Codeine Phosphate

codeine phosphate (koe' deen) Pregnancy Category C (during pregnancy) Pregnancy Category D (during labor) Controlled Substance C-II Drug classes

Opioid agonist analgesic Antitussive Therapeutic actions

Acts at opioid receptors in the CNS to produce analgesia, euphoria, sedation; acts in medullary cough center to depress cough reflex. Indications

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Relief of mild to moderate pain in adults and children Suppression of coughing induced by chemical or mechanical irritation of the respiratory system

Contraindications and cautions

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Contraindicated with hypersensitivity to opioids, physical dependence on an opioid analgesic (drug may precipitate withdrawal). Use cautiously with pregnancy, labor, lactation, bronchial asthma, COPD, respiratory depression, anoxia, increased intracranial pressure, acute MI, ventricular failure, coronary insufficiency, hypertension, biliary tract surgery, renal or hepatic dysfunction.

Available forms

Tablets—15, 30, 60 mg; oral solution—15 mg/5 mL; injection—30, 60 mg Dosages ADULTS Analgesic

15–60 mg PO, IM, IV or SC q 4–6 hr; do not exceed 360 mg/24 hr. Antitussive

10–20 mg PO q 4–6 hr; do not exceed 120 mg/24 hr. PEDIATRIC PATIENTS

Contraindicated in premature infants. Analgesic

> 1 yr: 0.5 mg/kg SC, IM or PO q 4–6 hr. Antitussive

2–6 yr: 2.5–5 mg PO q 4–6 hr; do not exceed 30 mg/24 hr. 6–12 yr: 5–10 mg PO q 4–6 hr; do not exceed 60 mg/24 hr. GERIATRIC PATIENTS OR IMPAIRED ADULTS

Use caution; respiratory depression may occur in elderly, the very ill, those with respiratory problems. Reduced dosage may be necessary.

Pharmacokinetics Route Oral, IM, IV

Onset 10–30 min

Peak 30–60 min

Duration 4–6 hr

Metabolism: Hepatic; T1/2: 2.5–4 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine IV facts

Preparation: Protect vials from light. Infusion: Administer slowly over 5 min by direct injection or into running IV tubing. Adverse effects

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CNS: Sedation, clamminess, sweating, headache, vertigo, floating feeling, dizziness, lethargy, confusion, light-headedness, nervousness, unusual dreams, agitation, euphoria, hallucinations, delirium, insomnia, anxiety, fear, disorientation, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, seizures CV: Palpitation, increase or decrease in BP, circulatory depression, cardiac arrest, shock, tachycardia, bradycardia, arrhythmia, palpitations Dermatologic: Rash, hives, pruritus, flushing, warmth, sensitivity to cold EENT: Diplopia, blurred vision GI: Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency Local: Phlebitis following IV injection, pain at injection site; tissue irritation and induration (SC injection) Respiratory: Slow, shallow respiration; apnea; suppression of cough reflex; laryngospasm; bronchospasm Other: Physical tolerance and dependence, psychological dependence

Interactions

Drug-drug • Potentiation of effects of codeine with barbiturate anesthetics; decrease dose of codeine when coadministering Drug-lab test • Elevated biliary tract pressure may cause increases in plasma amylase, lipase; determinations of these levels may be unreliable for 24 hr after administration of opioids Nursing considerations CLINICAL ALERT!

Name confusion has been reported between codeine and Cardene (nicardipine) and Lodine (etodolac); use caution.

Assessment

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History: Hypersensitivity to codeine, physical dependence on an opioid analgesic, pregnancy, labor, lactation, bronchial asthma, COPD, increased intracranial pressure, acute MI, ventricular failure, coronary insufficiency, hypertension, biliary tract surgery, renal or hepatic dysfunction Physical: Orientation, reflexes, bilateral grip strength, affect; pupil size, vision; pulse, auscultation, BP; R, adventitious sounds; bowel sounds, normal output; liver and kidney function tests

Interventions

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Give to nursing women 4–6 hr before scheduled feeding to minimize drug in milk. During parenteral administration, ensure that an opioid antagonist and facilities for assisted or controlled respirations are readily available. Use caution when injecting SC into chilled body areas or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored. Instruct postoperative patients in pulmonary toilet; drug suppresses cough reflex. Monitor bowel function, arrange for laxatives (especially senna compounds— approximate dose of 187 mg senna concentrate per 120 mg codeine equivalent), bowel training program if severe constipation occurs.

Teaching points

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Take drug exactly as prescribed. Do not take any leftover medication for other disorders, and do not let anyone else take it. These side effects may occur: Dizziness, sedation, drowsiness, impaired visual acuity (avoid driving and performing other tasks that require alertness); nausea, loss of appetite (lie quietly; eat small, frequent meals); constipation (use a laxative). Report severe nausea, vomiting, palpitations, shortness of breath or difficulty breathing.

Adverse effects in Italic are most common; those in Bold are life-threatening.