Codeine tolerance

The patient who uses codeine repeatedly may develop a tolerance to the drug s analgesic effect as well as physical dependence. 

Codeine Empirin with Codeine, Fiorinal with Codeine, Robitussin AOC, Tylenol with Codeine Captain Cody, Cody, schoolboy II, III, IV Injected, Swallowed Drowsiness/respiratory depression and arrest, nausea, confusion, constipation, sedation, unconsciousness, coma, tolerance, addiction... 

As previously mentioned, the detection period for a drug depends on a number of factors, including the type of opiate, the type of sample, the frequency of drug use, metabolic rate, age, body mass, drug tolerance, and overall health. Generally speaking opium can be detected for 5-7 days after its use. Other opiates such as heroin and codeine have significantly shorter detection periods (Table 10.3). 

Chronic use of codeine leads to tolerance. After repeated use of codeine, a particular dose loses its effect so that a higher dose is needed to provide the desired effect (such as relief from pain or coughing) that a smaller dose originally provided. This loss of sensitivity to a given dose of codeine is known as tolerance. Eventually, tolerance even develops to the euphoric effect ( high ) of codeine, so that the euphoria becomes less intense over time. A patient may also develop a tolerance to some of codeine s other effects, both medicinal and toxic for example, tolerance develops to codeine s analgesic and sedative effects, but not to its constipating (antidiarrheal) effect. 

Codeine,oxycodone, dihydrocodeine, and hydrocodone are all somewhat less efficacious than morphine (they are partial agonists) or have adverse effects that limit the maximum tolerated dose when one attempts to achieve analgesia comparable to that of morphine. 

Many myths surround the stronger opioids and their use can become restricted when the definitions of addiction, tolerance and physical dependence are confused. Some opioids, e.g. codeine, are less potent and are readily available in OTC products. 

Codeine acts less on the stomach and bowel than does morphine but, when given in large doses, also causes constipation. It is excreted unchanged in the urine. Tolerance for codeine is difficult to develop, but cases of addiction to it have been reported. They are usually secondary to the use of morphine that is, the patient, addicted to morphine and unable to secure this drug, resorts to codeine. 

In potency, pethidine is graded between codeine and morphine (50-100 mg is equivalent to 10 mg morphine in man),(2) and it is useful for the management of mild to moderate pain, especially in patients intolerant to opioids. Its toxicity is relatively low and its duration of action is somewhat shorter than that of morphine. At equivalent dosage, pethidine is at least as depressant as morphine upon respiration and while morphinelike side effects such as nausea and vomiting frequently occur, it produces little disturbance of urinary function or bowel action. It is extensively used for the relief of labor pain even though it increases the incidence of delay on the first breath and cry of the neonate (3) several critical reports on the efficacy of the drug in obstetrics have been made.(4) Tolerance to pethidine develops slowly, and its dependence liability is claimed to be lower than that of morphine.(5) Full accounts of the clinical use of pethidine are available.(4,6)... 

Codeine (t/ 3 h) activates opioid receptors on the smooth muscle of the bowel to reduce peristalsis and increase segmentation contractions. Tolerance may develop with prolonged use, as may dependence (rarely). It should be avoided in patients with... 

The authors noted that many opioids are potent histamine releasers and most reactions to opioids are anaphylactoid rather than IgE-mediated. It was of particnlar interest that the patient was able to tolerate the opioids hydrocodone and codeine. 

Glaucine is a non-narcotic antitussive agent. The D-isomer of glaucine is an alkaloid from Glaucium flavum Grantz, a species of Papaveraceae. It is better tolerated in doses claimed to be equieffective with codeine. Glaucine (30 mg capsules 3 times daily for 28 days) caused mild constipation in five patients (1). 

In a 4-week, double-bhnd, multicenter, randomized study, tramadol plus paracetamol (37.5/325 mg) was as effective as codeine plus paracetamol (co-codamol 30/300 mg) in chronic non-mahgnant low back pain and osteoarthritis pain, with acceptable tolerability (6). 

Carbetapentane Citrate. Carhetapentane citrate. 2- 2-idiothylamino)-ethoxy ethyl l-phcnylcyclopcntanecarbox-clate citrate, is a white, odorless crystalline powder that is fiecly soluble in water (1 1). slightly soluble in alcohol, and insoluble in ether. It is reportedly equivalent to codeine as at antitussive. Introduced in 1956, it is well tolerated and has... 

Methocarbamol is available by either prescription or as an over-the-counter product, often in combination with analgesics (acetylsalicylic acid, acetaminophen, codeine). It appears to be a relatively safe drug, one which is well-tolerated and widely used. Nevertheless, cases of fatal intoxication have been reported35-73-80 and a potential for abuse has also been evaluated in individuals with a history of recreational substance abuse81 -82. 

First application (first day) contact time 10-25 minutes. A few minutes after the first application, the patient feels some heat and then a tolerable burning sensation. This sensation starts where the resorcinol has penetrated most rapidly. The cheeks are usually more permeable than the forehead. The areas where the patient first feels burning are the first to be cleaned of the resorcinol paste at the end of the peel. The sensation of acid burning can sometimes become intense, and a yellow serous fluid may be seen to weep through the partially lysed epidermis. In this case, the patient should be given an analgesic for the first night paracetamol (acetaminophen) plus codeine. 

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