Pronunciation:

(KOE deen)

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Use - Dental:

Restrictions:

Pregnancy Risk Factor:

Lactation:

Contraindications:

Warnings/Precautions:

Use with caution in patients with hypersensitivity reactions to other phenanthrene derivative opioid agonists (morphine, hydrocodone, hydromorphone, levorphanol, oxycodone, oxymorphone); respiratory diseases including asthma, emphysema, COPD, or severe liver or renal insufficiency; some preparations contain sulfites which may cause allergic reactions; tolerance or drug dependence may result from extended use

Not recommended for use for cough control in patients with a productive cough; not recommended as an antitussive for children <2 years of age; the elderly may be particularly susceptible to the CNS depressant and confusion as well as constipating effects of narcotics

Not approved for I.V. administration (although this route has been used clinically). If given intravenously, must be given slowly and the patient should be lying down. Rapid intravenous administration of narcotics may increase the incidence of serious adverse effects, in part due to limited opportunity to assess response prior to administration of the full dose. Access to respiratory support should be immediately available

Adverse Reactions:

Frequency not defined: Increased AST, ALT

>10%:

Central nervous system: Drowsiness

Gastrointestinal: Constipation

1% to 10%:

Cardiovascular: Tachycardia or bradycardia, hypotension

Central nervous system: Dizziness, lightheadedness, false feeling of well being, malaise, headache, restlessness, paradoxical CNS stimulation, confusion

Dermatologic: Rash, urticaria

Gastrointestinal: Xerostomia, anorexia, nausea, vomiting

Genitourinary: Decreased urination, ureteral spasm

Hepatic: Increased LFTs

Local: Burning at injection site

Neuromuscular & skeletal: Weakness

Ocular: Blurred vision

Respiratory: Dyspnea

Miscellaneous: Histamine release

<1%: Convulsions, hallucinations, mental depression, nightmares, insomnia, paralytic ileus, biliary spasm, stomach cramps, muscle rigidity, trembling

Overdosage/Toxicology:

Drug Interactions:

CYP2D6 inhibitors: May decrease the effects of codeine. Example inhibitors include chlorpromazine, delavirdine, fluoxetine, miconazole, paroxetine, pergolide, quinidine, quinine, ritonavir, and ropinirole.

Decreased effect with cigarette smoking

Increased toxicity: CNS depressants, phenothiazines, TCAs, other narcotic analgesics, guanabenz, MAO inhibitors, neuromuscular blockers

Ethanol/Nutrition/Herb Interactions:

Ethanol: Avoid or limit ethanol (may increase CNS depression). Watch for sedation.

Herb/Nutraceutical: St John's wort may decrease codeine levels. Avoid valerian, St John's wort, kava kava, gotu kola (may increase CNS depression).

Stability:

Compatibility:

Mechanism of Action:

Pharmacodynamics/Kinetics:

Onset of action: Oral: 0.5-1 hour; I.M.: 10-30 minutes

Peak effect: Oral: 1-1.5 hours; I.M.: 0.5-1 hour

Duration: 4-6 hours

Absorption: Oral: Adequate

Distribution: Crosses placenta; enters breast milk

Protein binding: 7%

Metabolism: Hepatic to morphine (active)

Half-life elimination: 2.5-3.5 hours

Excretion: Urine (3% to 16% as unchanged drug, norcodeine, and free and conjugated morphine)

Dosage:

Analgesic:

Children: Oral, I.M., SubQ: 0.5-1 mg/kg/dose every 4-6 hours as needed; maximum: 60 mg/dose

Adults:

Oral: 30 mg every 4-6 hours as needed; patients with prior opiate exposure may require higher initial doses. Usual range: 15-120 mg every 4-6 hours as needed

Oral, controlled release formulation (Codeine Contin®, not available in U.S.): 50-300 mg every 12 hours. Note: A patient's codeine requirement should be established using prompt release formulations; conversion to long acting products may be considered when chronic, continuous treatment is required. Higher dosages should be reserved for use only in opioid-tolerant patients.

I.M., SubQ: 30 mg every 4-6 hours as needed; patients with prior opiate exposure may require higher initial doses. Usual range: 15-120 mg every 4-6 hours as needed; more frequent dosing may be needed

Antitussive: Oral (for nonproductive cough):

Children: 1-1.5 mg/kg/day in divided doses every 4-6 hours as needed: Alternative dose according to age:

2-6 years: 2.5-5 mg every 4-6 hours as needed; maximum: 30 mg/day

6-12 years: 5-10 mg every 4-6 hours as needed; maximum: 60 mg/day

Adults: 10-20 mg/dose every 4-6 hours as needed; maximum: 120 mg/day

Dosing adjustment in renal impairment:

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

Clcr<10 mL/minute: Administer 50% of dose

Dosing adjustment in hepatic impairment: Probably necessary in hepatic insufficiency

Administration:

Monitoring Parameters:

Reference Range:

Patient Education:

Anesthesia and Critical Care Concerns/Other Considerations:

Cardiovascular Considerations:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Dental Comment:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Oncology: Vesicant:

Dosage Forms:

Injection, as phosphate: 15 mg/mL (2 mL); 30 mg/mL (2 mL) [contains sodium metabisulfite]

Solution, oral, as phosphate: 15 mg/5 mL (5 mL, 500 mL) [strawberry flavor]

Tablet, controlled release (Codeine Contin®) [not available in U.S.]: 50 mg, 100 mg, 150 mg, 200 mg

Tablet, as phosphate: 30 mg, 60 mg

Tablet, as sulfate: 15 mg, 30 mg, 60 mg

International Brand Names: