CODEINE

CODEINE (koe'deen) CODEINE PHOSPHATE Paveral  CODEINE SULFATE Classifications: narcotic (opiate) agonist analgesic; antitussive; Therapeutic:narcotic analgesic; antitussive Prototype: Morphine Pregnancy Category: C Controlled Substance: Schedule II

Availability

15 mg, 30 mg, 60 mg tablets; 15 mg/5 mL oral solution; 30 mg, 60 mg injection

Action

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.

Therapeutic Effect

Analgesic potency is about one-sixth that of morphine; antitussive activity is also a little less than that of morphine.

Uses

Symptomatic relief of mild to moderately severe pain when control cannot be obtained by nonnarcotic analgesics and to suppress hyperactive or nonproductive cough.

Contraindications

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.

Cautious Use

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

Analgesic Adult: PO/IM/SC 15–60 mg q.i.d. Child: PO/IM/SC 0.5–1 mg/kg q4–6h prn (max: 60 mg/dose) Antitussive Adult: PO 10–20 mg q4–6h prn (max: 120 mg/24 h) Child: PO 6–12 y, 5–10 mg q4–6h (max: 60 mg/24 h); 2–6 y, 2.5–5 mg q4–6h (max: 30 mg/24 h)

Administration

Oral

• Administer PO codeine with milk or other food to reduce possibility of GI distress.

Subcutaneous/Intramuscular

• 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, light-headedness, drowsiness, sedation, lethargy, euphoria, agitation; restlessness, exhilaration, convulsions, narcosis, respiratory depression. Skin: Diffuse erythema, rash, urticaria, pruritus, excessive perspiration, facial flushing, fixed-drug eruption. Special Senses: Miosis. Urogenital: Urinary retention.

Interactions

Drug: Alcohol and other cns depressants augment CNS depressant effects. Herbal: St. John's wort may cause increased sedation.

Pharmacokinetics

Absorption: Readily from GI tract. Onset: 15–30 min. Peak: 1–1.5 h. Duration: 4–6 h. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: In urine. Half-Life: 2.5–4 h.

Nursing Implications

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.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug