I had dental surgery last Thursday and as fun as that was, managing the pain since has been ever more so. It got me to thinking that mixing bipolar and codeine likely isn’t the best idea.
What Is Codeine?
Codeine is an opioid medication and can naturally be derived from opium and a form of morphine. It is primarily used as a pain medication but can be used for a myriad of other things such as suppressing preterm labor contractions and is on the list of essential medications as assessed by the World Health Organization.
Many people take codeine in the form of Tylenol #3s which contains codeine, acetaminophen and caffeine (caffeine speeds the absorption of the other drugs and helps to combat their sedating effects).
As with all opioids, codeine can be addictive and should not be used in people with addiction disorders (typically).
Codeine and Bipolar Medications
I will be the first one to say that I didn’t check the interaction list or seriously question anyone before taking this stuff. This was my bad but, in my defense, it’s sort of something that healthcare professionals should have been asking me about (I.e., What other medications are you taking?). But they didn’t. And when I went to pick up the prescription I was on sedative medication so it certainly didn’t occur to me to mount a major query offensive (walking was challenging at that point).
But, having looked it up, I can tell you that codeine/acetaminophen and even codeine alone has over 200 “significant” interactions and many “serious” (use alternative) interactions. And yes, some of these are codeine and bipolar/psych med interactions.
I’ve looked through the list and many of the “significant” interactions are either an increase in sedating effects (most antipsychotics and benzodiazepines, some antidepressants) or an increasing of potency (several antidepressants) both of which require close monitoring (according to Medscape). Here’s a sampling:
- Bupropion (Wellbutrin) – increases level of effect of codeine by effecting hepatic enzyme CYP206 metabolism. Significant interaction possible.
- Desvenlafaxine (Pristiq) – inhibits CYP206, with higher desvenlafaxine dosages (i.e., 400 mg) decrease the CYP206 substrate dose by up to 50%, no dosage adjustment needed with desvenlafxine dosages < 100 mg.
- Quetiapine (Seroquel) – both increase sedation. Potential for interaction, monitor.
See all the drug interactions for codeine here.
Codeine and Bipolar Disorder Interactions
There is not really any research on codeine and bipolar disorder except two case studies I found wherein codeine (and accompanying medications) was likely responsible for inducing mania.
Note that the adverse effects reported for codeine include:
- A false feeling of wellbeing
- Paradoxical central nervous system stimulation (as opposed to sedation, which is typical)
And I, personally, found I had a paradoxical reaction making sleep actually more difficult rather than easier, which is what it should be on an opioid medication.
(As an interesting side note, the opioid oxycodone has also been known to cause mania in bipolar individuals and has also been tried as an adjunctive treatment in bipolar depression.)
Bipolar and Codeine
All of this is to say that it’s not very fun for me to be on yet another medication in conjunction with all the psychiatric medications I currently take. It feels rather like all the meds have gotten together to throw a kegger in my brain. I’d avoid the experience again, if I could.
And, of course, I should have done this research and discussed it with my doctor long before going on the medication. This isn’t always possible, of course, but it was in my case and I should have done it. Feel free to learn from my error here and do your due diligence.
(It’s also worth noting that not all interactions are going to be known and that we, as a bipolar population, are special and our reactions may simply be unusual. That’s why closely monitoring your bipolar symptoms and psychiatric wellbeing in general while going on any medication – prescription or over-the-counter – is critical.)
Image: “TYLENOL3”. Licensed under GFDL via Wikipedia.