codeine phosphate

(koe' deen)

Pregnancy Category C (during pregnancy)

Pregnancy Category D (during labor)
Controlled Substance C-II

Drug classes
Opioid agonist analgesic
Antitussive

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

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

Contraindications and cautions

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

Available forms
Tablets—15, 30, 60 mg; oral solution—15 mg/5 mL; injection—30, 60 mg

Dosages
ADULTS
Analgesic
15–60 mg PO, IM, IV or SC q 4–6 hr; do not exceed 360 mg/24 hr.
Antitussive
10–20 mg PO q 4–6 hr; do not exceed 120 mg/24 hr.
PEDIATRIC PATIENTS
Contraindicated in premature infants.
Analgesic
> 1 yr: 0.5 mg/kg SC, IM or PO q 4–6 hr.
Antitussive
2–6 yr: 2.5–5 mg PO q 4–6 hr; do not exceed 30 mg/24 hr.
6–12 yr: 5–10 mg PO q 4–6 hr; do not exceed 60 mg/24 hr.
GERIATRIC PATIENTS OR IMPAIRED ADULTS
Use caution; respiratory depression may occur in elderly, the very ill, those with
respiratory problems. Reduced dosage may be necessary.
Pharmacokinetics
Route Onset Peak Duration
Oral, IM, 10–30 min 30–60 min 4–6 hr
IV

Metabolism: Hepatic; T1/2: 2.5–4 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

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

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

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

Nursing considerations
CLINICAL ALERT!
Name confusion has been reported between codeine and Cardene
(nicardipine) and Lodine (etodolac); use caution.
Assessment
• History: Hypersensitivity to codeine, physical dependence on an opioid
analgesic, pregnancy, labor, lactation, bronchial asthma, COPD, increased
intracranial pressure, acute MI, ventricular failure, coronary insufficiency,
hypertension, biliary tract surgery, renal or hepatic dysfunction
• Physical: Orientation, reflexes, bilateral grip strength, affect; pupil size, vision;
pulse, auscultation, BP; R, adventitious sounds; bowel sounds, normal output;
liver and kidney function tests

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

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

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