Codeine

Indications
 Oral
Mild to moderate pain
Adult: 30-60 mg every 4 hr. Max: 240 mg daily.
Child: 1-12 yr: 500 mcg/kg 4-6 times daily.
Renal impairment: Dose adjustment may be needed.
Hepatic impairment: Dose adjustment may be needed.
Oral
Cough suppressant
Adult: 15-30 mg 3-4 times daily. Max: 240 mg/day.
Child: 1-5 yr: 3 mg; 5-12 yr: 7.5-15 mg. Doses to be taken 3-4 times daily.
Renal impairment: Dose adjustment may be needed.
Hepatic impairment: Dose adjustment may be needed.
Oral
Acute diarrhoea
Adult: 30 mg 3-4 times daily.
Renal impairment: Dose adjustment may be needed.
Hepatic impairment: Dose adjustment may be needed.
Parenteral
Mild to moderate pain
Adult: IV/IM/SC: 30-60 mg every 4 hr. Max: 240 mg/day.
Child: IM/SC: 1-12 yr: 500 mcg/kg 4-6 times daily.
Renal impairment: Dose adjustment may be needed.
Hepatic impairment: Dose adjustment may be needed.
Contraindications
 Respiratory depression, obstructive airway disease, asthma. Acute alcoholism, convulsive disorders, head injuries, comatose patients, raised intracranial pressure. Pregnancy (prolonged use or high doses at term).
Warnings / Precautions
 Hypothyroidism, adrenocortical insufficiency; asthma, impaired hepatic or renal function, prostatic hyperplasia, hypotension, shock, inflammatory or obstructive bowel disorders, myasthenia gravis. Infants, neonates; Reduce dose in elderly or debilitated patients. May impair ability to drive or operate machinery. Lactation.
Adverse Reactions
 Dependence, withdrawal symptoms; nausea, vomiting, constipation; drowsiness, confusion; difficulty in micturition, ureteric or biliary spasms, urinary retention; dry mouth, dizziness, sweating, facial flushing, headache, vertigo, bradycardia, tachycardia, palpitations, orthostatic hypotension, hypothermia, restlessness, mood changes, decreased libido or potency, hallucination, miosis; raised intracranial pressure, muscle rigidity.
Potentially Fatal: Respiratory depression and hypotension, with circulatory failure and deepening coma (larger doses). Convulsions (especially in children and infants). Rhabdomyolysis.
Overdose Reactions
 CNS depression ranging from stupor to coma, respiratory depression which may progress to Cheyne-Stokes respiration, cyanosis, miosis, hypothermia, flaccid skeletal muscles, bradycardia and hypotension. Maintain an adequate, patent airway, using assisted or controlled respiration and oxygen as needed. Supportive and symptomatic treatment Parenteral naloxone may be given after weighing benefits versus risk of acute withdrawal syndrome in physically dependent patients. If respiratory depression is associated with muscular rigidity, admin of a neuromuscular blocking agent may help assist or control respiration. Gastric lavage may be effective many hr after drug ingestion since pylorospasm produced result in retention of the drug in the stomach for an extended period of time.
Drug Interactions
 Enhanced depressant effects with alcohol, anaesthetics, anxiolytics, hypnotics, TCAs, antipsychotics. Possible CNS depression or excitation with MAOIs. May alter effects of other compounds e.g. cyclizine, mexiletine, cisapride, metoclopramide and domperidone.
See Below for More codeine Drug Interactions
Mechanism of Actions
 Codeine provides relief by blocking the ascending pain pathways by binding to opiate receptors found in the CNS. It also helps suppress cough by direct action in the medulla.
Onset: Oral: 0.5-1 hr. IM: 10-30 min.
Duration: 4-6 hr.
Absorption: Oral and rectal: Adequate.
Distribution: Crosses placenta and enters breast milk.
Metabolism: Hepatic by O- and N-demethylation to morphine (active), norcodeine and other metabolites including normorphine and hydrocodone.
Excretion: In the urine, mainly as conjugates with glucuronic acid. Plasma half-life: about 3-4 hr.
Administration
 May be taken with or without food.
Storage Conditions
 Oral: Store at 15-30°C. Parenteral: Store at 15-30°C.
ATC Classification
 R05DA04 - codeine ; Belongs to the class of opium alkaloids and derivatives. Used as cough suppressant.
Storage
 Oral: Store at 15-30°C. Parenteral: Store at 15-30°C.
Available As
  • Codeine Phosphate 10 mg
  • Codeine Sulphate 10 mg
  • Codeine 10 mg
  • Codeine 15 mg
  • Codeine Sulphate 15 mg
  • Codeine Phosphate 15 mg
  • Codeine Sulphate 16 mg
  • Codeine Phosphate 30 mg
  • Codeine Sulphate 30 mg
  • Codeine Phosphate 5 mg
  • Codeine 50 mg
  • Codeine Phosphate 6 mg
  • Codeine Phosphate 7.5 mg
  • Codeine 9 mg

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