Codeine: Difference between revisions
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==Administration== | ==Administration== | ||
*Type: Opioid | *Type: [[Opioid]] analgesic, antitussive | ||
*Dosage Forms: Tablet: 15, 30, 60 Oral Solution: 30mg/5 mL | *Dosage Forms: Tablet: 15, 30, 60 Oral Solution: 30mg/5 mL | ||
*Routes of Administration: Oral | *Routes of Administration: Oral | ||
==Blackbox Warning== | ==Blackbox Warning== | ||
Line 9: | Line 8: | ||
==Adult Dosing== | ==Adult Dosing== | ||
*Mild to moderate pain: 15-60mg PO q4-6h | *Mild to moderate pain: 15-60mg PO q4-6h PRN | ||
**Max: 360mg/day | **Max: 360mg/day | ||
**Give with food | **Give with food | ||
**Doses >60mg are rarely more effective in opioid-naive patients | **Doses >60mg are rarely more effective in opioid-naive patients | ||
*Cough: 15-30mg PO q4-6h | *Cough: 15-30mg PO q4-6h PRN | ||
**Max: 120mg/day | **Max: 120mg/day | ||
*[[Diarrhea]]: 45-270mg/day PO divided q4-6h | *[[Diarrhea]]: 45-270mg/day PO divided q4-6h PRN | ||
**Start: 30-60mg/day PO divided QD-bid, then increase by 30-60mg/day | **Start: 30-60mg/day PO divided QD-bid, then increase by 30-60mg/day PRN | ||
**Max: 60mg/dose up to 270mg/day | **Max: 60mg/dose up to 270mg/day | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Pain, mild-moderate | *Pain, mild-moderate | ||
**3-6 yo: 0.5-1mg/kg PO q4-6h | **3-6 yo: 0.5-1mg/kg PO q4-6h PRN | ||
**7-12 yo: 15-30mg PO q4-6h | **7-12 yo: 15-30mg PO q4-6h PRN | ||
**13-17 yo: 15-60mg PO q4-6h | **13-17 yo: 15-60mg PO q4-6h PRN | ||
**Max: 60mg/dose up to 360mg/day | **Max: 60mg/dose up to 360mg/day | ||
*Cough | *Cough | ||
**2-5 yo: 1-1.5mg/kg/day PO divided q4-6h | **2-5 yo: 1-1.5mg/kg/day PO divided q4-6h PRN; Max: 30mg/day | ||
**6-11 yo: 1-1.5mg/kg/day PO divided q4-6h | **6-11 yo: 1-1.5mg/kg/day PO divided q4-6h PRN; Max: 60mg/day | ||
==Special Populations== | ==Special Populations== | ||
*Pregnancy risk factor: C | *Pregnancy risk factor: C | ||
Line 66: | Line 65: | ||
==References== | ==References== | ||
*Micromedex | *Micromedex | ||
* | *Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319. [PubMed 11487763] | ||
*American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 177: obstetric analgesia and anesthesia. Obstet Gynecol. 2017 129(4):e73-e89. [PubMed 28333819] | |||
*American Pain Society. Principles of Analgesic. 7th ed, Glenview, IL: American Pain Society, 2016. | |||
*Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed. Philadelphia, PA: American College of Physicians; 2007, p 18, 135. | |||
*Aurora RN, Kristo DA, Bista SR, et al. The treatment of restless legs syndrome and periodic limb movement disorder in adults—an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine clinical practice guideline. Sleep. 2012;35(8):1039-1062. [PubMed 22851801] | |||
*Berna C, Kulich RJ, Rathmell JP. Tapering long-term opioid therapy in chronic noncancer pain: evidence and recommendations for everyday practice. Mayo Clin Proc. 2015;90(6):828-842. doi: 10.1016/j.mayocp.2015.04.003. [PubMed 26046416] | |||
*Bolser DC, “Cough Suppressant and Pharmacologic Protussive Therapy: ACCP Evidence-Based Clinical Practice Guidelines,” Chest, 2006, 129(1 Suppl):238-48. [PubMed 16428717] | |||
*Brennan MJ. The effect of opioid therapy on endocrine function. Am J Med. 2013;126(3)(suppl 1):S12-S18. doi: 10.1016/j.amjmed.2012.12.001. [PubMed 23414717] | |||
*Broussard CS, Rasmussen SA, Reefhuis J, et al, "National Birth Defects Prevention Study: Maternal Treatment With Opioid Analgesics and Risk for Birth Defects," Am J Obstet Gynecol, 2011, 204(4):314. [PubMed 21345403] | |||
*Cardan E, “Fatal Case of Codeine Poisoning,” Lancet, 1981, 1(8233):1313. | |||
*Centers for Disease Control (CDC). Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm. | |||
<references/> | <references/> | ||
[[Category:Pharmacology]] | [[Category:Pharmacology]] |
Latest revision as of 17:47, 20 September 2019
Administration
- Type: Opioid analgesic, antitussive
- Dosage Forms: Tablet: 15, 30, 60 Oral Solution: 30mg/5 mL
- Routes of Administration: Oral
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: 0.5-1mg/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: 1-1.5mg/kg/day PO divided q4-6h PRN; Max: 30mg/day
- 6-11 yo: 1-1.5mg/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
- Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319. [PubMed 11487763]
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 177: obstetric analgesia and anesthesia. Obstet Gynecol. 2017 129(4):e73-e89. [PubMed 28333819]
- American Pain Society. Principles of Analgesic. 7th ed, Glenview, IL: American Pain Society, 2016.
- Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed. Philadelphia, PA: American College of Physicians; 2007, p 18, 135.
- Aurora RN, Kristo DA, Bista SR, et al. The treatment of restless legs syndrome and periodic limb movement disorder in adults—an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine clinical practice guideline. Sleep. 2012;35(8):1039-1062. [PubMed 22851801]
- Berna C, Kulich RJ, Rathmell JP. Tapering long-term opioid therapy in chronic noncancer pain: evidence and recommendations for everyday practice. Mayo Clin Proc. 2015;90(6):828-842. doi: 10.1016/j.mayocp.2015.04.003. [PubMed 26046416]
- Bolser DC, “Cough Suppressant and Pharmacologic Protussive Therapy: ACCP Evidence-Based Clinical Practice Guidelines,” Chest, 2006, 129(1 Suppl):238-48. [PubMed 16428717]
- Brennan MJ. The effect of opioid therapy on endocrine function. Am J Med. 2013;126(3)(suppl 1):S12-S18. doi: 10.1016/j.amjmed.2012.12.001. [PubMed 23414717]
- Broussard CS, Rasmussen SA, Reefhuis J, et al, "National Birth Defects Prevention Study: Maternal Treatment With Opioid Analgesics and Risk for Birth Defects," Am J Obstet Gynecol, 2011, 204(4):314. [PubMed 21345403]
- Cardan E, “Fatal Case of Codeine Poisoning,” Lancet, 1981, 1(8233):1313.
- Centers for Disease Control (CDC). Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm.