Adult Dosing & Uses
Dosing Forms & Strengths
tablet: Schedule II
- 15mg
- 30mg
- 45mg
oral solution: Schedule II
- 15mg/mL
- 15mg/5mL
- 30mg/mL
- 60mg/mL
Pain
15-60 mg PO/SC/IM q4-6hr PRN
Cough
10-20 mg PO q4-6hr PRN; no more than 120 mg/24 hours
Other Indications & Uses
Off-label: diarrhea
See Also
- Combo with acetaminophen
- Combo with ASA
Pediatric Dosing & Uses
Dosing Forms & Strengths
tablet: Schedule II
- 15mg
- 30mg
- 45mg
oral solution: Schedule II
- 15mg/mL
- 15mg/5mL
- 30mg/mL
- 60mg/mL
Cough
Infants: Safety & efficacy not established
2-6 years old: 1-1.5 mg/kg/day divided q4-6hr PO/IM/SC; not to exceed 30 mg/day
6-12 years old: 1-1.5 mg/kg/day divided q4-6hr PO/IM/SC; not to exceed 60 mg/day
>12 years old: As in adults
Other Information
Potential toxic dose <6 years old: 2 mg/kg
Drug Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Adverse Effects
>10%
Constipation
Drowsiness
1-10%
Hypotension
Tachycardia or bradycardia
Confusion
Dizziness
False feeling of well being
Headache
Lightheadedness
Malaise
Paradoxical CNS stimulation
Restlessness
Rash, urticaria
Anorexia
Nausea, vomiting
Xerostomia
Ureteral spasm, urination decreased
LFT's increased
Burning at injection site
Weakness
Blurred vision
Dyspnea
Histamine release
<1%
Hypotension, With IV use
Anaphylactoid reaction (rare)
Seizure, With excessive doses
Respiratory depression
Contraindications & Cautions
Contraindications
Absolute: acute abdominal condition, diarrhea associated w/ toxins, pseudomembranous colitis, respiratory depression
Relative: asthma (acute), inflammatory bowel disease, respiratory impairment
Cautions
Cardiac arrhythmias, drug abuse/dependence, emotional lability, gallbladder dz, head injury, hepatic impairment, hypothyroidism, incr ICP, prostatic hypertrophy, renal impairment, seizures w/ epilepsy, urethral stricture, urinary tract surgery
Do NOT give IV d/t severe adverse reactions
Risk of life threatening side effects in nursing babies, especially if mother is an ultra rapid metabolizer of codeine
Ibuprofen is more effective than codeine for pain from musculoskeletal injuries in children
Pregnancy & Lactation
Pregnancy Category: C; D if used for prolonged periods or near term
Lactation: excreted in breast milk; use with caution (AAP Committee states "compatible with nursing")
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Pharmacology
Half-Life: 3-4 hr
Peak Plasma Time: 0.5-1 hr
Onset: 30-60 min (PO); 10-30 min (IM)
Duration: 4-6 hr
Vd: 3.5 L/kg (PO); 2.6 L/kg (IM)
Metabolism: Prodrug metabolized to morphine by CYP2D6; demethylated/conjugated in liver (undergoes O-demethylation, N-demethylation, and partial conjugation with glucuronic acid)
Protein Bound: 25%
Excretion: urine, feces
Pharmacogenomics
10% of codeine is metabolized to morphine by CYP2D6; the active morphine metabolite has a higher affinity for opioid receptors
CYP2D6 poor metabolizers may not achieve adequate analgesia
Ultra-rapid metabolizers (up to 7% of Caucasians and up to 30% of Asian and African populations) may have increased toxicity due to rapid conversion
Mechanism of Action
Narcotic agonist analgesic with antitussive activity, mu receptor agonist
Pricing & Images
Patient Handout
Formulary
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