codeine sulfate

codeine sulfate,

a water-soluble salt of monomethylmorphine, an alkaloid derived from opium. It is used as a mild hypnotic, analgesic, and cough reflex suppressant. Dependency on the drug is possible, but is less likely to produce addiction than is morphine.

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codeine sulfate Warning - High-alert drug!

Pharmacologic class: Opioid agonist

Therapeutic class: Opioid analgesic, antitussive

Controlled substance schedule II

Pregnancy risk category C

Action

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

Availability

Injection (phosphate): 30 mg/ml, 60 mg/ml

Oral solution (phosphate): 10 mg/5 ml, 15 mg/5 ml

Tablets (sulfate): 15 mg, 30 mg, 60 mg; 30 mg, 60 mg (soluble)

⊘Indications and dosages

➣ Pain

Adults: 15 to 60 mg P.O. or 15 to 60 mg (phosphate) I.M., I.V., or subcutaneously q 4 to 6 hours. Usual daily dosage is 30 mg; maximum daily dosage is 360 mg.

Children ages 1 and older: 0.5 mg/kg or 15 mg/m² P.O., I.M., or subcutaneously q 4 to 6 hours

➣ Cough

Adults: 10 to 20 mg P.O. q 4 to 6 hours as needed. Don't exceed 120 mg/day.

Children ages 6 to 12: 5 to 10 mg P.O. q 4 to 6 hours as needed. Don't exceed 60 mg/day.

Children ages 2 to 6: 2.5 to 5 mg P.O. q 4 to 6 hours as needed. Don't exceed 30 mg/day.

Dosage adjustment

• Elderly or debilitated patients

Contraindications

• Hypersensitivity to narcotics
• Labor and delivery of premature neonate
• Premature neonates

Precautions

Use cautiously in:
• severe renal, hepatic, or pulmonary disease
• adrenal insufficiency, head trauma, hypothyroidism, increased intracranial pressure, prostatic hypertrophy, undiagnosed abdominal pain, alcoholism
• elderly patients
• pregnant or breastfeeding patients.

Administration

• If GI upset occurs, give with food.
• Titrate dosage for appropriate analgesic effect.
• When changing administration route, be aware that oral dose is two-thirds as effective as parenteral dose.
☞ Don't give I.V. to children.
☞ If overdose occurs, give naloxone I.V. as prescribed. Repeat administration as needed (up to manufacturer's recommended maximum dosage) to reverse toxic effects.
☞ Don't mix with other solutions; drug is incompatible with other drugs.

Route	Onset	Peak	Duration
P.O.	30-45 min	1-2 hr	4 hr
I.M.	10-30 min	30-60 min	4 hr
Subcut.	10-30 min	Unknown	4 hr

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.
☞ 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

• With oral use, advise patient to minimize adverse GI effects by taking doses with food or milk.
☞ 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.