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Codeine is indicated in patients older than 12 years of age for the treatment of acute moderate pain which is not considered to be relieved by other analgesics such as paracetamol or ibuprofen alone. Prior to starting treatment with opioids, a discussion should be held with patients to put in place a strategy for ending How much codeine can i take in a day with codeine in order to minimise the risk of addiction and drug withdrawal syndrome see section 4.
Codeine should be used at the lowest effective dose for the shortest period of time. This dose may be taken, up to 4 times a day at intervals of not less than 6 hours. Maximum daily dose should not exceed mg. The analgesic effect is not materially enhanced by increasing the dose to a greater level than that recommended above.
Elderly: Dosage should be reduced in the elderly where there is impairment of hepatic or renal function. The recommended codeine dose for children 12 years and older should be 30 to 60 mg every 6 hours when necessary up to a maximum dose of mg daily. The dose is based on the body weight 0. Codeine should not be used in children below the age of 12 years because of the risk of opioid toxicity due to the variable and unpredictable metabolism of codeine to morphine see sections 4.
Codeine is not recommended for use in children aged 12 years to 18 years with compromised respiratory function for the symptomatic treatment of cough see section 4. Codeine is contraindicated in children below the age of 12 years for the symptomatic treatment of cough see sections 4.
For all patients, prolonged use of this product may lead to drug dependence addictioneven at therapeutic doses. The risks are increased in individuals with current or past history of substance misuse disorder including alcohol misuse or mental health disorder e. Additional support and monitoring may be necessary when prescribing for patients at risk of opioid misuse. A comprehensive patient history should be taken to document concomitant medications, including over-the-counter medicines and medicines obtained on-line, and past and present medical and psychiatric conditions.
Patients may find that treatment is less effective with chronic use and express a need to increase the dose to obtain the same level of pain control as initially experienced. Patients may also supplement their treatment with additional pain relievers. These could be s that the patient is developing tolerance. The risks of developing tolerance should be explained to the patient. It is important that patients only use medicines that are prescribed for them at the dose they have been prescribed and do not give this medicine to anyone else. Prior to starting treatment with any opioids, a discussion should be held with patients to put in place a withdrawal strategy for ending treatment with codeine.
Drug withdrawal syndrome may occur upon abrupt cessation of therapy or dose reduction. When a patient no longer requires therapy, it is advisable to taper the dose gradually to minimise symptoms of withdrawal. Tapering from a high dose may take weeks to months. The opioid drug withdrawal syndrome is characterised by some or all of the following: restlessness, lacrimation, rhinorrhoea, yawning, perspiration, chills, myalgia, mydriasis and palpitations. Other symptoms may also develop including irritability, agitation, anxiety, hyperkinesia, tremor, weakness, insomnia, anorexia, abdominal cramps, nausea, vomiting, diarrhoea, increased blood pressure, increased respiratory rate or heart rate.
If women take this drug during pregnancy, there is a risk that their newborn infants will experience neonatal withdrawal syndrome. Hyperalgesia may be diagnosed if the patient on long-term opioid therapy presents with increased pain. This might be qualitatively and anatomically distinct from pain related to disease progression or to breakthrough pain resulting from development of opioid tolerance. Pain associated with hyperalgesia tends to be more diffuse than the pre-existing pain and less defined in quality. Symptoms of hyperalgesia may resolve with a reduction of opioid dose.
Risk from concomitant use of sedative medicines such as benzodiazepines or related drugs. Concomitant use of Codeine Phosphate Tablets and sedative medicines such as benzodiazepines or related drugs may result in sedation, respiratory depression, coma and death. Because of these risks, concomitant prescribing with these sedative medicines should be reserved for patients for How much codeine can i take in a day alternative treatment options are not possible.
If a decision is made to prescribe Codeine Phosphate Tablets concomitantly with sedative medicines, the lowest effective dose should be used, and the duration of treatment should be as short as possible. The patients should be followed closely for s and symptoms of respiratory depression and sedation. In this respect, it is strongly recommended to inform patients and their caregivers to be aware of these symptoms see section 4.
Avoid in biliary disorders. Codeine is metabolised by the liver enzyme CYP2D6 into morphine, its active metabolite. If a patient has a deficiency or is completely lacking this enzyme an adequate analgesic effect will not be obtained. However, if the patient is an extensive or ultra-rapid metaboliser there is an increased risk of developing side effects of opioid toxicity even at commonly prescribed doses. These patients convert codeine into morphine rapidly resulting in higher than expected serum morphine levels. General symptoms of opioid toxicity include confusion, somnolence, shallow breathing, small pupils, nausea, vomiting, constipation and lack of appetite.
In severe cases this may include symptoms of circulatory and respiratory depression, which may be life-threatening and very rarely fatal. Estimates of prevalence of ultra-rapid metabolisers in different populations are summarized below:. All children received doses of codeine that were within the appropriate dose range; however there was evidence that these children were either ultrarapid or extensive metabolisers in their ability to metabolise codeine to morphine.
Codeine is not recommended for use in children in whom respiratory function might be compromised including neuromuscular disorders, severe cardiac or respiratory conditions, upper respiratory or lung infections, multiple trauma or extensive surgical procedures. These factors may worsen symptoms of morphine toxicity. The leaflet will state in ' What you need to know before you take Codeine Phosphate Tablets ':. The dose and duration of concomitant use should be limited see section 4. Regular use during pregnancy may cause drug dependence in the foetus, leading to withdrawal symptoms in the neonate.
If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available. Administration during labour may depress respiration in the neonate and an antidote for the child should be readily available. During labour opioids enter the foetal circulation and may cause respiratory depression in the neonate. Respiratory malformation in neonates may be associated with exposure to codeine during pregnancy.
Gastric stasis and a risk of inhalation pneumonia could occur in the mother during labour. Administration should be avoided during the late stages of labour and during the delivery of a premature infant. Administration to nursing women is not recommended as codeine may be secreted in breast milk and may cause respiratory depression in the infant.
However, if the patient is an ultra-rapid metaboliser of CYP2D6, higher levels of the active metabolite, morphine, may be present in breast milk and on very rare occasions may result in symptoms of opioid toxicity in the infant, which may be fatal. If symptoms of opioid toxicity develop in either the mother or the infant, then all codeine containing medicines should be stopped and alternative non-opioid analgesics prescribed.
In severe cases consideration should be given to prescribing naloxone to reverse these effects. Effects such as confusion, drowsiness, dizziness, hallucinations, blurred or double vision or convulsions may occur. The effects of alcohol are enhanced with this combination. Do not drive or operate machinery if affected. This medicine can impair cognitive function and can affect a patient's ability to drive safely. This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act When prescribing this medicine, patients should be told:.
Symptoms may include tremor, insomnia, restlessness, irritability, anxiety, depression, anorexia, nausea, vomiting, diarrhoea, sweating, lacrimation, rhinorrhoea, sneezing, yawning, piloerection, mydriasis, weakness, pyrexia, muscle cramps, dehydration, and increase in heart rate, respiratory rate and blood pressure.
NOTE - tolerance diminishes rapidly after withdrawal so a ly tolerated dose may prove fatal. Symptoms of restlessness and irritability may result when treatment is then stopped. Reporting suspected adverse reactions after authorisation of the medicinal product is important. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme; website: www. Patients should be informed of the s and symptoms of overdose and to ensure that family and friends are also aware of these s and to seek immediate medical help if they occur. The effects in overdosage will be potentiated by simultaneous ingestion of alcohol and psychotropic drugs.
Symptoms Central nervous system depression, including respiratory depression, may develop but is unlikely to be severe unless other sedative agents have been co-ingested, including alcohol, or the overdose is very large. The pupils may be pin-point in size; nausea and vomiting are common. Hypotension and tachycardia are possible but unlikely. Management This should include general symptomatic and supportive measures including a clear airway and monitoring of vital s until stable. Give naloxone if coma or respiratory depression is present.
Naloxone is a competitive antagonist and has a short half-life so large and repeated doses may be required in a seriously poisoned patient. Observe for at least four hours after ingestion, or eight hours if a sustained release preparation has been taken. Codeine is an analgesic with uses similar to those of morphine but it is much less potent as an analgesic and has only mild sedative effects.
It is also used in the treatment of cough and diarrhoea. Codeine is a centrally acting weak analgesic. Codeine, particularly in combination with other analgesics such as paracetamol, has been shown to be effective in acute nociceptive pain. Codeine and its salts are readily absorbed from the gastrointestinal tract and ingestion of codeine phosphate produces peak plasma concentrations in about one hour.
Codeine and its metabolites are excreted almost entirely by the kidney, mainly as conjugates with glucuronic acid. Also contains lactose, magnesium stearate, pregelatinised maize starch, maize starch, stearic acid. The product containers are rigid injection moulded polypropylene or injection blow-moulded polyethylene tablet containers with polyfoam wad or polyethylene ullage filler and snap-on polyethylene lids; in case any supply difficulties should arise the alternative is amber glass bottles with screw caps and polyfoam wad or cotton wool.
An alternative closure for polyethylene containers is a polypropylene, twist on, push down and twist off child-resistant, tamper-evident lid. Product may also be supplied in bulk packs, for reassembly purposes only, in polybags contained in tins, skillets or polybuckets filled with suitable cushioning material. Help us improve emc by letting us know which of the How much codeine can i take in a day best describes you.
Toggle. Search emc: Enter medicine name or company Start typing to retrieve search suggestions. Continue typing to refine. Codeine Phosphate Tablets 30mg. Back to top Accord-UK Ltd contact details. Active ingredient codeine phosphate hemihydrate. SmPC Patient Leaflet. Last updated on emc: 23 Apr View changes Print. Show table of contents Hide table of contents 1. Name of the medicinal product 2. Qualitative and quantitative composition 3. Pharmaceutical form 4.
Clinical particulars 4. Pharmacological properties 5. Pharmaceutical particulars 6. Marketing authorisation holder 8. Marketing authorisation s 9. Date of revision of the text. This information is intended for use by health professionals. Each tablet contains 30mg Codeine phosphate hemihydrate.How much codeine can i take in a day
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Codeine for pain relief