Codeine
Synonym :
Dihydrocodeine
Mechanism :
Codeine acts as a narcotic analgesic. The major effects of codeine are on the central nervous system and the bowel. Opioids act as agonists, interacting with stereospecific and saturable binding sites or receptors in the brain and other tissues.
Indication :
- Analgesic (off-label)
- Antitussive (off-label)
Contraindications :
Contraindicated in paralytic ileus and avoid in acute respiratory depression.
Caution in renal impairment and hepatic impairment may precipitate coma.
Dosing :
Pain:
<12 years:
Safety and efficacy not established.
12 years:
0.5-1 mg/kg PO 4-6 hourly, Max: 30 mg/dose.
12-17 years:
0.5-1 mg/kg PO 4-6 hourly, Max: 60 mg/dose.
Cough:
≥12 years:
7.5-30 mg PO every 4-6 hours as and when required.
Adverse Effect :
Excessive sedation, constipation, headache, confusion, light headedness, dizziness, nausea, vomiting, and sweating.
Interaction :
Anxiolytics and Hypnotics: Enhanced sedative effect with anxiolytics and hypnotics.
Cisapride, Metoclopramide and Domperidone: Antagonism of Gl effects.
Cimetidine: Possible increase of plasma concentration with cimetidine.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Use small doses and titrate to response |
| <10 | Use small doses and titrate to response |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unknown dialysability. Dose as in GFR<10 mL/min |
| HD | Unknown dialysability. Dose as in GFR<10 mL/min |
| HDF/High flux | Unknown dialysability. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unknown dialysability. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
Initial lower doses or longer dosing intervals followed by careful titration are recommended in patients with hepatic impairment.