Codeine
Brand: (no brand; generic only)
Boxed warning · ISMP high-alert drug
Addiction, abuse, and misuse; life-threatening respiratory depression; profound sedation and death with benzodiazepines or other CNS depressants; neonatal opioid withdrawal syndrome with prolonged use in pregnancy. Also respiratory depression and death in children who are ultra-rapid CYP2D6 metabolizers; contraindicated under age 12 and after tonsillectomy or adenoidectomy under age 18.
- Caution
- Variable CYP2D6 metabolism makes the effect unpredictable between patients.
- Pregnancy
- Prolonged use in pregnancy causes neonatal opioid withdrawal syndrome (boxed).
Common side effects
- Constipation
- Drowsiness
- Nausea
- Respiratory depression
Key interactions
- Additive sedation with benzodiazepines and alcohol
- CYP2D6 ultra-rapid metabolizers convert more to morphine
Counseling points
- Constipation is expected: start a bowel regimen early
- Do not drive until you know the effect
- Avoid alcohol
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