Codeine

Indications

Codeine is used for: Mild to moderate pain, Cough suppression

Adult Dose

Oral Mild to moderate pain Adult: 15-60 mg 4 hrly. Max: 360 mg/day. Cough suppression Adult: 15-30 mg 3-4 times daily.

Child Dose

Oral Mild to moderate pain Child: <12 yr 0.5-1 mg/kg every 4-6 hr daily. Max: 240 mg daily. Cough suppression Child: 2-5 yr 3 mg; 6-12 yr 7.5-15 mg. Doses to be taken 3-4 times daily.

Renal Dose

Renal impairment: Dose adjustment may be needed.

Administration

May be taken with or without food.

Contra Indications

Respiratory depression; obstructive airway disease; acute and severe asthma attack; presence or suspicion of paralytic ileus, acute ulcerative colitis, antibiotic-associated colitis; comatose patients; acute alcoholism. Patients w/ head injury, raised intracranial pressure. Use in childn after tonsillectomy and/or adenoidectomy. Coadministration w/ MAO inhibitors or w/in 2 wk of its discontinuation.

Precautions

Hypothyroidism, adrenocortical insufficiency; prostatic hyperplasia, hypotension, shock, inflammatory or obstructive bowel disorders, myasthenia gravis. Patient who are ultra-rapid metabolisers of codeine. Renal and hepatic impairment. Pregnancy and lactation. Elderly or debilitated patients. May impair ability to drive or operate machinery. Monitoring Parameters Monitor BP, heart rate, respiratory and mental status. Lactation: Excreted in breast milk; use with caution (AAP Committee states "compatible with nursing")

Pregnancy-Lactation

Pregnancy category: C; D if used for prolonged periods or near term

Interactions

Enhanced depressant effects w/ anaesthetics, anxiolytics, hypnotics, TCAs, antipsychotics. May alter effects of other compounds e.g. mexiletine, metoclopramide and domperidone. Potentially Fatal: Additive effects w/ MAOI, avoid combination.

Adverse Effects

Side effects of Codeine : >10% Constipation,Drowsiness 1-10% Hypotension,Tachycardia or bradycardia,Confusion,Dizziness,False feeling of well-being,Headache,Lightheadedness,Malaise,Paradoxical CNS stimulation,Restlessness,Rash, urticaria,Anorexia,Nausea, vomiting,Xerostomia,Ureteral spasm, urination decreased,LFTs increased,Burning at injection site,Weakness,Blurred vision,Dyspnea,Histamine release <1% Hypotension, with IV use,Anaphylactoid reaction (rare),Seizure, with excessive doses,Respiratory depression

Mechanism of Action

Codeine is a phenantrene-derivative opiate agonist which alters the perception of and response to pain by binding to opiate receptors in the CNS, blocking the ascending pain pathways. It also helps suppress cough by direct action in the medulla.