Classifications: narcotic (opiate) agonist analgesic; antitussive; Therapeutic:narcotic analgesic; antitussive
Pregnancy Category: C
Controlled Substance: Schedule II
15 mg, 30 mg, 60 mg tablets; 15 mg/5 mL oral solution; 30 mg, 60 mg injection
Opium agonist in the CNS with actions similar to morphine. Parenteral codeine produces less analgesic and respiratory depression
than morphine. Analgesia is mediated through changes in the perception of pain at the spinal cord and higher levels in the
CNS. There is no ceiling effect of analgesia for opiates. The antitussive effects are mediated through direct action on receptors
in the cough center of the medulla. Codeine also has a drying effect on the respiratory tract, thus increasing viscosity
of bronchial secretions.
Analgesic potency is about one-sixth that of morphine; antitussive activity is also a little less than that of morphine.
Symptomatic relief of mild to moderately severe pain when control cannot be obtained by nonnarcotic analgesics and to suppress
hyperactive or nonproductive cough.
Hypersensitivity to codeine or other morphine derivatives; acute asthma, COPD; increased intracranial pressure, head injury,
acute alcoholism, hepatic or renal dysfunction, hypothyroidism; pregnancy (category C). Safe use in neonates not established.
Prostatic hypertrophy, G6PD deficiency; GI disease; hepatic disease; hepatitis; immunosuppression; debilitated patients,
very young and very old patients; history of drug abuse; lactation.
Route & Dosage
Adult: PO/IM/SC 1560 mg q.i.d.
Child: PO/IM/SC 0.51 mg/kg q46h prn (max: 60 mg/dose)
Adult: PO 1020 mg q46h prn (max: 120 mg/24 h)
Child: PO 612 y, 510 mg q46h (max: 60 mg/24 h); 26 y, 2.55 mg q46h (max: 30 mg/24 h)
- Administer PO codeine with milk or other food to reduce possibility of GI distress.
- Give parenterally to achieve greatest effectiveness. An oral dose is about 60% as effective as an equal parenteral dose.
- Preserve in tight, light-resistant containers at 15°30° C (59°86° F) unless otherwise directed.
Adverse Effects (≥1%) Body as a Whole:
Shortness of breath, anaphylactoid reaction. CV:
Palpitation, hypotension, orthostatic hypotension, bradycardia, tachycardia, circulatory collapse. GI: Nausea,
vomiting, constipation. CNS: Dizziness,
sedation, lethargy, euphoria, agitation; restlessness, exhilaration, convulsions, narcosis, respiratory depression
, rash, urticaria, pruritus,
excessive perspiration, facial flushing, fixed-drug eruption. Special Senses:
and other cns depressants
depressant effects. Herbal: St. John's wort
may cause increased sedation.
Readily from GI tract. Onset:
1530 min. Peak:
11.5 h. Duration:
46 h. Distribution:
Crosses placenta; distributed into breast milk. Metabolism:
In liver. Elimination:
In urine. Half-Life:
Assessment & Drug Effects
- Record relief of pain and duration of analgesia.
- Evaluate effectiveness as cough suppressant. Treatment of cough is directed toward decreasing frequency and intensity of
cough without abolishing cough reflex, need to remove bronchial secretions.
- Although codeine has less abuse liability than morphine, dependence is a major unwanted effect.
- Supervision of ambulation and use other safety precautions as warranted since drug may cause dizziness and light-headedness.
- Monitor for nausea, a common side effect. Report nausea accompanied by vomiting. Change to another analgesic may be warranted.
Patient & Family Education
- Make position changes slowly and in stages particularly from recumbent to upright posture. Lie down immediately if light-headedness
or dizziness occurs.
- Lie down when feeling nauseated and to notify physician if this symptom persists. Nausea appears to be aggravated by ambulation.
- Avoid driving and other potentially hazardous activities until reaction to drug is known. Codeine may impair ability to perform
tasks requiring mental alertness.
- Do not take alcohol or other CNS depressants unless approved by physician.
- Hyperactive cough may be lessened by avoiding irritants such as smoking, dust, fumes, and other air pollutants. Humidification
of ambient air may provide some relief.