ry depression literature. At a low codeine dose with a single drink, the combined effects are usually heavy drowsiness and slowed reactions. At higher doses, with binge drinking, or with another sedative on board, breathing can slow dangerously and overdose risk rises. Naloxone, the opioid reversal drug paramedics carry, can reverse opioid-related respiratory depression, but it may not fully reverse the effects of alcohol or mixed overdoses.
The Co-codamol Catch: Paracetamol and Your Liver
Co-codamol is codeine combined with paracetamol, and the paracetamol half adds its own alcohol question. Chronic heavy drinking induces the liver enzyme CYP2E1 (which produces more of paracetamol’s toxic metabolite NAPQI) and depletes glutathione, the body’s NAPQI defence (Prescott 2000; see also Caparrotta et al. 2018, a more recent critical review of the literature on paracetamol-induced liver injury). At standard doses for short courses, paracetamol is generally considered safe for most people without liver disease. Some experts caution that chronic heavy alcohol use may reduce this safety margin. If you drink above the UK 14-units-a-week guideline, do not exceed the co-codamol dose, and do not stack other paracetamol-containing products on top.
Side Effects That Get Worse with Alcohol
Codeine on its own commonly causes drowsiness, dizziness, nausea, constipation and slowed reactions (NHS). Alcohol overlays the first four directly. Mixing alcohol and codeine produces stronger sedative effects than either alone, leaving you sleepier, dizzier and less coordinated. Falls and accidents are the harms most people actually experience from amounts of alcohol that would normally be uneventful. Do not drive, operate machinery or look after a child while the combination is in your system. Vomiting while drowsy carries its own risk of aspiration.
Who Is at Higher Risk
The NHS warning becomes a flat no for some readers. Avoid alcohol entirely while taking codeine if you are:
- Over 65 (slower clearance, higher fall risk)
- Taking benzodiazepines, pregabalin, gabapentin or sleeping tablets (additive respiratory depression)
- Living with sleep apnoea, COPD or severe asthma
- Living with liver disease or alcohol-related liver damage
- Taking other paracetamol-containing products
If any apply, ask your GP or pharmacist before drinking, even one drink.
If You Have Already Taken Codeine and Had a Drink
For most adults who have had one or two drinks alongside a single therapeutic codeine dose, the picture is drowsiness rather than emergency. Take these steps:
- Stop drinking and skip the next codeine dose, then contact your prescriber or pharmacist for advice on adjusting your dosing.
- Drink water and eat something simple.
- Do not take other sedatives on top (sleeping tablets, antihistamines, pregabalin, recreational drugs).
- Tell someone what you took and when.
- Watch for slow or shallow breathing, blue lips or fingertips, severe drowsiness, pinpoint pupils, or vomiting while drowsy.
Call 999 immediately if any warning sign appears. Place the person on their side while you wait. Call NHS 111 if you are unsure but they are alert.
When Codeine Use Is Becoming Something Else
Codeine dependence often starts inside legitimate pain treatment. The MHRA reclassified over-the-counter codeine combinations in 2009, capping pack sizes at 32 tablets and adding the three-day warning. The leaflet asks you to watch for:
- Taking codeine longer than prescribed, or longer than three days for OTC products
- Taking more than the recommended dose
- Taking it for low mood, anxiety or sleep rather than pain
- Visiting different pharmacies to buy more
- Feeling unwell when you stop, and better when you restart
Codeine addiction often shows up alongside alcohol abuse, and the withdrawal symptoms can include agitation, palpitations, sweating and difficulty sleeping (NHS). If you recognise yourself, that is information, not a verdict. Steps Together is a CQC-regulated UK rehab group with residential centres in Leicestershire, Nottinghamshire and Merseyside. We offer medically supervised codeine rehab, opioid rehab and drug detox, with alcohol rehab where alcohol addiction has crept up alongside.
Worried codeine has become something more?
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Whether you started codeine for back pain, dental pain or after surgery, we can talk through what comes next. No pressure, no judgement.
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How Long After Codeine Before You Can Drink
Codeine’s half-life is around three hours, so most of a single dose is cleared within roughly 15 to 16 hours. UK pharmacy guidance recommends waiting sixteen to twenty-four hours after your last dose before any alcohol consumption. There is no formal NHS waiting period. If you have been on prescribed codeine for several days, give your body a day or two longer to clear before drinking.
Sources
- NHS, “Common questions about codeine” – https://www.nhs.uk/medicines/codeine/common-questions-about-codeine/
- NHS, “Common questions about co-codamol for adults” – https://www.nhs.uk/medicines/co-codamol-for-adults/common-questions-about-co-codamol-for-adults/
- NHS, “Calculating alcohol units” – https://www.nhs.uk/live-well/alcohol-advice/calculating-alcohol-units/
- MHRA, “Codeine and dihydrocodeine: minimising the risk of addiction” (Public Assessment Report) – https://assets.publishing.service.gov.uk/media/5df7610c40f0b60956f5a2e4/Codeine_and_dihydrocodeine_minimising_the_risk_of_addiction.pdf
- Office for National Statistics, “Deaths related to drug poisoning in England and Wales, 2024 registrations” – https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2024registrations
- Prescott, “Paracetamol, alcohol and the liver” (Br J Clin Pharmacol, 2000) – https://pmc.ncbi.nlm.nih.gov/articles/PMC2014937/
- Bachmutsky et al., “Neuronal mechanisms underlying opioid-induced respiratory depression” – https://pmc.ncbi.nlm.nih.gov/articles/PMC8424565/
- Caparrotta, Antoine & Dear, “Are some people at increased risk of paracetamol-induced liver injury? A critical review of the literature” (Eur J Clin Pharmacol, 2018) – https://pmc.ncbi.nlm.nih.gov/articles/PMC5765191/
Frequently Asked Questions
Can I have a glass of wine while taking codeine?
NHS guidance is to avoid alcohol the first few days of a course until you see how codeine affects you. After that, an occasional drink with a steady dose is unlikely to cause serious harm in most adults, but it can still amplify drowsiness and slow breathing. Avoid alcohol entirely if you also take benzodiazepines or sleeping tablets, or have lung or liver problems.
How long after taking codeine can I drink alcohol?
Codeine has a half-life of around three hours, so most of a single dose clears within roughly 15 to 16 hours. UK pharmacy guidance recommends waiting sixteen to twenty-four hours after your last dose. There is no formal NHS waiting period.
Is co-codamol worse than plain codeine when drinking?
It can be. Co-codamol contains paracetamol, and chronic heavy drinking raises the risk of paracetamol-related liver injury through CYP2E1 induction and glutathione depletion. Plain codeine carries the respiratory and CNS depression risks but no paracetamol component.
When should I call 999?
Slow or shallow breathing, blue lips or fingertips, severe drowsiness, pinpoint pupils, or vomiting while drowsy are signs of opioid overdose. Call 999 immediately and place the person on their side while you wait.
Can you become addicted to over-the-counter codeine?
Yes. The MHRA reclassified OTC codeine combinations in 2009 because of the dependence risk and added the three-day maximum warning. Continuing past three days, escalating the dose, or feeling unwell when stopping are the warning signs.
