Home Drug Guide Codeine Sulfate

Drug Guide

Generic Name

Codeine Sulfate

Brand Names Methylmorphine, Codeine

Classification

Therapeutic: Analgesic, Antitussive

Pharmacological: Opioid

FDA Approved Indications

Moderate to severe pain
Cough suppression

Mechanism of Action

Codeine is a prodrug that is metabolized to morphine, which binds to opioid receptors in the central nervous system, altering the perception of and response to pain and suppressing the cough reflex.

Dosage and Administration

Adult: Typically 15-60 mg every 4-6 hours as needed. Do not exceed 360 mg in 24 hours.

Pediatric: Use is contraindicated in children under 12 years old. For children 12-18, use with caution and under strict medical supervision.

Geriatric: Start with lower doses due to increased sensitivity and risk of side effects.

Renal Impairment: Use with caution; dose adjustments may be necessary.

Hepatic Impairment: Use with caution; dose adjustments may be necessary.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Metabolized in the liver via CYP2D6 to morphine and other metabolites.

Excretion: Excreted primarily in urine.

Half Life: Approximately 2-4 hours.

Contraindications

History of hypersensitivity to opioids
Respiratory depression
Use in children under 12 years old

Precautions

Use with caution in elderly, patients with respiratory issues, or head injury. Risk of dependence, abuse, and misuse. Potential for respiratory depression; monitor respiratory status. Avoid use in breastfeeding women unless advised by a healthcare professional.

Adverse Reactions - Common

Drowsiness (Common)
Dizziness (Common)
Nausea (Common)
Constipation (Common)

Adverse Reactions - Serious

Respiratory depression (Serious, potentially life-threatening)
Allergic reactions (rash, itching, swelling) (Serious)
CNS depression leading to coma (Serious)

Drug-Drug Interactions

Other CNS depressants, including alcohol, benzodiazepines, other opioids
MAO inhibitors

Drug-Food Interactions

Alcohol

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess pain levels regularly. Monitor respiratory status, mental status, and signs of misuse.

Diagnoses:

Acute pain related to tissue injury.
Risk for respiratory depression.

Implementation: Administer drug as prescribed. Use the lowest effective dose for the shortest duration. Monitor for effectiveness and adverse effects.

Evaluation: Evaluate pain relief, respiratory status, and signs of adverse reactions.

Patient/Family Teaching

Advise on the risks of respiratory depression and signs to watch for.
Use medication exactly as prescribed.
Avoid alcohol and other CNS depressants.
Do not operate heavy machinery until response to medication is known.

Special Considerations

Black Box Warnings:

Risk of addiction, abuse, and misuse.
Life-threatening respiratory depression.

Genetic Factors: Patients with CYP2D6 ultrarapid metabolizer genotype may experience increased effects.

Lab Test Interference: May cause elevated liver enzymes or other laboratory test alterations.

Overdose Management

Signs/Symptoms: Respiratory depression, somnolence, muscle flaccidity, pinpoint pupils, cold/clammy skin.

Treatment: Naloxone administration to reverse opioid effects, supportive measures for breathing and circulation.

Storage and Handling

Storage: Store at room temperature away from moisture, heat, and light.

Stability: Stable under recommended storage conditions.