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Codeine Dosage

Applies to the following strength(s): sulfate 30 mg ; sulfate 60 mg ; phosphate 30 mg ; phosphate 60 mg ; 30 mg/mL ; 60 mg/mL ; 15 mg/mL ; sulfate 15 mg ; 15 mg/5 mL ; phosphate ; sulfate 30 mg/5 mL

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Geriatric Dose for:

Additional dosage information:

Usual Adult Dose for Pain

Initial dose: Individualize dose based on patients prior analgesic experience
Maintenance dose: 15 to 60 mg up to every 4 hours as needed
Maximum dose: 360 mg in 24 hours

Comments: Doses higher than 60 mg have not been shown to improve pain relief and are associated with an increased incidence of adverse effects.

Individualization of dose should consider the following:
-Total daily dose, potency and specific characteristics of the opioid the patient has been previously taking
-Reliability of the relative potency estimate used to calculate the equivalent codeine dose needed
-Patient's degree of opioid tolerance
-General condition and medical status of the patient
-Concurrent medications
-Type and severity of pain
-Risk factors for abuse, addiction, or diversion, including a prior history of abuse, addiction, or diversion

Use: For the relief of mild to moderately severe pain where the use of an opioid analgesic is appropriate.

Usual Geriatric Dose for Pain

Dose selection should be cautious, generally starting at the low end of the dosing range.

Renal Dose Adjustments

Use with caution; start with lower doses or with longer dosing intervals and titrate slowly while carefully monitoring for side effects.

Liver Dose Adjustments

Use with caution; start with lower doses or with longer dosing intervals and titrate slowly while carefully monitoring for side effects.

Dose Adjustments

Gradually taper doses to prevent signs and symptoms of withdrawal in the physically dependent patient.

Precautions

US BOXED WARNING: Death related to Ultra-Rapid Metabolism of Codeine to Morphine
-Respiratory depression and death have occurred in children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers of codeine due to a CYP450 2D6 polymorphism.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule II

Dialysis

Data not available

Other Comments

Administration advice:
-Take orally with or without food

Storage requirements:
-Protect from moisture and light

General:
-When treating pain, dosing recommendations should be considered suggested approaches to what is actually a series of clinical decisions over time in the management of each individual patient.
-While initiating and titrating pain medications, patients should be under close medical supervision; for patients on longer-term therapy, routinely reassess for side effects associated with therapy and the need for continued opioid therapy.
-Patients who are ultra-rapid metabolizers of codeine due to a CYP450 2D6 polymorphism, will convert codeine more rapidly and completely to morphine resulting in unexpectedly high morphine levels, which may be life-threatening.

Monitoring:
-Cardiovascular: Monitor for signs of hypotension, especially in those whose blood pressure is compromised
-Respiratory: Monitor for respiratory depression
-Gastrointestinal: Monitor for constipation and decreased bowel motility in post-operative patients.
-General: Monitor routinely for maintenance of pain control and incidence of adverse reactions.
-Psychiatric: Patients should be monitored for the development of addiction, abuse, or misuse.

Patient advice:
-Patients should understand that this drug, even when taken as recommended can result in addiction, abuse, and misuse; instruct patients not to share their drug with others and protect their drug from theft or misuse.
-Patients should understand the risks of life-threatening respiratory depression and when this risk is greatest, patients should be aware that a genetic mutation may result in greater toxicity in some patients.
-For women who are breastfeeding and have this genetic mutation, their infant will be at risk for morphine toxicity; nursing mothers should be instructed to seek immediate medical attention for infants experiencing increased sleepiness, difficulty breastfeeding, breathing difficulties, or limpness.
-Women of child bearing potential should understand that prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome and that prompt recognition and treatment will be necessary.
-This drug may cause drowsiness, dizziness, or impair thinking or motor skills; patients should avoid driving or operating machinery until adverse effects are determined.
-Advise patients to store this drug safely out of the sight and reach of children; patients should be instructed in proper disposal.

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