinal cord to the brain. They also trigger the brain to release dopamine, the feel-good hormone. It means every time you take codeine, it can cause some sedation and give relief from the pain combined with the sense of wellbeing and euphoria. This can cause this drug to become addictive. 

So using it for a long time may cause a person to develop tolerance, provoking them to consume even more of the drug. Stopping codeine abruptly may cause withdrawal-like symptoms. Too much usage of codeine can develop tolerance, which might lead to the users seeking stronger drugs. 

At lower doses, codeine can make the person feel drowsy. But higher doses can slow down the breathing and heart rate, which could be dangerous. 

Codeine is not allowed for use in children less than 12 years of age. It can be used in pregnancy only under the supervision of the prescribing physician. Codeine can be used during pregnancy only if the potential benefit outweighs the potential risk of the drug to the fetus. Prolonged use of codeine in pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. 

Because of its addictive nature, the use of codeine must be done with caution. Use of codeine with benzodiazepines and other central nervous systems (CNS) depressants, including alcohol, may result in extreme sedation, respiratory depression, and coma.

Side Effects of Codeine (Codotab)

  • Pruritus
  • Vomiting 
  • Constipation 
  • Confusion
  • Gastrointestinal disturbance
  • Hypotension
  • Headache 
  • Somnolence 
  • Abdominal pain 
  • Asthenia 
  • Depression 
  • Diarrhea 
  • Fever
  • Anorexia
  • Dry mouth
  • Excess sweating
  • Loss of appetite 
  • Nausea 
  • Peripheral edema 
  • Rash 
  • Sweating 
  • Respiratory depression
  • Anxiety
  • Dizziness 
  • Hypersensitivity

Other Names For Codeine (Codotab)

Codeine is sold under many different names. All share the same risk and potential interactions.

Other names for Codeine include:

  • Cetcod
  • Code P
  • Codmine
  • Codophos
  • Codetol
  • Nikodin
  • Cotabflu
  • Cotabflu
  • Colrex
  • Fioricet with Codeine
  • Phrenilin with Caffeine and Codeine
  • Ascomp
  • Cheratussin
  • Codar Ar
  • Codar D
  • Codar Gf
  • Codeine Contin
  • Covan
  • Damylin With Codeine

Key Takeaways: Is it Safe to Take Codeine (Codotab) With CBD?

CBD can slow down the metabolism of codeine in the body and lead to an increased risk of side effects. 

However, this combination is considered mild, and the chances of experiencing adverse reactions are low. 

Despite the lower risk, codeine and CBD may lead to increased side effects, some of which can be severe. Because of this, it’s wise to speak to a medical professional before taking CBD alongside codeine for any reason. 

Using CBD as a potentiator for codeine, especially in higher doses, can be extremely dangerous. 


  1. Capano, A., Weaver, R., & Burkman, E. (2020). Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study. Postgraduate medicine, 132(1), 56-61. 
  2. Atalay, S., Jarocka-Karpowicz, I., & Skrzydlewska, E. (2020). Antioxidative and anti-inflammatory properties of cannabidiol. Antioxidants, 9(1), 21. 
  3. Gordon, R., Gordon, R. J., & Sofia, R. D. (1976). Antitussive activity of some naturally occurring cannabinoids in anesthetized cats. European journal of pharmacology, 35(2), 309-313. 

Learn More About CBD-Drug Interactions

Learn More About CBD-Drug Interactions

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