codeine, combinations excl. psycholeptics

N02AA59

Forms & Strengths

Tablets: Codeine phosphate combinations with acetaminophen, aspirin, or ibuprofen (various strengths)
Oral Solution/Syrup: Codeine combinations with expectorants or antihistamines

Adult Dosing

Mild to moderate pain: 15 mg to 60 mg orally every 4 to 6 hours as needed, combined with non-opioid analgesics
Cough (antitussive): 10 mg to 20 mg orally every 4 to 6 hours as needed

Pediatric Dosing

Contraindicated in children under 12 years of age for all indications
Contraindicated for post-operative management in tonsillectomy and/or adenoidectomy in children under 18 years

Indications

Management of mild to moderate pain where use of an opioid is appropriate
Temporary relief of cough associated with colds and upper respiratory tract infections

Mechanism of Action

Agonist at mu-opioid receptors in the central nervous system, providing analgesia and antitussive effects
Prodrug metabolized by hepatic CYP2D6 into morphine, the primary active moiety responsible for analgesic activity

Contraindications

Hypersensitivity to codeine or formulation components
Significant respiratory depression
Acute or severe bronchial asthma in an unmonitored setting
Known or suspected gastrointestinal obstruction, including paralytic ileus
Children under 12 years of age and post-tonsillectomy/adenoidectomy in pediatric patients
Known CYP2D6 ultra-rapid metabolizers

Adverse Reactions

Drug Interactions

CNS depressants (alcohol, benzodiazepines, other opioids): increased risk of profound sedation, respiratory depression, coma, and death
CYP2D6 inhibitors (quinidine, bupropion, fluoxetine): may decrease the analgesic efficacy of codeine by reducing conversion to morphine
CYP3A4 inducers (rifampin, carbamazepine): may increase metabolism of codeine
Monoamine Oxidase Inhibitors (MAOIs): potential for severe and unpredictable potentiation, leading to CNS excitation or depression

Curated Content: Needs Vetting Before Put to Clinical Use