Codeine: Difference between revisions
(Text replacement - "0 mg" to "0mg")
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==Administration==
==Administration==
*Type: Opioid
*Type: Opioid
*Dosage Forms: Tablet: 15, 30, 60  Oral Solution: 30 mg/5 mL   
*Dosage Forms: Tablet: 15, 30, 60  Oral Solution: 30mg/5 mL   
*Routes of Administration: Oral
*Routes of Administration: Oral
*Pharmacologic Category:  Analgesic, Opioid; Antitussive
*Pharmacologic Category:  Analgesic, Opioid; Antitussive
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==Adult Dosing==
==Adult Dosing==
*Mild to moderate pain: 15-60 mg PO q4-6h prn
*Mild to moderate pain: 15-60mg PO q4-6h prn
**Max: 360 mg/day
**Max: 360mg/day
**Give with food
**Give with food
**Doses >60 mg are rarely more effective in opioid-naive patients
**Doses >60mg are rarely more effective in opioid-naive patients


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


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


==Pediatric Dosing==
==Pediatric Dosing==
*Pain, mild-moderate
*Pain, mild-moderate
**3-6 yo: 0.5-1 mg/kg PO q4-6h prn
**3-6 yo: 0.5-1 mg/kg PO q4-6h prn
**7-12 yo: 15-30 mg PO q4-6h prn
**7-12 yo: 15-30mg PO q4-6h prn
**13-17 yo: 15-60 mg PO q4-6h prn
**13-17 yo: 15-60mg PO q4-6h prn
**Max: 60 mg/dose up to 360 mg/day
**Max: 60mg/dose up to 360mg/day
*Cough
*Cough
**2-5 yo: 1-1.5 mg/kg/day PO divided q4-6h prn; Max: 30 mg/day
**2-5 yo: 1-1.5 mg/kg/day PO divided q4-6h prn; Max: 30mg/day
**6-11 yo: 1-1.5 mg/kg/day PO divided q4-6h prn; Max: 60 mg/day
**6-11 yo: 1-1.5 mg/kg/day PO divided q4-6h prn; Max: 60mg/day
==Special Populations==
==Special Populations==
*Pregnancy risk factor: C
*Pregnancy risk factor: C

Revision as of 05:52, 19 July 2016

Administration

  • Type: Opioid
  • Dosage Forms: Tablet: 15, 30, 60 Oral Solution: 30mg/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: 15-60mg PO q4-6h prn
    • Max: 360mg/day
    • Give with food
    • Doses >60mg are rarely more effective in opioid-naive patients
  • Cough: 15-30mg PO q4-6h prn
    • Max: 120mg/day
  • Diarrhea: 45-270mg/day PO divided q4-6h prn
    • Start: 30-60mg/day PO divided qd-bid, then increase by 30-60mg/day prn
    • Max: 60mg/dose up to 270mg/day

Pediatric Dosing

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

Special Populations

  • Pregnancy risk factor: C

Renal Dosing

  • CrCl 10-50: decrease dose 25%; CrCl <10: decrease 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

See Also

References

  • Micromedex
  • UptoDate
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