Codeine overdose

Huffman DH and Ferguson RL (1975) Acute codeine overdose Correspondence between clinical course and codeine metabolism. Johns Hopkins Medical Journal 136 136-183. 

Using codeine as an example of the effects of a metabolizer state, patients who lack enzymatic activity (PM) will not be able to convert codeine to its most active metabolite, morphine, and thus patients will get little if any analgesic benefit from the drug. In contrast, it has been reported that ultrarapid metabolizers (UM) may convert codeine to morphine too quickly, resulting in an excessive dose of morphine even when giving only a standard dose of codeine. A true codeine overdose is probably due to multiple factors since it is not commonly reported and the CYP2D6 UM can be as high as approximately 30% in some populations. 

Adverse effects and drug interactions with codeine are similar to those reported for morphine, although they are less intense. Overdose in children results in the same effects as overdose of morphine, such as respiratory depression, miosis, and coma these symptoms are treated with naloxone administration. 

Codeine poisoning or an overdose of codeine may be accidental or intentional. Within one hour of ingestion of a large overdose of codeine, there is depression of the central nervous system the patient may be in a stupor or may go into a coma. 

Naloxone Narcotic drugs, other opioid derivatives A specific antagonist of opioids 1-2 mg initially by IV, IM, or subcutaneous injection. Larger doses may be needed to reverse the effects of overdose with propoxyphene, codeine, or fentanyl derivatives. Duration of action (2-3 hours) may be significantly shorter than that of the opioid being antagonized. 

Codeine Phosphate The presence of aspirin along with codeine, even at a low moisture level, leads to acetylation of codeine phosphate in solid dose forms and is incompatible.36 Codeine sulfate solutions are more stable than phosphate salts.37 Drug dependence and withdrawal resemble that of opioid analgesics. Overdose causes acute intoxication in children, as accidental or deliberate ingestion of cough preparations containing codeine.38... 

Analgesics. Opiates can precipitate hepatic encephalopathy in patients with decompensated liver disease. If required to control postoperative pain, doses should be reduced to 25-50% of normal. Constant intravenous infusions should be avoided if the patient is not to be insidiously overdosed. Codeine can precipitate hepatic encephalopathy by its constipating effect alone. Aspirin and other NSAIDs may exacerbate impaired renal function and fluid retention by inhibiting prostaglandin synthesis and may also precipitate gastrointestinal bleeding. 

A 44-year-old black man developed priapism 2 hours after having overdosed on 30-40 trazodone tablets 50 mg and 10 Tylenol No. 3 (paracetamol plus codeine) tablets (162). Toxicology analysis was positive for cocaine and opiates. The priapism required detumescence twice, on initial presentation and then 6 hours later, and 8 hours after presentation he again developed painless priapism, which resolved spontaneously after 1.5 hours. 

A 37-year-old man with a history of ethanol abuse presented with hepatic failure and non-cardiogenic pulmonary edema after an overdose of paracetamol, codeine, ibuprofen, and diazepam. He received two... 

The most widely used analgesic is Paracetamol, or A-acetyl-p-aminophenol (155), also known as acetaminophen (US), and Tylenol (with codeine), and synthesized from nitrobenzene. Care has to be taken with use hepatoxicity can develop with overdoses. 

Pain-relieving action is not superior to that of codeine Response to naloxone in overdose may be unreliable This drug, which does not activate opioid receptors, has been proposed as a maintenance drug in treatment programs for opioid addicts a single oral dose will block the effects of injected heroin for up to 48 hours (A) Amphetamine Buprenorphine Naloxone Naltrexone Propoxyphene... 

Dextroproposyphene Ls abcxji hull as potent as codeine, but has similar actions at equianalgesic doses. It isoften given in fixed combinations with aspirin cn- paracetamol (e.g. coproxamol) but there is little evidence that such combinations are more effective than the NSAID alone. Combinations with paracetamol are dangerous in overdose because the dexiropropoxyphene causes respiratory depression, while the paracetamol is hepatoioxic. 

The toxic effects due to codeine are similar bnt less toxic than those of morphine and other opium alkaloids. An overdose can cause respiratory failure. It is a weak depressant of the central nervons system. It also exhibits stimnlant action. Toxic symptoms from high dosages may inclnde drowsiness, sleep, tremors, excitement, and hallucinations. It may also produce gastric pains and constipation. An oral LD50 valne in... 

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