Codeine

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Administration

  • Type: Opioid
  • Dosage Forms: Tablet: 15, 30, 60 Oral Solution: 30mg/5 mL
  • Routes of Administration: Oral
  • Pharmacologic Category: Analgesic, Opioid; Antitussive

Blackbox Warning

  • Death related to ultra-rapid metabolism: respiratory depression and death have occurred in children who received codeine post-tonsillectomy and/or adenoidectomy and were ultra-rapid CYP2D6 metabolizers

Adult Dosing

  • Mild to moderate pain: 15-60mg PO q4-6h PRN
    • Max: 360mg/day
    • Give with food
    • Doses >60mg are rarely more effective in opioid-naive patients
  • Cough: 15-30mg PO q4-6h PRN
    • Max: 120mg/day
  • Diarrhea: 45-270mg/day PO divided q4-6h PRN
    • Start: 30-60mg/day PO divided QD-bid, then increase by 30-60mg/day PRN
    • Max: 60mg/dose up to 270mg/day

Pediatric Dosing

  • Pain, mild-moderate
    • 3-6 yo: 0.5-1mg/kg PO q4-6h PRN
    • 7-12 yo: 15-30mg PO q4-6h PRN
    • 13-17 yo: 15-60mg PO q4-6h PRN
    • Max: 60mg/dose up to 360mg/day
  • Cough
    • 2-5 yo: 1-1.5mg/kg/day PO divided q4-6h PRN; Max: 30mg/day
    • 6-11 yo: 1-1.5mg/kg/day PO divided q4-6h PRN; Max: 60mg/day

Special Populations

  • Pregnancy risk factor: C

Renal Dosing

  • CrCl 10-50: decrease dose 25%; CrCl <10: decrease dose 50%; HD/PD: no supplement

Contraindications

  • hypersensitivity to codeine
  • respiratory depression
  • paralytic ileus
  • post-tonsillectomy or adenoidectomy (peds)

Adverse Reactions

Serious

  • respiratory depression
  • CNS depression
  • hypotension
  • bradycardia
  • syncope
  • anaphylactoid reaction

Common

  • lightheadedness
  • dizziness
  • sedation
  • nausea/vomiting

Pharmacology

  • Half-life: 2.5-4 hours
  • Metabolism: Liver
  • Excretion: Urine

Mechanism of Action

  • Opioid agonist

See Also

References

  • Micromedex
  • UptoDate