Codeine
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Trade Name
Tylenol with Codeine (combination); generic codeine phosphate or codeine sulfate. No major standalone brand
Classification
Opioid analgesic; antitussive; Schedule II (pure), Schedule III/V (combinations) controlled substance
Dosage/Route
- * Dosage:
- – Tablets: 15 mg, 30 mg, 60 mg (codeine alone or with acetaminophen)
- – Oral solution: 15 mg/5 mL
- – Injection: 30 mg/mL, 60 mg/mL (rare)
- * Route: Oral (PO), intramuscular (IM), subcutaneous (SC, rare)
Usual Dosage
- * Pain (Adults): 15-60 mg PO every 4-6 hours PRN; max 360 mg/day codeine
- * Cough (Adults): 10-20 mg PO every 4-6 hours PRN; max 120 mg/day
- * Children (Pain, ≥12): 0.5-1 mg/kg PO every 4-6 hours PRN; max 60 mg/dose
- * Children (Cough, ≥12): 5-10 mg PO every 4-6 hours; max 60 mg/day
- * Avoid in children <12 for cough/pain (boxed warning, respiratory risk)
Mechanism of Action
Binds to mu-opioid receptors in the CNS, altering pain perception and response. Metabolized to morphine (via CYP2D6) for analgesia. As an antitussive, suppresses cough reflex in the medulla. Weak analgesic compared to morphine
Side Effects & Adverse Effects
- * Side Effects: Drowsiness, constipation, nausea, dizziness
- * Adverse Effects:
- – Respiratory depression (boxed warning; esp. in ultra-rapid CYP2D6 metabolizers, children)
- – Dependence/abuse (Schedule II/III risk)
- – Hypotension, confusion (esp. elderly)
- – Rare: Allergic reactions, seizures (high doses)
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor respiratory rate (hold if <12/min), sedation, BP
- – Assess pain/cough efficacy; bowel function (constipation risk)
- – PO: Give with food if GI upset; IM: Deep injection, rotate sites
- – Avoid in children <12, post-tonsillectomy, or with CYP2D6 variability (test if known)
- * Teachings:
- – Take as prescribed; don’t exceed dose (acetaminophen toxicity risk in combos)
- – Report slow breathing, confusion, or no stools >3 days
- – Avoid alcohol/driving (CNS depression)
- – Increase fluids/fiber; use laxative if needed
Indication for This Patient
- * Mild to moderate pain (often with acetaminophen)
- * Nonproductive cough (suppressant, adults/older children)
- * Short-term use due to risks
Time
- * Timing: Every 4-6 hours PRN
- * Onset: PO: 15-30 min; IM: 10-20 min
- * Peak: PO: 1-2 hr; IM: 30-60 min
- * Duration: 4-6 hours
