Codeine is an opioid medication with a strong analgesic effect. It is used to relieve moderate pain that does not improve with other pain relievers and also has an antitussive action, as it suppresses the cough reflex at the level of the brain.
This medication is available both as the generic drug codeine and under various brand names. It is sometimes combined with other simple pain relievers, such as acetaminophen, to increase its effectiveness when prescribed.
Codeine, or codeine phosphate, is a prescription-only medication. Pharmacies can dispense it as tablets, oral syrup, or an injectable solution, and its use is strictly regulated under medical supervision.
Indications for use
Codeine is an opioid analgesic indicated for:
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Treatment of moderate pain or pain that does not respond to simpler analgesics;
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Suppression of dry cough in restricted clinical situations, prescribed only for adults and under medical supervision..
Codeine acts directly on the brain, reducing the perception of pain and suppressing the dry cough reflex. Other medications may also be used to treat dry cough, depending on the cause and patient profile.
To enhance its analgesic effect, codeine is commonly prescribed in fixed-dose combinations with acetaminophen.
Dosing instructions
The use of codeine varies depending on its pharmaceutical form and may include:
1. Codeine syrup or oral solution
Codeine oral solution 3 mg/mL is taken by mouth, and the dose should be measured using the dosing device provided with the package.
Dosage is determined by a healthcare provider based on age and indication for treatment:
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Adults: the usual dose is 30 mg (10 mL) every 4 to 6 hours. Depending on medical guidance, the dose may range from 15 mg (5 mL) to 60 mg (20 mL) every 4 to 6 hours. The maximum dose should not exceed 360 mg per day, which corresponds to 120 mL of oral solution per day;
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Adolescents over 12 years of age: dosing must be individually assessed by a physician and carefully monitored. When prescribed, the dose is typically calculated based on body weight. The maximum dose should not exceed 60 mg per day, which corresponds to 20 mL of the solution.
In older adults, the dose of codeine should be individualized, as lower doses or longer dosing intervals may be required.
2. Codeine tablets
Codeine tablets are indicated for adults and may be available in different strengths, such as 30 mg or 60 mg of codeine.
The usual adult dose of codeine tablets is 15 mg (half of a 30 mg tablet) to 60 mg (two 30 mg tablets or one 60 mg tablet) every 4 to 6 hours, according to medical guidance. The maximum dose should not exceed 360 mg per day, which corresponds to 12 tablets of 30 mg or 6 tablets of 60 mg.
Codeine tablets should be taken by mouth with a glass of water, preferably after a meal, to help reduce stomach discomfort.
3. Injectable codeine
Injectable codeine in ampules of 30 mg/mL is used in hospital settings and should be administered into a muscle or under the skin by a healthcare professional, under medical supervision.
The dose of injectable codeine for adults or adolescents over 12 years of age should be determined by a physician based on the severity of the pain and clinical evaluation.
Side effects
The most common side effects that may occur during treatment with codeine include drowsiness, dizziness, constipation, abdominal pain, sweating, and mental confusion.
Codeine can cause severe allergic reactions, including anaphylaxis. If symptoms such as shortness of breath or swelling of the mouth, tongue, or face occur, stop taking the medication immediately and seek emergency medical care.
Contraindications for use
Codeine should not be used by people who are allergic to any component of the formula, during pregnancy or breastfeeding, or by children under 12 years of age.
The use of codeine is also contraindicated in individuals with acute respiratory depression, intestinal obstruction, diarrhea caused by poisoning or associated with pseudomembranous colitis, or in cases of productive cough with mucus.