What are the symptoms of codeine withdrawal, and how long does it last?
Codeine withdrawal symptoms, a day-by-day timeline, whether you can stop cold turkey or detox at home, what makes Stilpane and codeine syrups different in South Africa, and how medical detox in Cape Town works.
Codeine withdrawal feels like a heavy flu with restlessness on top: watery eyes, a runny nose, yawning, sweating, chills, aching muscles, wide pupils and a pounding heart, the list printed in South Africa’s own Stilpane leaflet. As with other opioids, it can begin within hours of the last dose, peaks at around two to three days and eases after about a week. Low mood, poor sleep and cravings usually last longer.
Codeine is easy to underestimate here because it sits in everyday painkillers and cough syrups. It is not a rare problem, though. In the first half of 2024, 493 people in South African treatment centres (9%) reported using codeine for non-medical reasons. Medical detox at Renewed Life Center, our residential centre in Lakeside, Cape Town, is built for this. Below are the symptoms, the timeline and whether a codeine detox at home is realistic.
Taking more codeine than you meant to, and scared of stopping? Message us and we will tell you whether you need a medical detox and help you arrange it. We reply the same day.
What are the symptoms of codeine withdrawal?
Codeine withdrawal symptoms are restlessness, watery eyes, a runny nose, yawning, sweating, chills, muscle pain, enlarged pupils and a fast or fluttering heartbeat. Anxiety and agitation come with them: the NHS warns that a sudden stop can leave you “feeling agitated or anxious“. Stomach cramps, diarrhoea and nausea are common as the days go on.
The early hours feel mostly like a cold coming on, with yawning, a runny nose and restless legs at night. Then the body joins in: goosebumps, hot and cold spells, aches in the back and legs, a stomach that will not settle. Sleep is the last thing to return. Many people also notice that the pain they started codeine for, a headache, a bad back, period pain, seems worse for a while. Part of that is rebound, and it does ease.
Underneath it all runs the craving, and the knowledge that one tablet would make it stop. So many attempts to stop at home end on day two or three, right at the peak.
How long does codeine withdrawal last?
Codeine withdrawal follows the opioid pattern: symptoms can start within hours, peak around day two or three, and the physical part eases after roughly a week. For opioids as a group, the MSD Manual’s yardstick is symptoms as early as 4 hours after the last dose, a peak within 48 to 72 hours, and easing after about a week. Codeine is a weaker opioid, so the exact hours depend on the dose, the product and how long it was taken.
| When | What usually happens |
|---|---|
| First hours to day 1 | Restlessness, yawning, watery eyes, runny nose, anxiety, the first craving |
| Days 2 to 3 | The peak: sweating, chills, goosebumps, aching muscles, stomach cramps, diarrhoea, almost no sleep |
| Days 4 to 7 | Physical symptoms ease; tiredness, irritability and broken sleep remain |
| Weeks 2 to 4 and after | Low mood, flat energy, poor sleep and cravings, often set off by pain or stress |
| Planned taper instead of a sudden stop | Several weeks or months, with milder symptoms at each step |
The weeks after the first one are where relapse usually happens. The body feels mostly normal again, the mood has not caught up, and the old answer to a bad day is in every pharmacy.
Can you stop codeine cold turkey?
It is not recommended. The NHS advice is plain: do not stop taking codeine suddenly, because that causes withdrawal symptoms, and a prescriber will gradually reduce your dose over several weeks or months. The Stilpane leaflet says the same for South Africa: if you were dependent on a high dose, tapering down can take weeks to months.
With codeine, the bigger risk of cold turkey is what happens when it fails. Opioid withdrawal on your own “can be very hard and may be dangerous“, MedlinePlus notes. Days of vomiting and diarrhoea drain the body, and the person who gives up on day three tends to take a large dose to make it stop.
If someone is hard to wake, breathing slowly or has blue lips after taking codeine, especially with alcohol or sleeping tablets, call 10177, or 112 from a cellphone, now.
Why is codeine withdrawal different in South Africa?
Because the codeine people get dependent on here usually comes mixed with something else. The biggest example is Stilpane. Each tablet combines meprobamate 150 mg, codeine phosphate 8 mg, paracetamol 320 mg and caffeine. Meprobamate is a sedative, so someone taking Stilpane daily is dependent on two drugs, and the withdrawal and taper have to account for both.
The same leaflet says Stilpane should not be used for longer than 10 days. People who end up needing a detox have usually been taking it for months, often several tablets at a time.
Codeine cough syrups are the other route. They are regulated under Schedule 2 and Schedule 3 of the Medicines Act, and SAHPRA warns that codeine “poses a risk of developing tolerance and eventually dependence“. Mixed with a cool drink, syrup becomes lean, which we explain in what is lean drink? Withdrawal from lean is codeine withdrawal, with the same timeline.
Can you do a codeine detox at home?
Sometimes. Someone who has taken a modest dose for a few weeks can often taper at home with a plan and a person checking in. A codeine detox at home tends to fail when the daily dose is high, when it is Stilpane or syrup in large amounts, when alcohol or sleeping tablets are in the mix, or when earlier attempts ended on day two or three.
Signs that home is the wrong place to stop
- You take codeine every day and need more than you did a few months ago.
- Tablets come from several pharmacies, or Stilpane and syrup are taken well past the label.
- You drink, or take Xanor, Urbanol or sleeping tablets, on top of the codeine.
- You have tried to stop before and gone back within days.
- Anxiety, depression or chronic pain sits underneath and is not being treated.
If two or more of those fit, message us with what you take and how much, and we will tell you whether you need a medical detox and help you arrange it. If benzodiazepines such as Xanor or Urbanol are part of it, read benzo withdrawal too: that withdrawal carries a seizure risk, and it changes how the whole detox is planned.
What happens in codeine detox at our centre?
Codeine detox at Renewed Life Center runs with 24-hour nursing supervision, and a resident GP sees you on site. It starts with an assessment of what you take, how much and alongside what. Medication to ease the symptoms is prescribed by a doctor where it is needed, for you, not from a fixed schedule decided in advance.
The aim of the first week is to get you through the peak with sleep, food and fluids back on track, so that therapy can begin as soon as you are well enough to use it. Days start at 07:00, meals come from our kitchen, and the house sits in Lakeside, in Cape Town’s Southern Suburbs, close to Muizenberg beach.
For how detox works for each substance we treat, see medical detox in Cape Town. If alcohol is part of the picture, our alcohol withdrawal timeline explains why that changes the plan.
What comes after codeine detox?
Treatment for the reason the codeine started. For most people it began with real pain, a migraine, an injury or an operation, and carried on because it also took the edge off stress, sleep or a low mood. Detox takes the drug away. The pain and the stress are still waiting at home.
Our dual diagnosis programme treats both on one plan. A psychiatrist selects medication where it is needed, Ruby Weber, our psychologist, leads the psychological side of our dual diagnosis work, and the weekday runs on a one-to-one session in the morning and groups until four, with relapse prevention, DBT and schema therapy among them. Every discharge includes a written relapse-prevention plan built for your home, including what to do the next time you are in pain. Families can join our family support group every Wednesday at 18:00 on Zoom.
What else do people ask about codeine withdrawal?
It can be. Stilpane contains codeine, which carries a risk of tolerance and dependence, and meprobamate, a sedative. Its leaflet limits it to a short course, and someone dependent on a high dose may need weeks to months to taper off.
The physical peak still comes around days two to three and eases within about a week. After long-term use, the low mood, poor sleep and cravings can last for weeks, which is why a planned taper over weeks or months, followed by treatment, works better than a sudden stop.
Yes. Agitation and anxiety are among the first withdrawal symptoms, and they can feel like the anxiety the codeine was covering. If anxiety was there before the codeine, it needs treating in its own right, not only waiting out.
A slow taper rather than a sudden stop, fluids, light food, rest and someone who checks on you, with the codeine kept by another person so the dose stays on plan. If the dose is high or other drugs are involved, home is the wrong place to do it: message us and we will help you work out the next step.
Yes. Lean is codeine cough syrup mixed with a cool drink, so stopping it brings the same opioid withdrawal and the same timeline: restlessness and a runny nose first, a peak around days two to three, and low mood and cravings for weeks after. Young people who drink lean often use cannabis or alcohol with it, which the detox plan has to cover too.
This article is general information, not medical advice.
Sources
- SAHPRA: Stilpane tablets patient information leaflet, October 2025 (PDF)
- SAHPRA: codeine-containing medicines
- NHS: codeine
- MSD Manual Professional Edition: opioid toxicity and withdrawal
- MedlinePlus: opiate and opioid withdrawal
- South African Medical Research Council, SACENDU update, January to June 2024 (PDF)
- Western Cape Government: emergency numbers
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