Codeine dosing

The usual codeine dose and timing of dose separation for children is 1 to 1.5 milligrams (mg) of codeine per body weight (in kilograms) per day, but given as several doses every 4 to 6 hours. The accepted medical or pharmacological shorthand is 1-1.5 mg/kg/day, q4-6h, where q stands for every, and h represents hours. The usual adult (older than 13 years of age) dose and schedule is 10-20 mg, q4-6h, as needed, although 60-mg doses may occasionally be needed. 

Fig. 2. Codeine metabolism. Roughly 90% of a codeine dose is metabolized to inactive compounds by CYP3A4. The other 10% of a codeine dose is metabolized to the active component morphine via CYP2D6. Alt are eventually excreted by the kidneys. Blue, inactive compounds red, active metabolites.

Caution Codeine doses above 65 mg often are not appropriate due to diminishing incremental analgesia with increasing doses but continually increasing constipation and other side effects. Caution Doses of aspirin and acetaminophen in combination opioid/NSAID preparations must also be adjusted to die patient s body weight. Maximum acetaminophen dose 4 gm/day in adults,... 

Codeine, like morphine, is isolated from the opium poppy. However, the low yield of 0.7—2.5% does not provide sufficient material to meet commercial demands. The majority of marketed codeine is prepared by methylating the phenolic hydroxyl group of morphine. Morphine yields from opium poppy are 4—21%. When prescribed for cough, the usual oral dose is 10—20 mg, three to four times daily. At these doses, adverse side effects are very few. Although the abuse potential for codeine is relatively low, the compound can substitute for morphine in addicts (47). 

Codeine (morphine methyl ether) resembles morphine in its general effect, but is less toxic and its depressant action less marked and less prolonged, whilst its stimulating action involves not only the spinal cord, but also the lower parts of the brain. In small doses in man it induces sleep, which is not so deep as that caused by morphine, and in large doses it causes restlessness and increased reflex excitability rather than sleep. The respiration is slowed less than by morphine (cf. table, p. 261). Cases of addiction for codeine can occur but according to Wolff they are rare. The best known ethers of morphine are ethylmorphine and benzyl-morphine [cf., table, p. 261), both used to replace morphine or codeine for special purposes. 

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... 

Codeine Upset stomach and itching after one dose. 

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... 

The answer is c. (Hardman, pp 528-537.) Morphine is a pure agonist opioid drug with agonist activity toward all the opioid subtype receptor sites. In high doses, deaths associated with morphine are related to the depression of the respiratory center in the medulla. Morphine has a high addiction potential related to the activity of heroin or dihydromorphine. Codeine has a significantly lower addiction potential. 

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. 

Prescription errors are unintentional mistakes in the prescription, transcription, dispensing, and administration of medications. The patient either receives the medication incorrectly or fails to receive it altogether. Some prescription errors include wrong patient, incorrect medication, inappropriate dose, wrong time, wrong route of administration, and wrong rate of administration. For example, the profile of a patient shows that he is allergic to codeine, and yet he receives Tylenol 3 by an error. 

If a cough syrup contains 0.24 g of codeine in 120 mL, how many milligrams of codeine are contained in each teaspoonful dose ... 

The clinical analgesic efficacy of THC is prominent. In a study of cancer patients, 10 mg of THC was equivalent to 60 mg of codeine (Noyes et al. 1975). This dose produced sedative but no other psychoactive effects. A dose of 20 mg was more effective, but produced additional dizziness, ataxia, blurred vision, and psychoactive effects. 

Codeine. Is a narcotic derived from morphine and is addictive. It can be purchased over the counter, but you will have to sign for it. Sometimes you will have to show identification. It creates feelings of euphoria and weightlessness with doses of about 50 to 150 mg. It can also be made much more potent by hydrogenating to dihydrocodeinone as instructed in the analgesic chapter in this book. 

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