Codeine sulfate

Pain

Pain 15-60 mg PO q4-6hr PRN; not to exceed 360 mg/day in naive patients Oral Mild to moderate pain Adult: 30–60 mg every 4 hours if required; maximum 240 mg per day Dry or painful cough USING LINCTUS Adult: 15–30 mg 3–4 times a day Acute diarrhoea Adult: 30 mg 3–4 times a day; usual dose 15–60 mg 3–4 times a day INTRAMUSCULAR INJECTION Adult: 30–60 mg every 4 hours if required

Codeine not be used in children <12 years Oral Acute diarrhoea Child 12–17 years: 30 mg 3–4 times a day; usual dose 15–60 mg 3–4 times a day Short-term treatment of acute moderate pain ORAL/INTRAMUSCULAR INJECTION Child 12–17 years: 30–60 mg every 6 hours if required for a maximum 3 days; Maximum 240 mg per day

Hypersensitivity to codeine Significant respiratory depression Children younger than 12 years Postoperative pain management in children (<18 years) who have undergone tonsillectomy and/or adenoidectomy Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment Concurrent use of monoamine oxidase inhibitors (MAOIs) or use of MAOIs within last 14 days Known or suspected gastrointestinal obstruction, including paralytic ileus

Addiction, abuse, and misuse Risk of opioid addiction, abuse, and misuse, which can lead to overdose and death; assess each patient’s risk prior to prescribing and monitor all patients regularly for the development of these behaviors or conditions Life-threatening respiratory depression Serious, life-threatening, or fatal respiratory depression may occur Monitor for respiratory depression, especially during initiation or following a dose increase Accidental ingestion Accidental ingestion of even 1 dose, especially by children, can result in a fatal overdose Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death Life-threatening respiratory depression is more likely to occur in elderly, cachectic, or debilitated patients because they may have altered pharmacokinetics or altered clearance compared to younger, healthier patients; monitor closely Monoamine oxidase inhibitors (MAOIs) may potentiate effects of morphine, codeine’s active metabolite, including respiratory depression, coma, and confusion; therapy should not be administered within 14 days of taking MAOIs Chronic use of opioids may cause reduced fertility in females and males of reproductive potential. It is not known whether these effects on fertility are reversible Use caution in cardiac arrhythmias, drug abuse/dependence, emotional lability, gallbladder disease, head injury, hepatic impairment, hypothyroidism, increased ICP, prostatic hypertrophy, renal impairment, seizures with epilepsy, urethral stricture, urinary tract surgeryLife-threatening respiratory depression and death reported in children who received codeine

Not Classi Pregnancy & Lactation Pregnancy: Prolonged use of opioid analgesics during pregnancy for medical or nonmedical purposes can result in physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth; observe newborns for symptoms of neonatal opioid withdrawal syndrome and manage accordingly; opioids cross placenta and may produce respiratory depression and psycho-physiologic effects in neonates; an opioid antagonist, such as naloxone, must be available for reversal of opioid-induced respiratory depression in the neonate; codeine sulfate is not recommended for use in pregnant women during or immediately prior to labor, when other analgesic techniques are more appropriate; opioid analgesics can prolong labor through actions which temporarily reduce strength, duration, and frequency of uterine contractions Lactation: Codeine is secreted into human milk; in women with normal codeine metabolism (normal CYP2D6 activity), amount of codeine secreted into human milk is low and dose-dependent; some women are ultra-rapid metabolizers of codeine; these women achieve higher-than-expected serum levels of codeine's active metabolite, morphine, leading to higher-than-expected levels of morphine in breast milk and potentially dangerously high serum morphine levels in their breastfed infants that can potentially lead to serious adverse reactions, including death, in nursing infants; there is no information on effects of codeine on milk production Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition

Contraindicated (3) alvimopan mavorixafor olanzapine/samidorphan

>10% Constipation Drowsiness 1-10% Hypotension Tachycardia or bradycardia Confusion Dizziness False feeling of well-being Headache Lightheadedness Malaise Paradoxical CNS stimulation Restlessness Rash, urticaria Anorexia Nausea, vomiting Xerostomia Ureteral spasm, urination decreased LFTs increased Burning at injection site Weakness Blurred vision Dyspnea Histamine release

Narcotic agonist analgesic with antitussive activity, mu receptor agonist