Drug reference

Codeine phosphate

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 497, 498, 499

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Acute diarrhoea ▶BY MOUTH ▶Child 12–17 years: 30 mg 3–4 times a day; usual dose 15–60 mg 3–4 times a day ▶Adult: 30 mg 3–4 times a day; usual dose 15–60 mg 3–4 times a day Mild to moderate pain ▶BY MOUTH ▶Adult: 30–60 mg every 4 hours if required; maximum 240 mg per day ▶BY INTRAMUSCULAR INJECTION ▶Adult: 30–60 mg every 4 hours if required Short-term treatment of acute moderate pain ▶BY MOUTH, OR BY INTRAMUSCULAR INJECTION ▶Child 12–17 years: 30–60 mg every 6 hours if required for maximum 3 days; maximum 240 mg per day continued → Dry or painful cough ▶BY MOUTH USING LINCTUS ▶Adult: 15–30 mg 3–4 times a day

PDF pages 497, 498

Contra Indications

Acute ulcerative colitis. antibiotic- associated colitis. children under 18 years who undergo the removal of tonsils or adenoids for the treatment of obstructive sleep apnoea. conditions where abdominal distension develops. conditions where inhibition of peristalsis should be avoided. known ultra-rapid codeine metabolisers

PDF page 498

Cautions

Acute abdomen. cardiac arrhythmias. gallstones. not recommended for adolescents aged 12–18 years with breathing problems CAUTIONS, FURTHER INFORMATION ▶Variation in metabolism The capacity to metabolise codeine to morphine can vary considerably between individuals; there is a marked increase in morphine toxicity in patients who are ultra-rapid codeine metabolisers (CYP2D6 ultra- rapid metabolisers) and a reduced therapeutic effect in poor codeine metabolisers.

PDF page 498

Prescribing And Dispensing Information

BP directs that when Diabetic Codeine Linctus is prescribed, Codeine Linctus formulated with a vehicle appropriate for administration to diabetics, whether or not labelled ‘Diabetic Codeine Linctus’, shall be dispensed or supplied.

PDF page 498

Safety

Important Safety Information

MHRA/CHM ADVICE (JULY 2013) CODEINE FOR ANALGESIA: Nervous system RESTRICTED USE IN CHILDREN DUE TO REPORTS OF MORPHINE TOXICITY Codeine should only be used to relieve acute moderate pain in children older than 12 years and only if it cannot be relieved by other painkillers such as paracetamol or ibuprofen alone. A signiﬁcant risk of serious and life- threatening adverse reactions has been identiﬁed in children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy: . in children aged 12–18 years, the maximum daily dose of codeine should not exceed 240 mg. Doses may be taken up to four times a day at intervals of no less than 6 hours. The lowest effective dose should be used and duration of treatment should be limited to 3 days . codeine is contra-indicated in all children (under 18 years) who undergo the removal of tonsils or adenoids for the treatment of obstructive sleep apnoea . codeine is not recommended for use in children whose breathing may be compromised, including those with neuromuscular disorders, severe cardiac or respiratory conditions, respiratory infections, multiple trauma or extensive surgical procedures . codeine is contra-indicated in patients of any age who are known to be ultra-rapid metabolisers of codeine (CYP2D6 ultra-rapid metabolisers) . codeine should not be used in breast-feeding mothers because it can pass to the baby through breast milk . parents and carers should be advised on how to recognise signs and symptoms of morphine toxicity, and to stop treatment and seek medical attention if signs or symptoms of toxicity occur (including reduced consciousness, lack of appetite, somnolence, constipation, respiratory depression, ’pin-point’ pupils, nausea, vomiting) MHRA/CHM ADVICE (APRIL 2015) CODEINE FOR COUGH AND COLD: RESTRICTED USE IN CHILDREN Do not use codeine in children under 12 years as it is associated with a risk of respiratory side effects. Codeine is not recommended for adolescents (12–18 years) who have problems with breathing. When prescribing or dispensing codeine-containing medicines for cough and cold, consider that codeine is contra-indicated in: . children younger than 12 years old . patients of any age known to be CYP2D6 ultra-rapid metabolisers . breastfeeding mothers

PDF page 498

Interactions

→Appendix 1: opioids

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Side Effects

GENERAL SIDE-EFFECTS Biliary spasm. hypothermia. mood altered. sexual dysfunction. ureteral spasm SPECIFIC SIDE-EFFECTS ▶With oral use Abdominal cramps. addiction. appetite decreased. depression. drug reaction with eosinophilia and systemic symptoms (DRESS). dyskinesia. dyspnoea. face oedema. fatigue. fever. hyperglycaemia. hypersensitivity. intracranial pressure increased. lymphadenopathy. malaise. muscle rigidity (with high doses). nightmare. pancreatitis. restlessness. seizure. splenomegaly. urinary disorders. vision disorders ▶With parenteral use Dysuria

PDF page 498

Breast Feeding

Manufacturer advises avoid (recommendation also supported by MHRA and specialist sources). Present in milk and mothers vary considerably in their capacity to metabolise codeine; risk of opioid toxicity in infant.

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Hepatic Impairment

▶With oral use Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment. ▶With intravenous use Manufacturer advises avoid. Dose adjustments ▶With oral use Manufacturer advises dose reduction in mild to moderate impairment.

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Renal Impairment

Avoid use or reduce dose; opioid effects increased and prolonged and increased cerebral sensitivity occurs.

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Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution, solution for injection Tablet CAUTIONARY AND ADVISORY LABELS 2 ▶Codeine phosphate (Non-proprietary) Codeine phosphate 15 mg Codeine 15mg tablets | 28 tablet P £1.50 DT = £1.02 m | 100 tablet P £3.64 DT = £3.64 m Codeine phosphate 30 mg Codeine 30mg tablets | 28 tablet P £1.79 DT = £1.25 m | 100 tablet P £5.68 DT = £4.46 m | 500 tablet P £22.30 m Codeine phosphate 60 mg Codeine 60mg tablets | 28 tablet P £3.39 DT = £2.88 m Solution for injection ▶Codeine phosphate (Non-proprietary) Codeine phosphate 60 mg per 1 ml Codeine 60mg/1ml solution for injection ampoules | 10 ampoule P £25.90 DT = £24.19 b Oral solution CAUTIONARY AND ADVISORY LABELS 2 ▶Codeine phosphate (Non-proprietary) Codeine phosphate 3 mg per 1 ml Codeine 15mg/5ml linctus sugar- free | 200 ml p £1.90 DT = £1.63 m sugar-free | 2000 ml p £16.30 m Codeine 15mg/5ml linctus | 200 ml p £1.73–£1.90 DT = £1.90 m Codeine phosphate 5 mg per 1 ml Codeine 25mg/5ml oral solution | 500 ml P £6.64 DT = £6.64 m ▶Galcodine (Thornton & Ross Ltd) Codeine phosphate 3 mg per 1 ml Galcodine 15mg/5ml linctus sugar-free | 2000 ml p £9.90 m Combinations available: Aspirin with codeine, p. 467 eiiii F 467

PDF pages 498, 499

Clinical care

Patient And Carer Advice

Medicines for Children leaflet: Codeine phosphate for pain www.medicinesforchildren.org.uk/codeine-phosphate-pain-0

PDF page 498

Dose text by age group

Adult

30 mg 3–4 times a day; usual dose 15–60 mg

First-line fragment. Read the complete Indications and Dose section above.

PDF page 497

Adult

30–60 mg every 4 hours if required; maximum

First-line fragment. Read the complete Indications and Dose section above.

PDF page 497

Adult

30–60 mg every 4 hours if required

First-line fragment. Read the complete Indications and Dose section above.

PDF page 497

Adult

15–30 mg 3–4 times a day

First-line fragment. Read the complete Indications and Dose section above.

PDF page 498

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Codeine phosphate

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 497, 498, 499

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF pages 497, 498

Contra Indications

PDF page 498

Cautions

PDF page 498

Prescribing And Dispensing Information

PDF page 498

Safety

Important Safety Information

PDF page 498

Interactions

→Appendix 1: opioids

PDF page 498

Side Effects

PDF page 498

Breast Feeding

PDF page 498

Hepatic Impairment

PDF page 498

Renal Impairment

Avoid use or reduce dose; opioid effects increased and prolonged and increased cerebral sensitivity occurs.

PDF page 498

Dose and formulations

Medicinal Forms

PDF pages 498, 499

Clinical care

Patient And Carer Advice

Medicines for Children leaflet: Codeine phosphate for pain www.medicinesforchildren.org.uk/codeine-phosphate-pain-0

PDF page 498

Dose text by age group

Adult

30 mg 3–4 times a day; usual dose 15–60 mg

First-line fragment. Read the complete Indications and Dose section above.

PDF page 497

Adult

30–60 mg every 4 hours if required; maximum

First-line fragment. Read the complete Indications and Dose section above.

PDF page 497

Adult

30–60 mg every 4 hours if required

First-line fragment. Read the complete Indications and Dose section above.

PDF page 497

Adult

15–30 mg 3–4 times a day

First-line fragment. Read the complete Indications and Dose section above.

PDF page 498

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.