Names and pronunciation
(koe′deen)
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Individual generic drug information
Extracted information for codeine only.
(koe′deen)
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Func. class.: Opiate analgesic, antitussive
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Chem. class.: Opiate, phenathrene derivative Controlled Substance Schedule II, III, IV, V (depends on content)
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Do not confuse: codeine/Lodine/iodine
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ACTION: Depresses pain impulse trans- mission at the spinal cord level by inter- acting with opioid receptors; decreases cough reflex, GI motility
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USES: Mild to moderate pain
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Extracted information for codeine only.
CONTRAINDICATIONS: Breast- feeding, hypersensitivity to opiates, respi- ratory depression, increased intracranial pressure, seizure disorders, severe respi- ratory disorders
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Black Box Warning: Children recovering from tonsillectomy/adenoidectomy who are ultrarapid metabolizers; respiratory depression Precautions: Pregnancy, geriatric patients, cardiac dysrhythmias, prostatic hypertrophy, bowel impaction Black Box Warning: Accidental exposure, coadministration with other CNS depres- sants, including opioids Black Box Warning: Increase: CNS de- pression—alcohol, antihistamines, anti- depressants, opiates, sedative/hypnotics, antipsychotics, skeletal muscle relaxants; monitor response Increase: toxicity—MAOIs; use cautiously Drug/Herb Increase: CNS depression—chamomile, kava, valerian Drug/Lab Test Increase: lipase, amylase Decrease: opioid effect—opioid antagonists Black Box Warning: Monitor for toler- ance, addiction, abuse Black Box Warning: Children (tonsillec- tomy/adenoidectomy and are ultrarapid metabolizers): deaths have occurred; use is contraindicated Respiratory Black Box Warning: dysfunction: respiratory depression, character, rate, rhythm; notify prescriber if respirations are <10/min, shallow; obstructive sleep apnea (children) (tonsil- lectomy/adenoidectomy) • Beers: avoid in older adults unless safer alternative is unavailable; may cause ataxia, impaired psychomotor function Black Box Warning: To avoid alcohol, other CNS depressants unless directed by prescriber • To increase fiber, water in diet to help avoid constipation • Pregnancy/breastfeeding: to notify prescriber if pregnancy is planned or sus- pected; infants born to those using opioids are at risk of neonatal opiate withdrawal; not to breastfeed
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SIDE EFFECTS CNS: Drowsiness, sedation, dizziness, dependency, headache, confusion CV: Bradycardia, palpitations, orthostatic hypotension GI: Nausea, vomiting, anorexia, con- stipation, dry mouth GU: Urinary retention INTEG: Flushing, rash, sweating RESP: Respiratory depression
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INTERACTIONS
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TREATMENT OF OVERDOSE: Naloxone 0.4-mg ampule diluted in 10 mL 0.9% NaCl and given by direct IV push, 0.02 mg q2min (adult)
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Extracted information for codeine only.
DOSAGE AND ROUTES Pain • Adult: PO 15-60 mg q4hr prn • Child 6-17 yr (unlabeled): PO 0.5 to 1 mg/kg/dose, max: 60 mg/dose every 4 hours as needed Renal disease • Adult: PO CCr 10-50 mL/min, 75% of dose; CCr <10 mL/min, 50% of dose
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Available forms: Tablets 15, 30 mg; injection 15, 30, 60 mg/mL; oral solution 10 mg/5 mL , 25 mg/5 mL
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Administer: • Discontinue gradually after long-term use, use stool softener, laxative for con- stipation • Store in light-resistant container at room temperature
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Extracted information for codeine only.
Assess: • Pain: intensity, type, location, aggra- vating, alleviating factors; need for pain medication, tolerance; use pain scoring • I&O ratio; check for decreasing out- put; may indicate urinary retention, espe- cially among geriatric patients • GI function: nausea, vomiting, consti- pation • Cough: type, duration, ability to raise secretion for productive cough; do not use to suppress productive cough • CNS changes, dizziness, drowsiness, hal- lucinations, euphoria, LOC, pupil reaction • Allergic reactions: rash, urticaria • B/P, pulse respirations baseline and periodically
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Evaluate: • Therapeutic response: decrease in pain, absence of grimacing, decreased cough, decreased diarrhea
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report any symptoms of CNS changes, allergic reactions • That physical dependency may result after extended periods, product should be used short term • To change position slowly; orthostatic hypotension may occur • To avoid hazardous activities if drows- iness or dizziness occurs
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Extracted information for codeine only.
PHARMACOKINETICS Bioavailability 60%-90%; peak ½-1 hr; duration 4-6 hr; metabolized by liver (CYP3A4 to morphine); excreted by kid- neys, in breast milk; crosses placenta; half-life 3 hr; protein binding 7%; altered codeine metabolism occurs in different ethnic groups PO: Onset 30-60 min
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Filter the extracted dose blocks for this individual drug.
Pain
• Adult: PO 15-60 mg q4hr prn
Candidate age grouping · source page 312
Pain
• Child 6-17 yr (unlabeled): PO 0.5 to 1 mg/kg/dose, max: 60 mg/dose every 4 hours as needed Renal disease
Candidate age grouping · source page 312
Pain
• Adult: PO CCr 10-50 mL/min, 75% of dose; CCr <10 mL/min, 50% of dose
Candidate age grouping · source page 312