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Codeine Linctus BP 2. Use with caution, a reduced dose can be recommended by a doctor. Codeine should not be used for the treatment of children under the age of 18 years. The dose may be repeated after four hours if required, but not more than 4 doses in any 24 hours. In cases of liver failure, respiratory depression , or patients at risk of paralytic ileus.
In patients with raised intracranial pressure or head injury. In patients for whom it is known they are CYP2D6 ultra-rapid metabolisers. During an acute asthmatic attack. Children under 18 years of age. In women during breastfeeding see section 4. Administration of pethidine and possibly other opioid analgesics to patients taking a monoamine oxidase inhibitor MAOI has been associated with very severe and sometimes fatal reactions.
Use with caution in the elderly, as codeine may induce faecal impaction, producing incontinence, spurious diarrhoea, abdominal pain and, rarely, colonic obstruction.
Prolonged use could aggravate irritable bowel syndrome. A reduced dose is recommended in elderly or debilitated patients, in hepatic and renal impairment but avoid if severe , in hypothyroidism, and in adrenocortical insufficiency.
Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence or in acute alcoholism. Codeine Linctus and other cough suppressants may cause sputum retention and this may be harmful in patients with chronic bronchitis and bronchiectasis. If symptoms persist consult your doctor.
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.
General symptoms of opioid toxicity include nausea, vomiting, constipation, lack of appetite and somnolence. In severe cases this may include symptoms of circulatory and respiratory depression. These patients convert codeine into morphine rapidly resulting in higher than expected serum morphine levels.
Estimates of prevalence of ultra-rapid metabolisers in different populations are summarized below: Sunset Yellow may cause allergic reactions. Do not exceed the stated dose. Keep out of the sight and reach of children. This product contains 4g of sucrose per dose. To be taken into account in people with diabetes.
It also contains invert syrup. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.
It contains a small amount of ethanol alcohol , less than mg per 5ml. Metabolism of codeine is accelerated by rifampicin leading to reduced effect. As an opioid analgesic, codeine phosphate may potentiate the effects of tranquillisers such as barbiturates, general anaesthetics, anxiolytics and hypnotics, sedatives and alcohol. Possible CNS excitation or depression hypertension or hypotension can occur when opioid analgesics are given with antidepressants such as moclobemide a reversible MAO-A inhibitor.
The sedative effects of codeine can possibly be increased when given with tricyclic antidepressants, with anxiolytics or hypnotics, or with sedating antihistamines. Antipsychotic medicines can enhance hypotensive and sedative effects when opioid analgesics are given with antipsychotics.
MAOIs taken with pethidine have been associated with severe CNS excitation or depression including hypertension or hypotension. Although this has not been documented with codeine, it is possible that a similar interaction may occur and therefore the use of codeine should be avoided while the patient is taking MAOIs and for 2 weeks after MAOI discontinuation, including MAO-B inhibitor selegiline. This may also apply to the antibacterial linezolid, which is a reversible, non-selective MOA inhibitor.
The reduction in intestinal motility caused by codeine may delay the absorption or antagonise the gastrointestinal effects of other drugs e. Metabolism of opioid analgesics is inhibited by cimetidine leading to increased plasma concentration.
May delay the gastro-intestinal absorption of mexiletine or quinidine which may also reduce the efficacy of codeine. Opioid analgesics enhance the effects of sodium oxybate, used to treat symptoms of narcolepsy, and concomitant use should be avoided. Opioid administration in the third trimester may cause respiratory depression in the newborn, withdrawal effects in neonates of dependent mothers, gastric stasis and risk of inhalation pneumonia in the mother during labour.
Codeine should not be used during breastfeeding see section 4. At normal therapeutic doses codeine and its active metabolite may be present in breast milk at very low doses and is unlikely to adversely affect the breast fed infant. However, if the patient is an ultrarapid metaboliser of codeine 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.
The infant itself may be a CYP2D6 ultra-rapid metaboliser. In either case on very rare occasions this may result in symptoms of opioid toxicity in the infant. See also section 4. 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. Patients should be advised not to drive or operate machinery if affected by dizziness or sedation.
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: The frequency of adverse effects cannot be estimated from available data. Respiratory, thoracic and mediastinal disorders: Skin and subcutaneous tissue disorders: Musculoskeletal and connective tissue disorders: Renal and urinary disorders: Reproductive system and breast disorders: Reporting of suspected adverse reactions.
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 at: 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.
This should include general symptomatic and supportive measures including a clear airway and monitoring of vital signs until stable. Consider activated charcoal if an adult presents within one hour of ingestion of more than mg or if more than 2. 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. It has been suggested that the usual doses of opioids produce their major effect on the patient's subjective reactions to the cough, rather than on the frequency and intensity of coughing.
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 metabolites are excreted almost entirely by the kidney, mainly as conjugates with glucuronic acid. Ingestion of codeine phosphate produces peak plasma - codeine concentrations in about one hour. It is incompatible with phenobarbitone sodium, forming a codeine-phenobarbitone complex.
Marketing authorisation holder L. This site uses cookies. By continuing to browse the site you are agreeing to our policy on the use of cookies. Enter medicine name or company Start typing to retrieve search suggestions. Continue typing to refine. Active ingredient codeine phosphate. Last updated on eMC: Show table of contents Hide table of contents 1.
Name of the medicinal product 2. Qualitative and quantitative composition 3. Marketing authorisation holder 8. Marketing authorisation number s 9. Date of revision of the text. This information is intended for use by health professionals. Codeine is indicated in adults for relief of the symptoms of dry or irritating coughs. Suspected opiate abuse, known hypersensitivity to codeine or to any of the other ingredients. Use with caution in patients with renal and hepatic impairment but avoid if severe , patients suffering from asthma or other respiratory disorders, or patients with a history of asthma, hypotension, shock, myasthenia gravis, cardiac arrhythmias, acute abdomen, gallstones, prostatic hypertrophy, urethral stenosis, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders.
The product should not be used during pregnancy unless considered necessary by the physician and should be avoided during the first trimester. Using the dose recommended, Codeine Linctus is not considered to be a hazard, however the use of codeine phosphate at higher doses or in more sensitive individuals may cause sedation, dizziness and nausea.