Codeine Smoking

Decreased cigarette consumption in smokers, easier to stop smoking Exaggerated response to warfarin and phenytoin Increased efficacy of omeprazole, increased toxicity of mephenytoin Absence of codeine efficacy, no effect of encainide, increased levels of tricyclic antidepressants, fluoxetine, phenothiazines Sustained paralysis to succinylcholine, possible increased toxicity of cocaine Unknown... 

Increased appetite is frequently attributed to smoking marijuana. Cannabinoids are effective antiemetics, particularly in treating emesis arising during chemotherapy. A -THC has been reported to be as effective as codeine as an analgesic, although pronounced behavioral effects occur with analgesic doses. 

Opiates are compounds extracted from the milky latex contained in the unripe seed pods of the opium poppy (Papaver somniferum). Opium, morphine, and codeine are the most important opiate alkaloids found in the opium poppy. Opium was used as folk medicine for hundreds, perhaps thousands of years. In the seventeenth century opium smoking led to major addiction problems. In the first decade of the nineteenth century, morphine was isolated from opium. About 20 years later, codeine, one-fifth as strong as morphine, was isolated from both opium and morphine. In 1898, heroin, an extremely potent and addictive derivative of morphine was isolated. The invention of the hypodermic needle during the mid-nineteenth century allowed opiates to be delivered directly into the blood stream, which increases the effects of these drugs. Synthetically produced drugs with morphine-like properties are called opioids. The terms narcotic, opiate, and opioid are frequently used interchangeably. Some common synthetically produced opioids include meperidine (its trade name is Demerol) and methadone, a drug often used to treat heroin addiction. 

Opioids morphine, codeine Cigarette smoking Cocaine insufflation... 

The Juice opium in Greek) or latex from the unripe seed pods of the poppy Papaver somniferum is among the oldest recorded medications used by humans. The writings of Theophrastus around 200 BC describe the use of opium in medicine however, evidence suggests that opium was used in the Sumerian culture as early as 3500 BC. The initial use of opium was as a tonic, or it was smoked. The pharmacist Surturner first isolated an alkaloid from opium in 1803. He named the alkaloid morphine, after Morpheus, the Greek god of dreams. Codeine, thebaine, and papaverine are other medically important alkaloids that were later isolated from the latex of opium poppies. 

Dai Y, Moriyama T, Higashi T et al (2004) Proteinase-activated receptor 2-mediated potentiation of transient receptor potential vanilloid subfamily 1 activity reveals a mechanism for proteinase-induced inflammatory pain. J Neurosd 24 4293 299 Davenport PW, Bolser DC, Vickroy T et al (2007) The effect of codeine on the Urge-to-Cough response to inhaled capsaicin. Pulm Pharmacol Ther 20 338-346 David GL, Koh WP, Lee HP, Yu MC, London SJ (2005) Childhood exposure to environmental tobacco smoke and chronic respiratory symptoms in non-smoking adults The Singapore Chinese health study. Thorax 60 1052-1058... 

Aylward M, Maddock J, Davies DE, Protheroe DA, Leideman T (1984) Dextromethorphan and codeine comparison of plasma kinetics and antitussive effects. Eur J Respir Dis 65 283-291 Barbee RA, Halonen M, Kaltenbom WT, Burrows B (1991) A longitudinal study of respiratory symptoms in a community population sample. Correlations with smoking, allergen skin-test reactivity, and serum IgE. Chest 99 20-26... 

Yue Q-Y, Tomson T, Sawe J. Carbamazepine and cigarette smoking induce differentially the metabolism of codeine in man. Pharmacogenetics (1994) 4, 193-8. 

The interaction appears to be well established. Prescribers should be aware that smokers may require a greater amount of opioids postoperati vely than non-smokers. In contrast, codeine metabolism does not appear to be affected to a clinically important extent by smoking. 

Hull JH, Findlay JWA, Rogers JF, Welch R Butz RF, Bustrack JA. An evaluation of tiie effects of smoking on codeine pharmacokinetics and bioavailability in normal human volunteers. Drug Intell Clin Pharm(m2) 16, 849-54. 

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