Ver el código de «Codeine»

==Administration==
*Type: [[Opioid]] analgesic, antitussive
*Dosage Forms: Tablet: 15, 30, 60   Oral Solution: 30mg/5 mL   
*Routes of Administration: Oral

==Blackbox Warning==
*Death related to ultra-rapid metabolism: respiratory depression and death have occurred in children who received codeine post-tonsillectomy and/or adenoidectomy and were ultra-rapid CYP2D6 metabolizers

==Adult Dosing==
*Mild to moderate pain: 15-60mg PO q4-6h PRN
**Max: 360mg/day
**Give with food
**Doses >60mg are rarely more effective in opioid-naive patients

*Cough: 15-30mg PO q4-6h PRN
**Max: 120mg/day 

*[[Diarrhea]]: 45-270mg/day PO divided q4-6h PRN
**Start: 30-60mg/day PO divided QD-bid, then increase by 30-60mg/day PRN
**Max: 60mg/dose up to 270mg/day

==Pediatric Dosing==
*Pain, mild-moderate
**3-6 yo: 0.5-1mg/kg PO q4-6h PRN
**7-12 yo: 15-30mg PO q4-6h PRN
**13-17 yo: 15-60mg PO q4-6h PRN
**Max: 60mg/dose up to 360mg/day
*Cough
**2-5 yo: 1-1.5mg/kg/day PO divided q4-6h PRN; Max: 30mg/day
**6-11 yo: 1-1.5mg/kg/day PO divided q4-6h PRN; Max: 60mg/day
==Special Populations==
*Pregnancy risk factor: C
===Renal Dosing===
*CrCl 10-50: decrease dose 25%; CrCl <10: decrease dose 50%; HD/PD: no supplement

==Contraindications==
*hypersensitivity to codeine
*respiratory depression
*paralytic ileus
*post-tonsillectomy or adenoidectomy (peds)
==Adverse Reactions==
===Serious===
*respiratory depression
*CNS depression
*hypotension
*bradycardia
*syncope
*anaphylactoid reaction
===Common===
*lightheadedness
*dizziness
*sedation
*nausea/vomiting
==Pharmacology==
*Half-life: 2.5-4 hours
*Metabolism: Liver
*Excretion: Urine

==Mechanism of Action==
*Opioid agonist


==Indications by Condition==
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==See Also==
*[[Opioids]]
*[[Opioid toxicity]]
==References==
*Micromedex
*Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319. [PubMed 11487763]
*American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 177: obstetric analgesia and anesthesia. Obstet Gynecol. 2017 129(4):e73-e89. [PubMed 28333819]
*American Pain Society. Principles of Analgesic. 7th ed, Glenview, IL: American Pain Society, 2016.
*Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed. Philadelphia, PA: American College of Physicians; 2007, p 18, 135.
*Aurora RN, Kristo DA, Bista SR, et al. The treatment of restless legs syndrome and periodic limb movement disorder in adults—an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine clinical practice guideline. Sleep. 2012;35(8):1039-1062. [PubMed 22851801]
*Berna C, Kulich RJ, Rathmell JP. Tapering long-term opioid therapy in chronic noncancer pain: evidence and recommendations for everyday practice. Mayo Clin Proc. 2015;90(6):828-842. doi: 10.1016/j.mayocp.2015.04.003. [PubMed 26046416]
*Bolser DC, “Cough Suppressant and Pharmacologic Protussive Therapy: ACCP Evidence-Based Clinical Practice Guidelines,” Chest, 2006, 129(1 Suppl):238-48. [PubMed 16428717]
*Brennan MJ. The effect of opioid therapy on endocrine function. Am J Med. 2013;126(3)(suppl 1):S12-S18. doi: 10.1016/j.amjmed.2012.12.001. [PubMed 23414717]
*Broussard CS, Rasmussen SA, Reefhuis J, et al, "National Birth Defects Prevention Study: Maternal Treatment With Opioid Analgesics and Risk for Birth Defects," Am J Obstet Gynecol, 2011, 204(4):314. [PubMed 21345403]
*Cardan E, “Fatal Case of Codeine Poisoning,” Lancet, 1981, 1(8233):1313.
*Centers for Disease Control (CDC). Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm.

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[[Category:Pharmacology]]