codeine sulfate

Action

Binds to opioid receptors in CNS, altering perception of painful stimuli. Causes generalized CNS depression, decreases cough reflex, and reduces GI motility.

Availability

Tablets: 15 mg, 30 mg, 60 mg

Indications and dosages

➣ Mild to moderately severe pain

Adults: 15 to 60 mg P.O. q 4 hours as needed. Doses above 60 mg may fail to give commensurate pain relief, and may be associated with an increased incidence of undesirable adverse effects.

Dosage adjustment

• Renal or hepatic impairment

• Elderly or debilitated patients

Contraindications

• Hypersensitivity to drug, its components, or other opioids

• Respiratory depression, severe bronchial asthma, hypercarbia

• Paralytic ileus or suspected paralytic ileus

Precautions

Use cautiously in:

• severe renal, hepatic, or pulmonary disease

• adrenal insufficiency, circulatory shock, hypotension, pancreatic or biliary tract disease, urethral stricture, seizures, head trauma, hypothyroidism, increased intracranial pressure, prostatic hypertrophy, undiagnosed abdominal pain, alcoholism

• concomitant use of alcohol, other opioids, illicit drugs

• elderly or debilitated patients

• pregnant or breastfeeding patients

• labor and delivery patients

• children younger than age 18 (safety and efficacy not established).

Administration

• If GI upset occurs, give with food.

• Titrate dosage for appropriate analgesic effect.

See If overdose occurs, give naloxone I.V. as prescribed. Repeat administration as needed (up to manufacturer's recommended maximum dosage) to reverse toxic effects.

Adverse reactions

CNS: confusion, sedation, malaise, agitation, euphoria, floating feeling, headache, hallucinations, unusual dreams, apathy, mood changes

CV: hypotension, bradycardia, peripheral vasodilation, reduced peripheral resistance

EENT: blurred or double vision, miosis, reddened sclera

GI: nausea, vomiting, constipation, decreased gastric motility

GU: urinary retention, urinary tract spasms, urinary urgency

Respiratory: suppressed cough reflex, respiratory depression

Skin: flushing, sweating

Other: physical or psychological drug dependence, drug tolerance

Interactions

Drug-drug. Antidepressants, antihistamines, sedative-hypnotics: additive CNS depression

Nalbuphine, pentazocine: decreased analgesic effect

Opioid partial agonists (buprenorphine, butorphanol, nalbuphine, pentazocine): precipitation of opioid withdrawal in physically dependent patients

Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression

Drug-behaviors. Alcohol use: increased CNS depression

Patient monitoring

• Monitor vital signs and CNS status.

• Assess pain level and efficacy of pain relief.

• Evaluate patient for adverse reactions.

See Stay alert for overdose signs and symptoms, such as CNS and respiratory depression, GI cramping, and constipation.

• Assess other drugs in patient's drug regimen for those that could cause additive or adverse interactions.

• Monitor patient for signs and symptoms of drug dependence or tolerance.

Patient teaching

• Teach patient to minimize adverse GI effects by taking doses with food or milk.

See Tell patient to notify prescriber promptly if he experiences shortness of breath or difficulty breathing or if nausea, vomiting, or constipation become pronounced.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, vision, coordination, and physical dexterity.

• Instruct patient to move slowly when sitting up or standing, to avoid dizziness or light-headedness from sudden blood pressure decrease.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.