codeine (Rx)

 
 
 

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
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Pediatric Dosing & Uses

Dosing Forms & Strengths

tablet: Schedule II

  • 15mg
  • 30mg
  • 45mg

oral solution: Schedule II

  • 15mg/mL
  • 15mg/5mL
  • 30mg/mL
  • 60mg/mL

Pain

0.5-1.0 mg/kg IM/PO/SC q4-6hr PRN 

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

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Drug Interactions

Interaction Checker

codeine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 
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            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

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            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

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            View Category Definitions

            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.

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            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

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            Pricing & Images

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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