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RESPIRATORY SYSTEM › COUGH AND COLD PREPARATIONS › COUGH SUPPRESSANTS, EXCL. COMBINATIONS WITH EXPECTORANTS › Opium alkaloids and derivatives
codeine
R05DA04
Forms & Strengths
- Tablet: 15 mg, 30 mg, 60 mg
- Oral Solution: 10 mg/5 mL, 15 mg/5 mL, 30 mg/5 mL, 60 mg/5 mL
- Injectable Solution: 30 mg/mL, 60 mg/mL
- Combination Products: Tablets/Syrups with acetaminophen, promethazine, or guaifenesin
Adult Dosing
- Pain: 15 mg to 60 mg orally every 4 hours as needed; max 360 mg/day
- Cough (as antitussive): 10 mg to 20 mg orally every 4 to 6 hours as needed; max 120 mg/day
Pediatric Dosing
- Contraindicated in children under 12 years of age
- Contraindicated for post-tonsillectomy/adenoidectomy pain management in children under 18 years of age
- Pain (children 12-18 years): 0.5 mg/kg to 1 mg/kg orally every 4 to 6 hours as needed
Indications
- Management of mild to moderate pain when non-opioid analgesics are insufficient
- Temporary relief of cough due to minor throat and bronchial irritation (antitussive)
Mechanism of Action
- Weak opioid agonist at mu-opioid receptors in the central nervous system
- Analgesic effect relies on metabolic conversion to morphine via hepatic cytochrome P450 2D6 (CYP2D6)
- Antitussive effect acts directly on the cough center in the medulla
Contraindications
- Significant respiratory depression
- Acute or severe bronchial asthma in an unmonitored setting or lack of resuscitative equipment
- Known or suspected gastrointestinal obstruction, including paralytic ileus
- Hypersensitivity to codeine
- Children under 12 years of age
- Postoperative pain management in children younger than 18 years following tonsillectomy or adenoidectomy
- Known CYP2D6 ultra-rapid metabolizers
Adverse Reactions
- Respiratory depression
- Somnolence, dizziness, sedation
- Constipation, nausea, vomiting
- Pruritus, rash, urticaria
- Hypotension, orthostatic hypotension
- Dependence, abuse, and tolerance
Drug Interactions
- CNS depressants (alcohol, benzodiazepines, other opioids, general anesthetics): Increased risk of profound sedation, respiratory depression, coma, and death
- CYP2D6 inhibitors (e.g., bupropion, fluoxetine, paroxetine): Decreased analgesic efficacy due to reduced conversion to morphine
- CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin): Decreased plasma concentrations of codeine
- CYP3A4 inhibitors (e.g., macrolide antibiotics, azole antifungals): Increased plasma concentrations of codeine
- Serotonergic drugs: Increased risk of serotonin syndrome when co-administered with other serotonergic agents
- Mixed agonist/antagonist opioid analgesics (e.g., buprenorphine, nalbuphine): May decrease analgesic effect and precipitate withdrawal symptoms
Curated Content: Needs Vetting Before Put to Clinical Use