The Full Wiki

Codeine: Wikis

  
  
  
  

Did you know ...


More interesting facts on Codeine

Include this on your site/blog:

Encyclopedia

From Wikipedia, the free encyclopedia

Codeine
Systematic (IUPAC) name
(5α,6α)-7,8-didehydro-4,5-epoxy-3-methoxy-17-methylmorphinan-6-ol
Identifiers
CAS number 76-57-3
ATC code R05DA04 N02AA59
PubChem 5284371
DrugBank APRD00120
ChemSpider 4447447
Chemical data
Formula C18H21NO3 
Mol. mass 299.364 g/mol
SMILES eMolecules & PubChem
Pharmacokinetic data
Bioavailability ~90% Oral
Metabolism Hepatic, via CYP2D6 (Cytochrome P450 2D6)[1]
Half life 2.5–3 hours
Therapeutic considerations
Pregnancy cat.  ?
Legal status Controlled (S8) (AU) Schedule I (CA) ? (UK) Schedule II (US)
Routes oral, intra-rectally, SC, IM
 Yes check.svgY(what is this?)  (verify)
.Codeine (INN) or methylmorphine is an opiate used for its analgesic, antitussive, and antidiarrheal properties.^ Codeine: Encyclopedia - Codeine Codeine Codeine (INN) or methylmorphine is an opioid used for its analgesic, antitussive and antidiarrheal properties.

^ Codeine is an effective antitussive and is widely used as a cough suppressant.

^ With this in mind, several more detailed studies have been done in an attempt to prove or disprove the theory that codeine's analgesic properties are due to its conversion to morphine by 2D6.
  • Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II -- Armstrong and Cozza 44 (6): 515 -- Psychosomatics 19 January 2010 9:54 UTC psy.psychiatryonline.org [Source type: Academic]

Contents

History

.Codeine, or methylmorphine, is a natural alkaloid found in opium poppy, a plant in the papaveraceae family.^ Indeed, codeine is found naturally along with morphine in the poppy seed.
  • Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II -- Armstrong and Cozza 44 (6): 515 -- Psychosomatics 19 January 2010 9:54 UTC psy.psychiatryonline.org [Source type: Academic]

^ Codeine is an alkaloid extracted from Opium.
  • 10 posts tagged “codeine phosphate” - 容易なトラ’s Blog on Vox 16 September 2009 22:14 UTC idj3.vox.com [Source type: General]

^ Codeine is an alkaloid obtained from opium or prepared from morphine by methylation and occurs as white crystals.
  • Codeine Phosphate - http://www.drugbuyers.com/freeboard 19 January 2010 9:54 UTC www.drugbuyers.com [Source type: FILTERED WITH BAYES]

Opium poppy has been cultivated and utilized throughout human history for a variety of medicinal (analgesic, anti-tussive, anti-diarrheal...) and hypnotic properties linked to the diversity of its active components, which include morphine, codeine, papaverine...
Until the beginning of the 19th century, raw opium was used in diverse preparations known as laudanum (see Thomas de Quincey's "Confessions of an English Opium-Eater", 1821), paregoric elixirs (a number of them, very popular in England since the beginning of the 18th century; the original preparation seems to have been elaborated in Leyden,Holland around 1715 by a chemist named Lemort; in 1721 the London Pharmocopeia mentions an Elixir Asthmaticum, replaced by the term Elixir Paregoricum ("pain soother") in 1746)
The progressive isolation of opium's several active components opened the path to improved selectivity and safeness of the opiates-based pharmacopeia.
Morphine had been isolated in the early 1800s. .Codeine was first isolated in 1832 in France by Pierre Robiquet, a French chemist and pharmacist already famous for the discovery of alizarin, the most widespread red dye, while working on refined morphine extraction processes, and this opened to path to the elaboration of a new generation of specific antitussive and antidiarrheal potions of much safer use, based on codeine only.^ In a four week multidose trial Kjaersgaard-Andersen et al found a significant difference between the paracetamol-codeine group and the paracetamol alone group only in the first week.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ If there are alternative painkillers which could be used doctors should use them, particularly as, in most situations when morphine/codeine is likely to be needed, the extra distress can only exacerbate the situation (e.g.

^ What information is already given to people to ensure safe use of codeine products?
  • PAGB 19 November 2009 18:018 UTC www.pagb.co.uk [Source type: FILTERED WITH BAYES]

.Codeine is nowadays by far the most widely used opiate in the world and very likely even the most commonly used drug overall according to numerous reports over the years by organizations such as the World Health Organization and its League of Nations predecessor agency and others.^ The World Health Organisation recommends that for mild pain people should use a pain relief product with paracetamol or a non steroidal anti-inflammatory (NSAID) such as ibuprofen or aspirin.
  • PAGB 19 November 2009 18:018 UTC www.pagb.co.uk [Source type: FILTERED WITH BAYES]

^ Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use.
  • Acetaminophen; Codeine 19 January 2010 9:54 UTC www.stjohn.org [Source type: FILTERED WITH BAYES]

^ Amphetamine and cannabis are the most commonly encountered drugs in DUID suspects in Sweden, but morphine and codeine are also high on the list of substances confirmed present in blood specimens.
  • Concentration Ratios of Morphine to Codeine in Blood of Impaired Drivers as Evidence of Heroin Use and not Medication with Codeine -- Ceder and Jones 47 (11): 1980 -- Clinical Chemistry 19 January 2010 9:54 UTC www.clinchem.org [Source type: Academic]

.It is one of the most effective orally-administered opioid analgesics and has a wide safety margin.^ Also, most commonly, the post operative self-administered analgesic contains some kind of morphine.

^ Bioavailability is about 50% (Moffat, 1986) Codeine, in contrast to morphine, is two-thirds as effective orally as parenterally, both as an analgesic and as a respiratory depressant.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Codeine: Encyclopedia - Carfentanil Carfentanil Carfentanil, also Carfentanyl, is an analogue of the popular opioid Fentanyl, and is one of the most potent opioids known (and the most potent opioid used commercially).

.It is from 8 to 12 percent of the strength of morphine in most people; differences in metabolism can change this figure as can other medications, depending on its route of administration.^ I'd heard) that most medical codeine is a morphine derivative.

^ Most Caucasians seem to be rapid metabolizers of codeine, and morphine/codeine ratios within this population are always much less than unity ( 27 ).
  • Concentration Ratios of Morphine to Codeine in Blood of Impaired Drivers as Evidence of Heroin Use and not Medication with Codeine -- Ceder and Jones 47 (11): 1980 -- Clinical Chemistry 19 January 2010 9:54 UTC www.clinchem.org [Source type: Academic]

^ Most people taking Crestor or other problems such as gonorrhea.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

.While codeine can be directly extracted from opium, its original source, most codeine is synthesized from morphine through the process of O-methylation.^ PHYSICO-CHEMICAL PROPERTIES 3.1 Origin of the substance Codeine is obtained either naturally, from opium (extracted from Papaver somnifera) or by methylation of morphine.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ I'd heard) that most medical codeine is a morphine derivative.

^ Most Caucasians seem to be rapid metabolizers of codeine, and morphine/codeine ratios within this population are always much less than unity ( 27 ).
  • Concentration Ratios of Morphine to Codeine in Blood of Impaired Drivers as Evidence of Heroin Use and not Medication with Codeine -- Ceder and Jones 47 (11): 1980 -- Clinical Chemistry 19 January 2010 9:54 UTC www.clinchem.org [Source type: Academic]

.By 1972, the effects of the Nixon War On Drugs had caused across-the-board shortages of illicit and licit opiates because of a scarcity of natural opium, poppy straw, and other sources of opium alkaloids, and the geopolitical situation was getting less helpful for the United States.^ This agrees with the findings of Stewart, who noted that multidose studies have been reliable predictors of the tendency of a drug to cause side effects.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ Avoid alcoholic beverages because they may increase the risk of this drug's side effects.
  • Codeine Sulfate (Codeine) Drug Information: Uses, Side Effects, Drug Interactions and Warnings at RxList 19 January 2010 9:54 UTC www.rxlist.com [Source type: FILTERED WITH BAYES]

^ Morphine is naturally occurring substance in the opium poppy, Papaver somniferum.
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

.After a large percentage of the opium and morphine in the US National Stockpile of Strategic & Critical Materials had to be tapped in order to ease severe shortages of medicinal opiates — the codeine-based antitussives in particular — in late 1973, researchers were tasked with and quickly succeeded in finding a way to synthesize codeine and its derivatives and precursors from scratch from petroleum or coal tar using a process developed at the United States' National Institutes of Health.^ These natural opium derivatives include heroin, morphine, and codeine.
  • Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II -- Armstrong and Cozza 44 (6): 515 -- Psychosomatics 19 January 2010 9:54 UTC psy.psychiatryonline.org [Source type: Academic]

^ While codeine can be extracted from opium, most codeine used in the United States is synthesized from morphine through the process of O-methylation.

^ Codeine is synthesized from Morphine and Morphine is used to manufacture Heroin.
  • 10 posts tagged “codeine phosphate” - 容易なトラ’s Blog on Vox 16 September 2009 22:14 UTC idj3.vox.com [Source type: General]

.Numerous codeine salts have been prepared since the drug was discovered.^ This makes some intuitive sense, since the CYP450 enzymes prepare the drug for a handle to allow for the conjugation reactions.
  • Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II -- Armstrong and Cozza 44 (6): 515 -- Psychosomatics 19 January 2010 9:54 UTC psy.psychiatryonline.org [Source type: Academic]

^ Codeine: Encyclopedia - Dextromethorphan Dextromethorphan (DM or less commonly, DXM) is an antitussive drug that is found in many over-the-counter cold and cough preparations.

The most commonly used are the hydrochloride (freebase conversion ratio 0.805), phosphate (0.736), sulphate (0.859), and citrate (0.842). .Others include a salicylate NSAID, codeine salicylate (0.686), and at least four codeine-based barbiturates, the cyclohexenylethylbarbiturate (0.559), cyclopentenylallylbarbiturate (0.561), diallylbarbiturate (0.561), and diethylbarbiturate (0.619).^ If any contain a narcotic, a barbiturate, aspirin, or other salicylates, including diflunisal, check with your doctor or pharmacist .
  • Barbiturates, Aspirin, and Codeine (Systemic) 19 January 2010 9:54 UTC allnutritionals.com [Source type: FILTERED WITH BAYES]

^ Tell your doctor if you have ever had any unusual or allergic reaction to aspirin or other salicylates including methyl salicylate (oil of wintergreen); butalbital, phenobarbital, or other barbiturates; caffeine; codeine; or any of the following medicines: .
  • Barbiturates, Aspirin, and Codeine (Systemic) 19 January 2010 9:54 UTC allnutritionals.com [Source type: FILTERED WITH BAYES]

^ Analgesic drugs act in various ways on the peripheral and central nervous system; they include paracetamol (acetaminophen), the nonsteroidal anti-inflammatory drugs (NSAIDs) such as the salicylates, narcotic drugs such as morphine, synthetic drugs with narcotic properties such as tramadol, and various others.

Pharmacology

.Codeine is considered a prodrug, since it is metabolised in vivo to the primary active compounds morphine and codeine-6-glucuronide (C6G).^ Codeine, and most opioids in this class, get metabolised TO morphine, the active metabolite being morphine-3-glucuronide.

^ In adults, glucuronide conjugation in the liver apparently inactivates codeine, but 10% of an oral dose is demethylated to form morphine, which is believed by some to be the active form of the drug.
  • Use of Codeine- and Dextromethorphan-Containing Cough Remedies in Children -- Committee on Drugs 99 (6): 918 -- Pediatrics 19 January 2010 9:54 UTC pediatrics.aappublications.org [Source type: Academic]

^ In 1948, Sanfilippo first suggested that the analgesic effect of codeine was because of the proportion of the drug metabolized to morphine and this has lead to the belief that codeine is a prodrug, with morphine as its principal active metabolite and having little or no intrinsic analgesic activity of its own.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

[2][3] .Roughly 5-10% of codeine will be converted to morphine, with the remainder either free, conjugated to form codeine-6-glucuronide (~70%), or converted to norcodeine (~10%) and hydromorphone (~1%).^ Consequently, infants of nursing mothers with a certain CYP2D6 (converts codeine to morphine) genotype, may be exposed to potentially dangerous serum levels of morphine as well.
  • Codeine: Drug Information Provided by Lexi-Comp: Merck Manual Professional 19 November 2009 18:018 UTC www.merck.com [Source type: Academic]

^ Of the 86% excreted after an oral dose 40 to 70% is free or conjugated codeine, 5 to 15% free or conjugated morphine, 10 to 20% is free or conjugated norcodeine; unchanged drug accounts for 6 to 8% of the dose excreted in urine within 24 hours but this can increase to 10% if the urinary pH is decreased.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Excretion: Urine (3% to 16% as unchanged drug, norcodeine, and free and conjugated morphine) .
  • Codeine: Drug Information Provided by Lexi-Comp: Merck Manual Professional 19 November 2009 18:018 UTC www.merck.com [Source type: Academic]

.It is less potent than morphine and has a correspondingly lower dependence-liability than morphine.^ Less respiratory depression than morphine .
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

^ It also has a correspondingly lower dependence-liability than morphine.

^ Codeine is less potent than morphine as an analgesic.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

[4] .Like all opioids, continued use of codeine induces physical dependence and can be psychologically addictive.^ Tolerance, psychological and physical dependence may occur with prolonged use.
  • Codeine: Drug Information Provided by Lexi-Comp: Merck Manual Professional 19 November 2009 18:018 UTC www.merck.com [Source type: Academic]

^ Codeine may produce physical and psychological dependence.
  • Acetaminophen and Codeine - Plum Market 19 January 2010 9:54 UTC www.plummarket.com [Source type: Academic]

^ May cause physical and/or psychological dependence.
  • Codeine: Drug Information Provided by Lexi-Comp: Merck Manual Professional 19 November 2009 18:018 UTC www.merck.com [Source type: Academic]

.However, the withdrawal symptoms are relatively mild, and, as a consequence, codeine is considerably less addictive than the other opiates.^ Withdrawal symptoms from codeine.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ Coproxamol is more addictive and less effective than codeine phosphate.
  • Codeine discussions (experiences, side effects, dosages, etc...) 19 January 2010 9:54 UTC www.drugtalk.com [Source type: General]

^ Most Caucasians seem to be rapid metabolizers of codeine, and morphine/codeine ratios within this population are always much less than unity ( 27 ).
  • Concentration Ratios of Morphine to Codeine in Blood of Impaired Drivers as Evidence of Heroin Use and not Medication with Codeine -- Ceder and Jones 47 (11): 1980 -- Clinical Chemistry 19 January 2010 9:54 UTC www.clinchem.org [Source type: Academic]

.A dose of approximately 200 mg (oral) of codeine must be administered to give analgesia approximately equivalent to 30 mg (oral) of morphine (Rossi, 2004).^ Indication for prescribing codeine 30 mgs..
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ Theoretically, a dose of approximately 200 mg (oral) of codeine must be administered to give equivalent analgesia to 30 mg (oral) of morphine (Rossi, 2004).

^ It has been suggested that a dose of codeine 1 mg kg –1 i.m.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

.However, codeine is, in general, not used in single doses of greater than 60 mg (and no more than 240 mg in 24 hours)[5].^ Maximum effective analgesic dose of codeine is 60 mg (1 grain).
  • Codeine: Drug Information Provided by Lexi-Comp: Merck Manual Professional 19 November 2009 18:018 UTC www.merck.com [Source type: Academic]

^ Most studies used a codeine dose of 60 mg.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ H of more than 9 in a 0.5% solution of codeine in water.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

.When analgesia beyond this is required, stronger opioids such as hydrocodone or oxycodone are favored.^ Phenanthrene hypersensitivity: Use with caution in patients with hypersensitivity reactions to other phenanthrene-derivative opioid agonists (hydrocodone, hydromorphone, levorphanol, oxycodone, oxymorphone).
  • Codeine: Drug Information Provided by Lexi-Comp: Merck Manual Professional 19 November 2009 18:018 UTC www.merck.com [Source type: Academic]

^ Hydrocodone is a weaker opioid than morphine but still a effective opioid with similar potency to oxycodone.
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

.Codeine is metabolized to C6G by uridine diphosphate glucuronosyl transferase (UGT) 2B7, and, since only about 5% of codeine is metabolized by cytochrome P450 CYP2D6, the current evidence is that C6G is the primary active compound.^ Codeine: Encyclopedia II - Codeine - Pharmacokinetics Codeine is considered a prodrug, since it is metabolised in vivo to the principal active analgesic agent morphine.

^ Incidentally, the 3 and 6 positions are also the main sites for conjugation with glucuronic acid by various uridine diphosphate glucuronosyl transferase (UGT) enzymes.
  • Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II -- Armstrong and Cozza 44 (6): 515 -- Psychosomatics 19 January 2010 9:54 UTC psy.psychiatryonline.org [Source type: Academic]

^ Unlike morphine, which is metabolized chiefly through conjugation reactions with uridine diphosphate glucuronosyl transferase (UGT) enzymes, these five drugs are metabolized both through oxidative reactions by the cytochrome P450 (CYP450) enzyme and conjugation by UGT enzymes.
  • Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II -- Armstrong and Cozza 44 (6): 515 -- Psychosomatics 19 January 2010 9:54 UTC psy.psychiatryonline.org [Source type: Academic]

[6] .Claims about the supposed "ceiling effect" of codeine doses seemed to rest on the assumption that high doses of codeine saturated CYP2D6, which prevented further conversion of codeine to morphine, which is simply incorrect.^ Theoretically, a dose of approximately 200 mg (oral) of codeine must be administered to give equivalent analgesia to 30 mg (oral) of morphine (Rossi, 2004).

^ In adults, glucuronide conjugation in the liver apparently inactivates codeine, but 10% of an oral dose is demethylated to form morphine, which is believed by some to be the active form of the drug.
  • Use of Codeine- and Dextromethorphan-Containing Cough Remedies in Children -- Committee on Drugs 99 (6): 918 -- Pediatrics 19 January 2010 9:54 UTC pediatrics.aappublications.org [Source type: Academic]

^ Parenteral A dose of 120 mg of codeine given subcutaneously produces analgesia equivalent to that resulting from 10 mg of morphine.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

.There is also no evidence that CYP2D6 inhibition is useful in treating codeine dependence,[7] though the metabolism of codeine to morphine (and hence further metabolism to glucuronide morphine conjugates) does have an effect on the abuse potential of codeine.^ Therapeutic doses of codeine have no effect on acetaminophen clearance or metabolism.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ Use and abuse of codeine.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ It has been presumed that UGT 2B7 is largely responsible for DHC-6-glucuronide formation, 22 similar to codeine's conversion to C6G. With dihydrocodeine's metabolism so similar to codeine, it should come as no surprise that there is the potential for controversy as to what chemical(s) or metabolite(s) contributes to its analgesic effect.
  • Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II -- Armstrong and Cozza 44 (6): 515 -- Psychosomatics 19 January 2010 9:54 UTC psy.psychiatryonline.org [Source type: Academic]

[8]

Pharmacokinetics

.The conversion of codeine to morphine occurs in the liver and is catalysed by the cytochrome P450 enzyme CYP2D6.^ Because of polymorphisms of the CYP2D6 enzyme, large interethnic differences in the rate and extent of demethylation of codeine exist ( 27 ).
  • Concentration Ratios of Morphine to Codeine in Blood of Impaired Drivers as Evidence of Heroin Use and not Medication with Codeine -- Ceder and Jones 47 (11): 1980 -- Clinical Chemistry 19 January 2010 9:54 UTC www.clinchem.org [Source type: Academic]

^ O-Demethylation of codeine to morphine is dependent on the cytochrome P450 enzyme, CYP2D6, which is known to show genetic polymorphism, 23 32 116 whereas the other metabolic pathways for codeine are not dependent on this enzyme.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Codeine is an alkaloid obtained from opium or prepared from morphine by methylation and occurs as white crystals.
  • Codeine Phosphate - http://www.drugbuyers.com/freeboard 19 January 2010 9:54 UTC www.drugbuyers.com [Source type: FILTERED WITH BAYES]

.CYP3A4 produces norcodeine and UGT2B7 conjugates codeine, norcodeine, and morphine to the corresponding 3- and 6- glucuronides.^ Metabolism Codeine is metabolized mainly in the liver where it undergoes 0-demethylation to form morphine, N-demethylation to form norcodeine , and partial conjugation to form glucuronides and sulphates of both the unchanged drug and its metabolites (Moffat, 1986).
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Poor metabolizers will produce little or no morphine from codeine whereas extensive metabolizers will produce significant amounts of morphine although the actual amount produced may show wide variation.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Parenteral A dose of 120 mg of codeine given subcutaneously produces analgesia equivalent to that resulting from 10 mg of morphine.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

.Approximately 6–10% of the Caucasian population, 2% of Asians, and 1% of Arabs[9] are "poor metabolizers"; they have little CYP2D6, and codeine is less effective for analgesia in these patients (Rossi, 2004), although it is speculated that codeine-6-glucuronide is responsible for a large percentage of the analgesia of codeine, and, thus, these patients should experience some analgesia.^ Because of polymorphisms of the CYP2D6 enzyme, large interethnic differences in the rate and extent of demethylation of codeine exist ( 27 ).
  • Concentration Ratios of Morphine to Codeine in Blood of Impaired Drivers as Evidence of Heroin Use and not Medication with Codeine -- Ceder and Jones 47 (11): 1980 -- Clinical Chemistry 19 January 2010 9:54 UTC www.clinchem.org [Source type: Academic]

^ It has been presumed that UGT 2B7 is largely responsible for DHC-6-glucuronide formation, 22 similar to codeine's conversion to C6G. With dihydrocodeine's metabolism so similar to codeine, it should come as no surprise that there is the potential for controversy as to what chemical(s) or metabolite(s) contributes to its analgesic effect.
  • Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II -- Armstrong and Cozza 44 (6): 515 -- Psychosomatics 19 January 2010 9:54 UTC psy.psychiatryonline.org [Source type: Academic]

^ Poor metabolizers will produce little or no morphine from codeine whereas extensive metabolizers will produce significant amounts of morphine although the actual amount produced may show wide variation.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

[3] .Many of the adverse effects will still be experienced in poor metabolizers.^ However, the lack of analgesic effect consistently seen in poor metabolizers makes both this mechanism and a direct effect of codeine itself unlikely.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Codeine was shown to have no effect on opioid-insensitive phasic pain in either extensive or poor metabolizers in these studies, which suggests that an opioid receptor mediated effect for codeine is likely.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Furthermore, there is evidence that adverse effects may occur in the absence of analgesia in poor metabolizers of the drug.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

.Conversely, 0.5-2% of the population are "extensive metabolizers"; multiple copies of the gene for 2D6 produce high levels of CYP2D6 and will metabolize drugs through that pathway more quickly than others.^ Higher levels of morphine may be found in the breast milk of lactating mothers who are “ultra-rapid metabolizers” of codeine; patients with two or more copies of the variant CYP2D6*2 allele may have extensive conversion to morphine and thus increased opioid-mediated effects.
  • Codeine: Drug Information Provided by Lexi-Comp: Merck Manual Professional 19 November 2009 18:018 UTC www.merck.com [Source type: Academic]

^ Poor metabolizers will produce little or no morphine from codeine whereas extensive metabolizers will produce significant amounts of morphine although the actual amount produced may show wide variation.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Most Caucasians seem to be rapid metabolizers of codeine, and morphine/codeine ratios within this population are always much less than unity ( 27 ).
  • Concentration Ratios of Morphine to Codeine in Blood of Impaired Drivers as Evidence of Heroin Use and not Medication with Codeine -- Ceder and Jones 47 (11): 1980 -- Clinical Chemistry 19 January 2010 9:54 UTC www.clinchem.org [Source type: Academic]

.Some medications are CYP2D6 inhibitors and reduce or even completely block the conversion of codeine to morphine.^ Conversion of codeine to morphine.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ I'd heard) that most medical codeine is a morphine derivative.

^ PRECAUTIONS: Before taking codeine, tell your doctor or pharmacist if you are allergic to it; or to other narcotic pain medications (e.g., morphine, hydrocodone, oxycodone); or to sulfites (found in some brands); or if you have any other allergies.
  • Codeine Sulfate (Codeine) Drug Information: Uses, Side Effects, Drug Interactions and Warnings at RxList 19 January 2010 9:54 UTC www.rxlist.com [Source type: FILTERED WITH BAYES]

.The most well-known of these are two of the selective serotonin reuptake inhibitors, paroxetine (Paxil) and fluoxetine (Prozac) as well as the antihistamine diphenhydramine and the antidepressant, buproprion (Wellbutrin, also known as Zyban).^ This particular oxidative step is important in the metabolism of more than 30 drugs and environmental chemicals, including about 20% of commonly prescribed drugs, for example tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), some neuroleptics, some antiarrhythmics and ß-adrenoreceptor blockers as well as codeine and tramadol.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Example inhibitors include chlorpromazine, delavirdine, fluoxetine, miconazole, paroxetine, pergolide, quinidine, quinine, ritonavir, and ropinirole.

^ Clin Pharmacol Ther 1992; 51 : 388–97 [Web of Science] [Medline] 15 Brosen K. The pharmacogenetics of the selective serotonin reuptake inhibitors.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

.Other drugs, such as rifampicin and dexamethasone, induce CYP450 isozymes and thus increase the conversion rate.^ Many other studies, also in adults, confirm that codeine 30–60 mg can add significantly to the analgesic effect of drugs such as aspirin, paracetamol and NSAIDs.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Furthermore, alteration of hepatic enzyme pathways by illness or concurrent drug therapy (such as acetaminophen) may further alter metabolism of this drug and increase the risk of drug toxicity.
  • Use of Codeine- and Dextromethorphan-Containing Cough Remedies in Children -- Committee on Drugs 99 (6): 918 -- Pediatrics 19 January 2010 9:54 UTC pediatrics.aappublications.org [Source type: Academic]

.While a CYP2D6 extensive metaboliser (EM) needs higher doses of drugs metabolized by CYP2D6 to maintain sufficient plasma levels for therapeutic effect and a poor metaboliser (PM) may suffer from drug toxicity due to slow drug clearance and excessive plasma concentration, prodrugs like codeine have the opposite effect.^ Therapeutic doses of paracetamol do not influence the pharmacokinetics and metabolism of codeine, 41 and codeine has no effect on the metabolism and clearance of paracetamol.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ CYP2D6 Inhibitors (Moderate): May diminish the therapeutic effect of Codeine.
  • Codeine: Drug Information Provided by Lexi-Comp: Merck Manual Professional 19 November 2009 18:018 UTC www.merck.com [Source type: Academic]

^ Therapeutic doses of codeine have no effect on acetaminophen clearance or metabolism.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

.Thus an EM may have adverse effects from a rapid buildup of codeine metabolites while a PM may get little or no pain relief.^ I have severe chronic pain with no relief.

^ Adverse effects codeine.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ Main > Strong Pain Relief > Codeine-Paracetamol Codeine and Paracetamol are combined and used to treat moderate to severe pain.
  • Buy Codeine-Paracetamol online at DrugPriceGrabber.com 19 January 2010 9:54 UTC www.drugpricegrabber.com [Source type: General]

.CYP2D6 is dysfunctional in 7% of white and black Americans, resulting in reduced metabolism of codeine.^ In early life, the immaturity of infant metabolic processes is also likely to reduce the efficacy of codeine.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ These CYP2D6 inhibitors may prevent the metabolic conversion of codeine to its active metabolite morphine.
  • Codeine: Drug Information Provided by Lexi-Comp: Merck Manual Professional 19 November 2009 18:018 UTC www.merck.com [Source type: Academic]

^ It has been suggested that infants and neonates have a reduced metabolic capacity for codeine.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

.Other individuals may have two or more copies of the CYP2D6 gene, resulting in rapid metabolism of the target drug.^ I understand that they bailed out Chrysler because there was a willing bidder and its failure may have resulted in several hundreds of thousands more job losses.
  • New 2012 Ford Focus unveiled (pics) - Democratic Underground 19 January 2010 9:54 UTC www.democraticunderground.com [Source type: FILTERED WITH BAYES]

^ CYP2D6 “ultra-rapid metabolizers”: Use caution in patients with two or more copies of the variant CYP2D6*2 allele; may have extensive conversion to morphine and thus increased opioid-mediated effects.
  • Codeine: Drug Information Provided by Lexi-Comp: Merck Manual Professional 19 November 2009 18:018 UTC www.merck.com [Source type: Academic]

^ Apparently there's a genetic test that can reveal if you are a rapid metabolizer of codeine and other drugs.

.CYP2D6 metabolizes and activates codeine into morphine, which then undergoes glucuronidation.^ A small percentage of codeine is metabolized into morphine but not nearly all of it.

^ Poor metabolizers will produce little or no morphine from codeine whereas extensive metabolizers will produce significant amounts of morphine although the actual amount produced may show wide variation.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Most Caucasians seem to be rapid metabolizers of codeine, and morphine/codeine ratios within this population are always much less than unity ( 27 ).
  • Concentration Ratios of Morphine to Codeine in Blood of Impaired Drivers as Evidence of Heroin Use and not Medication with Codeine -- Ceder and Jones 47 (11): 1980 -- Clinical Chemistry 19 January 2010 9:54 UTC www.clinchem.org [Source type: Academic]

.Life-threatening intoxication, including respiratory depression requiring intubation, can develop over a matter of days in patients who have multiple functional alleles of CYP2D6, resulting in ultra-rapid metabolism of opioids such as codeine into morphine.^ Less respiratory depression than morphine .
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

^ A small percentage of codeine is metabolized into morphine but not nearly all of it.

^ Use with caution in patients with hypersensitivity reactions to other phenanthrene derivative opioid agonists (morphine, hydrocodone, hydromorphone, levorphanol, oxycodone, oxymorphone); respiratory diseases including asthma, emphysema, COPD, or severe liver or renal insufficiency; some preparations contain sulfites which may cause allergic reactions; tolerance or drug dependence may result from extended use .

[10][11][12]
.The active metabolites of codeine, notably morphine, exert their effects by binding to and activating the μ-opioid receptor.^ Codeine binds to the µ receptor like morphine but with a much lower affinity.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Codeine, and most opioids in this class, get metabolised TO morphine, the active metabolite being morphine-3-glucuronide.

^ It may have a direct (opioid or non-opioid receptor mediated) analgesic effect or, as already mentioned, may act through metabolism to morphine or other active metabolites.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

Indications

Approved indications for codeine include:
.
  • Cough, though its efficacy in low dose over the counter formulations has been disputed.^ Clinical efficacy Both adult and paediatric clinical studies have demonstrated that the efficacy of codeine is low and that it has a ceiling effect at higher doses above which there is a marked increase in the incidence of side-effects.
    • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

    ^ Weak opioids, such as codeine, are available over-the-counter (OTC) in low doses to provide pain relief.
    • PAGB 19 November 2009 18:018 UTC www.pagb.co.uk [Source type: FILTERED WITH BAYES]

    [13]
  • Diarrhea
  • Mild to moderate pain
  • Irritable bowel syndrome
.Codeine is marketed as both a single-ingredient drug and in combination preparations with the analgesic acetaminophen (paracetamol), as co-codamol, paracod, panadeine, or the Tylenol With Codeine series (e.g., Tylenol 3 and 4 tablets and elixir); with the analgesic acetylsalicylic acid (aspirin), as co-codaprin; or with the NSAID (non-steroidal anti-inflammatory drug) ibuprofen, as Nurofen Plus.^ A superior analgesic effect was found with the paracetamol-codeine combination.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ Codeine is often used in combination with other drugs, for example aspirin, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and diphenhydramine in the treatment of mild to moderate pain.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Codeine in combination with acetaminophen or aspirin is recommended.

.These combinations provide greater pain relief than either agent alone (drug synergy).^ These combination medicines may provide better pain relief than either aspirin or codeine used alone.
  • Barbiturates, Aspirin, and Codeine (Systemic) 19 January 2010 9:54 UTC allnutritionals.com [Source type: FILTERED WITH BAYES]

^ Main > Strong Pain Relief > Codeine-Paracetamol Codeine and Paracetamol are combined and used to treat moderate to severe pain.
  • Buy Codeine-Paracetamol online at DrugPriceGrabber.com 19 January 2010 9:54 UTC www.drugpricegrabber.com [Source type: General]

^ I had total relief of all pain without any drugged feeling.

.Codeine is also commonly marketed in products containing codeine with other pain killers or muscle relaxers such as Fioricet with Codeine, Soma Compound/Codeine, as well as codeine mixed with phenacetin (Emprazil With Codeine No.^ What kind of pain can codeine containing products treat?
  • PAGB 19 November 2009 18:018 UTC www.pagb.co.uk [Source type: FILTERED WITH BAYES]

^ In this column, we will review the metabolism and pharmacokinetic drug-drug interaction profiles of codeine and related compounds (dihydrocodeine, hydrocodone, and oxycodone) as well as buprenorphine.
  • Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II -- Armstrong and Cozza 44 (6): 515 -- Psychosomatics 19 January 2010 9:54 UTC psy.psychiatryonline.org [Source type: Academic]

^ Alcohol and other CNS depressants may produce an additive CNS depression when taken with Butalbital compound with Codeine, and should be avoided.
  • Fioricet with codeine - http://www.drugbuyers.com/freeboard 19 January 2010 9:54 UTC www.drugbuyers.com [Source type: FILTERED WITH BAYES]

.1, 2, 3, and 4), naproxen, indomethacin, diclofenac and others as well as more complex mixtures including such mixtures as aspirin + paracetamol + codeine ± caffeine ± antihistamines and other agents such as mentioned above.^ The caffeine in the butalbital, aspirin, and codeine combination interferes with the results of certain tests that use dipyridamole (e.g., Persantine) to help show how well blood is flowing to your heart.
  • Barbiturates, Aspirin, and Codeine (Systemic) 19 January 2010 9:54 UTC allnutritionals.com [Source type: FILTERED WITH BAYES]

^ Criteria for inclusion were (a) equal dosage of paracetamol in the paracetamol-codeine and paracetamol only groups, (b) controlled clinical trial or randomised controlled trial, and (c) only codeine added to paracetamol (not caffeine).
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ Codeine has a weaker depressive effect than other opiates to the cortex and medullary centres, but is more stimulating to the spinal cord.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

.Codeine-only products can be obtained with a prescription as a time release tablet (e.g., Codeine Contin 100 mg and Perduretas 50 mg).^ Combaren (Codeine 50 mg / Diclofenac) .
  • Buy Codeine Phosphate online at DrugPriceGrabber.com 19 January 2010 9:54 UTC www.drugpricegrabber.com [Source type: General]

^ When 100 mg of codeine phosphate was given to healthy volunteers, the peak plasma morphine concentration was only 3.2% of the peak codeine concentration ( 19 ).
  • Concentration Ratios of Morphine to Codeine in Blood of Impaired Drivers as Evidence of Heroin Use and not Medication with Codeine -- Ceder and Jones 47 (11): 1980 -- Clinical Chemistry 19 January 2010 9:54 UTC www.clinchem.org [Source type: Academic]

^ I know about a site that offers tylenol #1 (only 8 mg of codeine), but at reasonable prices.
  • Acetaminophen and codeine - http://www.drugbuyers.com/freeboard 19 January 2010 9:54 UTC www.prescriptionbuyers.com [Source type: FILTERED WITH BAYES]

.Codeine is also marketed in cough syrups with zero to a half-dozen other active ingredients, and a linctus (e.g., Paveral) for all of the uses for which codeine is indicated.^ Bromotuss w codeine cough syrup.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ I took antibiotics and codeine cough syrup.
  • Codeine discussions (experiences, side effects, dosages, etc...) 19 January 2010 9:54 UTC www.drugtalk.com [Source type: General]

^ Codeine cough syrup in pregnancy.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

.Injectable codeine is available for subcutaneous or intramuscular injection; intravenous injection can cause a serious reaction that can progress to anaphylaxis.^ Relevant animal data Codeine LD50 (oral) rat 427 mg/kg LD50 (intravenous) rat 75 mg/kg LD50 (subcutaneous) rat 229 mg/kg Codeine phosphate LD50 (oral) rat 266 mg/kg LD50 (intravenous) rat 54 mg/kg LD50 (subcutaneous) rat 365 mg/kg LD50 (intramuscular) rat 208 mg/kg (Sax & Lewis, 1989) 7.2.3 Relevant in vitro data No relevant data available.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ I had a life threatening reaction to Codeine which nearly caused a heart attack and did cause hyperventilation.

^ Intravenous injection may cause these effects more rapidly.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

Codeine suppositories are also marketed in some countries.

Narcotic Content Numbers (US & Canada)

.The narcotic content number in the US names of codeine tablets and combination products like Tylenol With Codeine No.^ Rxpuravida has acetaminophen and codeine (not tylenol brand name).
  • Acetaminophen and codeine - http://www.drugbuyers.com/freeboard 19 January 2010 9:54 UTC www.prescriptionbuyers.com [Source type: FILTERED WITH BAYES]

^ The 15 single dose studies showed no significant difference between paracetamol-codeine combinations and paracetamol alone.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ Comparing all possible combinations showed that the increase in efficacy with the paracetamol-codeine combination versus paracetamol alone was no different from the increase with codeine versus placebo.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

3, Emprin With Codeine No. .4, and pure codeine tablets are as follows: No.^ A study in healthy adult volunteers showed no difference in codeine bioavailability following rectal or oral administration with a systemic availability of about 90%.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

1 - 7½ or 8 mg (1/8 grain), No. 2 - 15 or 16 mg (1/4 grain), No. 3 - 30 or 32 mg (1/2 grain), No. .4 - 60 or 64 mg (1 grain).^ Maximum effective analgesic dose of codeine is 60 mg (1 grain).
  • Codeine: Drug Information Provided by Lexi-Comp: Merck Manual Professional 19 November 2009 18:018 UTC www.merck.com [Source type: Academic]
  • Codeine - Erewhon Natural Foods 19 January 2010 9:54 UTC www.erewhonmarket.com [Source type: Academic]

The Canadian 222 series is identical to the above list 222=1/8 grain, 292=1/4 grain, 293=1/2 grain, and 294=1 grain of codeine. .This system, which is also used at present in the trade names of some dihydrocodeine and ethylmorphine products both in and outside of North America, was inaugurated with the Pure Food and Drug Act of 1906 and related legislation and refined since.^ At this time, we believe it is unclear what primarily causes dihydrocodeine's analgesic properties—parent drug, metabolites, or some combination.
  • Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II -- Armstrong and Cozza 44 (6): 515 -- Psychosomatics 19 January 2010 9:54 UTC psy.psychiatryonline.org [Source type: Academic]

^ In this column, we will review the metabolism and pharmacokinetic drug-drug interaction profiles of codeine and related compounds (dihydrocodeine, hydrocodone, and oxycodone) as well as buprenorphine.
  • Pharmacokinetic Drug Interactions of Morphine, Codeine, and Their Derivatives: Theory and Clinical Reality, Part II -- Armstrong and Cozza 44 (6): 515 -- Psychosomatics 19 January 2010 9:54 UTC psy.psychiatryonline.org [Source type: Academic]

^ Addiction is a behavior related to getting and using a drug for a non medical reason.
  • Acetaminophen; Codeine 19 January 2010 9:54 UTC www.stjohn.org [Source type: FILTERED WITH BAYES]

Equivalent scales for labeling stronger opioids such as diacetylmorphine (heroin), morphine, opium salts mixtures, and others were in common use in the past, and on occasion one can find past references to brand names for hydrocodone (invented 1920, introduced in US 1943), hydromorphone (invented 1924), oxycodone (invented 1916), paregoric and similar drugs containing narcotic content numbers
Contrary to the advertising matter of some pharmacies, 60 mg is No. 4, not No. .6, and tablets with 45 mg of codeine are not No.^ No controlled trial of 8 mg codeine added to paracetamol has been reported.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ Tylenol #4 w/ codeine - 60 mg codeine, no caffeine .
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

^ The commonest combined tablet in the United Kingdom is paracetamol 500 mg with only 8 mg codeine.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

4 and would in all likelihood be classified as No. 3½ under that system. Whether the scale goes to No. .5 and higher is moot at this point, as in the United States and Canada single-dose-unit concentrations of more than 64 mg are not manufactured.^ Canada has OTC codeine products available if product has no more than 8 mg of codeine per unit dose.
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

^ In addition, plasma drug concentration data indicate that a rectal dose of codeine of 0.5 mg kg –1 in children can result in similar, or slightly greater, plasma concentrations of codeine and its metabolites than after 60 mg orally in adults.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ In a group of Chinese volunteers with low capability of metabolizing codeine, the morphine/codeine concentration ratios after a dose of 50 mg of codeine were even less than in Caucasians.
  • Concentration Ratios of Morphine to Codeine in Blood of Impaired Drivers as Evidence of Heroin Use and not Medication with Codeine -- Ceder and Jones 47 (11): 1980 -- Clinical Chemistry 19 January 2010 9:54 UTC www.clinchem.org [Source type: Academic]

.The Controlled Substances Act of 1970 does place dosage unit strengths of 90 mg of codeine and higher in Schedule II, even if mixed with another active ingredient, and oral tablets, hypodermic tablets, liquid forms, and capsules of less common doses such as 5, 10, 12, 20, 25, 40, 45, 50, 75, 80, 90, 96, 100, 105, 120 and 128 mg and others and in some cases the equivalent dihydrocodeine, dionine, benzylmorphine, and opium dosages were available in North America (and in most cases still are in other countries, the 45 mg paracetamol/codeine and 50 and 100 mg single-ingredient codeine tablets).^ Most studies used a codeine dose of 60 mg.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ No controlled trial of 8 mg codeine added to paracetamol has been reported.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ Most studies in this review added 60 mg codeine to the paracetamol.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

Availability

.Codeine phosphate and sulfate are marketed in the United States and Canada.^ Canada has OTC codeine products available if product has no more than 8 mg of codeine per unit dose.
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

^ Therapeutic dosage 4.2.1 Adults Analgesic Codeine and its salts (sulfate or phosphate) are administered in doses of 15 to 60 mg, four to six times a day.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Codeine Phosphate Codeine Sulfate Methylmorphine Generic Available .
  • Codeine: Drug Information Provided by Lexi-Comp: Merck Manual Professional 19 November 2009 18:018 UTC www.merck.com [Source type: Academic]

.Codeine hydrochloride is more commonly marketed in continental Europe and other regions, and codeine hydroiodide and codeine citrate round out the top five most-used codeine salts worldwide.^ Codeine has a weaker depressive effect than other opiates to the cortex and medullary centres, but is more stimulating to the spinal cord.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Amphetamine and cannabis are the most commonly encountered drugs in DUID suspects in Sweden, but morphine and codeine are also high on the list of substances confirmed present in blood specimens.
  • Concentration Ratios of Morphine to Codeine in Blood of Impaired Drivers as Evidence of Heroin Use and not Medication with Codeine -- Ceder and Jones 47 (11): 1980 -- Clinical Chemistry 19 January 2010 9:54 UTC www.clinchem.org [Source type: Academic]

^ If there are alternative painkillers which could be used doctors should use them, particularly as, in most situations when morphine/codeine is likely to be needed, the extra distress can only exacerbate the situation (e.g.

.Codeine is usually present in raw opium as free alkaloid in addition to codeine meconate, codeine pectinate, and possibly other naturally-occurring codeine salts.^ It is a phenanthrenic alkaloid and constitutes 0.5% of raw opium.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Codeine is an alkaloid obtained from opium or prepared from morphine by methylation and occurs as white crystals.
  • Codeine Phosphate - http://www.drugbuyers.com/freeboard 19 January 2010 9:54 UTC www.drugbuyers.com [Source type: FILTERED WITH BAYES]

^ For codeine : Breathing problems may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of codeine.
  • Barbiturates, Aspirin, and Codeine (Systemic) 19 January 2010 9:54 UTC allnutritionals.com [Source type: FILTERED WITH BAYES]

Codeine bitartrate, tartrate, nitrate, picrate, acetate, hydrobromide and others are occasionally encountered on the pharmaceutical market and in research.
.In certain jurisdictions, codeine is available over-the-counter in combination with guaifenesin or promethazine to be sold at the pharmacist's discretion, though many pharmacists decline to do so[citation needed].^ Combination products that contain codeine and promethazine should not be used in child...
  • Over-the-counter medications for acute cough in ch...[Cochrane Database Syst Rev. 2004] - PubMed Result 16 September 2009 22:14 UTC www.ncbi.nlm.nih.gov [Source type: Academic]

Relation to other opiates

.Codeine is the starting material and prototype of a large class of mainly mild to moderately strong opioids such as hydrocodone, dihydrocodeine, and its derivatives such as nicocodeine.^ INDICATIONS Codeine phosphate is an analgesic indicated for the relief of mild to moderate pain.
  • Codeine Phosphate - http://www.drugbuyers.com/freeboard 19 January 2010 9:54 UTC www.drugbuyers.com [Source type: FILTERED WITH BAYES]

^ It is considered to be suitable for mild to moderate pain but not for more intense pain even in large doses.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

.Other series of codeine derivatives include isocodeine and its derivatives, which were developed in Germany starting around 1920. As an analgesic, codeine compares moderately to other opiates.^ Codeine has a weaker depressive effect than other opiates to the cortex and medullary centres, but is more stimulating to the spinal cord.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Codeine 50 mg is an analgesic indicated for the relief of mild to moderate pain.
  • Codeine Tramadol Acetaminophen Celebrex - Online pharmacy drugs, no prescription fees. 19 January 2010 9:54 UTC www.rxpricegrabber.com [Source type: Reference]

^ Codeine phosphate is an analgesic indicated for the relief of mild to moderate pain.
  • Codeine Tramadol Acetaminophen Celebrex - Online pharmacy drugs, no prescription fees. 19 January 2010 9:54 UTC www.rxpricegrabber.com [Source type: Reference]

.Related to codeine in other ways are Codeine-N-Oxide (Genocodeine), related to the nitrogen morphine derivatives as is codeine methobromide, and heterocodeine, which is a drug six times stronger than morphine and 72 times stronger than codeine due to a small re-arrangement of the molecule, viz.^ I didn't know that Morphine was a derivative of codeine at the time.

^ In effect, codeine administration may be regarded as a complicated and unreliable way of giving a low dose of morphine.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ I'd heard) that most medical codeine is a morphine derivative.

moving the methyl group from the 3 to the 6 position on the morphine carbon skeleton. .Drugs bearing resemblance to codeine in effects due to close structural relationship are variations on the methyl groups at the 3 position including ethylmorphine a.k.a.^ The importance of this finding is that, ironically, poor metabolizer groups whilst having inadequate analgesia may still experience side-effects from codeine.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ The available evidence implies that codeine may in fact be particularly unsuitable for use in the younger child given the difficulties in pain reporting and assessment in this group and the unpredictable effects of the drug.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Some studies included an additional placebo or codeine control group.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

codethyline (Dionine) and benzylmorphine (Peronine). .While having no narcotic effects of its own, the important opioid precursor thebaine differs from codeine only slightly in structure.^ In 1948, Sanfilippo first suggested that the analgesic effect of codeine was because of the proportion of the drug metabolized to morphine and this has lead to the belief that codeine is a prodrug, with morphine as its principal active metabolite and having little or no intrinsic analgesic activity of its own.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ There are no commercial name for products containing only codeine in US. Found under common name of codeine.
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

^ In a four week multidose trial Kjaersgaard-Andersen et al found a significant difference between the paracetamol-codeine group and the paracetamol alone group only in the first week.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

.Pseudocodeine and some other similar alkaloids not currently used in medicine are found in trace amounts in opium as well.^ The results of some other tests may also be affected by this medicine.
  • Barbiturates, Aspirin, and Codeine (Systemic) 19 January 2010 9:54 UTC allnutritionals.com [Source type: FILTERED WITH BAYES]

^ Gout-Aspirin can make this condition worse and can also lessen the effects of some medicines used to treat gout .
  • Barbiturates, Aspirin, and Codeine (Systemic) 19 January 2010 9:54 UTC allnutritionals.com [Source type: FILTERED WITH BAYES]

^ If the medicine stops working as well as it did when you first started using it.
  • Barbiturates, Aspirin, and Codeine (Systemic) 19 January 2010 9:54 UTC allnutritionals.com [Source type: FILTERED WITH BAYES]

Adverse effects

.Common effects other than analgesia associated with the use of codeine include euphoria, itching, nausea, vomiting, drowsiness, dry mouth, miosis, orthostatic hypotension, urinary retention, depression and constipation.^ Others Urinary retention may occur.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Central nervous system (CNS) depressants (medicines that often cause drowsiness)-These medicines may add to the effects of barbiturates and codeine and increase the chance of drowsiness or other side effects .
  • Barbiturates, Aspirin, and Codeine (Systemic) 19 January 2010 9:54 UTC allnutritionals.com [Source type: FILTERED WITH BAYES]

^ Codeine has a weaker depressive effect than other opiates to the cortex and medullary centres, but is more stimulating to the spinal cord.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

[14] .Another side effect commonly noticed is the lack of sexual drive and increased complications in erectile dysfunction.^ Thus for occasional pain relief a paracetamol-codeine combination might be appropriate, but repeated use increases the occurrence of side effects.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ The three multidose studies showed an increase in reported side effects with paracetamol-codeine.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ What side effects may I notice from receiving this medicine?
  • Acetaminophen; Codeine 19 January 2010 9:54 UTC www.stjohn.org [Source type: FILTERED WITH BAYES]

[15] .Some people may also have an allergic reaction to codeine, such as the swelling of skin and rashes.^ You can take codeine at nite(BUT BE CAREFUL! some people are allergic ...
  • Codeine discussions (experiences, side effects, dosages, etc...) 19 January 2010 9:54 UTC www.drugtalk.com [Source type: General]

^ My regular doc (a GP), who knew I was allergic to codeine, prescribed tramadol and provided some Ultram samples to me in May for my fibromyalgia pain.

^ I had a severe reaction to codeine when given some pills to deal with pain after having a root canal.

[15]
.Tolerance to many of the effects of codeine develops with prolonged use, including therapeutic effects.^ Confirmatory evidence for the dominant role of morphine in the effects of codeine in man have been obtained by competitive inhibition of codeine O -demethylation using quinidine.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Further attempts to elucidate the mechanism of action of codeine used adult human experimental models to compare the effect of codeine on phasic and tonic pain.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Despite the popularity of codeine in paediatric practice, the influence of development on the efficacy and side effects of codeine has not been well investigated.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

.The rate at which this occurs develops at different rates for different effects, with tolerance to the constipation-inducing effects developing particularly slowly for instance.^ The rate at which this occurs develops at different rates for different effects, with tolerance to the constipation-inducing effects developing particularly slowly for instance.

^ Dangerous side effects CODEINE may develop at different rates for different effects, with tolerance to the original people.

^ Tolerance to many of the effects of codeine develops with prolonged use, including therapeutic effects.

.A potentially serious adverse drug reaction, as with other opioids, is respiratory depression.^ Children Doses over 5 mg/kg may cause serious respiratory depression.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Main adverse effects In acute asthma attack, codeine depresses the respiratory centre and increases airway resistance.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Antidiarrhoeal opioids given concurrently with codeine may result in increased constipation, paralytic ileus, as well as an increased risk of respiratory depression (Shee & Pounder, 1980).
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

.This depression is dose-related and is the mechanism for the potentially fatal consequences of overdose.^ This depression is dose-related and is the mechanism for the potentially fatal consequences of overdose.

^ This hemoptysis is dose-related and is the instructions for the rather circumstantial consequences of mourn.
  • Buy CODEINE 8mg. 100 Caplets ... ≡ codeine phosphate 19 January 2010 9:54 UTC noey.2trom.com [Source type: FILTERED WITH BAYES]

^ As you take greater doses of the CNS depressing medication, your risk of overdose increases.
  • Codeine and Promethazine - Addiction, Withdrawal, Detox and Treatment 19 January 2010 9:54 UTC hubpages.com [Source type: General]

.As codeine is metabolized to morphine, morphine can be passed through breast milk in potentially lethal amounts, fatally depressing the respiration of a breastfed baby.^ Poor metabolizers will produce little or no morphine from codeine whereas extensive metabolizers will produce significant amounts of morphine although the actual amount produced may show wide variation.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Bioavailability is about 50% (Moffat, 1986) Codeine, in contrast to morphine, is two-thirds as effective orally as parenterally, both as an analgesic and as a respiratory depressant.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ A small percentage of codeine is metabolized into morphine but not nearly all of it.

[16][17]

Withdrawal effects

.As with other opiate-based pain killers, chronic use of codeine can cause physical dependence.^ Codeine has a weaker depressive effect than other opiates to the cortex and medullary centres, but is more stimulating to the spinal cord.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Chronic poisoning 9.2.1 Ingestion Clinical findings in case of chronic use or addiction of codeine may not be evident.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Thus for occasional pain relief a paracetamol-codeine combination might be appropriate, but repeated use increases the occurrence of side effects.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

.When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops the medication.^ You may develop tolerance to the medication.
  • Acetaminophen; Codeine 19 January 2010 9:54 UTC www.stjohn.org [Source type: FILTERED WITH BAYES]

^ Do not suddenly stop taking your medicine because you may develop a severe reaction.
  • Acetaminophen; Codeine 19 January 2010 9:54 UTC www.stjohn.org [Source type: FILTERED WITH BAYES]

^ Codeine is used as a drug of abuse, and it may produce dependence and withdrawal syndromes.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

.Withdrawal symptoms include: drug craving, runny nose, yawning, sweating, insomnia, weakness, stomach cramps, nausea, vomiting, diarrhea, muscle spasms, chills, irritability, and pain.^ It is very important to realise that the normal reactions to narcotics include: -Shallow breathing -Decreased heartrate -Constipation -Coolness -Light-headedness, fainting, dizziness, confusion, anxiety -Very short-term memory problems -Nausea, vomiting, stomach pain, diarrhea -More...

^ The withdrawal syndrome is characterized by yawning, lacrimation, pilomotor reactions, severe gastrointestinal disturbances with cramps, vomiting, diarrhoea or constipation, sweating, fever, chills, increase respiratory rate, insomnia, tremor, mydriasis and myalgia.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Symptoms of withdrawal may be cramps, vomiting, diarrhoea or constipation, sweating, fever, chills, increase in respiratory rate, insomnia, tremor and mydriasis.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

.To minimize withdrawal symptoms, long-term users should gradually reduce their codeine medication under the supervision of a healthcare professional.^ Withdrawal symptoms from codeine.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ Codeine plus paracetamol versus paracetamol in long term treatment of chronic pain due to osteoarthritis of the hip.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Definition: Codeine has been medically proven to soothe depression by submerging the user in a state of calm.
  • Sub Pop Records 19 January 2010 9:54 UTC www.subpop.com [Source type: General]

[18] .A support group called Codeine Free exists to help people who have found themselves dependent on codeine.^ In a four week multidose trial Kjaersgaard-Andersen et al found a significant difference between the paracetamol-codeine group and the paracetamol alone group only in the first week.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ From that which has been done it appears that the popularity of codeine in this patient group is not supported by convincing data of its efficacy or suitability, despite its apparently good safety record.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ The dosage of the antagonist should be carefully titrated when used to treat codeine overdose in patients who are dependent (USP,1985).
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

Recreational use

.Codeine can be used as a recreational drug.^ Codeine is used as a drug of abuse, and it may produce dependence and withdrawal syndromes.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Codeine is an old drug that still enjoys widespread clinical use although the logical basis for its popularity has been questioned.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

.However, it has much less abuse potential than some other opiates or opioids, such as oxycodone, and hydrocodone.^ Absence of or reduction in unpleasant or potentially dangerous side effects for equal analgesia in comparison with other opioids would be an important advantage for codeine.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Codeine has a weaker depressive effect than other opiates to the cortex and medullary centres, but is more stimulating to the spinal cord.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ VW's are much less reliable than Fords.
  • New 2012 Ford Focus unveiled (pics) - Democratic Underground 19 January 2010 9:54 UTC www.democraticunderground.com [Source type: FILTERED WITH BAYES]

.In some countries, cough syrups and tablets containing codeine are available without prescription; some potential recreational users are reported to buy codeine from multiple pharmacies so as not to arouse suspicion.^ Tylenol codeine without prescription.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ Lean is cough syrup w/ codeine or codone...
  • How do you make sippin syrup? - Q&A 19 January 2010 9:54 UTC www.faqs.org [Source type: General]

^ Syrup=codeine cough syrup .
  • How do you make sippin syrup? - Q&A 19 January 2010 9:54 UTC www.faqs.org [Source type: General]

.A heroin addict may use codeine to ward off the effects of a withdrawal.^ In effect, codeine administration may be regarded as a complicated and unreliable way of giving a low dose of morphine.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Confirmatory evidence for the dominant role of morphine in the effects of codeine in man have been obtained by competitive inhibition of codeine O -demethylation using quinidine.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Chronic poisoning 9.2.1 Ingestion Clinical findings in case of chronic use or addiction of codeine may not be evident.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

[19]
.Codeine is also available in conjunction with the anti-nausea medication promethazine in the form of a syrup.^ Promethazine codeine syrup.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ Promethazine with codeine syrup.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

.Brand named as Phenergan with Codeine or in generic form as promethazine with codeine this medication is quickly becoming one of the most highly abused codeine preparations.^ There is also Phenergan Pronounced: FEN-er-gan who's generic ingredients are Promethazine hydrochloride and Codeine phosphate.
  • How do you make sippin syrup? - Q&A 19 January 2010 9:54 UTC www.faqs.org [Source type: General]

^ I'd heard) that most medical codeine is a morphine derivative.

^ FYI promethazine is actually used for nausea, while codeine is a wide range medication used for things such as pain and when mixed with promethazine it acts as a sedative while supressing your cough.
  • How do you make sippin syrup? - Q&A 19 January 2010 9:54 UTC www.faqs.org [Source type: General]

[20]
.Codeine is also demethylated by reaction with pyridine to illicitly synthesize morphine.^ Confirmatory evidence for the dominant role of morphine in the effects of codeine in man have been obtained by competitive inhibition of codeine O -demethylation using quinidine.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Codeine is known to penetrate the BBB more rapidly than morphine, 84 and the presence of CYP2D6 in the CNS allows local tissue O -demethylation of codeine to morphine.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ She was later phenotyped and found to be an ultra-rapid EM. Rapid and extensive formation of morphine by O -demethylation of codeine was the suggested cause of these symptoms.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

.Pyridine is toxic and possibly carcinogenic, so morphine illicitly produced in this manner (and potentially contaminated with pyridine) may be particularly harmful.^ Poor metabolizers will produce little or no morphine from codeine whereas extensive metabolizers will produce significant amounts of morphine although the actual amount produced may show wide variation.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Morphine is administered by several routes (injected, smoked, sniffed, or swallowed); but when injected particularly intravenously, morphine can produce intense euphoria and a general state of well-being and relaxation.
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

^ This suggests that post-operative factors may significantly influence codeine metabolism, possibly leading to lower plasma concentrations of morphine and its metabolites.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

[21] .Codeine can also be turned into α-chlorocodide, which is used in the clandestine synthesis of desomorphine (Permonid).^ As for the person who said that codeine turns into morphine when taken by the body, that's not entirely true.

^ Overall there has been little clinical research into the use of codeine in children.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

.Codeine can also be turned directly into stronger derivatives of the dihydrocodeine and hydrocodone families and a few others with various chemicals and equipment.^ Committee on Drugs - American Academy of Pediatrics (1983) The transfer of drugs and other chemicals into human breast milk.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Unfortunately, there have been very few clinical studies investigating the analgesic efficacy of codeine in which genetic variation is taken into consideration, and none in paediatric groups.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ As for the person who said that codeine turns into morphine when taken by the body, that's not entirely true.

Controlled substance

.In Australia, Canada, New Zealand, Romania, Sweden, the United Kingdom, and many other countries, codeine is regulated.^ Many other studies, also in adults, confirm that codeine 30–60 mg can add significantly to the analgesic effect of drugs such as aspirin, paracetamol and NSAIDs.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ The commonest combined tablet in the United Kingdom is paracetamol 500 mg with only 8 mg codeine.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

.In some countries it is available without prescription in combination preparations from licensed pharmacists in doses up to 15 mg/tablet in Australia, New Zealand, Poland (Thiocodin) and Costa Rica, 12.8 mg/tablet in the United Kingdom, 10 mg/tablet in Israel and 8 mg/tablet in Canada and Estonia.^ The commonest combined tablet in the United Kingdom is paracetamol 500 mg with only 8 mg codeine.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ Introduction Paracetamol is well tolerated and available without prescription.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

^ Parenteral A dose of 120 mg of codeine given subcutaneously produces analgesia equivalent to that resulting from 10 mg of morphine.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

[citation needed]

Canada

.In Canada, codeine can be sold over the counter only in combination with two or more ingredients, which has resulted in the prevalence of AC&C (aspirin, codeine, and caffeine), and similar combinations using acetaminophen (paracetamol) rather than aspirin.^ Can i buy aspirin with codeine from canada online.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ Canada aspirin codeine.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ Paracetamol-codeine combinations versus paracetamol alone.
  • Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review -- de Craen et al. 313 (7053): 321 -- BMJ 19 January 2010 9:54 UTC www.bmj.com [Source type: Academic]

.Caffeine, being a stimulant, tends to offset the sedative effects of codeine.^ Codeine has a weaker depressive effect than other opiates to the cortex and medullary centres, but is more stimulating to the spinal cord.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Sold under many name brand products, the most popular being theTylenol with Codeine series, the number on the tablet corresponds to the amount of codeine and caffeine found in the each tablet.
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

^ Codeine in combination with other narcotic analgesics, phenothiazines, sedative hypnotics, and alcohol has additive depressant effects.
  • Codeine Phosphate - http://www.drugbuyers.com/freeboard 19 January 2010 9:54 UTC www.drugbuyers.com [Source type: FILTERED WITH BAYES]

It also can increase the effectiveness and absorption rate of analgesics in some circumstances.[22]
.In Canada, codeine preparations must be sold only at a pharmacy and be either behind the dispensing counter (or elsewhere, like in a back room) or on shelves in an area of the store that can be seen from said counter.^ They only gave me codeine because they forced you to goto their pharmacy and ...
  • Codeine discussions (experiences, side effects, dosages, etc...) 19 January 2010 9:54 UTC www.drugtalk.com [Source type: General]

^ Codeine is a narcotic is available by prescription only, so whoever said something about buying over the counter in the US is wrong.
  • How do you make sippin syrup? - Q&A 19 January 2010 9:54 UTC www.faqs.org [Source type: General]

Germany, Switzerland and Austria

.Codeine is listed under the Betäubungsmittelgesetz in Germany and the similarly-named narcotics and controlled substances law in Switzerland.^ NAME 1.1 Substance Codeine (USAN) (Fleeger, 1993) 1.2 Group ATC classification index Cough and cold preparations(R05)/Antitussives excl.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

In Austria, the drug is listed under the Suchtmittelgesetz in categories corresponding to their classification under the Single Convention on Narcotic Drugs. .Dispensing of products containing codeine and similar drugs (dihydrocodeine, nicocodeine, benzylmorphine, ethylmorphine etc.^ Drugs containing codeine.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ There are no commercial name for products containing only codeine in US. Found under common name of codeine.
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

^ Hi, i'm looking for some of the counter drugs that contain PROMETHYZINE W/ CODEINE?...
  • How do you make sippin syrup? - Q&A 19 January 2010 9:54 UTC www.faqs.org [Source type: General]

), in general, require a prescription order from a doctor or the discretion of the pharmacist. .Municipal and provincial regulations may impact availability, in particular in Austria and Switzerland, which allows cities and provinces to regulate the selling of the least-regulated schedule of the SMG/BtMG; and, of course, individual chemists' shops can opt out of providing them or imposing volume, frequency, or single-purchase limitations and other things of the same store.^ That is to say, that taking one may make the feeling of the other seem less(not at the same time obviously), but you could still overdose quite readily.
  • Fioricet with codeine - http://www.drugbuyers.com/freeboard 19 January 2010 9:54 UTC www.drugbuyers.com [Source type: FILTERED WITH BAYES]

^ Frequently, herpes simplex break out from sleeping, you should provide relief.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ As a single product codeine is a schedule II controlled substance in the US. When combined with other non-controlled substance, and depending on amount per dose unit, codeine combined products range from schedule III to V. .
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

.Plain codeine hydrochloride tablets (which in the USA would share CSA Schedule II with drugs like morphine, cocaine, hydromorphone, and bezitramide) as well as other non-injectable forms of codeine and its midrange derivatives can be dispensed in this way; the same goes for most chemical classes of benzodiazepines, the majority of non-barbiturate sedative/hypnotics, and at least a handful of barbiturates.^ I'd heard) that most medical codeine is a morphine derivative.

^ It would be useful if someone compiled all the codeine (morphine) derivates like percocette and others.

^ II drug, and when combined with other non-controlled drugs, is found from schedule III-IV. .
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

.Title 76 of the Schengen treaty has made it possible for countries within the signatory states to import and export drugs with various provisos, recording and ordering requirements, and various other rules.^ Specifies that all environment variables active within the qsub utility be exported to the context of the job.

Greece

.Codeine is classed as an illegal drug in Greece, and individuals possessing it could conceivably be arrested, even if they were legitimately prescribed it in another country.^ Except in extreme situations, doctors are obliged to respect those lists as allergies and not give you the drug, even when they are very often not.

^ Maybe the moral is always to ask them exactly what they are prescribing, and also ask "That doesn't contain morphine or codeine or a derivative does it?"

[23]

Hong Kong

In Hong Kong, codeine is regulated under Schedule 1 of Hong Kong's Chapter 134 Dangerous Drugs Ordinance. It can be used legally only by health professionals and for university research purposes. The substance can be given by pharmacists under a prescription. Anyone who supplies the substance without prescription can be fined $10,000 (HKD). .The maximum penalty for trafficking or manufacturing the substance is a $5,000,000 (HKD) fine and life imprisonment.^ Drug Policy Controlled Substances Act Federal Trafficking Penalties Drug Scheduling .
  • DEA, Drug Scheduling 19 January 2010 9:54 UTC www.justice.gov [Source type: Academic]

Possession of the substance for consumption without license from the Department of Health is illegal with a $1,000,000 (HKD) fine and/or 7 years of jail time.
However, codeine is available without prescription from licensed pharmacists in doses up to 0.1% (5 mg/5ml) according to Hong Kong "Dangerous Drugs Ordinance".

Japan

.Codeine and similar mid-level centrally acting agents in combination with non-opioid analgesics, antihistamines, vitamins, inert GI agents like kaolin & pectin, mild laxatives, antacids, and herbal preparations, can be purchased over the counter, with 10 mg being the ceiling for OTC dispensing.^ Parenteral A dose of 120 mg of codeine given subcutaneously produces analgesia equivalent to that resulting from 10 mg of morphine.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Increases in intrabiliary pressure may be observed after administration of 10 to 20 mg of codeine (Reynolds, 1982).
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Non-analgesic effects Codeine has a side-effect profile that is broadly similar to other opioids (Table 1 ).
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

This is also true of ethylmorphine and dihydrocodeine, and also diphenoxylate, some weak relatives of the thiambutene opioid family.

Spain

.Codeine tablets and preparations of codeine and other drugs can be obtained over the counter in Spain where available, even 30, 45, 50, and 60 mg per dosage unit.^ Indication for prescribing codeine 30 mgs..
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ Codeine is an alkaloid, obtained from opium or prepared from morphine.
  • Codeine Tramadol Acetaminophen Celebrex - Online pharmacy drugs, no prescription fees. 19 January 2010 9:54 UTC www.rxpricegrabber.com [Source type: Reference]

^ Codeine is an alkaloid obtained from opium or prepared from morphine by methylation and occurs as white crystals.
  • Codeine Phosphate - http://www.drugbuyers.com/freeboard 19 January 2010 9:54 UTC www.drugbuyers.com [Source type: FILTERED WITH BAYES]

United Kingdom

.In the United Kingdom, higher-strength codeine formulations - such as 30/500 co-codamol, where 30 mg of codeine phosphate is combined with 500 mg paracetamol - are prescription-only medicines (POM).^ Non prescription codeine medicine.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ Indication for prescribing codeine 30 mgs..
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ Tylenol #3 w/ codeine - 30 mg codeine, 30 mg caffeine .
  • Frequently Asked Questions about heroin, morphine, and opioids 19 January 2010 9:54 UTC www.druglibrary.org [Source type: Reference]

Lower-strength combinations, such as 8/500 (various brands) or 12.8/500 (Panadol Ultra, Solpadeine MAX and others) are available as pharmacy supervised ("behind the counter") medicines. .Codeine is also available combined with Ibuprofen; a common formulation is 12.8 mg Codeine alongside 200 mg Ibuprofen.^ A double-blind comparison of ibuprofen, codeine phosphate and two combination ratios.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Shelf-life of the locally available formulation Codeine formulations are generally considered to be stable.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

.Codeine Linctus of 15 mg per 5ml is also available behind the counter at some pharmacies, although a purchaser would have to request it specifically from the pharmacist.^ If codeine had been discovered today it is possible that it would not have made it as far as the pharmacy shelves.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Therapeutic dosage 4.2.1 Adults Analgesic Codeine and its salts (sulfate or phosphate) are administered in doses of 15 to 60 mg, four to six times a day.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Antitussive 15 mg to 30 mg of codeine phosphate 3 to 4 times a day (Reynolds, 1993).
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

Intramuscular injection of codeine is a controlled drug under the Misuse of Drugs Act 1971.

United States

In the United States, codeine is regulated by the Controlled Substances Act. .It is a Schedule II controlled substance for pain-relief products containing codeine alone or more than 90 mg per dosage unit.^ H of more than 9 in a 0.5% solution of codeine in water.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ Tylenol 3 (tylenol with codeine ) is no more effective at treating dental pain than ...
  • Codeine discussions (experiences, side effects, dosages, etc...) 19 January 2010 9:54 UTC www.drugtalk.com [Source type: General]

^ Codeine has a weaker depressive effect than other opiates to the cortex and medullary centres, but is more stimulating to the spinal cord.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

In combination with aspirin or acetaminophen (paracetamol/Tylenol), it is listed as Schedule III or V, depending on formula. .Preparations for cough or diarrhea containing small amounts of codeine in combination with two or more other active ingredients are Schedule V in the US, and in some states may be dispensed in amounts up to 4 fl.^ A double-blind comparison of ibuprofen, codeine phosphate and two combination ratios.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ Poor metabolizers will produce little or no morphine from codeine whereas extensive metabolizers will produce significant amounts of morphine although the actual amount produced may show wide variation.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ My regular doc (a GP), who knew I was allergic to codeine, prescribed tramadol and provided some Ultram samples to me in May for my fibromyalgia pain.

oz. per 48 hours without a prescription. .Schedule V specifically consigns the product to state and local regulation beyond certain required record-keeping requirements (a dispensary log must be maintained for two years in a ledger from which pages cannot easily be removed and/or are pre-numbered, and the pharmacist must ask for a picture ID such as a driving licence) and also maintain controlled substances in the closed system at the root of the régime intended by the Controlled Substances Act of 1970; the codeine in these products was a Schedule II substance when the company making the Schedule V product acquired it for mixing up the end-product.^ Mechanism of action Potentially codeine could act via a number of different mechanisms.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ These two products have very expensive and is not offered by the tobacco industry.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ I've been taking Tylenol 3 (acetaminophen with codeine ) for over two years on a regular basis for unrelated ...
  • Codeine discussions (experiences, side effects, dosages, etc...) 19 January 2010 9:54 UTC www.drugtalk.com [Source type: General]

.In locales where dilute codeine preparations are non-prescription, anywhere from very few to perhaps a moderate percentage of pharmacists will sell these preparations without a prescription.^ Unfortunately, there have been very few clinical studies investigating the analgesic efficacy of codeine in which genetic variation is taken into consideration, and none in paediatric groups.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ In fact, there are few data on the non-analgesic effects of codeine in children.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

However, many states have their own laws that do require a prescription for Schedule V drugs. The December 2008 issue of The Bulletin of the National Codeine OTC Lobby (Vol. XVIII, No. .4) listed 12 states with some kind of OTC access to codeine, noting that small independent pharmacies are the most likely to have it.^ Drug List > Codeine Pages : 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 .
  • Codeine discussions (experiences, side effects, dosages, etc...) 19 January 2010 9:54 UTC www.drugtalk.com [Source type: General]

^ He needs it for legitimate purposes, but his doctor definitely likes it if he requests codeine most of the time.
  • codeine vs hydrocodone - Drugs Forum 19 January 2010 9:54 UTC www.drugs-forum.com [Source type: FILTERED WITH BAYES]

^ If there are alternative painkillers which could be used doctors should use them, particularly as, in most situations when morphine/codeine is likely to be needed, the extra distress can only exacerbate the situation (e.g.

.This situation is roughly equivalent to that in February 1991, when the aforementioned organisation undertook its first comprehensive study of Schedule V and overall codeine, dihydrocodeine, ethylmorphine, and hydrocodone availability.^ A study in healthy adult volunteers showed no difference in codeine bioavailability following rectal or oral administration with a systemic availability of about 90%.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ However, the number of PMs was very small and the overall efficacy of codeine was low throughout the study.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ A recent study using a rat animal model has shown that hydrocodone, a possible minor codeine metabolite, has analgesic properties that are independent of its O -demethylated metabolite hydromorphone.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

.Other drugs that are present in Schedule V narcotic preparations like the codeine syrups are ethylmorphine and dihydrocodeine.^ Many other studies, also in adults, confirm that codeine 30–60 mg can add significantly to the analgesic effect of drugs such as aspirin, paracetamol and NSAIDs.
  • Codeine phosphate in paediatric medicine -- Williams et al. 86 (3): 413 -- British Journal of Anaesthesia 19 January 2010 9:54 UTC bja.oxfordjournals.org [Source type: Academic]

^ It would be useful if someone compiled all the codeine (morphine) derivates like percocette and others.

^ I also hope that it gives you a better picture of what an allergy really is, and what a side-effect is, particularly for codeine and other narcotics.

.Paregoric and hydrocodone were transferred to Schedule III from Schedule V even if the preparation contains two or more other active ingredients, and diphenoxylate is usually covered by state prescription laws even though this relative of pethidine is a Schedule V substance when adulterated with atropine to prevent abuse.^ Thanks for the pharmacist's view, Anon, and the explanation of what the active ingredient is that some of us react to badly - so it's morphine-3-glucuronide and drugs that contain it, is that right?

.Codeine is also available outside the United States as an over-the-counter drug in liquid cough-relief formulations.^ Specific properties and composition Codeine is commercially available as water soluble hydrochloride, sulfate or phosphate and is administered orally in the form of linctuses for the relief of coughs, and as tablets for the relief of pain.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

^ I was basically asking for the codeine cough syrup, she made me feel like a drug abuser!
  • Codeine discussions (experiences, side effects, dosages, etc...) 19 January 2010 9:54 UTC www.drugtalk.com [Source type: General]

^ Shelf-life of the locally available formulation Codeine formulations are generally considered to be stable.
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

.Around the world, codeine is, contingent on its concentration, a Schedule II and IV drug under the Single Convention on Narcotic Drugs.^ Drug concentrations in codeine fatalities are approximately 2.8 mg/L in blood and 103.8 mg/L in urine (Baselt & Cravey, 1989).
  • Codeine (PIM 140) 19 January 2010 9:54 UTC www.inchem.org [Source type: Academic]

[24]

Other countries

Most national controlled-substance laws are implementations of requirements in the Single Convention and related treaties. .The aforementioned dilute preparations are scheduled in such a way that in many countries preparations, liquid or solid, of codeine, dihydrocdeine, nicocodeine, nicodicodeine, benzylmorphine, propoxyphene, panadeine, dextropropoxyphene, and acetyldihydrocodeine may be non-prescription and/or over the counter; some local, provincial and national regulations and registry programmes in various European and Pacific Rim countries may provide for even stronger analgesic preparations of the aforementioned drugs to be dispensed by the senior chemist without prescription or after an initial prescription with certain volume, documentation, and record-keeping requirements.^ Tylenol codeine without prescription.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ Non prescription codeine medicine.
  • GLEE.com - codeine 19 January 2010 9:54 UTC www.glee.com [Source type: FILTERED WITH BAYES]

^ Some drug stores will sell it over the counter.
  • How do you make sippin syrup? - Q&A 19 January 2010 9:54 UTC www.faqs.org [Source type: General]

Related articles

References

  1. ^ Shen H, He MM, Liu H, et al (August 2007). "Comparative metabolic capabilities and inhibitory profiles of CYP2D6.1, CYP2D6.10, and CYP2D6.17". Drug Metab. Dispos. 35 (8): 1292–300. doi:10.1124/dmd.107.015354. PMID 17470523. 
  2. ^ Vree TB, van Dongen RT, Koopman-Kimenai PM (2000). "Codeine analgesia is due to codeine-6-glucuronide, not morphine". Int. J. Clin. Practa. 54 (6): 395–8. PMID 11092114. 
  3. ^ a b Srinivasan V, Wielbo D, Tebbett IR (1997). "Analgesic effects of codeine-6-glucuronide after intravenous administration". European journal of pain (London, England) 1 (3): 185–90. doi:10.1016/S1090-3801(97)90103-8. PMID 15102399. 
  4. ^ Vree TB, van Dongen RT, Koopman-Kimenai PM (2000). "Codeine analgesia is due to codeine-6-glucuronide (C6G), not morphine". Int. J. Clin. Pract. 54 (6): 395–8. PMID 11092114. 
  5. ^ http://www.sdrl.com/druglist/codeine.html retrieved December 1, 2008
  6. ^ Armstrong SC, Cozza KL (2003). "Pharmacokinetic drug interactions of morphine, codeine, and their derivatives: theory and clinical reality, Part II". Psychosomatics 44 (6): 515–20. doi:10.1176/appi.psy.44.6.515. PMID 14597688. 
  7. ^ Fernandes LC, Kilicarslan T, Kaplan HL, Tyndale RF, Sellers EM, Romach MK (June 2002). "Treatment of codeine dependence with inhibitors of cytochrome P450 2D6". J Clin Psychopharmacol 22 (3): 326–9. doi:10.1097/00004714-200206000-00014. PMID 12006904. 
  8. ^ Kathiramalainathan K, Kaplan HL, Romach MK, et al. (August 2000). "Inhibition of cytochrome P450 2D6 modifies codeine abuse liability". J Clin Psychopharmacol 20 (4): 435–44. doi:10.1097/00004714-200008000-00008. PMID 10917405. 
  9. ^ "Codeine Information - Facts - Codeine". http://codeine.50g.com/info/codeine.html. Retrieved 2007-07-16. 
  10. ^ Lurcott G (1998). "The effects of the genetic absence and inhibition of CYP2D6 on the metabolism of codeine and its derivatives, hydrocodone and oxycodone". Anesth Prog 45 (4): 154–6. PMID 10483388. 
  11. ^ Gasche Y, Daali Y, Fathi M, et al. (December 2004). "Codeine intoxication associated with ultrarapid CYP2D6 metabolism". N. Engl. J. Med. 351 (27): 2827–31. doi:10.1056/NEJMoa041888. PMID 15625333. 
  12. ^ Caraco Y (December 2004). "Genes and the response to drugs". N. Engl. J. Med. 351 (27): 2867–9. doi:10.1056/NEJMe048278. PMID 15625340. 
  13. ^ Schroeder K, Fahey T (2001). "Over-the-counter medications for acute cough in children and adults in ambulatory settings". Cochrane Database Syst Rev (4): CD001831. doi:10.1002/14651858.CD001831. PMID 15495019. 
  14. ^ Australian Medicines Handbook (2004). Rossi S. ed. Australian Medicines Handbook. .Adelaide: Australian Medicines Handbook.^ Australian Medicines Handbook (2004).

    ^ Rossi S: Australian Medicines Handbook .

    ^ Adelaide: Australian Medicines Handbook.

    ISBN 0975791923. OCLC 224913182 224831213 224913182.
     
  15. ^ a b Codeine Information from Drugs.com
  16. ^ CTV News, Codeine use while breastfeeding may be dangerous, Wed. Aug. 20 2008 9:42 PM ET.
  17. ^ Koren G, Cairns J, Chitayat D, Gaedigk A, Leeder SJ (August 2006). "Pharmacogenetics of morphine poisoning in a breastfed neonate of a codeine-prescribed mother". Lancet 368 (9536): 704. doi:10.1016/S0140-6736(06)69255-6. PMID 16920476. 
  18. ^ Alberta Health Services; AADAC (April 16, 2007). "The ABCs - Codeine and Other Opioid Painkillers". Alberta Alcohol and Drug Abuse Commission. http://www.aadac.com/87_436.asp. Retrieved Sep 12 2008. 
  19. ^ Boekhout van Solinge, Tim (1996). "7. La politique de soins des années quatre-vingt-dix" (in French). L'héroïne, la cocaïne et le crack en France. Trafic, usage et politique. Amsterdam: CEDRO Centrum voor Drugsonderzoek, Universiteit van Amsterdam. pp. 247–262. http://www.cedro-uva.org/lib/boekhout.heroine.fr.7.html. 
  20. ^ Leinwand, Donna (2006-10-18). "DEA warns of soft drink-cough syrup mix". USA Today. http://www.usatoday.com/news/nation/2006-10-18-lean_x.htm?csp=34. Retrieved 2006-10-23. 
  21. ^ Hogshire, Jim (June 1999). Pills-A-Go-Go: A Fiendish Investigation into Pill Marketing, Art, History & Consumption. Los Angeles: Feral House. pp. 216–223. ISBN 0922915539. 
  22. ^ "Headache Triggers: Caffeine". WebMD. June 2004. http://www.webmd.com/content/article/46/1826_50681.htm. Retrieved 2007-03-23. 
  23. ^ "Pharmacies in Greece". About.com. http://gogreece.about.com/od/planagreattriptogreece/a/greecepharmacy_2.htm. Retrieved 2009-10-10. 
  24. ^ International Narcotics Control Board. "List of Narcotic Drugs under International Control" (PDF). http://www.incb.org/pdf/e/list/46thedition.pdf. Retrieved 2006-05-24. 

Simple English

File:Codein -
the chemical structure of Codeine
Codeine or methylmorphine is an opiate used for its analgesic properties. It is also used to treat coughing and diarrhea. It is marketed as the salts codeine sulfate and codeine phosphate. Codeine hydrochloride is more commonly marketed in continental Europe and other regions.

Codeine is an alkaloid found in opium in concentrations ranging from 0.3 to 3.0 percent. Codeine can be extracted from opium. Today, most codeine is synthesized from morphine through the process of O-methylation.

Uses

Codeine is used to treat the following:

Compound analgesics

Codeine is often marketed as drugs in combination with paracetamol (acetaminophen) as co-codamol (best known in North America as Tylenol 3). Research has shown the combination to be very much more effective than paracetamol, and much less addictive that pure codeine.

There are similar combinations with aspirin as co-codaprin or with ibuprofen. These combinations provide greater pain relief than either agent alone. Drug synergy is an important principle.

References

  1. Schroeder K, Fahey T (2001). [Expression error: Unexpected < operator "Over-the-counter medications for acute cough in children and adults in ambulatory settings."]. Cochrane Database Syst Rev: CD001831. doi:10.1002/14651858.CD001831. PMID 15495019. 



Citable sentences

Up to date as of December 13, 2010

Here are sentences from other pages on Codeine, which are similar to those in the above article.








Got something to say? Make a comment.
Your name
Your email address
Message