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This medication carries significant safety risks, including the potential for addiction, severe respiratory issues, and complications during pregnancy. It is important to adhere to the following guidelines to ensure safe use:

• Risk of Addiction and Abuse: This medication, like other opioids, has a high potential for addiction, misuse, and abuse, leading to overdose or death. Always use the smallest effective dose for the shortest duration necessary. If your symptoms do not improve after 5 days, consult your healthcare provider.

• Breathing Problems: The medication can cause severe respiratory depression, especially when starting the treatment or if the dosage is incorrect. This risk is heightened in individuals over 65, those with respiratory conditions like asthma or COPD, or if taken with other substances such as alcohol or benzodiazepines. Seek immediate medical help if symptoms like slow or shallow breathing, severe drowsiness, or confusion occur.

• Interactions with Other Substances: Combining this medication with alcohol, benzodiazepines, or other drugs that slow the nervous system can lead to dangerous side effects, including coma or death. Certain medications can also alter the effectiveness of this drug, so consult with your healthcare provider before starting or stopping other treatments.

• Pregnancy and Newborn Risks: This medication is generally not recommended during pregnancy, particularly in the first trimester, due to the risk of birth defects. Long-term use can lead to neonatal opioid withdrawal syndrome in newborns, which is potentially life-threatening. Pregnant individuals should discuss the risks and benefits with their doctor.

• Emergency Actions in Case of Overdose: Overdose symptoms include slow breathing, severe drowsiness, muscle weakness, and unresponsiveness. Immediate medical intervention is required, and naloxone (Narcan) may be administered to reverse opioid overdose effects. Always use the correct measuring tools to avoid dosing errors.

• Special Populations: Children under 12, individuals with severe asthma, or those with a history of seizures should not use this medication. It is also contraindicated in individuals with certain surgical histories or who have recently used MAO inhibitors.

• Other Considerations: This medication can cause low blood pressure, adrenal insufficiency, and seizures. Be cautious when standing up quickly and report any persistent dizziness or fainting to your healthcare provider. If you experience symptoms of low cortisol levels, such as nausea or weakness, contact your healthcare provider.

Always store this medication securely to prevent misuse or accidental ingestion, especially in households with children. If accidental ingestion occurs, seek medical help immediately.

When taking this medication, you might experience some common side effects such as drowsiness, dizziness, headache, and stomach-related issues like nausea, constipation, or bloating. It's also possible to encounter dry mouth, shortness of breath, or vision problems like blurred or double vision. These effects are generally mild, but if they persist or worsen, consider consulting with your healthcare provider. Keeping hydrated and moving slowly from sitting to standing can help manage dizziness and dry mouth.

Some users may also report feeling confused, agitated, or having trouble sleeping. Other less common experiences include sweating, uncontrollable muscle movements, or a general feeling of discomfort. These symptoms should be addressed with your healthcare provider if they become concerning.

It is crucial to be aware of serious side effects, although they are rare. These include severe breathing problems, significant changes in mental state such as hallucinations, or a feeling of extreme drowsiness. An allergic reaction, characterized by rash, severe dizziness, or difficulty breathing, needs immediate medical attention. Furthermore, the medication may cause serious mood changes or very rare but potentially fatal breathing issues due to its content of codeine or dihydrocodeine, which can convert into strong opioids in the body. If you notice any severe symptoms like slowed breathing, fast or irregular heartbeat, or signs of overdose, seek urgent medical care.

Some medications and products may interact with this drug, potentially leading to increased risk of serious side effects such as slowed or shallow breathing, and severe drowsiness or dizziness. Products applied to the skin, like certain antihistamines (e.g., diphenhydramine cream, ointment, spray), as well as drugs like Naltrexone and samidorphan, are known to interact. It's crucial to inform your doctor or pharmacist if you are using other substances that may cause drowsiness or breathing issues. These include other opioid pain relievers or cough medications (e.g., codeine, hydrocodone), alcohol, marijuana (cannabis), sleep or anxiety medications (e.g., Alprazolam, Lorazepam, Zolpidem), muscle relaxants (e.g., Carisoprodol, Cyclobenzaprine), or other antihistamines (e.g., Cetirizine, diphenhydramine).

Be sure to check the labels on all your medications, including those for allergies or colds, as they may contain drowsiness-inducing ingredients. Consult your pharmacist about the safe use of these products. Additionally, other drugs may alter how this medication is removed from the body, thus affecting its efficacy. Such drugs include certain antifungals (e.g., Ketoconazole), bupropion, Fluoxetine, certain antibiotics (e.g., Erythromycin), paroxetine, quinidine, rifamycins (e.g., Rifabutin, Rifampin), Ritonavir, and some seizure medications (e.g., Carbamazepine, Phenytoin).

This drug may also interfere with specific laboratory tests, such as those measuring amylase or lipase levels and certain allergy skin tests, potentially leading to incorrect results. Ensure that all healthcare providers and lab personnel are aware that you are using this medication.