Codeine in Pregnancy: When It Is Used and When to Ask

Codeine in pregnancy: how to think about it

NHS guidance on codeine says it is not usually recommended during pregnancy, and that paracetamol is generally a better choice for pain relief. Two specific concerns shape that. Taking codeine regularly late in pregnancy can lead to withdrawal symptoms in the baby after birth, which is why use near delivery is treated cautiously and why the maternity team needs to know. There is also a general principle in pregnancy prescribing of using the simplest effective medicine at the lowest dose. That said, codeine is sometimes prescribed in pregnancy where a clinician judges the benefit worthwhile, for example after surgery or for pain that paracetamol does not control. The guidance is therefore not a blanket prohibition but a reason for the decision to sit with a prescriber. Codeine also appears inside several combination painkillers, which is the most common way people take it without realising.

Codeine: safer choices

• Using paracetamol first for ordinary aches and pains, which NHS describes as the preferred painkiller in pregnancy.
• Continuing codeine exactly as prescribed if a clinician has weighed it up for your situation, and asking them what the plan is as you approach delivery.
• Telling every clinician you see, including the maternity team, that you take codeine, so pain relief and newborn care can be planned.
• Asking about the lowest effective dose and shortest duration if codeine is needed for a specific short-term problem such as post-surgical pain.

Codeine: what to avoid or double-check

• Do not start codeine yourself, including from a leftover prescription or a combination painkiller bought over the counter.
• Avoid codeine-containing combination products without checking. Some pharmacy painkillers combine codeine with paracetamol or ibuprofen and the codeine is easy to miss.
• Do not use codeine regularly or long term in pregnancy without a clinician actively managing it, because of the possibility of withdrawal symptoms in the newborn.
• Do not stop suddenly on your own if you have been taking it regularly. Ask for advice on how to reduce safely.

How SafeMama helps

SafeMama can flag codeine on medicine labels, including inside combination painkillers where it appears alongside paracetamol or ibuprofen, so you can check a pharmacy product before taking it.

Open the SafeMama app, scan the barcode or search the ingredient, then use the result as a starting point for a conversation with your healthcare provider.

Sources

• NHS codeine in pregnancy
• NHS medicines in pregnancy