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Pronunciation:

(AS pir in & KOE deen)

Synonyms:

Codeine and Aspirin

Generic Available:

Yes

Canadian Brand Names:

Coryphen® Codeine

Use:

Relief of mild to moderate pain

Use - Dental:

Treatment of postoperative pain

Restrictions:

C-III

Pregnancy Risk Factor:

Pregnancy Implications:

Refer to Aspirin monograph.

Lactation:

Enters breast milk/use caution

Contraindications:

Hypersensitivity to aspirin, codeine, or any component of the formulation; premature infants or during labor for delivery of a premature infant; pregnancy

Warnings/Precautions:

Use with caution in patients with impaired renal function, erosive gastritis, or peptic ulcer disease

Enhanced analgesia has been seen in elderly patients on therapeutic doses of narcotics; duration of action may be increased in the elderly; the elderly may be particularly susceptible to the CNS depressant and constipating effects of narcotics

Adverse Reactions:

Frequency not defined.

Cardiovascular: Palpitations, hypotension, bradycardia, peripheral vasodilation

Central nervous system: CNS depression, increased intracranial pressure

Dermatologic: Pruritus, rash, urticaria

Endocrine & metabolic: Antidiuretic hormone release

Gastrointestinal: Nausea, vomiting, constipation

Hematologic: Occult bleeding

Hepatic: Hepatotoxicity

Respiratory: Respiratory depression, bronchospasm

Ocular: Miosis

Miscellaneous: Physical and psychological dependence, biliary or urinary tract spasm, histamine release, anaphylaxis

Drug Interactions:

Aspirin: Substrate of CYP2C8/9 (minor)

Also see individual agents.

Ethanol/Nutrition/Herb Interactions:

Food: Food decreases rate but not extent of absorption (oral).

Mechanism of Action:

Aspirin inhibits prostaglandin synthesis, acts on the hypothalamus heat-regulating center to reduce fever, blocks prostaglandin synthetase action which prevents formation of the platelet-aggregating substance thromboxane A2; codeine binds to opiate receptors (mu and kappa subtypes) in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain

Pharmacodynamics/Kinetics:

See individual agents.

Dosage:

Oral:

Children:

Aspirin: 10 mg/kg/dose every 4 hours

Codeine: 0.5-1 mg/kg/dose every 4 hours

Adults: 1-2 tablets every 4-6 hours as needed for pain

Dosing adjustment in renal impairment:

Clcr 10-50 mL/minute: Administer 75% of dose

Clcr<10 mL/minute: Avoid use

Dosing interval in hepatic disease: Avoid use in severe liver disease

Administration:

Administer with food or a full glass of water to minimize GI distress

Dietary Considerations:

May be taken with food or milk to minimize GI distress.

Patient Education:

See individual agents. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.

Nursing Implications:

Observe patient for excessive sedation, respiratory depression.

Dental Health: Effects on Dental Treatment:

Key adverse event(s) related to dental treatment: Elderly are a high-risk population for adverse effects from nonsteroidal anti-inflammatory agents. As many as 60% of elderly patients with GI complications from NSAIDs can develop peptic ulceration and/or hemorrhage asymptomatically. Concomitant disease and drug use contribute to the risk of GI adverse effects. Use lowest effective dose for shortest period possible. Consider renal function decline with age.

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Dental Comment:

Codeine products, as with other narcotic analgesics, are recommended only for limited acute dosing (ie, 3 days or less). The most common adverse effect you will see in your dental patients from codeine is nausea, followed by sedation and constipation. Codeine has narcotic addiction liability, especially when given long-term. The aspirin component has anticoagulant effects and can affect bleeding times.

Mental Health: Effects on Mental Status:

Sedation is common; may produce euphoria or dysphoria

Mental Health: Effects on Psychiatric Treatment:

May cause leukopenia; use caution with clozapine and carbamazepine; may displace valproic acid from binding sites resulting in an increase of unbound drug; monitor for toxicity; codeine is a CNS depressant; monitor for additive effects with concurrent psychotropic use

Dosage Forms:

Tablet:

#3: Aspirin 325 mg and codeine phosphate 30 mg

#4: Aspirin 325 mg and codeine phosphate 60 mg

International Brand Names:

Coryphen® Codeine (CA)

References

Dionne RA, "New Approaches to Preventing and Treating Postoperative Pain,"J Am Dent Assoc, 1992, 123(6):26-34.

Gobetti JP, "Controlling Dental Pain,"J Am Dent Assoc, 1992, 123(6):47-52.

Mokhlesi B, Leikin JB, Murray P, et al, "Adult Toxicology in Critical Care: Part II: Specific Poisonings,"Chest, 2003, 123(3):897-922.

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