Drug Interaction:
Narcotic Agonist Analgesics include-
Alfentanil, Codeine, Fentanyl, Hydrocodone, Levorphanol, Meperidine, Methadone, Morphine, Oxycodone, Propoxyphene PO, Sufentanil
Refer - Fentanyl
Potentiates depressive effects of CNS depressants and alcohol.
Potentiates analgesic action of aspirin,hence often used in combination.
Indication:
FIXED DOSE COMBINATIONS APPROVED BY DCG(I)
FROM JANUARY 1961 TILL NOVEMBER 2014
Name of Drug Indication Date of Approval
Each 5ml contains Codeine Phosphate 10mg + 18-02-2003
Triprololidine HCL 1.25ml syrup
For symptomatic treatment of dry cough
Cough
Narcotic Agonist Analgesics include-
Alfentanil, Codeine, Fentanyl, Hydrocodone, Levorphanol, Meperidine, Methadone, Morphine, Oxycodone, Propoxyphene PO, Sufentanil
Refer - Fentanyl
INFORMATION UP DATE-
CODEINE PRODUCTS; NEW RISKS MORE CONTRAINDICATIONS
The U.S Food and Drug Administration (USFDA) has warned deaths have been reported
in children who were administered codeine following tonsilectomy and/or adenoidectomy
Once consumed Codeine gets converted to morphine in the body. Such conversion is very
rapid when codeine is combined wirh paracetamol.Such covertion is ultra rapid in some
people (with C6P2D6 gene) that lead to fatal respiratory depression
- Deaths have also occurred in breast-fed infants who were exposed to high levels of morphine because their mothers were ultra rapid metabolizers of codeine
- Since morphine is excreted in breast milk, codeine containing products must not be
given to breast feeding mothers.
- Signs and symptoms of morphine toxicity include- drowsiness, sedation, breathing difficulties, difficuly feeding, and decreased tone in babies.
-The prevalence of CYP2D6 phenotype varies widely; 16-26% in North Africans, Ethiopians and Arabs; 1-10% in Caucasians: 3% in Negroes ; 0.5 to 1% in Hispanics, Chinese and Japanese, Data not available for other ethinic groups
-The British drug regulator has banned the use of Codeine in all children 0-18 years undergoing tonsilectomy or adenoidectomy for obstructive sleep apna, children with compromised breathing such as neuromuscular disorders, URTI or multiple trauma
(MIMS- FEB 2014)
Adverse Reaction:
Respiratory depression especially overdose and in patients with pre-existing respiratory difficulties.
Constipation, nausea, vomiting, dizziness, drowsiness, dependence, hallucinations,
dry mouth, sweating, flush, bradycardia, palpitation,
orthostatic hypotension, hypothermia, restlessness,
change of mood and miosis.
Contra-Indications:
Any unproductive cough.
Bronchial asthama.
Respiratory depression, raised intracranial pressure, pregnancy.
Special precautions:
Neo-nates.
Dosages/ Overdosage Etc:
Indications:
Relief of mild to moderate pain. Cough
Dosage:
Adults- 15 to 60mg every 4 to 6 hours . Do not exceed 360mg in 24 hours.
Children(6 to 12 years)- antitussive - 5 to 10mg orally every 4 to 6 hours..
Do not exceed 60mg in 24 hours.
Patient Information:
1. May impair mental or physical abilites required for performance of potentially hazards tasks. Observe caution while driving or performing other tasks requiring alertness.
2. Concomittant use of alcohol or CNS depressants, including sedatives,hypnotics, antidepressants, tranquilizers, antihistamines, phenothiazines, may have an additive effect.
3 May produce hypostatic hypotension.
4. Do not take for persistent or chronic cough such as as occurs with smoking, asthma, or emphysema, or cough accomapanied by excessive secretions, except under medical supervision.
5 May cause dry mouth or constipation
6. May cause GI upset; take with food or milk.
Pharmacology/ Pharmacokinetics:
Pharmacology:
Codeine has good antitussive activity; side effects are frequent at antitussive dose. The dose required to supress coughing is lower than the dose rquired for analgesia.
Pharmacokinetics:
Codeine and its salts are well absorbed. It is metabolised primarily in the liver and excreted inthe urine within 24 hours.
Interaction with Food:
Take with or without food
Pregnancy and lactation:
Pregnancy:
Use during pregnancy, only if needed.
Lactation:
Excercise caution.
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