Codeine Acetaminophen

Catalytic reduction of codeine gives dihydrocodeine and Oppenauer oxidation (a ketone such as acetone and an aluminum alkoxide, the ketone being reduced to an alcohol) gives hydrocodone. Hydrocodone can also be prepared directly from codeine with a metal catalyst, which isomerizes the allylic alcohol to a ketone. Codeine is prepared by methylation of morphine, which is isolated from the opium poppy. Hydrocodone is more potent than codeine. Acetaminophen is a mild analgesic and is discussed in Section 8. 

Tylenol with codeine acetaminophen Tablets, liquid Relief of acute pain of mild-to-moder-ate intensity... 

Codeine/acetaminophen (generic, Tylenol with Codeine, others)... 

SCHEDULE II Certain barbiturates, cocaine, codeine, codeine + acetaminophen (depends on dose and formulation), fentanyl (depends on dose), hydrocodone, hydromorphone, meperidine, methadone, morphine (depends on combination with other pain relievers), oxycodone, propoxyphene... 

SCHEDULE V Codeine + acetaminophen (depends on dose and formulation)... 

III Significant but less abuse and dependency potential than that of schedule I and II agents. They may contain limited quantities of certain narcotics. Aspirin with codeine Acetaminophen with codeine... 

Mullican WS, Lacy JR TRAMAP-ANAG-006 Study Group. Tramadol/acetaminophen combination tablets and codeine/acetaminophen combination capsules for the management of chronic pain a comparative trial. Clin Ther 2001 23(9) 1429-45. 

Canada has the dubious distinction of having the world s largest per capita consumption of precursor opiate-containing compounds (e g., codeine, oxycodone, and hydrocodone) (Korcok 1979). A drug utilization review of opiate use in Canada from 1978 to 1989 shows continued increase in the use of prescribed codeine combination products. The defined daily dose (DDD)/1000 inhabitants/day for prescribed codeine-acetaminophen products has increased from 3.3 DDD/1000 inhabitants/day in 1982 to 8.1 DDD/1000 inhabitants/day in 1989. Oxycodone-acetaminophen containing products have also been increasing from 0.04 DDD/1000 inhabitants/day in 1978 to 0.21... 

Moderate 4-6/1 0 Add an opioid to the non-opioid for moderate pain regular scheduled dosing Acetaminophen 325 mg + codeine 60 mg every 4 hours Acetaminophen 325 mg + oxycodone 5 mg every 4 hours Consider step-up therapy if pain is not relieved by greater than or equal to 2 or more different drugs... 

Severe pain should be treated with an opioid such as morphine, hydromorphone, methadone, or fentanyl. Moderate pain can be treated effectively in most cases with a weak opioid such as codeine or hydrocodone, usually in combination with acetaminophen. Meperidine should be avoided owing to its relatively short analgesic effect and its toxic metabolite, normeperidine. Normeperidine may accumulate with repeated dosing and can lead to central nervous system side effects including seizures. 

Dose based on codeine—children 1 mg/kg per dose every 6 hours adult 30-60 mg/dose Hydrocodone + acetaminophen... 

JAN2004 01JAN2004 Acetaminophen 101 20DEC2003 20MAR2004 Tylenol w/ Codeine... 

High-dose NSAIDs and the combination of aspirin or acetaminophen with butalbital or, rarely, codeine, are effective options. The use of butalbital and codeine combinations should be avoided when possible. 

Medium abuse potential with possible medical value in U.S. Acetaminophen (Tylenol) with codeine, some barbiturates... 

From what we see on the next page (properties) we can tell that codeine is not very soluble, so it stands to reason that this will be the last substance that will be eluted from the column. Acetaminophen looks the most soluble, so lets get rid of it first. Acetone looks like a good choice, but its hard to tell because the Merck Index did not say if the other substances are soluble or insoluble in acetone. Try a little and see what types of crystals appear upon evaporating off the solvent, test the melting point and see if it is exactly as stated for acetaminophen. If there are only two types of crystals then it may be easier to go ahead and elute these and then separate... 

Schedule (C-lll) III Low to moderate risk of physical dependence, high risk of psychologic dependence prescription must be rewritten after 6 months or five refills (eg, acetaminophen plus codeine). 

There are some additional choices in patients with refractory arthritis despite the use of NSAIDs or paracetamol (acetaminophen), alone or in combination. Narcotics can be used with little risk of addiction, but with the caveat that they can cause cognitive changes, constipation, urine retention and respiratory depression (see section on analgesics). Codeine... 

A 37-year-old woman visited her dentist for removal of her wisdom teeth. The teeth were found to be impacted, and removal necessitated extensive surgery. Following completion of the procedure on one side of the mouth, the patient was given a prescription for acetaminophen 300 mg with codeine 30 mg (combination product) for the relief of pain. The patient took the prescription as prescribed for approximately 2 days, but little pain relief was achieved. She called the dentist to get a prescription for another analgesic. What is a possible explanation for this lack of efficacy ... 

Acute pain is managed with either nonopioids such as acetaminophen, NSAIDs, or, when severe, opioids such as meperidine, morphine, methadone, hydromor-phone, fentanyl, or sufentanil (Golianu et ah, 2000). The latter are generally used parenterally, and when the patient is converted to oral analgesics, agents such as codeine, oxycodone, and hydrocodone are often used. 

The word analgesia is from the Greek an-, meaning not or without, + algesis, sense of pain. Codeine is more potent than other pain-relieving medications, such as aspirin and ibupro-fen, but less potent than the really serious painkillers—morphine, oxycodone -I- acetaminophen, hydromorphone. When a... 

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