Medicines with codeine

It is difficult, but possible, to extract the codeine from tablet and syrup preparations. This is usually done by people who wish to abuse codeine and need higher doses than could be safely taken when it is combined with other medications. Once extracted, the codeine powder is typically mixed with a liquid of some kind and drunk. Since OTC medicines with codeine contain very small amounts of the drug, large quantities must be purchased in order to be able to extract enough codeine to... 

Non-prescription cough medicines with codeine are Schedule V chugs, which have a low potential for abuse compared to Schedule IV drugs, an accepted medical use in the United States, and the likelihood of limited physical or psychological dependence if abused. Federal trafficking penalties for a first offense of a Schedule V substance is not more than one year and fines of up to 100,000 for individuals and 250,000 for organizations. A second offense carries a maximum of 30 years to life if a death is involved and fines up to two and 10 million dollars. 

Schedule V Abuse may lead to limited physical or psychological dependence relative to Schedule IV drugs but there is a currendy accepted medical use. Cough medicines with codeine... 

The medicinal chemistry and pharmacology of codeine can also shed light on why specific side effects (the unintended, undesirable, and unwanted effects) associated with codeine occur. Codeine s side effects, or toxicities, are discussed in the next chapter. 

Cobeine is the methyl-phenyl ether with the hydroxyl hydrogen in position 3 replaced by methyl. Both morphine and codeine are crystalline compounds reacting as tertiary mono-acid bases. Morphine is slightly soluble in water, codeine being more so, the former being more bitter in taste than the latter. The salts are soluble and in this form the alkaloids are used in medicine though codeine is also used as the free base. 

Phenacetin was very popularly used in medicines like headache cures for many years. It was commonly combined with codeine (see p347) in medications. Following severe injuries in a plane crash in 1946, the American business magnate and aviator Howard Hughes was heavily dependent upon painkillers and it has been suggested that their phenacetin content may have caused kidney failure. 

The first scheme for the separation of the six chief alkaloids of opium, VIZ., morphine, codeine, thebaine, papaverine, narcotine and narceine, is probably that of Plugge. Much later Kljatschkina investigated for each of these six bases the properties by means of which isolation and estimation could probably be effected and, on the basis of the results, devised a plan for such analyses. More recently Anneler has published a detailed account of a scheme with the same objective. l Attention had already been given to complex, systematic analyses of this kind, in connection with examination of the mixtures of opium alkaloids, which have long been in use in medicine in these at first only morphine and other alkaloids were determined, but in the more recent schemes provision is made for the estimation of each alkaloid. ... 

Use of codeine may result in respiratory depression, euphoria, light-headedness, sedation, nausea, vomiting, and hypersensitivity reactions. The more common adverse reactions associated with the antitussives are listed in the Summary Drug Table Antitussive, Mucolytic, and Expectorant Drugs. When used as directed, nonprescription cough medicines containing two or more ingredients have few adverse reactions. However, those that contain an antihistamine may cause drowsiness. 

Gasche, Y., Daali, Y., Fathi, M., Chiappe, A., Cottini, S., Dayer, P. and Desmeules, J. (2004) Codeine intoxication associated with ultrarapid CYP2D6 metabolism. New England Journal of Medicine, 351 (27), 2827-2831. 

Morphine (10) and codeine (11), constituents of opium, are the most interesting alkaloids found in nature. Morphine is also the oldest alkaloid isolated, in 1805, by the German pharmacist Sertiimer from opium, the sun dried latex of Papaver somniferum. The structure of morphine with its so-called morphinan skeleton, once called the acrobat under the alkaloids, was finally elucidated in 1952 by the first total synthesis performed by Gates and Tschudi. Many syntheses would follow [26], but all morphine used today, whether legal or illicit, originates in the natural source P. somniferum or its extract, opium. The latex may contain up to 20% morphine. Most legal morphine is converted into the anticough medicine codeine (Table 5.1) by treatment with trimethylanilinium methoxide, whereas almost all illicit morphine is acetylated to the diacetate heroin. 

An alkaloid is a complex organic chemical substance found in plants, which characteristically combines nitrogen with other elements, has a bitter taste, and typically has some toxic, stimulant, analgesic effects. There are many different alkaloids, 30 of which are found in the opium plant. While morphine is the most important alkaloid in opium—for its natural narcotic qualities as well as providing the chemical structure for heroin—another alkaloid, codeine, is also sought after for its medicinal attributes. Other alkaloids include papaverine, narcotine, nicotine, atropine, cocaine, and mescaline. While the concentration of morphine in opium varies depending on where and how the plant is cultivated, it typically ranges from 3 percent to 20 percent. 

Pain is actually difficult to define. In medicine, it is characterized by its intensity mild, moderate, or severe. Codeine is commonly used to relieve pain that is of mild-to-moderate intensity. Codeine is also used to treat acute pain, or pain that is associated with tissue injury that lasts less than one month. An example of acute pain is the intense pain experienced after having a tooth removed. In addition, codeine is used to treat chronic pain, such as the constant, unrelenting pain that accompanies some types of advanced cancer. Chronic pain can also be... 

Source Y. Gasche Y. Daali M. Fathi A. Chiappe S. Cottini P. Dayer and J. Desmeules. Codeine intoxication associated with uitrarapid CYP2D6 metaboiism," New England Journal of Medicine 351 (2004) 2827-2841. 

Codeine, also known as methylmorpliine, C H2 NOt H20, is a colorless white crystalline substance, mp 154.9 C, slightly soluble in water, soluble in alcohol and chloroform, effloresces slowly in dry air. Codeine is derived from opium by extraction or by the methylation of morphine. For medical use, codeine is usually offered as the dichlotide, phosphate, or sulfate. Codeine is habit forming. Codeine is known to exacerbate urticaria (familiarly known as hives). Since codeine is incorporated in numerous prescription medicines for headache, heartburn, fatigue, coughing, and relief of aches and pains, persons with a history of urticaria should make this fact known to their physician. Codeine is sometimes used ill cases of acute pericarditis to relieve severe chest pains in early phases of disease. Codeine is sometimes used in drug therapy of renal (kidney) diseases. 

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