Paracetamol + Codeine

Indications

Paracetamol + Codeine is used for: Mild to moderate pain

Adult Dose

Oral Mild to moderate pain Adult: Each tab contains paracetamol 500 mg and codeine phosphate 10 mg: 1-2 tab 4-6 hrly. Max: 8 tab/24 hr. Each 5 mL oral soln contains paracetamol 120 mg and codeine phosphate 12 mg: 15 mL 4 hrly as needed. Hepatic impairment: May tolerate low-dose therapy in hepatic cirrhosis; avoid chronic use

Child Dose

Oral Mild to moderate pain Child: Tab: 12-18 yr 1-2 tab 6 hrly. Max: 8 tab/24 hr. Oral soln: 3-6 yr 5 mL 3 or 4 times daily; 7-12 yr 10 mL 3 or 4 times daily.

Renal Dose

Renal impairment: Use caution

Administration

Contra Indications

Post-op pain management in childn who underwent tonsillectomy and/or adenoidectomy.

Precautions

Patient w/ paralytic ileus, GI obstruction, adrenal insufficiency, CNS depression, history of drug abuse or acute alcoholism, head trauma, prostatic hyperplasia and/or urinary stricture, pre-existing resp disease, thyroid dysfunction, known G6PD deficiency, history of seizure disorder. Hepatic or renal impairment. Pregnancy and lactation. Patient Counselling May impair ability to drive and operate machinery. Monitoring Parameters Monitor relief of pain, resp and mental status, BP, bowel function and signs or symptoms of hypogonadism or hypoadrenalism. Lactation: Excreted in breast milk; caution advised

Pregnancy-Lactation

Interactions

Increased paracetamol absorption w/ metoclopramide and domperidone. May increase risk of bleeding w/ warfarin and other coumarins. Codeine may antagonise GI effects of metoclopramide and domperidone. Increased CNS depression w/ CNS depressants (e.g. anaesth, anxiolytics, hypnotics, TCAs, and antipsychotics).

Adverse Effects

Side effects of Paracetamol + Codeine : Nausea, vomiting, constipation, abdominal pain, pruritus, dizziness, drowsiness, lightheadedness, shortness of breath, sedation, euphoria, dysphoria, voice disorder, dyspnoea, allergic reactions, rash, thrombocytopenia, agranulocytosis. Potentially Fatal: Hepatotoxicity. Rarely, Stevens-Johnson syndrome, acute generalised exanthematous pustulosis, toxic epidermal necrolysis.

Mechanism of Action

Paracetamol, a para-aminophenol derivative, exhibits analgesic action by peripheral blockage of pain impulse generation; produces antipyresis by inhibiting the hypothalamic heat-regulating centre; and its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS. Codeine, a phenanthrene derivative, binds to opiate receptor in the CNS, causing inhibition of ascending pain pathways.