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 increase 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: 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