Codeine

Administration

• Type: Opioid
• Dosage Forms: Tablet: 15, 30, 60 Oral Solution: 30 mg/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: 15-60 mg PO q4-6h prn
  • Max: 360 mg/day
  • Give with food
  • Doses >60 mg are rarely more effective in opioid-naive patients

• Cough: 15-30 mg PO q4-6h prn
  • Max: 120 mg/day

• Diarrhea: 45-270 mg/day PO divided q4-6h prn
  • Start: 30-60 mg/day PO divided qd-bid, then incr. by 30-60 mg/day prn
  • Max: 60 mg/dose up to 270 mg/day

Pediatric Dosing

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

Special Populations

• Pregnancy risk factor: C

Renal Dosing

• CrCl 10-50: decr. dose 25%; CrCl <10: decr. 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

References

• Micromedex
• UptoDate