Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

codeine (Rx)Brand and Other Names:

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet: Schedule II

  • 15mg
  • 30mg
  • 60mg

oral solution: Schedule II

  • 30mg/5mL

injection solution

  • 15mg/mL
  • 30mg/mL
more...

Pain

15-60 mg PO/SC/IM q4-6hr PRN; not to exceed 360 mg/day in naive patients

Dosing considerations

  • Patients with prior opioid exposure may require higher initial doses

Cough

7.5-20 mg PO q4-6hr PRN; not to exceed 120 mg/24 hours

Dosage Forms & Strengths

tablet: Schedule II

  • 15mg
  • 30mg
  • 60mg

oral solution: Schedule II

  • 30mg/mL

injection solution

  • 15 mg/mL
  • 30 mg/mL
more...

Pain

0.5-1 mg/kg IM/PO/SC q4-6hr PRN; not to exceed 60 mg/dose 

Dosing considerations

  • See Black Box Warnings and Contraindications sections for warning regarding postoperative use following tonsillectomy and/or adenoidectomy
  • Potential toxic dose <6 years: 2 mg/kg

Cough

Infants: Safety and efficacy not established

2-6 years: 1-1.5 mg/kg/day divided q4-6hr PO/IM/SC; not to exceed 30 mg/day 

6-12 years: 1-1.5 mg/kg/day divided q4-6hr PO/IM/SC; not to exceed 60 mg/day

>12 years: As in adults

Dosing considerations

  • Potential toxic dose <6 years: 2 mg/kg
Next

Interactions

Interaction Checker

codeine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 
            Previous
            Next

            Adverse Effects

            >10%

            Constipation

            Drowsiness

            1-10%

            Hypotension

            Tachycardia or bradycardia

            Confusion

            Dizziness

            False feeling of well-being

            Headache

            Lightheadedness

            Malaise

            Paradoxical CNS stimulation

            Restlessness

            Rash, urticaria

            Anorexia

            Nausea, vomiting

            Xerostomia

            Ureteral spasm, urination decreased

            LFTs increased

            Burning at injection site

            Weakness

            Blurred vision

            Dyspnea

            Histamine release

            <1%

            Hypotension, with IV use

            Anaphylactoid reaction (rare)

            Seizure, with excessive doses

            Respiratory depression

            Previous
            Next

            Warnings

            Black Box Warning

            Respiratory depression and death reported in children who received codeine following tonsillectomy and/or adenoidectomy that were also ultra-rapid metabolizers of codeine due to CYP2D6 polymorphism

            Contraindications

            Absolute: Acute abdominal condition, diarrhea associated w/ toxins, pseudomembranous colitis, respiratory depression, postoperative use in children following tonsillectomy and/or adenoidectomy (see Black Box Warnings)

            Relative: Asthma (acute), inflammatory bowel disease, respiratory impairment

            Cautions

            Cardiac arrhythmias, drug abuse/dependence, emotional lability, gallbladder disease, head injury, hepatic impairment, hypothyroidism, increased ICP, prostatic hypertrophy, renal impairment, seizures with epilepsy, urethral stricture, urinary tract surgery

            Do NOT give IV, because of severe adverse reactions

            Risk of life-threatening side effects in nursing infants, especially if mother is an ultra-rapid metabolizer of codeine

            Prescribe an alternate analgesic for postoperative pain control in children undergoing tonsillectomy and/or adenoidectomy

            Postoperative pain in children

            • Deaths have occurred in children with obstructive sleep apnea who received codeine for postoperative pain following tonsillectomy and/or adenoidectomy
            • Codeine is converted to morphine by the liver; these children had evidence of being ultra-rapid metabolizers (via CYP2D6) of codeine, which is an inherited (genetic) ability that causes codeine to be converted rapidly into life-threatening or fatal amounts of morphine
            Previous
            Next

            Pregnancy & Lactation

            Pregnancy category: C; D if used for prolonged periods or near term

            Lactation: Excreted in breast milk; use with caution (AAP Committee states "compatible with nursing")

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next

            Pharmacology

            Mechanism of Action

            Narcotic agonist analgesic with antitussive activity, mu receptor agonist

            Absorption

            Onset: 30-60 min (PO); 10-30 min (IM)

            Duration: 4-6 hr

            Peak plasma time: 0.5-1 hr

            Distribution

            Protein bound: 25%

            Vd: 3.5 L/kg (PO); 2.6 L/kg (IM)

            Metabolism

            Prodrug metabolized to morphine by CYP2D6; demethylated/conjugated in liver (undergoes O-demethylation, N-demethylation, and partial conjugation with glucuronic acid)

            Elimination

            Half-life: 3-4 hr

            Excretion: Urine, feces

            Pharmacogenomics

            10% of codeine is metabolized to morphine by CYP2D6; the active morphine metabolite has a higher affinity for opioid receptors

            CYP2D6 poor metabolizers may not achieve adequate analgesia

            Ultra-rapid metabolizers (up to 7% of Caucasians and up to 30% of Asian and African populations) may have increased toxicity due to rapid conversion

            Previous
            Next

            Images

            Previous
            Next

            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Add or Remove Plans
            Plans for
            Select State:
            Non-Medicare PlansMedicare Plans

            Select a box to add or remove a plan.

            Select a class to view formulary status for similar drugs

            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
             
             
             
            All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.