codeine sulfate
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codeine sulfate
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
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.
☞ 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.
☞ 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.
☞ 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.