What kind of drug is codeine

Added: Deondre Mcneill - Date: 27.10.2021 07:24 - Views: 26892 - Clicks: 4712

Codeine Sulfate is a prescription medicine used to treat the symptoms of mild to moderately severe pain. Codeine Sulfate may be used alone or with other medications. It is not known if Codeine Sulfate is safe and effective in children younger than 12 years of age. Its empirical formula is C 18 H 21 NO 3 and its molecular weight is Its structure is as follows:.

Each tablet contains 15, 30, or 60 mg of codeine sulfate and the following inactive ingredients: colloidal silicon dioxide, microcrystalline cellulose, pregelatinized starch, and stearic acid. Codeine sulfate is an opioid analgesic indicated for the relief of mild to moderately severe pain where the use of an opioid analgesic is appropriate. Selection of patients for treatment with codeine sulfate should be governed by the same principles that apply to the use of similar opioid analgesics. As with any opioid drug product, adjust the dosing regimen for each patient individually, taking into the patient's prior analgesic treatment experience.

In the selection of the initial dose of codeine sulfate, attention should be given to the following:. The following dosing recommendations, therefore, can only be considered suggested approaches to what is actually a series of clinical decisions over time in the management of the pain of each individual patient.

Continual re-evaluation of the patient receiving codeine sulfate is important, with special attention to the maintenance of pain control and the relative incidence of side effects associated with therapy. During chronic therapy, especially for noncancer-related pain, the continued need for the use of opioid analgesics should be re-assessed as appropriate. The usual adult dosage for tablets is 15 mg to 60 mg repeated up to every four hours as needed for pain.

The maximum 24 hour dose is mg. The initial dose should be titrated based upon the individual patient's response to their initial dose of codeine. This dose can then be adjusted to an acceptable level of analgesia taking into the improvement in pain intensity and the tolerability of the What kind of drug is codeine by the patient. It should be kept in mind, however, that tolerance to codeine sulfate can develop with continued use and that the incidence of untoward effects is dose-related.

Adult doses of codeine higher than 60 mg fail to give commensurate relief of pain and are associated with an appreciably increased incidence of undesirable side effects. When the patient no longer requires therapy with codeine sulfate, doses should be tapered gradually to prevent s and symptoms of What kind of drug is codeine in the physically dependent patient. Each 15 mg tablet for oral administration contains 15 mg of codeine sulfate, USP.

Each 30 mg tablet for oral administration contains 30 mg of codeine sulfate, USP. Each 60 mg tablet for oral administration contains 60 mg of codeine sulfate, USP. Blisters are not child-resistant. Use child-resistant closure if dispensing to outpatient. All opioids are liable to diversion and misuse both by the general public and healthcare workers and should be handled accordingly. Serious adverse reactions associated with codeine are respiratory depression and, to a lesser degree, circulatory depression, respiratory arrest, shockand cardiac arrest. The most frequently observed adverse reactions with codeine administration include drowsiness, lightheadednessdizziness, sedation, shortness of breath, nausea, vomiting, sweating, and constipation.

Other adverse reactions include allergic reactions, euphoriadysphoriaabdominal pain, and pruritis. Other less frequently observed adverse reactions expected from opioid analgesics, including codeine sulfate, include:. Cardiovascular system: faintness, flushing, hypotensionpalpitationssyncope. Digestive System: abdominal cramps, anorexiadiarrhea, dry mouthgastrointestinal distress, pancreatitis.

Nervous system: anxiety, drowsiness, fatigue, headache, insomnia, nervousness, shakiness, somnolencevertigovisual disturbances, weakness. Skin and Appendages: rash, sweating, urticaria. Concurrent use of other opioids, antihistaminesantipsychotics, antianxiety agents, or other CNS depressants including sedatives, hypnotics, general anesthetics, antiemeticsphenothiazines, or other tranquilizers or alcohol concomitantly with codeine sulfate tablets may result in additive CNS depression, respiratory depression, hypotension, profound sedation, or coma.

Use codeine sulfate with caution and in reduced dosages in patients taking these agents. Use of MAO inhibitors or tricyclic antidepressants with codeine sulfate may increase the effect of either the antidepressant or codeine.

What kind of drug is codeine

MAOIs markedly potentiate the action of morphine sulfate, the major metabolite of codeine. Codeine should not be used in patients taking MAOIs or within 14 days of stopping such treatment. Patients taking cytochrome P enzyme inducers or inhibitors may demonstrate an altered response to codeine, therefore analgesic activity should be monitored.

The concurrent use of drugs that preferentially induce codeine Ndemethylation cytochrome P 3A4 may increase the plasma concentrations of What kind of drug is codeine inactive metabolite norcodeine. Drugs that are strong inhibitors of codeine O-demethylation cytochrome P 2D6 may decrease the plasma concentrations of codeine's active metabolites, morphine and morphineglucuronide. The contribution of these active metabolites to the overall analgesic effect of codeine is not fully understood, but should be considered.

Codeine sulfate tablets may cause an elevation of plasma amylase and lipase due to the potential of codeine to produce spasm of the sphincter of Oddi. Determination of these enzyme levels may be unreliable for some time after an opiate agonist has been given. Codeine sulfate is an opioid agonist and is a Schedule II controlled substance. Codeine sulfate can be abused and is subject to criminal diversion.

Drug addiction is characterized by compulsive use, use for non-medical purposes, and continued use despite harm or risk of harm. Drug addiction is a treatable disease, utilizing a multi-disciplinary approach, but relapse is common. Abuse and addiction are separate and distinct from physical dependence and tolerance. Physicians should be aware that addiction may not be accompanied by concurrent tolerance and symptoms of physical dependence.

The converse is also true. In addition, abuse of opioids can occur in the absence of true addiction and is characterized by misuse for nonmedical purposes, often in combination with other psychoactive substances. Careful record-keeping of prescribing information, including quantity, frequency, and renewal requests is strongly advised. Codeine is intended for oral use only. Abuse of codeine poses a risk of overdose and death. The risk is increased with concurrent abuse of alcohol and other substances. Parenteral drug abuse is commonly associated with transmission of infectious diseases such as hepatitis and HIV.

Proper assessment of the patient, proper prescribing practices, periodic re-evaluation of therapy, and proper dispensing and storage are appropriate measures that help to limit abuse of opioid drugs.

What kind of drug is codeine

Tolerance is the need for increasing doses of opioids to maintain a defined effect such as analgesia in the absence of disease progression or other external factors. Physical dependence is manifested by withdrawal symptoms after abrupt discontinuation of a drug or upon administration of an antagonist. Physical dependence and tolerance are not unusual during chronic opioid therapy. The opioid abstinence or withdrawal syndrome is characterized by some or all of the following: restlessness, lacrimationrhinorrheayawningperspirationchills, myalgiaand mydriasis. Other symptoms also may develop, including irritability, anxiety, backache, t pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rateor heart rate.

Deaths have also occurred in nursing infants who were exposed to high levels of morphine in breast milk because their mothers were ultra-rapid metabolizers of codeine [see Use in Specific Populations ].

What kind of drug is codeine

The prevalence of this CYP2D6 phenotype varies widely and has been estimated at 0. Data are not available for other ethnic groups. These individuals convert codeine into its active metabolite, morphine, more rapidly and completely than other people. This rapid conversion in higher than expected serum morphine levels. Respiratory depression is the primary risk of codeine sulfate. Respiratory depression occurs more frequently in elderly or debilitated patients and in those suffering from conditions accompanied by hypoxiahypercapniaor upper airway obstructionin whom even moderate therapeutic doses may ificantly decrease pulmonary ventilation.

Codeine produces dose-related respiratory depression. Caution should be exercised when codeine sulfate is used postoperatively, in patients with pulmonary disease or shortness of breath, or whenever ventilatory function is depressed. Opioid related respiratory depression occurs more frequently in elderly or debilitated patients and in those suffering from conditions accompanied by hypoxia, hypercapnia, or upper airway obstruction, in whom even moderate therapeutic doses may ificantly decrease pulmonary ventilation.

Opioids, including codeine sulfate, should be used with extreme caution in patients with chronic obstructive pulmonary disease or cor pulmonale and in patients having a substantially decreased respiratory reserve e. In such patients, even usual therapeutic doses of codeine sulfate may increase airway resistance and decrease respiratory drive to the point of apnea.

Codeine sulfate is an opioid agonist of the morphine-type and a Schedule II controlled substance. Such drugs are sought by drug abusers and people with addiction disorders. Diversion of Schedule II products is an act subject to criminal penalty. Codeine can be abused in a manner similar to other opioid agonists, legal or illicit.

This should be considered when prescribing or dispensing codeine sulfate in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse, or diversion. Misuse and abuse of codeine sulfate poses a ificant risk to the abuser that could result in overdose and death. Codeine may be abused by crushing, chewing, snorting or injecting the product [see Drug Abuse and Dependence ]. Concerns about abuse and addiction should not prevent the proper management of pain.

Healthcare professionals should contact their State Professional Licensing Board or State Controlled Substances Authority for information on how to prevent and detect abuse or diversion of this product. Codeine sulfate may be expected to have additive effects when used in conjunction with alcohol, other opioids, or illicit drugs that cause central nervous system depression, because respiratory depression, hypotensionprofound sedation, coma or death may result.

Respiratory depressant effects of opioids and their capacity to elevate cerebrospinal fluid pressure resulting from vasodilation following CO2 retention may be markedly What kind of drug is codeine in the presence of head injury, other intracranial lesions or a pre-existing increase in intracranial pressure.

Furthermore, opioids including codeine sulfate, produce adverse reactions which may obscure the clinical course of patients with head injuries.

What kind of drug is codeine

Codeine sulfate may cause severe hypotension in an individual whose ability to maintain blood pressure has already been compromised by a depleted blood volume or concurrent administration of drugs such as phenothiazines or general anesthetics. Codeine sulfate may produce orthostatic hypotension and syncope in ambulatory patients.

Codeine sulfate should be administered with caution to patients in circulatory shock, as vasodilation produced by the drug may further reduce cardiac output and blood pressure. Codeine sulfate should not be administered to patients with gastrointestinal obstruction, especially paralytic ileus because codeine sulfate diminishes propulsive peristaltic waves in the gastrointestinal tract and may prolong the obstruction.

What kind of drug is codeine

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Codeine Addiction and Abuse