Codeine

(koe' deen)

PCaution when used during lactation : Caution when used during pregnancy

LCI  : Contraindicated in lactation

Molecule Info

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Indication(s) & Dosage

Mild to moderate pain  Adult: 30-60 mg orally 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 orally 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.

Administration

Should be taken with food.

Overdosage

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.

Contraindications

Respiratory depression, obstructive airway disease, asthma.  Acute alcoholism, convulsive disorders, head injuries, comatose patients, raised intracranial pressure.  Pregnancy.

Special 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 Drug Reaction(s)

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.  Convulsions.  Rhabdomyolysis.

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.

Pregnancy Category (FDA)

Category C: Either studies in animals have revealed adverse effects on the foetus and there are no controlled studies in women or studies in women and animals are not available.  Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Category D:If prolonged use/high doses at term. There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk

Storage

Oral:  Store at 15-30°C.  Parenteral: Store at 15-30°C.

Pharmacology

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, 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.

ATC Classification

R05DA04 - codeine; Belongs to the class of opium alkaloids and derivatives.  Used as cough suppressant.

 

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Gen. MedInfo

Why is this medication prescribed?

Codeine is used to relieve mild to moderate pain.  It is also used, usually in combination with other medications, to reduce coughing.  Combination products that contain codeine and promethazine should not be used in children younger than 16 years of age.  Codeine will help relieve symptoms but will not treat the cause of symptoms or speed recovery.  Codeine belongs to a class of medications called opiate analgesics and to a class of medications called antitussives.  When codeine is used to treat pain, it works by changing the way the body senses pain.  When codeine is used to reduce coughing, it works by decreasing the activity in the part of the brain that causes coughing.

Codeine is also available in combination with acetaminophen; aspirin; and in many cough and cold medications.  This monograph only includes information about the use of codeine.  If you are taking a codeine combination product, be sure to read information about all the ingredients in the product you are taking and ask your Doctor for more information.

How should this medicine be used?

Codeine comes as a tablet, a capsule, and a solution to take by mouth.  It is usually taken every 4 to 6 hours as needed.  Follow the directions on your prescription label carefully, and ask your Doctor to explain any part you do not understand.  Take codeine exactly as directed.

Codeine can be habit-forming.  Do not take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor.

If you are giving codeine to a child, give the medication only as needed.  Do not give codeine on a regular schedule and do not give more than 6 doses in 24 hours.

Shake the solution well before each use to mix the medication evenly.  Do not use a household spoon to measure your dose.  Use the measuring cup or spoon that came with the medication or use a spoon that is made especially for measuring medication.

Other uses for this medicine

This medication is sometimes prescribed for other uses; ask your Doctor for more information.

What Special Precautions should I follow?

Before taking codeine,

  • tell your Doctor if you are allergic to codeine, any other medications, or any of the ingredients in the codeine product you plan to take.  Ask your Doctor for a list of the ingredients.
  • tell your Doctor what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.  Be sure to mention any of the following: antidepressants; medications for cough, cold, or allergies; medications for anxiety, mental illness, nausea, or seizures; monoamine oxidase inhibitors such as isocarboxazid, phenelzine, selegiline, and tranylcypromine; sedatives; sleeping pills; and tranquilizers.  Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you drink or have ever drunk large amounts of alcohol and if you have had recent abdominal or urinary tract surgery.  Also tell your doctor if you have or have ever had a head injury; a brain tumor; any condition causing increased pressure in your brain; seizures; mental illness; lung disease such as asthma, chronic obstructive pulmonary disease, or other breathing problems; prostatic hypertrophy; urinary problems; low blood pressure; Addison's disease; allergies; or thyroid, pancreatic, intestinal, gallbladder, liver, or kidney disease.
  • tell your doctor if you are pregnant or plan to become pregnant.  If you become pregnant while taking codeine, consult your doctor.
  • tell your doctor if you are breast-feeding.  Some women who take codeine may have increased amounts of the medication in their breast milk, which can cause serious or life-threatening side effects in their breast-fed babies.  Consult your doctor immediately if you become very sleepy and have difficulty caring for your baby.  You should also call your baby's doctor or get emergency help if your baby is sleepier than usual, has trouble breast-feeding or breathing, or becomes limp.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking codeine.
  • you should know that this medication may make you drowsy.  Do not drive a car or operate machinery until you know how this medication affects you.  If you are giving codeine to a child, watch the child to be sure he or she does not get hurt while riding a bike or participating in other activities that could be dangerous.
  • talk to your doctor about the safe use of alcohol while you are taking this medication.  Alcohol can make the side effects of codeine worse.
  • if you are giving codeine to a child, especially a child who is recovering from surgery, you should know that some children who received codeine after surgery to remove the tonsils or adenoids experienced serious side effects or died.  Watch your child closely during his or her treatment with codeine.  If your child is unusually sleepy, is breathing loudly or with difficulty, seems confused, or has blueness on the lips or around the mouth, he or she may be experiencing serious side effects.  Get emergency medical attention immediately and do not give your child any more codeine.  Be sure to tell the medical staff that your child has been taking codeine.
  • you should know that codeine may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position.  This is more common when you first start taking codeine.  To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
  • you should know that codeine may cause constipation.  Talk to your doctor about changing your diet and using other medications to treat or prevent constipation.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

Codeine is usually taken as needed.  If your doctor has told you to take codeine regularly, take the missed dose as soon as you remember it.  However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule.  Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Codeine may cause side effects.  Tell your doctor if any of these symptoms are severe or do not go away:

  • dizziness
  • lightheadedness
  • headache
  • drowsiness
  • mood changes
  • nausea
  • vomiting
  • constipation
  • stomach pain
  • difficulty urinating
  • difficulty breathing or swallowing
  • fast, pounding, or irregular heartbeat
  • rash
  • itching
  • hives
  • changes in vision
  • seizures

Some side effects can be serious.  If you experience any of the following symptoms, consult your doctor immediately or get emergency medical attention:

Codeine may cause other side effects.  Consult your doctor if you have any unusual problems while you are taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Office of Directorate General, Drugs Administration.

What Storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children.  Store it at room temperature and away from excess heat and moisture.  Throw away any medication that is outdated or no longer needed.  Talk to your Doctor about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, consult your Doctor.  If the victim has collapsed or is not breathing, consult local medical emergency services.

Symptoms of overdose may include:

  • difficulty breathing
  • excessive drowsiness
  • loss of consciousness
  • loss of muscle tone
  • cold and clammy skin
  • fainting
  • dizziness
  • slow heartbeat

Before Calling Emergency

Determine the following information:

  • Patient's age, weight and condition
  • Name of the product/medicine (ingredients and strengths, if possible)
  • Time it was swallowed/taken
  • Amount swallowed/taken

 What to Expect at the Emergency Room

 The Health Care Provider/ Emergency Doctor will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate and blood pressure. Symptoms will be treated as appropriate. The patient may receive:

  • Antidote, gastric lavage, activated charcoal or other drugs/procedures as required
  • Blood tests to determine body chemical levels and blood acid/base balance
  • EKG/ECG test
  • Medicines to correct fluid and electrolyte imbalances

Do not let anyone else take your medicine.  

It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals or other dietary supplements.  You should bring this list with you each time you visit a doctor or if you are admitted into a hospital.  It is also important information to carry with you in case of emergencies.