codeine and ibuprofen

N02AJ08

Forms & Strengths

Adult Dosing

1-2 tablets orally every 4 to 6 hours as needed for pain
Maximum daily dose: 6 tablets (1200 mg ibuprofen / 180 mg codeine) due to ibuprofen and opioid limits

Pediatric Dosing

Not recommended for children under 12 years of age
Contraindicated for management of postoperative pain in children undergoing tonsillectomy and/or adenoidectomy

Indications

Short-term management of acute moderate to severe pain where use of an opioid is appropriate

Mechanism of Action

Codeine: Mu-opioid receptor agonist, metabolized primarily by CYP2D6 to morphine for analgesic effect
Ibuprofen: Nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis

Contraindications

Known hypersensitivity to codeine, ibuprofen, or other NSAIDs
Asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
Post-operative pain management in children younger than 18 years following tonsillectomy or adenoidectomy
Significant respiratory depression
Acute or severe bronchial asthma in an unmonitored setting or absence of resuscitative equipment
Known or suspected gastrointestinal bleeding or ulcer active disease
Third trimester of pregnancy

Adverse Reactions

Drug Interactions

CYP2D6 inhibitors (e.g., bupropion, fluoxetine, paroxetine) decrease conversion of codeine to active morphine
CYP3A4 inducers (e.g., rifampin) may increase codeine metabolism
CNS depressants, alcohol, and sedatives increase risk of profound sedation, respiratory depression, coma, and death
Anticoagulants (e.g., warfarin) and antiplatelet agents increase risk of severe bleeding
ACE inhibitors, ARBs, and diuretics may have decreased efficacy and increased risk of renal impairment when combined with ibuprofen
Lithium and methotrexate toxicity risks increased by concurrent NSAID use

Curated Content: Needs Vetting Before Put to Clinical Use